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Margaret's Grand Adventure at OHSU: my final days there part 2

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 Dr. Hansen explained to me that more is not always better when it comes to screening, because if she finds something she has to do something about it, and that could lead to more complicated and less ideal situations. For example, if she could screen for one thing and instead find another—say, a benign tumor in the colon. If she operates on that tumor, even though it will most likely never become malignant, and there’s a complication, it could result in a hernia and cause havoc. So, while I think that I would always prefer to know what is going on with my body, I can understand not treating everything we could potentially find. There is a gene that can predispose a person for breast cancer, and I would love to know whether or not I have it, and I hope that I would have the courage to face the likely possibility of cancer. Angelina Jolie just had a preemptive bilateral mastectomy because of this gene, and I dearly hope that her bravery and openness give other women the strength to fight their battles.

 
In the clinic we saw a patient who had fallen and badly injured her head. She developed a large swelling “goose egg” on her forehead, the bump wouldn’t go away entirely, and some of the internal blood fragments traveled down the woman’s face and collected in the sub dermal facial crevices. We also met with a patient who had accidently amputated both her pointer and middle fingers, and she needed her stitches removed. Another patient needed his leg removed after a host of other procedures failed, and another patient sustained several facial fractures and needed screws and bolts to set everything back into place. Another patient broke his mandible and another patient needed tendon repair in both of their arms after attempting to commit suicide.
 
 
In the OR the surgeons use an instrument called a “Bovie” or a cauterizing stick. The surgeons use the scalpel very little—mostly just to cut through skin—and the Bovie does the rest. What I didn’t realize until near the end of my time at OHSU is that the Bovie is sending electric charged into the patient and is cauterizing through electrical burns. The surgeons wear two pairs of gloves (one rubber and one latex), and the patients lay on grounding pads to prevent either one from getting hurt. The most fascinating part is that if the surgeon cannot reach a tight or hard to get to spot, he or she can take their surgical tweezers, place the tip on the hard spot, and tap the end with the Bovie. Since electricity conducts well through metal, the hidden spot is zapped. I had no idea how much physics was used in a biological and chemical procedure!
 
 
Some final anecdotes include that I couldn’t touch anything in blue because it was sterile (“don’t touch the blue, or the nurses will kill you”), and I had to stand for many hours at a time and fell in love with my Dansko clogs (a little shameless product placement; every person at OHSU wears them…every). Over the course of my time at OHSU I witnessed some part of surgical and healing process behind breast reductions, breast reconstructions, preemptive and post cancer mastectomies, breast implantations, and breast tissue expander implantations. During surgery the tissue expanders—which can be filled with fluid via a long needle and expand to stretch the skin to make room for an implant—can be taken out of their packaging, placed in a person for sizing, be taken out, and re-sterilized. The implants, on the other hand, cannot be re-sterilized, and once they’re out of their packaging they have to be used or thrown away.
 
 
The attending surgeons, attending anesthesiologists, surgical residents, nurse anesthetists, circulating nurses, and scrub techs all work together as a close team in the OR, and they each do their own job to make sure the patient receives the best care. For each job there are a million was to arrive in the OR, and while there are so many ways to get to the same room, peoples’ priorities don’t change: save a life. They huddle before and after a surgery to ensure that patients receive the correct and best care, and the nurses count all the tools repeatedly to avoid objects being left in patients. It’s a terribly tricky job, putting people back together, and I have such respect fur plastic surgeons and anesthesiologists, and their entire team. As the anesthesiologists say, anyone can put someone to sleep; the trick is waking them up again.

I has such a wonderful time and would like to thank my lovely mentor, Dr. Julie Hansen, her fantastic residents, the entire OHSU staff, and my senior project teacher advisor, Veronica Ledoux. This has been a fantastic month, and i hope to stay in touch often.

All my love,
Margaret

Comments

Thank you!!!

You are a beautiful blogstress and a beautiful person. Hope the time in the San Juans is FABULOUS!!

Nichole

What a great experience you've had!

And you even got to recall a little science II physics...

Margaret's Grand Adventure at OHSU: my final days there part 1

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 From now on I lost track of what happened on which corresponding number day, so I’ll just talk about everything that I saw or did in the rough order that it happened.

 
 
Today I watched Dr. Hansen perform Botox and learned that it can be used for more than wrinkles. Botox is a muscle paralytic and can be used to combat severe headaches. There are also no age restrictions and the product can be used on patients as young as babies.
 
I also learned about breast reductions…for men. Yes, this is a thing. I had no idea. Sometimes men develop excess breast tissue, and in some cases this results in fully formed breasts. The patient I watched Dr. Hansen operate on was young and suffered from a mild case of the condition, but his excess tissue and protruding nipples had negative psychological effects. I hope the best for him and that the procedure gives him the desired effect, as well as some relief and renewed confidence to feel comfortable skin.
 
I also attended another preop meeting in which we discussed upcoming cases, as well as previous ones. One of the residents presented on hospital regulations that aim to ensure patient safety. During the presentation his computer froze, the little spinning rainbow wheel of doom appeared, and PowerPoint became unresponsive. As a joke, another resident exclaimed, “Doctor, he’s unresponsive!”
That comment made the whole room laugh a lot.
 
During this day I also looked more case pictures, in particular gunshot and bike accident patients. In one of the bike cases a patient got their tires stuck in the Max tracks and took a nosedive over the handlebars. The fall caused them to skid across the pavement and their nose and upper lip were ripped off. Other violent accidents included hand and arm avulsions (i.e. arms ripped off by machinery), hand de-gloving and finger amputation injuries (i.e. hands caught in lawnmowers), genitalia avulsions (i.e. penises being torn off), and crush injures (i.e. hands and arms crushed in metal presses).
 
 
 
During one procedure a patient had small residual cancerous tumors in one breast after the majority of them were removed. A breast cancer surgeon was called in and she only operated on the “dirty” side and used the “dirty” tools, and Dr. Hansen took over afterward and used the “clean” tools. Anything that could possibly come in contact with cancerous tissue was regarded as “dirty, “and it was essential that unhealthy tissue didn’t come in contact with the healthy breast.
 
In clinic I met with the patient who received the tram flap operation I saw. During her postop appointment she got her drains removed and her scars were healing well. The surgical glue—which is applied right after the incisions are closed with sutures—was still covering the stiches, and I was told that it flakes off over the course of several weeks.
 
In clinic I also got to feel a patient’s abnormally shaped breast and capsular contracture around their radiated skin, and this was my first significant physical patient contact (other than shaking hands). Later I got to assist in taking out a patient’s wires that had held his broken jaw in place for several weeks. Aric, an extremely helpful and friendly resident, had me hold the tongue depressor and a long Q-tip in place to keep the patient’s cheeks out of the way while Aric works. I have a moderate phobia of not being able to open my mouth, and I have no idea how this patient did it for so long. He had such an energetic, positive, and grateful attitude that again reminded me how fortunate I am and how much I take being healthy for granted.
 

Later on in the clinic I saw postop visits for breast implantations and reductions, a preop for a breast reduction patient with size G breasts and chronic back pain, a preop for chin surgery to remove an unknown lesion, and a postop for a facial laceration surgery that I saw on the first day. During one of these visits I encountered my first unhappy patient who received faulty postop instructions in regard to the process of scheduling a postop visit, as well as where to fill their pain medication prescription. This made me realize OHSU is a big facility and is prone to some errors just as a result of the it’s size, but also that there are patients who can get a perfect result and be disgruntled, and then there are patient with terrible options or results who remain positive and appreciative. These are just different approaches and outlooks, and as my granddad used to say, “that’s what makes horse races.”

Margaret's Grand Adventure: My time at OHSU Days 7-11

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 Day 7

My grandmother died this day. Spent far too much time in the hospital for the wrong, hard reasons,
 
Day 8
Didn’t go to senior projects because I needed to be with my family
 
Day 9-10
At the state track meet, and my mentor was out of town for a conference in Mimi.
 
Day 11
Today I attended the weekly Monday pre-op meeting and we hosted a visiting professor from New York. He talked about rhinoplasty and showed slides about some of his patients and techniques he used to reduce error. Afterward I followed him on his resident-guided tour of both upper and lower OHSU campuses, and learned some history about the school’s location. Apparently, many years ago, a railroad company bought the property without looking at a topographical map, but upon arriving for construction they noticed a minor problem: the land was located entirely on the side of a hill. This, of course, was useless to the railroad company, and they had to find a different route around the mountain. In the meantime the company donated the land to the hospital. Now days there’s a tram, but before that it was extremely time consuming to travel in between the upper and lower campuses (the lower campus is much more recent). That being said, the tram is not a “trambulance.” This means that patients often have to be transported between campuses by way of an ambulance because they cannot use the tram.
 
Later in the day I looked at more case photos and talked to Dr. Hansen about a number of them. I also learned about radiated skin and how hard it is to work with. Tissue that has undergone radiation is highly unpredictable, and capsular contracture often develops in radiated tissue around breast implants. This is an abnormal immune system response to foreign materials in the human body, and follows the formation of capsules of tightly woven collagen fibers. The capsules contract and tighten around the implant, resulting in misshaped tissue and moderate to extreme physical discomfort.
 

Later in the day I was reading a medical magazine and found out that a company names “Pear” claims that arnica can be used to minimize surgery related bruising, both through the usage of a external/topical gel and internal pellets.

Margaret's Grand Adventure: My time at OHSU Days 5 and 6

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 As you may know, I haven’t posted a blog in many days. I apologize for the delay, there were a number of deaths in the family—one of which included my grandmother—and the past couple weeks have been tremendously difficult. Time is still scarce, but I have been steadily compiling notes on my daily activities and need to organize them into complete posts.

 
On day #5 I witnessed probably my favorite operation during my month at OHSU. In this procedure a patient received a breast reconstruction by way of a rectus muscle and skin flap. That means that Dr. Hansen removed the abdomen skin and fat, as well as the lower portion of the right side of the patient’s rectus muscle (a.k.a. the ab muscle, or abdominis rectus). That skin, fat, and muscle flap was then moved to the previously mastected breast area—along with am artery and vein, which were attached under a microscope to a vein and artery found in the chest. A sounding probe was used to affirm the restoration of blood flow throughout the procedure. The rest of the extraneous lower abdomen tissue was removed but the remainder of the rectus muscle was left intact. The remaining lower abdomen tissue was then sutured together, producing a “tummy tuck.”
 
While Dr. Hansen and one of her residents connected the veins and arteries (a micro vascular surgical procedure), another resident demonstrated different suture techniques on a portion of removed tissue. I was able to glove-up and practice the sutures for myself. When first going into the operating room, I had no idea stitches were so difficult!! Ina (the resident) carefully showed me the different kinds of sutures and explained what each one was predominantly used for. To be perfectly honest, I’ve never been handed a body part before and been told to “play with it,” but I had a great time handling and working with the tissue.
 
During this surgery, Dr. Hansen mentioned something called a “beta blocker”—which I learned about in science class this year—and it was fun to see the connection. Beta-blockers are a class of drugs that target the beta-receptors on cells found in heart muscles, smooth muscles, airways, arteries, kidneys, and other tissues involved with the sympathetic nervous system.
 
(See a picture of the flap PROCEDURE and SUTURE STYLES in the attachments)

Prodcedure picture found from: www.mayoclinic.com/images/image_popup/br7_free_tram_flap.jpg

 

Day 6:

Today was a slower day in which Dr. Hansen had to catch up on office work, so I spent my time looking at pictures of past patients. The cases included breast reconstructions, mastectomies, breast reductions, avulsions (i.e. hands ripped off), de-gloving injuries (i.e. skin being pulled off of the muscle), crush injuries, tumors, facial fractures, tummy tucks, dog bites, gunshot wounds, trunk injuries (i.e. on the chest or abdomen), and many more.
 
One patient who Dr. Hansen spent a lot of time with was one who attempted suicide by shooting themself in he head. However, instead of destroying their brain or brainstem—which would have taken out necessary functions such as breathing and blood pressure—the patient accidently blew their face off. This tragic incident led to tens of surgeries and years of work, and the end result is remarkable. If you look at the reconstructed face without looking at the bloody beginnings, it doesn’t look nearly as impressive, and this patient stands as a strong example of the powers of plastic surgery.
 
Later today I attended M&M, which is a conference in which attending (senior) doctors from different fields and their residents gather to discuss cases that ended with a poor result (i.e. an unforeseen complication, a human error related complication, and/or a fatality). The plastic and vascular surgeons each presented a case to the assembly, and different doctors from a number of fields discussed what wen wrong, why, and how/if these complications can be avoided in the future. Residents from each surgical division take turns presenting at M&M, and while I know that I’d be terrified to get up there in front of all those doctors and showcase a medical error and/or mistake, these residents handled the pressure remarkably well.

The Chapman Chronicles, vol III: How Not to Design a Building

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I had a weird 3rd week of senior projects, what with the trip to the zoo on Tuesday and the annoying retake of a Calculus BC test on Thursday.  Despite all this, I feel I owe it to my loyal and interested readers to report on week three of my time in the Farrens Lab, which includes (but is not limited to) a spectrofluorometer, seminar, more thai food, and head-scratching building design.  Let's get started.
On Monday I was introduced to several pieces of lab instrumentation, including one, and possibly two, spectrofluorometers.  I say "possibly two" because the two machines work in very similar ways, but I don't know that both are actually called "spectrofluorometers". I know at least one has this name because I had to practice saying it to get it right.  The machine in question is capable of measuring both fluorescence and absorbance, allowing Amber to measure certain properties of our protein samples and deduce many more.  For those of you who take, have taken, or teach Advanced Chemistry, this machine measures absorbance in the same manner that we measured in class---light is directed at the sample, and measured through a slit behind the sample.  The difference between the amount of light directed at the sample and the amount measured at the end is the amount of light absorbed by the sample, or absorbance.  The main differences between the one at OHSU and the ones at Catlin are the accuracy of values obtained and all of the bells and whistles on the one at OHSU---it has a monochromator to measure absorbance or fluorescence at certain wavelengths of light and polarizers to measure photons of a given polarization.  It can also measure fluorescence in a similar manner---light is directed at the sample and measured through a slit located at 90 degrees to the light source; because fluorescence is emitted in all directions, the slit at 90 degrees can measure fluorescence without collecting photons that pass straight through the sample.  The spectrofluorometer is very expensive and a bit temperamental.  I'm scared to touch it.
I attended a seminar during week two and two practice lectures during weeks two and three.  Graduate students here give seminars on the progress of their work, first to students and faculty here at OHSU, and then to anyone who wants to listen.  These talks are dense but interesting, and I was especially proud when Chris, another grad student in the Farrens lab, gave his practice lecture and I understood pretty much everything he said.  Of course, I don't have any proof because my pencil gave out on me after three slides of note-taking.  
My exploration of the lunch menu of the Sweet Basil food cart across the street continued this week with orders of pad thai and pad kee mao.  The pad thai scores a less-than-satisfactory; they used copious quantities of barbecue sauce for the noodles, which made for a really odd taste combination.  The pad kee mao, however, was really good---this one was cooked to my order and featured bell peppers, really hot peppers, onion, sprouts, and yes---sweet basil.  They also have thai sweet tea available for free whenever you come to pick up your order, which is the best drink I've ever had.  It tastes like the crisp top layer of creme brulee in liquid (dissolved) form...
Finally, on to building design.  For all you aspiring architects out there, learn from OHSU's mistakes.  I went to the DNA sequencing office before Chris's practice talk, and went from floor 3 of one building to floor 2M (two and a half?) of another building to floor 5 of a third building, all without setting foot in a stairwell or an elevator.  I then tried to go outside, which was way more  difficult than I thought it would be because the ground floor was actually floor 3.  Floors 2, 1, 0, and B each have doorways labelled "EXIT" that do not actually lead outside.  Luckily, I wasn't too late to Chris's talk.

Photo Guide:
3937: The spectrofluorometer.
3934: Protein gels! These ones basically tell us that we have successfully purified three proteins, but we probably could have gotten a better yield.

Comments

Update on last week's protein crystallization cliffhanger?

So are you using both of the spectrofluorometers to collect data, or just one? In each of your gels, one lane of what I think must be one of your protein samples has two distinct bands, rather separated from each other....why is that?

I know the answer to your question, but I don't think I can...

...tell you. Amber asked me the same question and made me puzzle it out, which took a little while. Unfortunately, I don't think it prudent to post a response to this question as it could endanger the lives of our agents in the field (it hasn't yet been published). I'm actually not entirely sure that even this picture is OK, so it might disappear come Tuesday. Sorry! I know this is an unsatisfying answer.

Quite unsatisfying, but Amber must be proud

of how well you're protecting her secrets! Can you address the crystallization question? Can you tell me something else scientifically interesting to distract me from noticing that you're not answering my original questions?

Other scientifically interesting things

Back in the fall, I shadowed Amber for a couple of days for Advanced Bio, and during that short period, she was working with rhodopsin, a pretty well-known GPCR found in the rod cells in the eye and responsible for low-light vision. Back then, I'd just had a unit on intra- and intercellular signalling, enough to understand pretty much how rhodopsin converts light into an intracellular signal, which eventually becomes an action potential. The really fantastic thing was that because of my past experience and self-directed research on rhodopsin and my experience with fluorescence analysis over the past three weeks, I knew what Chris was talking about and how he had gotten his results when I heard his lecture. I suppose it also helped that I heard it for the second time today. Some interesting tidbits from his talk:
Rhodopsin cycles through several different states depending on the state of its ligand, retinal. The apoprotein, or protein without a bound ligand, is called opsin. Opsin binds very tightly to 11-cis-retinal, so in a solution containing excess retinal, almost all wild-type rhodopsin is in its ligand-bound but inactive "dark" state. When a photon hits the dark state complex, the 11-cis-retinal isomerizes to All-trans-retinal (the 11th single carbon bond rotates 180 degrees), inducing a conformational change in the rhodopsin protein, called Meta I. Activated rhodopsin exists in equilibrium between Meta I, Meta II, and Meta III states, with Meta II being the conformation that may bind a G-protein and propagate the signal. Metas II and III can release their bound All-trans-retinal, reverting back to the opsin state and completing the cycle.
Chris used these properties of rhodopsin to measure the rates of retinal uptake and release in samples of wild type and mutated rhodopsin, and used his results as the basis for new hypotheses and further experimentation. Both procedures were very cool, so I'll ask him tomorrow if I can include them in my next post.

Crystallization

Steve Mansoor, a former grad student from the Farrens lab who also worked with T4L, has successfully crystallized the protein samples we sent to him at the end of week one, but has not gotten around to producing data or pretty images yet. All I know as of the beginning of week four is that the crystals are very small and yellow because we bound a fluorescent label called monobromobimane to them.
Further updates as events warrant!

Picture

Picture's back up, Amber didn't have a problem with it. I can also describe to you the protein purification process in more detail (and explain the gels) in person, but I'd rather not on a public forum---playing it safe.

The Chapman Chronicles, vol. II.

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Abstract: It's hard to describe exactly what I'm doing at work through this blog for several reasons; some of the procedures I have performed haven't been published yet, so I can't talk about them, and many of the other tasks I've done are challenging to describe in detail for my readers without the benefit of some background in molecular biology or science research.  I will give a general overview of what I've done so far in my project, and describe in more detail a few of the interesting episodes of the past week, including (but not limited to) performing top secret science procedures, watching exchange columns, and eating pie.

These past two weeks, I have been working on several different related mini-projects with Amber, my mentor.  The general goal behind each of these projects is to express a protein that has been mutated in specific places, and then perform a range of tests on it either to better understand the structure of the protein itself, or to develop new methods for analyzing protein structure.  I won't delve into specifics, but so far I have inserted a point mutation into a plasmid and amplified the DNA; I have also expressed two different mutated versions of the protein in E. coli cells and isolated our desired protein from all the other gunk in bacterial cells.  We performed some tests on one of these proteins using really expensive machines today, and I learned what each piece of equipment does and what our results mean.  The other is being crystalized in a different lab; we will have results within the next few days!

It's fun, interesting and challenging to learn about Amber's research in molecular biology and the tools she uses to obtain and study her results; it's taken two weeks, but by now I've reached a point where I can find things around the lab without needing to ask somebody for them, perform lab procedures with less-than-constant supervision, and generally be helpful around the lab.  One of my least favorite lab procedures so far has been eluting protein through columns; the procedure allows the isolation of a desired protein from a solution containing lots of dissolved material, which is cool, but requires that I watch solutions drip through plastic columns for a good chunk of my day, which is less than exciting.

Another excellent aspect of my senior project thus far has been the cuisine available to me in the lab.  Perhaps I say this because I enjoyed a particularly delightful day food-wise today, but the variety of food choices has been consistently satisfactory (the adjective, not the verbal equivalent).  Today I enjoyed a cold-brew latte which tasted like creamy deliciousness; and for lunch I had a bowl of ramen from the downstairs cafeteria, which was pleasingly heavy on the pulled pork and vegetables.  The Farrens lab has also had a couple of birthdays this week (happy birthday John and Emily), so Amber brought in a homemade strawberry rhubarb pie.  The pie was good and definitely worth the kidney stones I'll probably get, because rhubarb is notoriously high in oxalates. 

To the readers of my blog who are science teachers, I leave you with this final question: what happens to your tongue when you eat capsaicin and menthol at the same time?

Photo guide:
3931: Watching columns drip.
3927: The sweet view from the lab window.
3928: The bacteria food from last week!


Comments

Have you read the research

Have you read the research articles that Amber gave you earlier this week? Can you give us a general overview of that research? And since you're keeps us informed of your culinary experiences, I have to ask if you are enjoying the Tuesday farmers' markets?

"Sort of" on both counts.

I've read one of the four papers she's given me---the 1999 publication that began this line of research---and plan to read the others this week. In the 1999 publication, Steve Mansoor (a former graduate student in the Farrens lab) et al. explores fluorescence as a potential method for deducing the structure of a protein. He creates many different mutations of the T4 lysozyme by removing all cysteines from the protein, then substituting a single cysteine for a different amino acid in each mutant; the resulting protein contains only one cysteine at a known and controlled location. He then binds a fluorescent label to the cysteine in each of his mutants, and performs a range of tests and analysis to determine whether the protein's fluorescence correlates to its other properties. He concludes that the fluorescent label can be attached to the protein without substantially altering its function at exposed and partially buried sites, that one can deduce the solvent accessibility of a site (degree to which the site is exposed to a solvent in which the protein is dissolved) by fluorescence emission (wavelength of light emitted by the fluorophore) and steady-state anisotropy values (I know what the first is, and do not understand the second), and that he couldn't draw conclusions about 3D structure of the protein from fluorescence excitation, fluorescence lifetime, and quantum yield values (understand each of these: the wavelength which excites the fluorophore most, the length of time at which the fluorophore remains in an excited state, and the fraction of times that the protein will fluoresce per photon).
In the 2002 paper, he studies the degree to which tryptophan quenches the label's fluorescence---the label's fluorescence diminishes with the proximity of tryptophan; I can't really discuss it because I've only skimmed the article.
I haven't enjoyed a Tuesday farmer's market, but I enjoyed a Saturday one a few days ago. Ate crepes which were good but overpriced, cheesecake, kettle corn and pita chips. All very tasty.

ps. Nice view!

When I worked at OHSU I was in the sub-basement...

Capsaicin + menthol = OUCH!

Were you able to show off your previous understanding of exchange columns? (Yes, they can be quite slow!)

Sadly, this is not really an answer...

Unfortunately, the exchange process is one of the things that I'm not allowed to talk about. It's a very cool set of reactions, however, so look for future publications by the Farrens lab!

Margaret's Grand Adventure: My first week at OHSU! (Day 4)

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Day 4:

Today was another clinic day, and my time there was cut short by my visit to see the Dalai Lama speak--what an absolutely amazing experience!!

In the morning Dr Hansen and i met with 2 of the 4 scheduled patients because 2 didn't show up. One of the ones that did arrive wanted a breast augmentation. They had received a free muscle flap to reconstruct one breast after chemotherapy. During this consultation, Dr Hansen explained that radiated skin usually hardens in a process called capsular contracture, but any skin around an implant is prone to a similar result.

Another term that I learned (I forgot to mention in in my post about day 3) is surgical procedure called a lumpectomy, in which only a small portion (or lump) of a breast is removed.

Another patient wanted cosmetic breast implants, and this demonstrates a different side of Dr Hansen's services. She mostly operates on cancer-related cases but also performs purely cosmetic procedures. Another area of her practice (one i forgot to mention in m day 3 post about a patient) is the female to male / male to female transition surgeries. Dr Hansen commented that this is a newly booming part of her practice, and that she specializes in performing breast removals (mastectomies) and breast implants.

A surgical note: often the nipple is grafted onto the newly reconstructive breasts straight from the old breasts, and this is as 'simple' and removing the nipple, removing several layers of epidermis on the reconstructed breast, and sewing on the nipple.

Comments

timely NYT articles for you

Check out yesterday's NYT Op Ed, written by Angelina Jolie, about her recent double mastectomy, and today's piece in the Health section describing how genetic testing is leading to more and more women electing to have surgery before being diagnosed with breast cancer.

Pure, sweet hope

Miss Margaret! What thoughtful, informative posts! Your first week sounds incredibly educational and varied--let's hope your dark past doesn't catch up with you and cut your job short!

I love your attitude, as always. I, too, find that the best way to deal with the blows that life throws at us is to concentrate on the beauty and hope that emerge--just like you've noticed in the patients you've seen. And a visit with His Holiness doesn't hurt, either!

An idea: since you need some photos, can you show us what you look like all suited up? I'd love to see you in your glory.

Miss you!!!

Nichole

Margaret's Grand Adventure: My first week at OHSU! (Day 3)

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Day 3:

Today we spent the day at the clinic for preop (pre-operation) and postop (post-operation) consultations. One of the patients had received a mastectomy and needed to reconstruct one or more of their breasts. Another patient had implants but needed an augmentation to fix existing complications with the breasts' appearances.

Interesting fact: saline implants can remain in place for life, while medical professionals recommend replacing silicone implants every 10 years or so.

Another patient had sustained a crush injury to their pointer finger and met with Dr Hansen during the recovery process to determine the best course of action as the finger continue to heal. The finger had sustained multiple fractures, as well as concentrated cell death and partial amputation.

Another patient in the clinic had battled a reoccurring type of cancer, which contributed to an infected open-leg wound with tissue damage, inflammation, and decay, as well as bone visibility. After a failed skin flap graft the options were limited to a transverse free muscle flap from the back area, or an amputation.

What surprises and inspires me most is the energy and passion that remains so vividly alive in these patients, despite the hardships they have had and will continue to endure. Their vibrant spirits are catching, and they give me hope; pure, sweet, hope.

Comments

This is fascinating; thanks

This is fascinating; thanks for the thoughtful and detailed posts! Given the longevity of saline, why would one choose silicone implants instead?

Saline vs. Silicone

That's a great question! I wondered the same thing when Dr. Hansen showed me the two different models, and she said that silicone feels more natural to patients. Silicone implants hang more naturally than saline implants, and the texture is different. There have been allegations that silicone is damaging, but the two implants are virtually the same, other than what i previously mentioned. Often times, it just comes down to patient-preference, but doctors usually suggest silicone.

Margaret's Grand Adventure: My first week at OHSU! (Day 2)

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Day 2:

Today was a SURGERY day!! After arriving at OHSU South (the upper campus) I suited up in my scrubs, hair covering, surgical mask, booties, and Dansko clogs. The clogs were essential, practically every surgeon, nurse, technician, anesthesiologist, and person in between wears these Dansko clogs, and the shoes' strong arch support helps relieve stress on the feet, knees, and back during a long day in the OR (operating room).

The first surgery I watched was the tail end of a facial surgery. The patient had suffered facial drooping as a result of an accident, and Dr Hansen reopened the old scar and repaired muscle damage. As you know, I cannot release the names or specifics of patients (I don't even know most of them), but I will discuss the types of procedures from a surgical standpoint.

The second surgery was a rather unusual one, even from Dr Hansen's extensive experience. The surgery was called a labiaplasty, or a surgical reduction of the labia. The labia minora and majora are the folds of skin surrounding the human vulva, and anatomically these are found in the female sex genitals. This was an interesting procedure to watch, and the whole process didn't take long. During the labiaplasty, Dr Hansen and one of her residents removed wedge-shaped flaps from the patient's labia and sutured the remaining tissue together, with a net result of reduced labia size.

The last surgery of the day was a bilateral breast implantation. I believe that the patient had sizer implants in place to stretch the tissue and make room for the permanent implants, and those were removed during the procedure. The surgeons chose a permanent implant size by testing different sizers to test the shape of breasts. The sizer implants can be re-sterilized and used again, while the permanent implants cannot, so they surgeons wanted to be sure of what they wanted before inserting the permanent ones. I loved watching the miracle of the whole process; everything from the surgeons' ability to create breasts from skin and silicone, to the anesthesiologist's ability to put the patient under and then bring them back again. I look forward to many more days like this one!

Margaret's Grand Adventure: My first week at OHSU!

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Howdy there! This week I spent 5 wonderful, jam-packed, intense days shadowing Dr. Julie Hansen at OHSU. She's a reconstructive plastic surgeon there and I got to follow here around her clinic and her operating room. Dr. Hansen and I met during my advanced biology class when I shadowed her for several days, and during that time I also got to know the plastic surgery residency coordinator, Amanda Kotsovos.
Now let me summarize each day of senior projects so far one at a time, starting with the first:

Day 1:
I showed up to the south campus of OHSU bright and early in the morning (so much for sleeping in on senior projects, eh?), and I met with Dr. Hansen for the first time in several months. We discussed the possible directions/focuses of the project and then she showed me around her office in Mackenzie Hall and introduced me to some of the staff. Next Dr Hansen had to make some phone calls and do paper work, so Amanda and I went to the parking office to get my ID badge. However, we ran into an snafu: the regulations changed and became stricter since my last visit (unbeknownst to Amanda, Dr Hansen, or me). Instead of a 5 minute process similar to what I experienced in the fall, I suddenly had to take several online classes, pass several online tests, and get a background check. I received a temporary 2 week pass, and Amanda and I returned to Dr Hansen's office where I spent all day passing the classes and tests. However, it wasn't that bad, and I learned more about hospital regulations and expectations, especially in regard to patients' private information. We're still awaiting the results of the background check, and we all joke that my "dark past" will come back to haunt me (haha, just kidding). After all the bouncing around and test taking I got few minutes to browse through a plastic surgery journal before heading off to track practice. It never occured to me that science magazines would have different advertisements than non-scienctific ones, but it makes perfect sense now that I think about it. Still, I don't know whether I'll ever be able to consider the ad selling leeches as 'normal.' It read, "Leeches! On call 24 hours. Just like you."
It's the little things that me you simle, right?