Thursday, May 8, 2008

Pimped like a *itch!

Today, I attended 2 conferences at a local university's Pathology department, and of course, it was an absolute blast (as much as these things can be considering that the dx made changes people's lives forever). And even though the conferences were related to cytology (Hemolytic transfusion reactions) which is my least favorite of the 2 main areas of pathology (the other being Anatomic), I not only managed to enjoy the conference, but I asked some good questions too!

The second part of my morning was spent in the sign-out room of the hospital which is where diagnosis of patient samples occurs. And it was here that I got pimped like a *itch, lol!! Now the Attending KNOWS that I'm not a Resident, but ironically this is the same Attending that made it clear the first time I sat in with him that he didn't have time to explain anything to me because he wouldn't have time. No problem, I keep my Robbins and Coltran Atlas of Pathology as well as my Gartner Atlas of Histology handy, so it's cool. But I felt good about answering 3 of 5 questions correctly and I had NO problem saying I don't know to questions I didn't know, because faking it in medicine can kill folks. But we had a little meeting of the minds when he asked me what was the most common type of thyroid tumor, a question I should have known the answer to because I've had thyroid "issues" too. When I couldn't name it, he asked me to name one type of thyroid tumor and I said "the only one that comes to mind was medullary thyroid carcinoma". Now my experience from the NIH taught me to always be mindful of "zebras" or rare malignant tumors. That's not a bad strategy for a place like the NIH which often gets those rare cases no one else can figure out, but a good Pathologist has to be able to differentiate a "zebra" from a "horse" since there are far more "horses" than "zebras". Then he said "medullary carcinomas aren't that common, where else are they found?" (and by now I'm thinking this guy sure does talk a LOT for a person with little time, lol!!), and I replied "kidney". Then he replied "no, they aren't found in the kidney, what is the most common kidney tumor"? I said "Clear Cell" which I knew from my work at the NIH, which was primarily kidney and prostate cancer.

So now I'm thinking THIS is one reason why there are disparities in cancer mortality. Renal meduallary carcinomas are a very rare form of kidney cancer, but for unknown reasons, they're found an overwhelming majority of the time in young, black, pateints with hemoglobinopathies. BUT YOU HAVE TO KNOW TO LOOK FOR IT!!!!! So when a sickle cell patient comes in complain about hematouria, SOMEBODY had better start thinking about "zebras" because this is a very aggressive tumor and thus is highly fatal.

Now I'm the kinda person that has taken practically EVERY research project I've ever worked on and tried to find how my work can improve morbidity/mortality in minority populations.. For instance, my current project involves breast cancer, so I made SURE to look at cells lines relevant to black/minority women (namely ER- tumors). I did the same thing when I was at the NIH, I started looking for biomarkers in Renal Medullary carcinoma that could help dx this disease in its early stages (didn't go as far as I wanted to take it). Unfortunately, there isn't nearly enough research being directed at diseases which disproportionately affects minorities.

So in my quest to have my research career, you can bet that if I'm "forced" to for example, to conduct research in Thallasemia (which irronically runs in my family), I'm gonna throw in a little sickle cell anemia too for good measure!

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