Day 3 was off to a slow start but picked up after my lunch break. Upon my arrival, Mrs. Bridges and I examined the patient schedule to plan which visits I could sit-in on. She pointed out various “difficult” patients and explained that many of the patients today were rather complicated. For me, that meant that I would only be able to sit-in on a few office visits. Below were the two patients that I encountered in the morning…
- 9:45am patient (40 year old female): This patient came to the office for an urgent visit, regarding a potential stress fracture of her foot. Mrs. Bridges assessed her pain while showing her to the exam room. The patient explained how she had a running injury, which started hurting about a week ago. She has pain along the top of her foot, especially when she bends her big toe. The pain doesn’t radiate up her leg, but rather stays within her foot. When she sits and rests, the pain wanes; however, it progresses again during exercise. Mrs. Bridges then sent her to receive an x-ray, where three scans were taken from various standing positions. When Dr. Bloom entered the exam room, he asked various questions regarding her injury. The patient explained how she has been running for the past 2 months, but eased into her exercise by walking first. She runs 4 times a week for 2 miles and considers herself to be a “hard-runner,” in the sense that she pounds the pavement. Dr. Bloom then felt around her foot, pressing in various areas and bending her toes. She was in pain whenever he pressed on her tarsals and metatarsals. He then detailed how her x-rays looked normal and recommended a recovery plan. He suggested that she goes back to walking for the next 10 days. After those 10 days, she should only run 2 times a week for the first week. For the second week, she can increase her running to 3 times a week (every other day). Dr. Bloom also recommended that she checks her shoes to see if she needs more supportive ones.
- 11:00am patient (22 year old male): This patient was here for his physical. I witnessed Mrs. Bridges administer a tetanus shot in his right deltoid. Upon receiving the correct vial with the solution, she placed the needle into the tube and shook the vial. She cleaned the patient’s right arm with a small alcohol pad, squeezed the skin around his arm, and quickly injected the needle. Mrs. Bridges then covered the point of injection with a small band aid.
After taking my lunch break from 12:00pm to 1:15pm, the afternoon schedule was much busier and I was able to visit with more patients…
- 1:15pm patient (61 year old male): This patient came to the office for an urgent visit, regarding a knee injury. He injured his right knee 10-12 days ago when he was walking up a long flight of stairs. He explained to Dr. Bloom that he has pain in the back of his knee and towards the sides, as well as some pain down his calf. After assessing his condition, Dr. Bloom pressed various areas around the patient’s knee; the patient was sensitive along the knee cap. When the patient lied down, Dr. Bloom tested his resistance and movement, to which the patient was pain-free. Dr. Bloom ordered for him to get an x-ray so he could examine the joint space. The patient was asked to change into special shorts for the x-ray by the x-ray technician. His first 2 scans were done standing up, while the next two were done lying down and sitting down respectively. Upon reviewing his x-ray, Dr. Bloom explained that the x-rays look good. There is some slight “wear-and-tear,” which is normal for someone of the patient’s age. Dr. Bloom also stated that the source of the patient’s inflammation is some irritation between the knee cap and femur. He recommended that the patient only does light-impact activity for the next 10 days. He should ice for 20 minutes, 3-4 times a day, with a 30 minute break between each icing session. He also suggested taking an anti-inflammatory (800mg of Ibuprofen) twice a day. Dr. Bloom stated that if the patient is still in pain within the next few weeks, he should come back and Dr. Bloom will administer a cortisone shot into the knee.
- 2:30pm patient (16 year old male): This patient came to the office for an urgent visit, regarding ankle pain. He injured his foot/ankle about 3 weeks ago while he was playing basketball; he jumped in the air and when he landed, he rolled his ankle. His current pain level was at a 6 or 7 out of 10. The patient also explained that most of his pain comes from lateral movements, rather than sprinting in a straight line. Upon Dr. Bloom’s entry, he felt around the patient’s foot. He then asked the patient to squat in various positions, including single-legged, on his toes, and then single-legged on his toes. The patient only felt slight pain in the last squat. Dr. Bloom declared that the patient has sinus tarsi, which is nothing too serious and often occurs after an ankle sprain. He recommended that the patient take 800mg of Ibuprofen twice a day for the next 10 days, a break from playing basketball, ice 3 times a day for 20 minutes, and do physical therapy exercises for the next 3 weeks. During workouts and practices, the patient can also wear a lace-up brace if needed. The patient’s mom was concerned about the popping that occurs while the patient walks; however, Dr. Bloom reassured her that it is normal. If he is still in pain within a month, Dr. Bloom will administer a cortisone shot.
- 4:15pm patient (14 year old female): This patient was here for a follow-up on her concussion. May 5th was the day when she was hit in the head while playing lacrosse; however, she was not taken to the doctor’s until 10 days later. Mrs. Bridges explained to me that previously she had been taking a lot of Advil and Aleve which Dr. Bloom had limited, and she was not performing her vestibular exercises, hence her failure to improve. The patient arrived 30 minutes early to take the ImPACT test and to perform the other vision tests. Today she felt about 70% normal; she said should would feel 100% normal if it weren’t for her headaches. She has been participating in physical activity (bike rides, walking, running, etc.), performs her vestibular exercises twice a day, and sleeps 7-9 hours a night. She is mostly caught up with her school work and has been taking EOGs the past week; her concussion has not impaired her thinking abilities. Mrs. Bridges then listed off a bunch of symptoms, asking for a severity ranking from 0 to 6. The only symptoms the patient felt were headache (2), fatigue (1), sensitivity to light (2), sensitivity to noise (2), and neck pain (1). Other symptoms that Mrs. Bridges asked about included nausea, vomiting, balance problems, dizziness, drowsiness, anxiousness, and irritability, but the patient experienced none of these. She then proceeded to take the 20 minute ImPACT test. After completing the test, Mrs. Bridges went through a series of vision tests with the patient, measuring when objects became blurry, when the patient became cross-eyed, etc.
Despite today starting out slowly, I ended up encountering various patients with unique conditions. Hopefully day 4 will be just as insightful, with even more patients!