Last diverse week! Gotta get my project going from now on.

I have had it with surgeries. This week I attended an arm reconstruction in the plastic surgery unit, which was great, but I think it's gonna be my last one. Nothing is wrong with it; it's just interesting for the first 15 minutes and then after that, it's just a lot of tissues with some blood being push around for a long time. I'm much more interested in trying to figure out what's wrong with the patient and what would be the best treatments. I'd be happy with just hearing about what will be done in a surgery in order to fix the problem rather than watch for 3 hours and try to figure out what's going on. I think the thing I learn the most when observing a surgery is about anesthesia. It seems so much easier in human. I'm not sure if it's because my mouse is way smaller than a person, so it's harder to maintain appropriate level of anesthesia; or may be the anesthesiologists are just a thousand times better with human than I am with mice.

Anyway, a saw or something fell on this patient's arm and almost cut off his wrist since he works as a construction worker. (And don't you dare tell me that this is too much identifiable information on a public blog. There are thousands of young male construction workers in NYC. I'll give you 50 bucks if you can actually identify this patient! --except those of you who saw the surgery, of course) To fix this, Dr. Spector and the team had to reconnect the nerve bundle. The problem is, the nerve tissue was too short to be sew back together, so they used endothelium flap to connect both nerve endings. My thought throughout this whole process was on a talk I attended at one Biomedical Engineering Society conference. One group showed that axon of a neuron can be stimulated to grow up to 15 cm during a period of several weeks if a constant, small PHYSICAL force is applied. I can't help but keep thinking that if the surgeons can preserve the nerve tissues while stretching them for a few weeks, the neurons will grow longer. They can then connect the endings without using the endothelium which doesn't conduct as well as nervous tissues. It seems like it'd work...

Hematology clinics this week was extra cool because I suggested radiation therapy for a patient with uncontrollable Chronic Myeloid Leukemia and Dr. Silver actually took it. I might start asking for a commission if he takes a few more of my wild suggestions :) The patient had very high white count among a whole bunch of other elevated components of the blood. He feels tired and sick and had insomnia and etc. due to his condition and drugs side effects. I'm not sure why, but Dr. Silver never prescribe radiation therapy. He always uses chemo drugs only.

My favorite case this week was with Dr. Prince. It was the first time I observed a physician making a diagnosis by looking at an MRI. An MRI scan of a 74 year old lady showed that she has a stenosis on the artery that goes to her left kidney. She has hypertension because of this incomplete blockage, and her right kidney is dying due to this pressure. However, she feels fine. There's no symptoms whatsoever. Dr. Prince said the location of the stenosis is an easy location to put a stent in, however, there are still risks. The dilemma is that she feels fine. Should she risk putting a stent to fix the arterial blockage? And if she doesn't have this operation, her right kidney will completely stop functioning eventually. If she opens up the blockage, then the hypertension could still remain and that will kill the currently good left kidney. I find the decision making process in order to balance the risks and the advantages more challenging and fun.