Well, today was my last day of family practice in Kentucky! It was actually a pretty busy day in the clinic, so that was good. Also, everyone at the clinic got me a cake! They also said they were all going to miss having me around, so that was really nice to hear. I like the clinic and the people who work there a lot, and I really did have a great time here. I'm sad to leave, but also excited to get back to Pittsburgh and to start my ER rotation!
Today, there were a lot of procedures, but nothing particularly exciting. I did a bunch of trigger point injections into sore muscles, and also did two punch biopsies of moles on someone's neck and then sewed them up so they would make prettier scars. It was good that I got to practice both suturing and doing a pelvic exam and Pap smear (yesterday) recently, since I'm sure those are two things I'll be doing fairly frequently in the ER. Earlier this week was also busy, but there wasn't anything that was super exciting. I did some knee injections for a couple of people, and saw some rare(r) conditions like gout and shingles, but that was about it.
As of right now, my car is 90% packed, so all I have to do in the morning is put the last two bags in my car and I'm good to go! I'm planning to leave pretty early so I can beat afternoon Pittsburgh traffic through the tunnel and into the city. It should be a beautiful drive, and there will be nice weather, so that's exciting!
Thursday, September 26, 2013
Sunday, September 22, 2013
Getting ready to start my last week down south!
Not too much has been happening at the clinic, but I figured I should at least post something since I haven't in about a week! This past week was really fairly slow, and I think I was only actually at the clinic for about 28 hours total. Tuesday and Thursday were long 12-hour days, Monday was a half-day, and I didn't have to go in on Wednesday or Friday! Not bad...I could get used to the primary care lifestyle. :)
Last week was mostly regular check-up visits - there weren't even that many procedures. I did some trigger point injections into sore back/neck muscles for a few people, and cut off a skin tag or two, but that's about it. There was one pretty remarkable patient that came in on Thursday, though: she hadn't been to a doctor in about four years, except for one brief visit to our clinic back in March where she got some labs drawn but nothing else. She was complaining of fatigue, headaches, significant weight gain despite good diet and exercise, constipation, being cold all the time, trouble with her memory, hair being dry and falling out, irregular periods... pretty much all of the textbook symptoms of hypothyroidism. Turns out, she had been diagnosed with Hashimoto's thyroiditis when her son was born...11 years ago...and was never on medication for it. In Hashimoto's thyroiditis, the thyroid gets all inflamed and secretes too much thyroid hormone for a short time, but then the thyroid gets burnt out and can't produce enough thyroid hormone for normal function anymore - hence the resulting hypothyroidism like this patient was experiencing. Hypothyroidism is both miserable and potentially deadly for the patient, so it was good that this patient came in! The way you officially diagnose hypothyroidism is by checking a thyroid-stimulating hormone (TSH) level - if it's high, that means that the thyroid isn't producing enough thyroid hormone, so the brain is "stimulating" it to make more because it thinks the body needs it. Normal levels are typically between 0.5 and 4.5 mIU/L, depending on the laboratory and the guidelines you use. Turns out, her TSH level had been checked when she was in the clinic in March, and it was...are you ready? 29.4!!! This is absolutely unheard of, and it's amazing that she was still functioning at all with levels that high.
Anyway, that was pretty much the only excitement at the clinic last week. This coming week will probably be more of the same. My last day is Thursday, and I head back up to Pittsburgh on Friday morning! I'm excited to be back in Pittsburgh with some of my friends from school, and to see what medicine is like in a city environment. My next rotation is part ER, part urgent care...so the entire experience will be basically the complete opposite of what I've been enjoying in Kentucky! I'm looking forward to it, though, and I think it will be a good experience.
Last week was mostly regular check-up visits - there weren't even that many procedures. I did some trigger point injections into sore back/neck muscles for a few people, and cut off a skin tag or two, but that's about it. There was one pretty remarkable patient that came in on Thursday, though: she hadn't been to a doctor in about four years, except for one brief visit to our clinic back in March where she got some labs drawn but nothing else. She was complaining of fatigue, headaches, significant weight gain despite good diet and exercise, constipation, being cold all the time, trouble with her memory, hair being dry and falling out, irregular periods... pretty much all of the textbook symptoms of hypothyroidism. Turns out, she had been diagnosed with Hashimoto's thyroiditis when her son was born...11 years ago...and was never on medication for it. In Hashimoto's thyroiditis, the thyroid gets all inflamed and secretes too much thyroid hormone for a short time, but then the thyroid gets burnt out and can't produce enough thyroid hormone for normal function anymore - hence the resulting hypothyroidism like this patient was experiencing. Hypothyroidism is both miserable and potentially deadly for the patient, so it was good that this patient came in! The way you officially diagnose hypothyroidism is by checking a thyroid-stimulating hormone (TSH) level - if it's high, that means that the thyroid isn't producing enough thyroid hormone, so the brain is "stimulating" it to make more because it thinks the body needs it. Normal levels are typically between 0.5 and 4.5 mIU/L, depending on the laboratory and the guidelines you use. Turns out, her TSH level had been checked when she was in the clinic in March, and it was...are you ready? 29.4!!! This is absolutely unheard of, and it's amazing that she was still functioning at all with levels that high.
Anyway, that was pretty much the only excitement at the clinic last week. This coming week will probably be more of the same. My last day is Thursday, and I head back up to Pittsburgh on Friday morning! I'm excited to be back in Pittsburgh with some of my friends from school, and to see what medicine is like in a city environment. My next rotation is part ER, part urgent care...so the entire experience will be basically the complete opposite of what I've been enjoying in Kentucky! I'm looking forward to it, though, and I think it will be a good experience.
Friday, September 13, 2013
Procedures galore!
Well, life at the clinic hasn't been too thrilling in the past week, but I thought I'd write a short update anyway! As I've said before, most of my day consists of doing the history and physical on people who are just coming in for their three-month checkups for the holy trinity of primary care (at least in the southeastern U.S.): high blood pressure, high cholesterol, and type II diabetes. Most people are really nice, and I end up spending about 30% of the time I'm in the room just talking to them about non-medical things. And, occasionally, we do cool procedures!
Something that was a slight frustration this week was the number of pain medication-seeking patients we saw yesterday. My preceptor said that, for some reason, there seem to be days when everyone is coming in with "back pain...just everywhere, I don't know what caused it" and seems to know exactly what kind of pain medication they "need" and in what precise dose. I'm pretty gullible, and I always want to believe the patient, but even I know that those are red flags for abuse. My feelings about these patients are pretty complicated... I usually talk to them and sympathize with them, then let my preceptor tell them she's not going to give them anything stronger than Tylenol (unless, of course, she thinks they have legitimate pain). I just hope that I don't get too jaded, like a lot of practitioners, and write people off without listening to them.
Anyway, I got to see and do some pretty cool procedures this week! Earlier in the week, we had a patient come in with an injury he got at work (in an auto body shop) - apparently, something exploded and he had all these shards of steel embedded in his hands and arms. He had already removed a piece from his forehead and another one from his forearm at home (!!), but there was a persistent one right above a tendon in his hand that he wanted a doctor to take out. He knew it was there because he held a magnet over his hand and could see the skin tenting a little bit over the knuckle. So, my preceptor dug these tiny, tiny shards out of the man's hand, bandaged him up, and then he went right back to work. People in Kentucky are tough, and they work hard!
Another cool, but unexpectedly gross, procedure this week was taking off a man's ingrown toenail. Apparently, he had dropped some wood on it when he was splitting the wood in his backyard a few months ago, and the nail had broken off about halfway down and had grown back all ingrown and painful. I had never seen a toenail removal before and didn't really know what was involved, but I was feeling tough - I did, after all, just finish my surgery rotation! But I wasn't really prepared for this... my preceptor started by numbing the entire toe from the base, so the numbing medicine would get in the nerve and numb underneath the nail bed. Even watching her force 10 mL of lidocaine into a toe was painful, because there's not a lot of extra fat or room in people's toes, so it looked really swollen and even more painful before the toenail even came off. She also had the patient soak his foot so the nail was nice and soft ... then, she cut down the one side of the nail, and used a pair of hemostats (fancy surgery clamps) to grab the edge of the toenail, then rolled the clamps across his toe to pull the nail off. Gross!! And very bloody! Luckily, the patient was numb and didn't feel a thing.
Finally, on Tuesday I got to do an entire incision and drainage of an infected sebaceous cyst all by myself! My preceptor asked me if I had ever done one before, and I told her I had done a couple at my last rotation. We were really busy at the clinic, so she just showed me where all the supplies were and then told me to go do it. At first I was really nervous, but the procedure isn't actually that hard - just numb all around the area by injecting lidocaine, then slice into the infected area, push all the infected yucky stuff out, then pack the wound and dress it. Kinda gross, but it's really satisfying to drain all of that nasty stuff out and know that the patient is going to feel so much better when it's over. Anyway, I did it, and called my preceptor in to check my work before I dressed the wound and let the patient leave, and she said I did a really good job! There was another one today, and she let me do that one too since I did such a good job earlier in the week.
I'm looking forward to this weekend to relax - for some reason, this week seemed really long, even though it wasn't. I'm taking my general exam for the end of the rotation tomorrow, and then hopefully exploring another nearby state park and just getting some assignments done for school! It should be a nice, relaxing weekend!
Something that was a slight frustration this week was the number of pain medication-seeking patients we saw yesterday. My preceptor said that, for some reason, there seem to be days when everyone is coming in with "back pain...just everywhere, I don't know what caused it" and seems to know exactly what kind of pain medication they "need" and in what precise dose. I'm pretty gullible, and I always want to believe the patient, but even I know that those are red flags for abuse. My feelings about these patients are pretty complicated... I usually talk to them and sympathize with them, then let my preceptor tell them she's not going to give them anything stronger than Tylenol (unless, of course, she thinks they have legitimate pain). I just hope that I don't get too jaded, like a lot of practitioners, and write people off without listening to them.
Anyway, I got to see and do some pretty cool procedures this week! Earlier in the week, we had a patient come in with an injury he got at work (in an auto body shop) - apparently, something exploded and he had all these shards of steel embedded in his hands and arms. He had already removed a piece from his forehead and another one from his forearm at home (!!), but there was a persistent one right above a tendon in his hand that he wanted a doctor to take out. He knew it was there because he held a magnet over his hand and could see the skin tenting a little bit over the knuckle. So, my preceptor dug these tiny, tiny shards out of the man's hand, bandaged him up, and then he went right back to work. People in Kentucky are tough, and they work hard!
Another cool, but unexpectedly gross, procedure this week was taking off a man's ingrown toenail. Apparently, he had dropped some wood on it when he was splitting the wood in his backyard a few months ago, and the nail had broken off about halfway down and had grown back all ingrown and painful. I had never seen a toenail removal before and didn't really know what was involved, but I was feeling tough - I did, after all, just finish my surgery rotation! But I wasn't really prepared for this... my preceptor started by numbing the entire toe from the base, so the numbing medicine would get in the nerve and numb underneath the nail bed. Even watching her force 10 mL of lidocaine into a toe was painful, because there's not a lot of extra fat or room in people's toes, so it looked really swollen and even more painful before the toenail even came off. She also had the patient soak his foot so the nail was nice and soft ... then, she cut down the one side of the nail, and used a pair of hemostats (fancy surgery clamps) to grab the edge of the toenail, then rolled the clamps across his toe to pull the nail off. Gross!! And very bloody! Luckily, the patient was numb and didn't feel a thing.
Finally, on Tuesday I got to do an entire incision and drainage of an infected sebaceous cyst all by myself! My preceptor asked me if I had ever done one before, and I told her I had done a couple at my last rotation. We were really busy at the clinic, so she just showed me where all the supplies were and then told me to go do it. At first I was really nervous, but the procedure isn't actually that hard - just numb all around the area by injecting lidocaine, then slice into the infected area, push all the infected yucky stuff out, then pack the wound and dress it. Kinda gross, but it's really satisfying to drain all of that nasty stuff out and know that the patient is going to feel so much better when it's over. Anyway, I did it, and called my preceptor in to check my work before I dressed the wound and let the patient leave, and she said I did a really good job! There was another one today, and she let me do that one too since I did such a good job earlier in the week.
I'm looking forward to this weekend to relax - for some reason, this week seemed really long, even though it wasn't. I'm taking my general exam for the end of the rotation tomorrow, and then hopefully exploring another nearby state park and just getting some assignments done for school! It should be a nice, relaxing weekend!
Wednesday, September 4, 2013
"What's a carb?"
The past week or so has been pretty busy, which is why I haven't written anything in a while! Actually, I guess I haven't written since the first day of this rotation....sorry! Even though I'm in family practice, the hours are fairly long and I just get tired by the time I get home and do everything I need to do for school. Most visits are pretty routine--three-month checkups for chronic conditions and medication refills. Something I have been enjoying is getting to talk to the patients. My preceptor always sends me in first to get a feel for how the patient is doing, and if they have any other issues besides their chronic conditions and needing more pills. All of the patients here have been really friendly, and seem to enjoy talking to me. I think a big part of this might be that I go in there without a computer in front of me, so I'm actually looking at the patient and really listening to them. My preceptor, and other providers at the clinic, are always staring at their computers and just going through the checklists. While this has its benefits, like standardizing documentation and making sure every pertinent question is asked, I can tell that it definitely makes patients feel alienated and ignored. So, I think they appreciate someone taking the time to sit at their level, without a computer, and finding out how they're feeling.
One thing I don't like so much is that practically every patient will look a little confused when I start talking, and eventually they ask me where I'm from. My lack of a Southern drawl is pretty obvious in this town, and people always ask where I'm from, what I'm doing here, and if I think they're a hillbilly. I've had people tell me I must be rich because of my accent and the fact that I'm from "up North", and that my accent sounds "proper" so I must think everyone in the town is an idiot. This is all, of course, about as far from the truth as you can get. The people in this town have hard lives, and I have an incredible amount of respect for them. I don't like that people assume that just because I talk differently, I've already judged them and think less of them. But! I still really like it here, but it's definitely interesting to experience life as a very obvious outsider.
Last Friday, there was a festival downtown to commemorate the anniversary of the founding of the town. We went down for the morning and set up a table to check people's hemoglobin A1C levels (basically an average blood sugar level over the past three months) for free, so they could know if their diabetes was controlled, or find out if they had diabetes in the first place. At least 80% of people that we see in the clinic are diabetic, and it's really sad because a lot of them don't control it and have pretty bad end-organ damage, meaning that they're going blind, entering kidney failure, or losing sensation in their feet. What I didn't know was that most people really just do not know what diabetes is, how to prevent it in the first place, and how to control it...and they really do want the information, but have never gotten it. When we were at this table, there were so many people who came up and wanted us to tell them all about diabetes, how to control it, what to eat, how to cook healthy meals, etc. It was kind of nice to see people who were actively interested in their health and be able to help them out! And yes, people really did ask us, "What's a carb?" I guess I just took it for granted that I know the basics of nutrition, and while I'm not an expert by any means, I know what's good and what's bad. I really think that some people in this part of the country just don't know why certain things are bad, and might not ever be told that certain foods are bad for them. It was nice to be able to give people information that will be helpful, and hopefully prevent them from having to be in the clinic here so often!
I haven't done many cool procedures in the past week, just a couple joint injections here and there. But, I did diagnose a heart murmur on just a basic visit! It's nothing serious for the patient, but it was really cool for me that I could hear it. I told my preceptor, and she listened and agreed with me! I'm also getting better at remembering everything from our Physical Diagnosis class and doing a really good physical exam...it's something I was worried about, since I never had to check anything beyond the pelvis/abdomen the entire time. But everything is coming back to me, and I'm really enjoying primary care. I know I've said this every time, but I really could see myself working in an area like this. As much as I love the OR, I think talking to patients, managing their chronic conditions, and hopefully preventing the development of those chronic conditions is much more rewarding. :)
One thing I don't like so much is that practically every patient will look a little confused when I start talking, and eventually they ask me where I'm from. My lack of a Southern drawl is pretty obvious in this town, and people always ask where I'm from, what I'm doing here, and if I think they're a hillbilly. I've had people tell me I must be rich because of my accent and the fact that I'm from "up North", and that my accent sounds "proper" so I must think everyone in the town is an idiot. This is all, of course, about as far from the truth as you can get. The people in this town have hard lives, and I have an incredible amount of respect for them. I don't like that people assume that just because I talk differently, I've already judged them and think less of them. But! I still really like it here, but it's definitely interesting to experience life as a very obvious outsider.
Last Friday, there was a festival downtown to commemorate the anniversary of the founding of the town. We went down for the morning and set up a table to check people's hemoglobin A1C levels (basically an average blood sugar level over the past three months) for free, so they could know if their diabetes was controlled, or find out if they had diabetes in the first place. At least 80% of people that we see in the clinic are diabetic, and it's really sad because a lot of them don't control it and have pretty bad end-organ damage, meaning that they're going blind, entering kidney failure, or losing sensation in their feet. What I didn't know was that most people really just do not know what diabetes is, how to prevent it in the first place, and how to control it...and they really do want the information, but have never gotten it. When we were at this table, there were so many people who came up and wanted us to tell them all about diabetes, how to control it, what to eat, how to cook healthy meals, etc. It was kind of nice to see people who were actively interested in their health and be able to help them out! And yes, people really did ask us, "What's a carb?" I guess I just took it for granted that I know the basics of nutrition, and while I'm not an expert by any means, I know what's good and what's bad. I really think that some people in this part of the country just don't know why certain things are bad, and might not ever be told that certain foods are bad for them. It was nice to be able to give people information that will be helpful, and hopefully prevent them from having to be in the clinic here so often!
I haven't done many cool procedures in the past week, just a couple joint injections here and there. But, I did diagnose a heart murmur on just a basic visit! It's nothing serious for the patient, but it was really cool for me that I could hear it. I told my preceptor, and she listened and agreed with me! I'm also getting better at remembering everything from our Physical Diagnosis class and doing a really good physical exam...it's something I was worried about, since I never had to check anything beyond the pelvis/abdomen the entire time. But everything is coming back to me, and I'm really enjoying primary care. I know I've said this every time, but I really could see myself working in an area like this. As much as I love the OR, I think talking to patients, managing their chronic conditions, and hopefully preventing the development of those chronic conditions is much more rewarding. :)
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