DMU self-proclaimed super-geniuses of the third row

[IlizaRob]

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79 year old patient presented yesterday with severe onychocryptosis. No big deal right? Just numb it up and take it out. She refused treatment and just went home with antibiotics. She could barely put her sock on she was in so much pain. Where do these people come from? She must have thought we were going to cut off her leg or something. The doc was baffled but what can you do? We will see her again after she gets osteomyelitis.

 

[krabmas]

79 year old patient presented yesterday with severe onychocryptosis. No big deal right? Just numb it up and take it out. She refused treatment and just went home with antibiotics. She could barely put her sock on she was in so much pain. Where do these people come from? She must have thought we were going to cut off her leg or something. The doc was baffled but what can you do? We will see her again after she gets osteomyelitis.

Why were antibiotics prescribed for a patient with onychocryptosis. was is burried into the skin with signs of infection?

 

[IlizaRob]

Why were antibiotics prescribed for a patient with onychocryptosis. was is burried into the skin with signs of infection?

It was very infected.

 

[jonwill]

Week One

Hours: 60
Patients seen: 110
Lessons learned:
1) Don't get drunk and jump off of a high dock into shallow water or you will crush your calcaneus and someone will have to spend 3 hours on a Thursday night in the OR fixing it.

2) Eat, drink, and use the bathroom whenever you get a chance and regardless of whether you really need to because it may be a long time before your next chance.

3) If you kick a concrete wall, your foot may break.

 

[krabmas]

Week One

Hours: 60
Patients seen: 110
Lessons learned:
1) Don't get drunk and jump off of a high dock into shallow water or you will crush your calcaneus and someone will have to spend 3 hours on a Thursday night in the OR fixing it.

2) Eat, drink, and use the bathroom whenever you get a chance and regardless of whether you really need to because it may be a long time before your next chance.

3) If you kick a concrete wall, your foot may break.

do you feel like you know stuff.

Are these new lessons to you?

sounds like fun.

so you get to do on-call?

 

[jonwill]

do you feel like you know stuff.

Are these new lessons to you?

sounds like fun.

so you get to do on-call?

Yes, they give you a pager. You'll be surprised at all the stuff that you remember.

 

[jonwill]

Freaking tropical storm Alberto.

 

[gustydoc]

Freaking tropical storm Alberto.

He's still alive! any exciting stories from FL Jon?

 

[krabmas]

Freaking tropical storm Alberto.

my brother is in orlando - he said it is a really cool storm.

 

[IlizaRob]

Bumpity bump. What does that mean anyway? I see it everywhere. So JonWill, have you promised florida that you would rank them #1 yet?

 

[jonwill]

Bumpity bump. What does that mean anyway? I see it everywhere. So JonWill, have you promised florida that you would rank them #1 yet?

No promises. It's all about sitting back, relaxing, and watching the residency programs fight for me!

 

[IlizaRob]

No promises. It's all about sitting back, relaxing, and watching the residency programs fight for me!

Ah yes, the power of the dreamer.

 

[krabmas]

Ah yes, the power of the dreamer.

jonwill is right - arogant - but right. with 340 students competing for about 300 PM&S spots it makes sense that it is really the residencies competing for us. not to mention the rest of the PM&S 24 spots.

 

[Dr_Feelgood]

Jon must be busy today b/c he is nowhere to be found.

 

[IlizaRob]

Jon must be busy today b/c he is nowhere to be found.

He should be back on soon posting like a maniac as usual. Last Friday he got off at like 2pm and he still worked a 60 hour week. Im just trying to get into the "500" club. In fact...

 

[IlizaRob]

...Ill just post my responses in segments, that way I can get there faster. So where is Psionic Blast anyway? I havent seen that trash around here in a long time. And whats with the name "gustydoc" anyway? How does that work? Discuss...

 

[jonwill]

He should be back on soon posting like a maniac as usual. Last Friday he got off at like 2pm and he still worked a 60 hour week. Im just trying to get into the "500" club. In fact...

No more posting until you guys pass part 1.

 

[Dr_Feelgood]

Geez get off our backs. Your not our dad. Who do you think you are? You can't tell me what to do. 😀

 

[gustydoc]

...Ill just post my responses in segments, that way I can get there faster. So where is Psionic Blast anyway? I havent seen that trash around here in a long time. And whats with the name "gustydoc" anyway? How does that work? Discuss...

Gustavus Adolphus college is a small liberal arts college in Minnesota and rumor has it the most impressive student in the DMU class of 2008 graduated form there. Their mascot is the Gusty and they have an awesome hockey team.

 

[IlizaRob]

Gustavus Adolphus college is a small liberal arts college in Minnesota and rumor has it the most impressive student in the DMU class of 2008 graduated form there. Their mascot is the Gusty and they have an awesome hockey team.

I wonder who that is. Let me know when you find out.

 

[IlizaRob]

No more posting until you guys pass part 1.

You dont know me man...YOU DONT KNOW ME!!

 

[jonwill]

I got paged at 8:30 this morning to the OR. Some of our patients took a turn for the worse and we ended up doing some digit/ray amputations. Good times. There is nothing like the smell of gangrene on a Saturday morning!

 

[krabmas]

I got paged at 8:30 this morning to the OR. Some of our patients took a turn for the worse and we ended up doing some digit/ray amputations. Good times. There is nothing like the smell of gangrene on a Saturday morning!

I can't wait til it is my turn!

Just don't tell the patients that you think of it as good times

 

[jonwill]

I can't wait til it is my turn!

Just don't tell the patients that you think of it as good times

There was actually a guy from NYCPM visiting us on Friday. He is a DPM 08 and wants to end up in Florida so he has spent the last year visiting programs in FL when he gets a chance. Geez, I wish CPMS 08er's were that organized!

 

[krabmas]

There was actually a guy from NYCPM visiting us on Friday. He is a DPM 08 and wants to end up in Florida so he has spent the last year visiting programs in FL when he gets a chance. Geez, I wish CPMS 08er's were that organized!

do you know his name. I re-call some one telling me they were going to look but I forgot who.

if you remember a name please PM me.

 

[gustydoc]

Feelgood, I love the new avitar. Sounds great but I just gotta have more cowbell baby!

 

[Dr_Feelgood]

Feelgood, I love the new avitar. Sounds great but I just gotta have more cowbell baby!

 

[IlizaRob]

Feelgood, I love the new avitar. Sounds great but I just gotta have more cowbell baby!

He jacked it from someone, that dirty thief. Ive seen it before on SDN. Nonetheless, we can always use more cowbell.

 

[jonwill]

Anybody want to know what happens when a man gets drunk and kicks a tree with his barefoot really, really hard?

 

[Dr_Feelgood]

Anybody want to know what happens when a man gets drunk and kicks a tree with his barefoot really, really hard?

toe first or midfoot?

Toe, I'd say they have a broken toe. May even have a nice large pressure fissure. Maybe a Lisfranc's dislocation, if they hit it right.

Midfoot, I'd say Lisfranc's, metatarsal fracture, and/or a large wound.

 

[jonwill]

toe first or midfoot?

Toe, I'd say they have a broken toe. May even have a nice large pressure fissure. Maybe a Lisfranc's dislocation, if they hit it right.

Midfoot, I'd say Lisfranc's, metatarsal fracture, and/or a large wound.

Lisfranc's dislocation = surgery when the swelling goes down.

 

[krabmas]

Lisfranc's dislocation = surgery when the swelling goes down.

when do you guys take traumatology at DMU? is it part of or separate from surgery?

 

[Dr_Feelgood]

Lisfranc's dislocation = surgery when the swelling goes down.

Do I win a prize?

Dr. Yoho and Freschi got called in this weekend for a Lisfranc's dislocation. Dr. Yoho had to pick Freschi up on a date.

 

[dpmgrad]

Lisfranc's dislocation = surgery when the swelling goes down.

Do you know if the surgeons at the residency program do primary arthrodesis or ORIF of Lisfranc's dislocation? I am curious as to what surgeons are doing around the country. There is literature supporting both primary arthrodesis for initial management of Lisfranc's dislocation and ORIF for Lisfranc's dislocation.

 

[jonwill]

when do you guys take traumatology at DMU? is it part of or separate from surgery?

Trauma is taken 3rd year and is separate from surgery.

 

[jonwill]

Do you know if the surgeons at the residency program do primary arthrodesis or ORIF of Lisfranc's dislocation? I am curious as to what surgeons are doing around the country. There is literature supporting both primary arthrodesis for initial management of Lisfranc's dislocation and ORIF for Lisfranc's dislocation.

I'm pretty sure that an ORIF will be done in this case.

 

[krabmas]

I'm pretty sure that an ORIF will be done in this case.

the guy that taught us keeps the hardware in the medial column but removes all hardware from the lateral column. I know this is not the same as primary AD but it effectively acheives the same thing.

 

[dpmgrad]

I'm pretty sure that an ORIF will be done in this case.

Thanks. By the way, if you want to read more about doing primary arthrodesis vs. ORIF for initial management of Lisfranc's dislocation, you can read more about it in the March 2006 issue of JBJS. The reason why someone would prefer doing primary arthrodesis initially is that it saves the patient from going to the OR a second time for Lisfranc arthrodesis since many of the ORIF of Lisfranc dislocation would result in arthritis in the Lisfranc joint. By the way, if one was to do a primary arthrodesis for initial management of Lisfranc dislocation, Dr. Sigvard Hansen recommends that the 4th Met - Cuboid and 5th Met - Cuboid joints not be fused.

It sounds like you are seeing some really cool trauma stuff in your externship. I hope that you are enjoying your externship.

 

[jonwill]

Thanks. By the way, if you want to read more about doing primary arthrodesis vs. ORIF for initial management of Lisfranc's dislocation, you can read more about it in the March 2006 issue of JBJS. The reason why someone would prefer doing primary arthrodesis initially is that it saves the patient from going to the OR a second time for Lisfranc arthrodesis since many of the ORIF of Lisfranc dislocation would result in arthritis in the Lisfranc joint. By the way, if one was to do a primary arthrodesis for initial management of Lisfranc dislocation, Dr. Sigvard Hansen recommends that the 4th Met - Cuboid and 5th Met - Cuboid joints not be fused.

It sounds like you are seeing some really cool trauma stuff in your externship. I hope that you are enjoying your externship.

Ok, I downloaded the article. Thanks.

 

[krabmas]

Thanks. By the way, if you want to read more about doing primary arthrodesis vs. ORIF for initial management of Lisfranc's dislocation, you can read more about it in the March 2006 issue of JBJS. The reason why someone would prefer doing primary arthrodesis initially is that it saves the patient from going to the OR a second time for Lisfranc arthrodesis since many of the ORIF of Lisfranc dislocation would result in arthritis in the Lisfranc joint. By the way, if one was to do a primary arthrodesis for initial management of Lisfranc dislocation, Dr. Sigvard Hansen recommends that the 4th Met - Cuboid and 5th Met - Cuboid joints not be fused.

It sounds like you are seeing some really cool trauma stuff in your externship. I hope that you are enjoying your externship.

This is a test - why do you not fuse the lateral column joints involved in the lis franc's injury?

 

[IlizaRob]

Hey Jonwill, guess who has been popping in the clinic? Your beloved jailbird. I saw him today and man all that dude wants is drugs. I read your initial note. That must have been one nasty trans malleolar fracture. What was his excuse? He broke it riding his bike at the jail or something? Yeah right, that guy got beat up bad. I think he had multiple fractures in the forefoot as well. We discharged him today and he was pretty sad that he wasnt going to get to come back. 🙁

 

[jonwill]

Hey Jonwill, guess who has been popping in the clinic? Your beloved jailbird. I saw him today and man all that dude wants is drugs. I read your initial note. That must have been one nasty trans malleolar fracture. What was his excuse? He broke it riding his bike at the jail or something? Yeah right, that guy got beat up bad. I think he had multiple fractures in the forefoot as well. We discharged him today and he was pretty sad that he wasnt going to get to come back. 🙁

Don't worry, he'll get beat up again

 

[krabmas]

where do the jailbirds come from. it seems like all your patients at DMU are from the jail.

 

[Dr_Feelgood]

I had a long case today. This really nice gentlemen developed gangrene in his 5th toe. Freschi removes his toe, and then a vascular surgeon removes his 4th toe at a later date. The surgeon ended up leaving exposed bone. Pehde gets the case and goes into the OR to debride. The pathology comes back w/ signs of osteo, but the lab doesn't get a culture from the bone. So I call pathology, no culture but they culture some of the exudate. I tell the guy well that isn't what I'm looking for but what did it say? After I heard the news, I had them fax over the results. MRSA, Enterococci, and Enterobacter. The guy is on augmentine, so I mention to Bennet that isn't going to work if it is MRSA. I also pointed out that this guy is DM so the chances are high that he might have Pseudomonas. We talk pictures of his wound and got X-rays.

So, to make a long story short we slap on the Wound Vac again. Change the antibiotics to IV Vanco and oral Levoquin. If felt good actually working as a doctor on someone who has a serious condition and not just long nails.

 

[krabmas]

I had a long case today. This really nice gentlemen developed gangrene in his 5th toe. Freschi removes his toe, and then a vascular surgeon removes his 4th toe at a later date. The surgeon ended up leaving exposed bone. Pehde gets the case and goes into the OR to debride. The pathology comes back w/ signs of osteo, but the lab doesn't get a culture from the bone. So I call pathology, no culture but they culture some of the exudate. I tell the guy well that isn't what I'm looking for but what did it say? After I heard the news, I had them fax over the results. MRSA, Enterococci, and Enterobacter. The guy is on augmentine, so I mention to Bennet that isn't going to work if it is MRSA. I also pointed out that this guy is DM so the chances are high that he might have Pseudomonas. We talk pictures of his wound and got X-rays.

So, to make a long story short we slap on the Wound Vac again. Change the antibiotics to IV Vanco and oral Levoquin. If felt good actually working as a doctor on someone who has a serious condition and not just long nails.

yessss! the secret is out. it is not just NYCPM that cuts long nails.

in all seriousness (hard for me) that was an interesting case.

 

[dpmgrad]

This is a test - why do you not fuse the lateral column joints involved in the lis franc's injury?

Since I have not seen anyone answer this question, I will go ahead and will attempt to answer this question. The lateral column joints (fourth metatarsal - cuboid and fifth metatarsal - cuboid) have greater joint motion than the medial and middle columns joints (which normally have very little motion). This extra range of motion of the lateral column joints is important for load bearing and weight transfers. Fusion of the lateral column joints would severely limit the functional motion of the foot during gait.

 

[IlizaRob]

So, to make a long story short we slap on the Wound Vac again.

Was that what all the nasty smell was from it the clinic yesterday?

 

[Dr_Feelgood]

Was that what all the nasty smell was from it the clinic yesterday?

Probably, it smelled kind of like a bottle of vinegar.

 

[krabmas]

Since I have not seen anyone answer this question, I will go ahead and will attempt to answer this question. The lateral column joints (fourth metatarsal - cuboid and fifth metatarsal - cuboid) have greater joint motion than the medial and middle columns joints (which normally have very little motion). This extra range of motion of the lateral column joints is important for load bearing and weight transfers. Fusion of the lateral column joints would severely limit the functional motion of the foot during gait.

how so?

 

[IlizaRob]

how so?

Hey, no pimping allowed in the super-genius forum. This is a happy place.