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.
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,
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.
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.”
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.
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.
Prodcedure picture found from: www.mayoclinic.com/images/image_popup/br7_free_tram_flap.jpg
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.
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.
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?
3931: Watching columns drip.
3927: The sweet view from the lab window.
3928: The bacteria food from last week!
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.
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.
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!
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:
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?