Author: graceg705
Day 8: Last Day :(
Today was our last day at the NIEHS, and it was definitely memorable. In the morning we met at the Keystone building to watch a project meeting. Different people would present projects or questions, and the audience of 20-30 people would pose questions about the structure of the procedure or the uniqueness of the study. The presentation that was most interesting was a member of the NIEHS who talked about adding e-cigs and hookahs to the RoC list for study, expressing how they were different than tobacco products. The crowd had some arguments about this, especially with the hookah, saying it was a tobacco related product. There seemed to be no real conclusion, just a series of questions and concerns asked to the presenter.
Next, we talked with the head of the Molecular pathology program, who described to us what that meant. These Molecular Pathology scientists, looked more at the genes of the samples and evaluated those, how the RNA or DNA pairs switched. This was an important difference to normal pathologists who go only far enough to look at the tissue and cells of the organism being studied. We talked to him for awhile, and he explained to us his background and asked us questions about school.
After this meeting, we headed down to the basement where we watched some of the pathologist take part in a Ping-Pong game. Underneath the facility is a library, and fitness room, with a small Ping-Pong table adjacent.
Our final activity was presenting the presentations we had made concerning the cell-phone modulated radio frequency radiations. I presented the method, results, and analysis from the rat study, showing what I had learned about cells and cancer tumors
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Day 7 : Animal Facility Tour
Today was a slow day, with the excitement starting at 10 when we ventured to the digital imaging lab to get the pictures of the malignant schwannoma of the eye. We took snapshots of the images at 7.5 magnification, 0.7 magnification, and 40.0 magnification. There were about 10 different images of 3 different slides with 3 different stains. While we were taking the images, Mrs. Allen stopped by to see what we were doing. We explained to her, with the help of Dr. Malarkey, what each stain meant and what each tumor was.
Our next big event was after lunch when we got a tour of the basement of the NIEHS building. In this basement area was where all of the mice and rats were kept for the studies. Although we were not allowed to walk in the room with the animals since you need a full gown and mask, but we were able to look through the glass at them. There were huge rooms filled with mice and rats in individual containers stacked on shelves. Some mice were even held in rooms with red light, making it seem like nighttime during the day and day during the night. Around these rooms were rooms were the containers were being cleaned and dried for new studies. There were also surgical rooms for mice and rat operation, and other testing rooms for the mice reaction time and hearing and eyesight.
After our tour Anthony and I went upstairs to continue working our presentation for Thursday on the cellphone radiation study. I am excited for our presentation tomorrow!
Day 6 : NTP Archives
Our main activity for today was visiting the NTP archives in Keystone, a facility a small drive from campus. However, since I didn’t know that the facility was off campus, I didn’t grab my government ID when we left our cubicle in the morning. Once we were leaving the building and I had turned in my visitor badge (which you have to return every time you leave the building), I realized that I probably should have gotten it. However, I couldn’t run upstairs and grab it considering I needed my ID to get into the building at all. I was in a real pickle, but we decided to figure it out when we got back from the archives later. We drove a few minutes to a building labeled the NTP archives in the keystone area of RTP. We were welcomed by a lady named Callie who welcomed us and gave us a tour around the office. Although the offices looked small, we would begin to realize that this facility was actually quite large, storing all of the data and samples from NTP research over the years. We first walked into a two floor storage facility of paper project files, with an incredible amount of boxes stacked one on top of another. Next, we were shown the film room and CD storage room which had filing cabinets lining the walls. In each shelf of the filing cabinet there were thousands of thin pieces of film, each with five or more pages of documents on them. In the center of the room was a small projector, which you could use to read the information on each of the film strips. After, we went to see another two leveled storage room of tissue blocks, the waxed blocks with tissue inside of them. Our tour guide explained to us how this room was actually full, so they were requesting to their supervisor to throw the samples of more than seven years out. We then saw the room storing histological glass slides (another two story room), which had an incredible amount of green storage compartments filled with hundreds of slides. Then we went to see the wet tissue storage room, also two-leveled, and also piled high with brown boxes. After out tour was finished, we met with an employee at the NTP archives who mans the database and digital imaging of the slides. She explained to us how the database works and how scientists are able to receive specific pictures for a specific study, usually using the images as aids to research articles. We then were given a tour of the frozen tissue storage room, which was basically three huge rooms combined. There were multiple refrigerators at -80 degrees Celsius and -20 degrees Celsius along with liquid nitrogen refrigerators and -20 walk-in freezers. All of these refrigerators held and enormous amount of samples, dating back to 1970.
Our tour had finished and we now met up with Dr. Malarkey to review some slides from the cell phone radio frequency radiation study. We looked at a number of slides, all of different rats in the study. We were able to locate a few lesions, characterized by the clumping of blue nucleus’ in one area to fight a disease or infection. After a few minutes we were able to categorize this lesion as a meningioma brain tumor.
We eventually returned back to the main NIEHS complex to eat lunch and sit in on the Dr. Malarkey’s gross review. Every Tuesday, Dr. Malarkey meets with students from 1-3 to help them review for their pathology exams. He told us that in order to become a pathologist, you have to know every disease of every animal. The review consisted of him putting nasty pictures of animals on the board and having the students name the disease present and describe it. Of course, the incredibly scientific and confusing words went straight over our heads, and we instead looked (or tried not to) at the bloody pictures of the animals.
I am so excited for tomorrow and all the fun activities to come!
histological glass slides
tissue blocks
wet tissue
frozen tissue
digital images
Day 5: The NTP at the NIEHS
Today was my first day at the National Toxicology Program with Dr. Malarkey inside the National Institute of Environmental Health Science site. First I had to go through security clearance at the front gate, showing my ID and my incredible smile (they knew I wasn’t a criminal). We then drove through the campus to reach building 101, which was a huge building overlooking their lake. I received my visitor ID and met Anthony in the front lounge who was checking in at the same time. We waited in the front couches until Dr. Malarkey came to pick us up. We went up to the third floor of the building, and Dr. Malarkey showed me the cubicle Anthony and I would be sharing. There were already a few abstracts on the countertop that I would need to read, to familiarize myself with the cell phone radio frequency radiation study. We made the short walk from our cubicle to his office, where he showed us his pathology museum. This consisted of shelves full of antiques and artefacts including his first set of miniature microscopes and slides, horse intestine stone, emu egg, and old books. We looked at a few of the old slides through the two person microscope he had in his office, looking at lobster larvae.
We set Anthony up with a few slides of the eye and Dr. Malarkey asked him to identify the different parts in the eye, location and type of tumor, and type of tissue and cells. While Anthony was squinting into the microscope, Dr. Malarkey gave me a tour of the third floor office and an introduction to what he and the pathology group does. In his doctorate program at NC State, Dr. Malarkey specialized in looking at liver cancer in mice. Hence, he went to teach in a lot of different countries after becoming well-known for this research. His research and focus still involves testing rat and mice, but the most important study of present is looking at the effects of cell phone radio frequency radiation on the presence of cancer. The National toxicology program also releases thick reports every few months about the results of the research they have been conducting. Dr. Malarkey explained how these thorough documents take close to ten years to prepare with almost 30 people working on each edition. We looked at a few together, all looking at how different chemicals, radioactive sources, or drugs effect the chance for cancer. To do this they test the materials on mice, rats, fish, and genetically modified mice. Most studies use mice and rats as the group, testing both species male and female.
After this, we all went downstairs to the ten person microscope to look at the slides Dr. Malarkey had given Anthony. After focusing all of our individual eyepieces, we determined that the first slide was actually a cross section of an eye. Dr. Malarkey helped us to name and locate each part of the eye including the optic nerve, lens, cornea, etc. The slide also had a tumor on the right and left sides of the optic nerve, and helped us characterized each type of nerve so that we could recognize them in this slide and the next ones. We then looked at other slides, including one with a cat who had cataracts. After discuss more characterizations of cancer, cells, and learning that blue means nucleus (bad) and red means blood, we headed to lunch.
After lunch, Anthony and I went to the histology labs to watch how samples and slides are made. First we visited the Necropsy department to watch the dissection of a mouse. The mouse was killed with carbon monoxide poisoning, and then the scientist covered it’s skin in ethanol. Using scissors the scientist cut open the mouse’s skin, and carefully removed all organs in the mouse. With our careful observation, we were then allowed to dissect a mouse of our own, removing every organ as well except for the esophagus.
I had so much fun today and am so excited for tomorrow!
Day 4: Last Day
For my last day at the Fuquay Varina Pediatrics office, I was again with Dr. Dupuy. Unlike this past week, today was unusually slow. In fact, in the morning we only had a handful of patients, but this was on purpose. Dr. Dupuy’s most intensive special needs patient was coming in to get a yearly blood analysis test, and this appointment would take longer than others. It took the nurses about 20 minutes to fill a few tubes of blood, and then after Dr. Dupuy did his normal wellness check procedure. The family was incredibly appreciative and complementing of Dr. Dupuy, describing how he was so popular they had to schedule their appointment four months in advance. This truth was again repeated when the nurse asked about a patient who needed a necessary wellness check by the next two weeks, but Dr. Dupuy was booked until august. With his passion and true care about each patient, he decided to give up one of his lunch hours to meet with this stressed patient.
The afternoon was also slow, with more wellness checks and a few checkups for patients with ADHD. This was a simple check of social, emotional, and physical components of the patients. Dr. Dupuy would first question the parents, asking if they have noticed any difference in the kids attitude. Next, he would ask the patient if they had noticed a difference in their social interactions or behavior. This was important to understand if the drug was too intense for the child, and affecting them in more ways than it should.
I also saw a cholesterol test today on two patients. Dr. Dupuy likes to test a patients cholesterol levels when they are between 9-11, to make sure everything is ok. The nurse just finger pricks the patients, and squeezes the incision to fill a very small tube full of blood. This is than brought to a machine in the office which does a blood analysis, including cholesterol.
Other than these checkups, today was pretty relaxed and similar to the past few days (a lot of wellness checks). I have had a lot of fun, and am so excited for the NIH next week!
(I had to use this picture from the internet because HIPPA laws do not allow me to take pictures of the patients or their results)
Day 3: There’s a New Doc in Town
Today was a little different, because instead of shadowing Dr. Dupuy, I was shadowing Dr. Durand-Smith. At this particular office, doctors get one weekday off each week, and today just happened to be that day for Doctor Dupuy. Either way, I had a great time with Dr. Durand, and it was interesting to see two different techniques to the same job. Like Dr. Dupuy, Dr. Durand had a lot of well-checks or physicals, and a few abstract appointments as well. In the first minute of meeting her, she was very open and informed me about a particularly unique patient. This patient’s feet turned white, purple, and were freezing, and eventually the patient had to use a wheelchair because she was not able to walk on her feet which felt like they had needles going through them. Dr. Durand thought this was Raynaud’s disease combined with chilblains. Raynuad’s is a disease in which a part of your body feel numb and cold in response to cold temperatures or even stress. Chilblain is a medical diagnosis to describe a painful, itching swelling on the skin from poor circulation. When the patients feet were iced, they turned a bright red color and were swollen, indicators of this chilblain phenomenon. However, Dr. Durand was not hesitant to seek extra help, getting in contact with multiple duke doctors in dermatology, rheumatology, and neurology.
While this particular patient was in the back of her mind all day, Dr. Durand had a number of wellness checks for today. The first couple started in the morning, with the patients being two and under. I observed as Dr. Durand checked the babies knees, hips, back, heart, lungs, eyes, ears, nose, stomach, and privates. There were a few things that were different than Dr. Dupuy’s checkups I had seen the day before. Dr. Durand checked the patient’s knees and eyes, while Dr. Dupuy spent that time to have more in-depth conversations about food intake, nights, pooping, etc. Dr. Durand also talked about these subjects but usually when prompted by the mothers after the doctor asked “is there anything of concern today”. What I learned was that neither approach was better than one another, but unique to each doctor. What is again so interesting is that if I do decide to study medicine, you have a large canvas to decide and create whatever doctor patient experience you would like to.
In the afternoon, Dr. Durand mostly saw teenagers. Most of these appointments were also wellness checks, so I sat in her office to not make the patient uncomfortable (considering we were around the same age). While in her office she gave me a textbook to read called The Atlas of Pediatric Physical Diagnosis. With more than 500 pages, I mostly flipped through and looked at the pictures and their captions. However, there were about three to four pictures per page, so I had a lot of reading to do. It was incredibly interesting with subjects ranging from orthopedic studies to surgical observations.
After all of the teenage wellness checks ended, I accompanied her to a sick patient appointment. This patient complained of not being able to hear out of her left ear after using her q-tip to clean her ear. This would of course be concerning, but Dr. Durand already had a hypothesis of the problem – ear wax. She thought that by using the q-tip, the patient had pushed her ear wax towards her ear drum, blocking it’s ability to hear. After using a water pressurizer machine to loosen the ear wax from the back of her ear drum, Dr. Durand used a tool to pull a dark glump of ear wax greater than the size of the pea. Of course this sounds disgusting, but it was actually awesome. She preformed the same procedure on the other ear, and received a similar sized glump of dark ear wax. Other than being super cool, the patient remarked how she was able to hear better than she had in a long time.
I am so excited for my last day at the office!
Day 2: In the Groove
I arrived promptly at 8am, to learn about the new plethora of patients we would be seeing today. Although there were a smaller amount of walk-in patients, there was a great amount of already scheduled appointments. Most of the morning appointments consisted of physicals, and most of them for toddlers. With younger children, Dr. Dupuy asks that the parents bring their child in more regularly to record their development. These physicals consist of checking the throat, eyes, nose, ears, hips, pulses, and private parts. Of course, the toddlers hated when the stethoscope was placed to their chest, an unfamiliar person and an unfamiliar instrument. However, with Dr. Dupuy’s incredible experience, he knew exactly how to handle these precautious babies. With one particular baby, he allow them to touch the instrument, play with it, and then touch it to himself. Then when Dr. Dupuy went to listen to the baby’s heartbeat, there was minimal squirming.
Most of his patients were within the 2-4 range today, but two patients were less than a week old. After being discharged from the hospital, Dr. Dupuy likes for mothers to bring their child in for a postnatal checkup. These babies were incredible fragile and were incredibly cautious to everything that Dr. Dupuy used; they cried a lot. What I thought was the most interesting was that there was a black, red bulb inside the babies belly button, the umbilical cord. Dr. Dupuy assured the parents that these umbilical cords would fall off within 10-15 days after the babies birth. Including this information, Dr. Dupuy was very thorough in describing everything about this babies journey and what the parents should be expecting. With a particular patient he offered detailed expectations of breastfeeding for the mother. He explained to her how it was normal for the baby to not latch on, have incredible energy, or feed very often in the first few days after birth. This is because the babies system is full of waste and excess liquid, also explaining why babies decrease in weight their first week after birth.
Before and after each patient, Morgan and Doctor Dupuy would look and fill out medical charts. Before the appointment, Doctor Dupuy would scan through past medical records and history of the patient, to familiarize himself. After each appointment, he would fill in the observations, symptoms, diagnosis, and treatment for each patient. A picture of the area in which these were completed, is picture below.
I had a great day today, and am continuing to learn more about this field and medicine in general
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Day 1: A Busy Day
My experience with the Fuquay-Varina Pediatrics office didn’t start on May 29th, but instead in the weeks leading up to it in which I completed close to two hours of HIPPA training. Of course, I passed with streaming colors, all 100s after my third and fourth attempts at the test, but I am incredibly educated in the Health Insurance Portability Act. This specifically surrounded around information that I could and could not know and share, specifically with personal patient information. After handing my two certificates in this morning to the clinical manager, we were off to the races with a number of costumers lining up for the walk-in clinic appointments starting at 8 am. Of course, with already close to 14 people signed up for these morning appointments (8-10), Dr. Dupuy could not accomplish this on his own. Instead, a physicians assistant student from Campbell was there to assist, Morgan. We all entered each room to be faced with a different kid with a different problem, whether a viral infection, a simple wellness check, developmental problems, or bacterial infections. I was immediately blown away with the sophistication and importance of Dr. Dupuy social attitude, whether tickling the toddlers that were crying or comforting a new mother. Although it was the cause of us getting behind schedule, Dr. Dupuy didn’t hesitate to be incredibly thorough with each patient, not only supplying patients with medication, but really helping them understand why each pill was going to be used for their child. As one mother quoted “I learned more from you in these thirty minutes than I have in our five months at Duke hospital”. With this particular five month old premature baby post open heart surgery, Dr. Dupuy took exceptional patience to answer each of the mothers questions with incredible truthfulness while providing a blanket of comfort. His patience, thoughtfulness, and true care for each patient was very memorable. Yet, this attitude shown because he was really passionate about each of his patients and what he did. I asked him why he choose pediatrics specifically and he responded with “I couldn’t resist these kiddos”. He cares about the welling of each of his patients and that shows through his work and care with the thirty costumers we saw today.
Most of his patients were toddlers or newborns, and only a few ranged into the adolescent or teen ages. However, one of the most memorable cases that we looked at today was with a middle schooler who had second degree sun burns. His skin had huge blisters filled with yellow pus, and his skin was completely red. Morgan, the physicians assistant, took charge with his two year background in dermatology, and we brainstormed how to bandage the wounds without using adhesive tape. Another memorable case was a kid who came in with an incredible itchy and painful rash, which happened to be hot tub folliculitis. Morgan educated Dr. Dupuy and I on this disease caused by hot tubs, and I eventually decided that I will never go into a hot tub again.
With a very busy day, and numerous patients to see, I was always entertained and always learning something new. Of course we saw many different diseases and problems in kids but I was able to observe the preparation of a strep sample, a hemoglobin test, a vaccine shot, and I was even able to listen to a baby’s heart. I learned so much today, and am so excited for these next few days!
The office