Last night, I went Christmas caroling with some other medical students at the Hanna House over at Case. Hanna House is a residential rehabilitation center. We went from room to room singing whatever Christmas songs the residents requested. They were really glad to have us there. This one cute old lady was following us in her wheelchair so that she could hear the songs we were singing for the other people. In another room, the nurse asked the man who was staying there if he wanted to hear us sing. To her surprise, he said yes. (Apparently he is normally a big grump.) When we left the room, I heard her exclaim to him that she had seen him singing along with us. Going caroling like this was kind of spontaneous. We got together and practiced the songs for about an hour, and then we went to sing them at Hanna House for an hour afterward. I had never gone Christmas caroling before, but it was really fun, and I'm glad that I went. I would definitely do it again next year.
We had anatomy lab this morning, and the clinical case was mostly covering the embryology of the uritogenital system. We did some review of the abdomen and went over the ribs and vertebrae as well. But the really cool part about anatomy today is that we did a laparoscopic nephrectomy on a cadaver. That was seriously awesome. The urology fellows inserted a camera and two cutting instruments through small incisions in the cadaver's side, and all of us got to take a turn at operating the camera and the cutting instruments. You are watching a TV screen while you do this surgery, and it's just amazing. I still have zero interest in being any kind of surgeon whatsoever, but if I were going to do surgery, I think that laparoscopic techniques are definitely the way to go. Apparently patients recover from them faster too, and the surgeries can take less time since there's no need to sew the patient up afterward.
Our new PBL case is about a guy who has been vomiting for the past few days. Naturally, this has totally screwed up his electrolytes (sodium, acid-base chemistry, potassium, etc.). We had a long discussion today about whether vomiting would change the concentration of salts in his blood or not. The group was pretty much split half and half on it, and my learning objective now is to find out one way or the other for Wednesday.
In the afternoon, I went to the gym and stopped by the anatomy lab to look at the bones again. Then I went to the hospital to hear a cardiology talk. This research group figured out a way to miniaturize a cardiac ultrasound probe so that they could image atherosclerotic plaques in the arteries of living people's hearts. The transducer is 1 mm in diameter, and it rotates around inside the vessel, producing an ultrasound picture of the inside of the artery and showing the plaques. This technology allowed them to learn some important things. One is that with early atherosclerosis, a plaque develops in the artery wall, but the open part (called the lumen) is still ok. As the atheroma develops, the lumen didn’t really narrow in most cases. It is important to know this because if you did an angiogram, you won’t be able to see the plaques, so you wouldn’t know that there was any coronary artery disease (CAD). Young, healthy people (even teens) who eat Western diets have extensive CAD, particularly if they are obese. When the researchers examined multiple heart transplant donor hearts, 17% of teens, 37% of people in their twenties, 60% of people in their 30s, 71% of people in their 40s, and 85% of people over age 50 have plaques. The plaques are all over the body, not just in the heart. The research group also found that lower cholesterol leads to much lower risk of CAD, so now they are working on developing new drugs to lower patients' cholesterol levels.