March 2007
Any given Sunday
The weather is gorgeous outside, but I find myself sitting at my bench in lab.
Besides school, I spent quite a bit of time in lab. I've been working with Dr. Karl Sylvester, a pediatric surgeon, since February of last year. The research we do is on Wnt signalling in oval cells, which are adult liver stem cells. These cells, which are near and dear to my heart, are bipotential--meaning the can become either hepatocytes or cholangiocytes, and thus they express markers for both.
The main approach we take is exposing mice to either acute or chronic injury. If you guys paid attention in your English and Lit classes in grade school, you'll remember the story of Prometheus. A rather nice chap, Prometheus stole fire from the gods and gave it to Man. The Greek gods being the rather selfish bunch that they are, got rather upset and chained our protagonist Prometheus to a rock. Each day a vulture would fly to the rock and peck away at his liver. Fortunately, his liver would grow back every night. Unfortunately, the vulture would be there again the next morning.
Long story short, the liver is the only solid organ that can regenerate. The theory is that in response to acute injury the hepatocytes proliferate and hypertrophy. However, in cases of chronic injury where there is damage to the extant hepatocytes, oval cells become a transient population of proliferative cells that can help to reconstitute the liver. Our lab studies the role of beta-catenin in that proliferative response, with the hypothesis that pertubations to beta-catenin signalling in oval cells may be responsible for liver cancer.
The liver happens to be my favorite organ--afterall it is the unsung hero of the body. I've been doing research since high school, starting at M.D. Anderson with my initial projects on minimal residual disease detection of ALL with PCR and cancer gene expression profiling using cDNA microarrays (back then microarrays were still fairly novel).
Enough reminiscing--I spent the day checking on my little cells growing in soft agar. Watching the cells does not make them grow faster. I also ran some gels for a PCR I did a week ago. It's tough scheduling lab in between classes, meetings, and such. What normally would take a few hours during the summer, ends up taking a week to do during term time.
Thursdays at the Valley
Every Thursday, Margie, Jayson, and I trek down to the Santa Clara Valley Hospital, known affectionately as "The Valley."
As part of our second-year Practice of Medicine course, we have the opportunity to hone our history taking and physical exam skills at various clinical practicum sites. I chose to go to the Valley, a rater unpopular location for most due to the 30 minute drive from Stanford, because I wanted to see different patients than those we get at Stanford hospital. So far its been a phenomenal experience.
The attendings have been extremely nice and welcoming, taking time out of their busy schedules to critique our presentation skills and go over pertinent physical findings.
I had a really interesting case today of a 40-year old man who presented with complaints of pain around the left orbit that has progressively worsened since December. He also had fairly prominent proptosis of the left eye. He's been in the hospital since Thursday, and the physicians here have empirically treated him for orbital cellulitis with vancomycin, cefapime, and flagyl to cover potential bacterial or fungal abscesses. His CT showed a large mass behind his left eye that was causing the proptosis, and they now believe it to be a neuroendocrine tumor.
What was most memorable for me thought was in the course of the hour I spent with him, he did not mention the fact that he was HIV positive. I asked him about his past medical history and HIV never came up, and it was only when I asked about his current medications that he mentioned he was taking Atripla, a new combination pill of nucleoside and non-nucleoside RT inhibitors. Of course, this opened up a whole avenue of history.
It's scary to think that I could have also missed such an important part of his history. Luckily, our clinical practicum is mostly for us to practice, as we are not yet responsible for managing the patients yet. The patient also had a really compelling story--he had a detached retina from physical abuse at home when he was 15, leading to loss of vision of his right eye. As a result of his family issues, he's now dealing with PTSD and depression, and talking to him made me appreciate the importance of the patient-doctor encounter and the medical interview. For the first 45 minutes he was a patient with proptosis, but then all of a sudden the details of his life were filled in and he became a more complete individual and not just a patient.
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