Day 4 of my work experience was slightly different than the past few days. For starters, Dr. Bloom wasn’t in the office, so Mrs. Bridges and I were paired with Dr. Gavankar, another primary care doctor. It was also a “dress-down” day, meaning that I was able to wear jeans! My day also started 30 minutes later than usual, at 9:00am, due to a faculty meeting in the morning. My day then ended 2 hours earlier than usual, at 2:30pm, due to a doctor’s appointment that Mrs. Bridges had. The following are some of the patients I visited with…
- 9:45am patient (53 year old male): This patient came to the office for an urgent visit, regarding pain in his right hand. His pain initiated around 3 months ago when he started lifting weights. It hurts more severely in the mornings, and the pain is centered around his ring finger, palm, and top of hand. He has not been trying many home remedies to ease the pain, other than stretching. Upon Dr. Gavankar’s entry into the room, he pressed along the patient’s palm, which was the source of the most pain. He also asked the patient to make a fist and bend his fingers in certain positions. When the patient would bend his fingers, they curved at an angle. Dr. Gavankar predicted that the patient has a flexor tendon nodule, which becomes more irritated when the patient bends his fingers (this leads to rubbing against the nodule). He also thought that the patient likely has arthritis in a joint in his ring finger. Dr. Gavankar ordered for the patient to receive an x-ray of his hand. After receiving the x-ray, Dr. Gavankar explained to me how the patient’s metatarsals in his ring finger are not symmetric, which could be the reason the finger bends at an odd angle. He also clarified that this was where the patient’s arthritis was. When Dr. Gavankar returned to the patient’s room, he reiterated the patient’s condition of a flexor tendon nodule. He also explained that the patient was in the beginning stages of trigger finger, which is a condition in which a patient’s finger locks up when they make a fist. The patient was able to make repetitive fists without his finger completely locking up; however, he sometimes experiences stiffness. Dr. Gavankar recommended the patient to ice and take a prescribed anti-inflammatory as needed. The patient should also wear a glove during lifting and should avoid excessive gripping. Before the patient left, Dr. Gavankar allowed me to feel the patient’s hand; the nodule was a very solid and obvious bump in his palm.
- 10:45am patient (34 year old male): This patient was here for an office visit, concerning pain in his right foot. He has been having paint intermittently for the last 3 months. His pain is concentrated around his heel and the back of his heel. He thinks the likely cause is from a cricket game that he played with unsupportive shoes. He has not been doing any home exercises, taking anti-inflammatories, wearing a night splint, or icing. Most of his pain occurs in the morning, but he also has a consistent “tingling” sensation throughout the day. After walking for a while, the patient’s pain wanes; however, after resting, the pain accelerates again. Mrs. Bridges explained to me that the likely has plantar fasciitis. The plantar fascia connects the heel bone to the toes and is often indicated by intensive pain in the morning. It can also be caused from a tight calf. When Dr. Gavankar entered the room, he felt along the bottom of the patient’s foot and heel, which was the source of his pain. He agreed with Mrs. Bridges that the patient has plantar fasciitis, but also ordered him to receive an x-ray to see if he also has a bone spur in his heel. Upon reviewing the x-ray, Dr. Gavankar pointed out to me where a bone spur would be located and how this patient did not have one. He recommended that the patient perform physical therapy exercises for the next month, ear silicon heel cups which help to alleviate some of the pressure on his foot, and avoid walking barefoot (especially on hard surfaces, for this causes microtears in the fascia). He also suggested the patient to take prescription-strength anti-inflammatories, but the patient was not willing to. Dr. Gavankar stressed the importance of the patient performing his home exercises, for that is the only way he will get better.
- 1:30pm patient (10 year old male): This patient was here for an office visit, regarding a check up on his shoulder. Last visit, he was diagnosed with an interior subluxation, which means that his shoulder popped out of its socket and then back in. Upon his arrival, the patient explained that he is currently pain free and came out of his sling on Monday. He also happened to be scheduled for physical therapy after his check-up. When Dr. Gavankar entered the room, he had the patient demonstrate his exercises from physical therapy. The patient then took his shirt off and Dr. Gavankar tested his movement and strength with various stretches. He recommended that the patient continues with physical therapy and has a follow-up appointment in 3 weeks, which is when he should be cleared.
- 2:15pm patient (41 year old male): This patient was here for an office visit, regarding a stitch removal. Last visit, he had two sebaceous cysts removed from his head. Mrs. Bridges explained to me that a cyst is a fluid-filled sac that can be moved around. In order to remove it, one must make a thin incision without puncturing the sac and then remove the sac completely, otherwise it will just be refilled with the liquid. Suturing then takes place to sew up the cut. The patient had two different cysts removed: one on the top of his head and one at the base of his neck. They had 2 and 3 stitches respectively. After Dr. Gavankar approved the removal, Mrs. Bridges snipped each stitch before pulling it out from beneath the patient’s skin. She explained to me that these stitches slid out easily because they were tied loose enough to be removed, but still tight enough to close the incision.
