Wednesday, March 30, 2011

Close to the Bone

Guest post of the week by Deangelo Spencer

Baking shows are the best.  They are the perfect show to put on after a long day of hard, grueling work at the office.  There may be nothing in the world that is better than watching a nice show about baking.  It is such a great escape.  I love to learn new tips and tricks about how to make mouth-watering dishes for myself and my family.

My absolute favorite baking show of all-time is Close to the Bone - Surgeons and Chefs.  Close to the Bone - Surgeons and Chefs is an extremely intriguing and ambiguous cooking show.  I watch this fine program on my Best Choice TV.  It was created by the very smart Mr. Richard Hu.  Richard Hu is actually a great orthopedic surgeon in his day job.  But at night, he is a world-class chef.  What a talented guy.  This show is on the Canadian Learning Channel.  The show's set is even made up to look like an operating room.  The various surgeons who are on this show cook a variety of interesting meals that relate in some way to their medical specialties.  For instance, a surgeon who focuses on knees is likely to come on the show and cook fried drumsticks.  A hematologist could cook up some liver.  It's a goofy show, but I can't get enough of it.

Close to the Bone is an excellent show.

Sunday, March 27, 2011

Post Operative Rehabilitation

I am finishing orthopedic surgery this week and thinking back over all the things I have learned. Basically, if it hurts take an anti-inflammatory, when that doesn't work we start poking holes in your joints and if that is no longer helping we fix you surgically. Then you get pain killers, numerous follow up visits and lots of physical therapy.

Bionic Therapy 

I happened to get a sneak peak at patients in therapy and wondered, "who really has time to do rehab anymore?" Every now and then I hear about TENS units as a therapeutic option for pain control and rehabilitation. Once upon a time I came across one and played with it for a few minutes which was rather amusing. Without making any effort at all, the muscle under the pads contract and your body contorts accordingly as if you were signaling the movement. These muscle stimulators take the work out of therapy and let the electricity carry the responsibility. It may not be the best method of recovery, but it is certainly an alternative option. For additional information about LGMedSupply's products visit their online customer blog.


Personally, I feel that physical therapy is designed to be strenuous to muscle to help build tone, resistance, and muscle memory. Getting back into routine activities can be difficult without the proper training and many of the patients we see have mixed feelings about their post-operative therapy. Electrical stimulating devices may be a part of that process, but should not replace the participation in other therapeutic activities. As my use of such devices is limited, I would be interested in hearing your experiences with TENS units and the usefulness of physical therapy.


Question of the Week

A 25 year old active male visits your office after experiencing a twisting injury of his right leg during a soccer match. On exam you palpate and hear clicking when performing a McMurray test. There is a negative Lachman's and posterior drawer test. Varus and valgus stressing shows no laxity of the knee joint. The initial step in management for this patient would be to


A. Immobilization with a leg brace
B. Arthroscopy of the affected joint
C. Prescribe cryotherapy and NSAIDs
D. Obtain an X-ray of the knee
E. Order magnetic resonance imaging of the knee


Answer & Explanation

Sunday, March 20, 2011

Preparing for Board Exams... Again

Round two of board exams is now in full swing. It seems like just last month I was preparing for the first of many and here I am again, squeezing every opportunity to study out of every waking moment.

Step 2 Resources

On the way to the hospital or clinic, the lecture tour of medical topics begins in mp3 format. The few minutes between patients give me just enough time to consume a page or two from Boards and Wards. If I can avoid sleep driving, I catch up on the audio files during the ride home. After a quick break for dinner it's back to the books. My time is divided among Step-Up to USMLE Step 2, Premier Review and First Aid for the USMLE Step 2 CK. Of course there is a lot of overlap between texts that has been beneficial for review purposes which can easily be skimmed. Depending on the day, I may do a set of questions from various Qbanks or get together with classmates to prepare for the clinical skills exam. For the latter we have been using First Aid for the USMLE Step 2 CS as it provides clinical cases to prompt our interaction.

Looking at all the resources can be overwhelming. Thankfully, I was recently introduced to an iPhone app that helps calm my mind by taking the guesswork out of organizing everything. Cram Fighter is the perfect tool for students who plan to follow their own schedule when reviewing for board exams. By simply entering the books, Qbanks, subject order, dates and times, the application builds a calendar checklist to meet your deadlines. It breaks down the number of pages to cover on any given day, provides "catch-up" days if you fall behind and will adjust your calendar if needed. For the nominal cost of the application, I have saved myself undue stress and anxiety. Perhaps it really appeals to me because filling in check boxes has always been a rewarding experience in and of itself. Whatever the case may be, I think this is a valuable tool in preparing for boards.

Question of the Week
An 18 year old college freshman presents to the emergency department after experiencing a seizure at a party. Her friend says that she was consuming alcohol and complained of severe abdominal pain before vomiting and later convulsing. She has no signs of convulsive activity after admission to the hospital for observation. The next morning, an observant medical student notices red-brown urine in her Foley catheter bag and that the patient's urine toxicology screen is positive. Which drug most likely contributed to the patient's symptoms?

A. Cocaine
B. Heroine
C. Marijuana
D. Methamphetamine
E. Phenobarbital

Answer & Explanation

Sunday, March 13, 2011

Orthopedic Surgery

Although it may appear as though I am on my way to play virtual Tron or that I have the worst dental apparatus around, this little device was quite fascinating to myself, the naive student on orthopedic surgery.



Surgical Expectations

My first day in the operating room was a little of what I expected and a lot of what I hadn't. When they handed me a helmet, I thought perhaps I was about to be the brunt of a prank. It was legit and even had a nifty battery pack to boot. When we scrubbed in they attached the bio-hazard-like helmet cover to keep us sterile. It was quite comfortable inside with a little fan to keep the air flowing in the hood almost like a personalized air conditioning device. Apparently, with the amount of fluid and debris flying during orthopedic procedures, this is a rather important device. Thankfully I didn't sneeze on my little window, but the runny nose was on full display for everyone else as there was no way to get a tissue inside the hood.

I did expect to see hammering and the use of a chisel, after all this is orthopedics. I did not expect to see the jackhammer that was used to prepare for the femoral implant, however. It was akin to something out of a horror movie. The team and I held open the hip while the doctor got to work. As could be expected for any medical student, I held the retractors long enough that my hands ached with pain and lost sensation from the lack of blood. Fortunately, there was enough movement and hands available throughout the procedure to avoid too much damage. Being the new medical student on board meant I wasn't expected to know much. If it wasn't for the scrub nurse, I am rather certain I would have had no idea what instruments to use during the procedure. In the end, it was a great learning experience and now I kind of want one of those helmet and hood devices to brave the Las Vegas heat.

Question of the Week
A 70 year old women has recently been operated on for a total right hip arthroplasty. All of the following are appropriate prophylaxis for deep-vein thrombosis EXCEPT

A. Warfarin
B. pneumatic compression boots
C. subcutaneous low molecular weight heparin
D. intravenous heparin
E. Aspirin

Answer & Explanation

Sunday, March 6, 2011

Medical Investing

With a little work directed appropriately our efforts will pay off in the end. It is a matter of making the initial investment that determines the success we obtain. As Benjamin Franklin said, "An investment in knowledge pays the best interest."

Seeking Dividends

There are definitely times when it becomes difficult as a student to see the finish line. We question everything we are doing and wonder if it makes any sense at all. Think just for a second, how many people do you know would pay thousands of dollars to work for free, be given endless hours of study responsibility, and be deprived of leisure or sleep for four years? I thought it was funny when my attending recently commented that nobody pays to go to work and that it just wouldn't make sense for people to invest like that. In good humor I rose my hand and said that I do, to which he quickly replied that my situation was different. I disagree, however. My time, money and resources are currently being invested in my education so that one day I can realize a lifelong goal and reap the accrued interest.

Unfortunately, we are not educated in school as to the inner workings of medical business. Most of that must be learned in practice or from personal research. As far as finances go, there are some wise decisions to be made, assuming you know what those are. One of my favorite places to get money-wise information for the medical professional is at PoorMD. From one who has been there and done that, the author gives great financial advice that is easy to implement at any stage of practice. It's just a matter of seeing now the potential our investments could have latter, and taking advantage of those opportunities.

Question of the Week

A 4-month-old male presents with twitching of the facial muscles. He has previously been seen for several severe episodes of Candida infections. On examination, the child has low-set ears, hypertelorism, and a shortened philtrum. What additional findings would be likely in this individual?

A. Prominent telangiectasias around the eyes
B. Decreased alpha-fetoprotein
C. Decreased IgA levels
D. Elevated IgM levels
E. Absent thymic shadow on chest x-ray

Answer & Explanation

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