Blog 1

Blog 1:

I'm making this blog to outline my rotations with Dr. --- and Dr. D--- over my December break. Even through I have just returned from 3 months worth of clinical rotations in Mexico, my clinical ventures continue to live on over my vacation! When it comes to surgical exposure I'm unstoppable! In my first blog, I will be going over my recent experiences shadowing Dr. ---.

In my first week back, I started rotating with Dr. ---, a world-renowned neurosurgeon who graduated from UCSF's neurosurgical residency program (it ranks in the top 5 worldwide). Dr. --- has a practice at Washington Hospital in Fremont, CA (where I rotate). He also works as attending faculty in the neurosurgical residency program at UCSF; therefore, he has his own residents and research projects (his research is super interesting, it has to do with chemotherapeutic drug delivery into the brain). Because of his experience, intelligence, and humility, Dr. --- is the ideal mentor and teacher. Even if he's busy, he's never afraid to take the time to explain things in great detail. He's pretty much an encyclopedia for neurooncological conditions. I'm really lucky to follow and learn from him, and I know that he will serve as a life-long mentor to me, in my journey through medicine. I'm going to hold on to him with all I've got because it's hard to find teachers with his calibre of expertise, humility, and insight.

12/08/08-12/12/08

My first surgery with Dr. --- would've been on Monday, but the patient caught a form of stomach flu, so the procedure had to be cancelled. Ironically, it was my dad's patient as well, and I found out later that my dad was going to assist while I was observing. In the end, everything worked out because I was able to spend some free time with Dr. --- instead . He went over my future plans and helped me set up a way to do research after I graduate. I decided I was interested in working at UCSF's Brains and Spinal Injury Center to immerse myself with upcoming treatments of biological trauma responses initiated by the body. However, I also really liked current translational research in UCSF's Brain Tumor Research Center. I think I'll have to further discuss with Dr. --- the benefits and differences between the two areas of research; It's still really hard for me to decide which path to pursue. Throughout the week we saw patients with a variety of neurological conditions. I will mention the one's I found most interesting. No names will be used in my cases, in order to protect doctor and patient confidentiality.

The most interesting patient I saw had massive hemorrhaging in the brain, due to relatively unknown circumstances. It was a very odd case, and it was lucky he survived the massive bleed. It was a full two hours before he was operated on, due to the patient's unique circumstances. The procedure involved removing a piece of his skull and storing it beneath the skin of his abdomen. The piece of skull was removed in order to redistribute the intracranial pressure caused by the hemorrhage. The bleed caused the brain to be pushed to one of his skull, potentially causing a variety of neurological damage. Unfortunately by the time the patient was brought into the hospital, most of his temporal lobe was compromised. They were worried that he had lost his speech and language functions, and would remain a vegetable for the rest of his life; however, he made a miraculous recovery. After speech rehabilitation, the patient was able to recover almost all of his speech function, even through most of his temporal lobe was dead. The last procedure he will undergo is the repositioning of the piece of skull from his abdomen to his head.

Another interesting case...well at least to me... was a woman who had benign meningiomas. I liked this case because it was the first case to introduce me to neurooncology. Dr. --- showed me MRI scans of meningiomas and explained to me how they look and act. Meningiomas tend to originate from the dura mater and therefore only appear on the surface of the brain. They're generally benign and aren't cancerous, however they can cause neurofunctional problems by putting pressure on surrounding nervous tissue. These tumors generally grow at an extremely slow pace and cause problems many years after their inception. They're easy to treat. The newest technology, effective in treating all types of tumors smaller than 3 cm (or mm? I have to check again), is the Gamma Knife. It uses highly focused gamma rays to damage DNA, thereby eliminating cell reproductive function and ultimately killing tumor cells. Due to the focused nature of gamma rays, it only works on certain sizes of tumors, and surgical resection maybe required for tumors larger than 3 cm. The advantages of the Gamma Knife is that it doesn't require surgical intervention and has virtually no post-operative side-effects. The Gamma Knife can be used to slow down aggressive metastatic tumors as well, but unfortunately there still isn't permanent fix for metastatic tumors; it prolongs the lifes-pan of stage 4 patients for about 5-10 years.

The last patient had a Stage 2-3 tumor in his brain that Dr. --- resected. The tumor was interfering with his visual function, and caused damage to one of his visual fields. The patient recovered some visual field function. It was sad because even though tumor was resected, it would eventually return as a stage 4 due to the residual cancerous cells mixed in with regular brain tissue. Surgical intervention lengthened the patient's life-span for about 8-10 years. Hopefully, the increase in technology and development of treatments may provide an answer for this patient in the near future. The MRI showed that a huge part of this gentlemen's brain was gone, due to the resection of the cancer invaded brain tissue.

Dr. ---'s cases are fascinating. I've only talked about the three cases I remembered off of the top of my head. Next time I'll take notes (without violating patient confidentiality). I'm increasingly compelled to neurosurgery because it's an increasingly expanding field. The field of neurosurgery benefits from the plethora of research currently undertaken at UCSF, and other prestigious institutions; it's why we see such drastic advances in neurosurgical and neuropharmalogical treatment technology. I was initially interested in orthopedic surgery, but that's changing as I see how much more research intensive neurosurgery really is. I feel that it's a much more diverse field of medicine. I can't wait to continue my rotations with Dr. --- when he returns from his conference. He's a fascinating individual who's pushing the fields of neurosurgery with his research and usage of Gamma Knife technology. I really find it amazing that Dr. --- can integrate his clinical practice with his research; it allows him to be a unique doctor that has perspectives in medicine 10 yrs ahead of everyone else. I can't tell you how lucky I am to be under his mentorship, and I will continue it through my whole medical journey... If he'll let me! haha.