Hello!
During the past two weeks, my advisor at iCAMP left town and so I turned my focus toward shadowing in the SALSA (Southern Arizona Limb Salvage Association) clinic and in the Operating Room as well as my work with the tribe. I did keep working on data analysis for the controls on the gait and BMI study and on the dialysis systematic review at iCAMP but mostly they have taken the back burner for the time being.
At clinic I have been assigned to shadow the main podiatry fellow on his rounds and attend his scheduled surgeries.
The first day was intense and gory. The second I came in, I was ushered into a room where a woman sat waiting. She had a very severe type of fungal foot infection that caused her toe nails to become thick (about an inch) and yellow-green. She had been treating them to no avail with anti-fungal cream that was causing severe irritation around her toes. She had not been able to get the insurance company to pay for the oral anti-fungal medication because they claimed to need proof that it was fungal. We took samples of her nails for the lab and sent her on her way. The next person we saw was a man whose toe was gangrenous. He was also diabetic and blood flow to the little toe had been cut off, leaving the toe to die. Because of this, his little toe was pitch black and a red infection was apparent moving up his leg. He was immediately admitted and prepped for amputation surgery. While he was being prepped, I got to go to the OR and observe another surgery. This one involved a diabetic man who had undergone an amputation of his first two toes several years earlier. He had developed arthritis and had excess bone growth on the ball of his foot due to the abnormal pressure distribution caused by losing his toes. Beneath the bone growth, a massive bursa had developed that was causing additional complications to his walking. The surgery involved cutting open the bottom of the foot, cutting out the bursa (about the size of a closed fist) and then using a male and chisel to break off the extra bone. After this was finished the foot was sown back up.
Over the course of the following days I continued to attend clinic. A majority of people there were diabetic and were coming in for treatment of ulcer or amputation related concerns. Some had underwent treatment for ulcers and had to come in for cleaning, some came to get new cleaning vacs. There were also the occasional bunion or young man with mysterious open leg wounds that seemed to have no obvious cause but for the most part diabetes was at the root of everyone's foot crises.
I don't get phased much by blood and guts but I must admit that some of the wounds were pretty gnarly. One even had maggots involved...I don't want to shock you with the images, but if you are curious I can send you photos (or just type diabetic foot ulcer into google images and you will get the idea). I have also gotten to attend two more surgeries recently. One was a simple 45 minute surgery that involved cutting out a piece of infected bone in a woman index toe and cutting the tendon so that the toe would remain straight (one result of diabetes is reduced muscle control which can cause toes to curl permanently. This can lead to ulcers on the toes). The other surgery I attended was in vascular surgery rather than podiatry. One of our family friends is a vascular surgeon and he got me in touch with one of the surgeons in his department. The surgery I watched was a femoral potliteal bypass surgery. The man was diabetic and had reduced blood flow to his feet. He had developed a wound on the top of his foot that was unable to heal due to the reduced blood supply. Because of this, the wound just got worse and worse (at the time of the surgery he had exposed bone and blackened, infected issue). The surgery lasted for about 6 hours. The man was put under general anesthesia and received a catheter. His leg was shaved and then opened to reveal a portion of vein. Carefully a portion was removed and then grafted on to the artery to reroute blood and help flow to the feet. The surgery went well and an angiogram taken at the end revealed enhanced blood flow.
Overall one thing I found frustrating in clinic was seeing patients who needed certain treatments but had to be denied for insurance reasons. There were a number of these patients (who would have benefitted extraordinarily from a certain therapy but could not afford it and thus were left to suffer).
With the tribe I have begun shadowing the dietitian and one of the outreach workers. In this way I have gotten to see some of the challenges individuals face on the side of preventing diabetes. Some of these challenges can be as devastating as the disease itself.
Music of the week: 1. Brahms Double Concerto (I fell in love with the last movement of this piece at the Tucson Symphony Orchestra performance last week), and 2. This awesomeness (in honor of my robotics team's awesome performance at the AZ East Regional).
Monday, April 6, 2015
Tuesday, March 3, 2015
Week 3: Three Times the Charm (Highlights from SRP Week Three)
Hello dedicated readers,
I am fully aware that it is now week 4 of SRP's not week three but I got a bit behind in posting and trust you are a forgiving crowd...
It is said that 3 times is the charm. That maxim felt appropriate last week as I finally began to get into the flow of my work.
With the Pascua Yaqui Tribe I finally finished the "New Employee Orientation" that all individuals involved with the tribal government must complete. It was a 6 hour program where they went over tribe history as well as the ethics, drug policies and harassment-free culture of the tribal government. Some of the information did not apply to me as a volunteer (employee benefits for instance), but I did learn a lot and also got to meet some wonderful women who were doing the orientation along-side me. One of them was a seasoned nurse from New Orleans who had moved to Tucson two days prior for the job with the tribe. She told me a lot about her time working as a psychiatric nurse which I found fascinating (neuroscience is one of my favorite subjects ever). Another of them was a nurse who had worked with El Rio for over 30 years, but had just retired and was coming on as a part-time employee and thus had to take the orientation again. She talked a lot about her experiences as a nurse there. Once the day was over I was issued my employee badge which was exciting...and now I can OFFICIALLY begin my work there (though unofficially I already did).
Side note: This week I am going out of town on Thursday with my fellow Bit Buckets to attend our first FRC regional in Central Valley California. I am so excited for the trip but it also means I won't get to work with the tribe on Friday. It will give me a little bit of time to prepare and plan interviews that I would like to do with people working with the diabetes prevention program.
The rest of my time last week was spent at the University Medical Center where I got to continue working on a number of different projects.
Last week I mentioned doing some background review for the prospective studies on gait analysis in the prediction of diabetic foot ulcers and exercise in dialysis patients. I have continued work on these. If you want to see my preliminary article review you can check them out: 1. Exercise in Dialysis Patients 2. Gait Analysis and Foot Ulcers. For the exercise in dialysis patients I began to investigate whether dialysis patients suffer from other physical limitations/frailty that would make certain exercises difficult and compromise their physical health. For this study, I am interested in whether ankle strengthening exercises would be beneficial to dialysis patients because they provide a minimally destructive form of muscle strengthening. If you want to read more about that in particular, see my report: Physical Functioning on Dialysis. At this point I have begun doing a systematic review for the dialysis project (basically using certain key search words like Hemodialysis, Exercise, and Physical Functioning I search all of PubMed for articles related to the subject and then go through every single one—there are 591—to find whether it is meaningful for our particular study). I am about half way done with the review now.
Beyond that I also continued my data analysis work using MATLAB. The data I am looking at now involves diabetic patients completing walking trials. I looked at two different sets that included normal walking, dual task walking (walking while simultaneously counting back by 7's from some odd starting number), and walking over obstacles. The program uses data from accelerometers attached to the participants legs (one of the sets also includes data from the back) to graph movement, find knee angles throughout the stride, see time spent on each foot, and calculate walking speeds. The analysis is still not quite done but it is getting there. I still need to do the analysis on the control group and then compare the results.
One thing I was very excited about last week was that I got to go to the clinic to observe (I cannot do it alone because I am still under 18) data collection. We were going to be receiving a smart mat back from a participant who had been using it all year and do a follow up gait analysis test. Unfortunately, she got a flat tire and did not show but the clinic was still pretty cool.
I will try to be more punctual with my next post...
Thank you for reading and I wish you all the best.
I am fully aware that it is now week 4 of SRP's not week three but I got a bit behind in posting and trust you are a forgiving crowd...
It is said that 3 times is the charm. That maxim felt appropriate last week as I finally began to get into the flow of my work.
With the Pascua Yaqui Tribe I finally finished the "New Employee Orientation" that all individuals involved with the tribal government must complete. It was a 6 hour program where they went over tribe history as well as the ethics, drug policies and harassment-free culture of the tribal government. Some of the information did not apply to me as a volunteer (employee benefits for instance), but I did learn a lot and also got to meet some wonderful women who were doing the orientation along-side me. One of them was a seasoned nurse from New Orleans who had moved to Tucson two days prior for the job with the tribe. She told me a lot about her time working as a psychiatric nurse which I found fascinating (neuroscience is one of my favorite subjects ever). Another of them was a nurse who had worked with El Rio for over 30 years, but had just retired and was coming on as a part-time employee and thus had to take the orientation again. She talked a lot about her experiences as a nurse there. Once the day was over I was issued my employee badge which was exciting...and now I can OFFICIALLY begin my work there (though unofficially I already did).
Side note: This week I am going out of town on Thursday with my fellow Bit Buckets to attend our first FRC regional in Central Valley California. I am so excited for the trip but it also means I won't get to work with the tribe on Friday. It will give me a little bit of time to prepare and plan interviews that I would like to do with people working with the diabetes prevention program.
The rest of my time last week was spent at the University Medical Center where I got to continue working on a number of different projects.
Last week I mentioned doing some background review for the prospective studies on gait analysis in the prediction of diabetic foot ulcers and exercise in dialysis patients. I have continued work on these. If you want to see my preliminary article review you can check them out: 1. Exercise in Dialysis Patients 2. Gait Analysis and Foot Ulcers. For the exercise in dialysis patients I began to investigate whether dialysis patients suffer from other physical limitations/frailty that would make certain exercises difficult and compromise their physical health. For this study, I am interested in whether ankle strengthening exercises would be beneficial to dialysis patients because they provide a minimally destructive form of muscle strengthening. If you want to read more about that in particular, see my report: Physical Functioning on Dialysis. At this point I have begun doing a systematic review for the dialysis project (basically using certain key search words like Hemodialysis, Exercise, and Physical Functioning I search all of PubMed for articles related to the subject and then go through every single one—there are 591—to find whether it is meaningful for our particular study). I am about half way done with the review now.
Beyond that I also continued my data analysis work using MATLAB. The data I am looking at now involves diabetic patients completing walking trials. I looked at two different sets that included normal walking, dual task walking (walking while simultaneously counting back by 7's from some odd starting number), and walking over obstacles. The program uses data from accelerometers attached to the participants legs (one of the sets also includes data from the back) to graph movement, find knee angles throughout the stride, see time spent on each foot, and calculate walking speeds. The analysis is still not quite done but it is getting there. I still need to do the analysis on the control group and then compare the results.
One thing I was very excited about last week was that I got to go to the clinic to observe (I cannot do it alone because I am still under 18) data collection. We were going to be receiving a smart mat back from a participant who had been using it all year and do a follow up gait analysis test. Unfortunately, she got a flat tire and did not show but the clinic was still pretty cool.
I will try to be more punctual with my next post...
Thank you for reading and I wish you all the best.
Friday, February 20, 2015
Week 2: Forging Ahead
Greetings again!
Week two of my SRP was quite a whirlwind!
This week marked the end of the daily-meeting craziness of the FRC Robotics Build Season (finished on Tuesday). It came down to the wire but in the end the Bit Buckets rallied and the robot (see CAD at left) looked pretty fine. We still have work to do for the team—some of the systems need quite a bit of fine tuning, awards need to be submitted, a practice robot must be build, the drivers need practice—so we will still be having meetings 3-4 times a week. But I digress...
In terms of my SRP this week was VERY exciting because it marked the beginning of my internship at the University Medical Center. There I am working with an interdisciplinary group called iCAMP, which is led by the great Dr. Najafi and focuses on using bio-instrumentation based on advanced wired/wireless capabilities to help patients suffering from a slue of problems including chronic pain, frailty, osteoarthritis, wounds, sports injuries and diabetes. The atmosphere there is extremely collaborative with surgeons, engineers and clinicians all working together on dozens of projects simultaneously. While I will be working predominantly on the Orpyx study, I will also be involved in a number of different projects to get a sense for ALL the work that goes on there. My work there will complement my work with the Pascua Yaqui diabetes program in giving me a sense for the clinical/investigative side to disease prevention.
The Orpyx study is so named for the device it is testing—a smart shoe designed by the Canadian company Orpyx Medical Technologies. This shoe is designed to help diabetic patients suffering with peripheral neuropathy from developing dangerous and painful foot ulcers. For a little background: peripheral neuropathy is a problem that arises in about 70% of diabetes cases and involves the loss of sensation in the extremities. Individuals with reduced sensation in their feet are more likely to exert excessive pressure on their feet because they do not feel the pain such pressure causes. As a result, patients with peripheral neuropathy are prone to developing calluses and ulcers that can ultimately lead to amputation. Treating ulcers is extremely expensive and constitutes a majority of the cost of treating diabetes on a national scale. The Orpyx device hopes to help this problem by providing patients with feedback about the pressure they are putting on their feet. The actual device consists of two parts: 1. a pressure sensitive insole, and 2. a smart watch that wirelessly receives pressure data from the insole. The idea is that when pressure reaches a certain dangerous threshold for a certain amount of time (about 15 minutes) it notifies the user via the smart watch. The watch then stores the information on how many warnings the user received over time and how quickly the user offloaded foot pressure. I am interested in whether the preventative nature of such wearable devices has the potential to radically reduce the incidences of ulcers and consequently save on health care costs.
This week I also delved into work on a number of other projects including one investigating the effects of an exercise program in dialysis patients and one looking at gait analysis in diabetes patients with peripheral neuropathy. I did a lot of literature review for both projects and wrote up a report for each study. After that I did data analysis work for the gait study. This work is giving me a good sense of how the process of a clinical study works.
Shout-outs: Before I end here I would like to give a few quick shout-outs to things that helped make this week awesome. First, thanks to the Tucson Sun Link (street car) which I have been riding everyday to work. It is wonderful. Especially when combined with reading (re-reading in this case) Musicophilia by Oliver Sacks. I learned that one of my favorite humans on the planet, Dr. Oliver Sacks was diagnosed with terminal cancer this week and am consequently rereading all the books I have of his. He is such a remarkable man and has added so much awesomeness to this universe. Because of this, my second shout-out goes out to Dr. Sacks. I am so grateful he exists. Lastly while I do not play video games, I do often find their scores to be very good work music. This week the soundtrack to Civilization 5 allowed played through a majority of my work day. :)
Note: As I am very busy I did not go into as extreme detail as possible with regard to the studies. If you are confused or want me to elaborate on any aspect of my work, let me know and I will be more than happy to discuss further.
This week marked the end of the daily-meeting craziness of the FRC Robotics Build Season (finished on Tuesday). It came down to the wire but in the end the Bit Buckets rallied and the robot (see CAD at left) looked pretty fine. We still have work to do for the team—some of the systems need quite a bit of fine tuning, awards need to be submitted, a practice robot must be build, the drivers need practice—so we will still be having meetings 3-4 times a week. But I digress...
In terms of my SRP this week was VERY exciting because it marked the beginning of my internship at the University Medical Center. There I am working with an interdisciplinary group called iCAMP, which is led by the great Dr. Najafi and focuses on using bio-instrumentation based on advanced wired/wireless capabilities to help patients suffering from a slue of problems including chronic pain, frailty, osteoarthritis, wounds, sports injuries and diabetes. The atmosphere there is extremely collaborative with surgeons, engineers and clinicians all working together on dozens of projects simultaneously. While I will be working predominantly on the Orpyx study, I will also be involved in a number of different projects to get a sense for ALL the work that goes on there. My work there will complement my work with the Pascua Yaqui diabetes program in giving me a sense for the clinical/investigative side to disease prevention.
The Orpyx study is so named for the device it is testing—a smart shoe designed by the Canadian company Orpyx Medical Technologies. This shoe is designed to help diabetic patients suffering with peripheral neuropathy from developing dangerous and painful foot ulcers. For a little background: peripheral neuropathy is a problem that arises in about 70% of diabetes cases and involves the loss of sensation in the extremities. Individuals with reduced sensation in their feet are more likely to exert excessive pressure on their feet because they do not feel the pain such pressure causes. As a result, patients with peripheral neuropathy are prone to developing calluses and ulcers that can ultimately lead to amputation. Treating ulcers is extremely expensive and constitutes a majority of the cost of treating diabetes on a national scale. The Orpyx device hopes to help this problem by providing patients with feedback about the pressure they are putting on their feet. The actual device consists of two parts: 1. a pressure sensitive insole, and 2. a smart watch that wirelessly receives pressure data from the insole. The idea is that when pressure reaches a certain dangerous threshold for a certain amount of time (about 15 minutes) it notifies the user via the smart watch. The watch then stores the information on how many warnings the user received over time and how quickly the user offloaded foot pressure. I am interested in whether the preventative nature of such wearable devices has the potential to radically reduce the incidences of ulcers and consequently save on health care costs.
This week I also delved into work on a number of other projects including one investigating the effects of an exercise program in dialysis patients and one looking at gait analysis in diabetes patients with peripheral neuropathy. I did a lot of literature review for both projects and wrote up a report for each study. After that I did data analysis work for the gait study. This work is giving me a good sense of how the process of a clinical study works.
Shout-outs: Before I end here I would like to give a few quick shout-outs to things that helped make this week awesome. First, thanks to the Tucson Sun Link (street car) which I have been riding everyday to work. It is wonderful. Especially when combined with reading (re-reading in this case) Musicophilia by Oliver Sacks. I learned that one of my favorite humans on the planet, Dr. Oliver Sacks was diagnosed with terminal cancer this week and am consequently rereading all the books I have of his. He is such a remarkable man and has added so much awesomeness to this universe. Because of this, my second shout-out goes out to Dr. Sacks. I am so grateful he exists. Lastly while I do not play video games, I do often find their scores to be very good work music. This week the soundtrack to Civilization 5 allowed played through a majority of my work day. :)
Note: As I am very busy I did not go into as extreme detail as possible with regard to the studies. If you are confused or want me to elaborate on any aspect of my work, let me know and I will be more than happy to discuss further.
Sunday, February 15, 2015
Week One: Preparation and Healthy Hearts
Greetings and welcome to my blog! Here I will be chronicling my BASIS Senior Research Project adventures tackling type II diabetes from both a preventative and treatment perspective.
After so many years, I am very excited to finally beginning my official SRP. If you are curious about my process in choosing my topic, you are welcome to check out my internship blog from last summer, here. If not, read on.
For this project I will be interning with two different groups over the next couple of months.
For most of my week I will be at the University of Arizona Medical Center working with a team of doctors and biomedical engineers at iCAMP. This team focuses on how technology and wearable devices can be used to help people dealing with medical complications. I am interested in pursuing the topic of wearable devices in my future and am curious to see them being tested in a medical setting. While I will be generally observing how high tech devices can be used to treat and prevent diabetes, I will also be involved with specific clinical research on a device used to monitor pressure in individuals with peripheral neuropathy. This last week was spent getting caught up on reading articles and buying books necessary for my research. Next week I will be starting my UMC internship so stayed tuned for updates about that.
One day a week I will also be working with the Pascua Yaqui tribe on diabetes prevention. I will spend a lot of my time with Dr. Apryl Krause and her team at the clinic of the diabetes prevention program, however, I will also be shadowing others in different aspects of the program (home outreach, dietitians, kid's fittest etc.) This last week I was involved with the February "Healthy Heart" initiative aimed at raising awareness about women with diabetes and heart disease. On Friday there was a special event where the program offered free consultations, flyers and cholesterol/blood pressure check ups as well as healthy snacks. It was an honor to work with the women hosting the event and great to see the turn out.
If you have any questions about my project, feel free to reach out.
Have a lovely day,
Xóchitl
After so many years, I am very excited to finally beginning my official SRP. If you are curious about my process in choosing my topic, you are welcome to check out my internship blog from last summer, here. If not, read on.
For this project I will be interning with two different groups over the next couple of months.
For most of my week I will be at the University of Arizona Medical Center working with a team of doctors and biomedical engineers at iCAMP. This team focuses on how technology and wearable devices can be used to help people dealing with medical complications. I am interested in pursuing the topic of wearable devices in my future and am curious to see them being tested in a medical setting. While I will be generally observing how high tech devices can be used to treat and prevent diabetes, I will also be involved with specific clinical research on a device used to monitor pressure in individuals with peripheral neuropathy. This last week was spent getting caught up on reading articles and buying books necessary for my research. Next week I will be starting my UMC internship so stayed tuned for updates about that.
One day a week I will also be working with the Pascua Yaqui tribe on diabetes prevention. I will spend a lot of my time with Dr. Apryl Krause and her team at the clinic of the diabetes prevention program, however, I will also be shadowing others in different aspects of the program (home outreach, dietitians, kid's fittest etc.) This last week I was involved with the February "Healthy Heart" initiative aimed at raising awareness about women with diabetes and heart disease. On Friday there was a special event where the program offered free consultations, flyers and cholesterol/blood pressure check ups as well as healthy snacks. It was an honor to work with the women hosting the event and great to see the turn out.
If you have any questions about my project, feel free to reach out.
Have a lovely day,
Xóchitl
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