Yesterday was an interesting day. After rounds we went downstairs to work on a guy who's having some problems. He had a NAIS procedure two weeks ago (Neoaortoiliac System, which is basically a procedure that bypasses an infected graft of the iliac arteries.) What are the iliac arteries? Well, your aorta is the big artery that leaves the heart and supplies blood to the rest of the body. (My research is looking at complications that affect the surgery to repair aortic aneurysms.)

**It seems this image is quite popular across the internets, especially when you search for "aorta" on google images. Hurray for that!**

Well, eventually the aorta branches into two different arteries called the iliac arteries which supply each leg with blood. Often the iliacs can become blocked with plaque (similar as to what happens to the coronary arteries in a heart attack or the carotid arteries in a stroke) and will require a bypass or actual removal of the blocked part and replacement with a synthetic graft. In this patient's case, the graft became infected, which is bad. You can't cut the graft out and put a new one in, because it will probably get infected again. So, a vascular surgeon does what's called a NAIS procedure to bypass the infected graft. Anyway, this guy isn't doing too well, and apparently some of the infection has spread to his right foot. It's not good if the infection gets worse (gangrene) or continues to spread up the leg. So in this patient's case, we had to amputate his foot to hopefully save the leg. I actually had never seen or performed an amputation, so it was kind of weird to take part. (stop reading if you're weak of heart) What basically happens is you draw a circle around the leg where you're going to amputate. Then you take a knife and cut around the circle, making sure you go to the bone. Then you take this chain-like thing and hold the two ends and saw the rest of the foot off. Then you tie the three major arteries that supply the foot, and it's all done. Before that we did a tracheostomy, which is cutting a hole in the trachea (wind pipe) and putting a tube in there so the patient can breathe. This is better (less chance for infection) than being intubated, which is having a tube placed through the mouth into the trachea. Anyway, it was interesting to partake in both procedures, although I felt weird that the patient would wake up without his right foot.

The research stuff is going wonderfully. I think tomorrow or maybe today if I have time, I'll talk about aneurysms and pseudoaneurysms (complete with illustrations).

I picked up my digital camera from the repair shop here in Houston. Apparently it is so damaged, they can't fix it. So I'll be sending it to the Kodak factory for repairs. I'm sort of pissed at the repair shop, because their website says free estimates. Of course, the estimate actually costs $15, even if they can't perform the repair, which is complete bullshit. I'd understand if they quoted a price which was too high and the customer walked away. But if they can't fix the camera, they should refund the estimate fee. So don't take your camera to Houston Camera, cause they suck.

I also had a big meeting today with the surgery clerkship director, Kim Anderson. Dr. Anderson is probably one of the nicest, coolest faculty members at UT-Houston. She's very, very sarcastic and jovial and really looks out for her students. So of course, her personality meshes with mine perfectly. Anyway, today we discussed residency programs and decided on 30 or so that I will apply to in a few weeks. It also turns out that she is the President of the Association of Surgical Education, which is a national committee that helps to decide how surgery is taught to residents. Plus, she knows tons of people around the country who help decide who will be training at their institution each year. So I'm really grateful to have her on my side. Plus, we decided on some really nice programs around the country which is also a relief, cause I really had no idea where I wanted to go or which were good programs.