Week 6

This week was more of the usual. I followed Dr. Goodman as she saw patients. One of the patients we saw was a woman who was in for her second appointment this summer. She has RA which had been under control until she was hospitalized in April for a bad case of the flu. Both times that I have seen her she has been complaining of weakness and shaking. She is so weak that she supports her head with her fist under her chin because her neck isn't strong enough. She has been tapering off of her steroids which Dr. Goodman thought may have been causing her shaking. Based on her blood counts all of her medications are working as expected, but she is still symptomatic and Dr. Goodman isn't sure why. Dr. Goodman suggested that she continue with PT to get her strength up and see a neurologist to make sure there isn't a neurological cause of her muscle weakness. I also saw another patient with RA who has mild joint pain (worst in her right hip) but severe pain along the side of her calf. She is planning to get her hip replaced but is worried that this procedure (risky due to her other underlying conditions) won't do anything for her calf pain. Dr. Goodman says it is possible that the calf pain is referred from the hip, but there really isn't a way to prove that. The patient will see a neurologist to get more information before her procedure at the end of the month.

At CAP conference this week another patient with JIA was discussed. This case was not as severe as the last JIA case I heard about. His joints are not as badly fused and he still has a fair amount of mobility and ROM. Until recently he could walk around his house with a walker. But his bilateral knee pain has become so severe that this is no longer possible. He was diagnosed with JIA at age 5 which meant that his growth plates were severely affected by the near constant inflammation. He has a very small stature and "trombone knees". Because of this he would likely require custom total knee replacement implants which are very costly and time intensive. Unfortunately, this patient has a history of missing appointments which makes the surgeons hesitant to take this case. They were going to talk with him more during clinic to see how serious he is about waking again.

I spent one very long day this week in the OR with Dr. Spector, Aaron, and Terrence. The first procedure we saw was what I've been calling an "eye tuck". Dr. Spector removed some of the skin, fat, and other tissue from above and below the patient's eyes to give her a more open eyed appearance. The coolest thing about this procedure was probably the plastic contact-like things put on her eyes to protect them during the surgery. I'm not sure what they were made of but they looked like black plastic and were big enough to cover her entire eye. The rest of the day was spent working on an 18 year old patient with necrotic tissue on his foot. I didn't get his full history but from what I understood, he was in some kind of accident and had surgery on his leg in Peru. He must have lost circulation to his foot at some point during or after the surgery which caused some of the tissue to die to the point that the bone was exposed on the bottom of his heel and the top of his foot. Though amputation was recommended to him when he came here, he chose to try and save the foot. An Integra graft and skin grafts were used with limited success. So during this surgery, Dr. Spector took a large (12 in x 6 in) flap (which unlike a graft contains vasculature) from his thigh to put on the wounds. This procedure was very delicate because the vasculature needed to be carefully detached from the surrounding tissue in the thigh and reattached to a healthy blood supply at ankle. The reattachment process involved micro surgery which was really cool to observe. The surgeons needed to have a lot of fine motor skills. Despite how delicate this procedure was, the microscope they used to do it was wicked bulky and took up a lot of prime real estate in the OR.

The rest of the week was spent working on my research project. One of the other summer students I'm working with needed an abstract for a conference by the end of this week. So I was busy with lots of data analysis.