Vascular surgery.

I spent Monday working in Dr. S's vascular clinic. It was an insane day - from 8 AM to 5 PM we were seeing patients basically nonstop - I had a fifteen minute break for lunch midafternoon, but other than that we were running around pretty much constantly.

Even though I dislike clinic, I admit that I learned quite a bit. I'm finding that I'm getting much better at locating things on CT scans and ultrasounds. I'm pretty sure I could now point out a decent-sized abdominal aortic aneurysm (AAA) on a CT, for example.

Anyway, the day was spent doing patient evaluations and follow-ups. The first patient was a 71-year old woman with pain in an old AV hemodialysis fistula. I'd already encountered AV fistulas when I shadowed nephrology and dialysis, but it was neat to be able to feel another one.

At some point I was instructed to head off with one of the ultrasound techs and watch them perform a carotid ultrasound on a middle-aged man. That was pretty neat because you could clearly see the areas of stenosis by watching the blood flow.

In a weird twist of luck, I got to see the same woman with the huge leg ulcer I described a few weeks ago - this time being evaluated following her unilateral above-knee amputation. According to Dr. S, the wound site was healing nicely, though there was a bit of raised swelling around the staples, leading him to think that she might have developed a fungal infection.

The neatest case of the day was a 70-ish man visiting post-AAA repair. Endovascular aneurysm repair involves fitting a synthetic graft inside the damaged blood vessel so a thrombus forms in the space between the graft and vessel wall, with the blood rerouted inside the graft. This takes the pressure off the native vessel and prevents it from rupturing. Anyway, Dr. S showed me the patient's post-op CT scan, where the graft and the wires were clearly visible running down the aorta and branching into the iliac arteries. I thought that was pretty cool.

All in all, it was a very educational day, though I'm not eager to repeat that sort of crazy clinic schedule anytime soon. I meant to go for a run yesterday because the weather was so lovely, but by the time I got back to my room and kicked off my shoes, it was all I could do not to collapse for the night. Blah.