PCP: Four weeks later

During my last week at Dr. P's office, we had a patient, RP, who presented with a testicular mass about 1-2 cm in diameter that had felt like a rock. Dr. P had suggested that I come back in 4 weeks to follow up on him, so I did (I was curious to know what the final diagnosis was). When I returned to Dr. P's office, Meme said that RP had just come in two days ago to discuss his diagnosis with Dr. P, and she let me see his chart. In addition to the testicular mass, RP had also presented with night sweats and early satiety, so the GI doctor endoscoped him and found a bleeding cancerous mass in the fundus of his stomach. The testicular mass was found to be diffuse B-cell lymphoma, so now we had to ask, was the stomach mass a lymphoma, or a separate gastric adenocarcinoma? A biopsy showed that it was the same lymphoma as the testicular mass. A PET scan (which arrived minutes after I showed up) revealed three lymph nodes in his abdomen were positive for tumor cells, but there was no metastases to the brain. So RP's diagnosis, while not great, was still better than if he'd had two separate cancers in his body. Dr. P still had one more patient to see when I stopped by, but he took the time to go over RP's chart with me and explain what they were going to do next. RP's CBC, to my surprise, was unremarkable except for anemia attributed to his gastric bleed, but Dr. P said some lymphomas are normocytic like that. *sigh* RP had that testicular mass for at least one year. If only he'd gotten it checked out sooner...

Still, it was good to see Dr. P and his staff again, and I also got to meet Dave, his new PA that he talked about so much before he even came to work here. Dave is a licensed nutritionist as well as a PA and worked with a GI doctor for many years, so primary care is actually new to him. But he likes it, and he already fits in with everyone at the clinic. =)

OMM: Shelf Exam

Even though today was the day of the shelf, OMM students still had to work in the morning. I know several of us didn't go, but the PCC students were expected to work and so was I. So I went to Dr. KB's clinic for a little more than 2 hours (got through about 3 patients in that time). One of the patients I saw was a 30 year old woman with a hx of endometriosis (which sucks at a young age like that) and she's been taking Yaz continuously for a year to stop having periods. In the meantime, she has become depressed, bloated, and tired. Dr. KB normally doesn't approve of hormone suppression (as OCPs tend to do), but in this case, she didn't want to mess with the woman's endometriosis.

I stayed up until 2 a.m. last night working on my case report on adhesive capsulitis (which SUCKED, by the way) and pretty much didn't have time to review, so I had no clue what to expect for the OMM shelf. As it turned out, after peds, OB, and psych, the OMM shelf was the easiest shelf of them all. A huge chunk of the exam was material from Ch 2 in the Simmons manual (neuro), so KNOW THOSE WELL. I used both Savarese and Simmons to study; the questions in the back of Savarese are helpful but not necessary; I only did 2 of the 4 tests and thought that was enough. Then there were some really weird questions (i.e. what explains the effects of Raynaud's phenomenon) that depended on your knowledge of medicine, not OMM. There were several anatomy questions, too. But at the end of the afternoon, I left feeling like I passed for sure, unless I filled in the wrong circles. After the exam I hung around for a class meeting on preparing for Step 2 and what to do for electives in the 4th year that was pretty helpful. It was probably the first time our class has all been together (minus the Corpus people and others) since summer, and some people have noticeably gained a lot of weight. I know I gained weight, too, but hopefully it's not so obvious.

Later I picked Jennifer up from DFW (Fallon's taking her to Houston tomorrow) and we drove to Ben's house for a Christmas party hosted by him and Susan. We played Apples to Apples (Dina, Kimberly, and I only won once...*sigh*) and then chatted. Nice way to spend the evening.

OMM: Three's a Crowd

Today there were three students in Dr. KB's office today: me and the two first-years, David and Kevin. Only two students could enter the room at the same time. Once, after we finished talking to a patient who ended up needing manip, the first years went to the manip room with Dr. KB while I went to see the next patient (a 19-year-old getting her first Pap smear) alone. Well, I didn't do the Pap smear alone; I just did her physical and chatted with her since she went to Seguin HS and I went to LHS. Dr. KB explained everything that she was going to do during the Pap smear so the girl was pretty relaxed. A lot of people brought food today (Robin brought Chick Fil'A nuggets in biscuits, another doctor sent a tin of chocolates, Melissa made mint chocolate chip cookies, etc), so in our spare time we went to the back to grab some snacks. In the middle of the morning Kevin and I went to see a manip patient who wore leather pants (not good for finding PSIS on), and I successfully did two lumbar rolls on her (one on each side) so that when Dr. KB came by to check on the patient, there was nothing left to pop. I even got one successful Kirksville crunch, though I am by no means good at it. The first years took turns seeing patients with Dr. KB and me since Melanie doesn't take students; whenever one was in the exam rooms, the other sat down with Robbins and studied (they have an immunology exam next week). I couldn't help but wish that I could sit down and study for OMM (I did get some study time in during lunch hour)

I think I'd make a good preceptor someday; whenever I had a manip patient and felt something out of place, I'd let the first year with me diagnose, too. Kevin actually found a non-neutral on the thoracics of one patient before I did, and David got a head start on diagnosing cervical spine. For one 88-year-old lady under severe emotional stress (her husband of 70 yrs passed away last summer), Kevin even offered to do Reiki, a form of energy healing. I'd never heard of such a thing, but Dr. KB has done it before and seemed impressed that Kevin knew how to do it (and very well, apparently; that lady walked away more relaxed than when she came in) Kevin seems very interested in alternative medicine and had no problem chatting with patients or Dr. KB about trying different supplements and other things. At one point after Dr. KB came back in from a smoke break, Kevin said, "Think of all the time and money you'd save by not smoking." Dr. KB just laughed, but I was just amazed b/c no one else (even her employees) would dare tell her not to smoke. At any rate, both David and Kevin learned a lot from Dr. KB about using hydrocortisone to treat patients with autoimmune diseases and were impressed with what she does. We had one patient come in hoping to get off prednisone after taking it for 20 years; her skin is very thin and bruises easily and her bones hurt all the time =/ Not very pleasant effects, but it was an interesting case to see.

OMM: Messed-up Sacrums

Today was rainy and cold (just like yesterday), so I was 15 min late getting to the clinic. I called Michelle ahead of time to let her know I'd be late, but she predicted that I'd still get to the clinic before Dr. KB did (she was right). We had a fairly busy morning with back-to-back well women exams that set us behind by more than an hour. If Melanie was here, she could have helped see patients, but Wednesdays are her day off, so we were stuck. Somehow we managed to see everyone by 12:50, which gave Dr. KB enough time to get her massage with Chris. Meanwhile, I ate lunch in the back room, where Michelle and Heather were teasing Melissa for having a crush on one of the patients (Michelle had actually told him Melissa liked him. His response: "Tell her I'll be back in 3 weeks.") It was pretty funny.

We had three manip cases today, two of which involved sacral disorders. In the morning, we had a lady whose sacrum had a shear so bad that her coccyx was literally pointing toward her right knee (VERY lopsided). In the afternoon I took David with me to see the manip patients. Our first manip patient had a really jacked-up sacrum that has tender and rockhard to springing (hint: NON-NEUTRAL), and the left sacral base was much higher than the right sacral base. There was an indentation difference of at least one cm. It was clear this was not a simple shear. Dr. KB sent me to her office to find an OMM reference book, but I never found it (I did, however, get hugged by Max, her Australian shephard, who stays in her office during the day). By the time I got back, the patient had been treated. Our last patient had a huge ropy muscle spasm down the side of her left back, but I managed to pop one of her ribs successfully with the Kirksville crunch. Who knew I could crunch anyone? =P

OMM: The Things We Learn

It's always interesting, the things we learn about our patients. Today we had a couple in their seventies come in as new patients, and the wife was quite a character. She believes that taking estrogen for her heart and bones gave her breast cancer and that cortisol caused the bottom of her husband's sternum to flip out (he has a bony protuberence under his sternum; it's pretty interesting). Even more amazing, she surfs the web a lot in her spare time and is in the know about all things on the internet. Today, for example, she taught me how to download videos from YouTube (which I always thought was impossible). I'm not going to do that, though; YT videos are fun to watch but I'm not going to resort to downloading something that doesn't belong to me.

This afternoon we had a 1st year, David F, come here to do part of his preceptorship. There will be two 1st year students coming in and out this week, and because Heather accidentally overbooked, those two students and I will all be present on Thursday. I don't know how that's going to happen; I can see patients on my own pretty well, but the 1st years need to be with Dr. KB or Melanie for optimal learning experiences. I did let David palpate a patient's cervical spine so he could get an idea of how to diagnose (the 1st years haven't done cervicals yet), so I think I'd make a very good person to learn from =)

OMM: Arrest on Campus

It was back to the PCC again this morning, and I worked with Dr. W, Sital, and Sindura. Dr. W recently had a barbecue for family friends and long-time patients, and many patients raved that Dr. W barbecued the best tasting brisket they'd ever had. =) Dr. W also commented that the three of us were some of the brightest students he'd worked with (this year, most likely), since we pick up on techniques really fast and were able to answer his many pimp questions. Different professors have different ways of teaching and treating. Dr. G, for example, almost never pimps, but when Dr. W pimps he's still nice about it, so he doesn't intimidate people easily.

Back when we first had OMM orientation, a young neurologist attended lectures along with us; he said that he'd recently gotten a job with the neuro department and was there to refresh his OMM skills. No one questioned him, not even Dr. W. Well this morning, Sain said that one of the student coordinators was passing out flyers with that very same doctor's face on it, saying that he'd been arrested for trespassing and that if anyone were to see him on campus, he/she should notify the campus police immediately. Everyone exclaimed, "WHAT?!?" As it turns out, the guy really is a doctor who graduated from here, but he's been using the library's resources and other things without permission for weeks, maybe even months, and that constituted "trespassing." When the police asked him to leave, he insisted he had a right to be at our school (maybe he really was looking for a job here), but they arrested him anyway. But man...talk about crazy.

OMM: On Schedule

Wow...today had to be the best day ever as far as time goes. Dr. KB arrived at 8:30 this morning to see her first patient, and though we eventually fell behind, we still got out at noon b/c Melanie (the PA) saw two of Dr. KB's patients for her. After lunch, I was joined by a 1st year named Kevin who's interested in doing family practice and OMM (he applied only to DO schools). So I let Kevin shadow Dr. KB while I saw a few patients on my own (I did all the physicals today, too). Our last patient was a manip patient and I had almost 30 minutes to myself to work with her. The problem: the more I tried to fix her back, the more problems she pointed out (she had a LOT of nasty ribheads popping out), and I kept hoping Dr. KB would walk through the door soon. When she finally did, she tried HVLA with no results, too, so she ended up floating the ribs. That's something I wouldn't have thought of doing, but it worked =) The best part about today: we were out by 5:00 pm!

OMM: Sick Again

Last night around 2:00 a.m. I woke up freezing cold even though I had a full-sized down blanket on hand, and I knew immediately that I had a fever. Dang it, why now?! I already got sick once last month! A part of me wanted to stay home from work, but I didn't want to look like a slacker so I ignored the fever and drove to Dr. KB's office. There, I took my temperature (100 degrees F) and tried my best not to look like I wanted nothing more than to lie down someplace and sleep. It was pretty tough. All day I felt like I was burning up, and sometimes I had headache and occasional nausea, but I tried not to let it show. I originally planned to ask Dr. KB if I could leave after lunch, but there were 2-3 manip cases in the afternoon and Dr. KB hinted that I could learn something from it. So during lunch, I went to one of the patient rooms, lay on the table, and took a nap.

The manip cases were good ones; I was able to fix a woman's hip all by myself. I think I'm more comfortable with pelvic techniques than lumbar and thoracic techniques. One other patient we had was a 2-year-old boy who was both tall and heavy for his age, but developmentally delayed. His mother was worried that he was autistic, especially after reading articles about how immunizations can supposedly cause autism. *sigh* When Dr. KB tried to examine him, he screamed up a storm, and later the patient next door jokingly asked us what we were doing to that poor boy. After he calmed down, the office manager took him to meet Max, the office's therapy dog. Max was a good sport =)

So now I'm just hoping to go to bed early and hopefully have no fever when I wake up tomorrow.

OMM: None Today

There were no OMM cases today, but there were about 3-4 new patients that I got to do physicals on. I think I've heard enough of Dr. KB's lectures on the benefits of hydrocortisone to educate patients about it before Dr. KB comes to see them; that's a good sign, right? One of the patients was the woman with Stage 4 breast cancer who took only hydrocortisone and Transfer Factor Advanced (natural immune factors) to treat her cancer (she'd refused radiation and chemo). She brought a copy of her PETscan results, and they showed no signs of metastasis. Wow. I don't know if it really was the hydrocortisone/TFA combo that did the trick or if someone up there was looking out for her, but it really was amazing.

OMM: Too many students

Last Friday nothing much happened so I didn't update. Aaron B stopped by to visit since he worked with Dr. KB the month before I did, and everyone there raved about what a great student he was. I think I need to get my act together if I have to live up to Aaron's performance =) Surgery schedules for January have also come out; I start with general surgery at JPS, continue on to ortho, and then finish with ENT. Sounds good except for the JPS part; that will be hectic.

Dr. KB didn't work today so I went to the PCC. On top of the five medical students already rotating there, there were also a 4th year student (Jim) and a PGY-1 from Plaza who's doing her OMM required rotation at the PCC this month. 8 students, 2 doctors. Dr. D has officially gone on medical leave so there are too many students and too few doctors. I paired up with Angela for two patients and got to treat them before Dr. G came along. Unlike Dr. KB, who likes HVLA, Dr. G prefers JSCS, MFR, and LAS. So I got to do a lot of "floating" today.