Family Medicine <--> Internal Medicine

Dr. RR didn't come to work today (had a meeting at school), so after a 45 min orientation on hospice care I went to shadow Dr. S, the other doctor at the clinic. Dr. S was an internist, so I was curious to see how internists differ from family doctors in the primary care setting. The first thing she did was write down all the patient's health problems (HTN, diabetes, GERD, etc) from previous visits so that she could address them all in the present visit, leaving no stone overturned. Definitely different from FPs I've seen who just address whatever the patient comes in for. She also spends more time with each patient and does a lot of preventative medicine and counseling, which I thought was a good thing. I think I got a good feel for internal medicine on this rotation, and look forward to doing my medicine rotations in April-June to see if internal medicine is "the one."

Luckily for me Dr. S said I could take the afternoon off so I went to school and looked up residency programs and electives for a while. I'd like to do away rotations, but I'd have to find a place that offers housing. Colorado would be an option if they didn't require a $2000 application fee. >_< Anyone have any advice on what elective I should take in November? Interviews will be starting around then so I don't want a hard elective, but I want a somewhat easy spring semester, too.

I also recently got addicted to an online game called "Amateur Surgeon" which is a lot like Trauma Center, where you use your mouse or touchpad to perform "surgery" on others. I've had to kill several patients before learning how to save them =P

Family Medicine: Burned Boobs and Benicar

This morning we had an ethics orientation after which we had to sign up for a date to attend an ethics commission meeting. Most of the dates were during my hospital week (not to mention the JPS ones were snatched up fast), so I ended up with a 5 pm slot at Baylor in April. I also found out Andrew will be doing hospital week with me, so it's good to have a friend around. In clinic Dr. RR pimped me on anti-hypertensive drugs (assignment) but aside from knowing why clonidine is such a bad drug to take (rebound HTN), I didn't do so hot. I didn't know the difference between atenolol and metoprolol (long acting vs short acting) and he told me to study it a bit more. One thing I've noticed about JPS clinics is that a lot of kids have caps on their teeth. It makes me wonder, if they can afford to buy candy to rot their teeth, then why don't they invest in toothbrushes, too? We had a few interesting/crazy patients today. One guy had flu on Sunday that led to non-stop vomiting and hiccups that disable him from keeping anything down (other than sips of water). He was, by his own admission, so weak that his wife had to wheel him in via wheelchair. But the wheelchair they used belonged to the clinic, and Dr. RR wanted to know how he was able to move from the car into the clinic. "Where's his weight?" he asked. The nurse didn't take it b/c he couldn't get up from the chair. "I don't believe that. Go weigh him," he said. When I examined him he had hiccups every 5 seconds and was constantly spitting up phlegm, and I was so scared he was going to spit on me while I was listening to his heart.

The last patient of the day was a very interesting African American lady. When Dr. RR saw her file, he said, "Is that the lady with the burned breast?" I must have looked very surprised, b/c he immediately told the story of how this lady came to the clinic years ago with a second degree burn on her breast. It made no sense how that could have happened, until the lady said she was cooking chicken at the stove without her clothes on (ok, who the hell cooks naked??), leaned over the stove, and her "titties fell in the grease." Everyone's reaction to the story: BWAHAHAHAHA! "Everyone likes that story," said Dr. RR. The reason she came today was because she had some congestion that hasn't resolved with medication. She also recently underwent a lung biopsy for a suspicious mass, and she was anxious about her results. Dr. RR later told me she probably had lung cancer b/c she was a heavy smoker. *sigh*

Later I went to a Benicar drug rep dinner at Pappadeaux (courtesy of Fallon's attending giving a lecture there and Fallon emailing us about it) with Carisa and Fallon. It was my first drug rep dinner, and it was really good. Later we talked with one of Fallon's residents about Drs B and S from obgyn, who were currently doing their medicine rotations. Apparently they haven't changed too much since August =P

Family Medicine: Knee Pain

This morning we had some residents from Plaza talk to us about knee pain, specifically patellofemoral syndrome, and how it should be diagnosed and treated before jumping the gun and heading to the orthopedic surgeon for an arthroscope. "Check the kneecaps and see if they're level," he said. "If the quads are tight, then one side will be higher than the other." Then after class, Deanna became a guinea pig for his talk; she'd hurt her leg skiing a while back and has trouble climbing stairs. Indeed, one kneecap was higher than the other, and after doing some muscle energy to stretch the quads, the kneecaps became more level. "See, good case study," said the resident, who seemed pleased that he was able to show how his lecture applies to real patients.

Afterwards it was back to the clinic. My topic to study last night was ear pain, so when we had a spare moment I talked to Dr. RR about otitis media, otitis externa, and chronic otitis media. I'm actually glad that Dr. RR gives me assignments to read and look up in my spare time; otherwise, I'd just go home and do nothing. Tomorrow's topic: hypertensive drugs *Goes to find drug charts* We saw slightly more adults than children today. Once again, colds and allergies were running rampant throughout the clinic, but I got one little girl with a temperature of 105. She was really sick; her heart rate was probably about 140 and she didn't want to move at all. The nurse gave her some Motrin in the room; her temp started falling after a while so then she was free to go. The last patient came for "shooting pain down her leg" that turned out to be just hamstring tightness, but Dr. RR sent me out of the room b/c she was also depressed and he wanted to ask her how she was doing on her meds. Later he said he probably shouldn't have sent me to see her, but it wasn't too bad. One interesting factoid that was thrown out was that 85% of patients are non-compliant. Great...

Family Medicine: Endless No-Shows

I don't know what was going on today, but I arrived at the clinic at 8:00 and we didn't see any patients until 8:45. Four no-shows. Who knew there'd be so much free time at a JPS clinic? I forgot to bring anything to study and ended up browsing through a dermatology textbook (and occasionally grossing myself out) looking for images of skin conditions I've seen. Did I mention I saw a case of Mollescum contagiosum on a kid yesterday? It was a classic textbook case, especially when magnified by an otoscope. Yesterday I mostly shadowed Dr. RR; today I got to see a few patients on my own. It's hard to find patients for me sometimes to see b/c most of them speak Spanish only and I only know OB Spanish. I'm starting to pick up a few words like otra vez and abra la boca, but that's not enough to conduct an interview with. Even Dr. RR, who's way more fluent than I am, needs an interpreter sometimes. *sigh* Needless to say I sometimes feel useless in the clinic. We did have a funny moment when the nurses couldn't read Dr. RR's handwriting, and when they got his attention, he couldn't remember what he'd written either. Fortunately he'd been talking out loud when he wrote his note, so I remembered what he'd written as "Healing well." Everyone started laughing as the nurses talked about how Dr. RR's handwriting is really bad, a fact he was willing to admit.

Today during lunch I drove by the future location of the clinic, located on the same block but in a brand new building reminiscent of the HCW. I'm going to keep my fingers crossed that I'll be around to at least set foot in that building, just to see what it's like. There was a dedication/opening ceremony for the clinic this afternoon so everyone got out early. Lucky for me, I guess. During the week I normally get one sort-of-half-day (7 a.m. - 3:30 pm)

Family Med: First Day

This morning I joined my fellow family med classmates (I'm still used to saying 'surgery' classmates) for orientation before heading off to my assigned clinic. It's a small JPS clinic that's really a huge portable building; when you walk, you can feel people's footsteps beneath your feet. My preceptor, Dr. R, is pretty friendly. He made it clear from the start that he's not out to make me feel like crap, that I'm there to learn, and asked me what I hoped to get out of the rotation. He also said he was going to give me mini-assignments: topics to research at night and then talk about with him in the morning. My topic for tonight: neonatal jaundice. Hopefully I still have that jaundice packet from Driscoll...

About 80-90% of the patients we saw today were Hispanic, with half of those not knowing how to speak English (including a 20-year-old who's been here for three years). Today was also a pedi-predominate day; for school district reasons most kids were given the day off, so their moms brought them to see the doctor. Lots of kids and babies with fever, congestion, and cough. One or two kids had flu, and it was pretty obvious in the way they just sat on the table not moving. When a kid turns down stickers, you know they're sick. I've forgotten a lot of things I learned in peds (i.e. when to give certain vaccinations), but I think I'll get it all back on this rotation.

Surgery Shelf Exam

Today's shelf was at 8:00 a.m. (much to many people's dismay), and for the most part, the surgery shelf exam was surprisingly not too bad. Compared to psych, it was more manageable for sure. To prepare for it, I read Blueprints Surgery Cases twice, did Kaplan questions, and did sample tests from various other books from the library. But...time was my worst enemy. One hour into the exam I'd only answered 45 questions, so for the latter half of the exam I rushed through most of the questions in order to give myself at least 10 minutes to answer the questions I'd skipped. One question I almost answered "pyloric stenosis" as soon as I saw "nonbilious emesis" but I later reread the question and found that the age wasn't right, and therefore changed my answer. *sigh* Hopefully I didn't fail; surgery is one thing I don't want to repeat (and it's not like I didn't study)

After the shelf we had Residency 101 followed by the Residency Fair itself. Sharon, Natacha, and I were walking past the Driscoll table when we saw...Dr. VJ! Surprisingly, he remembered our faces (even though Sharon and I haven't seen him since July) and said it was good to see us again. Also there was Dr. SC; I said hello and reminded him that we were on call together once. "I hope that was a good learning experience," he said. It was: I saw a baby with pyloric stenosis =) Most of the programs there were family med programs, which I was not really interested in (where are the medicine programs?), but it was good to look around anyway. Afterwards a bunch of us (Ben, Justin, Kristen, Erwin, Cyril, Stephanie, Dina, Heather, Fallon, me) went to Red Hot and Blue to celebrate Cyril's belated birthday. Since it was 2:30 by the time we arrived, I just got a blackberry cobbler (good stuff) It was good catching up with friends and finding out what we want to specialize in, as well as discussing our various rotation experiences with the same doctors or residents. After hearing that other people have already set up many of their rotations for the fall, it's time for me to get started, too. It's not like surgery gave me much time to think about the future.

ENT: Last Day

There were no surgeries yesterday, so I had the day to study before coming in today for my last day of ENT. I saw a few interesting patients today. One was a 15-year-old overweight girl who was taking like 10-15 drugs due to schizophrenia and bipolar disorder. Her mom and her grandmother were all there with her, and from appearances they were clearly cut from the same cloth. She reported having ear drainage that began shortly after she moved to TX about 3 years ago, yet Dr. P and I didn't find anything in her ear. "I cleaned them this morning," she said. If she came alone, I'd wonder if her schizophrenia was playing a role in this, but her mother confirmed she had some yellowish ear drainage so it's not made up. Another patient who came was born deaf, but she wore hearing aids and fortunately I was able to understand her speech. My last patient of the day was a 97-year-old man with mild dementia and had trouble breathing but was otherwise in good health. He's a lucky guy =) All in all, ENT has been a pretty laid back rotation. Sandy (the LVN) invited me to come back 4th year if I want an easy 4 weeks. We'll see.

Now...off to study.

ENT: Faulty charting

The first thing I heard when I arrived this morning was Sandy (LVN) calling my name. My first thought was, what did I do? It turns out I didn't document the symptoms of sinusitis and otitis media for two little girls who are scheduled to have tubes put in their ears next week, and it's important to have that information so that insurance companies will be willing pay for their surgeries. Crap...now what? I called their mom's cell phone numbers (provided on the file) and asked them to call me back, but they never did =( Maybe they didn't take me seriously? I just don't want those kids to have surgery, then have insurance refuse to pay for it because a certain med student was negligent and didn't justify why they needed the surgeries. =/ I felt bad all day, but I slightly redeemed myself by helping Dr. P find some coronal CTs on a CD; for some reason he couldn't call them up.

I had one notable patient today: a 13-year-old girl recovering from Bell's palsy. It's been two months since it first appeared, but she still has trouble closing her right eye and the right corner of her mouth still droops. She's regained some sensation on the right side of her face but it's still not 100% like the left (unaffected) side. She was given steroids and acyclovir, but apparently it wasn't enough. The problem, said Dr. P (to me, not the patient and her mom), was that the patient was on Medicaid (Amerigroup) and there aren't any neurologists in the area who take Amerigroup patients. He deferred the patient to her PCP to see if she can be seen at Cook's, but who knows. Kalan had her fair share of "weird" patients, too. One was a lady who wanted to keep her (bloody) nose splints as a souvenir after her septoplasty. What on earth is she going to do with those, show them around? (Never mind that she's HepB+/HepC+) Another was a MR man who had a bloody and hairy mucus plug sticking out of his nose (he got that trimmed), but refused to let the nurse look inside his nose to see how much drainage he had. Dr. P made a crack about using a weedwhacker, a little too loud, but hopefully the patient didn't hear.

After work I ran into Alex in the library so we chatted a bit about residency and the match. There are three programs in the DFW area he can go to, but he doesn't know how to rank them b/c he has to take his wife's career into consideration as far as choosing a location goes. That's the thing with being married with kids; you can't be totally selfish and go to the program that you want to go to the most. I can see myself going to residency anywhere in the nation (except Alaska), yet I don't know where I want to go. *sigh* Decisions, decisions.

ENT: Another Septoplasty

The title speaks for itself; I only had one surgery to see this morning, and it was a septoplasty/polypectomy that was observation only. Then there was a 3 hr break to study and eat lunch before urology lecture. Dr. R seemed pretty cool; at one point during his powerpoint presentation he showed us a man with what looked like a tree branch shoved up his groin; one leg was completely purple and mottled. Needless to say there were several gasps over that picture. Then there was a picture of a body covered by a blanket except for a single hump in the middle. Guess what that was? Yup, a priapism. "I took that picture myself," said Dr. R. LOL.

On a side note, as far as eating healthy and exercising goes, I've really let myself go this year. =/

ENT: Cardiothoracic Lecture

Man...thank goodness Ben sent me a link to some surgery practice questions yesterday that Jennifer had sent out ages ago. Two of those questions appeared on today's quiz, without which I would have done very bad (case in point: I still failed the quiz). Dr. Y's questions were pretty hard. Then Dr. P came to lecture and he gave us the exact same CIL/quiz questions that we did in Cardio 2 to see how much we remembered about vascular disease. Back in 2nd year, I think I got 1/5 correct, and this year I fared no better. Sure, it wasn't for a grade, but I was still disappointed that my way of processing information hasn't improved. *sigh* Gotta study my vascular stuff.

Jacob was post-call, and he had a rough night. Valentine's Day was not good to Surgery B; there were so many traumas and deaths that he didn't get a minute of sleep last night. Natacha's on call tonight, and she asked Jacob if his team took care of all the cases so that she could get an easy night. That was just like back in ob-gyn when the day team would count on the night team to deliver lots of babies so they'd have an easier day. Jacob also told us that he knows what he wants to specialize in now (psychiatry), and we were all happy for him. I wish I knew with absolute certainty what I want to specialize in...

ENT: Valentine's Day

The only thing that even remotely hinted of today being Valentine's Day was when Dr. B (surgeon) came by and passed out long-stem roses to everyone he crossed paths with. I was in the room with a patient so I didn't get a rose. Ah well. It was still a pretty good day. I had lunch with Ben and I got a mint dark chocolate Ghiradelli bar waiting to be eaten, so in a way I treated myself to something nice =) Poor Jacob is on call tonight though; I remember scheduling a patient to have rectal warts removed on Valentine's Day and thinking that was a crappy surgery to do on Valentine's Day (even if it was by his choice). I still say nothing gets worse than spending your birthday on call though. No surgery for me tomorrow; I have lecture from 8-12.

Speaking of surgeries, there were originally 5 scheduled for tomorrow but 3 of them got cancelled b/c Sandy (the nurse) just got a call this morning from AmeriGroup (Medicaid) saying that they weren't going to pay for the surgeries. She was on the phone all morning trying to straighten things out, but in the end she had to call those three people and tell them that they can't have surgery tomorrow. That's got to suck for them.

ENT: Neck mass and Ortho Lecture

Because today's lecture (ortho) was scheduled for 4 pm, I was able to go to the surgical hospital and meet Dr. P and Kalan for two surgeries. The first one, a nasal polypectomy/sinus surgery, was observation only. Man, I knew the nose was extremely vascular, but I couldn't believe the amount of blood that was suctioned out of those nostrils after he removed the (extremely numerous and huge) polyps. And to think, this was the patient's fourth polypectomy. Those things just don't know when to stop growing, apparently. The second surgery was a neck mass excision, and I got to scrub in. The mass was soft, about the size of a golf ball, most likely an epidermal inclusion cyst, according to Dr. P. The atmosphere in the surgery was extremely laid back. Mix 102.9 was playing on the radio, and the CRNA said he felt old when I said I first heard Alanis Morissette when I was in junior high. Then he was shocked when I didn't recognize Hootie and the Blowfish (I knew of them, but I recognize songs by their tune more than their title or artist), but I redeemed myself by identifying Madonna as the artist of "Vogue." There was also talk of politics; since Obama finally has a lead over Hillary, Dr. P commented that Hillary needs to win over 2 big states if she wants a chance, and that Obama may be the biggest figurehead in politics since MLK. I asked what Bill Clinton would be called if Hillary were to be elected. "Vice president," Dr. P replied, and said that the White House needed someone who hasn't already been in the White House in the last 20 years. At the end of the surgery, Dr. P let me sew the neck incision up with a running locking stitch. The first few were ok, but somewhere in the middle I messed up before correcting myself, so overall the stitches look like what "a drunk spider would have made." Still, they did the job, and since the stitches were covered by Sterry strips anyway, no one can see my not-so-great handiwork.

It was past noon by the time we finished surgery, so Dr. P treated Kalan and me to lunch at a Mexican restaurant called La Familia. There, we chatted about various things ranging from good restaurants in town to the various places Dr. P has traveled to (Napa Valley, Italy, the Alps, to name a few) and recommends that we visit someday. Geography-wise, he's really knowledgable; he's traveled all over the state and recognized Don Emelia's when I mentioned it had good mojitos. "The best mojitos I had were in Athens," he said. Wow, who knew? After lunch, I went to school and napped on the couches (fell asleep in the middle of reading) before lecture.

The lecturer was Dr. H (one of the three dreaded ortho docs), and when he entered the room he was wearing a funky-looking hat with a feather sticking up. He later said that it was a "flirting hat" worn on Valentine's Day in the Czech republic (a former student had given it to him since he likes collecting hats). Although he was nice overall, he still didn't hesitate to pick on people, me included (he said that my mouth made the shape of a zero when I was yawning). His former students all refused to sit in the front row for fear of getting picked on, but he still snagged a few people to be his guinea pigs in demonstrations. At one point he asked us what we all wanted to be. Most of us were undecided, but Corey said he wanted to do neurosurgery so he got teased a bit by Dr. H for that (he thought neurosurg was for weirdos). After class, when we were leaving the building, he said I gave him a lot of trouble b/c I looked so serious and didn't smile in the first few jokes he made (I'm very slow on the uptake), but eventually he got through to me and made me laugh. We also got our grades back for our first few quizzes, and my grades SUCK! Is there a possibility I'll fail surgery b/c of lousy quiz grades? Please let there be a curve...

ENT: Day One

I reported for my first day of ENT at 8:30 a.m ("late" compared to most surgical clinics) for a briefing on what goes on at the clinic before patients began arriving at 9:00 a.m. Aside from me, there's also a 4th year named Kalan working in the ENT clinic; we talked a little today about the residency application process. All in all there weren't many patients today. I did have one lady who had a ton of health issues (frequent nosebleeds, hearing problems, sleep apnea) and she kept Dr. P and me in the room for an hour combined because she had so many questions and was very adamant about taking as little medicine as possible (she's into homeopathic remedies). Afterwards Dr. P proclaimed the woman was crazy and asked Sandy, his LVN, to knock on the door the next time he gets sucked into a room for so long. Because of her, other patients had to wait. *sigh* I'm still learning the ropes.

From Ortho to ENT

Today we had an ENT lecture, and Dr. P (the ENT prof) gave us what was possibly the easiest quiz ever. I read some BRS Subspecialty Surgery (compliments of JB, who gave me some of his old review books) to prepare for the quiz, and it did help, but what really helped was Dr. P walking around the room looking at our answers while we wrote. To Jedd, he said, "You're thinking too hard" regarding a question about the most common cause of hearing loss in kids. He said nothing when he saw my quiz, but said, "Good" when he saw Elizabeth's quiz (and we later found we had the same answers). Aside from ENT info, he also taught us a few life lessons about maintaining a private practice (i.e. be careful of the contracts you sign) and how to avoid getting sued. After lecture I introduced myself to him and told him I'd be working with him next week. He told me that there are no surgeries scheduled for Monday so I can show up on Tuesday. WOOHOO! Three-day weekend!

The peds and obgyn people were taking their shelf today, so I saw several familiar faces. One surprising face was John M, one of the Corpus people; he came up here to see Lori and friends. Later I also ran into Aaron B outside the library and asked him how he was doing. He said he was taking 6 months off b/c he was burnt out after the boards; looks like he'll be graduating with the class of 2010. Still, I'm glad to see he's doing well.

Ortho: Last Day

This final day of ortho was fairly uneventful. There were four surgeries this morning: a labral tear repair, a carpal tunnel release, a menisectomy, and an ankle ORIF (open reduction internal fixation). This was my first ORIF so I was very interested in seeing it. The flu seems to be spreading throughout the clinic; the other ortho doc in the clinic had to leave yesterday after his surgeries b/c he had a fever, and the nurses commented that his face got greener with each surgery. The bad part: he got the flu despite getting a flu shot. Seems like the vaccine companies made a faulty batch this year =( Not cool. I can't afford to get the flu now, so I hope I wasn't exposed to the other doctor long enough to get sick. All in all, ortho wasn't too bad. If I were at JPS or at the other doctors' clinic, I would have had to work a lot harder. And now...onward to ENT.

Ortho: Closed Doors

I'll be the first to admit that unless my brain is totally fogged up (like this week, when I got the lecture dates mixed up), I'm a stickler for punctuality. It bothers me when there are patients lined up to be seen and the doctor disappears for minutes on end, even if it's beyond his/her control. Dr. JD is actually pretty good about seeing his patients on time; if they come to the back room at 3:00, he'll usually see them by 3:10. Today, for some reason, there were more interruptions that usual. There's an unspoken rule in the clinic that when Dr. JD goes to his office and shuts the door, no one is to bother him unless it's very very important. After the first five or ten minutes, however, the medical assistants and the PA start worrying because the patients are waiting and there's no telling when he'll come out to see them. The PA knocked and entered the room at one point to find Dr. JD on the phone, and he was quickly shooed out. Another time I could hear one of the managers arguing about something (again, I don't know what it's about) but with her voice loud and clear we all knew not to go inside. Then M, one of the MAs, got flustered when a bunch of patients needed to get X-rayed all at once, and she started closing the doors harder than usual so that every now and then we heard a loud "SLAM!" The PA was not pleased and said that was unprofessional behavior (M has only been here a few weeks or months). On top of that, the other orthopod in the clinic had a bad case of flu but still came in to see patients. He warned us to stay away from him because he might get us sick. I've already been sick this year; I don't want anything else. My flu shot hasn't worked at all; I keep getting different cold viruses instead.

Ortho: Young people

This morning we had four scheduled surgeries. The first was yet another rotator cuff repair, followed by a cubital tunnel release. This incision was made in the elbow, and from far away I asked what structures I was looking at. That led Dr. JD to pimp me on what nerve ran behind the medial epicondyle (ulnar nerve) as well as the distribution of the ulnar nerve throughout the hand. Because I got pimped on carpal tunnel last week, I'd brushed up on my hand anatomy and was able to answer the questions correctly. Dr. JD then asked me if I knew the surgery schedule beforehand, and I honestly replied no. I did say that I read up on carpal and cubital tunnel last week, though (to avoid another humiliating pimp session; I had enough of those with JB) After that was another carpal tunnel release followed by a labral repair that turned out to be more complicated than we thought. As a result, we didn't get out until about 1:00 pm (past lunchtime). A drug rep brought fajitas from Jason's Deli and there was still some left over; I also helped myself to some strawberry shortcake. That stuff is good; to think, I didn't even know what strawberry shortcake was until I went to Corpus.

One interesting thing about today was that a good chunk of the patients were teenage boys, mostly with broken collarbones, arms, and ankles. The ones with knee and ankle problems were usually hurt while playing basketball or some other sport; makes me glad I never got into sports as a kid (the worst injury I can think of in orchestra is a bleeding callus). Dr. JD used to wrestle when he was young and told us how he yelled at his son for 20 minutes this past weekend after his son lost a wrestling match. "And he listened, too," he said. The nurses just shook their heads at him for being an overinvolved dad. One 20-year-old TCU student actually had a piece of bone break off his knee and lodge in the space between the femur and the tibia (OCD, osteochondritis dissecans). For a young guy like this, the best option could be to use his own bone to repair the hole, or else use a cadaver graft. =( Who knew twisting a knee while playing basketball would cause so much damage? I thought twisting my ankle and wearing a brace for 2 months was bad enough; I'd hate to undergo ortho surgery.

Ortho: The Pathological Fracture

This morning I went to the hospital to scrub in on what was supposed to be a rotator cuff repair, but turned into something completely different entirely. The patient had developed abscesses in her shoulder about two weeks ago so there was an open wound there, and she said that three days ago she heard a "pop" and her arm hurt so much she couldn't move or lift it. She asked if the infection had caused it, and Dr. JD said he'd check it out. I got to help hold her arm (she was morbidly obese so her arm itself weighed anywhere from 10-20 lbs), but when Dr. JD tried to move it around to see how her shoulder was moving, nothing happened at the glenohumeral region. "Something's wrong," he said, and as he flexed her arm some more, it bent funny somewhere in the middle of her humerus. "Something's really wrong. She's got a fracture in there somewhere." He called for the X-ray tech to come and began feeling along her humerus to see if he could palpate the break. "The bone's soft," he said, and the way he said it gave the impression it wasn't supposed to be like that. Her rotator cuff was torn and he tried to repair it by sewing muscle to bone, but the bone was so weak that the sutures came right out. The X-ray tech finally came, and after a great deal of maneuvering around the operating table we saw it: a mid-humeral oblique fracture. "Well, now we know why her arm was hurting," said Dr. JD. "That's a pathological fracture." Bone and tissue samples were obtained for culture and biopsy, and the wound was closed with a vertical mattress stitch while the patient's arm was put in a sling. I asked what could have caused it, and Dr. JD said most likely her previous infection, but at this point we can't rule out cancer, so she's going to see a bone specialist for follow-up. *sigh* Dr. JD used the term "chronic osteo" often and I hope he means osteomyelitis and not osteosarcoma. The other surgery was yet another medial meniscus repair. I wish I could tell the menisci from each other but I'm not that good.