Week 10: Children’s Hospital Colorado

August 3rd, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This past week was spent putting the finishing touches on my presentation. After I presented on Wednesday, I got some really great feedback from the doctors and other research assistants. After spending so much time on this project, it was great to get such wonderful encouragement. I also had the chance to start working on the rough draft of an abstract for our project. My week officially ended on Friday, when I spent the whole day shadowing a neurosurgeon in the OR. He was performing a dorsal rhizotomy. I found the experience extremely interesting, and couldn’t have imagined a better way to end my time at Children’s.

I feel that I have learned so much during this Fellowship about the process of research and the importance of working with a team. I am so glad I had the opportunity to work at such an incredible facility. This Fellowship has provided me with so many learning opportunities, and I am excited for my future in medicine. I will be walking away from this experience with more confidence than ever before that medicine is the right career for me.

One of the most important aspects of this experience was the mentorship I received. Below is a picture of me with my PI, Dr. Gaia Georgopoulos.

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This photo was taken after my presentation.  Kiara is another research assistant working with Dr. Georgopoulos. She was also very helpful over the course of my Fellowship.

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Week 9: Children’s Hospital Colorado

July 25th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

I can’t believe it is already week 9! I have been enjoying myself so much at the Children’s Hospital I haven’t noticed how quickly the summer has gone by. I am in the stages of finalizing my project, which is bittersweet. I have collected all the data and have submitted it for statistical analysis. Once I get those results back, I will be able to better understand the data I spent so long collecting. Next week, I will be giving a presentation about my research. I will be adding the stats as soon as I get them back. In the mean time I have been working on starting my PowerPoint presentation, starting to write an abstract, writing an instruction manual for the next research assistant to work on this project, as well as continuing to enjoy several shadowing opportunities. This past week I shadowed in spinal defects clinic. Spinal defects clinic is a great resource for patients because different departments (orthopedics, urology, neurology, etc.) coordinate their schedules so that the patients can see all of the different departments at once. Many of the patients who come to Children’s live hours away (some live out of state) and have to make a trip out of coming to the hospital. The patients travel so far because Children’s has great resources, and also has a good reputation. I am so glad I’ve had the opportunity to conduct research in such a prestigious organization.

I am scheduled to shadow in the gait analysis lab on Friday, which I am very excited for. Gait refers to a particular manner of walking, and gait analysis is used to better understand children’s gait patterns so that the doctors can effectively provide the best treatment. The Center for Gait and Movement Analysis at Children’s is the only center like it in the region, and 1 of about 40 in the entire country, so this is a rare experience.

I have continued to explore more of what Denver has to offer. This past Friday, I was able to attend a major league baseball game. The Chicago Cubs played against the Colorado Rockies. Since I am from Illinois, I made sure to root for the Cubs (who won!). Below is a picture of Coors Field in Denver.

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Week 8: Children’s Hospital Colorado

July 18th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This past week I had some more shadowing opportunities. On Monday, I was in the OR again with a different orthopedic surgeon. In the morning, the surgeon performed a spinal fusion. I was very excited to be getting to watch a spinal fusion, since I have read a lot about them for my research project. First, the doctor made a long incision down the back which allowed them to begin exposing the spine. Next, the doctor had to remove the joints in order to make the spine more flexible. After that, the surgeon placed hardware into the spine to reshape it. Finally, the doctors roughed up the bone to allow new bone to grow. Bone graft was also added to help the bone fuse together. Although before the surgery the spine had a very obvious curve, an x-ray after the surgery showed that the spine had become almost completely straight.

In the afternoon, I was able to observe a hardware removal procedure. This patient had a spinal fusion in the past, but needed the hardware removed since it was bothersome. The physician assistant working with the surgeon told me that hardware can be removed after 1 year after spinal fusion, but it is preferred if the patient can wait at least 2 years. This procedure was very interesting because after the surgeons worked to expose the spine, I was able to see the results of a spinal fusion. It was very interesting to see how the bone had fused together.

This week I have also continued to work on my research project. I am working to collect as much data as possible before the end of next week because at that point the plan is to submit the data I have collected for statistical analysis. This has been stressful, because there are still several x-rays that I had ordered which have not arrived. I have also begun thinking about my final presentation. At the end of my research project, I will be presenting information to some of the doctors, as well as the other research assistants (which I am a little nervous about). I can’t believe I only have two more weeks left at Children’s. However, I am excited to be entering the next phase of my project soon.

Week 7: Children’s Hospital Colorado

July 10th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This past week has been one of the most exciting weeks so far. After a fun-filled 4th of July, I went in the next morning to watch surgery…for the first time! I was so nervous before I went because I was not sure how I would react to seeing surgery up close. I have known for a while I was interested in becoming a doctor, however, I had always thought I wouldn’t want to work in a surgical specialty in the future. I had shadowed other doctors in clinic in the past, and I always enjoyed that setting so much I just assumed a clinic-based specialty would be right for me. To my surprise, I found surgery absolutely fascinating, and I enjoyed the intense atmosphere in the OR (and no, I did NOT faint or vomit or anything of the sort!) This experience has forced me to reconsider a possible career path that would include surgery. Orthopedics is an interesting specialty because the doctors see patients both during clinic and also perform surgery, meaning the doctors are assigned a variety of tasks. I can’t say for certain at this point that orthopedics would be the right career path for me, but I can say that this experience has caused me to consider it more heavily that before.

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The day of the surgery, the patient was brought in to the OR with a slipped capital femoral epiphysis, or SCFE. This refers to a fracture through the growth plate near the head of the femur. This results in slippage of the overlying epiphysis (the head of the femur should sit squarely on the femoral neck). The doctor informed me that this type of fracture is especially common in obese adolescents. At the start of the procedure, the doctor inserted a screw in the affected leg to stabilize the fracture. This was done through a tiny incision. During the next part of the surgery, the doctor had to make a fairly large incision in order to reshape the bone (osteochondroplasty). This portion of the surgery took quite a bit of time. Although the patient only had a SCFE fracture on one side, there is a pretty good chance the patient will obtain a second SCFE fracture in the other side. Since there is such a high likelihood of a second SCFE fracture, the doctor placed a screw on the other side to stabilize the patient’s leg  in an attempt to prevent future problems.

Below are x-rays showing a typical SCFE, before and after surgical intervention.

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Week 6: Children’s Hospital Colorado

July 4th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This week I have been continuing to collect the necessary clinical data as well as measuring x-rays. I have finally been given access to the x-rays I need (which I couldn’t access before), so I have been able to make quite a bit of progress these past few days. After I measure the x-rays for pre and post-op degree of curve(s) and pelvic obliquity, I check in with my site mentor. She has been very patient with me as I work on perfecting this skill. The most difficult part for me is seeing many of the anatomical marks on the x-ray because sometimes the x-rays are not super clear. My site mentor assured me that it is indeed difficult to make these measurements, especially on the post-spinal fusion x-rays when the patient has hardware in place. However, at our last meeting she told me the numbers I was getting were, on the whole, pretty good (which made me really happy). One of the most valuable aspects of this experience has been the mentorship I have received from my supervisor, an orthopedic surgeon. The last time I met with my site mentor, she decided I should also collect the amount of levels fused during surgery, so she gave me a spine model to help me visualize the information I was collecting. Typical spine anatomy includes 7 Cervical (neck) 12 Thoracic (upper back) and 5 Lumbar vertebrae (lower back) with the sacrum below. In order to stop the motion at one segment, two vertebrae need to be fused. So, for example, an L4-L5 fusion is a one-level fusion. Many times the surgical notes may indicate that the level of fusion was T2 to the sacrum, posteriorly. From this information, I determine the number of levels fused. The spine model was especially helpful when thinking about the number of levels fused for such a large range because I am more of a visual person. It also just helped me become more familiar with typical spinal anatomy in general.

Spine Model

This week I have also been thinking about how Cornell has helped prepare me for this experience. There have been moments when I have felt overwhelmed by the workload, especially as a result of the unexpected issues with gaining access to “missing” medical records/x-rays I discussed in my last blog. I feel like the block plan has more than adequately prepared me to keep working despite feeling overwhelmed. Balancing the intensity of the block plan with extra-curricular activities has forced me to learn how to function under a stressful environment, and to just keep “chugging along”.

I have continued enjoy the beauty of Colorado in my free time. This past weekend I had the chance to visit Garden of the Gods. It was absolutely beautiful with lots of wonderful sights to see. I am so glad I have been given the chance to spend a summer in place filled with so much natural beauty.

Redrocks

Week 5: Children’s Hospital Colorado

June 27th, 2013
Bridget Ollesch ’15, Bowen Fellow in Children’s Research
This past week I have learned a lot about the process of research, not excluding the frustrating parts. I have continued to work on my research project as diligently as possible, however there have been a few setbacks this week. For example, I still have been unable to obtain the medical records that were not uploaded into Epic (the database where patients’ medical information is stored). These records needed to be ordered, so that I can look through the paper copies of patients’ medical records. In addition, although I had begun measuring x-rays for degree of curve and pelvic obliquity, I found out that many of the x-rays were also not available in Epic. So, I needed to contact radiology, who ordered the x-rays from a big warehouse. These will be copied into another program, called PACS, so that I can view them online and perform the correct measurements. However, I am still waiting for these to be uploaded so that I can access them. These problems occurred because this research project is looking at patients who had spinal fusion surgery up to fifteen years ago, so their medical information is not all centralized in Epic. The research assistant who has been helping me (over the phone now that she is in a summer program as I mentioned in my last post) had not worked with patient records this old before, so even she did not foresee these problems arising. These factors have set back my progress a bit, which is very, very frustrating for me. I am used to finishing projects very quickly, and if these setbacks had not occurred I feel I could be much farther along in collecting data. The tough lesson I have learned from this experience is that sometimes you just have to “roll with the punches” as my fellow research assistant Kiara stated. The good news is that I have come to feel fairly comfortable reading and interpreting the information I need to be collecting-really the more difficult part as of lately has been simply finding the information. However, another research assistant working in Orthopedics told me that research is all about the details; I am definitely starting to understand that statement. Everyone here has been so encouraging and helpful, which I am very appreciative of because I can be very hard on myself when something I am working on does not go the way I intended.
On a more positive note, I had the chance to shadow in orthopedics clinic again yesterday. Much of this research project has been focused on spinal fusion. However, the doctor I shadowed yesterday specialized in operating on hips. He works with a lot of patients who have hip dysplasia. It has been really informative to shadow here, as the doctors I have followed are very specialized. In the past, I have shadowed my family physician. I live in a more rural area in central Illinois, so my family doctor especially saw a very large variety of cases, as well as a large variety of patient ages. Here, not only are most of the patients children (although occasionally the doctors will see adults), but the doctor may only be looking specifically at the spine, or in yesterday’s case, the hips. It has been very fun to compare and contrast these different aspects of medicine. I have found both interesting in their own way, which encourages me to pursue a career in healthcare (though as to what specific field, I am still not sure). Almost every time I have shadowed, I have had the chance to meet a new doctor. This is another aspect I really appreciate about this experience because it has allowed me to see the different ways doctors interact with their patients. I am looking forward to the rest of my experience here at Children’s Hospital Colorado.

Week 4: Children’s Hospital Colorado

June 19th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This week has consisted of me continuing to collect data from chart reviews. Once I am done collecting data, I will focus on finishing up the radiographic measures. Something different this week is that I have been working almost completely independently. My fellow research assistant was awarded an opportunity to study disparities in healthcare in Chicago for most of the summer. I am very excited for her, but this has meant that my work has been extremely independent. I check in with her via e-mail or by phone every other day or so, and I check in with my faculty advisor about twice a week. Other than that, it’s up to me to set the pace for how quickly I work. I feel like I am getting into a daily routine and have learned to pace myself fairly well. It has taken awhile to collect all of the data, but I am close to being done with data collection. However, I will still need to finish several radiographic measurements, which I presume might take me a few days. The hardest part about working so independently is that I am not sure if I am ahead of schedule, on schedule, or behind schedule. My goal for the internship is to finish all data collection and radiographic measurements, finish data analysis, and have an abstract written before I leave. I have been trying to set weekly goals for myself and force myself to reach them. The beauty of working so independently, however, is I feel like I am really gaining an in-depth understanding of the data I am collecting. I am excited to see what the statistical analysis shows.

In addition to working on my project, I have also been able to do some shadowing. Yesterday I followed one of the orthopedic surgeons during his clinic days. It was exciting because I saw a large variety of spinal defects at various stages. For example, I saw one patient who had just previously been referred by their primary care physician for mild scoliosis, which will be monitored by the doctors for now. Then, I saw a patient whose scoliosis had become severe enough to require bracing. The goal of bracing is not to straighten out the spine, but rather to prevent the curve from progressing to avoid surgery. Another patient I saw had a curve that had progressed (and was continuing to progress) to a severity which required a spinal fusion. I have read a lot about spinal fusions, but it was different being in the room with a patient and their parents who had to decide if this major surgery was right for them. Once the doctor said surgery was the next step, the room became very silent. I had read so much about this surgery from an academic point of view, but I hadn’t stopped to think about what a major ordeal this is to a patient, and how scary it can be. I saw another patient who was coming in for pre-surgery preparation, as their surgery was scheduled to occur within the next few days. At this meeting, the patient was taught all of the details about what to expect before, during, and after surgery. The PA who met with the patient was very kind and understanding. I could tell the patient felt much more comfortable after meeting with the PA. Lastly, I got to see several patients who had undergone spinal fusion in the past, and it was encouraging to see many of them were doing quite well. I also saw various other types of cases, but those related to spinal fusion surgery particularly stuck out to me since my research is related to this particular surgery. It was very helpful to put faces and names to a surgery I had read so much about. My day of shadowing was very exciting, and continued to reaffirm my desire to become a doctor. It was also nice to take a break from the research aspect of my project, and observe from a clinical perspective.

Week 3: Children’s Hospital Colorado

June 12th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

If there is a take-home message from my work this week, it would be that research can be…well…messy. I have been working on collecting important information, such as post-operative complications, operative time, days in ICU, and estimated blood loss along with many other variables. To find this information I have to comb through old medical charts and decipher the various notes recorded by surgeons, doctors, and nurses (who, by the way, all record their notes in different styles). In theory, this sounds like a fairly simple task, which is the preconceived notion I had. The problem, however, is that in order to collect this data I have to be able to find the notes from surgery. For this project, the patient population we are researching, patients with myelomeningocele who have undergone spinal fusions, is fairly small. In order to get enough data, the project is including patients who had the spinal fusion up to fifteen years ago. Fifteen years ago, the medical charts were often paper form. These paper documents should have been uploaded to Epic, the database where medical information is now stored. The reason it is difficult to find many of the old medical charts is because sometimes the documents are filed according to when they were uploaded, not the day of the surgery. To add to the problem, they are often recorded under some nonspecific title like “historic documents”, in which the surgical notes may be uploaded, but along with pages and pages of medical documents (and not the medical documents I am looking for). This means I have to look through tons and tons of information in order to find the notes related to the patient’s spinal fusion. In other cases, the documents may not have been uploaded yet, in which case it becomes necessary to contact medical records to order a copy of the paper form. This can be frustrating at times, but when I do find and review the patients’ charts I find it very interesting. It is fun to read about the different procedures performed, and I have begun to notice trends. For example, some common post-operative complications many of these patients have are severe infection or hardware malfunction. I feel like I have become fairly good at navigating medical charts through this process, which is an important skill because of my future professional goals.

As I mentioned in my last post, I am also working on viewing x-rays in order to record radiographic measures. I have to look at the curve of the spine and the degree of pelvic obliquity both before and after surgery. It is very encouraging to see how a patient with a very severe curve will have an almost completely straight spine after fusion. Not only is it encouraging, but it also supports my desire to enter the medical field. Below are some photos of the radiographic measures I am referring to. (The x-ray isn’t a photo of measurements I have done myself because I don’t want to release any sensitive information, but, nevertheless, it gets the point across).

                                  pelvic obliquity                                               40-Cobb Angle-1

 

Week 2: Children’s Hospital Colorado

June 5th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

This has been a very productive week for me. After all of the reading I did last week, I was ready to start entering some data. This past week I have been working on calling patients to see if they are willing to help us with our research project. If they say yes, then we mail them consent forms and questionnaires. It was exciting to get to actually talk to some of the patients and to put a personality to information on a patient chart. In addition to that, I have started gathering important data, such as demographic information. I also have been working with the research assistant and my site mentor to decide what information is the most important to collect. I have already started to look through the medical charts of those patients who have agreed to participate in order to start collecting this information.

Another exciting part of this research is that I will be taking radiographic measurements of pelvic obliquity and the degree of curve the patient had in their spine, both before and after spinal fusion. These are important variables we will be collecting for our study, to see if they have any relation to complications in spinal fusions for patients with spina bifida. It is really exciting to be learning such an important skill. I met with my site mentor, Dr. Georgopoulos, on Tuesday so that she could provide me with instruction. I was really glad because I had only briefly met her before. She was very patient with me as she was teaching me this new skill, which I’m sure was very easy for her. Often times, the x-rays may be an image of poor quality, making it difficult to interpret the x-rays correctly in order to perform the correct measurements. This can be frustrating at times, however I am excited to be learning a new skill such as this one. I am finding all of the information I am learning to be extremely interesting, confirming my desire to enter the field of medicine.

Below is a photo of my office-that’s right I get my OWN office! I like to think its because I’m the boss around here, but really it’s just where they had space for me.

Work Space

This past weekend was very fun and relaxing. On Saturday, I picked up fellow Cornellian, Ari Penalva, at the airport. She will be working with another research team, but she will also be in Aurora for the summer. It was fun to help her move in to her apartment in Denver, and I am excited to have another friend close by. After helping her settle in, I had the chance to attend a local festival. It was a beautiful sunny day, and I had fun walking around to see the different arts, crafts, and other festivities. I am looking forward to the rest of my summer here in Colorado!

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Me at the festival I went to.

Week 1: Children’s Hospital Colorado

May 29th, 2013

Bridget Ollesch ’15, Bowen Fellow in Children’s Research

TCH

Wow! My first week has gone by really fast. I settled in with my host family the weekend before I started. I am living in a suburb near Aurora, so I have to commute (about an hour due to the heavy traffic) to work every day, which means I have had to get used to city driving. When I first got to the hospital on Wednesday, I got to meet one of the research assistants who will be working with me for the duration of my project. I entered through the main entrance of the hospital, and then she came to find me and lead me to where I would be working. The hospital is HUGE, so I was glad she was there to help. The first few days of my research have consisted of me doing background research so that I can begin to become familiarized with important terms. Although it seemed difficult at the time, I am really glad I was forced to write critiques of scientific articles in Cellular and Molecular Biology. It helped me learn to read dense scientific journals critically, which has been especially important this first week as I do background research. I have also been learning a lot about starting research, writing protocols, and working to get approval from the Institutional Review Board (IRB). This is necessary for our research because we will be looking at patient charts to collect our data and the IRB needs to approve research related to patients and their protected information.

My project is titled: “Outcomes and complications of spinal fusion in patients with myelomeningocele.” It is a retrospective study, so we will be collecting and analyzing data already present in patients’ medical charts. During the study, one of our goals will be to identify the incidence of post-operative complications among patients with myelomeningocele that underwent spinal fusion at Children’s Hospital Colorado. The secondary aim of the study is to identify factors indicative of an increased risk for complications. Already in the first week I feel like I have learned so much, and I am excited to learn more as my project progresses. In addition to reading plenty of articles, I also got the chance to attend grand rounds last Friday with doctors, residents and medical students, which is an important teaching tool for medical education. I am interested in going to medical school, so it was interesting to glimpse into my possible future.

hiking

I took advantage of the weather this past weekend by doing some hiking and attending a Memorial Day picnic with my host family. It is absolutely beautiful out here, so I am hoping I continue to get the chance to enjoy the outdoors while I am here.

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