19DorritE – CA Work Experience Program

WEP Raleigh Ortho Cary Clinic – Day 8

Today was unfortunately my last day of the Work Experience Program, but it was one of my favorites. It was just a regular day in the Cary Clinic with Dr. Logel, but it was my first day that Dr. Logel had me really help out with the patients. Dr. Logel’s PA had recently moved, so I acted as a bit of his assistant today!

The main thing that I did today was help with cortisone injections. Cortisone injections are steroids that are injected into a joint to help decrease inflammation and pain. However, these injections can be very painful, so it was my task to spray the injection area with numbing spray before Dr. Logel injected the patient. The first patient that I saw, a dancer with the Washington Ballet Company, said that I did such a good job with the numbing spray that she didn’t even feel the needle going into her skin! Luckily, Dr. Logel was pleased with my spraying skills and let me help out with two more patients! This was an unusual amount of cortisone injections in one day at the clinic, but I am very glad they all came in today, so I could get some hands-on experience!

The second thing that I helped out with today was with a patient who had back surgery that caused her to have drop foot and minimal sensation in her foot. This means that she wasn’t able to lift her foot and couldn’t feel much in her foot. Because of this, she easily twisted her ankle on stairs and broke big sections off of her bone. Dr. Logel knew he needed to do surgery, but based on her x-rays, you could see big blisters on the side of her ankle, so he wouldn’t be able to do the procedure. He took the splint off her leg, and her whole foot and ankle were swollen, badly bruised, and full of big, bloody blisters (and I’m talking multiple inches wide and long blisters). I got to watch Dr. Logel drain all of the blood out of her legs which was really gross, but cool to watch. Then I helped with the rewrapping process; I unwrapped all of the padding and bandages for Dr. Logel so things would run more smoothly, and even though I wasn’t doing much, I felt like I was really apart of the patient’s case, rather than just watching it.

Overall, the Work Experience Program was a great way for me to see what I am and am not interested in and I learned so much more than I expected!

WEP Orthopedic Surgery – Day 7

Today was a great day in the OR! I was back in the Raleigh Orthopedic Surgery Center and saw 5 surgeries today: a tendon repair using an artificial tendon, an ankle fusion, a broken ankle, multiple toe realignments, and a tendon cleanup.

One of the most interesting things that I saw today was arthroscopy being used twice in two different surgeries. Arthroscopy is where a probe with a camera is used and inserted into the body, so the surgeon can see what he/she is working on without having to make a big incision. Dr. Logel used arthroscopy today in the ankle joints of both patients. They both had had past injuries which caused debris, also known as scar tissue, cartilage, etc., to form in between the two bones. This causes inflammation of the joint and the patients feel pain. To get rid of this debris, Dr. Logel made two very small incisions on the joint and put the camera probe in on one side and a vibrating tool in the other. He would use the camera screen to see where his tool was and would cut away at all of the debris. He said arthroscopy was the doctor’s videogame, and he was pretty good at it! I enjoyed this part of surgery because I could fully see what was going on during the surgery, rather than just seeing from farther away.

Another cool thing that I saw today was a patient whos ankle joint had no cartilage in it between the two bones that she had minimal motion of the ankle and lots of pain as the bones were constantly rubbing together. The surgery that was done for this patient was to fuse the two ankle bones together. This was done by removing any debris from the joint, breaking a bit of bone here and there to simulate a bone break (the bone heals faster if it is broken), and then putting 4 screws in to the two bones to lock it together. Dr. Logel explained how the patient would still have some ankle motion from side to side but the ankle wouldn’t be able to move up and down. However, this was only a little less movement than she had already been dealing with, just without the pain.

Lastly, another thing that I thought was very interesting was the way that Dr. Logel fixed a broken ankle. This patient had broken his ankle 3 weeks prior and it had already started forming bone callus, but it wasn’t aligned correctly. This said, Dr. Logel went into the ankle and basically rebroke the ankle, taking out all of the newly formed bone callus and anything that was holding the bone sections together. He then used a tight clamp and an x-ray called the “C Arm” to make sure that the bones were lined up correctly and then he drilled a 7 screw plate into his ankle, securing the bones from separating.

Overall, I am very appreciative and grateful that I was given the opportunity to go into the OR with Dr. Logel and see about 10 surgeries! Everyone in the OR was very friendly, welcoming, and eager that someone was interested in their field! I learned so much more than I ever could have just in clinic and it was great to actually see things being fixed in person!

The staff lounge room – had to have some caffeine because surgery makes you tired!

All the rooms use x-rays, so you have to wear lead dresses and neck protectors (how cute!)

WEP Raleigh Ortho – Day 6

Today I was back in the Raleigh Orthopedics Clinic with Dr. Logel and it was nice to be back to something I was familiar with. I saw some of the same cases as I had seen previously and some new ones, but the ones that were the most interesting to me were a crushed foot, a huge ganglion cyst, and a stress reaction.

First off, the crushed foot was very interesting because the patient’s foot got completely crushed in a work accident and it was so bad that his skin surrounding the area blistered and scabbed over. Because of this, Dr. Logel could not perform surgery on his as the incisions would have to be over the blisters, which would cause infections. This left the patient to have to be fine with having his body heal his crushed bones by itself. Today when I saw him, he was just about to move out of his boot and after seeing his x-rays, it was crazy to see how the body is able to function, although parts of it is broken. He was nowhere near healed completely, but his body was able to build enough bone callus around the broken bones that he could put weight on it.

The next patient that I found very interesting was a patient who had had a huge ganglion cyst on the posterior side of his foot for years. A ganglion cyst is a noncancerous lump on the ankle or wrist that is filled with jellylike fluid and usually is caused by an injury to a tendon or joint. I wasn’t able to see his cyst in person, but based on the x-ray and CT scan, you could tell that his cyst was around 2-2.5 inches big. When I saw him today, he had just gotten his cast off from surgery and it was cool to hear Dr. Logel explain what he did in surgery; he removed the cyst, but since the skin was so stretched out, he had to take out wedges of the skin, so it would lay flat again. This was a really cool case as I have never seen anything like it; however, it did remind me how gross the feet and casts can be as it smelled very unpleasant in the room.

Lastly, one of the other cases that I enjoyed to see was not a very rare case like the others, but it was a patient that was very similar to me. This patient was very active everyday and was still exercising and dancing, even though her foot had been hurting her. This was also an interesting case because the x-rays didn’t show any complete breaks, but all of her symptoms lined up to be a stress reaction. This is basically the intermediate stage between a healthy bone and a stress fracture, where you can’t see the break on an x-ray because it is so faint, but it is making it’s way through the bone. Dr. Logel ended up giving her a boot to where at all times to be cautious of a stress fracture. She was pretty reluctant to wearing the boot all day and not being able to exercise which would be pretty similar to how I would react if I was in her situation. However, this case showed me that if I ever get injured, I need to follow what the doctor says or else I am going to end up needing surgery or something worse.

Overall, it was a very busy and fun day and I’m excited to see some more surgery tomorrow!

Foot model and anatomy terms used with patients

WEP Hand Center and Physical Therapy – Day 5

Today was my last day working with the Hand to Shoulder Center and Cary Athlete’s Performance Center. Both were kind of slow days at these two locations, but there were a few things that I took out of each. Firstly, the coolest thing that I saw today at the Hand to Shoulder Center was a patient with trigger finger. This is like the opposite of Duputryen’s Disease, where you aren’t able to bend your fingers down, as they lock up. We saw a patient who didn’t have severe trigger finger, but it was bad enough to do treatment right there. Dr. Messer injected a cortisone shot into the patients hand and right away, you could see how the finger was loosening up. The patient was able to bend his finger further down to his palm. I did get to see what happens when the finger “triggers” and becomes locked in a bent position. Then, the coolest things that I saw at Cary Athlete’s Performance Center was that there were quite a few new patients who hadn’t been in yet and were getting everything checked. It was cool to see how they measure the angle of every joint to see what needs to be loosened and what is concerning. Another interesting thing that I saw today was two different types of dry-needling. There was the type that I saw on Friday where one needle is placed into the sore area and moved up and down and the other one was multiple needles in various spots of the sore area. I asked Mr. Meszler what the different purposes are and he told me that the one needle is for a specific muscle and is used to get deeper down in the muscle and the second with multiple needles is for a tendon where multiple spots of the tendon hurt. Overall, I was very grateful for this experience to shadow two new people and I learned a lot!

WEP Hand Clinic and Physical Therapy – Day 4

Today I had an even newer experience as I wasn’t with Dr. Logel. I started my day off at the Raleigh Hand to Shoulder Clinic with Dr. Messer. He has been doing hand and upper extremity surgeries for years and was a great teacher today, explaining to me before and after each patient he saw. There happened to be a big theme today in the hand clinic and according to Dr. Messer, it was very uncommon to see so many Dupuytren’s disease cases in one day. Dupuytren’s disease is where the “cords” under the skin become thick and tight over time and cause the fingers to curl downward into the palm of the hand. It was cool how today played out because I started the day by seeing a few patients who had come in for other issues, but Dr. Messer had me feel their thickening cords that weren’t bothering them. I then saw a patient who recently had shots injected into her hand, a treatment for Dupuytren’s disease, and was back for a check up. Without even seeing her before pictures, it was crazy to see how straight her fingers were able to get. However, I was still very interested in seeing how bad Dupuytren’s disease could get, and lucky enough, an elderly man came in as he had a cyst on his nail bed, but happened to also have severe Dupuytren’s disease on his other hand. I was shocked to see how deformed the fingers really could get and their lack of mobility, yet the patient was used to it. I saw some other patients with broken bones or arthritis, but Dupuytren’s disease was definitely a common theme.

Around noon, I left the hand clinic and went to Cary Athletes Performance Center with Mr. Meszler. He works with Raleigh Ortho as their sports therapist and does a lot of their physical therapy work. I got to observe all of their therapists there and saw a variety of different cases. This was very interesting because I could watch the patient through the whole process of getting dry needling, to laser treatment, to their exercises. One of the main therapists that I stuck around was Damion who was from Ireland and he would also explain to me what the purpose of each machine was and would even let me test out some of the exercise machines and stretches. Although I didn’t see as many patients as this morning, I still learned a lot and it was a great experience!

WEP Raleigh Ortho – Day 3

Today I was back in the clinic, but in a new office! It was just Dr. Logel in the office today, so things ran much smoother. I was there from 8 to 4:30 and probably saw close to 40 patients. My favorite thing that I saw today was a patient that came in who said that her third toe was constantly numb. This is called neuropathy, where a nerve in between the toes is swollen and causes the toe to go numb. The cure to neuropathy is to surgically remove the nerve in between the toes, but this patient was not to the point of wanting the surgery. However, later in the day, another patient came in who had actually recently had this nerve removal surgery, so I got to see the effects of it. With this surgery, your toe is permanently numb, but any pain that was there is gone, as you can’t feel anything. She was saying how it felt as if she was walking on rocks though, as she had just recently had the surgery and some of the branching nerves were still confused as to where their main nerve went. On the topic of numbness, a rare case came in where the patients whole foot has been numb for 7 years since he had a ruptured achilles’ tendon repair in 2012. Dr. Logel was bewildered by this case as there was no definitive answer to his problems and the only thing to do was just live with it. Besides having abnormally numb patients today, I also saw many broken ankles, hurt achilles’ tendons, and even two casts. It was cool to stay and see the whole day with Dr. Logel and I was able to start and put bits and pieces of my knowledge together!

WEP Raleigh Ortho Surgery OR – Day 2

What an experience! Today I started my day bright and early at 7 AM in the Surgery center of the Raleigh Orthopedic Clinic. I scrubbed in and was on my way to the first surgery! All of the nurses were so nice and helpful, showing me the ins and outs of the OR from how to put on your mask to what you can and can’t touch. Everything in the operating room is very sterile, so I had to make sure that I was far enough away from contaminating anything.

The first surgery was an accessory bone removal in the top of the foot. I expected to feel nauseous or queasy observing the surgery, but I surprised my self and felt fine! During this surgery, Dr. Logel walked me through the steps he was taking, including how he almost chipped away at the bone until it popped out. He had to make sure that he didn’t cut into or break any ligaments or veins, so he was very cautious of where he was working. It was cool to see the bone on the table after the surgery and to understand how such a small bone could be causing such tremendous pain.

The second surgery that I saw today was a patient who fell and broke her ankle. Dr. Logel showed me the x-rays and you could not only see the crack in the bone, but you could also see how the tendon in between the bones was moved and caused the tibia and fibula to be separated. During this surgery, Dr. Logel drilled plates and screws into the bone to fix the crack and then used what they call “tight rope” to pull the two bones together over the tendon. The tight rope was basically a very small, but strong string that was anchored into the sides of the bone and pulled very tightly together. The operating room uses a portable x-ray machine during the surgery which was very interesting to watch because Dr. Logel would use it to make sure his drill or screws were in the right spot of the bone where he couldn’t see.

The next surgery that we went to was a patient who had very bad arthritis in the 1-2 tarsal- metatarsal joints due to an injury a few years earlier. The procedure that Dr. Logel did on this patient was a joint fusion, which is where they fuse the two bones together, so there isn’t a joint anymore. This was on the top of the foot, so the skin was very thin and there were a lot of little veins that Dr. Logel had to work around. The procedure for this surgery was to clean out the joints of any excess cartilage and chip off any excess bone so they two bones could come together evenly. It was interesting to watch this part of the surgery because I didn’t know that bone was so easily chipped away with certain tools. After Dr. Logel cleaned out the joints, he put 5 screws into the top and sides of the foot to hold the bones together, so they could start growing together. This is what happens when a bone is broken; the bone realizes there’s a crack and starts to reform bone.

The last surgery of the day was by far my favorite surgery. This patient had ruptured his Achilles tendon and this surgery was to repair it. Before the surgery, Dr. Logel showed me how you can tell if the Achilles is torn by the alignment of the foot neutrally and if you press on the calf, if the toes move. It was interesting to see the difference between this patient’s normal and ruptured tendons. The procedure of this surgery was to take out the frayed and ruptured parts of the tendons, and then finding the other two sides of the tendon and connecting them together. This was done by putting many stiches into each side with thick string and then yanking on both sides of the tendon to pull them together. It was so fascinating to see how you can still use what is left of your tendon to fill in the missing spots. Dr. Logel then used disintegrating stiches to hold the new tendon together, allowing the tendon to grow and reform over the stiches. Shockingly, this was the fastest surgery and only took a few minutes to do the actual procedure.

Overall, I had a very busy but fascinating day in the operating room and it was crazy to see the life behind the clinic!

WEP Raleigh Ortho – Day 1

Today was my first day at the Raleigh Orthopedic Clinic and overall it was a very interesting experience! In total, I saw about 20 cases with Dr. Logel ranging from torn or sore Achilles tendons to crushed ankles to crooked toes. I think one of the most interesting cases that I saw today was a case where the patients ankle was crushed between pipes and was left with little to no mobility. He came into the clinic today for a checkup, but ended up needing his caseworker to come in and help get a note proving that he was immobile and needed to find a new job. It was interesting to learn that there are programs that help you find a new job when you are permanently injured, and help train you quickly. Another interesting case that I enjoyed to see was a patient that had a “reverse bunion”, so instead of her toes being forced inwards, they were all forced outwards. She had a realignment surgery that straightened her big toe and shaved off bone of her other toes so they would lay evenly. I had never really thought about realigning your toes, but it was interesting to see how it was done, the x-rays of before and after, and the recovery process as she had recently had the surgery. Lastly, I dove right into the real world of office life today as we had one patient who was very frustrated that she had to wait for her appointment and proceeded to yell at Dr. Logel, saying how disrespectful it was that he made her wait and that her ankle wasn’t in any pain anymore. I had forgotten that there are some very interesting and rude people in the world and it was great to see the way Dr. Logel handled the situation. Overall, it was a very informational and interesting experience and I’m excited to put the material I have learned today into surgery tomorrow!

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