Pyrrhic victory

That is a new phrase added to my glossary thanks to the BBC. Yesterday I was super productive and indeed finished my presentation ( it was awesome; that feelings when you make your classmate awake and interested), mini assessment and a bedside discussion went smooth. I also did my first ortho on call. Simply amazing. I truly enjoyed it. We got to see loads of traumas and different fractures. Enough bragging. The price was me surrendering to my sinusitis induced headache ( sleeping when I was supposed to study). O and I should add I barely read/ prepare! The consultant said we don't need too. I swear.

I'm currently in my third week in ortho. And seriously considering it as a future specialty. My consultant also said it would suite me:) Well at least that is what he thought before I missed a basic question. (bye bye dear "remnant" ego. I am considering total face reconstruction once I graduate from medical school. Man, I need to shut my mouth and pretend I am thinking quite often).



Diabetes affect blood supply to nerves leading poor sensation and injury going unnoticed

In the ward I saw a lovely lady with Charcot foot (common in poorly controlled diabetes) who slipped in the bathroom and broke her ankle (grade C in Weber ankle classification.. umm..yes I know what that is). Because of her poorly controlled diabetes her wound got infected and the healing was delayed ( 2 months and the wound still swollen and not fused). Her motion at ankle was restricted in all directions. Sensation was almost normal. Joint position sense was not there! First time I test someone and they test positive! Needless to say her ankle was deformed. Much like the picture. There were many fracture cases with different correcting implants. And we got to know the name of different plates and screws used. We saw two cases of implant failure, one due to a combination of wearing off of the implants (estimated age of an implant is 15-20 years) and an advance osteoporosis. The other was due to infection. And after spending 2 hours teaching us about these stuff, the doctor conclude by saying that it is beyond what is expected from us! Hooray! Additionally we got to spent one day in the physiotherapy department!



In fractures (compared to joint replacement) implants is removed after one year, sometimes sooner!

Clinic wise; I saw many interesting cases in the wrist clinic ( I told you it is a highly specialized center). One was of an army fellow who managed to tear his TFCC ( help in forearm supination and pronation which were limited in our patient.) I also saw the classic scaphoid fracture. The patient main complain was pain in the anatomical snuff box ( yes, the area people used to put heroin to sniff it). I spent most of the time in the knee and spine clinic.

We learn loads of examinations to detect ligaments tears and impingementation and were introduced to different fracture classification system. I guess we are not expected to know them by heart ( or are we?) there is a classification system for almost each joint/bone. I guess I will learn the Ottawa one, because ankle injury is the commonest ( yeah, not because its super usefull and copys of it hanging from A & E walls).

In aside note, do students from other specialty share their experience over meal time or in trips? Because when I told my brother, who is a honor student , he said that is what nerds do!

Ok, I have boooooooooks to read. Wish me luck.

Busy

I feel so busy , yet I am doing nothing. I stupidly decided not to attend  the clinic and the seminar today  for no reason . I wasn't even sleepy and I t didn't study. Laying in bed from 12 am to 4 pm (  working day is from 6:30 where the bus pick us for the 1 hr trip to the hospital and the return is at 4 pm) is not a day well spent. But it's too late to regret. I have now to work  with.

I attended a knee clinic yesterday. The consultant explained knee examination nicely. I am still uncomfortable with meniscus exam. Other ortho exam…not sure at all. I didn't revise  them yet. I was determine to read the whole locomotor thing, but that is a nerve wrecking task. I am glad I passed that subject as I hate it most. There is a weekly assessment starting from the second week.  I guess I will go quickly over the examinations  and revise whatever I see in the clinic. Worrying about the end of year exam and my sister travel for 1 year is eating me.

I wish I can keep writing here to procrastinate more.  I am all grumpy right now. I guess I'll call dad, read for my presentation discussion tomorrow and maybe prepare view  slides. And if time allow , go through shoulder exam.

Wish me luck!

Big wards!

Hi,

I hope everyone is doing great. I am enjoying life at the moment. In fact, I have been socializing a lot for someone whose end of year exam is in less than 3 months. I started orthopedics ( bones and muscles rotation) in the biggest ortho center in my country. Saw a variety of cases. I attended pediatrics ortho clinic. There were many cerebral palsy cases. Cerebral palsy has a wide spectrum of causes (one is severe jaundiced in infants causing Kernicterus) with different presentations. It becomes apparent in the first 2 years of life. Patients need decent physiotherapy, usually until they are 16 years old. Tenotomy(releasing the tendon from its bony attachment) is necessary.

I also saw a case with operated meningocele and few developmental dysplasia of the hip (DDH) which I have been told is very common here. DDH is "an abnormal formation of the hip joint in which the ball on top of the thighbone (femur) is not held firmly in the socket. In some instances, the ligaments of the hip joint may be loose and stretched". It is important to detect it early as the prognosis is age dependant. Too bad (and scary), I couldn't appreciate the click generated by relocating the femur head while doing ortolani test. I can only hope to be able to do so by the end of this rotation!

 

I have been told the staff here is very keen to teach especially if they saw any sign of enthusiasms. I need to revise the ortho examinations ( which have funny big names, hence the title of this entry) and deformities names to not shy away and appear uninterested.!

Bed time already. It happens to be the time I feel sorry /anxious for not finishing/starting revising dermatology and family medicine notes! I have not even prepare for the new rotation. O and I am with one of the sharpest/nerdest medical students group…hallelujah!

P.S. I noticed I need respectable proof reading. My apology to any possible readerL