Human Anatomy at Colby

Breanna Davis: My January Experience

February 14th, 2014 · Comments Off on Breanna Davis: My January Experience

Breanna Davis: 2/14/14

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This Jan Plan, 2014, I was given the opportunity to take an Introduction to Anatomy and Physiology class with Dr. Thom Klepach. I have always loved Anatomy and Physiology and I hope to be a medical doctor some day, so it seemed necessary to take a class about the human body in College. Going in to the class, I had expected that I would be in class for around 3 hours, 4 days a week. I also expected that I would do really well on the quizzes and tests because I did very well in Anatomy and Physiology in High School. However, I did not expect what actually happened, which was to be pushed to my limits, learn about myself when under stress, and learn how to present a case-study.

I am a student-athlete at Colby and a student-worker. This allows for less time in my day that can be spent freely as I choose. I am a sophomore, so I have learned how to keep a healthy lifestyle and balance all my commitments in the past year. However, this January was something I haven’t quite experienced yet. In the Anatomy and Physiology class at Colby, I learned so much more than the names of the body and how the systems of the body work. I learned how to communicate with my boss, my coach, and my teacher in ways I haven’t yet done.

Our hockey schedule switches away games to home games each year. Last year, we had only one weekend away during Jan Plan, Connecticut College. This year, of the four JanPlan weekends, we had three away games, Trinity, Amherst, and Williams. We didn’t get back before 12 on any of those Saturdays because it was snowing every night when we came back. The one weekend home was our Alumni Weekend, which ended up being just as time consuming as an away trip. Some people would say, “Why put yourself through that?” My answer would be because we love our team and the sport. We aren’t quite ready to give up competing at a high level.

Having multiple commitments makes it hard to prevent them from ever overlapping. If you miss practice, you won’t get as much playing time. If you miss school, your grade will go down. If you miss work, you don’t make money. I managed to only miss work 3 times and practice once because of class. I realized that being a student-athlete may make things more complicated and may take away from the classroom, but I realized in this class that learning how to balance many commitments and keep my stress levels down will be a very important skill in Medical School.

Because I found a balance, I was able to go on the trip to Boston to see the Body World Museum, take a tour of MaineGeneral by 3rd year Medical Students, and present a case on Strokes in young adults to Doctors. With just those field trips, I would have felt like my Month of January was a success. For me, those trips helped me learn more about Medical School, anatomy, and presenting to a crowd than sitting in a lecture could. The lecture is necessary to get knowledge, but I believe the real learning is done by trying, practicing, touching, and taking what is learned in lecture to real life situations. The reason why I would recommend this class to anyone, even though it did put me in over my head, is because of the field trips and projects we did. This class did a great job teaching beyond the classroom.

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My coach came to our group’s presentation and learned about Ischemic Strokes in Young Adults. The other day when she sent me an article about a professional hockey player, age 28, that had a recent stroke, I realized that my grand rounds talk had made a difference. Our group’s main focus was to raise awareness of strokes in young adults because they have increased in recent years. In the article, the hockey player happened to say almost the exact same thing. He listed symptoms, as we did, and said to get checked immediately instead of trying to stick it out. I felt accomplished that I made my coach aware enough to notice the news. It was fascinating to see that something I had created in “class” could be so important and relevant to today.

As a whole, the class affected me in a positive way and taught me important knowledge, taught me useful life skills, and it allowed me to create connections with people I may work with in the future.

 

Tags: Body Worlds Vital · Grand Rounds · Maine General

Grand Rounds: Adolescent Stroke

January 29th, 2014 · Comments Off on Grand Rounds: Adolescent Stroke

By:   Breanna Davis, Emmie Lai, and Adam Lavertu

Rather than focusing on the specific case, we intend to discuss the incidence of ischemic strokes in adolescents drawing support from the case worked on by Phoebe H. Yager, M.D., Aneesh B. Singhal, M.D., and Raul G. Nogueira, M.D. Strokes in young adults are frequently misdiagnosed or not even recognized.

 

 

 

Pretreatment

 

 

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Pretreatment (above) and posttreatment (below) angiography

An ischemic stroke results from a blockage of a blood vessel that supplies the brain. This lack of blood results in oxygen deprivation of the brain; this is what we know as a stroke. There are two main types, cerebral thrombosis and embolisms. Thromboses are formed at the site of the blockage and while embolisms originate somewhere else in the body and travel to the site of the blockage. Some identifying risk factors of stroke include hypertension, diabetes and lipid issues. Many other diseases and conditions can also increase the risk of stroke, for instance patent foramen ovales (PFO) have a high correlation with strokes.

thrombus

Retrieved thrombus and MERSI retriever.

PFOs result from a failure of the neonatal hole in the heart between the right and left atrium to close post birth. Normally the closure of which results in what we know as the fossa ovalis. PFOs can allow clots to enter the aorta, where the clot has the potential to travel to the brain possibly resulting in ischemic strokes. A surprising 14% of all strokes occur in children and young adults (Yager et al.). The majority of which are ischemic strokes, with a lesser incidence of hemorrhagic strokes.

There are over 18 Cardiac causes of stroke in young adults. However, of all these causes of cardiac strokes in young adults, 37% of the patients have a PFO. Unlike many of the causes, PFO’s are source of low and uncertain risk because just having a PFO doesn’t directly relate to a person having a stroke, since 1 in 5 Americans have PFO’s and many of these people go through life with no cardiac issues. Along with a PFO, a person has to have clot form in their blood, and their blood pressure must be high in the right atrium to build enough pressure to push open the flap and send the clot through to the left atrium. This is relevant to our case because our patient had a PFO and got it closed and had no further issues with ischemic strokes. He has made a full recovery but did come very close to death due to the late diagnosis. This was not a surprise because people under 50 are often misdiagnosed since the general public and clinicians are unaware of how often young adults do have strokes and it is not their first assumption.

Common signs are numbness in face or extremities, trouble speaking, disturbed vision, trouble with motor control, dizziness, and headache. Our patient presented with ataxia or impaired motor control, blurred vision, and dysarthria or slurred speech. Initially receiving clinicians searched for a tumor and other sources due to the young age of the patient. After, the rapid onset of symptoms they began to search for other causes. Within 20 minutes of admission to the original receiving hospital, the patient progressed from difficulty walking to needing a wheelchair, within hours he entered into a coma and was promptly transferred to Mass General via airlift. Doctors at Mass General made the correct diagnosis of stroke after performing diagnostic tests including CT scans and MRIs, because the patient was diagnosed with a stroke past the three hour window, he was treated with an endovascular reperfusion, or a minimally invasive clot retrieval surgery. The other options were both made use of pharmacological agents and ran the risk of cerebral hemorrhage. This is due to the possible malignant interaction between the drug and the infarcted tissue surrounding the occlusion. A Merci retriever was guided into the femoral artery to the location of the clot. The retrieved thrombus was 1.8 cm in length. The patient made a full recovery and his PFO closed after a year. He now lives a normal life with an aspirin regimen.

Through this case study, we hope to raise clinician awareness of the rate of strokes in young adults. As clinicians become more aware hopefully there won’t be as many late and misdiagnoses that lead to fewer treatment options, higher risk of fatality and increased treatment costs. Incidence of strokes in people under 34 has increased in recent years, particularly in males. Therefore, it is important that clinicians become more aware and have better clinical cues in order to more quickly work up to the stroke diagnosis, as this problem will only increase.

 

Works cited:

 

George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol2011;70:713-721. http://www.ncbi.nlm.nih.gov/pubmed/21898534?dopt=Abstract. Accessed 13 Jan 2014.

 

“Ischemic Strokes (Clots).” Ischemic Strokes (Clots). American Heart Association, American Stroke Association. N.p., n.d. Webhttp://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp. Accessed 18 Jan. 2014.

 

Ji R, Schwamm LH, Muhammad P, Singhal AB. “Ischemic stroke and TIA in young adults: risk factors, diagnostic yield, neuroimaging and thrombolysis. Arch Neurol (in press).” JAMA Neurol. 2013 Jan;70(1):51-7. http://www.ncbi.nlm.nih.gov/pubmed/23108720. Accessed 14 Jan 2014.

 

Krasuski, R. M.D., Tuzcu, M. M.D., Kapadia, S., M.D. “Disease and conditions: Patent Foramen Ovale.” Clevelandclinic.org. Jan 2012. http://my.clevelandclinic.org/heart/disorders/congenital/pfo.aspx. Accessed 14 Jan 2014.

 

Yager, P.H., M.D., Singhal A.B., M.D., Nogueira, RG, M.D. “Case 31-2012: A Young Man with Neurologic Symptoms”. New England Journal of Medicine 368:2, 193-194. http://www.nejm.org/doi/full/10.1056/NEJMcpc1208150. Accessed 8 Jan 2014.

Tags: Grand Rounds