5/29/16

Last week, we posted a complete video to our YouTube channel called Understanding Aortic Stenosis. This was a big moment for our team, and we wanted to spread it around as quickly as possible- as of today, the video has accumulated over 700 views. I'd say we accomplished that goal. The video's success marked the first major stride towards developing the Heartwell Project, our effort towards educating everyday people of all backgrounds about heart disease. As I've said in previous posts, this summer is not meant to be a dormant period for it, so we'll continue to make progress. We also have a TV appearance with Deborah Duncan coming up at the end of June, which will work wonders in regards to our publicity. I see a lot of good things in The Heartwell Project, an incredible amount of potential that we're only starting to tap into. In addition to all of this, I have arranged to present the video (and do a Q&A) in an elderly community in Dallas next weekend. I'm so excited to host this whole process on my internship blog- it really tells a story of my thoughts and experiences throughout The Heartwell Project's development. Despite the huge importance I've been putting on the project, I haven't forgotten my "roots" at the HVI. I'll be able to join Dr. Nguyen for more surgeries, and school can't get in the way. Summer 2016 is going to be eventful, try to keep up!

Here's a link to our channel:

https://www.youtube.com/channel/UC600D_nPsIPZvv8zBbyjSqw

5/13/16

This morning's events were almost identical to last week's, with the exception being a rather interesting lecture that I attended before valve conference. The lecture was about robot-assisted tumor removals in the mediastinum (the upper chest cavity, containing the heart and lungs and surrounded by the ribs), something I'd never learned about. What really interested me about this lecture was the footage the doctors had of the surgery. The robotic arms sent into the mediastinum were accompanied by a high-quality video camera, which gave everyone watching the lecture a really great look at the cavity and the movement of the robotic arms. Robot-assisted surgery is being heralded as the next big step for minimally invasive surgery, and many of the doctors at the lecture were genuinely impressed by the robot's range of movement. The two robotic arms are even equipped with cauteries, special tools that use an electric current to burn through tissue. After the lecture, the room broke out into (well-mediated) discussion, with the doctors speaking their minds about the footage- some argued that the dexterity of a human hand would be hard to match using a machine, while others preferred the robot assistance for its cleanliness and quicker patient recovery time. The latter argument became much stronger after the lecturer told everyone that the patient from the footage went home just one day after the surgery. A thoracotomy tumor removal would take weeks to heal, and leave the patient with a noticeable scar along his or her chest; a robot-assisted removal, however, just leaves three small puncture holes. The world of thoracic surgery is truly changing rapidly.

Here's a video example of a robot-assisted posterior mediastinal tumor removal. This might be graphic for some:

https://www.youtube.com/watch?v=arUrgtTv1TY

P.S, I've had a bit of a cold recently, which is why this post is going up so late- but hey, better late than never.

5/6/16

Notice anything different around here? Though I'm sure some of you were super attached to the old gray color on this blog, I wasn't a huge fan- so, I changed the template and colors. I write on this blog almost weekly, so I see it frequently enough to want a design I'm actually happy with. I think this new one is an improvement.

Today, as I suspected, Dr. Nguyen did not have any cases. Despite this, it was still a great morning; after getting coffee and a banana, I met with Dr. Nguyen at valve conference in the HVI. It has been at least three weeks since I have attended a conference, and today's visit represented a healthy return to the lively, doctor-filled room. I got there early enough to get an agenda hand-out from one of the doctors mediating the conference, which covered the patient names and the doctors responsible for their cases. It became way easier to soak up and understand what they were referencing in conversation, as the patients' conditions were on the pages. After finishing patient rounds, Dr. Nguyen, his assistant Loren and I went down to imaging to see one of his patient's 3D TTEs (3D transthoracic echocardiographs). These are very different from echocardiograms, which are what most people imagine when they think of heart scans. 3D TTE is one of the most recent techniques for heart imaging, and its modernity definitely shows- it's easier to get an idea of what things are with 3D TTEs, as their colors do a great job of giving depth to the animations. 

Here's a gif of 3D TTE in action:
https://media.giphy.com/media/EpMr2qzXxrJny/giphy.gif

I'll post some more stuff regarding The Heartwell Project as soon as I get an update from our animator.

Update 5/1/16: "Dr. Heartwell" Animation Preview and Short Hiatus

"Two weeks without a blog post? Is he slacking off?"

It's been a bit over two weeks since I've posted anything, so I thought I'd address that (first). Since I only attend my internship once a week- on Fridays- these posts are totally contingent on me being able to go on that specific day, from 6:50 am to around 11:00 am. So, for the past two Fridays, scheduling conflicts have come up that have prevented me from going. Dr. Nguyen has his occasional business trips, and I have school. I'll almost definitely have a post for this upcoming Friday, but it's too early to tell what I'll be doing if I go; I'm hoping for a case, but Dr. Nguyen could very well have valve conference that morning. There's one surgery that I'm just dying to see, which is a VSARR (Valve-Sparing Aortic Root Replacement)- I talked about it a while ago in a detailed post, but I missed the last one that Dr. Nguyen performed (at least to my knowledge). I won't explain it here, as that would be...long, but what's being done in that surgery is nothing short of incredible. Not to mention the cool name. I'm definitely going to try to see one.

On to more important things, the gang and I have been patiently awaiting updates from our animator about progress on the Dr. Heartwell project. I've had a look at what's been created, and I'm really impressed with how far our basic ideas have come. We started this a few months ago with some simple goals- all we had to show for it was a few pages of rough pencil storyboard sketches and some Microsoft Word documents full of notes. It is quickly starting to unfold as something tangible, something ready to be shown to others with satisfaction; that's why I'd like to give a quick sample of the animation on this blog post. Its creation process has been a really unique experience for me, and it isn't comparable to any sort of work I've done in the past. It's grounded in the real world, but goes far past volunteer service, as I'm working with professionals from various fields to get it done. It'll definitely stand as the best group project of my high school career- too bad I'm not getting graded on it.

P.S., please tell me if the video isn't working.

4/15/16

Today, I went to a case w/ Dr. Nguyen. Valve clinic wasn't a lot of fun to blog about, so I wanted to spice things up for a while with a new procedure in each post. Lectures- like the one I covered a few months ago about vena cava filters- are great, but don't crop up often enough for me to consistently post about them. Feedback on what I'm covering is totally welcome, and I could probably even take requests about certain topics.

The case this morning was a sternotomy-CABG, which is a procedure that I've been looking forward to seeing for a while- the mini-repairs and replacements I've talked about in the past few weeks offer much less visibility, and aren't as interesting to watch. CABG is an acronym for coronary artery bypass graft. In this procedure, the doctors remove a faulty segment of a coronary artery in the myocardium (walls) of the heart, and replace it by grafting on an artery from elsewhere. The graft usually comes from the right or left interior mammary arteries, which run under the breast. This operation is performed if there's a blockage in the coronary arteries that can't be solved by PCI/stenting; the heart needs adequate amounts of blood to pump, so if one of its arteries is blocked by plaque (atherosclerosis), that needs to be taken care of. A lack of blood to the heart's muscles can lead to myocardial infarction, better known as a heart attack. Although I've seen this surgery before, I was really looking forward to seeing it in its entirety today. Complications getting the left mammary artery for the graft led to it taking longer than expected, but there was one good thing: the anesthesiologists let me hang out in their corner of the room. They sit adjacent to the patient, amongst a labyrinth of tubes, wires and equipment. They have a direct view into the chest cavity- and it's the best view in the house. It's an entirely different experience to see the patient's chest, spread open with a still-beating heart inside, and be able to look down to see his head. You realize that it's a person who's being operated on. I've had the same view before, but now that I have more experience and actually know what the doctors are doing, I guess it just gave me new perspective. I made it up to bypass before I had to head out, which is a bummer, but the new outlook I gained made it better than all of the past cases I've seen. 

Also, we've decided to call the project The Educated Patient Series. We also picked a name for the doctor/mascot who will be walking viewers through all of the animations: Dr. Heartwell (clever, right?). We're still working with the animator to make revisions and fine-tune the video, but all of the right things are there. More to come about both my neat OR visits and The Educated Patient Series over the next few weeks.

4/8/16

Here's that animation update I talked about last week.

I made some strides towards completing the Kickstarter, and got some feedback from the rest of the group on how it was progressing along. One of the main hurdles I was concerned about was the reward for donors. If you're not familiar with Kickstarter's system, they require the project owners to compensate its contributors (which is often based on how much they give) if the project meets its funding goal. For donors who give $10-$20, mailing stickers or naming them at the end of our videos would be enough- but problems arise when it comes to dealing with $50-$100 donations. Some ideas we thought of were t-shirts, coffee mugs, and even handwritten thank-you notes. I've noticed that plush hearts are given to recovering patients in the HVI ICU- maybe we could brand them with our project's name, or some design, and give those out. What we're doing is not like a lot of the other Kickstarter projects out there; it's really just a (great) community service, not a product. This makes it hard to deal with large donations. Dr. Nguyen recently reached out to Memorial Hermann's PR and marketing department, who loved the idea that we're proposing. They'll probably want to see what it looks like when we've completely finished the first animation, and if they are interested or impressed, we might not even need the Kickstarter. But hey, it never hurts to prepare.

3/31/16

 I don't usually go on Thursdays, which made today's schedule especially weird. I went with Dr. Nguyen to post-op patient checkups, which consisted of mostly severe-condition patients; it's always good to see the patients' families responding well to the recovery process, even if the news they're getting isn't ideal. A lot of the early recovery process involves the management of fluids secreted into the areas around the heart- a chest tube is attached through a chest incision to deal with drainage of blood, pus, and other nasty stuff. It uses suction to evacuate the heart's surrounding tissues of threatening fluid accumulations (called pericardial effusion), and is removed once the leakage stops. Multiple tubes can be installed, and can be removed based on which areas need tending to. Neat, right?

For the case this morning, I arrived with Dr. Nguyen. I got to see the entire pre-surgery process: antibacterial prep, moving bypass equipment into place, etc. The case was a mini-mitral valve repair, which isn't the most fun surgery to watch (mostly due to lack of visibility), but it's complicated and I definitely appreciate the amount of skill involved. I've talked about mini procedure in earlier blog posts- it's basically like digging a tunnel to the heart, starting near the ribs, on the right side of the upper chest. The left femoral artery and vein are cannulated and connected to a bypass machine, allowing the heart to be operated on. The mitral valve is so far back in this cavity that the doctors have to use special elongated tools to reach it, and are forced to jump through all sorts of hoops. It's safer than open-heart surgery and has a much lower recovery time, but is more difficult. From what I can tell, it's hard mode for heart surgery. Back to our specific case, the patient's mitral valve was prolapsed, which is something I haven't heard of before. The mitral valve has two leaflets-posterior and anterior- flaps that open and close when blood is pumped. These leaflets are attached to pieces of tissue called chordae tendinae. In prolapse, a tendon becomes loose, which causes the leaflet it is attached to to not pull shut. The prolapsed leaflet will begin to "climb" over the other one, causing mitral regurgitation, as the blood drips back into the left atrium after being pumped. To solve this problem, a ring has to be sized to fit the mitral annulus, and sutured in to keep the valve from leaking. In addition, a piece of tissue from the prolapsed valve is cut out to prevent overlap. I was familiar with mitral regurgitation/insufficiency before going into this surgery, along with mini procedures, but just about everything else was new. Every time I think I'm getting a handle on basic heart knowledge, something just has to take me down a rung...

Pictures of mitral prolapse and repair are below (non-graphic).

I intended to post a bit more this week, but I was waiting on some new info to roll in about the animation. Now that I've got a sizable amount of info (aka blog-worthy, because I love making long posts), I'll probably have something next week about that. Thanks for reading!

Normal v. Prolapsed, with a cutaway view of the left atrium and ventricle.

Repaired mitral valve, with annulus ring and fixed posterior leaflet overlap.