Great busy days

During last 3 days I spent most of the time in out-patient clinic with different doctors:

Dr.Kopp

With Dr.Molitch, who is the author of Pituitary adenoma and hyperprolactinemia guidelines and other great endocrinologists of Northwestern.

I would like to thank them all, it was a great opportunity for me to observe and "absorb" as much as I can)

Besides this, we visited Morphology department and got aquatinted with Dr.Ritu Nayar, who is one of the authors of Bethesda classification. Surgeons and morphologists work closely, analyzing every false case. In this way the sensitivity of the biopsy in Northwestern is 98%.

 We were shown different types of thyroid cytology, it was wholesome. 

Looks like a moon

Our guide in morphology department, cool clever guy who did military service in a Navy

We visited the Radiology department, where they performed biopsy of adrenal lesion, most likely metastasis of lung cancer. The aim of the biopsy in this case was to perform genetic diagnostics, to chose the right target treatment.

Transferral of the material from needle to slide

Morphologist brings his table with dyes and microscope to radiologists' room in order to check immediately result of the biopsy

Slides preparation with hairdryer)

 Do you want to see enormously big elevators of Northwestern?) There are douzens of them 

So it is our last day in Northwestern and we will move to Endo conference. 

For me all I saw and experienced during these two weeks was a great opportunity and adventure...! It definately changed in many ways my way of thinking as endocrinologist and human-being.

And of course I would like to thank the Endocrine Society for providing me such opportunity! For meeting such hospitable,  sincere, versatile PEOPLE! 

Dear Cord and Max, thank you for spending so much time with us, trying to do as much as you can for us to see more in the hospital, to meet all those great specialists and people, to do so many different things, listen to the great music, to ride a bike, to biopsy olives, to taste best Chicago steaks and deep-dish pizza! The world seems to me now much smaller but at the same time much bigger than it was.

It's a new day, it's a new life!

Hello, everybody! 

We received our bags, so we survived for 7 days without them)

Today we had a busy day, starting in clinic with Dr.Sturgeon. 

Dr.Sturgeon's nurse prepairing spicemen for cytology

What is ineresting is that they almost never estimate thyroid volume! It does not change there decision in choosing method of treatment for hyperthyroidism. What I mean is that in someone with compression they could use RAI even if it is really big goiter.

Doctors have access to the interpreter of any language by phone at any time

  

Later we had a wonderful talk with Dr.Stewart M.Spies, who is Medical Director of Nuclear Medicine department of Northwestern. Dr.Stewart kindly answered all of our questions. The dose of RAI which they give for Greaves is usually 5-10mCi, which is less what we usually give in our country.

After that I presented clinical cases to some residents and students. I was happy that Dr.Kopp, who is a Chief Editor of Thyroid was also there and gave us amazing comments on all of the cases.

Me and Max before presentation

Then we attended Thyroid board meeting, which takes place every two weeks in Northwestern. Best specialists of the clinic discuss all together most difficult cases of thyroid cancer.

Finding best solution

Presentation room has 3 big screens

PET CT scans - isn't it nice?

Dr.Sturgeon and Dmitry are planning to go biking tomorrow (I hope I can escape it), so Dr.Sturgeon brought one extra bike to his room))

In the evening we visited very unusual (I will not lie if I say amazing) concert at Chicago's Symphony. Great orchestra playing with famous American singer Melissa Etheridge. She has unusual voice pitch, if you like Janis Joplin you would love it! 

Walking home in night Chicago

DANCE as though no one is watching you, LOVE as though you have never been hurt before, SING as though no one can hear you, LIVE as though heaven is on earth. -Souza

We spent two days exploring DC.. it is hard to explain how wonderful it was!

It is worth saing that there are 5 Washington cities in US, so speaking about capital they say Washington DC (district of Columbia), or even better just say DC.

White house

There are always people striking in front of it. One woman is living their more than 30 years.

Kennedy center - main concert hall, builded up after Cold war. Different countries took part in it's erection. Red carpet from Holland and Italian beautiful   chandeliers

Washington's Cathedral is amazing, it is all decorated by gems and gold. It is the most expensive cathedral in the world.

Pictures unfortunately doesn't reflect it's real beauty

We visited House of Russian Ambassador during Stalin's times.

During two years this men absolutely officially exported out of Russia so many treasures. Tsar's porcelain enough to serve 3 meals a day during a week, it would be everytime  different... Icon of Saint George which was the official icon of the Battle of Borodino and chalice of Alexander Nevsky and many many other things.

Washington's library holds more than 20 mln books

 In the Smithsonian Institute's museums we saw:

Connected Russian and USA spacecrafts Appolo-Soyuz

One of the most comprehensive art collections. I had not known that Degas was not only a painter but also a sculptor

Diamond of Hope from Titanic 

Gingko biloba tree leave is an official symbol of DC. Isn't it nice?

Walking around we came across main building of American Red Cross

... met Pushkin

... and Einshtein

American squirrels 

Goodbye Washington DC, I hope to see you again!

Hello, Washington DC!

The city is so much different from what we saw in Chicago! 

Capitolium 

We already visited Smithsonian Art museum (just a half of it because of the size), again so comprehensive collection of Rafael, Tizian, Rembrandt and some Leonardo

Guy plaing in the street

Magnolia flings it's fragnance 

US is so different, not so much Starbucks here) we are addicted to cofee now, so we already miss it! 

Day #4

Today we spend most of the time with Dr.Sturgeon during his out-patient consultations. 

All medical records are electronic, almost nothing is printed. All doctors have an access to this system through their mobile phones or any computer. This system also keeps not only laboratory results, but all imaging studies with pictures. So patients bring nothing with them. 

Doctors can easily communicate through this system, sending messages. 

What seemed at first surprising for me, that they also use pagers. Every nurse, doctor has it and some of them actively use them. It saves your time if you don't know somebody's number or the line is busy just knowing the name you will reach this person.

Efficient device

As there are quite a lot of obese patients everything is fited out for them. 

Big chairs just for one person

So returning back to Dr.Sturgeon's consultations, each doctor has 2-4 fully equipped consultation rooms. It also helps to save time. While the doctor talks to one patient, his resident examine another one. 

Consultation room where you can perform ultrasound and biopsy

Doctors and nurses are really accurate and precise in making detailed history of disease, co-morbidities, complaints. It is very well-coordinated team work.

Dr.Sturgeon performs thyroid biopsy with local anesthesia. We were told that about half of doctors do this procedure without anesthesia in US. The difference is that in Russia we usually biopsy once, but here they do at least two specimens.

After that we were introduced to Dr.Kopp who is Editor in chief of Thyroid journal. We discussed the possibility of starting Thyroid in Russia and it is a great idea. 

The end if the day we spent in one of the best places I had ever seen Buddy Guy legends blues cafe with terrific bands! Don't miss it if you are in Chicago!

 

Third day

After meeting Dr.Sturgeon at Starbucks (believe me there is Starbucks in every bathroom of Starbucks in Chicago) we moved to Operating rooms. Anybody could get a uniform from special machine  of needed size, doctors could change it up to 3 times a day.

Dr.Sturgeon helping us to get the uniform

We are ready 

After seeing  some postoperative patients we moved to General surgery operating rooms. It looked like a factory, there are more than 110 operations a day in only this department of Northwestern. 

Time table of operations

Preoperative room has signs what patient has past and what should be done

Each surgeon leaves his sign on the skin of the patient near the operating area, so there is no mistake.

Me in the operating room

Dr.Sturgeon in the operating room revising patient's imaging studies

Surgeons sometimes work with lightning device and loupes

Each 2-3 operating rooms have there own store room around 30 m2 with everything what is needed

Before the operation begins everyone in the operating room announce there duties, even us, as observers

We saw operation for hyperparathyroidism. What is different is that in US more people with mild hyperpara are operated.

Operation plan)

Operating room is cleaned up after each operation, it takes less than 5 minutes

The rooms for residents have comfortable boxes, restrooms, shower, restzone, computers

After this I had a meeting with Dr.Amisha Wallia, whose main research interests are management of patients after liver transplantation. It was very interesting and helpful for me, cause in my practice I deal with these patients. 

The end of the day we spend on Architectural boat tour of Chicago. Chicago river and Michigan lake is the best place to see the city!

Great day! Thank you Dr.Sturgeon and Max!