Author: naomij344

Today was the last day of my work experience. I can honestly say that I learned so much like how I think I’d like to go into orthopedics, but definitely nothing to do with feet. I have seen so many feet of all sorts of odors. It was a fragrant experience to say the least. Moreover, today was day like any other full of clinic patients. An interesting case was one dealing with the consequences of having diabetes particularly the aspect connected to neuropathy. The patient had stepped on a pin and didn’t realize and proceeded to place their feet in shoes and areas with lots of bacteria. Needless to say, they got an extremely bad infection. Dr. Logel had suggested surgery for this patient 2 years ago, but they couldn’t undergo surgery because of heart conditions they were experiencing stemming from diabetes. It’s now 2 years later and the patient decides to have the surgery except now it has spread and Dr. Logel had to basically amputate the distal bone of their 3rd metatarsal. I just thought that that case was particularly interesting. It just comes to show that keeping yourself healthy but also being completely aware of your body is extremely pivotal.

Today was a day full of surgeries. The first one was the most interesting of the four. Dr. Logel did a debridement and stem cell injection of the patient’s achilles to repair the tear. The way he did this was he took blood from the patient’s arm and placed the vile in a centrifuge which separated the hemoglobin from the plasma (containing the platelets). Dr. Logel took the plasma and injected it into the patient’s achilles hoping that it would stimulate growth and repair the torn achilles tendon. I just thought that this was extremely cool and a great demonstration of how medicine is constantly evolving. Another surgery that he did today was inserting a joint cartilage implant at the big toe. This implant was only just approved by the FDA 6 months ago, so it’s extremely new. The implant is meant as an alternative solution to arthritis in the toe joints. Most commonly, arthritis in these joints is solved by fusion of the joints which inhibits movement of that joint. With the help of this implant, it allows for space between the joints, so that arthritis isn’t a problem. Arthritis occurs when the cartilage between joints has been worn down to the point where it’s just bone on bone which is painful. The surgery consist of Dr. Logel shaving down the ends of each joint to smooth the bones and then drilling a hole to fit the implant into and placing the implant into the hole. After the implant is placed, the surgery is complete. That was definitely pretty cool to witness especially considering it has only been performed a dozen times and he’s done the surgery 7 times.

Today was definitely a slower day; we did clinic all day which means no procedures, just patients. Unfortunately, there weren’t many interesting cases that came in which I guess is a good thing. The most interesting case was one involving a kindergarten teacher who thought she just sprained her ankle. Little did she know, she broke both her tibia and fibula in three places. She was also retiring next week, so she had some concerns regarding pay roll and whatnot. Dr. Logel quite explicitly stated that she will not be going back to work considering she is now having surgery tomorrow at 7:30AM. Anyways, I know today was a little slower, but I look forward to tomorrow which is full of surgeries and no clinic.

I apologize; I couldn’t take many interesting pictures today, so here’s a picture of Dr. Logel’s work desk.

Today, I started the morning with Dr. Logel doing clinic where I learned a lot about the possible causes of neuropathy: diabetes or vitamin B12 deficiency. In the afternoon, I witnessed three surgeries. The first was the removal of the biggest splinter I’ve ever seen from a 6 year old’s foot. The second was an implant of a pseudocartilage piece inserted in the big toe joints. Lastly, I watched Dr. Logel repair the tendon that is responsible for holding up one’s fourth toe. This patient had severed their tendon from a glass vase falling on their foot. The thing that made this surgery so unique was that she woke up during the surgery and all you could hear was, “Hello?”. Immediately, the anesthesiologist responded and said, “Hey, can you take a couple deep breaths for me?”. I thought it was quite comical and the patient will probably not remember this at all. I look forward to tomorrow where we will be in clinic all day!

“Scalpel! Clamp!” – yeah; they’d don’t actually say this. Nonetheless, today was definitely one of the highlights of my WEP thus far. So, remember the patient that had trouble in paradise? Well, his surgery was the one that I had the honor of witnessing today. Dr. Logel did a complete ankle reconstruction. The best part, I sat about three feet from the patient. Anyways, Dr. Logel made three incisions: medial, lateral, and posterior of the patient’s ankle. Throughout the procedure, Dr. Logel would use wires to decide on the precise position for the screws, taking x-ray pictures throughout to see which angle was best. Thankfully, the procedure went really well and Dr. Logel didn’t need to put an external fixator to try and maintain ankle stability. An external fixator is the contraption that one might see with the pins sticking into the inflicted area and metal rods holding it in place outside of the skin. It was honestly amazing to watch how Dr. Logel took an extremely unstable ankle and was able to irrigate the debris, remove the fragmented bones, and put them back in place with the help of screws all in under an hour and a half. I am looking forward to watching more procedures on Monday!!

Today, I went with Dr. Logel at the Cary location for Raleigh Orthopedics. We had quite the case come in today. There was this patient who was on a trip to celebrate his new job that he was supposed to start on Monday. While on his trip, he slipped on a rock and fell. He went to a Caribbean hospital where instead of trying to correct his now dislocated ankle, they simply put a cast on it and gave him the okay to fly. There are two problems with this: 1. the cast restricts the ankle’s ability to swell, thus resulting in blistering and 2. flying can make the dislocation worse due to the air pressure. Both of these things occurred. When this patient came in to see Dr. Logel, his x-rays not only showed an acute dislocation of the ankle where the talus moved backwards in relation to the tibia, but the talus bone had many fragments broken off that shifted and turned. Due to these extensive injuries, he also tore many ligaments. An injury of this gravity would generally require surgery within 48 hours; however, when Dr. Logel saw the patient, it had been 5 days since the injury. We’ve got a major problem now. So, Dr. Logel scheduled him for immediate surgery tomorrow at noon which I have the pleasure of watching. During this surgery, Dr. Logel is during a complete ankle reconstruction. I am looking forward to it and will give an update tomorrow!!

Today, I went to Wake Orthopedics in Raleigh, NC by Brier Creek to shadow Dr. Mark Wood and Dr. Alan Summers. I shadowed Dr. Summers in the morning where we actually had a patient that was exaggerating the seriousness of his injury. We took extensive x-rays to figure out what the problem was including x-rays of his pelvis, back, and knees. He claimed that he had arthritis in his knees; however, arthritis can be detected on an x-ray and there were no signs of bone spurs or small space between the femur and tibia. When Dr. Summers did a pressure test to test the strength of the ligaments in the patient’s knees, it was found that he was “faking” or exaggerating the weakness of his ligaments by purposely trying to make them weaker. This is known as “cog wheeling”. It’s different than legitimate weakness because the limb will slowly and smoothly move backwards. In “cog wheeling”, your brain and what you are trying to make your body do are conflicting. Thus, the limb will twitch back and forth as opposed to moving back smoothly.

When working with Dr. Wood in the afternoon, he’s mainly a knee and shoulder specialist, so we had lots of arthritis cases that came in and injuries to the clavicle. A particularly interesting case was one that involved an ATV accident where the patient had nearly complete range of motion of his shoulder, but had a “bump” sticking out of his shoulder. We performed the x-rays and come to find out that the patient completely tore through theirtendon that attaches their clavicle to the muscles of the upper arm extremities. The patient suffered a grade 5 tear (out of 6 grades) of this tendon and yet they only came with complaints of slight discomfort. Dr. Wood informed me that these injuries up until 2 years ago would always be treated with surgery; the sooner the better. However, thanks to innovations and extensive research and records, this injury can now be treated with extensive physical therapy as long as the patient is comfortable with the bone sticking out. If discomfort persist longer than the patient can withstand, surgery can be performed. The recovery time for this injury with and without surgery stands to be the same. Evidently, it’s up to the patient on whether they want to pursue surgery or not. This just comes to show how techniques and innovations in medicine are constantly evolving to make treatments more efficient.

Today, I had the honor of working with Dr. Kevin Logel and his team: Dr. Josie, his Physician Assistant, and Shewana. I became acquainted with many things pertaining to the orthopedics of the foot and ankle. Dr. Logel showed me many X-rays ranging from broken calcaneus’ (heel bone) to arthritis of the metatarsals. The patients ages ranged from middle school to nearly centennials, and I also got the opportunity to meet a professional athlete. An interesting thing that I found was that many of the repairs that he’s done consisted of screws and, in one case, a rode being put in place. Additionally, he showed me how at the end of everyday, he must record dictations for each patient. The quality of the doctor’s dictations is dependent on the amount of insurance coverage that the patient receives. Additionally, they go down into medical records for other doctor’s to get inspiration for a different technique possibly used. One of the neatest things that I saw today were the results of an arthroscopy which is a laparoscopic surgery that goes through the joints and shaves off excess cartilage and scar tissue. Unfortunately, I could not take pictures due to patient confidentiality. Nevertheless, I look forward to working with Dr. Summers and Dr. Wood tomorrow at Wake Orthopedics.

Hey Guys!

Today is the Friday before I start my work experience and I am super excited to start working withDr. Logel at Raleigh Ortho!