Week 7: Carolyn

As my time at the Hospital for Special Surgery comes to an end, I am grateful for all the opportunities here. This past week was again filled with priceless clinical exposure. I spent Monday and Thursday in the operating room and continue to be amazed by these massive procedures. While watching a total knee revision yesterday, I noticed that after the problematic prosthesis was removed, the remaining tissue was covered in a grey slime-like material. Everyone in the OR referred to it as “snot” and Dr. Bostrom confirmed that this is a normal tissue to see in the revision cases. He believes it is a fibrous tissue the forms in response to micromotion of the implant. If this tissue is indeed forming in response to micromotion, it would be interesting to attempt to quantify its presence with imaging techniques. This could provide surgeons with a definitive way to know if the implants are loose and too much motion is occurring, causing a reaction from the body.

With regards to revision, I am constantly surprised by the lack of guidance the surgeons are able to gain from the anatomy. Because the anatomy has already been altered once, they cannot use the same anatomic landmarks to determine where their cuts should be placed. However, Dr. Bostrom performs these operations frequently and therefore is not nearly as stressed during the operations as I would probably be! He speaks very highly of the vascular and plastic surgeons with whom he works, and it is clear that these fields are incredibly specialized. Each surgeon is an expert in their skill set, and often need to work together to help the patients to receive the best possible care.

In the clinic this week, I saw my first pseudotumor. This is a condition in which the patient develops what appears to be a tumor near the site of their total joint replacement. When it has been confirmed that the tumor is not cancerous, it is diagnosed as a pseudotumor. These typically occur as a complication of metal-on-metal bearing implants. The small particles produced by this bearing initiate the reaction from the body and the formation of the pseudotumor begins. The patient I saw had an excessively large pseudotumor that had not been properly addressed due to other complications. As the pseudotumor grows, it consumes other tissues in the area, including muscle and bone.

If I were a physician, I would find it very difficult to continually see these patients who either do not prioritize their health, or go against your suggestions. Even small instructions, such as the bandage type for a wound, are often disregarded. I saw one patient who had undergone their second total knee replacement and used bandages that did not allow for airflow to the wound and created a seal around the wound. This caused the wound to heal improperly and Dr. Bostrom had to try to explain to the patient and their family why this was not okay. I was not convinced by their reaction that they will follow his advice, and I worry that they may cause complications for themselves. Although the clinical exposure I gained this summer was incredibly insightful, it continues to convince me that I am not patient enough to practice medicine, and reaffirms my reasons for obtaining a PhD.

Outside of work this week, I was visited by my family. We enjoyed several iconic things in New York, such as the Highline and the Metropolitan Museum of Art.

During my last week, I went to one more Broadway show. Tibra, Jason, Regan and I saw Chicago. The show was so fun and the music was great – I am very happy we went. Other than this show, I continued to make it through my bucket list, picking new restaurants and key dessert places. One of my dessert recommendations this week include the dessert pizza (and milkshakes) from Max Brenner.

Additionally, the brioche bun ice cream sandwich from OddFellows was a very interesting dessert. I got the peanut butter and jelly ice cream flavor, which went perfectly with the bun. Patrick got a flight of six different flavors, and Tibra chose a scoop of olive oil & strawberry ice cream. The flavors offered at OddFellows were very interesting and different – fun to try!

For now, my dessert adventures will only be in my own kitchen back in Ithaca. I will have to travel back to New York City soon to try out some more fun desserts here.