Surgery #1
Yesterday was probably the best day I've had at Baylor so far. We started with the removal of a parathyroid adenoma. The parathyroid is a gland on the thyroid that controls the level of calcium in the blood. If you have too much parathyroid hormone (PTH), then your body will start stealing calcium from the bones to circulate it in the blood. Lots of stuff can happen including kidney stones and heart problems. The surgery is very cool, because the calcium returns to normal levels literally minutes after the hyperactive parathyroid is removed. The only thing you need to watch post-op is if the patient is speaking without difficulty and for a hematoma in the neck incision site. The reason for checking the voice is because the nerve that supplies the vocal cords runs in the thyroid gland (recurrent laryngeal nerve). If it is damaged, you can lose your voice. The other thing about hematoma is important, because if the buildup is great, the airway can become compromised (as the surgery is in the neck). I saw the patient yesterday, and all was well so we sent him home that day.
Surgery #2
Next was a laparoscopic resection of the pancreatic tail, spleen, and gallbladder. A laproscope is a camera that goes into the abdomen and then the surgeon uses tools outside the body to do inside surgery. It's very nice. I have pictures of the pancreatic tumor we took out which will be posted shortly. Since the tail of the pancreas is so close to the spleen, the spleen must be removed as well in case some of the cancer has migrated in that direction. We took the gallbladder out, because the patient had pancreatitis (inflammation) due to a gall stone that blocked the duct leaving the pancreas. The surgeon's name was Dr. Derrick from Georgia, who's a hoot. His anesthesia guy is Dr. Parks who is equally a hoot. I was very impressed with the amount of laughter during the case, which went remarkably well. Dr. Holden did an excellent job. I have since seen the patient, and she is doing well so far. Here is an image of the surgery. The big mass is the tumor growing from the tail of the pancreas. The purplish thing below the mass is the spleen, which was also removed.
Surgery #3
The final case was an incarcerated inguinal hernia. You all know about hernias (a loop of intestine that slips out of place). Well in a male, these hernias can slide in the scrotum and cause problems. One such problem is called strangulation where the bowel becomes twisted and looses its blood supply. If that happens the bowel can die or perforate causing spillage of bowel contents into the body (not good). This patient's bowel was caught in his scrotum and rather adhesed to the wall. So Dr. Derrick pulled the thing out and then we used a Doppler to make sure there was still blood flow to the bowel, which there was. This case was fun, because for the first half it was just Dr. Derrick and me. Eventually a resident popped in, but for a while I was pretty excited about being the 1st assistant in the procedure. I have seen this patient since the procedure, and he also is doing well.
I'm really amazed at how awesome the Baylor surgery residents have treated me this week. Dr. Holden, the chief, has been especially great. She is an excellent teacher and has made sure that I've participated with several of the doctors here and always the interesting cases. I've never had a chief go so far out of her way to help out a student. She's pretty cool if you ask me.
Finally, I got my 1st international hit to the website yesterday. It seems someone from Singapore found my site via google while looking for some medical stuff. I'm flattered this blog is even associated with medical stuff in the first place. I hope the visitor from Singapore found what he/she came to see.
Yesterday was probably the best day I've had at Baylor so far. We started with the removal of a parathyroid adenoma. The parathyroid is a gland on the thyroid that controls the level of calcium in the blood. If you have too much parathyroid hormone (PTH), then your body will start stealing calcium from the bones to circulate it in the blood. Lots of stuff can happen including kidney stones and heart problems. The surgery is very cool, because the calcium returns to normal levels literally minutes after the hyperactive parathyroid is removed. The only thing you need to watch post-op is if the patient is speaking without difficulty and for a hematoma in the neck incision site. The reason for checking the voice is because the nerve that supplies the vocal cords runs in the thyroid gland (recurrent laryngeal nerve). If it is damaged, you can lose your voice. The other thing about hematoma is important, because if the buildup is great, the airway can become compromised (as the surgery is in the neck). I saw the patient yesterday, and all was well so we sent him home that day.
Surgery #2
Next was a laparoscopic resection of the pancreatic tail, spleen, and gallbladder. A laproscope is a camera that goes into the abdomen and then the surgeon uses tools outside the body to do inside surgery. It's very nice. I have pictures of the pancreatic tumor we took out which will be posted shortly. Since the tail of the pancreas is so close to the spleen, the spleen must be removed as well in case some of the cancer has migrated in that direction. We took the gallbladder out, because the patient had pancreatitis (inflammation) due to a gall stone that blocked the duct leaving the pancreas. The surgeon's name was Dr. Derrick from Georgia, who's a hoot. His anesthesia guy is Dr. Parks who is equally a hoot. I was very impressed with the amount of laughter during the case, which went remarkably well. Dr. Holden did an excellent job. I have since seen the patient, and she is doing well so far. Here is an image of the surgery. The big mass is the tumor growing from the tail of the pancreas. The purplish thing below the mass is the spleen, which was also removed.
Surgery #3
The final case was an incarcerated inguinal hernia. You all know about hernias (a loop of intestine that slips out of place). Well in a male, these hernias can slide in the scrotum and cause problems. One such problem is called strangulation where the bowel becomes twisted and looses its blood supply. If that happens the bowel can die or perforate causing spillage of bowel contents into the body (not good). This patient's bowel was caught in his scrotum and rather adhesed to the wall. So Dr. Derrick pulled the thing out and then we used a Doppler to make sure there was still blood flow to the bowel, which there was. This case was fun, because for the first half it was just Dr. Derrick and me. Eventually a resident popped in, but for a while I was pretty excited about being the 1st assistant in the procedure. I have seen this patient since the procedure, and he also is doing well.
I'm really amazed at how awesome the Baylor surgery residents have treated me this week. Dr. Holden, the chief, has been especially great. She is an excellent teacher and has made sure that I've participated with several of the doctors here and always the interesting cases. I've never had a chief go so far out of her way to help out a student. She's pretty cool if you ask me.
Finally, I got my 1st international hit to the website yesterday. It seems someone from Singapore found my site via google while looking for some medical stuff. I'm flattered this blog is even associated with medical stuff in the first place. I hope the visitor from Singapore found what he/she came to see.
3 Comments:
I'm confused about the hyperactive parathyroid removal. How can you just remove it? Why doesn't that screw up the calcium levels in the blood even more, if there's nothing regulating it?
You make a valid point. Hormonal regulation in the body is based on several principals depending on the body system, but the most common is what's called negative feedback. In this concept, the end product regulates the upstream hormones. In the case of parathyroid hormone (PTH), the amount of calcium regulates how much parathyroid hormone is secreted. If there is too much calcium in the blood, PTH is turned down. And if there is too little blood calcium, PTH is turned up. In the case of a parathyroid gland tumor, it doesn't matter how much circulating calcium there is...it just keeps secreting PTH. So the treatment is cutting out that particular malfunctioning (and cancerous) gland. It turns out that we all have 4 parathyroid glands. So if one of the glands is removed, the other three will adequately regulate the blood calcium on their own. It's one of the many redundant systems The Creator has built into our bodies to cope with situations just like this.
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Excellent explanation -- thanks...
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