Author: maggiem871

Today, the last day, was another day of clinic. Today was just as busy as Monday if not more busy because of all of the invitations to travel to give speeches Dr. McElveen has. Today was similar to Monday, but I was more independent. I interviewed new patients to see where they were at and what symptoms they were having, I filled out  and completed patient’s charts, presented patients to Dr. McElveen as if we were doing grand rounds in medical school and then sat in on the consultations that Dr. McElveen had with the patients.

I saw many new things happen today (steroid injections to the ear drum/round window), but one of the coolest things I saw today was Dr. McElveen implanting a hearing device onto a patients ear drum as part of a trial. This implant was special because it was a tiny tiny device with a motor and surface that uses light to produce sound transmitted through the ear. They programmed it to play a certain song and tested it with a light instrument. What was really cool about it was it was implanted on the patients ear drum so it was like a mini speaker that produced sounds only he could hear with the activation of light. Dr. McElveen noted it was very new technology and only in testing phases, but I found it fascinating. I really enjoyed my time with Dr. McElveen, and found it very useful in figuring out where exactly I want to go with my career.

Today Dr. McElveen was performing surgeries at a hospital that I was not cleared for, so I spent the day with the audiologists instead. While Shadowing Kate, Leah, and Nicolle I saw a large variety of reasons for a hearing test to be performed. Each hearing test started with just beeps being sent to the patients ears (airway test), but then a bone conduction test was done to see if the results were stable with the first test. If these were stable with one another, then the conclusion was drawn that it was a nerve issue, but if one of them was higher than the other, than it was just one of the issues tested for.

The most interesting case I saw today connected dots that were formed yesterday when I observed Dr. McElveen place a cochlear implant in a patient’s ear in surgery. This case was the evaluation of a patient to see if they were a candidate for a cochlear implant. This was the longest appointment of the day, and all of the tests that were run were standardized and used to prove to the insurance company that the surgery was necessary for the patient’s health and well-being. Basically, the clinic fitted a set of hearing aids to the maximum level for their hearing and the test was performed with the hearing aids. If they failed the test, then that proved to insurance that regular hearing aids to their full potential provide no support to the patient and that the surgery is necessary. The patient today failed the test, so then Nicolle brought them back to her office and talked to them about the process and dedication it required. Sitting in on this consult helped me connect the dots because of all of the information that was presented and amount of tests run and why the tests are run. I look forward to my last day at the clinic tomorrow!

Today was surgery day! I shadowed Dr. McElveen at Duke-Raleigh Hospital while he performed 3 surgeries. When I arrived I got my scrubs and then we proceeded to the OR. Dr. McElveen performed one ponto surgery and two cochlear implants. The ponto surgery was very fast, done in about 15 minutes. The ponto surgery was just where a hole was drilled into the patients head and a device was inserted that stimulates the brain so that the patient can hear out of that ear. cochlear implants are similar, but are central to the ear. The first cochlear implant went very smoothly (see picture below) and was inserted by drilling into the mastoid and sneaking into the middle ear the back way. The second cochlear implant was more difficult because Dr. McElveen had to make an incision directly behind the ear and go through the actual ear. Additionally, this patient’s facial nerve (nerve that  controls your ability to move your face) was camouflaged in scar tissue, making it very difficult to work around it without damaging it. But without a doubt, it was a success! Today was very exciting and educational, and I can’t wait for what’s in store tomorrow.

My very first day at Dr. McElveen’s office was a very busy day. About 42 patients were seen in the span of about 6 or 7 hours, and thus I was thrown directly into the mix. With the help of Dr. McElveen’s Nurse, Margaret, and nurse practitioner, Christy, I became very familiar with the ins and outs of their office very quickly.  The most surprising part of my day was hearing that I would end up presenting all of the patients to Dr. McElveen before going into the room (like what is done during a residency in medical school). At first, I was very nervous. I didn’t know anything about the ear except for the fact that it was connected to the brain in a way that the two communicate together and allow you to hear. I thought, “How in the world am I supposed to present any of this to him when I have no idea what any of it is or means??”. Christy helped and prepped me the first time on what he expects to hear, and showed me how to read the chart to know what it was saying. She warned me that he would probably continue to ask me questions until I couldn’t answer them anymore, a technique referred to as “pimping” in medical school. As I finished a couple of them, I got quite comfortable doing it and could know where to look for certain things in the chart and understand what they mean. I even filled out part of a patients chart myself at the end of the day. All in all, although I was quite nervous, briefing turned into quite an exciting activity for me, and I can’t wait to join Dr. McElveen in the OR tomorrow.

Today we completed a third day of stability tests at Integrated Lab Solutions. So far, we had done a standard test (same day analyzing), one after 24 hours, and today we set up the test for 48 hours (after the sample was taken). Additionally the past two days we had messed around with the pH of samples so that they could continue the stability tests in different environments in the future. But today, after we (Ben, Chief Scientist, and I) set up the day 3 trial of the long term stability test, we got to take a look at some of the results that they got yesterday afternoon from the 24 hour trial. One of the other lab technicians had spent the morning reviewing and finalizing the results so that we could compare them to the results from day 1. While looking at the two sets of data, we noticed an increase in detected concentration of almost all of the drugs from day 1 to day 2. Only a few had decreased and when they did decrease it was much less significant than those that increased. Noticing this pattern, we made a joint spreadsheet with both sets of data and programmed the spreadsheet with equations to tell us the % difference from day 1 to day 2. Some of the detected concentrations increased by as much as 50%! Unfortunately, even though I got to program the LCMS-MS to read out day 3 samples, the results were not available by the time that I left ILS. Luckily, Ben said that he would send me the final results of the study when the data was retrieved with a discussion of all of the results. I look forward to hearing about the end of this experiment, and enjoyed my time at Integrated Lab Solutions.

Today at Integrated Lab Solutions, We began investigating the stability of samples at a low pH (acidic environment). A lot of time was spent trying to figure out how much formic acid solution needed to be added to a normal sample. We thought that we had calculated the right amount based on the diluted solution’s molarity and the pKa, but when we added it, the pH came out to be almost basic. We came to the conclusion that a component of the sample was reacting with the formic acid to create a buffer. To solve the issue, we continued to guess and check the amount of formic acid needed to reach a pH of 3. To check the pH of each sample, a small sample of each solution was placed into a machine called the Indiko Plus (pictured below) and a pH test was run. Finding the right concentration and amount of formic acid to be added was quite the accomplishment today, and tomorrow I look forward to seeing the results of the normal pH test that we started yesterday. 

Today we begun a series of stability tests. These tests are conducted to see if the pH of the samples affects the stability and consistency of the results. This will benefit ILS because less reruns will have to be completed if a pattern is found in the results that could change how they test their samples. This could simplify the process that they follow and make it more consistent if an answer is found in the data. This series of tests consists of one at normal pH, one at pH 3 and one at pH 9. Today we ran the test for normal pH and found the correct ratio of sample to NH4OH stock solution to make the pH 9 solution that will be tested tomorrow. After the standard samples were run through the LCMS, the data was reviewed and some of the bell curves of the retention times were re-integrated to make the data more precise. I’m excited to see if the results of this series will help ILS with their operations!

My first week of the WEP will be spent at Integrated Lab Solutions, a laboratory that specializes in drug toxicology. Today, I sat in on their weekly lab meeting, got a tour of the office and facilities and an introduction to some of the things that they do for their clients. Their clients consist of different medical clinics in North Carolina, Georgia, and many other locations. The first half of the day I shadowed the Chief Science Officer and observed him review all of the collected data so that any false positives/negatives could be filtered out before sending back to their clients. In this process, I learned all about the method that they use to detect all of the different drugs (liquid chromatography-mass spectrometry)  and how the data is read to ensure accurate results. The different components of the urine sample are separated when they pass through silica particles coated in hydrophobic oils. Retention time and ion size of the drug are then used  by the software to confirm the identity of the detected drug after it had passes through the different chambers of the machine. After all of the data has been collected, it is reviewed by a human to ensure accuracy. If there is doubt in the results, the concentration metabolite of the drug (metabolized counterpart) is referred to in order to either confirm or deny the presence of the drug. If the data is inconclusive or inconsistent, then a second test will be run.

The second half of my day I watched some of the lab personnel prepare cuvettes and sample trays to be tested later. The sample trays were loaded with different calibrating solutions, quality control solutions, a control solution, and then the samples to be tested. An internal standard was added to each cuvette of urine sample to make the data readings by the machine more accurate. They were then incubated, and spun in the centrifuge to finalize the preparation. 

I am very excited for the next 2 weeks of the Work Experience Program.