This week, I finally finished the project my mentor had me working on. I extracted all 636 diagnosis from 636 case files! I finished what was supposed to be a three week project in four days, much to my mentors surprise. That being said, I received another project to work on. Now that I know how to read an analyzes case studies, Dr. Miloh assigned me the task of filling out a 56-collum spreadsheet for a research project that he is working on. Fifty patients were selected to participate in a Text-Messaging study. In the study, patients half the patients were sent weekly texts to remind them to take their meds (which according to the case studies I have read, compliance is often poor even in life-threatening situations). The problem is that all of the data has not been properly recorded. Instead, I am to rely on the case studies of patients to see if there has been any effect. Here's what happens: every time a patient visits the hospital, the MD that sees him/her writes a two to three page report on what happened, why the patient came, the impression the MD had of the patient, a suggested course of actions, etc. Because this is written every time a patient steps into PCH, I can see the progression of each disease by reading every single report on the patient in all areas of the hospital (GI, neurology, genetics, dermal, Hem/Onc., etc.) In most cases there are well over forty documents per patient, and for each patient enrolled in the study, I have to read every word so I can properly record their progression. I am learning so much from reading these studies. By reading about each patient, I feel I really understand a lot of diseases and their treatments and causes. Working directly with cases has taught me probably as much as a whole textbook on the subject would. I also get to learn about how each patient reacts in each situation, and see exactly what doctors do to facilitate compliance. It is a very interesting look into the psychology of a patient. Additionally, I am learning as I am going, and the more patients I read up on, the greater my knowledge of GI diseases increases. Interning is really a very cool way to learn a new subject.
The good news is that I am now really good at reading case studies, and can easily understand them. Experience really is the best teacher.
On a side note, my mentor was in charge of coordinating a liver transplant at PCH the other day! I was SO impressed that (a) my mentor is such a boss and that (b) PCH offers transplant services! Apparently its a relatively new thing that they do, but its been working really well so far and lots of kids get the procedure done right in the hospital.
However, here is the best part of my internship: because I work hard and well, my mentor is pretty flexible on when I come in. Which means that I can get to the hospital as early as I want, work for a good seven hours on the research project, and then by 2pm get out of the office (which is exactly what I did on Friday). And do you know what I do after 2pm? I get to volunteer with kids!!!!!!!! I am started on Friday!! I volunteer in the playroom with the kids from 2pm to 5pm every Friday from now on, and I absolutely love working with the kids. They are so adorable and you can tell they really appreciate having someone to play and talk with. Also, because I am 18, I can even go bedside with kids and play with them if they are unable to leave their rooms. It is really sad to see kids so sick, however at the same time it feels amazing to be able to put a smile on their faces. My first day working with them went really well, and I am definitely going to try to work more hours with the kids into my schedule.
I have an official purple volunteer apron, and I have the best Senior Project Ever! I am learning so much, my mentor is amazing, I get to work with kids in the one of the best facilities in the state, and I am able to make a positive difference in kids' lives. I could not have asked for a better internship :)
Hoping you all stay healthy and happy,
Lior
Sunday, March 3, 2013
Friday, March 1, 2013
Of Medical Conferences
On Tuesday, I had the pleasure of attending a pediatric medical conference at the Ritz Carleton with my mentor. Sitting in a room full of physicians and MDs, it was a humbling experience being presented with the same information they were. The conference lasted about six hours, with each MD allotted forty minutes to present his or her research. In between presentations, various medical companies sold their latest products. There were many interesting products for doctors to invest in. One company presented a pen for diabetics that held nearly twice as much insulin as regular diabetic shot pens. Another showed a head lice shampoo that was gentle enough to be used on children as young as six months, and so effective that in clinical studies, after one use (without fine combing) children were found to have gotten rid of all of their lice, and even when they were put back into an environment in which lice was prevalent, they remained lice free for a minimum of two weeks. Another interesting product was a non-invasive blood-sugar level detector that could be attached to an iPhone. A free downloaded application would process the information and tell the user their levels immediately, and without injury to the user. There was also a company that sold syringes pre-loaded with vaccines, for use in emergency situations. Lastly, and most impressively, a neurological company developed a program that, using MRIs, could re-create an entire skull of any patient out of a metal net. The net could then be cut to fit whatever part the of the bone skull needed to be removed. Because of the mesh-like design, bone cells would start growing on the net, until the patients skull would be made completely out of bone, with metal underneath.
Following are the presentations that each MD gave and a quick summary.
Tamir Milo and Don McClellan-- Pediatric Obesity: Sweet Kids/ Fat Livers. This presentation focused on the differences between Non-Alcoholic Fatty Liver Disease (NAFLD), and Non-Alcoholic Steatohepatitis (NASH). NAFLD and NASH are both caused by obesity. What happens is that children accumulate adipose tissue in their bodies. Over time, their livers accumulate adipose tissue as well, and they become unable to process wastes properly. Then, the cells of the liver begin to die. If the patient does not lose weight or get a transplant, NAFLD may turn into a liver carcinoma as liver cells begin to die at a rapid and uncontrollable rate. NASH is also caused by obesity, but often occurs as a product of heredity. NASH, as the name implies, is much more severe than NAFLD because it most closely resembles Hepatitis, a quick paced disease that terminates liver functioning. Both diseases may be treated with diet and exercise. Dr. Miloh also touched on Type 2 Diabetes and how to recognize early warning signs. He also stressed the importance of setting realistic goals for patients. To get rid of the liver threatening symptoms of NAFLD, patients only actually need to lose 5 to 10% of their weight. Also, he pointed out that fructose is one of the leading causes of NAFLD and NASH in both adults and children, as it is incorporated in nearly every processed food and is a much more chemically based and fattening alternative to plain sugar.
William Raszka-- Flim, Flam, and Phlegm: Diagnosis and Treatment of Community Acquired Pneumonia (CAP) in Healthy Children. This presentation focused mainly on how to identify and treat CAP and Complicated Pneumonias. The MD stressed that the diagnosis of CAP is currently absurdly general, making it difficult for doctors to correctly diagnose the disease. The reason for this is that there is virtually no research on the viral or bacterial CAP (there are two kinds). Thus, it MDs have to use their intuition to diagnosis a CAP, rather than a set test. Complicated Pneumonias (that cause life-threatening symptoms, and CAPs that arise from a non-bacterial infection) are also difficult to treat. The end result is that MDs treat the symptoms of pneumonia, and sometimes not the disease itself. It is also interesting to note that viral types of pneumonia and also Bronchitis are not treated with antibiotics, as antibiotics are only used to treat bacterial infections. In these cases, the disease is not treated and MDs strictly treat the symptoms until the patient gets better
Hilary McClafferty-- Pediatric Integrative Medicine: Looking Forward. This MD works in educating doctors about Integrative Medicine. Integrative Medicine aims to integrate "alternative medicine," such as physical therapy, herbal and vitamin supplements, and acupuncture, with "hard medicine," which deals more with treatments such as antibiotics, surgery, and vaccines. Her point was that doctors should always consider alternative treatments, especially physical therapy, in conjunction with traditional medicine when diagnosing and creating a plan for patients. She argued that by considering integrative medicine, doctors had a chance of greatly reducing hospitalization time for patients and sometimes even reducing the need for surgery or harsh chemical treatments. She stated that she created this initiative through her alma mater, UNC Chapel Hill, and now teaches it at a specified branch of the U of A med program.
Scott Schraff-- Pediatric Head and Neck Masses: When to Worry About Lumps. This MD was a surgeon who dealt directly with masses protruding from children's head and necks. He explained that the masses, or "bumps," that were visible from the outside were really only the tip of the iceberg-- the masses often extend deep into children's head and necks, causing problems by physically pushing structures together. The masses arise in many ways, but a common course is that children are born with empty 'sacks' in their heads. After getting a mild infection (it could even be a cold), the sacks become inflamed and fill with fluid, extremely quickly. In some cases, these lumps appear in under a week. The problem is that the lumps will push on the appendages in the head. For example, a mass occurring under the jaw could push the tongue up and restrict breathing. The traditional way of treating these masses was to operate on them and remove them. The surgery, however, is risky and goes horribly awry at times (the MD cited cases in which the frontal esophagus was cut out instead of the mass) because it becomes very difficult to tell where everything is during surgery, as it is all pushed together. Thus, the MD has started using steroids to reduce and drain the inflammation from the masses, which works very effectively. He also pointed out that at times the bumps arise from inflamed lymph nodes, and require multiple surgeries and medications to treat. Most interestingly, he showed photos of an MRI of a pregnant woman, who's fetus had a clear mass coming out of its mouth inside the womb. To save the child, Dr. Schraff opened the woman's stomach, removed the head and shoulders of the baby from the womb, put in a breathing tube and cut out the mass, and put the baby back into the womb to finish growing. Apparently, fetuses are born with masses quite frequently, and they can get very bad very quickly. He showed a photo of a newborn with a mass extending from its face all the way down to its feet. The mass was half as thick and as long as the baby itself, but by careful surgery it was successfully removed. This was presentation was easily one of the most interesting of the conference, and I learned a lot about a field I did not even know existed.
Jeffery Weiss-- Talking to Families about Preventing Injuries. This presentation was not very fact-filled. In summary, the MD said that teach a child under four years to swim is fine, which is a change in the official statement from a few years ago that recommended children do no not learn to swim before age four. Also, taking swim lessons and knowing how to swim does not prevent drowning. Additionally, the MD presented that Drivers Ed classes should not be taught in schools, as they give more 16 year olds incentive to drive, and 16 year olds are easily the worst divers. Ever. For all you parents out there, there are video cameras you can install in your child's car so you can see what goes on in the car when they are driving.
I enjoyed the conference very much. As a side note, I had a chance to hike Squaw Peak afterwards, which I highly recommend! It is an intense hike that leads straight to a summit (the second highest in Arizona), and the view is spectacular. It took about one hour up and one and a half down, but I can definitely see it taking up to two or three hours one way with a slow pace and frequent breaks. If you want to work hard an realize the rewards, and realize the true meaning behind "nothing worth having ever came easily," this hike is for you!
Warm Wishes,
Lior
Following are the presentations that each MD gave and a quick summary.
Tamir Milo and Don McClellan-- Pediatric Obesity: Sweet Kids/ Fat Livers. This presentation focused on the differences between Non-Alcoholic Fatty Liver Disease (NAFLD), and Non-Alcoholic Steatohepatitis (NASH). NAFLD and NASH are both caused by obesity. What happens is that children accumulate adipose tissue in their bodies. Over time, their livers accumulate adipose tissue as well, and they become unable to process wastes properly. Then, the cells of the liver begin to die. If the patient does not lose weight or get a transplant, NAFLD may turn into a liver carcinoma as liver cells begin to die at a rapid and uncontrollable rate. NASH is also caused by obesity, but often occurs as a product of heredity. NASH, as the name implies, is much more severe than NAFLD because it most closely resembles Hepatitis, a quick paced disease that terminates liver functioning. Both diseases may be treated with diet and exercise. Dr. Miloh also touched on Type 2 Diabetes and how to recognize early warning signs. He also stressed the importance of setting realistic goals for patients. To get rid of the liver threatening symptoms of NAFLD, patients only actually need to lose 5 to 10% of their weight. Also, he pointed out that fructose is one of the leading causes of NAFLD and NASH in both adults and children, as it is incorporated in nearly every processed food and is a much more chemically based and fattening alternative to plain sugar.
William Raszka-- Flim, Flam, and Phlegm: Diagnosis and Treatment of Community Acquired Pneumonia (CAP) in Healthy Children. This presentation focused mainly on how to identify and treat CAP and Complicated Pneumonias. The MD stressed that the diagnosis of CAP is currently absurdly general, making it difficult for doctors to correctly diagnose the disease. The reason for this is that there is virtually no research on the viral or bacterial CAP (there are two kinds). Thus, it MDs have to use their intuition to diagnosis a CAP, rather than a set test. Complicated Pneumonias (that cause life-threatening symptoms, and CAPs that arise from a non-bacterial infection) are also difficult to treat. The end result is that MDs treat the symptoms of pneumonia, and sometimes not the disease itself. It is also interesting to note that viral types of pneumonia and also Bronchitis are not treated with antibiotics, as antibiotics are only used to treat bacterial infections. In these cases, the disease is not treated and MDs strictly treat the symptoms until the patient gets better
Hilary McClafferty-- Pediatric Integrative Medicine: Looking Forward. This MD works in educating doctors about Integrative Medicine. Integrative Medicine aims to integrate "alternative medicine," such as physical therapy, herbal and vitamin supplements, and acupuncture, with "hard medicine," which deals more with treatments such as antibiotics, surgery, and vaccines. Her point was that doctors should always consider alternative treatments, especially physical therapy, in conjunction with traditional medicine when diagnosing and creating a plan for patients. She argued that by considering integrative medicine, doctors had a chance of greatly reducing hospitalization time for patients and sometimes even reducing the need for surgery or harsh chemical treatments. She stated that she created this initiative through her alma mater, UNC Chapel Hill, and now teaches it at a specified branch of the U of A med program.
Scott Schraff-- Pediatric Head and Neck Masses: When to Worry About Lumps. This MD was a surgeon who dealt directly with masses protruding from children's head and necks. He explained that the masses, or "bumps," that were visible from the outside were really only the tip of the iceberg-- the masses often extend deep into children's head and necks, causing problems by physically pushing structures together. The masses arise in many ways, but a common course is that children are born with empty 'sacks' in their heads. After getting a mild infection (it could even be a cold), the sacks become inflamed and fill with fluid, extremely quickly. In some cases, these lumps appear in under a week. The problem is that the lumps will push on the appendages in the head. For example, a mass occurring under the jaw could push the tongue up and restrict breathing. The traditional way of treating these masses was to operate on them and remove them. The surgery, however, is risky and goes horribly awry at times (the MD cited cases in which the frontal esophagus was cut out instead of the mass) because it becomes very difficult to tell where everything is during surgery, as it is all pushed together. Thus, the MD has started using steroids to reduce and drain the inflammation from the masses, which works very effectively. He also pointed out that at times the bumps arise from inflamed lymph nodes, and require multiple surgeries and medications to treat. Most interestingly, he showed photos of an MRI of a pregnant woman, who's fetus had a clear mass coming out of its mouth inside the womb. To save the child, Dr. Schraff opened the woman's stomach, removed the head and shoulders of the baby from the womb, put in a breathing tube and cut out the mass, and put the baby back into the womb to finish growing. Apparently, fetuses are born with masses quite frequently, and they can get very bad very quickly. He showed a photo of a newborn with a mass extending from its face all the way down to its feet. The mass was half as thick and as long as the baby itself, but by careful surgery it was successfully removed. This was presentation was easily one of the most interesting of the conference, and I learned a lot about a field I did not even know existed.
Jeffery Weiss-- Talking to Families about Preventing Injuries. This presentation was not very fact-filled. In summary, the MD said that teach a child under four years to swim is fine, which is a change in the official statement from a few years ago that recommended children do no not learn to swim before age four. Also, taking swim lessons and knowing how to swim does not prevent drowning. Additionally, the MD presented that Drivers Ed classes should not be taught in schools, as they give more 16 year olds incentive to drive, and 16 year olds are easily the worst divers. Ever. For all you parents out there, there are video cameras you can install in your child's car so you can see what goes on in the car when they are driving.
I enjoyed the conference very much. As a side note, I had a chance to hike Squaw Peak afterwards, which I highly recommend! It is an intense hike that leads straight to a summit (the second highest in Arizona), and the view is spectacular. It took about one hour up and one and a half down, but I can definitely see it taking up to two or three hours one way with a slow pace and frequent breaks. If you want to work hard an realize the rewards, and realize the true meaning behind "nothing worth having ever came easily," this hike is for you!
Warm Wishes,
Lior
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