raleighortho – 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 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 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!