Reflections on an Incredible Experience

I returned from Los Angeles on Saturday night. I am glad to be back in South Carolina, and I am excited to begin my junior year at Wofford. However, I will certainly miss working at Cedars-Sinai Medical Center as well as all of the friends I made in LA. Before I began working at Cedars-Sinai, I viewed the internship which I had been awarded as an opportunity of a lifetime. After working for three months in the department of neurosurgery, the experience definitely lived up to my expectations.

I lived in the second largest city in America. I worked in one of the best neurosurgical departments at one of the best hospitals in the country. I saw multiple brain surgeries. I shadowed some of the most brilliant physicians in the world. I attended lectures, brain tumor boards, neurovascular meetings, and lab meetings all of which were focused on providing the best care possible to the patients of the Maxine Dunitz Neurosurgical Institute. I studied immunology. I gained practical research experience while working very hard in the lab. I participated in an experiment that lasted over 24 straight hours and then directly afterwards went into the OR to shadow a surgery. I saw many, many movies in the movie capital of the world. I dined, danced, and enjoyed life in LA. I visited New York and met one of my favorite movie stars. I witnessed the tremendous amount of dedication and time that is required to be a successful neurosurgeon, and I gained even more excitement and enthusiasm at the prospect of becoming one. In short, I had an absolutely amazing experience!

I feel very blessed to have participated in this program. I come away from the past three months more excited than ever to become a physician. My time at Cedars-Sinai has significantly increased my desire to become a neurosurgeon. I am more determined than ever to study hard so that I can become the best physician that I can possibly be, and I absolutely cannot wait for the day when I too can work to improve the lives of patients. I only hope that one day I will be like the neurosurgeons of Cedars-Sinai: totally committed to the well-being of their patients, doing everything possible to give their patients hope and the chance at a brighter tomorrow, and tirelessly working to cure brain cancer. I know that this summer would not have been possible without God, the members of the selection committee, my professors at Wofford, and my being a Terrier. So I would like to take this opportunity to sincerely thank every single person who had a hand in providing me with this opportunity. I will truly never forget my summer at Cedars-Sinai, and I know that it will have an immeasurable impact on my future career and life.

So how do I end this blog? Perhaps with a challenge:
Dream big.
Develop your passions.
Pour your heart into what interests you.
Spend your time on things that matter.
Go after opportunities, no matter how unattainable they may seem.
Have faith.
If you do these things, then you just might stumble upon something that defines who you are, you just might find something that you love, you just might attain your dreams.

Thanks so much for reading my blog!

-Joseph H. McAbee

Can we crank the bipolar up to 35, please? … microscissors … let’s get some irrigation in here!

These are a couple of phrases that you may hear should you ever find yourself in the operating room. They are commands used by surgeons, regardless of specialty, many, many times each day. The “bipolar” is an instrument that delivers an electric current from one metal tip to another. It allows a surgeon to burn and cut through tissue, fat, etc. It also minimizes blood loss as it cauterizes the blood vessels as they are being cut. Microscissors are just that…micro scissors. The scissors portion of the instrument are smaller than a paper clip, but they are really useful for making precise cuts under a microscope. Finally, irrigation refers to a saline solution that surgeons utilize to wash out the wound should it get full of blood or fluid.

I saw my first brain surgery a few weeks ago! It was AMAZING! It was truly awe inspiring when I stopped and thought about what all the brain controls. I mean the brain controls breathing, memory, speech, walking, personality, and pretty much everything else about us! And neurosurgeons have the responsibility of operating in this complicated control center of our bodies! They have to get in, do what needs to be done, and get out without causing neurological deficits to the patient. That is no small task. It is nerve-racking, but mostly it is really exciting. Spending time in the Cedars-Sinai OR, working with the neurosurgeons and residents, seeing brain tumor resections, watching the brain pulse along with the heartbeat, examining facial nerves, and more, have convinced me that I want to become a neurosurgeon!

Just to give you an idea of a few cases that a neurosurgeon may have to deal with on any given day, I am going to briefly describe trigeminal neuralgia (TN) and ependymomas.

Trigeminal neuralgia is a disorder characterized by intense facial pain. It typically is caused by a blood vessel putting pressure on the left or the right trigeminal nerve. The trigeminal nerve controls a multitude of functions. It transmits signals from the face to the brain, it controls jaw muscle movement, and it involves a person’s ears, eyes, nose, forehead, teeth, tongue, and more. A patient who has TN may experience intense pain in any or all of the above areas, typically on one side of the face, many times throughout the day. Attacks can be triggered by something as simple as brushing one's teeth or a cool breeze. It is a debilitating disease that gets worse over time. A neurosurgeon can correct the problem through microvascular decompression. He/she can make an incision behind the ear, cut open the skull, move the brain to expose the trigeminal nerve, separate the nerve from the blood vessel, and place a Teflon pad between the nerve and vessel to insure that the blood vessel can no longer put pressure on the nerve. The patient should recover well with little to no pain or facial numbness.

An ependymoma is a tumor that develops from ependymal tissue of the central nervous system. Most often it develops in the fourth ventricle, but it is also common in the spinal cord. Symptoms, if they arise, are typically due to an obstruction in the flow of cerebrospinal fluid. A subependymoma is a less common type of ependymoma that is typically benign and more often found in men. Ependymomas may be treated through radiation or surgical resection. The fourth ventricle, as it is situated directly over the top of the brain stem can be a tricky place to operate. Neurosurgeons have to be extremely careful when operating near the brain stem as there are only a few layers of cells that protect it. The surgeon has to tease the tumor away from the healthy brain tissue and remove it piece by piece, while continuously monitoring the brain stem evoked responses and the heart rate. It is a long, but interesting process in which the surgeon looks for visual clues that distinguish tumor from brain, such as vascularity, color, and texture.

There are no words to describe this blog.

Bregma marks the spot. Well, sort of.

I apologize that this post is so long in coming. I typed this post up last week, but unfortunately I accidentally erased it all. Smooth, I know. I did not have time to retype it this weekend, as my parents were visiting me in LA. We had a lot of fun! We did many of the tourist activities in LA which was cool since I hadn’t done many of those things yet even though I have been living in LA for two months! I will post those pictures soon.



Several weeks ago, I was able to assist in my first surgery ever! It was awesome. Before I begin my description on tumor implantation, I want to reiterate that all procedures are done to ensure that the animals are treated in the most humane way possible. The mice are first anesthetized. Then their heads are shaved. Once they are completely under anesthesia, they are placed on the stereotactic frame, as shown above. After the mice are secure, betadine is applied to the incision area and the skin covering the skull is cut. The skull is exposed and the bregma is located. The bregma is actually easier to locate when the skull dries slightly. The bregma is the point of intersection between the coronal suture (horizontal line in the picture to the left) and the sagittal suture (vertical line) where the frontal and parietal bones meet. We use the bregma as the “zero point” or the point of reference. Once we find the bregma, we utilize the stereotactic frame to find the correct point in the right hemisphere where we will inject the tumor cells. A burr hole is created in the skull using a hand drill, a needle is inserted into the hole, and 50 K tumor cells are injected into the hole. After injection, bone wax is applied to cover the burr hole, the skin is clipped together, and pain killers are injected subcutaneously. The mice are observed closely for several hours after surgery and then each day until terminal symptoms become apparent. This particular type of surgery can be performed to derive tumor lines or to observe the effects that different treatment types have on tumor growth and mouse survival time.

To Perfuse or Not to Perfuse... That's Not Even a Question!

As I mentioned before, we do a lot of flow cytometry in the lab where I work. We concentrate most of our efforts on T cells: the molecules expressed on the surface and inside different populations of T cells, the presence or absence of T cells in brains with tumors, how T cells interact with and kill cancer cells, and more. In order to do this, many times we need to remove the brains and/or spleens of mice by perfusion.



I would like to preface my discussion of perfusions by saying that all work that we do on mice is done following a set protocol that has been created in collaboration with veterinarians, research scientists, and healthcare professionals to ensure the most humane methods of euthanasia. Also, all mice studies are only done when other routes of experimentation are unavailable and there is sufficient need for the experiment.


So why is doing a perfusion the definite route to go when you are seeking to resect a brain or spleen for flow cytometry or other types of analyses? I am glad you asked. It is because perfusions allow a scientist to remove the blood from the organ of interest which cuts down on auto fluorescence by RBCs. First, the mouse is anesthetized with a ketamine + xylazine IP injection. The mouse must be completely unconscious before the procedure can begin so that it will not feel any pain, and this can be tested by squeezing its paws and observing the reaction. Next, a dissection is performed to expose the abdominal and thoracic cavities on the ventral side of the mouse. The ribs are removed and the heart is exposed. After exposing the heart, the aorta is cut and a small hole is cut in the left ventricle. A butterfly needle is placed into the left ventricle and PBS is injected into the mouse. The mouse’s heart will carry the PBS throughout the body which will rid the body of RBCs and cause the organs to turn white in color. If the brain tissue needs to be fixed, then PFA can also be injected through the left ventricle to do so. After this procedure is done, the required organs can be removed and properly stored for analysis.


Another important procedure for researchers that are studying cancer is tumor implantation. Tumor implantation is two things: 1. It is a very neat procedure, and 2. It is the topic for my next blog… Stay tuned.

And The #1 Most Important Technique in Scientific Research is......

Labeling!!!!!!

Seriously, if you are considering doing your own scientific research for the first time, get in the habit of labeling everything! Label things clearly with as much detail as possible. Even if you are simply putting 20-mL of distilled water into a 50-mL tube, you should still label it because you may forget what you put in there when you come back from eating a bologna sandwich. Also someone else might need to know what it is and to whom it belongs. You want to make sure that your results are as accurate as possible by minimizing procedural errors. The easiest way to do this is to become an expert "labeler."

Another simple, but equally important tool for effective scientific research is reading! Read as much as you can about the work you are doing or are planning to do. Reading scientific papers is challenging, but the more papers you read and the more times you read each paper the easier it gets. Sometimes it can be rather difficult to make yourself read at night after a long day at work (something that I have experienced). However, what background reading can do for you is grant you an understanding of what you are researching. That way it means something to you when you find out that CD8+ T cell expansion occurred after lymphocytes from a particular transgenic mouse were injected into a nude mouse. Otherwise, you are just a robot. Otherwise, you are just following a protocol. Reading allows the research experience to be not just educational, but also meaningful and more enjoyable.

Stay tuned for a future post describing the art that is perfusion...

Living the L.A. Life

I went to Santa Monica today. I hung out on the pier for a little while, which is equipped with its own roller coaster, Ferris wheel, and food court, and then I went on the beach to read, listen to music, and admire the Pacific Ocean. I had a lot of fun, and luckily I did not get too sunburned! When I got back to my apartment, I walked down to San Vincente and got some supper at a small cafe in downtown Brentwood. Last weekend, I found a neat outdoor mall just outside of Beverly Hills with the nicest movie theater ever. This was a big deal to me because I am a huge movie buff (something that I have inherited from my father) and so I plan to spend a lot of time there this summer. It had three stories and had assigned seating! I saw Prince of Persia. It was great! I am not a shopper, but if I were it would be easy for me to do so since I drive right past Rodeo Drive on my way to work each day.



There is never a shortage of things to do in L.A. However, in addition to working full-time during the week and having fun on the weekends, I have to find time to cook, clean, wash clothes, iron, go to the grocery store, exercise, and study. It is a little different from being at Wofford where my meals are made for me each day and I can get my clothes washed every time I go home to visit. I like it though. I am truly living in the "real world," and it is great practice for the future.

One thing that I really like about L.A. is the interesting and eclectic group of people that I interact with on a daily basis. At the lab I am working in I get the opportunity to work closely with people of many different races and backgrounds. Each person has his/her own ideas, beliefs, and languages. I have enjoyed getting to know my labmates and many other people at Cedars-Sinai. L.A. is really teaching me that we truly do live in an internationally oriented world, and that advances in science, economics, and politics are made much easier when all people work together in a spirit of cooperation and brotherhood.

Even though I am a Woodruff boy and I am used to the slower pace of Spartanburg, South Carolina, I really love L.A. Sure it is busy, crowded, and crazy at times, but it is also beautiful, fun, and an exciting place to live and work. Oh and by the way...GO LAKERS!!!!!!!!!! NBA CHAMPS!!!!!!!!!!

Go with the Flow

During the past week I have been learning about an extremely important experimental procedure called flow cytometry. Flow cytometry has many uses in the lab. With flow cytometry you can discover the size, complexity, and phenotype of an individual population of cells in a heterogeneous mixture. The diagram below shows the main parts of a flow cytometer. Basically, cells are passed through a laser beam one at a time and optics catch the light that is scattered by the cells and direct it toward the detectors. The detectors then translate the light intensity to a voltage pulse and send this signal to the computer system where analysis can be performed.
A really cool thing that a researcher can do with flow cytometry is determine the surface molecules or antigens that are present on a particular cell type. This is done by collecting a cell sample and then labeling the cells with fluorophore-labeled antibodies. You can add many antibodies (all of different colors) to look for several molecules at the same time. You can also do intracellular staining if you are looking for a particular molecule that may be found inside the cell as opposed to on its surface. Intracellular staining requires the use of a Golgi plug because you must make sure that proteins, especially proteins that you are looking for, are not shipped out of the cell by anterograde transport once you create pores in the cellular membrane to allow the fluorophores inside. Once the cells have been labeled, they can be passed through the laser. The laser will excite the fluorophore to a higher energy level, the fluorophore will then return to its regular energy level causing a certain color light to be emitted, and this fluorescence will be detected by the flow cytometer. Subsequent analysis of the fluorescence intensities allows researchers to know what antigens and surface/intracellular molecules are present in a cell. This is clinically relevant because if you know what surface molecules are on a cell, you can gain insight into biological pathways or intercellular interactions of which the cells may be a part. This information can then be used to create treatments that could upregulate positive pathways or downregulate harmful pathways. As you can see, flow cytometry is extremely essential and exciting stuff. So don't forget...go with the flow.


The pictures in this post came from the website listed below. If you are interested in learning more about flow cytometry I would highly recommend this website! Más pronto...

http://www.invitrogen.com/site/us/en/home/support/Tutorials.html

Liberty Enlightening the World

If you are at all confused by the title of this post, don't be. "Liberty Enlightening the World" is simply the actual name of the Statue of Liberty given to it by its sculptor, Frederic Bartholdi. As you can tell by my short history lesson, I had fun seeing and learning about the Statue of Liberty. However, I did a lot more during my weekend in New York City besides visiting Lady Liberty. I was enamored by Picasso's works on display in the Metropolitan Museum of Arts, I was entertained by the Broadway performances of The Phantom of the Opera and Fences, I was amazed as I looked out over Manhattan from the top of the Empire State Building, and I was thrilled to spend some quality time with my parents. Needless to say, I had a great vacation in New York City! Of course the coolest thing about New York was the 2010 Pauletta and Denzel Washington Family Gifted Scholar in Neurosciences Award ceremony. The ceremony was held at Harlem Village Academy, an excellent public charter school in Harlem, in order to inspire the students to consider science and medicine as a potential career and to encourage them to apply to this program in the future. Before the ceremony I had the opportunity to meet many interesting people including Dr. Black and Mr. and Mrs. Washington! Mr. and Mrs. Washington are two of the most generous, humble, kind, and down to earth people you could ever meet. I had a lot of fun talking to them and taking pictures with them. I am so blessed to have met Pauletta and Denzel Washington, and I will be forever grateful for their investment in my future (Oh and Denzel said he really liked my Wofford tie!!!). As you can see, I had the weekend of a lifetime! Currently, I am back in L.A. where I am continuing to learn new research techniques. More soon...

First Week At Cedars-Sinai

My first day at Cedars-Sinai Medical Center was this Tuesday. I went through the hospital orientation, had several meetings, and became familiar with the Cedars-Sinai campus. I will be working in the Barbara and Marvin Davis Building (the tall building pictured above), also referred to as the Burns and Allen Research Institute. I will be in Dr. Christopher Wheeler's Dendritic Cell Vaccination lab which is a part of the Maxine Dunitz Neurosurgical Institue. Dendritic cell vaccine is made by pulsing a patient's dendritic cells (cells that elicit an immune response) with tumor lysate. This causes the patient's body to combat the tumor more effectively. My research focus for the summer has not been finalized, but it may involve testing to see which cell killing pathways (perforin or rapid response) chemotherapy and endogenous anti-tumor T-cell activity affect, and how that influences tumor growth. This research will involve cell culture, flow cytometry, brain surgery on mice, and more. I am so excited to get started on my research because it is fascinating material and it is clinically relevant. In addition to working in the lab, I will have the opportunity to shadow Dr. Black and other neurosurgeons at Cedars-Sinai! How cool is that?? I already sat in on the Tumor Board this Wednesday, and it was very interesting. First, however, I am flying to New York City tonight to attend the awards ceremony where I will be presented the award by Pauletta and Denzel Washington. I know that I am going to have an awesome time in New York this weekend and in L.A. this summer. I will make a new post about my NYC experience when I return to L.A.!