Crazy days!


It’s been a couple crazy, busy days here in Medellin.  I have a bit of a backlog of posts – from a day learning to finger crochet in a group crochet class, the festival of flowers, a visit to Clinica Medellin Occidente and the ALAT conference.  It will take me a little while to post everything before heading home in just a few short days.

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The ALAT conference was fantastic.  In addition to numerous wonderful, learned speakers from all over Latin America, it was a great chance to connect with innovative thoracic surgeons from practices all around the world.  We also re-connected with surgeons we’ve interviewed in the past – to hear what they have been doing since my last visit.

One of these surgeons was Dr. Andres Jimenez at Fundacion Santa Fe de Bogotá (SFdeB).  As astute readers of the Bogotá books may remember, our encounters haven’t always been as collegial as they could have been.   However, he did grant me an interview, and permit my ingress into the operating room.  To my surprise, I found that while he was a hesitant interviewee, he was also a promising young surgeon.

With that in mind, I re-connected with Dr. Jimenez briefly to ask about the program.  Dr. Jimenez reports that they have started a lung transplant program and recently performed his first lung transplant at SFdeB.

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal, who was a thoracic surgery fellow when we first interviewed him – is now a practicing thoracic surgeon at Hospital Santa Clara in downtown Bogotá.

Dr. Ricardo Buitrago continues his work in robotic surgery at Clinica de Marly.  Caught up with Dr. Luis Torres, the young and charming thoracic surgeon from Clinica Palermo.

But the biggest surprise at all – was the twinkling brown eyes of Dr. Cristian Anuz Martinez.  (The twinkling brown eyes above a surgical mask are all I remembered from my 2012 trip to the operating room with Dr. Frnando Bello in Santa Cruz, Bolivia).

with Dr. Cristian Anuz Martinez

with Dr. Cristian Anuz Martinez

We spent some time over coffee talking about the current state of cardiothoracic surgery in Bolivia, his private practice and his colleagues.

The conference itself was phenomenal – the amount and range of topics covered – from sleep medicine, tuberculosis, critical care medicine and pulmonology in addition to thoracic surgery.

The Festival of Flowers

The festival of flowers, one of the largest events in Medellin also started August 1st.  The event which is expected to draw 19,000 visitors to Medellin this year – celebrates the floral industry of Antioquia with ten days of events.  The events are staggered through out the city and include musical concerts, singing contests, parades, flora displays, children’s events and arts.

 

 

Festival of Flowers displays in Plaza Mayor

Festival of Flowers displays in Plaza Mayor

Tomorrow: Clinica de Medellin – Second time is the charm!

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In the operating room with Dr. Wilfredy Castaño Ruiz


I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.

Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”.  So, if you are squeamish, or if you don’t want to know – quit reading right about now…

It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met.  He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.

Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Yesterday, I joined him in the operating room to observe a VATS decortication.  The case went beautifully.

Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case.  (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).

Anesthesia was well-managed during the case, with continuous hemodynamic monitoring.  There was no hypotension (low blood pressure) during the case, or hemodynamic instability.  Pulse oxymetry was maintained at 98% or above for the entire case.   Surgical Apgar: 8 (due to blood loss**)

Monitors at HGM are large and easily seen from all areas of the OR

Monitors at HGM are large and easily seen from all areas of the OR

Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)

** In this particular case, the surgical apgar of 8 is misleading.  The anesthesia was excellent, and the surgery proceeded very well.  However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface.  This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.

Thoracic surgery and sympathectomy


Clinica Palermo,

Dr. Luis Torres, thoracic surgeon

I went back to see Dr. Luis Torres, thoracic surgeon and spent the day in the operating room with him for a couple of cases.   He is a very pleasant, and friendly surgeon that I interviewed last week.  Dr. Torres just recently returned to Bogotá after training in Rio de Janeiro for the last several years at the Universidade de Estado de Rio de Janeiro.  He completed both his general surgery residency and thoracic surgery residency in Rio after graduating from the University de la Sabana in Chia, Colombia.  (He is fluent in Spanish and Portuguese).

I spent some time out in Chia last year with the Dean of the medical school (and thoracic surgeon, Dr. Camilo Osorio).

The first case was a sympathectomy for hyperhidrosis.  I’ve written more about the surgical procedure over at Examiner.com, and I will be posting more information about the procedure – potential candidates and alternative treatments over at the sister site.

 

The second case was more traditional thoracic surgery – a wedge resection for lung biopsy in a patient with lung nodules.  **

In both instances, cases were reviewed prior to surgery, (films reviewed when applicable – ie. second case) and visibly posted in the operating room.  Patients were sterilely prepped, draped and positioned with surgeon present.  Anesthesia was in attendance for both procedures – and hemodynamic instability/ desaturations (if present) were rapidly attended/ addressed / corrected.

Dr. Torres utilized a dual-port technique for the sympathectomy, making 1 cm incisions, and using 5mm ports.  Each side (bilateral procedure) was treated rapidly – with the entire procedure from initial skin incision and application of final bandaids taking just 35 minutes.

Dr. Torres, performing VATS

The second case, proceeded equally smoothly, and without complications.  There was no significant bleeding, hypoxia or other problems in either case.  Surgical sterility was maintained.

** Both patients were exceedingly gracious and gave permission for me to present their cases, photographs etc.

Just as the second case ended – Dr. Ricardo Buitrago arrived – and performed a sympathectomy on one of his patients – using a single-port approach.  (I am currently working on a short YouTube film demonstrating both of these techniques.)

This week in Bogota


Finished a short film on robotic surgery yesterday and posted it to YouTube.

Going to the operating room this week with Dr. Torres, the nice young thoracic surgeon I spoke with last week.

Fashionistas beware!

I’ll be assisting Bogotano fashionistas this week – co-hosting a fashion party with my friend, Camila.  She is moving to Miami so she has to liquidate all the stock from her popular store on Calle 95.  It will be an afternoon of wine, cheese, fashion and fun – as she hosts a mini-fashion show for some of our friends on Saturday.

Closets by Camila is hosting a fashion event

A reggaeton group is playing down on Calle 83 this Friday – so we’ll be down there to check it out..

There’s also a big hip-hop event in Parque Simon Bolivar this weekend.  It’s the 16th year for this event – and it sounds like a lot of fun.

Still hoping to hike Monserrate but haven’t gotten around to it yet – but when I do, I’ll post some photos.

Robotic surgery at Clinica de Marly


I hope everyone is enjoying some of the changes in format – after all the wonderful experiences I had writing the Mexicali book, I thought I would start incorporating more local culture and content in the blog when I am in Bogotá.  (I have always enjoyed Bogotá – but my writing tended to be rather dry and uni-focal so from now on, I’ll try to include more local information about the city since I am in the midst of it all.)

Barbie display at Andino Mall, Carrera 11 No 82-01

It doesn’t mean that I am any less interested in crucial issues in medical tourism, quality measures or surgery – I just won’t focus on these topics exclusively.

I spent yesterday over at Clinica de Marly with Dr. Ricardo Buitrago to watch one of his robotic surgery cases.  They’ve been doing robotic surgery over at Marly for several years – but Dr. Buitrago just started the first robotic program in thoracic surgery in Colombia.  (Previously the robot was used exclusively for urology and gynecology surgery).

Robotic surgery with Dr. Ricardo Buitrago

Dr. Buitrago trained with the renown robotic (thoracic) surgeon, Dr. Mark Dylewski – and has been a thoracic surgeon for over 20 years so it is always interesting to watch one of his cases – robots or no robots..

Just published a new article about robotic-assisted thoracic surgery over at the Examiner.com along with photos and a short film clip that shows the robot in action.  I am working on a longer film that provides a better look at what robotic surgery really is/ what it entails.

 

Overseas Radio Follow-up


As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

You’ve come a long way, baby!


Wow..  a long couple of days – but I am sure not complaining!  Still having a blast – and as they teased me in the operating room, “Cristina, Cristina, Cristina!” I felt more like I belonged – instead of as a student, often lost/ confused.  Even more so – when I found myself irritated on rounds – irritated when the answers were obvious!!  Obvious – that’s certainly making progress..  (Irritated is such an improvement over clueless, I must say..) But the interns are a good bunch, even if they don’t love surgery like I do!

Residents at Mexicali General

The good doc gave me some homework – as we work on a ‘mystery diagnosis’ which I am enjoying.  Of course, it won’t be a mystery as soon as the pathology comes back, but I am surely enjoying the intellectual challenge (and kind of hoping that my preliminary leaps aren’t completely off-base..)  Of course – the doc is so smart – he probably already has it all figured out, and is just checking on the faculties of his student.  (He is secretly brilliant, and just hides it behind his braces and freckles.. Kind of scares me sometimes..)

Deceptively normal looking..

Bumped into Dr. Ramirez and Dr. Perez (the anesthesiologist) this morning, which reminds me that I still need to write about my visits to his operating room last week.  So I haven’t forgotten – expect it in just a couple of days..

It’s nice too when we run into people I know as we round at different hospitals around the city..  But then – as I glance at the calendar and realize that time is passing – I get a little sad.  Just as I am starting to understand things (Spanish, the hospital systems etc..) and I am enjoying it here so much, learning so much, yet time is flying, and before you know it – I will be returning home again (wherever that is!)