My last day at Carolina Family Practice & Sports Medicine was a strong finish to my work experience! The following are some of the patients I visited with…
- 8:45am patient (74 year old female): This patient came to the office for an urgent visit, concerning right shoulder pain. About a year a go, she tired to catch her husband when he fell and has had shoulder issues ever since. She was seen in the office in August for a cortisone shot and for some physical therapy. Dr. Bloom detailed that her diagnosis is chronic irritation of her rotator cuff tendon. Upon her visit today, she explained that she has no longer been doing the physical therapy exercises and has a constant aching sensation in her should; she rates her pain a frequent 4 out of 10. She also added that when she received the last cortisone shot, she was pain free and had a free range of motion. Now, she struggles to raise her arm above her head and bend it behind her back. Dr. Bloom decided to give her another cortisone shot, upon examining her shoulder with various stretches. To administer the injection, he first applied a jelly-like substance around the area of injection on her shoulder. He then sprayed a freeze-spray atop the area before inserting the needle. The shot was injected in an upward angle into the rotator cuff from the back of the patient’s shoulder. Dr. Bloom then ordered for the patient to pick-up her physical therapy exercises again after 3 days, to give the cortisone shot time to “kick-in”; he added that she should not perform any shoulder movements above her chest for the next 3 days. Aside from her shoulder problems, the patient also complained of left elbow pain along the bone. Dr. Bloom diagnosed this as tennis elbow and prescribed her Voltaren topical cream to be applied to her elbow 3-4 times a day. She then mentioned her left-cal pain and toe numbness from standing for long periods of time. Dr. Bloom explained to her that he expected these symptoms with a patient of her health, for she has minimal strength and has not performed any physical activity. He recommended that she perform some light-impact exercises, such as going for walks, for that is the best way to improve all of her health conditions.
- 10:45am patient (57 year old female): This patient was here for an office visit, regarding a follow-up from her visit with a specialist. She was last seen in April due to bilateral hand pain. Dr. Bloom gave her a brace to wear; however, she was still not improving. Thus, she was sent to a rheumatologist to check for arthritis. Mrs. Bridges explained to me that patients with lots of joint pain are often at risk for arthritis, which is why she was referred to there. The rheumatologist took some blood tests and x-rays, recommended that the patient continue to wear a splint at night, and prescribed her a new medication. The patient was here today to review what her specialist told her and to discuss a recovery plan with Dr. Bloom. She had received no definite diagnosis from the specialist and had been prescribed a medication that she was waiting to take. Upon her arrival, Dr. Bloom determined that she likely has seronegative rheumatoid arthritis, which is the result of some type of autoimmune disease rather than heredity. Her blood tests hadn’t shown any concerns, but her x-rays and symptoms did. He explained that the first step in the recovery process is anti-inflammatories, which are solely used to control the symptoms (they don’t “heal” her joints). The next step is to take disease modifying agents, which are used to slow the progression of her disease. Dr. Bloom recommended that the patient does indeed take the medication the rheumatologist prescribed, Plaquenil, for it is the simplest and most inexpensive agent. He also recommended that she continue to wear her splints. He said the last step would be biological agents, such as injections, which are incredibly effective. Dr. Bloom also declared that the patient has carpal tunnel syndrome, as demonstrated by her full-hand numbness.
- 11:45am patient (45 year old male): This patient came to the office for an urgent visit, concerning right elbow pain. About 6 weeks ago, he feel off a deck into a boat, landing on his elbow. Aside from the obvious pain he felt, there was also some purple bruising, slight inflammation, and tingling sensation from the elbow down. Upon his arrival, Dr. Bloom felt around the patient’s elbow, where he found a small bump. Dr. Bloom diagnosed the patient with ruptured bursa, which is a fluid-filled sac located between a bone and tendon. He said that the pain and tenderness will last indefinitely and his right elbow will always be asymmetric; however, the pain will lessen over time. He offered to prescribe the patient Prednisone to deal with the pain, but the patient said he was really fine, with a pain level of 2/3 out of 10.
- 1:15pm patient (73 year old female): This patient came to the office for an urgent visit, concerning a swollen left hand/wrist. Dr. Bloom felt around the swollen area, to which she she said was pain free. She also stated that the bump started more on the outside of her hand and then spread inward. Dr. Bloom diagnosed her condition as a large ganglion cyst. He said that she could have the cyst drained, but there is no need to if it is not causing any problems. Thus, he wrapped a 2inch wide ace bandage around the hand for compression and advised her to wear it for the next week. Dr. Bloom then said if there are any problems that arise, then the cyst can be drained at the next visit.
- 3:00pm patient (16 year old male): This patient came to the office for an urgent visit, concerning left ear pain. His pain started about a week ago, which was when he started swimming. He went to the minute-clinic 2 days ago and was prescribed amoxicillin; however, his pain is even worse today. The patient has pain even when he just touches his ear. Dr. Bloom diagnosed him with Swimmer’s ear, which is an external ear infection. He prescribed him ear drops: one drop should be put in the infected ear while the head is tilted sideways (allow the drop to be absorbed). Dr. Bloom said he should start to feel better within the next 48 hours. The patient’s dad asked how he could prevent this in the future, and Dr. Bloom answered with getting special drops to put in his ears before he goes swimming (the cause is water settling in the ear).
