Today was the first day of our rotation and we were all very excited! We went to the internal medicine meeting at 8am and the physicians discussed a case of a 36 yo man with postprandial vomiting. He has a history of alcoholism since 13yo. The physicians came up with some differentials for the patients, including Mallory-Weiss syndrome, alcohol gastritis, acute peptic ulcers…etc. Then, they asked the presenter for the specifics of the patient’s hx, such as, did he start to see blood in his vomit right from the beginning or did blood appear after a couple of days. In addition to knowing his blood pressure, they want to know his BP while standing up to check for orthostatic hypotension. Patient’s signs of polydipsia, whether or not he had low grad fever were also important since physicians depend on these symptoms to diagnose the patient as accurately as possible, I’ve learned that taking a detailed history of the patient is an absolutely crucial skill to master.
Amanda, Borhan, Karen and I have Oncology for our first week. We met with Dr. Chen in the morning as he was seeing patients in the oncology clinic. We observed his bedside manner toward patients, and I was surprise to see that he used humor in his practice in a way that was effortless and appropriate for the setting. We were so fascinated by what he was teaching us that some of us started to scribble furiously in our notebooks. He was quite amused by our nervousness and eagerness, he sat back relaxingly in his chair and reassured us not be so caught up with things. He told us to enjoy this experience, if something is important, we will remember it. Truthfully, I was a little hesitant when he said that. My mind screamed nervously -if it is not written down, I would forget, and this day would be a waste! But as I begin to put down my notebook, I realized that I listened more and saw more of what was coming out from the patient. Their expression of sorrow, courage and hope were plastered on their face. Everything I needed to learn was there, I just had to put down my notebook to be fully present.
The highlight of the outpatient clinic was seeing a Thymoma patient, as this disease is typically very rare. In the afternoon, Dr. Chen gave a presentation about lung cancer and its associated pharmacology. He mentioned a couple of interesting things: it is always better to have 1st line cancer treatment: traditional chemotherapy, 2nd line as target therapy OR vice versa, as long as the 1st and 2nd line are not the same kind of therapy. EGFR inhibitors are commonly used against lung cancer, but if the etiology of the cancer is k-ras mutation based, since k-ras is downstream of the EGFR gene, EGFR inhibitors would not work. Dr. Chen then showcased a study where there was a study of 2 drugs – Pemetrexed and Docetaxeel to see which is better for the various NSCLC. It turned out that Pemetrexed is best for Adenocarcinoma and Large cell lung cancer, while Docetaxel is best for Squamous cell carcinoma. I was surprise that I understood most of the drugs Dr. Chen talked about in his presentation. It was exciting to apply my classroom knowledge to real cases. Can’t wait for tomorrow!
No comments:
Post a Comment