This post will recount my time in New York City during the first and second weeks of immersion term.
Week 1:
Things were a little more hectic for me since my relocation involved actually moving my whole apartment to the city and settling into the Lasdon graduate housing. However, the move went semi-smooth and since one of my thesis advisors, Dr.Susan Pannullo, is acting as my clinician for the semester I was able to hit the ground running. I work in the Neurological Surgery department with Susan, primarily focused on the application of radiation therapy to brain tumors. On the very first day, I donned my resident attire and did patient rounds and already begun to see the immense application radiation therapy had beyond the treatment of tumors. For instance, one patient had trigeminal neuralgia, a condition in which the trigenimal nerve experiences compression due to vessel pressure. The symptoms involve a very sensitive face, numbness and an extremely painful sort of electric shock when eating, brushing ones teeth or even a breeze blows over the face. Typically in young patients, a surgery will correct the problem, however, in older patients who wish to avoid invasive surgery, radiotherapy is an option. The idea here is to essentially kill part of the trigeminal nerve while sparing the rest of the face's nervous system. It has a 60% success rate, compared to the near 100% from surgery but again, it's non-invasive and surgery is always an option should the procedure not succeed. The important part of this, from my perspective, is the realization that radiation therapy has other real applications in the clinic beyond tumor therapy. It really opens up a world of questions about what other nervous system interventions can be achieved in this way. It also reminds me of two-photon laser incisions, but where we've traded off the small incision points of 2p for a larger (mm) size from gamma therapy but you no longer have the penetration problem. This was the highlight of this week but there were many other stories the rest of the week. In general, I see all Dr.Pannullo's patients with her in the mornings and then in the afternoons, we do treatments and attend meetings regarding IRB's, Tumor board where other surgeons and radiologists discuss outstanding brain tumor cases, and other development projects.
Week 2:
This weeks highlight was definitely being involved in putting on a "halo" to one of the patients. A halo is a titanium and carbon ring that must be physically bolted into a patients skull in order for a helmet that then rests on the halo to stay fixes with respect to the patient's brain. This helmet then had a series of ports in which gamma rays are injected for therapy. This is the most invasive, painful part of radiation therapy. The patients tend to do well and generally forget the whole experience due to the drugs that accompany the procedure but it is painful for them and not a very graceful moment in the hospital room. I discussed with Dr.Pannullo a number of things that could make this procedure better. For example, currently it takes a number of people to screw the halo into place at the same time. Usually, it's the doctor, maybe a nurse and a couple interns. In our case, one of the interns fainted while holding the halo and went to the ground. Dr.Pannullo reflected this happens almost every time with someone new. Also, while Dr.Pannullo made some marks where the halo would be best fit, we missed the marks by quite some distance due to our inability to keep the halo level while tightening the screws. It seemed to me a special chair built to hold the halo in place while still enabling the physician to have the degrees of freedom they need to adjust would make this whole procedure much less clumsy. Also, medical school teaches a "two finger" rule for how much tension should be on the screws....an arbitrary assignment with no real meaning. A halo with a torque measurement would be very simple to create and standardize the procedure.
I also spent some time with Susan in meetings regarding a new innovation center in which she is the director. We saw some prototype facilities on 71st that will serve the innovation center well. We speculated about making the halo prototypes in these facilities as a test.
Finally, I nailed down a project. We want to assess a patient's response to therapy from computer algorithms in MRI. Currently, a patient comes back for a follow up MRI 3-6 months post procedure for a look at the progress of the tumors. Sometimes the tumors are larger, sometimes they are smaller. In general, we prefer the tumors to be smaller but even this shrinkage is not a good indicator of remission. Sometimes the tumors are larger but this doesn't mean they are getting worst. It could be that the tumor is inflamed and sort of balloons before shrinking away. As a result, many patients hear sort of ambiguous news without really knowing if we should change therapy plans or not. This is valuable time lost and figuring out some sort of biomarker or indication on an MRI could have significant impacts on patient care. Currently, I'm doing research for a lead on what MRI could show to this end.
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