Surgery Evaluation Reflection: For my Surgery Rotation, I presented a 63-year-old patient, who presented to the emergency room after being sent in by his urologist because of a very high white blood cell count of 22+ as well as a positive c.diff test. The patient had a mass removed from his abdomen a few weeks prior that was determined to be urachal in origin. I had never heard of a urachus before seeing this patient and was very interested to learn more. During all of my rotations I have been exposed to many new pathologies, all of which have helped me to further my medical knowledge. I learned of a new body part, the urachus, which is the tract used in-uterus to expel urine/waste from the fetus through the umbilical cord. It is a connection that usually closes after birth. I learned that a urachal mass is extremely rare as well. This patient allowed me the opportunity to follow a post-surgical patient throughout the treatment of their post-procedural complications/infections, which I found to be very helpful in understanding how to best treat a patient with c.diff. It was determined that the patient developed c.diff because of his antibiotic use, which is often the case. By following this patient for my week on the urology team, I was able to participate in the treatment of a c.diff infection as well as participating in the post-op care of a patient. This patient had a robotic-assisted removal of the urachal mass which was done with a urologist as well as a general surgeon. Therefore, the patient was split between the two services as primary care teams instead of one or the other being primary with consulting from the other team. I had never before seen a patient who was a primary on two separate services and so learned a lot about how the plan changes when a patient has two primary teams. I felt this was an important patient to present because of how rare their condition was. Upon presenting, I learned a lot about how to care for a patient with post-op complications. This patient had also developed a urinoma vs a cystoabdominal fistula. I learned that one can test drainage from a drain to see if it is in fact urine by testing the BUN and creatinine of the drainage fluid, which I did not know before this. This was also a valuable experience for me as I am interested in surgical specialties.
Surgery Article Summary: I chose to present an article that discussed urachal carcinoma in detail and the clinical, prognostic, and therapeutic aspects. While this was a different article than the type I would normally choose, I felt that I wanted to look into urachal carcinoma as I’d never heard of this particular cancer, or a urachus for that matter, prior to this patient presentation. In this particular article, a meta analysis of 1,010 cases total was conducted in Europe. It was found that most cases were discovered in the later stages, past stage 3, when the carcinoma had invaded the bladder, or when there was distant metastasis found at initial presentation. Ultimately it was determined that while 5-FU-based therapies were found to be superior to cisplatin-based therapies, the lack of prevalence of urachal carcinoma makes large-scale studies almost impossible in order to make an adequate recommendation for therapy. Largely, urachal carcinoma is treated with recommendation on an individual basis. Also, targeted therapies are a considerable option, as with my patient from my presentation who had a robotic-assisted removal of their urachal mass.
Surgery Self Reflection: During my surgery rotation I was exposed to several services of medicine I had very little experience with. I had been in an OR before as a radiology technologist, but had never before scrubbed into a case to assist in a surgical procedure. I found that I really loved the experience and working with my hands. The overall atmosphere of the OR felt comfortable for me and provided a great learning environment. While my mentor who guided me to become a PA student was neurosurgical PA, I myself was never very interested in neurosurgery as a specialty. However, I found neurosurgery to be my favorite service that I rotated through. I found the surgeries to be very interesting and included procedures I’d never seen before. In my ten years as a technologist in the OR, I’d never seen a craniotomy or a nasal approach for a surgery. I was lucky enough to see a brain mass (glioblastoma) debulking where a substance called Glilan was used to visualize the mass. As it is difficult to differentiate a glioblastoma from healthy brain tissue, the Glilan is taken up by the tumor cells and glows pink and blue under the blue light of a microscope making it easier to distinguish from healthy brain tissue. This assisted the neurosurgeon in removing only tumor tissue. I was able to scrub into and assist in spinal-orthopedic surgeries like laminectomies and fixations as well. Learning the names for the instruments used during each surgery proved to be quite a challenge, as I hoped to learn as many instruments as possible. Also, learning to perform a running subcuticular stitch was very difficult. I found it challenging to put the needle exactly in the dermal layer inorder to achieve adequate approximation of the skin. I feel that I personally found an area of medicine where I’d like to practice as a PA, surgery in general proved to be a niche where I felt I excelled and felt most useful in my potential and skills.
CV (on blackboard, available to staff)
Final CAT: Pindolol in conjunction with SSRIs for Depression
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