I started this week with more clinical exposure in the ER. Specifically, I was in the general ER department in the mornings from Monday to Wednesday. This was a new experience as it provided a sense of continuity to see a couple of patients over the course of three days to monitor their progress. I also was in area A of the ER for the 8-hour rounds Monday afternoon and I was able to compare the two experiences. In general, the ER rounds during the morning shift are pretty busy and seemingly become only more hectic as the day progresses and more cases are brought to attention. I was able to see a wide variety of people with various urgent and less urgent medical issues. In particular, the rounds provided a good opportunity to understand each patient's needs as the ER resident presents the patient history and current status. A few people arrived with minor to more severe asthma attacks, some were having convulsions or seizures, and others still had trauma injuries. The way the ER is designed and equipped to deal with all types of medical issues with immediate attention is pretty amazing. One case that stayed in my mind was a mother and son involved in a car accident. Both were brought into the ER since they sustained injuries from the crash. The mother was having painful spasms originating in her abdominal region while her son had broken his right forearm. The resident presented the case and both the mother and son were sent for imaging (X-ray and MRI) analysis. The boy had broken his radius and ulna, which were reset in the ER and he was given a cast. The mother had suffered from some internal bleeding and she was rushed for emergency surgery. We were able to follow-up with her on the next day and she seemed to be in good standing and recovering well from the surgery. The integration of diagnostic tools and analysis and the subsequent method of treatment (medication/surgery) is able to happen in such a precisely coordinated fashion in the ER - it is definitely something to experience firsthand.
I was with Dr. Gauthier later in the week during her neurological patient visits. I find this practice very engaging, as these visits correlate MRI analysis to the current physical health status of MS patients. Even here, there is a diversity in the types of lesions seen in the CNS (brain and spinal cord) and their resulting impact on physical symptoms. Some patients present with large lesions in ventricular areas of the brain and seemingly have no physical presentation of MS. Other patients have very mild cortical lesions and yet face pretty severe relapsing episodes of MS. One patient that was particularly unique was an elderly lady who said she had consulted 6 other neurologists previously. Her condition is somewhat confounding because her symptoms fall between the spectrum of MS and Neuromyelitis optica (previously known as Devic's disease). Whereas MS lesions can most certainly be found in the brain, NMO typically involves inflammation of the optic nerve and spinal cord. In this case, the patient had stated that some neurologists diagnosed her with MS and others with NMO. She has notable lesions in her spinal cord and eyes, and no lesions in the brain. However, physically, some of her symptoms are physically like that of MS. Additionally, she has suffered from severe episodes of near total paralysis and as a consequence of the optic inflammation, she is also now blind. While MS is T-cell mediated, NMO is antibody-mediated. Therefore, having the proper diagnosis is essential to dictate the best treatment moving forward, such that her condition does not accelerate at the same pace. Dr. Gauthier consulted with a fellow neurologist (both are MS specialists) and they agreed that she has NMO, since her physical symptoms are also not fully MS. They are gradually introducing a change to her medication to hopefully see an improvement in her leg weakness and fatigue that is a result of her spinal cord lesions.
Aside from that, I worked this week on the next phase of preparing the vaccine construct for delivery. Since we have a few epitopes that must be used for the study, I am working on performing the same conjugation experiment for the various peptides. Next week should be the final week in terms of preparation of the constructs for vaccine delivery and afterwards, things will be ready for the challenge experiments in mice.
Hope everyone enjoyed July 4th!
I was with Dr. Gauthier later in the week during her neurological patient visits. I find this practice very engaging, as these visits correlate MRI analysis to the current physical health status of MS patients. Even here, there is a diversity in the types of lesions seen in the CNS (brain and spinal cord) and their resulting impact on physical symptoms. Some patients present with large lesions in ventricular areas of the brain and seemingly have no physical presentation of MS. Other patients have very mild cortical lesions and yet face pretty severe relapsing episodes of MS. One patient that was particularly unique was an elderly lady who said she had consulted 6 other neurologists previously. Her condition is somewhat confounding because her symptoms fall between the spectrum of MS and Neuromyelitis optica (previously known as Devic's disease). Whereas MS lesions can most certainly be found in the brain, NMO typically involves inflammation of the optic nerve and spinal cord. In this case, the patient had stated that some neurologists diagnosed her with MS and others with NMO. She has notable lesions in her spinal cord and eyes, and no lesions in the brain. However, physically, some of her symptoms are physically like that of MS. Additionally, she has suffered from severe episodes of near total paralysis and as a consequence of the optic inflammation, she is also now blind. While MS is T-cell mediated, NMO is antibody-mediated. Therefore, having the proper diagnosis is essential to dictate the best treatment moving forward, such that her condition does not accelerate at the same pace. Dr. Gauthier consulted with a fellow neurologist (both are MS specialists) and they agreed that she has NMO, since her physical symptoms are also not fully MS. They are gradually introducing a change to her medication to hopefully see an improvement in her leg weakness and fatigue that is a result of her spinal cord lesions.
Aside from that, I worked this week on the next phase of preparing the vaccine construct for delivery. Since we have a few epitopes that must be used for the study, I am working on performing the same conjugation experiment for the various peptides. Next week should be the final week in terms of preparation of the constructs for vaccine delivery and afterwards, things will be ready for the challenge experiments in mice.
Hope everyone enjoyed July 4th!
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