True Stories From Podiatric Residency

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BFD, I did a Triple Lindy and won the diving competition for Grand Lakes University.

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BFD, I did a Triple Lindy and won the diving competition for Grand Lakes University.

I'm tellin ya, you get no repsect. back to school is a great movie by the way
 
I think I might have scrubbed the most unusual case so far. Here's the history:

White female mid forties is on vacation in Africa. She is on a elephant safari when two of the elephants start to fight. The elephant guide jumps off her elephant and runs for his life leaving her only to try to control the animal. She is thrown off the elephant and gets stepped on. She is taken to an African clinic where her open pilon and fibular fractures are washed and dressed w/ un-sterilized water and materials. She returns to Louisville the next day and presents to one of the ortho surgeons.

First case, an ex-fix is used on the tibia for stability while the wound is treated. Luckily she had no signs of infection. Second case (today), the pilion fracture is ORIF with a tibial locking plate and the fibula was reduced with one Steinman pin up the medullary canal. Amazingly the ankle looks great and we will see how the whole case turns out but it looks like she may be very lucky.
 
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I think I might have scrubbed the most unusual case so far. Here's the history:

White female mid forties is on vacation in Africa. She is on a elephant safari when two of the elephants start to fight. The elephant guide jumps off her elephant and runs for his life leaving her only to try to control the animal. She is thrown off the elephant and gets stepped on. She is taken to an African clinic where her open pilon and fibular fractures are washed and dressed w/ un-sterilized water and materials. She returns to Louisville the next day and presents to one of the ortho surgeons.

First case, an ex-fix is used on the tibia for stability while the wound is treated. Luckily she had no signs of infection. Second case (today), the pilion fracture is ORIF with a tibial locking plate and the fibula was reduced with one Steinman pin up the medullary canal. Amazingly the ankle looks great and we will see how the whole case turns out but it looks like she may be very lucky.

That is a strange case. Don't forget to dictate in your operative report "ankle trauma secondary to an elephant".
 
That is a strange case. Don't forget to dictate in your operative report "ankle trauma secondary to an elephant".

What killed me is what the heck would be running through your mind when you seen the elephant trainer running for his life and you are stuck on top of this crazy elephant? :scared:
 
today I saw a pregnant lady 10week4day gestation with vaginal bleeding x 2 weeks in the ED. She was having an at risk pregnancy.

but we only learn the feet in pod school - sarcasm:laugh:
 
today I saw a pregnant lady 10week4day gestation with vaginal bleeding x 2 weeks in the ED. She was having an at risk pregnancy.

but we only learn the feet in pod school - sarcasm:laugh:

I had a triple A day - Amputations, Abcesses, and Ankle fracture - OH MY! :laugh:
 
today I saw a pregnant lady 10week4day gestation with vaginal bleeding x 2 weeks in the ED. She was having an at risk pregnancy.

but we only learn the feet in pod school - sarcasm:laugh:

:thumbup:

So was the fetus okay?
 
:thumbup:

So was the fetus okay?

here is the scoop with 1st trimester vaginal bleeding

30% will lose the baby in the 1st trimester
30% will have a troubled pregnancy but still deliver either at term or early
30% will have a normal pragnancy

I do not know where the other 10% are, maybe they do not seek care in the ED?
 
here is the scoop with 1st trimester vaginal bleeding

30% will lose the baby in the 1st trimester
30% will have a troubled pregnancy but still deliver either at term or early
30% will have a normal pragnancy

I do not know where the other 10% are, maybe they do not seek care in the ED?

Thanks for the info but this line cracks me up. I hope to someday have a pimp question on this so I can say, I don't know where the other 10% are.
 
yesterday I saw some crazy people in the ED.

earlier in the week I was 1st scrub on a flat foot reconstruction b/c the 3rd year was in a case that ran late and all the 2nd years left for vegas.

we did a gastroc, evans, cotton and kidner in 1 hour 23 minutes. OK so the attending did the whole thing and I retracted.
 
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Got called to the ER today for a diabetic foot ulcer. I ordered xrays and there was gas freakin everywhere. So off to the OR we went. The thing I truly enjoy about gas gangrene is the smell :laugh:
 
Got called to the ER today for a diabetic foot ulcer. I ordered xrays and there was gas freakin everywhere. So off to the OR we went. The thing I truly enjoy about gas gangrene is the smell :laugh:

:barf:
 
They are both doing fine. we are all hanging in here together. I really like that there are 4 of us. I do not think that I would like to be at a program where I am the only one.

A gang cool are you guys that sharks or the jets? Do you have matching jackets and snap will you are on rounds?
 
A gang cool are you guys that sharks or the jets? Do you have matching jackets and snap will you are on rounds?

yes, the girls wear pink jackets and the guy wears a black leather jacket (grease anyone?)

Kust kidding. Actually I have been at the surgery center this week, a DMUer is on Medicine, another DMUer is on floors and the guy is on pathology for the rest of this week, I do not know where he goes next week.
 
Got called to the ER today for a diabetic foot ulcer. I ordered xrays and there was gas freakin everywhere. So off to the OR we went. The thing I truly enjoy about gas gangrene is the smell :laugh:

Hey, I was in on a case just like that yesterday too. Oh wait, same case. I forgot you were the surgeon. Good job by the way. Although you didnt leave much of the foot left. Ok, ok, I guess the clostridium didnt leave much of the foot left. It was nasty smellin. :eek:
 
Hey, I was in on a case just like that yesterday too. Oh wait, same case. I forgot you were the surgeon. Good job by the way. Although you didnt leave much of the foot left. Ok, ok, I guess the clostridium didnt leave much of the foot left. It was nasty smellin. :eek:

At this point Dr. Mandracchia would flip out b/c he would quote an article that staights that clostridium is not the #1 case of gas gangrene.
 
Hey, I was in on a case just like that yesterday too. Oh wait, same case. I forgot you were the surgeon. Good job by the way. Although you didnt leave much of the foot left. Ok, ok, I guess the clostridium didnt leave much of the foot left. It was nasty smellin. :eek:

That cuboid tumor was pretty sweet today. Curetting it out was like scooping cottage cheese out!
 
That cuboid tumor was pretty sweet today. Curetting it out was like scooping cottage cheese out!

Im interested to see what the path report says. I think it could be any one of FOG MACHINES or NFC GAMES:laugh:.

So Im down at Detroit receiving tomorrow. Cant wait for my 5 mile hike from the parking lot to the hospital. Have fun with Psionic Blast.
 
Im interested to see what the path report says. I think it could be any one of FOG MACHINES or NFC GAMES:laugh:.

So Im down at Detroit receiving tomorrow. Cant wait for my 5 mile hike from the parking lot to the hospital. Have fun with Psionic Blast.

Last night, I did a transmetatarsal amputation. It was a true "puss party". Needless to say, it was a very messy case. It was my 100th "C" procedure and a definite memorable one. Gotta love that smell!
 
Last night, I did a transmetatarsal amputation. It was a true "puss party". Needless to say, it was a very messy case. It was my 100th "C" procedure and a definite memorable one. Gotta love that smell!

100th surgical C?

What about H&Ps and biomechanicals - like casts and splints? Does this 100 include all of these as well?

THey keep you really busy there!
 
100th surgical C?

What about H&Ps and biomechanicals - like casts and splints? Does this 100 include all of these as well?

THey keep you really busy there!

No, those are my surgical procedures only. Yea, the surgical volume here is crazy. We're lucky if we can get a resident to every case. I have an ORIF 5th met fx, a 1st MPJ fusion, and hammertoes tomorrow.
 
I removed a soft tissue mass last week and found out today that it was an angioleiomyoma.

I removed a soft tissue mass today that we think was a neurolemmoma, I should find out next week for sure.
 
I removed a soft tissue mass last week and found out today that it was an angioleiomyoma.

I removed a soft tissue mass today that we think was a neurolemmoma, I should find out next week for sure.


Pretty crazy! That is pretty interesting pathology. I did a few more bunions and a ganglion cyst today. I did excise a "dermatofibrosarcoma protuberens (sp?)" a few weeks ago. We're still waiting on the path report from that cuboid that I scooped out.
 
Pretty crazy! That is pretty interesting pathology. I did a few more bunions and a ganglion cyst today. I did excise a "dermatofibrosarcoma protuberens (sp?)" a few weeks ago. We're still waiting on the path report from that cuboid that I scooped out.
DFSP... DFSP ;)

I think you actually did spell it right, though :confused:. That's cool stuff; we had a pretty solid derm class with Dr. Bakotic, but it'll be very interesting to run into some of those zebras in clinics to see them firsthand.
 
I removed a soft tissue mass last week and found out today that it was an angioleiomyoma.

I removed a soft tissue mass today that we think was a neurolemmoma, I should find out next week for sure.

Don't get fancy with me call it a schwannoma.:laugh: Did the patient have neurofibromatosis?
 
Don't get fancy with me call it a schwannoma.:laugh: Did the patient have neurofibromatosis?

Oh, my little 4th year. But they are very different entities. They say that the schwannoma is malignant where as the neurolemmoma is benign.

and there was no neurofibromatosis.

Last night in the ED I saw a perianal abscess. The lady was in Zurich when diagnosed and paid 10,000 US dollars for one night of a hospital stay for IV antibiotics. They wanted 25,000 US dollars to drain the abscess. She came to the ED where it was drained by the attending surgeon. Next time I'll do it.

Then I saw proximal phalanx fracture of the hallux in a 2 year old. no joint or growth plate involvement.

Tonight I helped reduce a prosthetic hip dislocation.

And dealt with admitting a crazy patient to Psych - real lunatic!

Last - a patient with intestinal adhesions from scar tissue from cholecystectomy and appendectomy that happened 20(ish) years ago when the incisions were long and procedures very invasive.

tomorrow is another day in the ED.
 
Holy crap. You guys are doing amazing stuff. After reading this thread, it makes me realize how much I don't know not just about podiatry, but about medicine in general. Keep up the hard work all.
 
Oh, my little 4th year. But they are very different entities. They say that the schwannoma is malignant where as the neurolemmoma is benign.

and there was no neurofibromatosis.

Last night in the ED I saw a perianal abscess. The lady was in Zurich when diagnosed and paid 10,000 US dollars for one night of a hospital stay for IV antibiotics. They wanted 25,000 US dollars to drain the abscess. She came to the ED where it was drained by the attending surgeon. Next time I'll do it.

Then I saw proximal phalanx fracture of the hallux in a 2 year old. no joint or growth plate involvement.

Tonight I helped reduce a prosthetic hip dislocation.

And dealt with admitting a crazy patient to Psych - real lunatic!

Last - a patient with intestinal adhesions from scar tissue from cholecystectomy and appendectomy that happened 20(ish) years ago when the incisions were long and procedures very invasive.

tomorrow is another day in the ED.

Whoever told you that is full of it. Schwannomas are the same thing as a neurilemoma. They are rarely malignant and if they progress to malignancy they are generally neurofibrosarcoma or malignant neurilemoma. Malignancy is thought to be more common in patients with von Ricklinghausen (neurofibromatosis) or MENS. But I have read a few sutdies that showed malingnany is more common in the general public.

I did a case study paper in Seattle on a neurilemoma, so I am now an expert. :laugh:
 
We have a patient in house with AFB (Acid Fast Bacilla) growing out of his leg wounds. And he has a diabetic/pressure ulcer on his heel that probes to bone that is most likely growing the same stuff - culture pending.

So it is tuburculosis of his leg and foot.
 
i got to do my first P&A without an attending, that goes into my logs as a C baby:laugh:

Just kidding...How about a thread for visiting students so they know what is expected of them.?
 
We have a patient in house with AFB (Acid Fast Bacilla) growing out of his leg wounds. And he has a diabetic/pressure ulcer on his heel that probes to bone that is most likely growing the same stuff - culture pending.

So it is tuburculosis of his leg and foot.

Drug user? Extended visit to SE Asia? Anything that would have clued you into TB?
 
Drug user? Extended visit to SE Asia? Anything that would have clued you into TB?

I was just on call for the weekend. He was already an in-patient so I did not do the work-up or the H&P. So I do not know. I think just the Diabetes, CHF, pacemaker and other comorbidities that are causing him to have a decreased immune system caused it. I did a lit search in pubmed of diabetes and tuberculosis and a bunch of stuff came up with the relation due to the deacrease immune system.
 
i got to do my first P&A without an attending, that goes into my logs as a C baby:laugh:

Just kidding...How about a thread for visiting students so they know what is expected of them.?

go ahead and start one. I give you my permission.:laugh::love:
 
I was just on call for the weekend. He was already an in-patient so I did not do the work-up or the H&P. So I do not know. I think just the Diabetes, CHF, pacemaker and other comorbidities that are causing him to have a decreased immune system caused it. I did a lit search in pubmed of diabetes and tuberculosis and a bunch of stuff came up with the relation due to the deacrease immune system.

I would imagine that DM patients would be more susecptable just like any immunocomprimised patient (AIDS, CA patient on chemo, ect). But the TB had to come from somewhere, I can't imagine it is living in his carpet.
 
I would imagine that DM patients would be more susecptable just like any immunocomprimised patient (AIDS, CA patient on chemo, ect). But the TB had to come from somewhere, I can't imagine it is living in his carpet.

It was living in his thigh and leg wounds and I think his heel (pressure) ulcer as well. The Calc was plained yesterday so maybe soon I will know what the osteo was in his heel. pretty cool if it was TB as well. Maybe we'll write it up? I've heard of TB of the spine - Pott's disease but not of the calcaneus.:thumbup::eek:
 
I scrubbed a case today that we thought was a ganglion cyst. I made my incision and started dissecting and what looked to be a muscle belly came popping out. As I dissected around it, I realized that it was EHB. It was totally enlarged and the muscle looked incredibly unhealthy. It was also displaced medially. I examined EDB which looked fine. So I ended up resecting the EHB and sending it to pathology. It was a pretty strange case and I'm interested to see what comes back. Any ideas?
 
I scrubbed a case today that we thought was a ganglion cyst. I made my incision and started dissecting and what looked to be a muscle belly came popping out. As I dissected around it, I realized that it was EHB. It was totally enlarged and the muscle looked incredibly unhealthy. It was also displaced medially. I examined EDB which looked fine. So I ended up resecting the EHB and sending it to pathology. It was a pretty strange case and I'm interested to see what comes back. Any ideas?
Myxoinflammatory fibroblastic sarcoma?
^Just kiddin... I have no idea but wanted to open up my pod path notes and throw a zebra out there. :laugh:

Rhabdomyoma or it's nasty cousin, "-sarcoma, would be the main ddx for you, wouldn't they?

Interesting and cool case!
 
Myxoinflammatory fibroblastic sarcoma?
^Just kiddin... I have no idea but wanted to open up my pod path notes and throw a zebra out there. :laugh:

Rhabdomyoma or it's nasty cousin, "-sarcoma, would be the main ddx for you, wouldn't they?

Interesting and cool case!

DO you think in africa medical zebras are called horses? I will do a medical mission to Africa next year and I don't want to say zebra and have herd standing next to me. What are a group of zebras called anyway?:laugh:
 
I saw a patient with unilateral hypertrophied sustentaculum tali w/ irrelgular border, with palpable boney prominance just inferior to the medial malleolus and slight pain at the FHL where it runs under the sustentaculum tali.

Anyone ever seen this or read anything about it?

I did a lit search and found hypoplastic sustentaculum tali in middle facet tarsal coalitions but not much about hypertrophy except some mention in a case or 2 of causing tarsal tunnel syndrome.
 
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