19 June. It's my last blog page, because tomorrow ENDO2014 will start and on behavior conditions of our ambassador programm it will be another story. 

I accompanied with Dr. Sturgeon in outpatient clinic, he examined a lot of postoperation patients. I couldn't find a scars on three persons, despite of only four weeks have passed.

The main event of the day was meeting with Ritu Nayar, the leder of cytology service of NWHospital, one of the founders Bethesda classification.

Our conversation continued approximately 2 hours, we have managed to see procedure of fine needle and cor biopsy of adrenal tumor,  suspicion for lung metastasis, we could see collection typically slices of thyroid citology and talk over demands of cytologist to procedure of biopsy. 

Ritu Nayar is the person, who keen on her business, and time flu very fast. At the end of meeting Dr. Nayar presented us her  atlas of thyroid cytology. 

Finishing my blog, I want to express my infinite gratitude for our hosts - Cord and Max for amazing hospitality and attention for us. I would also like to thank my English teacher. My trip and meeting people wouldn't be possible without her professional skills, encouragement and kindness. 

18, June. We observed procedure of sesta-MIBI scintigraphy and SPECT-CT for female with hyperparathyroidism.

We noted many interesting peculiarities, which would be useful in our practice.

After this we met with professor Dr. Mark Molitch, he is señor supervisor of endocrine research programs in North-Western Hospital. We had  enthralling conversation about problems of healthcare organization  in our countries, what are common, what are different. The  Endocrine society published an article about Ambassador Exchange Program in Endocrine News journal with our photo and small interview. You can find it on the 27 page. 

http://www.endocrine.org/~/media/endosociety/Files/Publications/Endocrine%20News/Issues/2014/457615_EndoNews.pdf

Daria spent a day in out-patient clinic observing Dr.  Molitch consulting patients. Afterwards we discussed the most interesting cases. 

At the end of our day we enjoyed night  Chicago, but all of the sudden heavens gifted us hard rain, and I was wet in one moment.

17, June.

 I spent the first part of my day with Dr. Sturgeon in operation room. He operated female with hyperparathyroidism and the second one with thyroid tumor (atypia  of undetermined significance). The procedure of preparing and surgery were usual, but I could watch more attentively for pleasant details, which  improve and make more convenient surgeons job.  

For example I saw original wound retractor, 

neuron-monitoring device, 

which has some differences, that I saw before, mini-clipator etc. 

Daria has a great impression from Dr. Koop's consultations (it continued for seven hours),

 and we had a hot discussion about some positions. For example Dr. Koop treats some patients with Grave's disease lifelong with methimazole if the patients has good toleration to small doses  and doesn't have enlarging goiter.    Dr. Koop means that adverse effects of this treatment depend on dose, and treatment is relatively safe. It's so different from our approach! 

The second part of my day I enjoyed biking with Cord.

He is great bicyclist and we did near 30 miles! (comparing with  the length of Moscow Boarding Ring which has 52 miles and required 1 hour to completing high-speed car driving). Just after biking I guess I will pass away, but after two hours I fill good, better then before walking. 

June16.

We have had our bags overnight at last! 

We have a new saturate day. In the beginning of the morning we observed for Dr. Sturgeon work in outpatient clinic, and we were witnesses of conversation with young female 16 years old, singer, who has hyper-function nodule sized nearby 40 mm. The choice between surgery and radio iodine  is also very actually question in the our country. I have impression, that Cord lead patient's decision to surgery, cos the application of radio iodine for teenagers is limited in USA, and the increasing risk of follow malignancy was shown in few papers.  There were many interesting cases else, but we interrupted to case presentation meeting.

 It was made by Daria, it carried out by supervision Dr. Koop for residents and doctors. Daria created excellent presentation about 3 cases. The comments of Dr. Koop were unbelievable, and I was delighted his explanation of pathogenesis of McCune-Olbrite  syndrome and his great skills to state scientific questions which issued from clinic position.  

Other cases were dedicated adrenal insufficiency and congenital adrenal hyperplasia, and comments were excellent again. 

Then, we met with chairman of radiology department, and discussed a lot of hot diagnostic and treatment problems. I had impression, that Dr. Spies has less watchfulness to concern radio iodine, then Dr. Sturgeon. It was very informative and useful talk, especially regard low dose ablation validity, indication and calculation iodine's dose for treatment Graves's disease. 

Next step of our rich for events day was Tumor Board. It look likes our consilium, which takes place monthly. Only most of challenged patients are considered, the list of cases  is given to every member of the Board, all of person souls be adeptness his opinion. It was really interesting, and I had big honor told my opinion about one of the discussing question. 

The ending of our day was really amazing, becose we visited delight performance : rock-style singer Melissa  Ethridge accompanied Chicago Symphonic  Orchestra  was excellent! 

I have know enough English words in order to express my impression about this concert, thanks for Cord and Max! 

June, 15

We have been spending the amazing time for last three days! We are in Washington DC. I will be short, because it doesn't concern to the main purpose of our visit in the USA, and only enumerate the list of sights when we were.

The first of all we went to national gallery of the art, and saw a lot of canvases of Italians, the Dutch, impressionists etc. after this we was walking nearby Capitol and took photos. 

We introduced with excellent sophisticated Russian hide Anna Toporovskaya  and her husband Albert on the second day of our staying in Washington DC. Anna was born in Baku, and left USSR thirty years ago.

 She perform very interesting and entertaining excursion for us during six (!) hours, and we could see the White House, monument of Einstein, 

Memorial of Washington, memorial of Lincoln, monuments for soldiers lost in Korea and Vietnam, the Capitol, the library of US Congress,

 the Pentagon, the memorial Arlington cemetery. We were in center of John Kennedy, 

and had great impression to observe the WashingtonDC Cathedral.

  In the and of our survey trip we visited  Hillwood museum, where a lot of Soviet's works of art from collection of American ambassador's in USSR wife is exhibited. 

This is the icon which was in avanguard of Russian soldiers in the Borodino Field (gifted by Stalin).

All our trip we enjoyed Anna's amazing stories. It was culture shock! 

We had excellent finish of the day - it was our attending really musical "Side show" in the Kennedy's center! It was great impression!

Today, before our flight to Chicago, we are going to selective visit rest Smithsonian museums, which were advised us by Anna Toporovskaya.

10, June. Today morning Dr. Sturgeon suggested us to listen to the very interesting research report about anti-hemorrhage therapy. This report was performed in the conference room, which has possibility of remote demonstration to the other places (there are 6 or 8 cameras).

After this report we visited few rooms, where trainees can get some surgical skills: I did endoscopic exercises with plastic triangles,  even performed colonoscopy, but I tied the twice loop and the level of patients pain in the screen was very hight.

Resident, who accompanied us, consoled me, that the case was very complicated :-) The amount of training facilities impressed us: we saw the hall for training endoscopic skills with cadavers: there are six working operation tables and each one has own both endoscopic counter and lighting.

The next exercise room are equipped as reanimation room with mannequin who can complain, suffer etc.

This "male" has some ports for intravenous manipulation, we can do reanimation procedure.   We could see simulators for performing the fine needle aspiration, tracheostomy, thoracoscopic and laparoscopic surgery for new-born child etc. All simulators are made by 3D printer. 

I concluded, that one of the main reason of very hight level of medical education in US is a lot attention to training practical skills.

We were introduced to the President of endocrine society Dr.Teresa Woodruff.

Dr.Woodruff told us, that research building has 3 floors (!) for experimental animals. It was very hearty welcome, Teresa kindly gifted us her monograph with welcoming signed.  

The next part of our day was dedicated to observing the work of very professional nurse, who teaches patients with diabetes. 

The end of our day we spent for learning the brilliant collection of Art Institute. 

We had been walking in their halls for two and half hours and we're really amazed!

  

12, June. We spent our morning in outpatient clinic in the dr Sturgeon's office. Cord has two rooms, each of it has the similar equipment. In each room has transformed place to observation, laptop, ultrasound machine, all set for fine-needle aspiration.

Cord explained us, that two similar rooms with not cheep devices  need in order to avoid patient's waiting. While Cord was talking with patient in the first room, in the other room his resident gathers complains and anamnesis. There are a lot considered decisions In outpatient clinic.

 This is the artificial meal for learning lostweighting patients. Cord has own specialist for painting slices by two methods. 

Next meeting was introducing us with dr Peter Koop, the main editor of "Thyroid". The result of interesting conversation became offer of publishing Russian version of "Thyroid". He accompanied us in our visit to genetic lab, which impressed us by modern facilities (for example - the machine, which reads gene entirely, not exon by exon, and it price tenfold less, then old sequence-reading  devices.  

Then I watched to parathyroidectomy, and I was exited  with learning process: Cord helped his resident, and explained her some details right on the paper sheet, covering patient.

Next big event of this day was visit to really best entertainment place in Chicago. It was very funny and we was happy to listen blues in this historical place.

It is I am and Ronnie Baker Brooks, one of the famous blues singers. 

We finished our day in the famous place - thematically (American football) restaurant with excellent steaks! 

Tomorrow morning we are leaving to Washington DC. 

11, June. Eventually we went to operation block. Operation's time-table disposed on the four big screens  looks like flight-schedule in the airport (number of patients comparable with number of flight in the JFK). 

Cord had to operate female with hyperparathyroidism  and we observed detailed talking about peculiarities of surgery, prognosis and possible complications. The part of conversation was going with help of special ward' board

At the end of conversation Dr. Sturgeon signed on the patient's neck and explained me, that it is insurance against possible mistakes. Before operation we had short excursion in the storage rooms behind operation hall:  there are unbelievable quantity of disposable surgical instruments different sizes and purposes. 

Arranging of patient's position on the operation table was performed by Cord and  only this process took near 40-50 min., pre operation US, performing local anesthesia, arranging headlight - all of procedures impress of their meticulous and thoroughness.  He performed revision all parathyroid glands, twice checked the level of parathyroid hormone, and once sent specimen to frozen section. All answers were delivered in shortest time. He has all need possibility for modern qualified work.  

After surgery, I watch the big laboratory, the size of it looks like the football field, it equipped with a lot, placed very tight lab machinery.

It was interesting, productivity of this lab is very high. 

After lunch we enjoyed walking on  the boat on the Chicago-River and Lake Michigan.

The hospitality of Cord and Max shifts any expectations, we have very rich and tight program  of our stay in Chicago. 

8 June, 12.00 Moscow. 

The first adventure we had in the airport. When we were passing the boarding we were stopped because we have transit tickets to Chicago throw Toronto, but we didn't have Canadian visa. Dasha is used to transit flights without any problems. We guess it links with recent sanctions. Just now we have bought new ticket to New York and are waiting our board in five hours. When we are in New York we will have to buy tickets to Chicago.

After flight, 8.06 at 16 hours domestic time in  NY: our baggage is lost, we guess it is left in Moscow in spite of confirmation of  serviceman of Aeroflot about reliability transfer of our baggage.    We filled request to Aeroflot and bought two tickets to Chicago for 1000 $, because before two hours the price rises twice and  the next flight only at morning. We informed Cord about our "entertainment" and he texted to us:"unbelievable"

23.30 local time in Chicago: we landed at last. Cord met us, and free next our morning for necessity shopping.  We stayed in the good hotel, but I live in the room for invalids. 

I realized, that the most of necessity things are recharger for mobile, antihypertensive and sleeping medicines. I don't have any desires to sleep. My washed things have been dried with ironing for one hour. At last we are in America and hope the long train of our troubles will be finished

Second day, 9 of June.

Today, after short shopping was completed, we met with Cord and Max.

We spent two hours for making our official badges (it thanks Cord's secretary - very kind and nice woman).  After this procedure Cord accompanied us and showed the all departments of NorthWestern hospital. It was culture shock! We were amazed with so large scale of this hospital. Dr. Sturgeon even doesn't know common amount of places for patients in this "factory of health". There are a few (5 or 6, I lost in quantity) buildings (research center, comprehensive cancer center, woman's and children hospital, orthopedic center and outpatient clinic). Each building has from 12 to 22  floors, and are connected by pedestrian crossing. 

Mad amount both of speed comfortable elevators (with elements of entertainment in the children department) and restaurants and coffee snakes makes a great impression.   Only one building combines 37 operating rooms! I asked about outpatient clinic and Cord explained me, that small insignificant operations is performed there, for example - cholecystectomy (!). Unfortunately, we don't have  experience of arranging this type of clinics in our country. 

Cord promised us very strong and high dense schedule for next day.