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I think this thread will be a fun one. Residents, as crazy, interesting, or funny things happen, please share!
I scrubbed my first BKA. Which is not the big of deal but what was weird is the vascular surgeon only cut of the guys feet. Literally just above the feet. I understand why and all of that pooh, but it was weird to see such a distal BKA or should I say AAA (above ankle amputation).
was there and infection in the feet that were cut off? Was it closed primarily?
I saw one of these and thought the same thing. But remember if there is an infection in the feet, the wound should be left open and then closed primarily on a different day after the infection had been successfully treated. During the primary closure more of the leg will be taken off creating a more normal looking stump with at least 4 cm or inches (oh crap I forgot) of leg distal to the tib tub.
They have been moving up the legs. TMA to a Chopart, now the new AAA. Primary closure was performed. The vascular surgeon send gangrene but I didn't see it or smell it. I did look and smell when I dropped the dressings b/c the nurses where guessing on why the BKA. The poor guys is circling the drain b/l BKA, renal failure, and DM.
We had a good calcaneal fx come in yesterday (rowe IIB). The guy apparently upset a few people and they beat the crud out of him. We ended up taking out the defect and re-attaching the achilles tendon.
How much outside of podiatric medicine exposure do we get in residency? Will I ever be in a position where I'll be doing chest compressions? During our first year, will I ever be called at 3am for a gunshot wound to the chest? When do we start to geographically confine ourselves to the lower extremity? Thanks for the posts guys
Each residency program structures their outside rotations differently. Some schedule their outside rotations throughout the three years; while other residency programs would schedule a large portion of the outside rotations in the first year. The number of outside rotations also varies from residency program to residency program. Some of these outside rotations include, but not limited to, Internal Medicine, General Surgery, Vascular Surgery, Endocrinology, Rheumatology, Infectious Disease, Plastic Surgery, Orthopedic Surgery, Emergency Medicine, Radiology, Pathology, Behavior Science / Psych, Family Practice / Medicine, Sports Medicine, Wound care, Dermatology, Physical Medicine / Rehab, Neurology, Pediatrics / Pediatric Orthopedics, and Trauma service. In certain residency programs, when a resident is on an outside rotation, they are usually on that rotation full time and is not involved with Podiatry (with exception of academic activities) for the length of the rotations. There are other residency programs where the podiatry resident will be on the outside service part time. For example, a podiatry resident on Internal Medicine may scrub on Podiatry cases and do Podiatry rounds part of the day and show up for Internal Medicine for the remainder of the day.
As for being called into the ER for a gunshot wound to the chest area, the chances are highly unlikely unless you are on a trauma rotation or an ER rotation at the hospital. In terms of responding to code blues in the hospital, the policy will vary from hospital to hospital. Some of the podiatry residents may only respond to code blues during their Medicine or General Surgery rotations. In some hospitals, podiatry residents are expected to participate in code blue if available. Of course, there are hospitals where podiatry resident are not responsible for responding to code blues. When I was a resident, I was expected to respond to code blues in my hospital since we were all ACLS certified.
In residency training, you are going to be specializing in the lower extremity. The only time you will venture outside of the lower extremity is when you are on outside rotations. Hopefully, this has answered some of your questions.
How are you going to know who to refer to or call for a consult if you don't really know what other specialties are capable of? How will you even recognize a non-pod pathology and diagnose it if you haven't at least got your feet wet in that area? Maybe most importantly, how will you gain connections and respect in other specialties if you did nothing in your residency but pod cases with fellow DPMs?As a Practicing Podiatric Physician can you explain the relevance of these outside rotations. I was asked this question by family and friends and ofcourse i also wonder sometimes that if Pods are allowed to do so many things outside the foot during their residency and school then how come they are not allowed to do more than foot in real practice. I mean there are several states that dont even allow them to do ankle yet during school & residency they do A-Z of medicine. I know it gives broad exposure and increases our knowledge of body but is there like a simple answer to this which i can use when someone asks me this question?
How are you going to know who to refer to or call for a consult if you don't really know what other specialties are capable of? How will you even recognize a non-pod pathology and diagnose it if you haven't at least got your feet wet in that area? Maybe most importantly, how will you gain connections and respect in other specialties if you did nothing in your residency but pod cases with fellow DPMs?
Residents learn a lot lot of things they'll never do again in most residencies - esp good PMS-36s, but the goal there is an understanding and appreciation of comprehensive medical and surgical care.
Only the union of medicine and surgery constitutes the complete doctor. The doctor who lacks knowledge of one of these branches is like a bird with only one wing.
-Sushruta
yeah tats true. no doubt abt it. But my question was more like why are they then subject to much scrutiny when they are like so much well trained. I mean if we compare a Pod resident to a IM resident or FM resident. He/She has literally same rotations for 1st year. So i mean isnt it so obvious to entire medical community, state govts, federal govts that Pods are doing this and that but still they impose so many restrictions on us. I mean are they missing something here or they just wanna ignore even though they know we are fully capable.
I guess I don't understand what you mean when you use the phrase "impose so many restrictions on us". What restrictions are you speaking of? I know that a few states still have some issues but for the most part, we are free to do surgery and treat our patients.
oh that i mean for example if a pod has to take a skin graft from upper part, he needs to call a general surgeon (when infact in his residency he might have practiced serveral of them during his rotation) and then i heard hospitals also (some here in illinois) dont give them priveledges. This just what i heard from others here.
Some places, it's close... many places, not at all....I mean if we compare a Pod resident to a IM resident or FM resident. He/She has literally same rotations for 1st year...
As a Practicing Podiatric Physician can you explain the relevance of these outside rotations. I was asked this question by family and friends and ofcourse i also wonder sometimes that if Pods are allowed to do so many things outside the foot during their residency and school then how come they are not allowed to do more than foot in real practice. I mean there are several states that dont even allow them to do ankle yet during school & residency they do A-Z of medicine. I know it gives broad exposure and increases our knowledge of body but is there like a simple answer to this which i can use when someone asks me this question?
yeah tats true. no doubt abt it. But my question was more like why are they then subject to much scrutiny when they are like so much well trained. I mean if we compare a Pod resident to a IM resident or FM resident. He/She has literally same rotations for 1st year. So i mean isnt it so obvious to entire medical community, state govts, federal govts that Pods are doing this and that but still they impose so many restrictions on us. I mean are they missing something here or they just wanna ignore even though they know we are fully capable.
oh that i mean for example if a pod has to take a skin graft from upper part, he needs to call a general surgeon (when infact in his residency he might have practiced serveral of them during his rotation) and then i heard hospitals also (some here in illinois) dont give them priveledges. This just what i heard from others here.
Based on what you said, a general surgeon who did a one month rotation in Podiatry Surgery and did couple of bunion surgery in the rotation and is comfortable doing them, should be qualified to do bunion surgery.
Oh so MDs also do Podiatric Rotations. Wow thats cool!
How much outside of podiatric medicine exposure do we get in residency? Will I ever be in a position where I'll be doing chest compressions? During our first year, will I ever be called at 3am for a gunshot wound to the chest? When do we start to geographically confine ourselves to the lower extremity? Thanks for the posts guys
I got called into the ER last night. The patient was getting into his car when a car coming the other way came too close to his car and hit his door. His foot was crushed in the door. It looked horrible on x-ray so I ordered a CT. The guy sustained a fracture dislocation with 1 displaced medially and 2-5 displaced laterally. There was quite a bit of comminution. I threw a posterior mold on him and wrote him for some pain pills. We'll probably do the case early this week. Nice!
Another Lis Franc fracture/dislocation today (left foot).
Lesson Learned: If you've already broken your right ankle and are non-weightbearing on crutches, you should not drink copious amounts of alcohol
Ill be expecting your Foot and Ankle Surgery textbook on the shelves by next week.
hey rob welcome to the fourth year. I hope your tan isn't interfering with your ability to see patients.
Soon, you'll be getting a tan and seeing patients at the same time. Best of both worlds.
Hmmm....make that the same day. But you wish it was the same time.
I can't wait to get to get to Kauai. One month of private practice in an ortho group during the day and sipping mai tais on the beach in the evening. I am jealous that you started out your fourth year with a trip to paradise and I have to wait. Where are you at this month anyway?
And when is the visit to INOVA? I'm not the only one that wants to be graced with your presence! There are 2 others looking forward to seeing you as well.
Hey I thought you wanted me to come visit? Now you are working your stuff on gusty? Yes he is taller, better looking and drives a Jag, but I've got this cool trick I can do, where it looks like I pull the tip of my thumb off.
I can't wait to get to get to Kauai. One month of private practice in an ortho group during the day and sipping mai tais on the beach in the evening. I am jealous that you started out your fourth year with a trip to paradise and I have to wait. Where are you at this month anyway?
Don't take it personal Feelgood, Sam and I go way back I really want to stop by inova, but I may have to do some juggling to make it happen. It is not exactly down the street from my other externships.
Im in Tucson right now. Freakin hot! But Im enjoying it. Everyone is nice and they let me do a lot in clinic.
Don't take it personal Feelgood, Sam and I go way back I really want to stop by inova, but I may have to do some juggling to make it happen. It is not exactly down the street from my other externships.