Day 5 was back to a normal day with Dr. Bloom! Upon my arrival, Mrs. Bridges and I examined today’s patient schedule to plan which patients I could visit with. The following are some of the day’s highlights…
- 9:45am patient (40 year old male): This patient was here for an office visit, regarding a 2 week follow-up on his left clavicle fracture, which happened 4 weeks ago. As soon as he arrived, he was sent to the x-ray room, where the x-ray technician took his 3rd x-ray. In the x-ray, the bone in the clavicle was evidently protruding. Dr. Bloom later explained to me that his fracture was known as a comminuted fracture, meaning that part of the bone sticks out on top of the other. A callus then forms around the bone, which causes a small “walnut-shaped” bump. The patient detailed that he has been pain-free the past two weeks and fells like his is plateauing in his healing process. He has been doing leg training fro exercises, as well as some dumbbells and bands with his right arm. Dr. Bloom advised him to begin some aerobic exercises, such as bike riding and the elliptical, for this helps to speed up the healing process. Dr. Bloom then had the patient take his shirt off and tested his movement and strength with various exercises. The patient was pain-free throughout the examination, even when Dr. Bloom pressed along the fractured spot. Dr. Bloom explained that the patient is healing properly and that he is about 60% healed (a clavicle fracture takes about 8-10 weeks to heal). He said that the patient can start some slight arm training (exercises below the shoulder), as long as he is not loading the collar bone and that he can begin running at the 6 week mark, as long as the symptoms don’t worsen. The patient also asked if he was able to use a bar for squats instead of a belt, and Dr. Bloom assured him that this was fine, as long as the bar didn’t load the collar bone. The patient will return in 3 weeks for a follow-up appointment, and then in another 7 weeks to be cleared for contact sports.
- 11:15am patient (55 year old female): This patient came to the office for an urgent visit, concerning a follow-up on bronchitis. 8 days ago, she was seen in urgent care for her condition, where they ran a chest x-ray and blood test for her white blood cell count, and then prescribed her some cough medicine and an antibiotic. She has had bronchitis for a week and a half now. She took a week off from playing tennis but started playing again last night. She has been improving, with no pain in her sides and back when she coughs, but still has some shortness of breath (especially when she was playing tennis). She finished all of her prescribed medications and hasn’t taken the cough medicine for the last 2 days. Dr. Bloom listened to her breathing and then checked her throat, which both sounded and looked good respectively. He recommended that she take Albuterol 15-20 minutes before exercising, which will help with the shortness of breath. Dr. Bloom also said that hot and humid days will be harder on her breathing. He assured her that she is healing well and is on the “mending track.”
- 11:45am patient (11 year old male): This patient came to the office for an urgent visit, concerning arm pain. During a baseball game, he had been swinging the bat when he noticed an abrupt onset of right upper shoulder pain. He was unable to throw the rest of the game and began having difficulty moving his right arm. He did not pitch this past weekend. Upon his arrival at Dr. Bloom’s office, he rated his pain level an 8 out of 10. Dr. Bloom ordered for him to receive an x-ray and diagnosed his condition as proximal humeral epiphystitis or little leaguer’s shoulder. He will have a follow-up appointment in 2 weeks and until then, he is not allowed to do any throwing or batting. He was given some gentle range of motion exercises for the next 2 weeks.
- 1:45pm patient (46 year old female): This patient came to the office for an urgent visit, concerning a follow-up from her appointments on Tuesday and Friday due to poison ivy. Dr. Bloom prescribed her prednisone, which she began to take last Wednesday; however, she developed a rash along her neck. Dr. Gavankar then met with her on Friday, ordering her to stop taking prednisone if the poison ivy/rash continued to spread. The poison ivy spread to her hands and up her arms and the rash grew along her neck. Thus, she stopped taking prednisone on Saturday. There was a chance that she was allergic to prednisone, but this was her 4th time taking it. She did detail to Dr. Bloom how she has had more reactions to prednisone this time, including restlessness, nervousness, and lack of sleep. Dr. Bloom and Dr. Gavankar met to discuss her recovery plan. They prescribed her Medrol dosepack (a tablet) and Clobetasol ointment to be put on her neck/chest twice a day. She will be sending them a My Chart message tomorrow with an update. Mrs. Bridges also called a dermatologist to schedule the patient an appointment on Friday, if the symptoms do not improve or worsen.
- 2:15pm patient (43 year old female): This patient was here for an office visit, regarding the removal of keratosis. The patient had some sort of spot on her neck that she wanted removed. Dr. Bloom performed cryotherapy, which is a method of removal by freezing the area desired. Dr. Bloom had a styrofoam cup of “dry ice” that he applied to the patient’s skin with a Q-tip. He squeezed the area around the patient’s keratosis and gently dabbed the Q-tip repetitively. He dipped the Q-tip back into the dry ice multiple times before finishing. He explained to her that there might be some slight irritation the next few days, but it will heal on its own.
- 2:45pm patient (40 year old female): This patient came to the office for an urgent visit, concerning an acute cough. She has had the cough for the past 3-4 weeks and feels as though there is a film covering her lungs that she can’t cough up. She has been taking Mucinex the past 3 days, which Dr. Bloom was content with, since that medication helps with drainage. Her coughing is much worse at night and has led to her having trouble while sleeping; last night was the first night she could sleep normally (she raised her pillow). Dr. Bloom checked her ears, which have slight fluid in them, and then checked her throat and breathing, which both looked and sounded good respectively. He explained to me that with these conditions, it’s important to determine whether it is infectious, caused by allergies, etc. Dr. Bloom advised her to continue taking Mucinex, and he also prescribed her Robitussin with narcotics at night to sleep better. He said that if she still isn’t better by Friday or if she gains more infectious symptoms (such as a fever), then she should portal him.
