week 6-Emily

              This week shadowing Dr. Spector was filled with some new patients as well as follow-ups of many of the patients we have come to know over the summer. It has really been a unique experience getting to see the patients in surgery and then follow their progression throughout the summer. One patient we saw a lot this summer was the one who had the Achilles heal surgery which ended up infected. After many weeks of debridement and use of the wound vacuum device, he ended up needing surgery to put a skin graft over the wound once it had sufficient granular tissue. This past week we saw the patient after that surgery. During the surgery there was a complication with the “twilight anesthesia” where the patient had a reaction and began coughing and vomiting. The patient had to be intubated and then put under general anesthesia. During this office visit, the patient complained about pain in his throat and jaw which Dr. Spector said was likely due to the process of intubation. This had made me think if there are ways to make the process of intubation simpler and less damaging to the patient.

              In addition, the patient who had squamous cell carcinoma removed on his head was back again to check on the wound left from the excision of the cancer. This patient has been back each week to check on the progress of the wound healing. Each time, Dr. Spector does debridement and cuts away at the wound to remove dead tissue and reveal bleeding, healthy tissue. This is a common theme in all of the patients with wound healing issues. You want to cut away at the calloused, dead tissue until you get to bleeding tissue, which is healthy tissue. In this patient, Dr. Spector used a matrix made by ACell to help facilitate healing of the wound. After a couple weeks of using the product on this patient, Dr. Spector thinks it was helping with the regeneration and this patient is improving each week we see him.

              There are some cases where unfortunately other conditions the patient has leads to complications with the surgeries we see. There was one patient who came in this week who had an infection of a hernia mesh implant. Unfortunately, this patient also has rheumatoid arthritis and was on Humira which had altered the immune system of the patient, likely contributing to the infection of the mesh. The patient is currently off of Humira to try and help with the infection, but suffering from rheumatoid arthritis as a result. In another case, the patient had developed keloids which are raised scars where the skin has healed after surgery. The keloids can grow to be much larger than the original scar which was the case for this patient. The keloids are more fibrotic and can be more tender and painful when the skin stretches. To fix this condition, the patient needs to have surgery to remove the fibrotic scarred tissue and then take precautions to ensure this type of scarring does not occur again. Dr. Spector said steroids can be used to prevent scar formation, however the downside to this is steroids will alter the healing process and could prolong the process since they act in an anti-inflammatory way.

              Another key moment from this past week was seeing the patient who had oral cancer and needed to use the forearm flap to repair the defect from the tumor resection. We have been following this patient’s progress for the past few weeks. This week, she came in and presented Dr. Spector with a plaque thanking him for everything he had done for her. The plaque thanked him for changing her life and giving her a “sweet lisp”. This moment really touched me to see how important health is to someone and how medical care makes so much of a difference in the lives of patients.

              Outside of shadowing and lab work, this week was filled with some great NYC exploring. Tuesday was my birthday and as a gift, my friends got me tickets to see Wicked on Broadway.