WILTIMS #459-461: Riddikulus!

MondayIL: Restrictive bariatric surgeries (when you decrease the size of the stomach to prevent a person from eating large meals) is not super useful for patients who are "grazers." These people tend to just constantly eat small amounts of food throughout the day, which adds up to enormous caloric totals. Restricting the stomach's size wouldn't do much to prevent these people from continuing with the same detrimental lifestyle. In contrast, "bingers" mostly eat at normal meal times but eat monstrous proportions. These are the best candidates for restrictive bariatric surgeries, as they will feel sated after eating only a tiny proportion of their normal portions.

Tuesday: Yesterday was fairly action packed. I saw three procedures: a hernia repair, a lymph node biopsy, and another far more complicated hernia repair. The team I worked with was surprisingly pleasant for surgeons. I got a good amount of medical student tasks (retracting, applying suction, cutting suture threads, and a little bit of suturing), but the most fun was actually a trip to the pathology with the lymph node of our second patient. There I watched a moment from my past from a different perspective.

The node in question was greatly enlarged and even upon the first incision into the tissue, the pathologist said it looked like lymphoma. Using a surprisingly wonton dying process, the pathologist prepared a thin slice of the tissue to look at under the microscope. This was a teaching microscope with two heads, so I could look too. There the pathologist pointed out the different cell types and said that preliminarily he would give a diagnosis of lymphoma, likely of the Hodgkin's variety - the same one I was diagnosed with 4 years ago.

YesterdayIL: A panniculectomy is the surgical excision of the excess folds of tissue below the belly that can occur in the very obese. We performed a pro bono one of these yesterday since we needed to get below that tissue anyway to repair the patient's hernia. I had the unenviable job of holding back the ~10 pounds of fat as two surgeons cut it away from the tissue beneath. It was quite a workout.

TIL: ...how to do a continuous subcuticular stitch. I've seen pieces of this technique several times but today I got to practice from start to finish on a patch of fake skin in the surgical skills lab with our preceptor. Now, if only I could practice with fake blood and a surgeon-boggart to replicate the OR anxiety...