Monday, July 15, 2013

Yogindra Week-1

Summer immersion started of great. I am matched with Dr. Mark Souwiedane, who is the director of Pediatric Neurosurgery at Weill Cornell and has appointments at MSKCC in Pediatric Neuro-Oncology. It was great finding out I was matched with a neurosurgeon. I was happy as it was a bit of a departure from what I work with in lab, a chance to learn something new. But when I found out the immersion was going to with Pediatric-Oncology, I was a bit ambivalent...those cancer kids advertisement automatically came to mind. However, after this week it seems that the cases we saw were mostly treatable.

From what I can tell, Dr. Souweidane spends his time split between the Craniofacial Clinic, Brain & Spine Center at Cornell-NYPH, the Operating room, MSKCC and his overseeing his lab. To handle all this he has his patient schedule mostly managed by his RN Coleen, and Charlotte. He has one Neurosurgery Fellow, Dr. Konstantine Margetis, who works primarily with him.

The first day was entirely a clinic day at the Brain and Spine center. As patients came in one by one the whole group started going thought notes, MRI’s, and CT scans. The usual logistics were Charlotte or Coleen had the original conversation/counsel after the patient has been referred to Dr. Souweidane. Then after a quick history and reason for visit refresher, the images are analyzed be the fellow plus resident and visiting med student. After a neuro work up/physical tests, the case is presented to Dr. Souweidane with all the finding and possible diagnosis/prognosis; where he revises all the images, makes a his conclusions, goes in with everyone and gives his medical opinion.

Day 1 (Brain and Spine center) we saw a total of 12 cases. Ranging from Craniosynostosis, where the infants cranial sutures fuse early lading to cranial deformity; to shunt revisions and Chiari malformation, where the cerebellum herniates from the foramen magnum.
Day 2 (OR day) where I observed two ventricular shunts being implanted into premature babies, that developed hydrocephalus. The way the head had swollen up, it seemed unreal. After the shunt was implanted to drain right under the scalp. After the shunt was implanted, the head radically shrunk down, and the babies’ head is turned to the other side every 3 hours, so they don’t form any deformities.  I also observed a shunt revision, where the shunt was not draining the ventricles, and the implanted was cleared with suction.
Day 3 (a lab day) Where I went to Dr. Souweidanes’ lab group meeting talked about lab project possibilities. Saw how they are working on their CED (Convection Enhanced Delivery) clinical study.
Day 4 (Cranial Facial Clinic Day) consulted 3 surgery cases dealing with Craniosynostosis, and talked about the possible clinical projects I could contribute on. After going to a Fellows case conference during lunch, we all went to Brain and Spine center. In the clinic a patient was consulted on a Chiari case, and since the surgery will be schedules for expedience, I might be able to observe this procedure.
Day 5 (OR day) Dr. Soueweidane and Dr. Grienfield lead the weekly morning Residents meeting, where they grill them on procedures and diagnostics. After that I was able to observe an endoscopic cyst removal. Then a cranioplasty of young girl with a synthetic machined bone that has been modeled from the patients CT scan. This case was super long, as there was soo much scar tissue, making in extremely hard to expand the scalp over the implant.

So needless to say, the first immersion week was pretty jam-packed. Hopefully, it will stay like this and I will share with you the highlights from now on.

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