First Cut: Angeli in SLMC Week 4

And with that last OR assist, my ‘summer’ Surgery clinical elective in St. Luke’s Medical Center has finally ended. I was able to learn quite a lot during my short stay. :) It feels like it’s over too soon!

DAY ELEVEN: MONDAY, JULY 20, 2015

OR day for me! Modified Radical Mastectomy, Lumpectomy, Open Parathyroidectomy — and learning at the Breast Conference and PIPC

What a day~! 3 OR exposures today – Modified Radical Mastectomy with Dra. Macel, Lumpectomy/Breast Conservation with Dra. Gene Padilla-Evangelista, and Open Parathyroidectomy with Dr. Domino. Thank you, awesome consultants, for orienting me anatomy-wise! Also, the surgical residents assisting in the three cases all helped me make sense of stuff, willingly answering my questions (well, the ones I was brave enough to ask. haha! Being makulit and mapagtanong, I had a lot more questions in mind, but I was ultimately too shy to ask.) Thank you, Chief Resident Dr. Maranon, Dr. de Asis, and Dr. Reyes-Lao! Let’s see if I remember some of the important tidbits…

The Anatomical Boundaries of Modified Radical Mastectomy
Superior: clavicle
Medial: lateral border of the sternum
Lateral: anterior margin of the latissimus dorsi 
Inferior: caudal extension of the breast 2-3 cm 
below the inframammary fold

- MRM preserves the pectoralis major (unless there is clear
tumor invasion to the muscle) with removal of the 
axillary lymph nodes


Breast Conversation - resection of the primary breast cancer
with a margin of normal tissue; superior to mastectomy with
regards to aesthetic appearance
On FS of the bordering tissues, should there be an area of 
(+) spread, further dissection and resection may be warranted.

At the Breast Conference, a case of metaplastic breast cancer, a rare type of breast CA involving less than 1% of invasive breast cancers, was discussed. It involved a lot of discussions on the histopathology (metaplastic involves a mix of malignant mesenchymal and epithelial components – squamous cells and spindle cells) and hormone receptor status (frequently triple negative – i.e. negative for ER, PR, Her2/neu) as well as the other biomarkers (all of which completely got lost on me. huhu). It’s a pretty hard to make diagnosis. Haha. Again, hooray for higher learning! :)

20150724_145814 (2)
Thank you very much for the amazing last 4 weeks, Tita Macel! :) I learned a lot and at the same time, enjoyed every experience. Yay~!

DAY TWELVE: WEDNESDAY, JULY 22, 2015

OPD Post! Just when you thought you left the Breast Center, guess what? It’s Benign Breast Day!

I got decked at the General Surgery OPD today and with the St. Luke’s clerks at their preceptorial, it was initially just me and Dr. Liquete. Oh boy. I’ve been spending much of my time at the Breast Center, since my preceptor’s a breast surgeon and the Head at that, so practically all history and PE has been concentrated on the breast, so this OPD exposure was supposed to let me see other cases. But, no! :)) It was still all about them breasts! Goes to show how common breast complaints really are. Chief complaints were mostly confined to either breast pain or a palpable mass. Thanks to my ICC stint at the OPD and the many learnings at the Breast Center, I was able to conduct Hx and PE on my breast patients with ease. Yay~! Puro r/o fibrocystic changes naman!

LAST DAY: FRIDAY, JULY 24, 2015

Open Total Thyroidectomy and Parathyroidectomy – grabe. ang laking parathyroid! Thank you, SLMC Surgery! Had a blast! :)

Ending this rotation with a bang! Chief Resident Dr. Maranon had me assist in an open total thyroidectomy and parathyroidectomy with Dr. Domino, and despite my painful wrist – still undiagnosed – I did my best to retract and hold those instruments as firmly as I should. Such a big parathyroid! O.O I think it was even bigger than the thyroid itself. Intense. Dr. Domino says in all his years of practice, this one’s the biggest he’s ever had to remove. I don’t think I’ll ever forget how that looked like. :)) Pity I didn’t get to take a picture on account of I was scrubbed in.

I very much enjoyed my stay with the St. Luke’s Institute of Surgery! :) My endless gratitude to Tita Macel, best preceptor ever, Chief Resident Dr. Maranon, who took care of my schedule, Dr. Siozon and all the consultants, the fellows, the residents, the nurses, and the hospital staff. I learned a lot. Mamimiss ko po kayong lahat! Maraming salamat po! 

This marks the end of my first clerkship rotation – inuna na talaga ang elective! It’s back to UP-PGH this August! Mixed feelings about it, but looking forward to LU6 just the same. Let’s do this! #ReignSupreme

20150724_135638
11778033_10205067125543836_2005521704_n
11805713_10205067125023823_84937025_n Pansit and cake to celebrate the end of my rotation as well as a token of gratitude for taking such good care of me over the past 4 weeks. Thank you, SLMC Surgery! :)

 

 

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