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!