Plastic Surgery -Not Just for VOGUE Cover

What field of surgery is given most attention by the entertainment industry; plastics of course. This being the entertainment industry with its quest for constant appeal, a one sided view is given. Can you imagine what impression is given after watching Doctor 90210 or Dr. McSteamy? The issue is that people see very little of what plastic surgery is truly about. This week I observed a plastics case that is worth mentioning to show that work of plastic surgeons is not just for Vogue cover.
The case involved a patient who had a large portion of skull bone removed due to tumor. The open area was replaced by a graft. The procedure was complicated by the fact that some skull tissue was gone, complicating proper alignment during closure. Now this was much more satisfying to see than McSteamy yelling at his residents and sleeping around.

The mini doppler was a device I found quite interesting. As shown in the photo above, it consists of a probe connected to a small box with a speaker. The probe allows to determine the location of important vessels without the need for opening the skin. The blood running through the vessels produces a rhythmic "whoosh" sound.

photo: Koven Technology, Inc. (http://www.koven.com/products/ES100X.htm)

List of Schools

I am on spring break and used the free time to put together a list 25 schools. This list used to be much larger, but had been narrowed down primarily by a location requirement. To me it is very important to live in a major metropolitan area so that I can have a descent social life and not rely on a car. I know there are great places in California, but I am not willing to be so far away from my parents and friends that all go to East Coast schools...
The schools represent major Eastern/Midwest cities (Chicago, Philly, NYC, Atlanta, and others) and are ranked by average MCAT score. The list will be narrowed down to around 18, and I welcome suggestions...

GE Cardiovascular Ultrasound for Aortic Valve Replacement

This is my second week volunteering in the OR, and now that I come in the morning, I get a chance to see a wide variety of cases. This week I observed a part of an aortic valve replacement procedure. The surgeons were busy with their work, but the anesthesiologist showed me his ultrasound machine that, it turned out, was an integral part of the procedure.

GE Healthcare has created the Vivid Cardiovascular Ultrasound System that gives anesthesiologists unprecedented capabilities for evaluating the heart and other organs. The device used at this OR was the Vivid 4 model. It has a probe that is inserted into the esophagus to show the coronal view of the heart, and into the stomach to show a horizontal view. A large monitor shows the imaged region in real time, which allows to evaluate the mechanical function of the valves and the myocardium (heart muscle). For example, I saw that the aortic valve was opening very poorly, a condition called aortic stenosis. A very cool feature that adds to evaluation and diagnosis is doppler. This allows to monitor blood flow inside the heart. As seen in the image; the blood flow is color coded according to velocity (but it might be mass flow). The heart I saw, had a clear flow back into the left atrium as the AV valves were closing, which is termed ventricular regurgitation. Besides giving different viewing capability, this machine allows to make measurements. In this procedure it is important to determine the size of artificial valve to be inserted, and that was done by measuring the width of the aortic opening in mm.

image source: GE Healthcare (www.gehealthcare.com)

To make a final comment, I learned that contact lenses and OR environment do not mix. My eyes were getting irritated from the dry air and from smoke caused by bowie (if spelled wrong let me know) knife. Also, here are images of the three general planes used in medical imaging.

image source: National Institute of Technology and Evaluation

What $1.5 Million Will Get You

Today I got a chance to see a prostatectomy, and not just any old school prostatectomy but a robotic one. Using a da Vinci robot that costs a whopping $1.5 million plus all the costs of the retractors and cutters it uses, the urologists performed this delicate procedure in about 3 hours. As explained to me, the benefits are the greater control of laparoscopic devices that the robot provides. It makes it easier to sew the sites of incision within the abdomen, and also leaves less bleeding. In addition, the camera of the robot is 3D, which makes it easier to navigate and move the instruments around; the regular laporascopic camera is 2D.

What was interesting was the fact that the procedure wasn't entirely done by the robot, a resident was standing by the incision site and was holding a laparoscopic retractor to help out with the procedure. It was very cool to watch, but seemed a little excessive.

image: www.marketwire.com

Four Months Till Application

The official application will start in four months when AMCAS is up. In the mean time I am looking up schools. I have determined three main requirements: located in large metropolitan area (so Chicago, Boston, NYC), be affiliated with a large hospital (level 1 trauma, children's, and VA), and standard curriculum (none of that PBL and self teaching, I like old school lectures).
My main way to see the locations is through Google Earth, works great.

How I Studied for the MCAT

Things to keep in mind before you read my strategy. I took ochem1,2 and bio1,2 the year I took the MCAT. This, I think gave me a valuable advantage.

Period of study: June 1 - August 17 (~2.5 months)
MCAT test date: August 19

Materials Used
KAPLAN 2005 Science Review ($23.00)
AAMCAS official practice tests ($120.00)
Textbooks ("free")

The Breakdown

June 1 - July 15: Thoroughly reviewed each subject in the KAPLAN Science Review Book
study period: 9am-1:00pm; 5 days a week
I sat down and systematically reviewed every chapter in that book. Almost all the material is the most basic parts of the subjects covered, so its not a problem to understand if you took the courses. I used my textbooks to supplement some things, and learn material new to me.

July 17 - August 17: Reviewed each subject two more times.
study period: 9am-1:00pm; 5 days a week; Practice MCAT every Saturday for next four weeks

This I think was the most beneficial decision I made. I am now convinced that reviewing material is crucial. I went back and each week reviewed everything for two subjects. For example the first week I went over all of physics and bio, and the following week all ochem and chem.

I also started taking practice MCAT tests every Saturday. I did this under real test conditions, with correctly timed breaks and test times. This is where I learned how to pace myself and how to deal with the test. I also developed a timing scheme that I will talk about in a little bit.

My Timing Protocol

The MCAT score is here

MCAT scores are released!

I got 34M (11VR 12PS 11BS)

I feel amazing.