Blog 22: Senior Project Reflection

I. Positive Statement
What are you most proud of in your Block Presentation and/or your senior project? Why?

I was most proud of my second activity. For one part of it, I brought isolation robes for everyone in the room to wear. When I told the audience what they were and that they could wear it, the kind of, relief and cheering some people let out like, "Woah this is cool!" was really exciting to hear.

II. Questions to Consider

1. What assessment would you give yourself on your Block Presentation (self-assessment)?
• P+
2. What assessment would you give yourself on your overall senior project (self-assessment)?
• P+

III. What worked for you in your senior project?
Most certainly the information I learned throughout the year. In the beginning, i had focussed on Rabies but quickly changed to Coronary Artery Disease. Specifically for an Internist, who look at multiple systems, it is important to understand how the body works. I have gained a small, but useful base of information regarding the body, and equipment doctors use when doing procedures and tests.

IV. If you had a time machine, what would have you done differently to improve your senior project if you could go back in time?
I would most certainly have memorised the authors of the individual papers I referenced through my presentation. These are the actual doctors and researchers that took the time to find out this information. Knowing what the article about is important, but knowing about the author is equally so.

V. Finding Value
How has the senior project been helpful to you in your future endeavors? Be specific and use examples.

I most certainly know now that I want to have a career in the medical field. The start of my senior project had me doing mentorship at a hospital and leading to another mentorship with an actual internist. This has allowed me to experience just a small part of the vast amount of information that I should have a grasp on if I'm going to pursue a career in medicine.

I hadn't a clue what I was reading when going through the complicated articles and science papers in the beginning of the year. But slowly and constantly reading through more and more gave me an understanding of the definitions of the medical jargon as well as the procedures. The research checks every few Fridays seemed boring at first, but I got a deep appreciation of them in the long run.

The ESA component for Senior Project and even Model Assembly was really helpful. For a large majority of my academic life, particularly in primary school, using sketchy sources was a common occurrence. But ESA taught us how to find reliable sources and how to find out if the information is so. Sources are important particularly for the medical field. Papers from the National Centre for Biotechnology Information or the Journal of the American Medical Association have a ton of sources on each paper. That is because information is highly valued! These experiences at iPoly have helped me understand this.

Blog 21: Mentorship

Literal
Mentorship Log

Dr. Francisco B. Fuscaldo, MD.
North Broadway Medical Clinic and AEON Medical Equipment & Supplies, Inc.

Interpretive
What is the most important thing you gained from this experience? Why?

I think the most significant thing I gained from this mentorship experiences was the realisation that information is incredible. It's the common phrase that knowledge is the key, but numerous times I've seen my mentor, nurses (and even fictional characters) use the knowledge that they're acquired over the years into application. But it isn't just coming straight from the book. Their experiences have shaped them into the professionals they are today. That is who I strive to be. I've got to start somewhere and experience isn't easy to come by, so I'll start by getting as much knowledge as I can and working harder than I ever have before.


Applied
How has what you've done helped you to answer your EQ? Please explain.

Some of the equipment I saw (and used) were scalpels and sutures for closing up wounds. The technique for the knot isn't that effective when we're going micro and zooming in on the artery, but the idea is clear: stitch up the arteries that you graft during Coronary Artery Bypass Graft Surgery. There have been a lot of models regarding how balloon angioplasty works–and research for the iSearch Finding 2 (angioplasty) was brilliant. I learned the history of how angioplasty was developed and the hardships that came with it. As for the first answer, I think it was a reality check when i went to urgent care for angina (chest pain). Thankfully it wasn't heart related (I was just overreacting)–It was a skeletomuscular issue. But what made me eventually make it my answer–and best answer was something my mentor once said. "The one thing you have throughout your life is your body." 

Reversal of Vascular Ageing

Article Title: Antioxidant Reverses Vascular Aging In Mice
Info: http://www.iflscience.com/health-and-medicine/antioxidant-reverses-vascular-aging-mice

Mice are cool. Rats are cool. Kawaii too. Sometimes rats are cats. Unless they get rabies and die from sick. The article mentions a study published in the The Journal of Physiology where researchers have been able to identify an antioxidant that may be able to reverse some negative effects of ageing on arteries. 

Ageing is the primary risk factor for the development of cardiovascular disease. Nitric Oxide, a chemical involved in regulating blood flow, is a naturally created in our body. MitoQ, the antioxidant that the researchers have identified is able to increase the amount of Nitric Oxide in the body. MitoQ has been able to reverse the "related vascular endothelial dysfunction" in the arteries of mice. That's why this is so significant.

Blog 20: Exit Interview

What is your essential question and answers? What is your best answer and why?

What is the most effective treatment for a patient suffering from Coronary Artery Disease?

1. By making lifestyle changes regarding personal nutrition which focus on low sodium and cholesterol intake
2. Undergo an Angioplasty procedure by placing a stent in the narrowed artery to widen it
3. Undergo a Coronary Artery Bypass Grafting Surgery to graft a substitute blood vessel into your heart, re-routing blood flow around the clogged artery

Best answer is Answer 1, "By making lifestyle changes regarding personal nutrition which focus on low sodium and cholesterol intake" because I believe naturally, the latter two answers eventually fall back to the first. Coronary Artery Disease is chiefly caused by poor health habits (Consuming an excess amount of cholesterol/sodium) which answer one covers. Answers 2 and 3 are procedures that utilise non-natural equipment (meaning tools like scalpels and catheters).

What process did you take to arrive at this answer?
I arrived at this answer through research. My findings about the causes of Coronary Artery Disease came down to the effectiveness of taking care of your body. As my mentor has said, "Your body is the one thing you have for the rest of your life." Answers 2 and 3 ultimately end with the doctor telling the patient to eat well, exercise, and to just live healthier; they are also short-term solutions compared to eating healthier, which It was this realisation that led the way for Answer 1 to be my best answer.

What problems did you face? How did you resolve them?
At first when I researched, I hadn't a clue what I was reading. Studies with abstracts, results and whatnot seemed overly complicated. Words like paclitaxel and percutaneous popped up with little to no context–these are the types of words that I knew I had to familiarise myself with so I could fully understand the article. Focussing on this, Google is a really handy tool. Whenever an obscure word popped up, I simply searched for it. But this impacted my research in more ways than one. Now, I'm able to read these journal articles with a better understanding than I had before. Repetition of particular words and phrases stuck with me. In addition to that, when I search up a word, I [fortunately] do not stop at the definition. I'll use Wikipedia as an example. For complicated jargon that's widely used in the medical field, Wikipedia does have a fairly simple summary as to what it is. But that is all it is: a summary. I have found myself at times grasping for more information either by clicking through more articles or more recently, scrolling through the numerous references at the bottom of the page.

What are the two most significant sources you used to answer your essential question and why?
My two most significant sources are the National Centre for Biotechnology Information (NCBI) and my Mentor. The NCBI has given me a load of information. While at first I looked at definitions and explanations on WebMD and similar sites, I eventually moved on to more academia-focussed archives (like NCBI). Similar sites such as The Journal of the American Medical Association (JAMA) and The New England Journal of Medicine (NEJM) were popular archives for medical journals that I frequent. 

But a problem I faced many times (as reiterated in my iSearch Paper) was the fact that many articles, particularly more recent studies cost money. $33 for a single pdf file isn't worth it from my position. I'm not doing a full-fledged study, so spending money is not my preference. Fortunately, sites like Reddit have smaller forums called subreddits where users sometimes give out these articles for free through file sharing websites. I believe it's a small duty of resourcefulness that I find these links.

My mentor has helped me out as well. He is a board certified internist with many years of experience. I will admit people may not be as thorough as articles devoted to the topic, but my mentor, as a trained professional knows an incredible amount of information. He can literally go on for hours on his clinical studies on Diabetes. I've come to him for answers and his influence and knowledge led me to my EQ and subsequent answers.

Blog 19: Independent Component 2

Literal

1. I, Alfonso Esquivel, affirm that I completed my independent component which represents 30 hours of work
2. My mentor, Dr. Francisco Fuscaldo, equipment technicians, and nurses helped me complete Independent Component 1.
3. Independent Component Log 2
   Total Mentorship Log
4. I learned much more about the heart than I ever did before. I have a more complete understanding of the different parts of the heart and not an elementary memory of the parts of it. I've come to understand that the body is far more complex than I could ever imagine. How the lungs effect the heart, how the lumen determines blood pressure; the importance of Systole and Diastole. I reused an ultrasound machine and looked at someone's heart and how they beat. You're even able to see individual vessels!

Interpretive

Pulmonary Exam

Cardiovascular Exam

Outside the American Red Cross in Irvine

Helping out with the CPR session

Applied

1. I learned a lot during Independent Component 2. I learned about the importance of keeping up to date with research. It's mind-boggling how fast research is being done and what's coming out of it. I'll put it into reference with the Pacemaker. It took over half a century to come up with an incredibly efficient and useable Pacemaker, but this was happening all in different parts of the world. It was an incredible breakthrough and its effects were phenomenal. I've been trained in CPR for less than a year, but when I helped with the training, I also got to talk to the trainer who was a former Paramedic. Fast pace and fast thinking were needed to do his job. I understood the fragility of the human body. I want to improve my research as soon as possible.

Egyptian Princess

Article Title: Egyptian princess was first person with diagnosed coronary artery disease
Info: http://esciencenews.com/articles/2011/05/17/egyptian.princess.was.first.person.with.diagnosed.coronary.artery.disease

Well, the article title is a bit misleading. Very misleading, in fact, when you say it slowly. Surely had been diagnosed before a corpse, no? Well, yes. It's a sensational title–more accurately poorly worded, but essentially meaning Princess Ahmose-Meryet-Amon was the earliest person who we can confirm has Coronary Artery Disease.

But what was interesting was that since she was an Egyptian, her diet must have consisted of vegetables, fruits, some meat and barley. Yet she still developed Coronary Artery Disease.

Dr Thomas and his co-principal investigator Dr Adel Allam of Al Azhar University, Cairo, suggest three possibilities:

1. Our understanding of Coronary Artery Disease is limited–our understanding is not complete
2. Genetic inheritence
3. Inflammatory response due to parasites common to Ancient Egypt

Else, another possibility is that because she was a Princess–royal her diet was not similar to a normal Egyptian. Surely her status grants her the ability to indulge in luxury foods like butter and cheese. Meats were stored using salts, another determinant of high cholesterol. It's incredible what we can infer from CT Scans of mummies!

Ah, the Old Switch-a-roo

I'll probably switch what I planned as my answer three to become my answer two. Just a (physically) mental note. No problem!

Blog 18: Third Answer

Content 

What is the most effective treatment for a patient suffering from Coronary Artery Disease?

|
Undergo a Coronary Artery Bypass Surgery to graft a substitute blood vessel into your heart, re-routing blood flow around the clogged artery.

|

1. Can "unblock" multiple blockages with a single bypass. Unlike angioplasty, which targets a single blockage, grafting a vessel in a bypass surgery can effectively reroute the affected vessel over multiple blockages.
2. Uses other blood vessels to reroute blockage. One of the most common vessels in the body to remove and graft to the heat is the Internal thoracic artery.
3. Very effective–the surgery isn't like an angioplasty, pushing the plaque against the vessel wall. It makes the affected blood vessel obsolete. It's as if your coronary artery started back at square one!

|

1. How is CABG Surgery Done?
2. Angioplasty Versus Bypass Surgery for Coronary Artery Disease
3. Heart Disease: Should I Have Bypass Surgery?
4. Coronary Artery Bypass Grafting in the Elderly: Pros and Cons after three-year follow-up

|
Undergoing a Coronary Bypass Surgery is very effective because it uses another part of the body to fix the clogged artery and has a better efficiency than an angioplasty.

Saltybet

Article Title: Experimental drug might get the salt out
Info: https://www.sciencenews.org/article/experimental-drug-might-get-salt-out

Clearly, by intaking less sodicum, you can stay away for high blood pressure and even heart disease. But researchers note of a potential drug (candidate) that can push it out of your system before it can reach your bloodstream and kidneys.

The drug is called tenapanor inhibits a protein that allows sodium passage. Much of the salt would be immediately passed to your waste. Patients in the study were given tenapanor whilst others a placebo. Those who were given tenapor were noted to have more sodium in faeces and urine. (Bleh!) There were no adverse side effects too, which is helpful. This might be the birth of another way to help patients with CAD.

Blog 17: Fourth Interview Questions

1. What is the most effective treatment for a patient suffering from Coronary Artery Disease?
2. What is an angioplasty procedure?
3. What is a heart bypass surgery?
4. What is the difference between the two?
5. What are the pros of angioplasty procedures?
6. Are there any drawbacks to the procedure?
7. What are the pros of heart bypass surgeries?
8. What are the dangers of bypass surgeries?
9. Is there a possibility of re-narrowing of the arteries?
10. Is it more effective to have an angioplasty procedure or a bypass?
11. At what stage of plaque build-up should either procedure be done?
12. What do you recommend a patient do before getting any of these procedures?
13. Is it more effective to have these procedures or to exercise and diet?
14. How does someone live their life after getting a bypass surgery?
15. What is the daily life of someone whom got a bypass surgery?
16. Can you explain what the The McGinn Technique is in regard to Bypass surgery?
17. What are stents?
18. How effective are the stents at keeping the artery open?
19. How do the surgeons get the blood vessel to use in the bypass?
20. Is it possible to get multiple bypasses? Is there a maximum?

Blog 16: Advisory Meeting #2

Content 

What is the most effective treatment for a patient suffering from Coronary Artery Disease?

|
Undergo an Angioplasty procedure by placing a stent in the narrowed artery to widen it

|

1. Short term procedure in the sense that it can be done immediately unlike dieting and exercising (which could take months). An angioplasty procedure takes 1-2 hours and is painless because the patient is given a sedative.
2. Effective because it pushes the plaque away and widens the lumen of the artery with a balloon. Opposite of atherosclerosis which narrows the artery because of plaque.
3. Not open-heart surgery. The procedure is also not even surgery. It's a tube going through blood vessels all the way to the heart. No need to cut bones.

|

1. Percutaneous Transluminal Coronary Angioplasty: How Important is Stand-By Surgery?
2. Angioplasty Versus Bypass Surgery for Coronary Artery Disease
3. Laparoscopic nephrectomy, ex vivo angioplasty, and renal autotransplant for a renal artery aneurysm: a case report.
4. Aortic Stenosis

|
Undergoing an Angioplasty procedure to treat Coronary Artery disease is very effective because it is much faster than dieting, artificially reverses the process of atherosclerosis, and has less risks than open heart surgery.

Robotic Surgeries

Article Title: First in California: Using robotic assisted stenting
Info: http://www.sciencedaily.com/releases/2013/12/131220143033.htm

Wah, wah, wah! Cool, cool cool. Robots used for surgeries? Been at use for a while, but they used it for actual stenting. Well, I'm sure they've done it already, but this is the first time they've done it in California. A cardiology team at UC San Diego have been the first to use a surgical robot to place a stent in a patient with Coronary Artery Disease. The robot acts like an extra hand and holds the devices in place. Really helpful, saves money, and lowers the margin of error!

Blog 15: Independent Component 2 Approval

Describe in detail what you plan to do for your 30 hours
For Independent Component 2, I plan to do more mentorship. I plan to meet with my mentor more often and since I have a clear topic (that I'm fond of), I can ask more focussed questions and research more in depth.


Discuss how or what you will do to meet the expectation of showing 30 hours of evidence
I will take pictures and plan to do (seldom) posts about articles of research that I found interesting.


Explain how what you will be doing will help you explore your topic in more depth
The more I talk to my mentor and the more I research gives me an appreciation of what I'm actually working on. Senior Project is more than a grade to me. With that mindset, the more I talk to my mentor and others, the better I'll understand my topic; so I'm able to teach other what I learned during my 2-hour presentation.

Blog 13: Lesson 2 Reflection

Positive Statement
What are you most proud of in your Lesson 2 Presentation and why?

I'm most proud of the ability of my classmates to answer the questions from the Activity (What is LDL Cholesterol? What does it do to the body?) Their ability to answer the questions makes me hopeful that I explained my senior topic clearly.


What assessment would you give yourself on your Lesson 2 Presentation?
I'd give myself a P+. I understood and conveyed my research clearly. My activity went smoothly and was successful to the point that the audience were able to answer the questions. (Which if I can attest, is considerably complicated because the body is complex)


What worked for you in your Lesson 2?
The research and information part was surprisingly fun. While I was making the PowerPoint, I had to think of a way to convey the complicated process of atherosclerosis into layman's terms. This helps me understand it even better. What's better learning than teaching?


If you had a time machine, what would you have done differently to improve your Lesson 2?
I would most definitely have liked to have thought of a better activity.While my case studies activity got the information across, actually doing something with your hands could be more engaging. That's what I've learned from the past two weeks and even last year's senior presentation; hand-on projects are much more fun and you appreciate it more!


What do you think your answer #2 is going to be?

Very likely jumping from nutrition changes to surgical procedures such as angioplasty.

Independent Component 1

Literal

1. I, Alfonso Esquivel, affirm that I completed my independent component which represents 30 hours of work
2. My mentor, Dr. Francisco Fuscaldo, equipment technicians, and nurses helped me complete Independent Component 1.
3. Independent Component Log 1
4. I spent most of my time at AEON Medical Supplies. My mentor goes there often to meet with the boss. That is when I usually talk to him. Other than that, I would interact with technicians and the equipment stored at the warehouse.If I had time I would research about the equipment and how it could tie into my senior topic and ultimately my Essential Question.

Interpretive

CPAP Machine

Oxygen Concentrators

Oxygen Tanks

Applied

1. My mentor showed me many medical supplies. One of the most prominent equipment that was referenced back to many times were oxygen tanks. While I wasn't directly learning about CAD, the constant reference for oxygen helped me understand my foundation better. Necrosis of heart tissues can undeniably occur during myocardial infarction. Even a few seconds of oxygen loss in your heart can permanently damage the tissues in the heart reinforcing the importance of oxygen.

Whisker Synthesis!

Article Title: Nanotube whiskers could aid robot-human interaction
Info: https://www.sciencenews.org/article/nanotube-whiskers-could-aid-robot-human-interaction

Carbon is a brilliant element. Structured perfectly, it can create incredibly tough material with no sacrifice to weight. Engineers have developed a carbon nano tube sensor that mimics the whiskers of catskys. "The whiskers picked up pressures less than one-tenth as high as previous designs could detect." This has many applications in surgical robots!

Blog 12: Third Interview Questions

1. What is the most effective way to treat a patient with Coronary Artery Disease?
2. Could you explain the various symptoms of CAD?
3. How serious of a disease is CAD?
4. How does CAD affect daily life?
5. What are things you should know about a patient before you can recommend a choice?
6. How does exercise help to treat CAD?
7. If its effects have gone past a certain point, are there surgical procedures that can be done?
8. Can you explain ways of preventing CAD before it starts to develop?
9. If I have chest pains, does that mean I have CAD? Are there other reasons why someone's chest would hurt?
10. How should a doctor act in front of a patients suffering from CAD?

Blog 11: Mentorship 10 Hours Check

Where are you doing your mentorship?
First at North Broadway Medical Clinic, but currently at AEON Medical Equipment & Supplies, Inc. (with same mentor)


Who is your contact?
Dr. Francisco B. Fuscaldo, MD


How many total hours have you done?
As of the 9th of January, 2013: 21 Hours.


Summarize the 10 hours of service you did.
My mentor has been showing me a lot about the field of medicine. He talks about the tools he uses as well as the methods he uses such as how to talk to patients, how important it is to know your patient, etc. Every time I meet him, it seems like there is more to learn. (The mix of massive amounts of information as well as the broad field does give off that effect!)

Senior Project, The Holiday

It is important to consistently work on your senior project, whether it is break or we are in school. What did you over the break with your senior project?

1. The main thing I did was more research. I want to change my EQ from rabies to have more options. The heart is interesting. So is the cardiovascular system. Maybe how to solve chest pains?

What was the most important thing you learned from what you did and why?  What was the source of what you learned?

1. I learned that focussing on something too specific is ambitious, but not good in the long run. I'm specifically talking about my current EQ.  I need to change it. Body pains! But not with anaesthesia!

If you were going to do a 10 question interview on questions related to answers of your EQ, who would you talk to and why?

1. My mentor and probably other people (doctors?) if I can. My mentor is knowledgeable in this area and I would like to hear his take on it. But to have a better idea, I will aim to ask more experts. Be it a doctor or not. Perhaps someone who deals with chest pains!