Week 6: Spreading Knowledge

Hello,

Now that the research part of my project is finished, I am now focusing on patient education. In order to do this, I have started making a small, postcard size, handout (using Microsoft Publisher) which has information for patients in risk of getting diabetic neuropathy.

In the past, a lack of awareness and inappropriate management of diabetic peripheral neuropathy has led to unnecessary morbidity and substantial healthcare costs. At least half of all foot ulcers, the end stage of such neuropathy, can be preventable by appropriate management and patient education. However, lack of time and inappropriate or inadequate information may lead to insufficient care. By creating a simple, easy-to-understand handout for patients, I hope to bring awareness to those in risk.

Furthermore, being able to detect and treat neuropathy early will save money for both the patients and the hospital. If the diagnosis is done too late, the disease may have gotten to a point where amputation is necessary. Such invasive surgical tasks will cost more expenditure which could have been prevented. According to Healthcare Bluebook, the total fair price of a leg amputation is $14,245. All that money can be better used for hospital improvements or other research.

In my research, I found many comorbids for diabetic neuropathy. A lot of the patients had similar other diseases. With this information, I compiled a list of the most common illnesses which may be correlated with diabetic neuropathy. In addition to this, high HbA1c levels and smoking or drinking habits can lead to a significantly higher risk. All of these factors will be mentioned in the handout.

After making the handout, I will also refer to Dr. Jyothinagaram (the endocrinologist I shadow) to get his opinion on what I can change or add. This way, I'll have the input of a doctor who deals with diabetic patients every day.

I look forward to finishing this within the coming weeks.

Happy Easter!

Week 5: Data Analysis

Hi all,

After we finished cleaning up the data, we made a lot of graphs, so they can be interpreted easier. Here are a few examples.

In this one, you can see the number of patients spread across each age group.

Here you can see what percentage of the patients belonged in each race.

There are of course many more graphs with more detailed information about the actual usage of alcohol, tobacco, and drugs, but you'll have to read my paper for those.

With the data, we used excel to find the regression statistics. In order to do this, we had to make a lot of adjustments to the data. For example, every time the data said "Yes" or "No" for alcohol or drugs, we had to change it to a numerical number. We used 1 for yes, and 0 for no. Here is a small portion of the data, to give you an idea of what it looks like.

Through this, we obtained an equation which tells us a prediction of what age a person might expect a below-knee amputation. The equation involves two variables: the HbA1c level of the person, and whether or not the person had a long-term use of aspirin. These variables were the most common among the patients in our data set who did get a below-knee amputation, which is why they can be used for predictions. Additionally, their P-values were below 5%, meaning they have statistical significance. I can't tell you what the equation is yet; you'll have to find out in my paper.

Since this week was purely for analyzing data, there isn't much else to say. Check back next week for updates!

Week 4: Shadowing

Hello all,

This week I finally finished collecting data! In total, there were 185 patient records. Next week, I'll be analyzing this information after we clean it up (making sure there are no errors).

On Monday, I was able to go on hospital rounds with Dr. Jyothinagaram and his resident Dr. Crawford.  We saw about five patients, but I'll talk about the ones I thought were most interesting.

One patient was an old woman who had her thyroid and parathyroid glands removed, along with her larynx because she had invasive thyroid cancer. Because her larynx was taken out, she could not talk. She could only mouth some words and had a whiteboard to communicate with the nurses and doctors. Because she had her thyroid gland removed, she was given a thyroid hormone injection which acts to provide the functions of the thyroid gland (controlling body functions). However, there was no injection for the parathyroid hormone, which controls calcium levels. As a result, they were giving her calcium through her IV, and trying to discharge her soon by putting her on calcium pills.

Another patient had pancreatic cancer, so he had to have his pancreas removed. Like I talked about in my introductory post, the pancreas controls how much insulin is released. Without the pancreas, the patient needed to have an insulin pump. This pump could be controlled by the patient; he can tell it how many units of insulin to pump into his blood. A number of units he pumps is calculated by how much he eats. However, he was told to be careful. For example, if he pumps a certain number of units, he must wait around 3 hours for the insulin to kick in and reduce his blood sugar. If he doesn't wait and anxiously pumps more, his blood sugar will be dangerously low once both doses kick in.

The next morning, I went to Dr. Jyothinagaram's clinic and shadowed him there. In my opinion, this was a better experience since the patients who come to clinics have a specific problem, and so easier to understand for students like me. Again, I stayed for around six patients, but I'll talk about the most interesting one.

One patient who had uncontrolled diabetes also had neuropathy. So I was really excited for this one. The patient had lost sensation from his elbows to his hands, and from his knees to his feet. This is called a glove and stocking distribution of neuropathy. The doctor told the patient to hold out his hands, and he too held out his hands. He told me to look at both the hands and find any differences. He then explained that in the patient's hands, the muscles between the thumb and index finger were completely gone, because of the neuropathy. He told me to feel the area too; it was completely hollow. Then, the doctor told the patient to lie down so we could examine the feet. We looked for pulses and found a few faint ones. He explained to me that since there was still blood flow to the feet, they were in an okay condition; however, if the blood flow stopped, an amputation would be likely. Then we looked at the patient's diet -- it was mostly junk food. Since the patient also gained weight from his last visit and had high blood sugar levels, the doctor told him to control his diet.

Next week, I'll continue shadowing Dr. Jyothinagaram; I'm excited to see more patients!