6/20/16

Last week, some scheduling conflicts arose and Dr. Nguyen was out of town for a few days. making me unable to go to MH. I also had to reschedule a presentation of the Understanding Aortic Stenosis video at The Gardens of Bellaire, a senior community here in Houston. That's pushed it awfully close to another presentation I'm doing at the Elmcroft senior community, but I'll be able to do both. I'm interested in seeing how much the seniors will contribute to the discussion; many of them just want to get to bingo. I'll see how the presentations go and report the details here. Anyways, here's the case from June 20th.

Today was a single CABG (coronary artery bypass graft), a procedure that I haven't exactly seen yet. It's really just half of a double CABG, if that makes sense, since only one new vessel is being grafted on. So, in this case, only the saphenous vein got taken, while the interior mammary artery (which gets used in a double CABG) is disregarded. I forgot to mention (last time I talked about CABG) that the saphenous vein grafts that I've seen have all been harvested endoscopically, meaning that a probe was inserted into the leg to extract them.  I recently learned that there is an "open" method that requires the leg to be cut open length-wise, giving a clear view at the tissue and veins. Today's endoscopic vein harvest could've gone better, as some problems arose with getting appropriate vein segment lengths- I'm not sure if this was a technical issue, but I'd really like to see if the open method is any easier. This seemingly simple misstep made the surgery much longer than expected, delaying bypass and all of the "interesting" parts of the surgery. Nonetheless, the graft placement went rather well, and was definitely the highlight of the case. Grafting the saphenous vein onto the coronary arteries is a lot more complicated than dealing wth the interior mammary artery. With the saphenous, both ends are being attached to the heart, rather than just one with the interior mammary. Interesting instruments are brought in to support the graft placement- my favorite is this gray-colored device with two prongs that encircles the graft area. It has two sets of gears that seem to be used to tighten or loosen the grip on the myocardium, and is really cool to see in action. I still don't know what it is called, though, and "gray rotator tool for CABG" yielded no results on google images. I'll keep looking. 

I’ll have plenty of interesting stuff to report about early next week, including the Elmcroft visit and (possibly) another case. I recently learned that the producers of Great Day Houston won't be able to fit Matt and I onto their TV spot on the 27th, but Dr. Nguyen will still be on that morning to talk about our project. It won't be as cool without us, but hey, things happen. I definitely recommend that you all tune in and see what he says about it!

6/8/16

After a great weekend at Free Press Summerfest, a music festival here in Houston, I return with the memorable events of last week- pertaining to the HVI and Heartwell, of course. Last Wednesday, I entered some previously uncharted territory by staying for an entire case. It was a double coronary artery bypass (CABG) via sternotomy, and a great surgery to watch. I've mentioned in earlier blog posts that the more invasive the procedure, the easier it is to see what's going on; here, I could see everything, especially when the anesthesiologist wasn't tending to the patient's anticoagulant needs. From that angle, I could peer down at the chest cavity, able to see the performing doctors' precise techniques as they worked to graft the new arteries to the patient's heart. Reflections aside, I'll explain the procedure in brief (brief, only because I have some other things to discuss in this post). Coronary artery bypasses allow the coronary arteries to receive proper blood flow if their normal vessels are blocked by plaque, which is usually a result of high cholesterol. Rather than doing something like an angioplasty to repair existing vessels, a CABG uses grafts from other vessels in the body. For this double bypass, a saphenous vein segment was taken from the patient's left leg, and one end of the left interior mammary artery. One might ask, "why one end?" That is because the other is already connected to the subclavian artery, which receives a healthy blood flow from the aorta. Detaching it completely would be super unnecessary, as another hole would have to be created for the other end of the mammary artery. So, the saphenous vein graft connects from the aorta to some part of the right coronary artery, and the interior mammary artery connects from the subclavian artery to some part of the left coronary artery. It was very difficult to tell which of the tiny coronary vessels the new artery and vein were being sutured onto, in this specific case, so that's about as precise as I can be. I will link a picture at the bottom, though those vessel connections might not have been the same as the ones in this case. It all depends on what coronary segments are blocked.

What I really wanted to discuss in this post was my first presentation of the Understanding Aortic Stenosis video. I went to the Amelia Parc senior community, where my grandmother lives, to present the video and do a short Q&A about it. The elderly people there were really receptive of the video, and some had a lot to say about it- ranging from questions to personal accounts of dealing with heart disease. It was good to get the video out to our target audience, as they're the ones who we want to be getting across to. They're the ones meeting with doctors about disease treatment and trying to decipher things. The secret to a good senior community presentation, I've learned, is to stay far away from bingo time; as soon as that started, a good part of the group I had gathered rushed out. I'd never seen people that old move so quickly.

By the way, I might do more local senior community visits- in fact, I already have two set up for this month. If you guys have any suggestions for places to visit and present this information, feel free to contact me or comment on the post. Thanks!

Double CABG (general overview):

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.