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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.
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.
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.
I was a bit disappointed when I only saw one scheduled manip case today, but we ended up doing OMM on about five patients today. One lady came in complaining of LLQ pain; she had a colonoscopy done earlier this week which revealed the presence of diverticulosis. Her pain was typical of diverticulitis except she'd been taking medication for quite a while with no relief in sight. She'd had a hysterectomy so there was nothing else that could cause pain there. Except...a light bulb lit up and Dr. KB suggested that we diagnose her pelvis to see if everything was aligned. It wasn't; she had a left posteriorly rotated innominate (by one inch!) and a right anteriorly rotated innominate, which (naturally) jacked up her pelvis. Afterwards, she said the pain wasn't as bad as it used to be (probably pulled the psoas muscle), and I'm to follow up on her in a week to see if OMM fixed her pain. Similarly, another patient came in with chest pain; turns out her ribs were out of place. One of our last patients came in for back pain following a car accident (she had a LOT of ribs out of place), but when Dr. KB saw her name, she immediately asked Melanie, the PA, to see her and talk to her about taking low-dose cortisol for her RA and other things. "I have to get my cut after this and I'm already behind," said Dr. KB. Never mind that Melanie still had one more patient to see? Melissa, one of the MAs, asked Melanie why she agreed to see Dr. KB's patient for her just like that. "I don't know," was Melanie's reply. Probably because everyone always listens to the doctor. 
This is very different from Dr. P's office, where Dr. P's "girls" respect him and have a good rapport with him. Dr. KB is an excellent doctor to be sure, but very often she rubs on people the wrong way.
It's never fun when doctors get BFs (if you don't know what a BF is, refer to the movie White Chicks), even worse when the whole office is involved. Today Dr. KB and I fell way behind schedule (it doesn't help when the first patient arrives at 8:20 and isn't seen until 20 min later) so that we didn't finish seeing the morning patients until 1:20 (and afternoon hours begin at 1:40). The problem happens when patients have tons of problems and like to talk (I spent a good 20-30 minutes interviewing a 20-year-old girl who had all sorts of problems; it sounds like she has low thyroid and maybe low cortisol but gets hot flashes too; hopefully she's not going into ovarian failure), and Dr. KB will usually talk to them until they are reassured. Talking and listening are good traits in every doctor, but not when it cuts into another patient's time by a lot. Dr. KB had an appointment with her massage therapist (who comes here to treat patients as well), at 12:30; well as you can imagine, she had to reschedule. I asked Chris (the therapist) if she could just do a quickie massage on Dr. KB (who seemed very stressed and needed that massage), but Chris said it usually takes Dr. KB twenty minutes alone for her muscles to relax, so she needs a good hour. I'm hoping tomorrow we won't fall behind so much.But because we did fall behind schedule, we didn't see the 1:40 patient until 2:00 (everyone had to eat lunch after all), and our second patient had no clue why she was even there. It said on the complaint sheet that she had a UTI, so I began interviewing her for that. Ten minutes into the interview, one of the MAs came in and told me that the patient wasn't here to discuss her UTI (she's already seeing a urologist for it), but to get some "energy treatment" (soft tissue?) Dr. KB came in and asked the patient whether she wanted to get her energy treatment or talk about her lab results, and the patient asked if they could do both. No, because it doesn't work that way. Meanwhile, the 1:40 patient was still at the front desk waiting for a prescription. Dr. KB barked at the MAs and me to write her prescription, but no one could find a prescription pad (we'd used the last sheet in the morning). Dr. KB stormed to her office, couldn't find a spare pad, then stalked back to the therapy room (where her energy tx patient was waiting), yelling, "Call it in!" over her shoulder. Poor Melissa, the MA she yelled at, just came in from lunch and had no clue what was going on (and why Dr. KB was so pissed off) Everyone gathered around to comment on Dr. KB's BF and what caused it, and the 1:40 patient offered to make things easier for us by calling the pharmacy herself (yes, even she was a witness to the BF) I think a combination of falling behind, not getting patients in and out fast enough, and no prescription pad (and no massage) contributed to the BF. Yikes...My next patient was a woman named CD who ended up teaching me a lot based on her medical history alone. Several years ago she had a bad case of Graves disease (her TPO level was around 4500!), but managed to bring it down and control it symptomatically with exercise, diet, and "detox." This worked for seven years until suddenly, she had a flare-up that nearly killed her and she got her thyroid ablated. Even still, her TPO levels remained sky high, so she began doing some of her own research to see what she could do. She then came across the papers of one Dr. William Jeffries, who stated that most autoimmune diseases such as RA, Graves', psoriasis, fibromyalgia, and more can be treated with physiologic levels of cortisol since most patients with autoimmune diseases have lower levels or cortisol than normal, and the way to treat them is to replace the cortisol that is lost. Most professionals (med students included) are taught to have the mindset that all steroids are bad, when in fact the smallest dose of prednisone used pharmacologically (which may have side effects) has twenty times the amount of hydrocortisol that Dr. Jeffries treated HIS patients with just to boost their immune system. So once CD learned this information, she had to find a doctor who was willing to put her on hydrocortisone. Dr. KB was this doctor, and as a result CD's TPO levels fell all the way from 4500 to 1400 in a matter of months. Who knew? =) But because of this, Dr. KB has started treating many of her patients with autoimmune diseases with low-dose hydrocortisone if they have the signs and symptoms of adrenal failure, and many of them have done well as a result. I had to admit, I was impressed. There really is something to alternative medicine =)
One thing I'll never get used to on these rotations is how far preceptors can fall behind schedule. With Dr. P, he scheduled 15 or 30 minute slots with each patient and did his best to see each one on time. Inevitably, there' d be overlap if a patient (or their spouse) had a lot of medical (or psych) issues to discuss and work with, but by the end of the day, we saw anywhere from 25-35 patients and were rarely more than one hour behind. Today, with Dr. KB, the last patient didn't leave until 6:30, and her scheduled appointment was around 4:20. The difference: Dr. KB sees only about 18-20 patients a day and schedules 20 minutes with each, but with the work she does (manip, hormone therapy, general family practice), it's very easy to fall behind. After seeing one patient together, I went to the manip room and spent 45 minutes treating a guy for back pain, and when I left to find her afterwards, she was still with the same patient...for a lab follow-up. This patient, however, was a sad case; she had interstitial pneumonitis and her lungs were infested with Aspergillus and Pseudomonas, but because her WBCs are too low due to chemo (what they use to treat pneumonitis), she can't fight off the infections. It's sad. Another time, Dr. KB spent about 20 minutes chatting with a patient (a nurse) about bio-identical hormone therapy (her specialty) and how she wants to educate others on that. A good goal, to be sure, but I couldn't help but think that while she was talking, others were waiting.As far as manip goes, I'm still hesitant to use HVLA (and Dr. KB knows it; she has me pegged as the "muscle energy/indirect technique" type), but I'm getting better at it. With one tall guy today, I cracked his thoracics simply by pushing down on his back while he lay prone (a trick Miguel taught me when we were OMM partners) rather then use the Kirksville crunch. I've also gotten better and diagnosing the sacrum, but don't ask me to pop any OAs anytime soon. Everyone has their own way of doing the OA, so I'm a bit confused as to what's best for me. The bad news: no manip cases at all tomorrow. =/ Oh well. I'll just learn more about holistic medicine.
Because Dr. KB doesn't work on Mondays, I went to the PCC for today's OMM rotation. To my surprise, the clinic had the morning off due to NBOME stuff, so I spent my morning going through OMM slides and looking at sample OMM papers. I can't believe some of the detail that a few students put into their papers; it was really like reading a journal article. I don't know how I'm going to be able to write something like that. =( Too out of practice.With me included, there were seven medical students at the PCC today: three with Dr. G, three with Dr. W (me included), and a visiting med student from AZCOM with Dr. D. Our first patient was a couple in their 60s; Mrs. K had fibromyalgia and Mr. K had a history of a ruptured disc. Dr. W had all three of us working on the patients; one would be at the head doing soft tissue while the other two worked on the legs (interosseous membrane tx) Along the way, Dr. W pimped us on some basic anatomy and OMM (i.e. what percent of flexion/extension does the OA do? What muscles make up the hamstring?) and surprisingly, I knew most of the answers. Why didn't I know all this in first year when OMM was my worst subject? After that, we split up and went to see patients with Dr. W in twos. The other student stayed in the student charting room. The first time I stayed behind, I eavesdropped on Dr. D and Jim, the AZCOM student, as they talked about OMM, residencies (Dr. D doesn't think highly of neurology since neurologists can diagnose but not cure most of their patients), and more. In the middle of it, he got a call from one of the other OMM people about the first years; to his surprise, only one person failed the practical =P Interesting how little faith he has in us.Dr. W is a lot of fun to work with. He likes to reminisce and talk about his father (who I presume is also a DO), his wife, and his "happy dog" Hosanna (there's a very cute pic of the two of them in one of the exam rooms). We get to learn a lot about him that way. So far, however, he hasn't let us see patients on our own. Dr. G has let his students see patients on their own (initially) to take a history and do some soft tissue (and attempt treatment) before he goes in. But I'm kind of glad for that; I like to make sure I'm doing something correctly. Today, for example, I found out that I did the CT HVLA completely wrong on a patient I saw at Dr. KB's last week. =( Fortunately Dr. KB followed up and did it correctly afterwards; otherwise I would have hurt the patient more. Tonight is for brushing up on more OMM because Dr. KB lets me work on my own, and I'd like to be able to do things correctly.
Today I began my OMM rotation with a family doctor, Dr. KB, who specializes in naturopathic and holistic medicine. It didn't take me long to realize that she was not like most PCPs. The first few patients we saw were here for follow-up visits on bloodwork, focusing on hormones like testosterone (for libido), estrogen (for energy and others), pregnenelone (for memory), and adrenals (for cortisol production). We had one middle-aged man come with a testosterone level quadruple of what it should be (it's at a teenager's level), and he joked, "That's probably why I feel so good." We then had another lady come in for fibromyalgia that was not resolving with hydrocortisone; Dr. KB increased her dosage and recommended that she come back in 2 months. In the family medicine setting, Dr. KB rarely uses conventional medicines. If a patient shows up with high cholesterol, she prescribes red yeast rice instead of Lipitor because they have the same effect. If a patient can't sleep, she prescribes progesterone because it will also increase melatonin levels to help a patient sleep better. It's actually pretty interesting. Her clinic also offers something called "activated air" that ionizes air and helps treat all sorts of disorders (mainly asthma) as well as ionized foot soaks that supposedly detox the body. I'm not against natural medicine, but I got to admit it's all very new to me right now. But I digress, this is an OMM rotation, and we did see a few manip cases today. The first patient had a clear-cut case of painful adhesive capsulitis, and I think I may use her case in my OMM paper. Another patient had a huge muscle knot running along her left side; I did muscle energy on her with no effect. Yet another patient had a major sacral shear that was giving her knee pain; we had to treat both her innominates and her shear. For another patient, I spent close to an hour on trying to diagnose and treat all her disorders (she had a right upslipped pelvis and was sidebent right all the way down her back), but ended up leaving her for Dr. KB to treat (while I was working on her, Dr. KB was next door talking to a disgruntled patient who had to wait an hour to see her and refused to talk to me b/c she "already did the student thing the last time"). Instead, Dr. KB referred me to see a 1st year med student who needed the 7 stages of Spencer done on him. This student, who I'll call T, was actually a postbac when I was a 1st year, and he'd wanted to attend our school but didn't meet the GPA requirement for automatic admission. He'd broken his clavicle in a motorcycle accident years ago, and the 7 stages helped his mobility a lot. He came to the clinic with his pregnant wife and expressed an interest in transferring to our school after 2nd year b/c all his family is here. I encouraged him to do so, since at least 2 people from other schools are now in my class (i.e. Wendy from TUCOM-NV).I had nearly 90 min for lunch and drove to school to use the computer. There, I ran into Dustin N, who is doing ob-gyn and is on the Green team (he has 2 weeks of nights, too). I asked how how Dr. D and Dr. C were doing, and apparently his experiences have not been good ones. Dr. C has apparently become more uptight than usual, which doesn't bode too well. Dustin and Deanna have had no one to teach them since Drs C and D are always busy and they have two FP interns with them (no Dr. M to help out). Even though it's the 3rd week, Dustin hasn't been able to deliver a single baby (he only got 1-2 placentas) because the FP interns jump on every delivery to get experience and don't let the med students deliver. I was surprised when Dustin said that only the FP does postpartum checks and that he (Dustin) doesn't have to arrive until 6:30. What happened to all those mornings Anita and I had to arrive at 5:45?! They don't have to scrub in for all the C-sections, either, and the FP interns do most of the H&Ps or else take the med students' work. So according to Dustin, the OB rotation has been less than stellar (Dr. C has told him and Deanna that they weren't being proactive). Now I am really glad that Anita and I had Dr. B, Dr. K, and Dr. G to help us out when Dr. C and Dr. D didn't have time; they taught us enough to be more independent and probably look good in Dr. C's eyes. Also, apparently one of the previous students got Dr. C in trouble by letting it slip to one of our attendings (Dr. Ch____) that Dr. C had given them a day off, so he's afraid he won't get time off the 2nd week. If it was someone from the last rotation, then I have an idea who it is, but still...that stinks.Thank goodness my OB rotation was a good one. And now...THANKSGIVING WEEKEND!
OMM began today at the Research center at 8:00, but because Dr. W was in a meeting we didn't actually get started until around 8:45. Dr. W gave us a brief intro before one of the fellows, Ben W, came to give us a review about cephalgia, ribs, cervicals and thoracics. Between sections, we'd practice techniques on each other (or at least go through the motions). In the middle of some soft tissue, Anita hit a really painful spot on my left upper back (which was not the arm I'd been swinging the Wiimote with so it shouldn't have been sore) that made me say, "Ow," so Ben came over to see what was going on. Apparently my third rib was sticking out funny, so after confirming its location (like a wimp I screamed a little when he pressed on it b/c it really did hurt), Ben popped the rib back into place with HVLA and then let Anita float it. I don't know how you float a rib, but it did feel better afterwards =D At the end of the day Ben also spent about 5-10 minutes fixing Jason W's back pain, which has apparently been plaguing him for years. He did this in various ways, including sacral shear treatment (leg tug), psoas JSCS (Jason flinched bigtime when Ben pressed that tenderpoint), and others. Wonder if tomorrow will be as interesting.
It was my last day at Dr. P's office, and to thank him and his staff for putting up with me for four weeks, I brought them a box of Ghiradelli chocolates. "My favorite," Chris, his manager, said, and Dr. P said the other girls will like them for sure. As usual, it was a busy Friday, and a drug rep brought lunch for us at around 10:30. We fell behind schedule again (sometimes Dr. P sees patients from church who like to chat with him about non-medical topics) and at one point overheard one woman say, "I'm about to go ballistic." I quickly ran to talk to her and her nephew after that one. He had a generalized rash that was brought about by amoxicillin; this was discontinued and changed to a Z-pak.Then, while Dr. P and I were with one patient, the two MAs knocked on the door and said there was an emergency. I could hear what clearly sounded like a woman screaming and cryng in one of the other rooms. She was having a panic attack (funny enough, she came to the office for a follow-up visit on her anxiety) and had to be moved to a larger room. It didn't help that she'd brought her 2-year-old toddler with her, and when she started freaking out, her baby started crying too. What kid wouldn't be scared at the sight of Mommy screaming? Mommies are supposed to be stronger than that. She later got a shot to calm down, but dang...At the end of the afternoon, Dr. P and I talked a little about what I learned and then parted on good terms. He invited me to come back at the end of my OMM rotation so I can find out about our patient with the testicular mass, whether it's cancer or not. I'll take him up on that.
