Week 4-Emily

Hard to believe we are now halfway through our immersion experience! This week started out on Monday with clinic with Dr. Spector, seeing lots of different types of cases. Many of these patients are ones we have seen week after week which has really been a nice experience being able to see their progress. We saw one patient who was diagnosed with oral cancer about 2 months ago and had surgery to remove the cancer. This surgery removed part of her tongue so Dr. Spector came into the surgery in order to take a flap from her forearm to use to reconstruct the tongue. While we did not see the actual surgery in this case, we have seen her post-operative appointments with Dr. Spector. It was shocking to see the results of her surgery. Due to both the surgery and work with a speech therapist, she was now able to speak nearly perfectly. It is interesting to see how so many health care professionals are involved in one case. In addition to this case, we saw a similar type of oral cancer case however, this surgery was done elsewhere and left the patient without a reconstructed tongue and therefore he was unable to talk. He had to use a tablet to write down what he wanted to say. This patient came to Dr. Spector to see if there was anything he could do to treat his lymphedema. There was a lot of lymphatic fluid buildup in his neck that was causing him pain. His current treatment was palliative care using things such as bandage wrapping and massages. Lymphedema is when there is damage to the lymphatic vasculature or lymphatic system at large that causes buildup of lymphatic fluid. This can be the result of surgery when removing tumors or the result of the radiation. There currently is no treatment for lymphedema just treating the symptoms and trying to relieve the discomfort the patient experiences. This patient was coming to Dr. Spector for a second opinion after seeing another doctor who had told him surgery might be able to help. This made me wonder how patients deal with getting multiple opinions that might contradict each other. This patient said he trusted Dr. Spector and would go with his opinion. It seems like trust, experience, ratings might be things that go into a patient’s decision of who’s opinion to go with. Dr. Spector told him there isn’t any cure for lymphedema and what he was currently doing with palliative care is really all there is to do. This past fall in my stem cell bioengineering class my group wrote our grant proposal on a stem cell therapy for treatment of lymphedema. It was eye opening to now see a patient suffering from lymphedema and seeing how there really is a huge need for improvement as there is no real treatment available to patients.

              On Monday night we all attended the plastic surgery M&M meeting where the doctors go through difficult cases and discuss as a group how things could have maybe been done differently in the future. The fellows presented each case outlining the patients background and going through the treatment they received. They then provided a few slides discussing things that could be done differently in the future. In addition, they provided a literature review of articles discussing similar cases and novel research in the field to direct their treatment. It was interesting to see how doctors stay up to date on current research to see how they can incorporate it into their treatment. It would be interesting to see how often they actually do alter their treatment based on the literature. After the M&M meeting we joined the plastic surgery group to a dinner where ACell was presenting a scientific talk about their product and the fellows were each presenting a journal article in a journal club style talk. The speaker from ACell had a PhD in biomedical engineering with a focus on regenerative medicine and tissue engineering. This was really interesting to see this as a potential career after a PhD in biomedical engineering. She gave a presentation about the porcine urine bladder ECM product used as a skin graft for regeneration. She began her talk going into the more basic research on the product showing how the graft promotes pro-regenerative macrophages over pro-inflammatory macrophages. She presented data on the de-cellularization processing of the product over other existing products. What was really interesting to observe was how one of the surgeons requested she skip ahead to the clinical data. This was eye opening seeing how what is more important to the surgeons is the patient clinical data. This makes sense that they would care more about clinical research and less about the basic science. This just shows how it is so important to know your audience and how as engineers we should make sure to always keep in mind the end user.

              Much of the rest of the week was lab work where I am working on looking at the interactions between muscle cells and endothelial cells using a vascularized biomimetic construct. In addition, we all got together for a fourth of July picnic in Central Park! I am looking forward to exploring more of the city this weekend!!