Putting together the Puzzle Pieces

Recently I’ve had the opportunity to widen my horizon further beyond the Urology department. I’ve done rounds with Dr. Cooke in the ICU and followed Dr. Tagawa in the Medical Oncology clinic. Although both of these areas are very different from my general experiences in Urology rounds and clinic, at the same time, they are all related.

In the ICU, I experienced two different types of care. Many patients had come in the night before or the day before with an acute symptom (ie nausea, disorientation, shortness of breath). These patients were quickly being moved through diagnosis, treatment and recovery either in the ICU or in another unit of the hospital. Other patients though had more devastating diagnoses which left them in the ICU for a lengthier period of time. Many of these cases were due to the severity of disease or the patients’ inability to breath on their own.

In the Oncology clinic, we visited with patients who had metastasized cancers generally from the bladder, prostate or kidney. Additionally, many of these patients had been through either a surgical procedure to treat their primary cancer site or had undergone chemo or radiation. In general, the patients were visiting Dr. Tagawa in order to alter chemo, enroll in a clinical trial, start hormonal therapy or get general consultation as to what to do next. I was amazed by the variety of patients he saw and how thorough he was with each patient. Each case definitely required customized care and Dr. Tagawa was able to provide not only the standard options for care, but also the numerous clinical trails that were going on under a variety of clinicians.

So now to putting all the puzzle pieces together… My research project with Dr. Scherr is analyzing data from radical robotic cystectomies. Included in the database is detailed information for each patient which allows us to analyze the outcomes with regards to prior surgeries or treatments and complications that occur afterwards. Having looked at this data for a while now, visiting the ICU brought new life to the complications of re-admittance due to sepsis or pneumonia. As well, visiting the Oncology Clinic gave me an idea of what patients go through if their cancer returns. I had visited patients after their cystectomy in Dr. Scherr’s clinic and often the difficulties are with incontinence at night, but the patients in the Oncology Clinic with recurrence deal with many more challenges as they weigh their options for further treatment.

Finally, I’d just like to make a comment about the many roles I’ve seen Dr. Scherr play over the past few weeks. He is both a physician administering personalized care, a surgeon with technical skills, a researcher always asking questions and even an entrepreneur looking for new developments to change the way treatment in administered. I’ve been amazed to see him put on these different “hats” and even more astonished to see just how well each one fits.

I like mice

Other than going to clinics for 5 hours, I spent my week in the library in front of my laptop. My research project is on polycythemia vera patients who have mild symptoms when they have high JAK2 allelle burden, or severe symptoms with minimal JAK2 positive ratio. Normally, patients with increasing ratio of JAK2 positive burden have increasing phenotypes of the disease. For some reasons, these people have opposite output than what's expected. Several problems I run into during my statistical analysis include: incomplete/unorganized data (missing from different doctors, etc.), very small sample of patients, and not being able to rule out what causes what exclusively since we can't just test things on human patients. I'm not so sure if a publication is going to come out of this, but my fingers are crossed.

Week 5: Rollin'

Finally back to a regular full week's schedule, unobstructed by the national holidays nor other commitments! The last two weeks have been shortened one way or another, so it's great to be immersed for a full week again!

I spent most of the time bouncing around between Floors 0, 2, and 4 of the Starr Building this week, and reinforcing what I have learned about cardiology and different kinds of imaging so far in the program. Got to ask the fellows, nurses, and techs in each department tons of questions, as well as getting a lot more interesting references and resources to read. It was also great to see the end of the tunnel for my immersion project, for which I now have a realistic timeline to complete the study and possibly a paper or an abstract.

This week, I'll write a little bit more about the software that's used in my project, the LVMetric Segmentor, which was developed at WCMC to speed up the segmentation process of cardiac images. Image segmentation provides a lot of important information, such as the chamber volume, blood mass, etc. which can be used as an indicator for certain diseases. In the past, doctors spend an awfully long time on each image case to segment myocardium from the chambers, while taking into account the papillary muscle mass, etc. For each patient's image, it can take anywhere from 4 to 10 minutes for an experienced doctor like Jonathan to segment the image profiles at the systolic and diastolic cardiac phases. LVMetric, on the other hand is very efficient, as it automates this segmentation process using some nifty image transforms and segmentation algorithms, and does it for all 25 or so different cardiac phases; in a matter of few seconds!

In addition to speeding up the process for doctors, the software can get data point at almost every cardiac phase; this allows us to study the temporal aspects of the chamber volume, etc. at each moment in the cardiac phase. We've recently added a new function to the program, so that it can output a decent amount of data from different cases that we examine. The remainder of my project starting Monday will be to organize, process, and analyze the volume curve for a number of these cases (Jonathan said it would be ~20 or so).

From this study, we are hoping to identify a quantitative indicator of certain physiological defects by analyzing quantitative data that I will work with. So it will be time to hit my Statistics textbooks hiding somewhere in my room next week (where are they?!). I'm really looking forward to wrapping up my project.

Finally, I got to follow Dr. Frayer on the rounds in the NICU this morning; I really must resonate Shawn and everybody else's earlier comments: man those babies are cute!