Medicine – Page 15 – CA Work Experience Program

Day 2- Contraceptive Commotion

Today, three of our four meetings consisted of members from the Contraceptive Technology Innovation Department- meaning we learned about devices, hormones, and bodily functions we never knew existed. In order to fully appreciate the work of this group, we needed to learn the basics of all forms of contraception on the market and of their purposes, pros, and cons. With Ms. Sergison, we discussed female and male anatomy and contraception basics, with Dr. Dorflinger we learned about more details and differences in contraception, and finally with Dr. Callahan reviewed her latest project- a dissolving contraceptive micro-needle patch. Partnering with Georgia Tech, she and other colleagues are collaborating on this project to make a new and improved form of non-intrusive contraception using progestin, estrogen, and micro-needles. With these elements, this contraceptive is painless, fast, discreet, and disposable. Once placed on the patient’s skin, the small needles are inserted and are released painlessly into the patient’s blood stream delivering the hormones. Next, the patient can remove the patch and dispose of its remains. While also discussing her research in other countries for this project, she also introduced us to another of NHI’s projects- a biodegradable contraceptive implant. With this implant, the hormones could be released through a patient’s arm over the course of a few years and then would dissolve, requiring no treatment after insertion. These medical advances are fascinating! However, the highlight of my day was watching the baseball game from the cafeteria balcony.

A shelf with many forms of contraception within the office.

The baseball game today!

Day 2 – WakeMed Hospital

Today I watched two open heart surgeries. The first one was a less invasive valve replacement. I was able to watched two hours of it. I learned about the different possibilities for open heart surgeries, ways, and reasons to do a more or less invasive procedure. The second one was a triple bypass surgery. The doctor took an artery from the leg and used it to go around the blockage. I was able to watch four hours of this surgery.

Day 2- TLC in Pediatrics

The photo above depicts an artwork piece in the office. Many kids like to find the hidden creatures in the pictures while they walk to their room.

Babies galore seems to be a common thing at Carolina Kids Pediatrics. Most children come for a visit during the first few days of their life, at 2-3 weeks old, then around 4 or 6 months, then a year, 18 months and 24 months. Thus, a lot of young children pass through since they need more wellness visits. I also met a number of four year olds with bellyaches, coughs, fevers, and rashes. Some of today’s illnesses included ear infections, persistent bumps, and back pain.

Despite learning the ropes, i am still surprised and sad to hear kids wailing in the room next to me. Dr. Willey does an amazing job calming down her patients when they’re being treated. However, I’ve learned that preventing a toddler or newborn from crying can be an impossible task. The battle continues when the patients receive shots. Nonetheless, Dr. Willey’s calm nature proves effective in establishing a safe environment for the kids.

Dr. Willey uses a wide variety of techniques to calm her patients. Before interacting with any newborn, she strokes their head and establishes a calm, comfortable setting. For 18 month old patients, she typically hands them a cup within a cup to distract their hands. For the quieter patients, she simply gives them a light bounce in her arms before listening to their heart and lungs. For older kids, she begins by asking them about school and what they like. Therefore, she uses both physical and emotional connections to calm her patients before beginning her examination. I can tell she is comfortable with her patients. She remembers all of their information even if she hasn’t seen a patient in over a year.

Overall, today was wonderful. Dr. Willey inspires me with her calm, nurturing approach to medicine. She told me today that her residency program promoted a wholistic approach to medicine, meaning they should focus on the patient as a whole person with physical and emotional needs. I see this in each of her visits as she takes the time to understand each patient beyond their medical needs. I can’t wait to learn more about pediatrics from such a caring, knowledgable doctor!

Fun Facts:
– Swimmers ear comes during the summer as the water gets hot and bacteria begins to ‘fester’.
– Babies first see bright, bold colors. They cannot see pastel colors until later in life.
– At four months old, it is difficult for babies to sweat. This puts them at risk for overheating.
– Sometimes drooling can be due to a sore throat rather than incoming teeth.
– Arms can become sore with a cold as lymph nodes become swollen.
– Nitrates in your urine can indicate infections and bacteria.
– Line 5 is never used on the phone system in the office. I don’t know why.

Day 2- (Excel)-ing in my Field

Today was a day devoted strictly to working on my project. In the morning, I worked in an office space to continue compiling the final data for my project in Microsoft Excel. I spent all morning sorting through each patient’s operative report to determine age, gender, graft type, months since surgery, and the femoral fixations. For some patients, I additionally noted if they had a meniscus repair or a microfracture as these affect data. In total, I sorted through approximately 150 reports. The next step in the project is to begin an analysis of the sorted data. Based on the results, I will find averages and find trends and sort the data based on it.

To continue to the research, I will be calling each patient to discuss whether their surgery was a success or a failure, depending on whether or not they needed a revision surgery. A lot of work is still impending, but the data shall be interesting to see when it’s all said and done!

Day 1: A Busy Day

My experience with the Fuquay-Varina Pediatrics office didn’t start on May 29th, but instead in the weeks leading up to it in which I completed close to two hours of HIPPA training. Of course, I passed with streaming colors, all 100s after my third and fourth attempts at the test, but I am incredibly educated in the Health Insurance Portability Act. This specifically surrounded around information that I could and could not know and share, specifically with personal patient information. After handing my two certificates in this morning to the clinical manager, we were off to the races with a number of costumers lining up for the walk-in clinic appointments starting at 8 am. Of course, with already close to 14 people signed up for these morning appointments (8-10), Dr. Dupuy could not accomplish this on his own. Instead, a physicians assistant student from Campbell was there to assist, Morgan. We all entered each room to be faced with a different kid with a different problem, whether a viral infection, a simple wellness check, developmental problems, or bacterial infections. I was immediately blown away with the sophistication and importance of Dr. Dupuy social attitude, whether tickling the toddlers that were crying or comforting a new mother. Although it was the cause of us getting behind schedule, Dr. Dupuy didn’t hesitate to be incredibly thorough with each patient, not only supplying patients with medication, but really helping them understand why each pill was going to be used for their child. As one mother quoted “I learned more from you in these thirty minutes than I have in our five months at Duke hospital”. With this particular five month old premature baby post open heart surgery, Dr. Dupuy took exceptional patience to answer each of the mothers questions with incredible truthfulness while providing a blanket of comfort. His patience, thoughtfulness, and true care for each patient was very memorable. Yet, this attitude shown because he was really passionate about each of his patients and what he did. I asked him why he choose pediatrics specifically and he responded with “I couldn’t resist these kiddos”. He cares about the welling of each of his patients and that shows through his work and care with the thirty costumers we saw today.

Most of his patients were toddlers or newborns, and only a few ranged into the adolescent or teen ages. However, one of the most memorable cases that we looked at today was with a middle schooler who had second degree sun burns. His skin had huge blisters filled with yellow pus, and his skin was completely red. Morgan, the physicians assistant, took charge with his two year background in dermatology, and we brainstormed how to bandage the wounds without using adhesive tape. Another memorable case was a kid who came in with an incredible itchy and painful rash, which happened to be hot tub folliculitis. Morgan educated Dr. Dupuy and I on this disease caused by hot tubs, and I eventually decided that I will never go into a hot tub again.

With a very busy day, and numerous patients to see, I was always entertained and always learning something new. Of course we saw many different diseases and problems in kids but I was able to observe the preparation of a strep sample, a hemoglobin test, a vaccine shot, and I was even able to listen to a baby’s heart. I learned so much today, and am so excited for these next few days!

Image result for fuquay varina pediatrics

The office

Day One- Babies Galore

Today I began my work experience at Carolina Kids Pediatrics. The day started at 8:30 AM when I arrived at the office. Dr. Emmet introduced me to the nurses and a few of the other doctors, and she also took me through the office to look at the conference room where we eat lunch and where I can put my lunch beforehand. The office features a carefully designed layout where patients naturally walk through a hallway that leads them to a curved room with the 15 doors leading to various exam rooms and bathrooms. A large, semi-circular desk stands in the middle of the curved room. The area consists of desks for each nurse and doctor, an island to prepare vaccines, and a fridge that holds the vaccines. The layout of the office proved conducive to effective work.

Throughout the day, I saw patients from all walks of life. I think it’s safe to say that pediatricians take care of children from their time in the womb until they are 21 years of age. I learned that due to the wide array of patients, pediatricians need to know a lot about kids! It seems obvious, but the most important information I took from today was that knowledge of children includes not only medical information, but also behavioral and emotional tendencies. Spending time with an 18-month-old boy makes for a completely different visit than one with an eight-year-old girl. Also, a pediatrician tailors the visit to the number of family members in the exam room and the child’s typical behaviors. For the rambunctious, four child check-up group, Dr. Willey moves right into physical examinations. After examining one child, she talks with the general group of kids for a few moments before moving on to the next patient. Throughout the visit, however, she will converse with the child about their life at home while fielding questions from parents. Then, once the patients are all checked out, she will sit down and speak with the parent. However, for the visits with younger, shyer kids, Dr. Willey will begin in a seated position while she speaks to the parents and the patient about life at home, their eating habits, their favorite activities, recent illnesses, and, everyone’s favorite, their bowel movements. After connecting with her patients for a few minutes, Dr. Willey will perform her examination. The visit usually lasts about 20 minutes, seeing as Dr. Willey likes to converse with her patients and spend time getting to know them. I learned throughout the day that she connects with her patients while working efficiently, ensuring that she maximizes her time with each patient. She exercises immense care and empathy with each patient, making it obvious why so many families in the area choose to see her.

Overall, we saw a lot of younger children today. Some frequent conversations included rashes, (most commonly the hand, foot, and mouth virus), car-seats, persistent coughs, fevers, and again, bowel movements. Dr. Willey also painted some fluoride onto the teeth of younger patients since children don’t see their dentist until they are two or three years old. On the whole, today was the best first day I could’ve had. I learned numerous fun facts about kids and got to witness a wonderful doctor at work. I can’t wait for the next few days with Dr. Willey!

Fun Facts:

You can lose a nail without it every growing back. It’s not necessarily a bad thing, seeing as many people have survived without a nail on their nailbed!
Your red blood cell count is typically higher than your white blood cell count.
Pink eye drainage consists of white blood cells, bacteria, and “sleep”
An adult takes an average of 18 breaths per minute while newborns can take more than 40 breaths per minute.
The inside of an infected ear appears peach colored with puss.
Two week old babies sometimes sleep with their eyes open.

Day 1 – WakeMed Hospital

On my first day, I saw three heart procedures. The first was a surgery dealing with a pacemaker and a defibrillator. During the procedure, Dr. Hamrick added a third lead to the pace maker. During this, I learned about improvements that are being made to pacemakers. Below is a picture of the beginning of nanotechnology being used for hearth surgery and pacemakers. The second and third procedures were both A TAVR. This was a value replacement via a catheter coming in from the femoral artery.

Day 1 – Welcome to Dr. Bloom’s Pod!

Upon my arrival at 8:30am, I was greeted by Mrs. Megan Bridges, Dr. Bloom’s assistant who I will be paired with for the next two weeks. We sat down in an empty patient room to discuss the logistics of the workplace. She showed me the “in basket,” which is a portal she uses to help schedule appointments with patients through a messaging system. Mrs. Bridges then gave me a tour of the clinic, where I was introduced to various doctors and assistants and also examined the most important rooms, such as where orthotics are made and the x-ray room. She then led me to her desk, where a seat had been added for me to accompany her. Mrs. Bridges showed me Dr. Bloom’s schedule, which consisted of 26 patients throughout the day, either every 15 minutes or every 30 minutes. I also signed a Duke Confidentiality agreement, which ensures that I will not reveal any patient information. From there, the day officially began.

Over the course of the 7-hour day, Mrs. Bridges entertained me with a variety of random facts, including the following…

Dr. Bloom sees about 25-27 patients each day
The morning sessions usually consist of labs and physicals, while the afternoon session are the more specified appointments
Each doctor has a pod of 3 rooms that rotate out throughout the day
This week has about 5,000 patients in total visiting
June is one of the slowest months for appointments
She received her Masters in Athletic Training
There is a high demand for athletic trainers at the office
Dr. Bloom is fluent in Spanish, which helps ease the language barrier, for he sees lots of Hispanic patients
For any skin checks, she has to be present in the room to “chaperone” because Dr. Bloom is a male doctor
Dr. Bloom has a template for all of his doctor’s notes that consist of 4 main categories: Subjective, Objective, Assessment, Plan (SOAP)
An appointment that is classified as URGENT/ACUTE is one that is a same-day appointment
An OFFICE VISIT is a follow-up appointment, a med management appointment, an appointment scheduled in advance, etc.

My favorite parts throughout the day were the specific appointments that I was able to sit in on. These include the following…

9:00am patient: I watched Mrs. Bridges administer a tetanus and pneumonia shot. After cleaning the area of injection with an alcohol pad and squeezing the skin of the arm, she quickly injected both needles and then covered them with a small band aid.
10:00am patient (72 year old female for a physical): I watched Mrs. Bridges check her vitals and review her medications. Her blood pressure was 112 over 62 and her pulse was 70bpm. Mrs. Bridges then went over her medications, which consisted of Zyrtec, astepro nasal spray, Flonase, metformin, Citrucel, multivitamin, and more. The patient needed a refill of her Valtrex, which she takes to heal the blisters that form on her hands after the cancer she had.
11:15am patient (29 year old male): I watched Ms. Grace, another one of Dr. Bloom’s assistant administer an EKG. The patient was there due to fatigue and chest pain, which was why he was getting his heart monitored. There were multiple stickers placed on the body, which corresponded with a diagram on the EKG machine. There were then wires hooked up to each stick that connected to the machine. Ms. Grace then hit “record” and printed out the patient’s heart monitor; his heart rate was 62bpm. Dr. Bloom diagnosed his condition as an unclear etiology, meaning that he is unsure of the diagnosis and will be running more tests to figure it out.
2:00pm patient (55 year old male): I watched Ms. Grace prepare a cortisone injection in the ratio of 6:1 for the substances mixed (clear and then cloudy). She used a large needle to gather the substances into one tube and then switched to a smaller needle when injecting the patient. The cortisone shot was administered for a joint in the patient’s right shoulder that was in a lot of pain. The patient also received some shoulder exercises.
2:15pm patient (13 year old male): I examined the x-rays of the patient, whose appointment was a follow-up on the fracture of his right humorous 3 weeks ago. During the x-ray, the specialist only scanned his right (injured) shoulder, for both shoulders were too broad to fit in the frame. Dr. Bloom then assigned him physical therapy exercises to ease back into any overhead activity.
3:00pm patient (75 year old male): I examined the x-rays of the patient, who had scheduled an urgent appointment to discuss his shortness of breath. During the x-ray, the patient leaned his chest against the plate and held his breath during the scan. Dr. Bloom’s verdict regarding his diagnosis is TBD.
3:15pm patient (46 year old female): I watched Mrs. Bridges create the patient’s orthotics due to bilateral foot pain. Dr. Bloom led the patient to the orthotics room, where flat soles were heated in order to mold to the patient’s feet when she stepped on them. Mrs. Bridges then placed glue on the bottom of the sole and on blanks. The blanks were heated and then stuck to the soles. The soles cooled off so it would be easier to cut off the excess blank and grind it for shaping. Once the grinding took place, Megan explained how Dr. Bloom will return to finish the soles based on the patient’s needs (ex. grind more off in a certain area). After finishing her soles, Dr. Bloom watched the patient walk and run with the inserts to see how they felt.
The blue part is the blank that was added to the sole. You can see that it was shaved along the sides and ends.

This is what the orthotic looked like once Mrs. Bridges was finished with it.

This is the grinder that was used to shave off the extra blank from the sole.

All in all, today was a great introduction as to what my work experience will look like the next two weeks! I am excited to examine various patients each day and continue to learn what an average day is like in Dr. Bloom’s workplace.

Day 1- Introduction to FHI360

Today, Salma, Krishan, RJ, and I all drove to downtown Durham to FHI360 for our first day of the work experience program. Upon arriving, I knew little about the organization- it’s non-profit, it has a medical focus, and it helps other countries through its international relations. After touring this beautiful office, we sat down with doctors Dorflinger and Nanda to discuss the history, accomplishments, and work of the organization. Primarily funded by the US Government and Gates Foundation, FHI (Family Health International) first focused on the prevention of HIV and later developed many different branches including nutrition, education, and expanded in health while acquiring AED and changing the organization’s name to FHI360. Within the health section, Dr. Dorflinger directs the entirety of the Contraceptive Technology Innovation department and Dr. Nanda is the director of medical research. Next, with Ms. Lorenzetti, we discussed one of the projects with which we will help the health department. With a focus on economics involving health policy, Ms. Lorenzetti is now examining barriers and facilitators of adherence to HIV care in Mozambique. We will help her by sorting through different resources for relevance and categorizing our findings. After a pizza lunch with a few faculty members, we met with library associate Ms. Manion and library manager Ms. Burns to learn more about literary searches using different databases and methods to use for the most accurate search results. All in all, I am very excited for the next two weeks and cannot wait to learn more about this organization!

The view of the Durham Bulls Stadium from the view of the cafeteria on the tour!

Day 1- Orientation & Project & Sports Med (Oh my!)

This morning I began my adventure at Wake Orthopedics. The morning started with an orientation of the North Raleigh Wake Orthopedics office. I met some of the physician assistants, got to know the ins and outs of the office, and was given a little work space for when I am working on my project.

Over the course of the next two weeks, I will be both shadowing different doctors and working on a project. The project is co-authoring an article with my father to be submitted for publication to the American Academy of Orthopedic Surgeons. The article is comparing the success and failure rates of autografts (replacement of tissue with tissue from the patient) versus allografts (replacement of tissue from a cadaver) in Anterior Cruciate Ligament repairs. Today, I spent time compiling the data from surgeries over the past 5 years, including information such as age, gender, type of graft, additional surgeries performed, and the femoral fixations implicated. I also collaborated with my dad to construct the abstract of the report.

In the afternoon I shadowed Dr. Jon Chappell. Dr. Chappell specializes in sports medicine, specifically shoulders. I had the opportunity to shadow him in all of his clinics, listening in to his meetings with patients. I was intrigued watching him explain x-rays and MRI’s to the patients. His capability to identify and explain each individual tendon and ligament in the x-rays. A common thread I noticed was how he performed similar mobility tests on each of the patients to determine their condition. Based on their answers and responses, he then came up with a plan for normally the next 6 weeks.

I enjoyed the first day and cannot wait for tomorrows adventure!