Anda di halaman 1dari 7

SEP

10/30
Myfirstdayofshadowingistomorrow.I'mreallyexcitedbutI'malsonervous.Ihavenoidea
what'stocomeorhowthingswillbehandled.IhopeIhavetheopportunitytodoalotof
handsonstuff,eventhoughI'mnot18,IhopethatIwillhavetheprivilegetoatleaststepin
meetingsorpatientvisitstofurthercomprehendanatomyandhowthewellbeingofpatientsis
achieved.IhopethatIwillbeluckyenoughtoseethingsthatarenotconsideredtheordinary
checkups.

10/31
WalkingintoJason'sofficewasawesome.Iwasreadyforthedayandanythingthatwasaboutto
getthrownmyway.Ifeltimportant.BeforethedayevenstartedIfeltsofortunatetobeina
positionwhereIcouldbeinanenvironmentstudyingwhatIloveandhopefullywillgointoin
thefuture.Jasonadvisedmethathewouldbeworkingalongsideadoctorforthea.m.
appointmentsuntilabout12pmandthenwewouldgooffonourownfrom1to4fortherestthe
dayinhisownprivatepractice.

10/31
OneofthefirstthingsIlearnedtodayisthatthereisaproductovertheshelfthatpatientscan
buycalledSuperFeet.Theycommonlyhavethestaminatorelievepatientswhothinktheymight
haveseriousorthopedicproblemsthatneedfurthertreatment.However,alotofpeopleare
misleadandreallyonlyneedasimplechangeinthearch,softnessorfirmnessoftheirinsoles.
theyrangeinpricebutarealmostalwayscheaperthanpersonalizedinsolesprescribedbya
doctor.

10/31
Almostallpatientswhetherneworreturningarescannedforxrays.Physicalcheckupsare
provided,butthexraysprovideamoreaccuratediagnosis.Duringthefirstcouplepatientsmost,
ifnotallofthepredictionsthatJasonfiguredoutbeforethexraycamebackwerecorrect.The
secondpatientofthedaywasamanwithcerebralpalsy.IfyouaskedmeIwouldsayhelooked
45,butinrealityhewasonly23.Itwasinterestingtoseethathehadbootsespeciallymadefor
him.Hehadfeetcomplications,andthebootsmadeitalittlelesschallengingforhimtoget
around.
10/31
Thenextpatientweexaminedhadapossibleminiscustearinsideonlateralsideoftheleftknee.
Priortotheirappointmenttodaytheyhaveseveredamotorcycleaccidentwhichhadthemoffof
theirfeetforasubstantialperiodoftime.Anotherpatient,andinterestingwomenwhousedto
playmajorleaguesoccerstoppedbyforasecondtime.Shehadstoppedphysicaltherapyand
juststartedrunningtobuildupherlegmusclesagainshewasveryexcitedasthatwasthefirst

timeshegottoexercisefasterthanawalkingpace.Itwasinterestingbecausealthoughphysical
therapywasrecommendedforthenextthreeweeksshefeltgreatdoingtheproperexercises
everyday,exercisingregularlybutinmoderation.

10/31
Ididn'tthinkmyfirstdaycouldgetanybetteruntiltheinjectionscamealongwhichIwas
thrilledby,butthatwasn'teventhebestpart.IgottoseeJasonremovepinsandneedlesfrom
footsurgeries!Icouldn'ttellyouwhyitfascinatedmesomuchbutthere'ssomethingthatisso
intriguingaboutseeinghowthebodygrowsaroundforeignobjectsthatareplacedinsideto
reconstructpartsofourbodythataretoodamagedtofusebacktogether.SomethingIwishI
couldseewasthecastingofpatientsoreventheremovalofsutures.However,IknowthatIcan
seeeverythingbecausethereispatientconfidentialityandIknowsomepeopleare
uncomfortablewithpeoplewatchingtheirexaminations.BeforeIsawthefirstshotJasonasked
meifIwantedtositdownandItoldhimthatIwasfine.

10/31
Lateronwediscussedhowtherewasanincidentinadeliveryroomwhereawomanwhowas
givinglaborhadherhusbandbyhersideandhegotsonauseousthathepassedoutandhithis
head,gettingaconcussionandsuedthedoctors.ImmediatelyafterheaskedmeifIwantedtosit
downIstartedtofeelalittledizzybecauseIgotscaredofwhyhewouldaskmetotakeaseaton
suchasmallaction.IfIcouldgoinandwatchmeorfootsurgery,seeingthemcutopenand
placeofmicroscopesinsidesomeone'sbodyIwouldwithoutatroublecrossingmymind.

10/31
Igotveryluckywiththenextpatient.IgotthechancetolearnabouttheOsTrigonum.Itisan
accessorybonethatformsbehindtheanklebone(Talus),connectedtoitbyafibrousband.Only
fewpeoplearebornwiththisitbecomesvisibleduringadolescenceasitisnotfusedwithany
partoftheTalus.Mostpeoplewon'tevenrecognizethattheyhavethisphoneuntilitstartsto
causeproblems.Mostofthepatientstocomeinwithcomplaintsaboutitaretriggeredfrom
sportsinjuries.Themanthatcameintodaywasafootballplayerwhohavehadseveralinjuries
includinganoldsprainoftheanklewhichcausedpain.Helateronhadasurgerywhich
afterwardslefthimwithnumbness,extremeback,andhippain.Jasonexterminatedhisbootas
wefoundoutthatitwasoneofthecausesofthepain.Hewasprescribedantiinflammatoriesand
advisedtoattendrehabforhisknees.Athomehecouldbringtoactivityascomfortableandtake
icebathsregularly.

10/31
ForthefirstfewpatientsIwasnervousbecauseJasonwouldaskmequestion,whichIwas
nervoustoanswerfirst.AsthedaywentonIrealizedthatpeopleunderstoodthatIwasonlya

studentandImaynothavetheperfectdiagnosesthattheyarelookingfor.Fromthenonout
whenJasonaskedmeaquestionIwouldblurtoutwhatIthoughtwasblatantlyobvious.He
wouldadvisethepatienttostandupandaskme"Whatdoyouseedifferentaboutthispatient's
feetwhatdoyounoticeabouthowtheyarestanding?"MostofthetimeIwouldseethatpeople
wereflatfooted,orthattheirfeetwouldrollinwards.forexample,thisnextpatientcamein
complainingaboutpaininhisleftkneeandleftankle.Akneereplacementontherightsidenow
consistedofpigbonefromhavingtocutthelateralsideofhiskneesodeep.Todaywegavehim
aninjectioncalledviscosupplementationinhisleftknee.Thepurposeoftheseinjectionsisto
reducepain.Wefoundanunderlyingissuethathistendonventraltohisleftanklewascausing
pressure,thereforediscomfort.

11/5
Therewasanotherfirsttoday,asIhadamanwhodidn'tspeakonewordofEnglishandwedid
nothaveanyoneintheofficethatdaythatspokeSpanish.Therefore,wehadtocalltothe
buildingacrossthestreetwithtranslators.Theeasiestwaytodothisisforthepatienttoholdthe
phoneandforJasontoaskquestionsofthepatientthatarethentranslatedbyheorshewhoison
theotherline.Andjustlikethat,wegavehimininjectioninhisrightkneeafterthexrayscame
backandshowedthattherewaslittletonocartilageleftbetweenhislateralepicondyles.This
mansexpressionreadscaredandlost,buthewasawareofwhatwashappening,Ijustthinkthat
hewisheshegotmoreanswers.Wedidwhatwasthebestthingforhimatthemoment.Itwas
sadinaway,towatchthismanbecauseIsawthathewasinpainandwantedhelprightaway,
buttherearequestionsthatIaskedmyself.Whywouldhecomehere?

11/5T
TherearequestionsIaskedmyselfafterpatientscameinthatdidn'tspeakanyEnglish,suchas
Whywouldn'thegosomewherewherehecouldbebetterunderstood?ButthenIthought,there
reallyisnootherplace.Yes,therearebilingualdoctorsandPAsbuthecan'trequestfora
Spanishspeakingdoctor!Yougetwhatyougetwhenyoumakeanappointment.It'ssituations
likethesewhereIwonderifmycompassionwouldgetinthewayoffuturejobpositions.

11/5
AlthoughthenameofthepracticethatIwasdoingmyshadowinginwasforsportsmedicine
specifically,therewerealotofpatientsthatcameinthatwerebeingtroubledfromissuesother
thansportsrelatedinjuries.Ihadpatientswhohadbeenhitbycars,incaraccidents,draggedfor
yardsonthegroundbytheir180pounddogs,andevenonewhowastrampledbyanelephant
whilehikinginSomalia!Todayboycameinwhoplayedbaseballandhehadalotoffluid
seepingfromhiskneebutthatwasnormal.Ithinkit'sawesomehowyoucandeterminewhether
somethingisinfectedbasedonitscolor,smell,texture,amount,etc.

11/5
Thiswasprobablythemostinterestingpatientofmywholeshadowingexperience.Hewasa
youngmalewhocameinforacheckupbecauseheneededtobeclearedforthemilitary.Aletter
sayingthathehadnopriorinjuriesthatwe'regoingtointerferewithhisdutieswaswhathewas
searchingfor.ThefirstthingInoticedwhenIwalkedintotheroomwasthathehadahorridscar
onhisleftknee.Beforeentering,Jasontoldmethatonhispapersitsaidthathewasinarollover
Jeepaccidentafewyearsback.Jasondidseveralphysicaltestwithhimtoseeifhefeltanypain
andhedidn't,whichwasgreat.NextthexrayscamebackandIgottoseealloftheleftover
materialfromthesurgery.Hehadbrokenhisfemurandhavemeaccidentwhichresultedinafull
metalbarrunningverticallythroughhiswholefemur.Horizontallythroughthebar,werethree
screwsholdingthatbarinplace.Justafewscrewsleftthereinthesuperiorpartofthelateralside
ofhisfibula.Weevennoticedthattheyhadleftastapleinfromthesurgerywhichtheyhad
forgottentoremove!

11/5
Whetheryou'readoctor,surgeon,PA,ornurse,youhavetoexaminepatientsbutIthinkitis
alsoimportanttopayattentiontotheirattitudesandbodylanguage.Afterwelefttheroomofthe
youngmanintheJeepaccident,JasonhadaskedmeifInoticedanythingabouthisbody
language.IdidnoticethathewasalittleshybutIjustthoughtthatbeingagirl,hemight've
been.JasonhadnoticedsomethingthatIhadnotbeenpayingattentiontobutthatIdidrealize
oncehetoldme.HeexplainedthatthatguywassoselfconsciousofhisscarthateverytimeI
lookedatorexaminedhimhewouldeitherpulldownhisshortstocoverit,andeverytimeJason
toldhimtostanduphewouldkindoffaceandanglethatwouldbeawayformebecausehe
didn'tfeelcomfortablewithmeseeingit.

11/5
IcanrespectpeoplebeingalittleshybecauseIwouldprobablybeinthesamepositionif
someoneIdidn'tknowthatwasmyagewasstandingintheroomaswell.JasonandIalso
discussedhowreadingcurrentinformationaboutthepatientisimportantbeforegoinginto
examinationbecausesomedoctorsjustwalkin,diagnose,andthinkeverythingisfine.Hetaught
methatit'simportanttoseeapatientshistorybecausetheycouldhaveunderlyingdepression,
anxiety,andseveralothermentalissuesthatcontributetotheirsocalledpain.
11/5
IthoughtaboutwhatJasonsaidwiththenextpatientthatIsaw.Shewasayoungwoman,who
wasactuallyanorthopedicnursesoshecameinhavinganideaofwhatshemighthave.Shewas
inacaraccidentlessthanamonthagoinwhichshewasatadeadstopandwasrearendedat45
milesanhourinasmallcar.Therewasneveradullmomentinshadowing,especiallywhenwe
discussedhowimportantitistostayrelaxedifyouknowyouaregoingtogethit,orabouttobe
inanaccident.Itisunbelievabletheextraamountofstrainitcanputonyourbodyifyoutense

uppriortoanaccident.IappliedthistotheanatomyIalreadyknew,andeverythingIknew
aboutmechanicsstartedtofallintoplace.

11/5
Thiswasanothersadcaseasthisyoungwomanhadhadakneesurgerywhenshewas12years
oldshehadchippedoffpartoftheanteriorcrestofhertibia.Whenxrayscamebackforher
complaintthistimewefoundoutthatthecartilagearoundhermeniscusinherrightkneewas
reallysoftfromtheaccidentstill.Shemostlikelytoreasmallpartofthemeniscusbutthexrays
weren'tshowinganythingdrasticyet.Shewasadvisedtobeputinafullrangeofmotionboot
andoncrutchesforsixweeksuntilshecametoseeJasonagaintofollowup.Inherpaperwe
onlyfoundoutthatshehadsomeprioranxietywhichshehadexpressedtouswhenshetoldus
thatshewasreallystressedoutaboutwhattheresultsweregoingtobebecausesheistheonly
oneprovidingforherfamilyandherjobrequireshertobeonherfeet.Wecomfortedherour
bestandtoldherthatallwecandoisbehopefulforthetimebeing,asshewasvery
understanding!

11/5
Todaytherewasa10yearoldboywhohadcameinwhoreallycaughtmyattention.Hecamein
withcomplaintsabouthisleftanklehurtingalongwithbothofhisheels.Wewereskepticalat
firstbecausehisfatherdidnotspeakEnglishwellatall.Jasonhadaskedhowlongagothepain
hadstartedandtheboykeptlookingtohisfatherforanswers.whichhedidnothelphimwith.
Next,theradiologiststookafewXrays,whichwecamebacktowhenwevisittheboyonce
again.ThiswasaninterestingcasebecauseIlearnedabouthowduringpuberty,yourfootgrows,
causinggrowthplatestoformbehindyourCalcaneus.Theyfusewiththeposteriorpartofyour
foot,butinthisboyscase,hewasanactiveathlete,playingbasketballandcurrentlyinsoccer
season.ThediagnosiswastobuysomeSuperFeettosupporthisfoot,andtostayoffthefield
foratotalof2weeks,andafterasecondcheckupifthingswerenthealed,tostayoffforanother
2weeks.

11/23
Somepatientsyouwonderabout,astheycomeinwithnotenoughpaininmyopiniontobe
complaining.IremembermyfirstdayofshadowingJasonyoutoldmethatpeoplecomeinand
theywantdrugs,justtohavethem.Peoplecomeinbecausetheyfeelliketheyhavetopaylarge
amountsofmoneytofixproblemstheyreallyarebasiclifestylechangesthattheycanmaketo
betterthemselves.Onepatientforexamplecameincomplainingthatthekneecapgivingoutand
theyalsohadbackproblems.Theysaiditwasmoderatepriortoakneesurgerythattheyhave
hadover15yearsago.Itwasnotconsideredamajorkneesurgeryonlyminor.Whenaskedwhat
thekneesurgerywasfor,sheexpressedtousthatshe"couldn'tevenremember"


11/23
Thenextpatientwascomplainingaboutseverekneepaininbothofhisknees.Hetoldusthathe
bikesabout30milesadayduetonothavingacar.He'sbeenoutofworkforaboutayearnow
becausehehadanonsiteinjurywhichnowhashimonWorker'sCompensation.Jasonletme
feelhiskneeduringaphysicalexercisewhereheforcedinversionandeversionofthefoot.
Whiledoingthis,IkeptholdofthekneeandIclearlyfeltboneonbonecontactashehad
absolutelynocartilageleftaroundhisknee.Forthemeantimewegavehimacoupleinjections
whichareusedtomakeanartificiallayerofpadding.Jasonadvisedhimthathewouldhaveto
havemajorsurgeryonbothkneestofullyrecoverfromallofhispain.Thesurgerywillcost
about$7000andthismanwasclosetopayingnothingforitduetohistypeofinsurance.

11/23
Anelderlywomancameinwhogavemeanotheropportunitytowitnesssomemorepinpulling
aswellasinjectionstotheknee.Sinceherlastfootsurgery,thepainwasremittingandwasa
substantialamounttobeworriedaboutinfection.LikeIsaidearlier,aftertakingoffthebootwe
didn'tnoticeanyodorordiscoloration,andthereforenoinfectionwassensed.Thiscasewas
different,asJasonrecommendedsomemedicationthatshedidn'tfeelcomfortabletaking.She
saidafterthesurgeryshewasputonPercocetanditmadeherseverelynauseous.Whenitcame
downtoit,wefoundamedicationthatwasaformofPercocetbuthadenoughdifferencestobe
wellwithoutfeelingnauseous.

11/23
Thenextelderlypatientcameinwithcomplaintsaboutshinsplints.Ididn'trealizetheseverity
ofwhatshinsplintsreallywere.Iknewtheywerepainful,butnottherealcaseofwhatis
happeninginsidethebody.Shewasanactiveracquetballplayerandwithinthat,thereisalotof
shufflingofthefeet.Withrunningincorrectly,strainisputontheanteriormusclesofyourTibia.
Themusclescanbeputthroughsomuchstrainthattheyactuallystarttopullapartfromyour
bone.Shewasanotheronewhowasflatfootedandusedtheinsidesofherfeetwaytoomuch.
Webothknewthatwastheimmediatecauseofpain.HerMRIshowedateararoundthe
meniscuswhichundoubtedlyneededsurgerytofullyrecoverfromthepain.Inoticedthat
anytimesurgerywasrecommendedpatientswouldfreakoutbecausetheythinkaboutthetime
thatwillnotbeonyourfeetandhowmuchitwillcost.Ifounditinterestingthatpeoplewere
willingtorisknotgettingsurgeriesbecauseofthesereasons.Ithinkthatrefusingtomakeyour
bodybetteragainisalmostaformofabuse.Wedon'trealizehowmuchourbodydoes,andwhat
itisputthrough,especiallyafterseveralyears.

11/23

OneofthethingsInoticedwasthatmostofthepatients,ifnotallwhohadpriorinjuriesiswhat
thecurrentpainisresultingfrom.Forexampletheoneswhohadkneesurgerieshaveaveryhigh
chanceofgettingarthritiswithintheknees,whichcanrangefrommildtoseverebutforthemild
casescanbetreatedbytheinjectionswhichsupportedbyprovidingartificialcushionforinter
areaoftheknee.

11/23
NextwasanolderAfricanAmericanmanwhocameincomplainingaboutshoulderpainwhich
heknewhehadalreadyhadarthritisbuthesaidhewouldhaveasharpshootingpainswhich
resultedinnumbnessfromhisshoulderallthewaydowntohisfingertips.Jasonsawanother
possibleissuesoheorderedxraysoftheshoulderandneck.Intheposteriorcervicalvertebrae
neckxraywesawthatbetweenC2andC3hehadverylittlecartilagebetweenhisintervertebral
discswhichiswherethepainwasoriginating,ashisvertebraewereactuallyrubbingagainst
eachother,whichcausedtheoddsensationstosparkallthewaydownhisarm.Weaskedhow
longthisisbeengoingonforandhehadsaidaveryfairamountoftimeashewasactuallya
slavewhodidalotofharshlaborworkforadenseperiodoftime.

11/23Attheendofmyshadowingexperience,IwasgladthatIchosetotakeanatomythisyear.
ItwasincrediblehowmuchofthelanguageIcouldunderstandthatthedoctorswerespeakingto
eachotherandthepartsofthebodythatIalreadyknewthescientificnamesfor.Jasonhadtold
methatthereismoreimportancetojustcuringapatient.Therearealotofunderlyingfactors
thatcancontributetopatientsmechanics.IwastoldthatIshouldconsidergoingintosurgery
becauseJasonnoticedthatIreallylikedandcomprehendedallofthehandsonthingsthatwe
performedduringthedays.ThisisacareerpaththatIamdefinitelyplanningonlookingintoin
thefuture!