Journal Entry #13

Amita Raj

Abney

6^th Period

Journal Entry #13: Tuesday, November 30^th

                I spent Tuesday with my mentor at her clinic. One of the two patients I saw today were somewhat different from t he patients I was normally accustomed to seeing.

                The first man was in his eighties and had a very severe medical history. He has been affected by two types of cancer, is diabetic, and has suffered memory loss from the extreme chemotherapy he took. He has had many surgeries and they have affected his ability to remember specific things from his past. The first problem with this was that his medical history still has holes in it, and the doctor found out two other important conditions that he has based on having a conversation with him. It has also been difficult for his doctors to keep a track of what medicines he takes for his symptoms/diseases. However, I was pleased to see that his kidney function was under control (for the time being) and he has been taking good care of himself by taking his medicines at the right time and in the right doses.

                This was my last day with Dr. Venkatesh. It has been a truly rewarding experience to work with her and she has taught me so much. I am surprised that I am able to retain a great deal of the information that he has taught me and I hope I will be able to use my experience in the future.

Journal Entry #12

Amita Raj

Abney

6^th Period

Journal Entry #12: Thursday, November 12^th and Tuesday, November 15^th, 2010

                I spent both Monday and Tuesday with my mentor at her clinic and saw four patients. In all cases, the patients were severely obese and this made their kidney function worse. One particularly interesting case I saw was a woman in her late seventies who exhibited less than 15% kidney function. Since she was diabetic, this meant that she would need to be put on dialysis soon. I was surprised to hear that she did not want to be hooked up to the machine that could potentially prolong her life. She told me that her sister had been using a dialysis machine and she did not want to experience the same hardships that she went through. She wanted to reach the end of her life naturally without having a machine supporting her. The doctor respected this decision and told her she would conservatively treat the symptoms and do the best she can to make the patient feel comfortable.

                I also discussed my final presentation with my mentor, and she offered to help me whenever I needed it. I also inquired about surgeons she knew who might be willing to mentor me for next semester. Last Tuesday was the last day I would be able to work with my mentor since she is going on vacation for the rest of the week. It has been a truly inspirational experience working with her. She has given me a lot of insight into her career and I hope I can be as successful as she is once I become an established physician.

Journal Entry #11

Amita Raj

Abney

6^th Period

Journal Entry #11: Monday, November 8^th and Tuesday, November 9^th, 2010

                I spent both Monday and Tuesday with my mentor at her clinic. I saw four patients and only one of them had received good news for the future. This was unorthodox. Normally, my mentor tells her patients that their conditions can never improve but can only be sustained, or have the deterioration period elongated and/or avoided. After reviewing the lab results, the doctor concluded that when the bloodwork was taken, the patient must not have been hydrated enough, therefore displaying high creatinine levels. The primary care physician saw this and immediately referred the patient to a sub-specialist (my mentor). I asked the doctor if this was a normal practice because if creatinine levels were only slightly higher (0.2 more for this patient) than normal, it would only make sense to do the bloodwork again. This led to a lengthy discussion about the health care system, the government, and the future of doctors and their salaries. Although the medicine field may be headed in the negative direction, I am not discouraged and I feel like I can still have the satisfaction of helping take care of others.

Journal Entry #10

Amita Raj

Abney

6^th Period

Journal Entry #10: Tuesday, November 2^nd 2010

                I spent Tuesday at my mentor’s clinic. I was able to learn about the cases of three patients, two of whom I had personally met. I learned a great deal about Urinary Tract Infection (UTI) and my mentor taught me about other bacterial infections and diseases that accompany low kidney function. The doctor told me about various strains of bacteria which can be acquired in the hospital environment and how some patients can be severely affected by acquiring the bacteria. One woman was in a great deal of pain from UTI because it caused her to have back pain and swelling. It was encouraging to see that the patients my mentor saw today have a stable kidney condition since they were following all the doctor’s instructions and gave her good descriptions of their progress.

                I was unable to meet my mentor again since she was not on call and did not have to go to the hospital or the clinic.

Journal Entry #9

Amita Raj

Abney

6^th Period

Journal Entry #9: Thursday October 21 and Monday October 25, 2010

                I spent Thursday with my mentor in her clinic. I saw two traditional cases of kidney disease and learned a great deal about biopsies and a lot of the chemistry-related details behind the lab work.

                My second visit with my mentor was at the hospital, and I had the opportunity to see more interesting cases. I learned a lot about various types of catheters and the risks and complications that accompany the different kinds. I met a patient who was in her seventies who has had juvenile diabetes since her childhood. This led to kidney problems quickly and she had to go through many surgeries with many different temporary catheters. She had a lot of scarred tissue and they were running out of places in which a catheter could be placed.

                This meeting with my mentor was very educational in terms of the patient-doctor relationship. This is because I was actually able to talk to the patient in length about her conditions and the precautions that she has had to take. I look forward to interacting with patients in the future.

Journal Entry #8

Amita Raj

Abney

6^th Period

Journal Entry #8: Monday October 18 and Tuesday October 19, 2010

                I spent Monday with my mentor in the hospital and spent Tuesday in her clinic. In the hospital, I saw two patients. One was in the general ward and had a more stable kidney function than the one in the ICU. However, woman was having major difficulties because she had a distended abdomen. This was filled with about 8-10L of fluid and had to be drained out periodically so it was not harmful to her body. The man in the ICU simply had chronic kidney failure. A certain level of ammonia in the body can have negative effects on one’s neurological system. It caused him to be confused, but after treatment, he became more mentally stable.

                In the doctor’s clinic, one patient was forced to be in a wheelchair because of a foot infection that was caused by kidney disease. Her other vitals seemed normal, and she had about 50% kidney function. She was on a great deal of medications (I counted over 15) and this was having a negative effect on her body. However, the doctor said her condition was manageable and she should come every month to the clinic to make sure that her kidneys are not deteriorating. The second patient I met at the clinic was deaf. She had  a translator with her, and it was interesting to see how the doctor communicated with her. This woman also had a manageable kidney disease, so the doctor was very positive that she did not need to see this patient as often anymore.

                With respect to the field of nephrology itself, I learned a great deal about the biochemistry involved in the functioning of the body. I remembered some information from AP Biology about sodium and potassium (etc.), and I was pleased to see that the doctor was impressed by that knowledge.

Journal Entry #7

Amita Raj

Abney

6^th Period

Journal Entry #7: Thursday October 7 and Tuesday October 12, 2010

                I spent both days with my mentor in her clinic. Since I was here last week, I knew what to expect with the kinds of cases she would receive. On Thursday, I saw a man who had just gotten a surgery for a fistula in his left arm. He was middle-aged and had very bad kidney failure. The fistula is used during dialysis. (Note: A fistula is formed when an artery is connected to a vein.) The doctor showed me that if I touch his arm, I will feel I slight buzzing because of this unnatural connection. It felt somewhat like a cell phone on ‘vibrate’. The rest of the time on Thursday, the doctor talked to me about some of the other interesting cases that she had at the clinic, describing in detail the kinds of medicines that were used in treatment.

                On Tuesday, I prided myself in being able to remember many of the medicines that I had previously learned about (although I cannot spell any of them). On this day, I was able to see one of the scariest cases of obesity that had led to Stage 3 (there are five stages, 5 is the worst and means they need dialysis) kidney disease. This woman had many other conditions like psoriasis, edema (caused by kidney failure, build up of fluid especially around ankles; is treated with diuretics), cirrhosis (caused by Hepatitis C rather than alcohol), and rheumatoid arthritis. In addition, she lost one of her kidneys some time ago and the only one left was barely functioning. However, the medications that she had been taking seem to have stabilized the kidney function.

                The second case I saw on Tuesday was extremely interesting. The patient was a 27-year-old man who had suddenly exhibited symptoms of kidney failure. He is not a smoker, a drinker, and never used illicit substances. He had slightly high blood pressure but was not obese. There was no family history of kidney disease either. The doctor was disturbed that a man so young would already have only 35% kidney function. She tested him for other diseases like HIV that would probably affect his kidneys. However, every test she ordered came back negative. This was when she decided she needed to do a biopsy on him. The results of the biopsy showed that the disease this man has is Focal segmental glomerulosclerosis (FSGS). This disease is normally found in children and adolescents, but can lead to kidney failure in adults. What scared me most was when the doctor said, “Kidney disease can never get better, it can only get worse. Our aim is to make the disease get worse slower than it would so you can put off dialysis for a long time.” The patient was nervous about the idea that he might have to start going for dialysis treatment within the next 5 to 10 years.

Journal Entry #6

Amita Raj

Abney

6^th Period

Journal Entry #6: Wednesday, October 6 2010

                This week, with my mentor, I worked one at her clinic and one hour at the hospital.  At the hospital, she showed me a patient with Peritoneal dialysis and explained how the machine cleaned the blood without being too intrusive on the body’s arteries. We discussed the importance of surgery with respect to kidney disease .

                At her clinic, I was able to see patients with milder forms of kidney diseases.  Most of the these patients showed good progress with their diagnoses and the treatments seemed to working out well, showing that there is great hope for the future. Our discussion also included the various medicines that the doctor used for treatment in her cases. She explained the implications of each and showed me some of the research that will be happening for future drugs.