Season 9 Episode 2: "Love The One You're With"

Opening Message: 

"Surgeons don't compromise.  We exceed perfection; we operate 17 hours straight if we have to."

Red = Grey's Anatomy

White = Findings/Personal Summary

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• *Derek Shepherd* is a main character and has multiple hand fractures with a median nerve injury.  In Shepherd’s case, his wrist is where most of the grievance is for him. 

“Median Nerve injury at the elbow may cause symptoms to appear in the forearm, wrist and hang.  Injuries to the median nerve at the elbow are either lesions- where the nerve is torn either partially or fully or compressed due to displacement of a fracture or excess fluid following injury."  http://www.sportsinjuryclinic.net/sport-injuries/elbow-pain/median-nerve-injury

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• *Arizona Robins* another main character, has an open femur with a result of an above knee amputation.  

Above Knee Amputation. “There is not enough blood getting down your leg to keep it alive.  The lack of blood causes severe pain and allows serious infection to take hold.  If left untreated, the leg will eventually get necrotic (become dead) and become life threatening.  The only choice is to cut off the damaged part.  This much be done high enough up the leg to an area that has a good blood supply to ensure proper healing of the stump.  In this case it means an amputation through the thigh.”

http://www.netdoctor.co.uk/surgical-procedures/amputation-above-knee.htm

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• *16 year old female in a sailing accident*          
• She says that “She can’t feel her foot.”
• Her foot is hanging on by a nerve and she can still move her toes.
•  She moved her toes with a nearly severed foot.  The nerve, tibial nerve could still be intact which can maybe save her foot. 

Tibial Nerve. “…it supplies the knee joint as it descends in the popliteal fossa and, continuing into the leg, supplies the muscles and skin of the calf and sole of the foot, and the toes…”

http://medicaldictionary.thefreedictionary.com/tibial+nerve

Even though viewers who are watching this scene may believe that this 16 year old girl shouldn’t be able to move her foot and toes because of how the foot is hanging on by a thread, it is possible though according to medical-dictionary.thefreedictionary.com because they say that the tibial nerve does supply knee joint as it descends in areas such as the toes during this particular scene which the female moved her toes.  

The treatment that the doctors did was a surgery which was successful by restoring blood flow to the foot to where they can save it.  The doctors tell the female that the next few months they will have to do a series of operations and she has to stay completely off the foot in order to get to full function.  

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• *Roxy Meyer* – 30 year old female – Excess skin removal after a 100 lbs. weight loss 2 years ago. 

   

• Excess Skin Removal.  “During weight gain, the skin expands to contain the underlying fat and can often lose elasticity.  If older individuals or people whose weight was excessive for many years lose weight, the skin and underlying tissue do not naturally return to their original size.  A number of surgical procedures for removing excessive skin and fat are available.”
• Doctors set up a consult congenial for the hernia repair.
• Hernia Facts.  Symptoms may include pain and discomfort and swelling on the surface on the abdomen or groin area.  Trapping of tissues in the hernia (incarceration), which can result in the damage of death of the tissue.  It requires surgery. http://www.medicinenet.com/hernia/article.htm
• She is cautious of her belly which there is a lot of skin that is just hanging on her belly.
• The doctors say that the incisions will be healed in 2 weeks and that she can have physical activity with her fiance. 
• (After the surgery, doctors say that it will be 2 weeks until physical activity.  According to emedicinehealth.com, "Recuperating from extensive surgical procedures can take time.  Most people remain in the hospital for 24-48 hours after the surgery.  Walking is important on the day of surgery.")  I would agree with the doctors on saying that she will be able to do physical activity in 2 weeks but I still think that it will take a few more weeks for her to fully recover.  
• After the surgery, the doctors say there is still a lot of swelling and bruising.  The camera shows the stomach and all the flab is gone and her stomach is bandaged up.  She doesn't look in pain at all and is walking around the room on her own strength. 

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• *Papa* - An older male patient with an Enlarged Heart

Enlarged Heart.  According to mayoclinic.com, "Enlarged heart (cardiomegaly) isn't a disease, but rather a symptom of another condition.  The term "cardiomegaly" most commonly refers to an enlarged heart seen on chest X-ray before other tests are performed to diagnose the specific condition causing your cardiomegaly.  You may develop an enlarged heart temporarily because of a stress on your body...or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.  While having an enlarged heart may not always be preventable, it's usually treatable.  Treatment for enlarged heart is aimed at correcting the underlying cause.  Treatment for an enlarged heart can include medications, medical procedures or surgery."

• Dr. Thomas is planning on doing a ventricular reduction surgery. 
• According to Grey's Anatomy, ventricular reduction surgery is hacking off working heart muscle so that what's left can work efficiently. 

Ventricular Reduction Surgery.  This surgery is an operation that is in cardiac surgery which is ultimately to decrease enlargement of the heart.  Comparing the definition of ventricular reduction to the Grey's Anatomy definition, I find that both are similar which is accurate with this specific surgery.  

• During the surgery, Dr. Yang and Dr. Thomas are working together and sewing up the heart.
• Dr. Yang, before the surgery, suggested they should have done an LVAD surgery which Dr. Thomas said no because of the risk factors and also that if they would have done the LVAD then the patient (papa) would have died waiting for a heart transplant which would never of happened.  

LVAD - According to webmd.com "... there are risks with having LVAD implanted.  They include: Infection, Internal Bleeding, Heart Failure, Mechanical breakdown of the LVAD.

To me, with regards to the picture above, I could see how it would be difficult for having a LVAD implanted for an enlarged heart.  The most concern that I would have would be mechanical breakdown of this device.  I think the doctors in Grey's Anatomy did the right thing by doing a ventricular reduction surgery that was successful for the patient in this particular episode.  

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