Day 6 was off to a late start, for I didn’t have to come into the office until 10:45am; there was an off-campus faculty meeting in the morning. Upon my arrival, the day went as usual, with the following patient visits…
- Follow-up on the 46 year old female from yesterday: This patient, who was seen in the office a couple of times in the past week due to poison ivy and likely an allergic reaction to prednisone, portaled Dr. Bloom this morning with an update concerning her condition. Yesterday, Dr. Bloom had prescribed her Medrol dosepack (tablet) and Clobestasol ointment to be put on her neck twice a day. This morning, she messaged him with an update saying that she has seen some slight improvement from yesterday. A couple of new poison ivy spots have formed; however, they are not blistering. She also said that her old spots are becoming darker and disappearing, which Mrs. Bridges confirmed as healing.
- 11:45am patient (45 year old female): This patient came to the office for an urgent visit, concerning eye pressure/pain. She was last seen in the office at the end of May for a physical, where she had some abnormal thyroid labs (blood test). Thus, she was referred to an endocrinologist, who found a nodule on her thyroid. Today, she came to the office regarding pressure behind her eyes and “enlarged lymph nodes.” She explained to Dr. Bloom that she feels pressure behind her eyes during yoga, specifically the downward dog pose or other positions where she is upside-down (blood rushes to her head). The pressure was initially just behind her right eye, but it moved towards the center. She feels no pressure when she is standing up-right or during any other times. Dr. Bloom went through a neurological exam with her, checking her coordination and balance and then feeling around her lymph nodes in her neck and armpit. He assured her that everything looks normal. The patient questioned about her enlarged lymph nodes, to which Dr. Bloom said were actually normal. She also mentioned that her ophthalmologist thought the eye pressure could be from her vision, which is strained in her right eye. Dr. Bloom agreed with this possibility and ordered the patient to wear her new prescribed glasses. He also said that if symptoms worsen, then keep him updated. He added that the patient is likely noticing a bunch of small tweaks in her body that usually go unnoticed, which means there is nothing to worry about.
- 2:15pm patient (36 year old male): This patient was here for an office visit, regarding trigger point injections. He was in a car accident in December, in which a car rear-ended him at a stop sign. He has been doing physical therapy since then and has been receiving dry needling for the past 2 months. Dr. Bloom assessed his pain by pressing on various areas in his back and testing his motion and strength. The patient’s pain is centered all around both of his shoulder blades. Dr. Bloom then gave him 5 trigger point injections. He explained to me that the injections work by stimulating a flare up (cells flood to the area of injection), which then leads to pain relief. The needle and injection themselves are not what cause relief, but rather the rush of cells to the area. Dr. Bloom cleaned the patient’s back thoroughly with alcohol pads. He then sprayed a freezing liquid on the area of injection. Dr. Bloom inserted the needle into the trigger point and moved it around 360 degrees, slowly injecting some of the Marcaine. Dr. Bloom repeated this process 4 more times, after feeling which spots were the source of the most pain. Some spots began to bleed after the injection, so Dr. Bloom massaged the area before covering it with a band aid. He recommended that the patient really focus on good posture for the next few weeks, perform aerobic exercises to raise his heart rate, and practice his high yield physical therapy exercises. Dr. Bloom also said for the patient to portal him at the end of a month with an update on his pain.
- 3:00pm patient (47 year old female): This patient came to the office for an urgent visit, concerning a wrist fracture. She had slipped on some rocks by a creek and hit her hand when she landed. Dr. Bloom ordered for her to have a short-arm, water proof cast for the next 10 days. In 10 days, she will then be switched to a plaster cast. To make the cast, first a layer of soft material was put along 2/3 of the patient’s forearm. Ms. Kristen explained how you should make it half an inch too long on each end for it to be folded over. A sticky layer then covered the cushioned material, followed by 2 more wet layers. The final layer was black, as requested by the patient. Dr. Bloom noted to Ms. Kristen that in the future, a short-arm cast is actually slightly longer (just below the elbow), but that this cast will work this time. The patient’s recovery will take about 6 weeks in total.
During my lunch break, I was able to have a mini-interview with Dr. Bloom to learn about his process of becoming a Primary Care Doctor…
- He attended Dartmouth University for his undergraduate degree and was a history major
- At Dartmouth, he studied abroad in Kenya for 4 months
- He took the MCAT his senior year and applied to multiple medical schools
- He attended Tulane University for medical school
- He explained to me that the process was 4 and 4: 4 years of actual schooling and then 4 years of residency (Dr. Bloom did 3 years of family practioning and 1 year of sports medicine)
- He has been working at the Carolina Family Practice & Sports Medicine for 15 years now