Week 3

I started off the week with an episode of nostalgia.
I was invited to the neurology department's research symposium, where all of the doctors gather to present their research projects from the last year. In other words, I attended a professional science fair. I was introduced to several other neurologists among rows and rows of poster-board displays, and all I could think of was the amateur melt-an-eggshell-with-soda project I had done as a nine-year-old. Of course, their experiments were much more complex, but it was still interesting to see the scientific method in practice. These posters contained a vast array of research topics ranging from dementia in patients with Down syndrome to ketogenic diets as a form of seizure treatment. It was especially exciting to know that I recognized some of the terminology (i.e. PCR, Western Blot Test) discussed in these studies from my biology classes.  

Dr. Zieman, my mentor, presented her own research from this last year, a study of domestic violence patients with TBI. Although different from my own, her research is the inspiration for my project, so there are some similarities between the two. First of all, her study was retrospective. There are several reasons why my own research should be conducted in the same way. The most immediate issue is the fact that I don't have access to my own patients. I only have access to medical records from former patients. Additionally, due to time constraints, I'm unable to search for a sample size of current patients who meet all of the criteria for my research.  The process of selecting patients and debriefing them about the study would be too lengthy. So, instead, I've decided to use information that is already in the system. 

I spent the rest of the week observing more patient visits. Despite the fact that I've already been a clinical observer for weeks, I haven't seen everything. I'm continually surprised by how different each case can be. One patient might show all of the classic symptoms of a mild TBI: headaches, nausea, dizziness, irritability, etc. Then the next patient (who also has a mild TBI) could show no common symptoms of a mild TBI, but instead display symptoms characteristic with Bell's palsy (muscle weakness in one half of the face). There's unpredictability everywhere. That's what makes my job so interesting.  

Week 2

Although most patient analysis is based on quantitative data, there is still an element of subjectivity in the medical field simply because there are humans involved. I've continued observing patients from various backgrounds; different ages, genders, ethnicities, education levels, beliefs, etc. Some patients come into the clinic with research articles and questions, eager to learn more about their condition. Others are just determined to get back to work. Perhaps the most problematic aspect of this is the fact that everyone has their own opinion. In some cases, patients are doubtful of their physician. While they may be severely misinformed, they still have the right to refuse treatment. This is an issue that I became interested in since I first began learning about domestic violence and TBI. As I've mentioned before, a significant portion of the domestic violence population does not return for a follow-up evaluation or outpatient therapy after the first visit and I want to know why. Why would someone refuse to take their medications or see their speech therapist? Is this the result of trauma or a preexisting problem?

I've also been working with the program coordinator who frequently handles domestic violence cases. For my first task, I've been researching the effects of drugs on the adolescent brain. This information will be presented to teens in juvenile detention to help them understand the consequences of their actions (and maybe scare them just a tiny bit). The second task is to compile information for an educational pamphlet on different brain injuries (TBI, stroke, aneurysm, etc.) and translate it into Spanish. These handouts will be written at a 3rd grade reading level in both Spanish and English to help educate the local population about these conditions. By making this information easily accessible to everyone, regardless of ethnicity or education level, people can learn how to recognize the symptoms of brain injury and prevent further damage. Neither of these tasks are directly related to my own research, but this kind of teaching could also be applied to the domestic violence population. Throughout my research, I will have to consider the different opinions and histories of each patient, especially since my data relies on self-reported numbers. Additionally, I would like to analyze how other factors (i.e. age or ethnicity) might affect the rate of progress in domestic violence victims. I hope to officially start with data collection in the coming week. 

Week 1

If there is one lesson I should take away from this first week, it's that there's a constant flow of new information in the medical field. On my first day as a clinical observer, I sat in on what was essentially a book club for doctors. The medical personnel here at the clinic meet on a weekly basis to discuss current research and national medical journals, which allows them to provide the best, most up-to-date care for their patients. That's true dedication. 

In addition to these conferences, I've been shadowing Dr. Zieman and Dr. Cardenas, observing patients with a history of TBI and common treatments used for their injuries. Although the clinic receives patients from very disparate backgrounds, the doctors always ensure that their patients understand the basics about TBI. Therefore, I'll also start off by explaining exactly what the term means. 

A traumatic brain injury is the umbrella term for any damage to the brain caused by trauma that interferes with normal functions. This includes injuries that result from penetration of the skull (i.e. bullet wound), blunt force trauma to the head (i.e. fall), or other bodily impacts that provide enough force to shake the brain within the skull (i.e. car accident). It seems self-explanatory, but there is a more complex classification system in place used to diagnose different types of TBIs. This differentiation can be made based on the initial period of unconsciousness and the Glasgow Coma Scale. The Glasgow Coma Scale is a range from 3 (worst) to 15 (best) that measures patient response to a series of vision, verbal, and motor tests conducted after a TBI. 

The first type of TBI is a mild TBI (mTBI) or a concussion. These patients experience loss of consciousness for less than 30 minutes and have a Glasgow Coma Scale score between 13 and 15. Common symptoms that can occur both at the time of injury or much later include headaches, fatigue, short-term memory loss, visual impairment, inability to concentrate, dizziness, sensitivity to light, nausea, loss of smell or taste, irritability, confusion, sleep disturbances and increased risk of seizures (all humans have at least a 1% chance of having a seizure during their lifetime). Within mild TBIs there are two subsections: complicated and uncomplicated. A mild uncomplicated TBI means that there are no observable structural changes to the brain in a CT scan or MRI, while a mild complicated TBI indicates that bruising, bleeding or other abnormalities are visible on the brain. 

Mild Complicated TBI

The next type, a moderate TBI, involves loss of consciousness for anywhere between 30 minutes to 6 hours and a Glasgow Coma Scale score between 9 and 12. Meanwhile, a severe TBI involves loss of consciousness for more than 6 hours and a Glasgow Coma Scale score between 3 and 8. Symptoms of moderate to severe TBI include but are not limited to persistence of headaches, vomiting, seizures, dilation of pupils, numbness of digits, vision impairment, balance problems and dizziness, loss of hearing or ringing of ears, inability to wake from sleep, profound confusion, memory loss, lack of focus, speech difficulties, diminished sensory receptiveness, and irregular mood changes. Although paralysis, cerebrospinal fluid leakage, and coma can also result from a severe TBI, patients at the BNI Concussion and Brain Injury Center are already undergoing the recovery process so these symptoms are not as common at the clinic. 

Along with the mass of information I've learned about TBIs themselves, I've also witnessed different treatment methods. Patients who complain of headaches or dizziness are prescribed various seizure or pain medications. Over time, these medications or the dosages can change depending on the impact of the medicine on the patient. The doctors usually assess first-time patients by testing their vision, reflexes, hand-eye coordination, and balance. In one case that I observed, the doctor performed a maneuver on a patient complaining of dizziness to "reset" the inner ear crystals that help maintain balance. 

Additionally, the doctors typically work in conjunction with physical therapists, neuropsychologists, and occupational therapists to treat all physical and mental effects of a patient's injury. In relation to my research project, this can be a problem because outpatient therapy requires a follow-up meeting. Patients who are domestic violence survivors tend to be less likely to return for another doctor's evaluation so that their progress can be monitored. This is something I need to consider throughout my research to gain the most reliable statistical data (based only on patients that return for multiple evaluations).  

Introduction

Seventeen years ago, I was born at St. Joseph's Hospital with absolutely no idea who I wanted to be. Years later, after seeing a human skeleton model in an encyclopedia, I became a self-proclaimed anatomy expert who was 100% sure about becoming a doctor. After the occasional identity crisis or two, I eventually figured out I wanted to study the brain and human behavior, but I still had no idea how I would put that into practice. Now, I have a more detailed plan for the future and I'm fortunate enough to be back where I started. 

As a part of my senior research project, I'm working with the wonderful Dr. Glynnis Zieman and Dr. Javier Cardenas at the Barrow Neurological Institute Concussion and Brain Injury Center in St. Joseph's Hospital. 

Initially, my project proposal was focused on how recurring brain injury results in physiological changes that can lead to chronic traumatic encephalopathy. Currently, I'd like to narrow down the scope of my research by studying one subset of patients at the clinic: domestic violence victims.

Although athletes in contact sports, military personnel, and domestic violence victims are all at risk for repeated head trauma, there has been a notable lack of attention given to the latter of the three groups. The prevalence of traumatic brain injuries in these populations has been dubbed the "Silent Epidemic", which is especially apparent in domestic violence victims because they are typically less likely to seek help. 

Throughout my project, I will observe the physical, emotional, and cognitive symptoms found in domestic violence victims post injury. I will also monitor patient progress and analyze the results of their treatment over time based on self-reported symptom scales and other factors. Of course, due to my age and the sensitive nature of the subject, I have limited access to patient notes, but I will make do with the information I have. My hope is to provide statistical evidence of the positive impact of TBI treatment on domestic violence victims, as well as contribute to raising awareness about the issue.