Family Medicine

Hello, it has been a while.  So much has happened I dont know where to start.  The last post was about ER so i will talk about Family Medicine rotation.  I did this rotation in February and March of 2012 with Dr. Hassrick at the Ogden Clinic. Most of the patients were your run of the mill upper respiratory illnesses and yearly checkups.  Dr. Hassrick also does on call substitution for people who come to Ogden to have their babies who live from farther away places like Evanston WY and such, so he gets to go check on the newborn babies and their moms.  This means that we got to do some circumcisions.  Not the first, most exciting thing on some peoples lists, but when you are a PA student it is awesome.  I was able to perform about a dozen, with more than half of them done on my own (with the Dr. supervising of course).  They all were using the Plastibel method which I found to be very easy to use.  I also had an interesting case with a young man who was having some ADD/ADHD issues with trying to go to school and work at Arctic Circle.  It was causing his mother some issues as well, and we tried to help them the best we could.
I also was able to spend some time with the general surgeon, the orthopedist, and the dermatologist this month.  Dr. Hassrick allowed me to remove some moles and stitch them up.  On one such incident I stuck myself with the suture needle and had to do some bloodwork.  Overall it was a good month, and I feel like a learned some about URI's and how to do a yearly physical exam.

I loved ER!

Well I am sad to say that my ER rotation is over. I really had a good time and learned a lot. I got to do some good procedures in my last week. The last day I spent in the EDx with Karen was awesome. I got to do a paronychia w a digital block, an ingrown toenail w a digital block, an I & D on the sole of the foot w a local block, and an effusion aspiration of the knee w local block. I also did some splinting and other regular sort of exams too! So for all of these procedures I was able to do them BY MYSELF :) This made me feel like Karen really trusted me to do them and to take care of the patients properly.
My last day was with Brian and my last patient was kind of sad. He came in with A fib and chest pressure and some pain in his shoulders which progressed into runs of PVC's. About 10 minutes later he was very pale and diaphoretic. A new EKG showed ST elevation, so we intubated him and sent him upstairs to the cath lab....but he didn't make it. He passed away in the cath lab from a total LAD blockage. He already had 4 drug eluting stents in his heart, but the blockage was up high in the LAD above the bifurcation so a large part of his heart was occluded and there wasn't anything that could be done for him. This was a difficult case, but a good one to learn from.
OH YEAH! I forgot to talk about the dog bite lady in my last post. She broke up a fight between her doberman and lab and had a TON of dog bites on the right side of her body. Her wrist and ankle were pretty swollen with puncture wounds on it, and I thought that she may have some fx's so we got some x rays. Sure enough she had an ulnar avulsion fx from the dog bites, and needed surgery to take care of the Fx. This was a good case, and I got to help clean out the puncture wounds and splint her arm.
So overall I really liked ER. I liked seeing all the different things all the time and being able to order tests and drugs and do procedures.....It was GREAT :)

ER!

January 2012 is my month to work in the ER. I am at McKay Dee Hopsital following Dr's Brian Smith, Karen Bossler, and Amber Mounday. In the beginning I was really overwhelmed by the speed with which patients are seen in the ER. But now, 23 days into the rotation, it doesn't seem quite as bad, but definitely still faster than I would be able to do it. I have worked in the EDx, which is like the "now care" section of the ED. I like it over there, as there is more minor trauma patients and less severely ill patients. This is more my speed. I have gotten to perform some new procedures in the ER! These are a shoulder dislocation under conscious sedation (propofol); this was neat because I felt the shoulder "clunk" back into place! I have also performed some quick caths, my first on an infant that didn't go so well, then 10 minutes later on an older lady which I got my first try. I have done a few of these cath's since and feel fairly competent with this procedure. I have helped relocate a displaced lower leg fracture and a displaced radius/ulna fracture. I saw a "blood bath" from a little old man who pulled the IV out of his arm and sprayed blood all over the exam room. I watched Amber perform a lumbar puncture on a lady with encephalitis. I got to do 7 stitches by myself - completely by myself with no doc even near the room - on a guy who was stabbed in the back 3 times with a screwdriver after being hit in the head with a cinderblock by his girlfriends son and his friends..... glad they are not my kids. The doc, "burkules", was dealing with the family of a 93 year old non responsive man, and came in to check on me as I was finishing. He said they looked good and gave me some tips on how to make it pretty for the patient, as that is how they judge just how good of a job I did. I have also done a nasal cautery on a young man for an anterior nosebleed, placed an NG tube, and removed a J tube. I have really liked working in the ER so far, and have enjoyed getting to know my preceptors a little better! I have worked some crazy shifts like 10 pm-6 am and 6 pm - 3 am. Lets just say there is a lot of sleeping going on after these shifts!
I got a sinus infection over Christmas that is finally cleared up.....One month later I am finally feeling "normal".
It has finally started snowing this season. I have been up 2 days for control work, and trained a couple of new patrollers - Lisel and Dickie - on control route in Sunshine bowl. We are on control alert for tomorrow, and since I don't go in to the ER until 2pm I might try to go to control.

The Toe Nail !

so i got to do something cool this last week! I got to remove an ingrown toenail! Some people think its gross, but it was neat and Dr. Ellie let me do the whole thing by myself :) First i did a local - digital block - using 1% lidocaine without epinephrine and let that get numb. Then i inserted the tool underneath the nail to make a tunnel. Then i cut down the tunnel with a pair of surgical scissors, and finally i grabbed the nail and pulled up and out and pulled the nail off. It went really smooth. The pt was a 13 yr old boy who weighed 188 lbs and cried alot. I mean more than a girl, ha ha ! Then i wrapped it up and sent him home for the weekend. Overall it was a good procedure and I learned a lot by being able to do it with Dr. Ellie supervising me.

OB & Peds happenings!

Hello again! I have finished my first rotation - OBGYN - and really loved it! I was able to see 2 C sections and 1 natural birth (on my last day :) ) I have started my Peds rotation and it is a bit overwhelming to work with the little ones that can not tell you why they are feeling bad. The babies are fun to see when they are well, and they have so much energy and love for life! M
My Avi dog Zena passed away this week :( She had her front leg amputated a couple of years ago and has not been feeling well for the last couple of months. Dan decided that she did not need to be in so much pain anymore so he let her go. I wish i could have visited her one last time before she left us. But i think that she knew that i would love her forever..... oh teeny zeeny! you got so much love, teeny zeeny! you will be missed.
Shadow has been so playful since i got home from school. She carries around her little feather toy and asks you to play with her. Then when she is tired she goes into the bedroom and sits on the bed and waits for me to come to bed. And at night she is so cuddly. Last week there was a huge windstorm and both Willow and Shadow came in and slept with us in the middle of the night because they were scared. The wind was around 80 mph and ripped a small piece oc siding off our house. There were so many pine trees and other trees and car parks and other items that got blown around the neighborhood. There were semis tipped over on the freeway and they were not letting the semis travel for a day or two. We lost power for almost a whole day. I had to shower by flashlight on the first day of my peds rotation. But we had hot water and the fireplace was still powered (gas) so that was not so bad. We ended up goin to Taco time for dinner then came home and went to bed early. It was super cold with the wind and only little cat was running on the mtn. Ben was super tired frfom trying to stay warm all day working on the lifts.
I am getting to see kids at my rotation, and I think i am doing OK. I have to see the child, Dx their symptoms, make a plan and tell the preceptor so it is kind of nerve racking, but i think it is helping me learn. i have to decide what Rx I would give, if any, and in what dose. That is the tricky part.....knowing what dose of what med to use for each situation. but everyday it gets a bit easier the more i see and do it. and my preceptors are good about teaching me and not making me feel like i'm a dummy.
Well thats all for now! :)

I just finished my first week of my first rotation. I have been working with Dr Swift in OBGYN. I have done some pap smears, fetal heart doppler monitoring, fundal height readings. He doesnt work on thursdays so I went to the maternal fetal monitoring and watched some ultrasounds. That was pretty cool. Then Friday was quite a day! THe morning started out with a psych pt who was 4 wks post op for hysterectomy and had re-opened her incision and was bleeding. profusely. So we cleaned her up and the Dr put in a stitch and then I bandaged her up. After that we went to surgery. Dr swift did 2 laparoscopies with laser. I got to put 1 stich in each of 2 pts. I was nervous because it was my first time stitching a live person. But it went well. He only had 2 pts so I stayed after and observed surgery w Dr. Lindsey Deschamps. She is close to my age and goes to our church. She did a cone biopsy and a D&C w endometrial ablation. Then I watched a toe amputation.
All in all it was a good week, and I only got pimped out a few times when I did not have a decent answer. I am definitely going to learn alot this next year of rotations!

woah! it has been forever since i wrote on my blog. Since i have a little time this weekend....here goes. I have been in Henderson NV going to PA school since last july. I am so glad that this time has gone as quickly as it has, although there are days that seem to last forever, and some that go way too fast. The quick days are usually either when i have a lot to do and not a lot of time to do it, or when i am out having fun and exploring in the mountains around here.

I have a couple of pretty good roommates who are in the PT program.
I am excited that there is only 5.5 weeks left to be here. i am definitely glad that i can go home to do my rotations :). I am ready to leave this place behind!
In October one of my friends from school is getting married in Minnesota so Ben and I are headed out there for a few days. Then a week of home life until I start my first rotation. It has been a long road, but i am glad that i am getting closer to getting to go home.