Weeks 9 and Ten

Hello everyone! First off, let me apologize for not posting anything at all last week. I know I'm supposed to post material on what's been happening with my project, but sadly I have to report that for past couple of weeks I've been doing the same thing. Recently, Dr. Steidley had to attend several conferences out-of-state and so I've just been working on the presentation that I will have to give at the Mustang Library in May and at the American Heart Association (AHA) later on in the year. That's it. That is literally what I've been doing, as it's really the only thing I can do. It's been slightly frustrating to do this with my hectic and unpredictable work schedule and with the fact that I still haven't been able to collect any data for the "Results" and "Analysis" portions since Dr. Steidley and I are still working with the people at Pfizer as our manuscript was only recently approved. I'm slightly worried that my final presentation may not be what I originally envisioned since I might still be in the process of determining which MCF value correlates with an increased probability of death from cardiac transthyretin amyloidosis.

Even though, the SRP is technically over. I still have much to do with this project and I know that I'll be working on this project over the summer. As of now, Dr. Steidley is trying to arrange another teleconference with Pfizer since I sent him our Table 1 for the abstract we're trying to form for the AHA conference.

For those who have followed my project so far, I thank you just for the fact that you decided to use your personal time just to hear about my experiences. While I know where my project should be talking me, I'm not sure which road I will be embarking on (or am on now) so to speak. Also, I want to thank those who have followed despite my weird formatting with each week's title (I don't know why I changed the numbers each week, I guess I'm just random). Although, my project has taken unexpected turns and I haven't been able to spend as much time with Dr. Steidley as I would have liked, I am ultimately grateful for what this project has done for me. It has allowed me to grow into a more mature and empathetic person while giving me a glimpse into what life is like for those who commit their lives to serving others.

I'll still be posting on my blog since technically my project isn't over; however, I won't be able to post as frequently (or infrequently) due to work. So for those who want to stop now with where my project has been, again I just want to thank you from the bottom of my heart for your support and encouragement. For those who decide to keep reading my blog, I'll continue to put forth my best effort into creating something that's interesting.

Regardless of which camp you fall into, I hope you have a wonderful day!

Week Eight

Hello everyone! Sorry for the slightly late post. Between family responsibilities and my job, I've had very little time to blog. However, I'm glad that I've been busy since its actually given me a direction to go forward in. Lately, I've been thinking about where I should go to college and why, in addition to considering other aspects like research opportunities, academic rigor, diversity, etc. Most people would be terrified to think about where they want to spend the next four years of their lives, but I find it to be exciting for I feel this is the bridge that actually leads you to adulthood (or at least young adulthood).

Anyway, the previous week has been the most fruitful for my SRP. Dr. Steidley and I talked to Dr. Maurer and Dr. Moh-Lim Ong, Sr. Director of Global Medical Affairs, Rare Disease, and Global Innovative Products for Pfizer, Inc. about the next steps for our manuscript. Specifically, we talked about how we would all do the logistics of an analysis for our study and I feel that we have the potential to do something that's promising. In the THAOS registry there are about 600-700 patients whose MCFs can be calculated to find the probability of mortality from cardiac transthyretin amyloidosis. So we have a good sample size to determine if MCF is better than ejection fraction (EF) in predicting this disease. What Dr. Steidley and I have to do now is that we just need to create a Table 1 (a visual representation that includes the common observed characteristics in a particular study) while Dr. Ong and Dr. Maurer send us the data from the THAOS registry. They said that they would compile everything that we need in a week's time, and we would just send them the table whenever we're ready. Our goal is to get our side of the project done within the week they send the data to us, so that we can create an abstract that we could send for review to the American Heart Association (AHA). We're trying to get another paper published within the THAOS registry, since the last one was published a few years ago. If all goes well, then I believe that Dr. Steidley and I will actually be able to present our research findings at the next American Heart Association meeting later this year in November.

That's what is happening as of now with my project. In other news, I went to a lecture called "A Talk on a Talk" in order to learn how to give a great oral presentation for when I have to present my findings at the Mustang Library and hopefully at the AHA later this year. The biggest takeaway I got from the lecture, was that for any speech you give you should speak as if you're telling a story and that people naturally want to be moved by what you're saying. I'm write this to encourage myself to give my best effort for when I do present as well to remind myself to always go out of way to connect with whomever I'm speaking to; for I feel that no matter how technical or unknown the disease is if I can make someone empathize for the people that do live with the disease while raising awareness for it, then I feel that I would have truly done something beneficial with the wonderful resources and extraordinary people I've been blessed with.

Also, I'm not sure how I'm going to do this project for this week since Dr. Steidley will be out of town all week for several conferences. The best I can do is to continue to work on the presentation and finish creating our Table 1 early, for further revisions if necessary. I'll continue to let you all about my progress, so until I hope everyone has a great week!

Week 7

So within the past few days, I've had the biggest stroke of luck. My project was halted when I was told that our manuscript most likely would not be approved until after the end of our SRP. I can officially say that is no longer the case, as I learned quite recently that our manuscript made it in time for the monthly review and the review committee endorsed us!
The next step that Dr. Steidley and I have to take is to have a teleconference with the Senior Director of Global Medical Affairs, Rare Disease, and Global Innovative Products for Pfizer, Inc. We'll be talking to him next Friday to discuss how we can get the information and analysis for our study. It's such a relief to know that all the work you've put in for a project like this is finally paying off.

I didn't do much this week due to unforeseen issues that we're out of our control. All I did this week was spending six hours preparing on the presentation that I will give at the Mustang Library at the end of my project and preparing for the national meeting that Dr. Steidley and I will go to later in the year.

I apologize for this week's blog post for being so short. I know that next week I'm going to transition into a more research-oriented role at the Mayo Clinic, besides observing the ICU and in-clinic patients. I feel that next week will be even more satisfying in terms of my personal growth and my project's development. So until then, have a great week!

Week Six

Hello everyone!

I have to start off by acknowledging that I'm still in the bind that I was previously in last week. We've reached out to Dr. Maurer, but I don't think THAOS will be able to review our manuscript in this month's meeting. This just means that they'll review it at next month's meeting. Despite this obstacle that has been placed in our path, I'm still very confident that I can find something truly extraordinary with my project. Dr. Steidley and I are trying to figure out if I can continue to work more after the end of the SRP, so that way we can compile the data that we'll get from Pfizer and hopefully prove our hypotheses.

That's what's going on with my project as of now. The past two days at the Mayo Clinic were in a one word... stressful. 

On Thursday, I observed more of Dr. Steidley's clinical patients and this one elderly couple stood out to me. Everything was going fine when all of a sudden, Dr. Steidley noticed a condition the lady had that was linked to one of her cardiovascular problems. I wish I could tell you more about exactly what she had, but HIPAA forbids me from doing so. I'll be honest, what she had actually freaked me out. I thought I had seen everything there was to see so far at the Mayo Clinic, but I was oh so wrong. Dr. Steidley had to bring in a urologist and a specialist for a second opinion, and they thought it would be best for her to be sent to the emergency room to be immediately treated.

Yesterday, I accompanied Dr. Steidley as he made his rounds in the ICU. Remember the patient I told you about several weeks ago that was my age? I'm happy to say that he's doing ok! Or at least better than what he was doing back then. Seeing his condition and how he's trying so hard to fight for his life, made me grateful for what I had now. I say this because of all of the college decisions that I've received so far and have yet to receive. I've been doubting myself and letting these decisions affect my sense of worth. I'm ashamed that I was thinking so much about myself when I was in a setting where patients' lives were on the line. Yet, when I saw the man that was my age I had a moment of clarity. At that moment my problems were completely insignificant, as I realized that I've lived a privileged life. I realized I should be thankful for what I have and what I've gained in these past few weeks and I wanted to mention that man as he was the one that gave me my epiphany.

I'll keep you all updated if I have any new information about the status of my project, so until then take care!

Week 5

Hello everyone!

Sorry for posting a little late. My schedule has been completely different since I recently got a job so I've been trying to find a good time to blog. Regardless, several interesting things happened to me this week that I thought I should share with you all.

When I came back to the Mayo Clinic after not being there for a whole week, the cardiologists were happy to see me again. I mention this since they made me feel like I belonged there. It was as if I was a part of their family and I've only been there for a little over a month. It felt truly wonderful to be in a place where I felt truly appreciated just for being there. Dr. Steidley was happy to see me again after spring break and in fact, gave me a packet containing excellent resources from the Association of American Medical Colleges (AAMC) for applying to medical school. He gave me information on what I needed to do during college, when I needed to do it during, how the test will be different, as well as the profile for the Mayo Medical School in Rochester, Minnesota. All of this free knowledge I've been given has encouraged me to be even more proactive when I do go to college. I'm sorry if I'm rambling, but I feel blessed to be given access to all of these resources in medicine and to be able to experience moments that restore humanity.

One of those moments occurred earlier this week where Dr. Steidley and I were walking to the ICU when all of a sudden an alarm rang and on the intercom a nurse said "Code Blue". I found myself running with Dr. Steidley to one of the operating rooms where one patient was thought to be going through cardiac arrest. There were fifteen nurses and three doctors (including Dr. Steidley) who tried to stabilize the patient while monitoring his vital signs. The whole ordeal lasted for about a few minutes, but it felt like someone one would see from "Grey's Anatomy". In the end, it turned out the patient just had a seizure and was going to make it through. Seeing nearly twenty people working in unison to save one life was incredible and in that moment I was not overcome with anxiety but rather relief. I can't explain why, but despite how extreme that situation was I felt as if everything was just going to be alright in the end. It might be just from my association with the people I've encountered at the Mayo Clinic, but their professionalism and calmness in this situation was inspiring. I can say that I can not forget this moment for it perfectly summed up the reason why I wanted to be a doctor.

Now to talk about my project itself.

On Thursday, we sent our final version of our manuscript to THAOS. As proud as I was of our accomplishment, I was dismayed to learn that we would hear back from the committee in five weeks for approval. I found it sad, since by the time we found out my SRP would be over and I wouldn't have had the chance to use the data that we would have received from Pfizer to calculate each patient's MCF. This might be a major roadblock, but Dr. Steidley and Dr. Maurer are trying to speed up the review process from five weeks to one, since THAOS has a monthly meeting where they review sent research proposals. Our fear is that our proposal won't make it in time for this month's review. The worst case scenario is that it doesn't and that I'm going to have to find another way to find the MCF using different data. I don't know what our plan is for now, but as soon as I do I will let you all know.

Week Four

Hello everyone!

This week was incredibly exciting since I finally got to talk with Dr. Maurer. Our conversation went extremely well and was surprisingly informal. We talked about how his volumetric index, the Myocardial Contraction Fraction, could be used as a reliable predictor of cardiac transthyretin amyloidosis. He and several other cardiologists developed it over a decade ago; however, they haven't established a numerical quantity with MCF yet that can accurately predict which patients have the deadly disease. He wanted Dr. Steidley and me to use data that Pfizer will give us in the near future to determine an average MCF value for afflicted patients. I'm continually humbled by this rare opportunity that I have been given to work with esteemed cardiologists and one of the world's largest pharmaceutical companies all in an effort to improve someone's quality of life. I feel that the highlight of our conversation was that Dr. Maurer would want us to present our findings later this year and afterwards Dr. Steidley told me he was looking for the next major cardiology conference to present our work! For now it seems that could actually happen, and I want to make that happen. The eagerness that I have to use the data that Pfizer will give us is killing me! At the end of our conversation, Dr. Maurer wanted us to send him our abstract proposal so that he could give that to a statistician he's working with.

All of that happened this Monday. I've revised the abstract proposal throughout the week, getting most of it done that day (I was on a roll and didn't want to stop). Yesterday, Dr. Steidley looked at our proposal, revised it to make it more scientific (because despite all my efforts I'm still a high school student), and sent it in to Dr. Maurer. Compared to previous weeks, I only focused on just one thing- my project. I felt like I made huge progress this week and that by the end of the project I'll have done something truly great. Next week Dr. Steidley and I are off for spring break, so I won't have anything to post. I'll be back in two weeks and hopefully Pfizer will give us that data we need to make our analysis. I've spent four weeks on this project so far and I can honestly say that I am enjoying my time at the Mayo Clinic. I've learned so much about the medical world, ideal doctor-patient interactions, and revolutionary biomedical technology that will be present within the upcoming years. I'm glad that I have this opportunity and I hope that I will continue to make a significant contribution to my project.

Week 3

After spending three weeks at the Mayo Clinic, I can positively say that in order to be a doctor one has to be emotionally durable. I continued to visit more of Dr. Steidley's clinic patients this week; however, two of them stood out to me that I want to talk about.

The first one was an elderly man who had recently been diagnosed with the disease I've been studying. While most physicians diagnose it four or five years after someone gets it, his physician was able to diagnose him with it in a month. I was personally happy for him since I thought that he could get a liver transplant and he could live a longer life. But he can't. Since he was too old, he couldn't be a candidate. I don't know what he can do now knowing that his only treatment option available for him was just gone.

The second one was a teenager who was around my age who had several serious health issues (again I'm being vague because of HIPAA sorry). In his case, Dr. Steidley knew that he most likely wasn't going to make it. I only got to see his patient information and I didn't even know him. Yet, I was heartbroken to see someone who had his whole life ahead of him only to be cut short. I actually saw him again when I was on break, I nodded him and he nodded right back. His family was with him also and despite the gravity of the situation, his family was somehow optimistic. They didn't let the fact that he would be gone in the near future plague them.

The two people were at the extremes in the spectrum of age, yet they were going to meet the same end soon. I'm not sure how Dr. Steidley or any of the other doctors don't get too preoccupied with these types of patients like I had been in the past few days. Maybe emotional resiliency naturally comes with the job, maybe they've gone through it too much and know how to handle that baggage. Either way, I don't know. One thing's for sure, having to interact with these two patients bolstered my resolve to become a doctor. I kept thinking to myself that by the time I get through college and medical school and residency and a fellowship that medical knowledge/technology would advance to the extent where I could save these types of patients. It might seem a little silly, but that's just something I've been thinking about that I felt I should share.

With regards to my Senior Research Project, I just started working on my hypothesis, background, and methods section for our publication. I will be meeting Dr. Mauer next week to discuss our project, what he may want, and what we can do. I'm both excited and nervous to meet him, since there's a lot riding on this. I'll update what'll happen soon.

Week Two

My second week at the Mayo Clinic Hospital has been engaging and eye-opening.

This week was my first one where I had the chance to meet Dr. Steidley's out-of-state clinical patients, whereas previously I met patients who were in the ICU (Intensive Care Unit). The more time I spend with Dr. Steidley, the more I get to observe his bedside manner with his patients. I mention this because in the three days that I was at the Mayo Clinic, I have met people from all over the country with each person expressing strong emotions with his or her respective heart condition. From dignified optimism to harrowing despair, I witnessed it all. What was even more remarkable to see was Dr. Steidley's response to each patient. Be it hilarious humor or sincere sympathy, he knew exactly how to console each person, so that when he or she left the room the individual would return home in high spirits.

In the time that I wasn't meeting out-of-state patients, I attended conferences or continued to develop my project.

A conference I thought was astounding was one that discussed the latest technology regarding Stem Cell Engineering for Diseased Tissues. Presented by a doctor from the Rochester Mayo Clinic, he talked about using skin cells from a baby to cultivate stem cells that could then turn into any desirable tissue. The tissue would then be placed into whatever organ and would replace the diseased tissue available in said organ. The significance was that it was now possible to cultivate stem cells without taking them from an embryo, thereby eliminating the controversy regarding the usage and destruction of embryos. I found this advance in science to be (in the truest sense of the word) incredible. The only problem that scientists have now is that this procedure only works for a small subset of a large group of people, so now the issue scientists face is how to make it work for everyone.

A few weeks ago, Dr. Steidley mentioned the possibility of getting a paper published. Now I can say that the possibility is becoming a reality. Yesterday, he and I started on a proposal publication for THAOS. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is a multinational, longitudinal, and observational database that compiles data regarding Transthyretin Amyloidosis for clinicians and patients. Its goal is that through combined knowledge and dedication, effective treatment options for the destructive disease will develop. Even though it was established in 2007, it has only published two articles. However it has a strict rule that each publication has to be original in that the topic has to be something different about amyloidosis, otherwise the Executive Committe won't approve the publication. Our paper is about Myocardial Contraction Fraction and how it may be used for determining patients with Cardiac Transthyretin Amyloidosis. We've already filled the basic information, now we just have to create our hypothesis, determine our methods, elucidate our results, and elaborate our discussion. I look forward to the upcoming weeks, as we work with the patients at the Mayo Clinic to see if MCF is a viable volumetric index for detecting this deadly disease.

My second day visiting the Mayo Clinic was even more eye-opening than my first day.

I started today by shadowing Dr. Steidley again as he made his rounds. This time, I got the chance to listen to someone who had a heart murmur. I have to say, the patients at the Mayo Clinic are very receptive and supportive of me. They commend my endeavor to learn everything I can about the medical world, so that I can become a doctor.

Later that day, I worked with Dr. Steidley to calculate the Myocardial Contraction Fraction (MCF) of a patient. It was a relatively simple problem, as MCF is just the ratio of stroke volume to myocardial volume. Stroke Volume (SV) is calculated from a patient's Cardiac Output (CO) divided by the Heart Rate (HR) [SV=CO/HR]. Myocardial Volume (MV) is calculated from the cubed value of a patient's Left Ventricular End-Diastole Dimension (LVEDD) plus the Inter Ventricular Septum Thickness (IVST) plus the Posterior Wall Thickness (PWT) minus the cubed value of the Left Ventricular End-Diastole Dimension (LVEDD) [MV=(LVEDD+IVST+PWT)³-(LVEDD)³]. It took me about twenty minutes to solve the problem, as I later realized that I was dealing with two different measurements and my work wasn’t making any sense. I mention this story since it was a good lesson on living and learning, not to mention that it I thought it was pretty funny.

After I calculated the problem, I observed another open-heart surgery where Dr. Steidley inserted a catheter through a patient’s left ventricle. The surgery itself wasn’t even the highlight of my day. At the end of my day, I was allowed to sit in on a conference where the cardiologists at the Mayo Clinic were discussing which patients would receive the next heart transplant.  As an outsider, it was interesting to see the doctors consider all types of factors for their decision. They considered matters such as age, organ stability, finances, access to family and friends, and current lifestyle. It was also interesting to see how long patients had been on the waiting list. Some were placed on there just yesterday where others had waited as long as a year and three months to receive a heart.

The more time I spend with Dr. Steidley and the other cardiologists at the Mayo Clinic, the more invested I become in my Senior Research Project.

Today I officially started my Senior Research Project, by visiting the Mayo Clinic Hospital. 

However, earlier this week, I had the pleasure of discussing the new aim of my Senior Research Project with Dr. Steidley over dinner. Through good fortune, I gained the opportunity to collaborate with Dr. Mathew S. Maurer, a cardiologist affiliated with the Columbia University Medical Center. He has been developing a volumetric index called Myocardial Contraction Fraction (MCF) that gives a more accurate measure of ventricular function, compared to the traditional method of ejection fraction. He wanted Dr. Steidley and me to explore this type of research, specifically with the number of patients available at the Mayo Clinic. The significance of my project would be that by using MCF and a simple echo screening, we would be able to identify patients with cardiac amyloidosis vs. other forms of heart failure. To this end, I am learning Basic Statistics for the Health Sciences so that I may be able to obtain reliable data using this index. If I progress far enough, Dr. Steidley believes that I may be able to publish a paper detailing MCF's efficacy and possibly present it at a national meeting.

I mention all of this, so I can better put into context the incredible experience that I had today. For the first three hours of my time there, I had the opportunity to shadow Dr. Steidley as he made his rounds for his patients. I was able to meet his team (six to eight people) who expounded every medical device, every procedure, and every detail they felt I needed to know. As someone who has wanted to be a doctor from a young age, I was enthralled. The more they explained what each patient was going through, the more I wanted to learn about the medical world. Having the opportunity to shadow Dr. Steidley today was academically enriching and personally special. 

After he made his rounds, I was able to witness a conference where a Fulbright Scholar from the University of Pennsylvania discussed HFpEF (Heart Failure with preserved Ejection Fraction) and the research he conducted with advanced cardiac biomechanics. His research idea was astounding and his presentation was engaging.

Near the end of my day, I got the opportunity to witness an open heart surgery. Where some people would be disturbed or grossed out by the medical operation, I was intrigued by everything that Dr. Steidley and his team were doing. It was in the viewing room that a medical technician explained to me what the team's progression step-by-step. I was already interested in cardiology, but this experience gave me a glimpse into the commendable profession of cardiac surgery.

Overall, I had an excellent first day at my site. Everything that I was able to do today strengthened my desire to become a doctor. I look forward to working with Dr. Steidley over the next ten weeks and applying the knowledge I will have gained to good use.

Introduction

Hello and welcome all! I am excited to share with you what I will be researching over the next few months.

My Senior Research Project is focused on a rare, genetic disease called Transthyretin (TTR) Amyloidosis. This disease occurs due to point mutations in the 127-amino acid protein transthyretin, leading to the creation of abnormal proteins called amyloids, or amyloid fibrils, which can be deposited in any organ or tissue. Most commonly, amyloid fibrils are deposited in the brain, kidneys, and heart. Transthyretin amyloidosis affects approximately 8,000–10,000 people around the world; specifically in areas such as Portugal, Sweden, and Japan, which are known as endemic regions.

There are three forms of transthyretin amyloidosis: neuropathic, leptomeningeal, and cardiac. Specifically, the cardiac form of transthyretin amyloidosis affects the heart. Individuals with cardiac transthyretin amyloidosis may have arrythmia, orthostatic hypertension, or cardiomegaly. This happens from amyloid fibrils invading the myocardium, the muscle tissue of the heart. The invasion leads to diastolic dysfunction, a decline in performance of one of the ventricles of the heart. Diastolic dysfunction can cause restrictive cardiomyopathy to occur, which ultimately leads to symptomatic heart failure.

Unfortunately, while treatment options exist for this disease, there is no cure. The disease is an autosomal dominant disorder where over 120 different mutations may be present in transthyretin. However, not everyone who carries a mutation in the TTR gene will develop this disease and the reason why some people do not develop the disease is not known. 

My research question focuses on why some ethnicities, like African American or Portuguese, develop this disease and if possible, develop a more efficient treatment option for these afflicted individuals.