Surviving surgery clerkship w/a bad back

[DaveinDallas]

So I'm on my first week of general surgery. Cool rotation and all that stuff.


But I've got a herniated disk from 1987 that usually doesn't cause me a
problem. However, standing in one position or in a position you can only
modify slightly (due to sterile field) for 2 hours at a pop (or longer) makes
for really excruciating pain.

I'm finding that my paraspinals at about a t12 to t1 level are locking up----
BAD. It really hurts. Anyone got any pointers -- other than lose the
gut pile ----

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[NPR]

Ibuprofen qAM

 

[GregsAnatomy]

Having a quality pair of shoes can be very good in the OR if you have a bad back. Tennis shoes, while great for running around the wards, tend to cause most people back pain when standing in one position for hours. Danskos (which have a large heel) might be a good option to look into.

 

[medicomel]

So I'm on my first week of general surgery. Cool rotation and all that stuff.


But I've got a herniated disk from 1987 that usually doesn't cause me a
problem. However, standing in one position or in a position you can only
modify slightly (due to sterile field) for 2 hours at a pop (or longer) makes
for really excruciating pain.

I'm finding that my paraspinals at about a t12 to t1 level are locking up----
BAD. It really hurts. Anyone got any pointers -- other than lose the
gut pile ----

try thesehttp://www.onlineshoes.com/productlist.asp?ptclass=brand&brandid=84&ptcat=Earth&gen=m&attribute_value_string|AgeGroupID=1&attribute_value_string|Brand%20Name=Earth&brand_category|0=BrandCategories~brand_root&brand_category|113084=_sale_shoes_~brand_0

I don't have the same back problems as you, but the shoes definitely help my lower back and calves.

 

[DaveinDallas]

Thanks all --- I was wondering if my running shoes might be causing me
problems. Anyone know of a store that sells Danskos or other shoes
mentioned in this thread in the Ft. Worth area (yeah, I moved)?

Also, just for giggles -- as a 3rd year, how many patients am I expected
to track on a general surgery rotation? How long should the daily visit
take per patient? I'm finding I'm tracking, on average, 7 patients and
it takes me roughly 2 hours to get them done before the attending
gets in at 7 --- I know surgery is long hours and am really not whining
but am wondering what's the norm for 3rd years, not Sub-Is or interns/residents?

 

[NPR]

7 patients??

The most I ever took care of was 5. And two were quick discharges.

At the beginning of the rotation, it does take a while. Once you realize what your residents are expecting, it speeds up quite a bit. By the end, I was able to see a patient in 5 minutes as the residents are expecting a very brief report for rounds.

 

[SoCuteMD]

I averaged 5-6. I prerounded and wrote notes on them all. I had it down to an hour after the first week or two.

 

[smq123]

Also, just for giggles -- as a 3rd year, how many patients am I expected
to track on a general surgery rotation? How long should the daily visit
take per patient? I'm finding I'm tracking, on average, 7 patients and
it takes me roughly 2 hours to get them done before the attending
gets in at 7 --- I know surgery is long hours and am really not whining
but am wondering what's the norm for 3rd years, not Sub-Is or interns/residents?

How long should it take? That depends on the patient, on how sick the patient is, and how far apart they put the patients from each other.

A post-appendectomy patient should take 5 minutes. A post-liver transplant patient should take significantly longer - you need to check up on a lot of different labs for the post-transplant patient, they're often VERY sick, etc.

And if they placed one of your patients on the 2 floor, and the other on the 15th floor, expect to lose some time trying to get from patient to patient. If you're REALLY good, you could try writing your note while waiting for the elevator, though.

 

[elr1983]

7 seems like a lot to me. The most I ever had as a third year was 4, although that was on peds/medicine where the notes are usually significantly longer. I had 5-6 NICU babies on my AI, which took me about 1.5-2 hours, mostly because of all the annoying calculations you have to do to get their I's and O's, the ******ed way data is saved in our computer system, and the least user friendly note template ever.

I did general surgery early in the year, and only had 2-3, partially because it was the beginning of the year, partially because the service was slow because one of our attendings was on vacation, and partially because there were a lot of students. I'm doing peds surgery now, and am carrying 8-10, a combination of floor and icu patients. It takes me like 1.5 hours to get everything ready in the morning, mostly because the notes are super short and the attendings don't really medically manage the patients at all (at our hospital, pretty much all surgery patients are co-managed by gen peds/icu teams).

 

[rmm262002]

Have you tried capsaicin patches? They're great, and you can supplement with NSAIDs if necessary.

You can get store brand ones for ~$1 each.

 

[DaveinDallas]

Thanks again all...

Yeah, 7 patients. There are no other students or residents/interns....just a private practice general surgeon and yours truly. He's in at 07:00 and we go over the patient list the evening before. I try to read up on the next days schedule of procedures but it's hard sometimes.

Basically, I've been doing the standard -- heart/lungs/abdomen - auscult all, palpate the abdomen, check extremities for edema, check foley, look at post-op incisions for any nastiness, verify eating/drinking/n/v, any new complaints or pains....chart it all, check record any new labs, I/Os, sign it and go.....

Oh, yeah, forgot-- pulses where indicated, bruits and flow on vascular patients.....

multiple floors, multiple towers, be ready to report on anomalies, and then hit the ground running for full procedure days......

Somewhere in there is sleep/eat/void/study.....I lost an hour last week due to taking a break for a cigar after work......but boy was it good....


Anyway, is this normal for a 3rd year? What do I have to do for honors?

 

[lord_jeebus]

I'm sure it's a lot of work, and physically tough with your situation, but getting to round on 7 patients with no residents between you and an experienced attending is a great learning opportunity.

I had as many as 10 patients when I was on surgery, but 4-5 was more typical.

Have you told your attending about your situation?

 

[DaveinDallas]

I hear you on the great learning experience....and I'm using it as such....

Yes, I did tell him about the back situation after a long day caused some
major back spasms. I also asked what to do about a long procedure he'll be assisting on on Monday. His response was 'I don't know, wear a back brace or something'.....cool.

Anyway, lots of motrin and seeing a chiro for the next 3 weeks...and a
new set of zapatos.....