week 7 - Emily

It is hard to believe that the Immersion term is already over! These seven weeks have gone by so fast. This final week shadowing Dr. Spector was filled with both clinic time and OR time. In the clinic, we saw a patient we had seen many weeks in a row at this point. This patient had a double mastectomy after being diagnosed with breast cancer. When breast tissue is removed, you can sometimes get necrosis of the breast skin due to the loss of vasculature that supplies the skin. This patient was coming in week after week to get breast tissue expanders in preparation for implants. Each week, the expanders are filled with saline to expand the tissue through a port. This expansion can be painful, so the patient is advised to take pain medication prior to the appointment. This week we also saw a follow-up with the patient who had the cyst removed from the back of his neck last week. The results from the infection came back positive for MRSA. It was interesting to hear Dr. Spector say that MRSA is not as bad as the media and people think. This was very shocking to hear, because like Dr. Spector said, when I hear MRSA I often think it is very scary and untreatable. However, the reason it is so complicated is more just that it is not treatable with the most commonly used antibiotics. Another patient we saw this day in clinic has scleroderma, which is a disease I had never heard of before. Scleroderma is an autoimmune disease in which the body’s immune system begins to attack the connective tissues. This results in the overproduction and accumulation of collagen in body tissues. This patient presented many complications such as tightening of the skin, Raynaud’s disease, pericarditis, digestive issues, difficulty opening her mouth, and muscle weakening. She came to Dr. Spector to see if there is anything he could do about the skin tightening. This is something Dr. Spector has had experience with in the past and the use of lipotransfer could be used to try and relieve some of the tightening especially around her mouth. The reason for the use of lipotransfer could be the potential therapeutic benefit of the stem cells in fat however, more research is needed to know for sure why this is beneficial.

In the OR, there was one large case where the patient has oral cancer that would require jaw reconstruction. The patient’s fibula along with surround muscle, skin and suppling vessels were to be used for the reconstruction. It was interesting to see all the players involved in this kind of surgery. An engineering company plays a large role in these cases, by taking patient images and creating custom cutting guides that the surgeons will use during the surgery to shape the fibula to fit the patient’s anatomy. We went into the surgery early Tuesday morning expecting a long day in the ER. Before the surgery even began, the patient, under anesthesia went into SVT which is an abnormally fast heartbeat. He also had very low blood pressure and was being given vasopressin and a lot of fluid to increase his blood pressure. The problem with this is that the surgery had not even begun yet and his blood pressure was already so low. With such an extensive surgery underway with lots of expected blood loss, this could become a real problem. The surgeons in the surgery called in a cardiologist to get their opinion on the case. Together all the doctors came to the agreement to cancel the surgery for now and wait until he had a full workup done with the cardiologist.

This last week was also full of celebrations with the program as well as the labs that hosted us. It has been such a unique experience collaborating and working with medical students and doctors and I am so grateful for Dr. Spector for hosting us and taking the time to explain things to us in such detail and for his lab members for helping us get going on our summer projects. This experience has shown me the importance of keeping communication between these two fields strong. Each field plays a distinct and important role in improving patient health and through this immersion experience we each learned a lot from one another. I am excited to be back in Ithaca with a new perspective and seeing patients with conditions that my research could benefit has been especially inspiring.

End of Immersion Happy Hour with Spector Lab