Week 3 and 4 - Mary Clare

Due to the shortened week 4, I have decided to combine week 3 and 4 summaries together. Week 3 was a highly eventful week, I was able to shadow Dr. Rodeo for patient appointmet, shadow a resident in the emergency department (ED), watch 5 different orthopaedic surgeries, attend a lecture on medical imaging, attend grand rounds, and work more on my research project.

Patient Appointments:

To my surprise, there is minimal redundancy in the patient cases that Dr. Rodeo sees. Although they all have a common underlying theme, each case has its own nuances that make it unique. A person could easily sum up Dr. Rodeo’s patients as a group of patient swith shoulder or knee joint problems related to damage to the tendon, ligament, or cartilage. Both the knee and the shoulder are highly complex joints, so one patient may have shoulder problems due to a torn rotator cuff, while another patient my have shoulder problems due to damage to the tendon that anchors at the elbow. This past week I saw patients with a range of issues from a torn hamstring to a dislocated clavicle. The most interesting thing that I saw in patient appointments this week was a synvisc injection.  As a biomedical engineer this is something that has come up in courses I have taken in the past and it was exciting to hear from patients that had used it previously and patients that were currently receiving arthritis treatment using synvisc.

Orthopaedic Operations:

The highlight of my week and perhaps the summer was in the operating room (OR) this week. I had the rare opportunity to see a meniscus allograft transplant. Meniscus allograft transplant is a procedure reserved for meniscus damage in which a partial meniscectomy (typical operation for meniscus damage) would be too extensive to serve the necessary biomechanical function in the knee. Shadowing Dr. Rodeo for knee and meniscus related surgeries has helped me understand the clinical problem I am seeking to address in my thesis. The meniscus allograft operation is a three to four hour procedure that is more invasive than most knee procedures. The waiting list to receive the allograft is at least one month and the patient often requires another transplant around seven years later. In Dr. Rodeo’s office you are able to see patients in each stage of joint degeneration. The patient I saw receive a meniscus transplant was 32 yrs old, which means his knees have a rather dismal future. Seeing meniscus operations has helped me understand the standard of care that motivates my research. However being in the clinic can be daunting in that you’re able to realize the full scope of the problem.

 On a different note, I learned a whole new aspect of the clinical world that I found to be rather exciting. While in the OR this week I met a vendor, Jude, from Smith and Nephew who told me the ins and outs of being a vendor at the hospital. Jude was there for a rotator cuff repair operation. Dr. Rodeo was using a new suture anchor product made my Smith and Nephew. When the operation happened vendors from other companies came into the OR to see what the new product was. Jude was telling me how competitive it is being a vendor and that often competing companies will purposefully sabotage a trail such as this to make the product look bad. If an influential surgeon such as Dr. Rodeo likes a company’s product it will boost sales and shift the preference of the industry. Aside from the competitive aspect of being a vendor, I was fascinated by the type of projects that these companies work on. I am really interested in working on clinically relevant research projects, so seeing a product that was related to some of the work I do for my thesis actually make it into the clinic was inspirational. Speaking with the Jude during surgery has further motivated my interest in pursuing industry after graduate school.

Emergency Department:

Last Wednesday I spent the evening shadowing a resident in the ED. I have always imagined the emergency room being a highly stressful environment. However for the most part I found the ED to be relatively calm. I realized that most of the stress occurs when a patient needs to be resuscitated which is somewhat rare and in general its stressful for the Attending Physician because he is in charge of monitoring all the cases of several residents combined.

From shadowing my resident, I learned that residents have the freedom to pick whatever case they choose and in a shift they probably only handle about 4-5 patients. The cases I saw with the resident were fairly ordinary; allergic reaction, high blood pressure, joint inflammation, and light headedness. One thing that surprised me in the ED was the essential role of social services. The light headedness case was rather strange in that there really was no reason for this patient to be in the ED. It was interesting to see how my doctor’s questions to the patient changed when he realized the patient had no job and was on welfare. This patient ended up being seen by social services to see if his “health issues” were related.

Research Project:

Over the past two weeks, I have been very active in the lab. My project involves characterization of genetic expression, therefore my time in the lab has been spent trying to obtain RNA and optimize primers for q PCR. At this point there are still several kinks to work out with the primers and the samples. We had originally planned to compare juvenile and mature explants, however since mature meniscus is relatively acellular we have had trouble obtaining enough RNA for the controls. This means it is unlikely that we would be able to get enough RNA for each of our samples. Therefore have decided to do the dynamic compression testing on juvenile explants. My postdoc and I conducted a test run last week on the bioreactor for mechanical loading. Today we will be obtaining explants to use for our official experiment starting Monday. Next week we will also try to do obtain a larger mature control sample to get enough RNA to use as a mature control genetic profile.