True Stories From Podiatric Residency

[jonwill]

I start internal medicine Monday followed by infectious disease. No cutting for two whole months

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[jays2cool4u]

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.

WTF?

I did a supercalifragilisticexpialidocious today. So, I rock!

 

[krabmas]

Today I did a TMA (c) while the 3rd year amputated toes on the other foot!

Ok so the real story - I worked with the attending on the TMA ( I did most of it) and the 3rd year did the toe amps with the student.

The patient has A fib and showered some emboli, got gangrene of all the toes except the 5th on the left. which lead to the amps.

 

[krabmas]

I am now on infectious disease rotation.

today I saw possible whipple's disease. This is the only intestinal disease that causes neurological effects.

Whipple was a very busy man. He has a disease, a general surgical procedure (pancreaticoduodenalectomy) for cancer of the ampulla Vater or bile duct. And he has a triad for hypoglycemia.

We saw a patient with colon cancer who had a colectomy, then the anastamoses perforated and intestinal contents spued into his abdomen. He was on abx already for prophylaxis. He formed several abscesses and all of them had yeast so he was treated with fluconazole.

 

[jonwill]

I am now on infectious disease rotation.

today I saw possible whipple's disease. This is the only intestinal disease that causes neurological effects.

Whipple was a very busy man. He has a disease, a general surgical procedure (pancreaticoduodenalectomy) for cancer of the ampulla Vater or bile duct. And he has a triad for hypoglycemia.

We saw a patient with colon cancer who had a colectomy, then the anastamoses perforated and intestinal contents spued into his abdomen. He was on abx already for prophylaxis. He formed several abscesses and all of them had yeast so he was treated with fluconazole.

I'm on internal medicine. I had my first 30 hour shift which our team does once a week. While you are on call, you are also on the code team. We had one patient code last night who ended up dying. I'm the chest compression guy. I also did a rectal yesterday. Anyway, this experience is making me very greatful to be going into podiatric medicine.

 

[PODonny]

I'm on internal medicine. I had my first 30 hour shift which our team does once a week. While you are on call, you are also on the code team. We had one patient code last night who ended up dying. I'm the chest compression guy. I also did a rectal yesterday. Anyway, this experience is making me very greatful to be going into podiatric medicine.

PD and ACLS put to use....NICE!

 

[densmore22]

I'm on internal medicine. I had my first 30 hour shift which our team does once a week. While you are on call, you are also on the code team. We had one patient code last night who ended up dying. I'm the chest compression guy. I also did a rectal yesterday. Anyway, this experience is making me very greatful to be going into podiatric medicine.

I can't wait to get paid to stick my finger up a random persons poop schute. Good times, good times.

 

[krabmas]

I'm on internal medicine. I had my first 30 hour shift which our team does once a week. While you are on call, you are also on the code team. We had one patient code last night who ended up dying. I'm the chest compression guy. I also did a rectal yesterday. Anyway, this experience is making me very greatful to be going into podiatric medicine.

As a student I got to do guiacs and pelvics in the ED - woo hoo.

Today on ID we saw a patient that has HIV and lung cancer. The patient had hydropneumothorax a few days ago and some head aches. He had an MRI that had a lesion in it. It was thought to be HIV related. He underwent a brain biopsy. Frozen section reveals adenocarcinoma. His lung cancer metastized to his brain.

 

[jonwill]

As a student I got to do guiacs and pelvics in the ED - woo hoo.

Today on ID we saw a patient that has HIV and lung cancer. The patient had hydropneumothorax a few days ago and some head aches. He had an MRI that had a lesion in it. It was thought to be HIV related. He underwent a brain biopsy. Frozen section reveals adenocarcinoma. His lung cancer metastized to his brain.

Yea, some of this stuff is interesting but quite honestly, these rotations make me very thankful that I chose podiatry.

 

[discusdan]

My first scrub last week and it was an ankle fusion. It was awesome!

 

[jonwill]

My first scrub last week and it was an ankle fusion. It was awesome!

Nice first scrub.

 

[krabmas]

Yea, some of this stuff is interesting but quite honestly, these rotations make me very thankful that I chose podiatry.

definitely. I get sort of board by just questioning the patient, listening to heart, lungs, look at throat, feel lymph nodes, listen to bowels, then rx some drugs based on a guess.

Today I was back on pod b/c I was on call. This AM we had a non-union of the 1st MPJ with a Wright Medical MPJ fusion plate that pussed out and dehissed. This has been occuring for 4 months and toe is not fused. We opened her up, resected the non-union, put in osteoset w/ vancomycin and gentomycin, and a minirail to hold it out to length. We also took some cultures of course.

 

[jonwill]

definitely. I get sort of board by just questioning the patient, listening to heart, lungs, look at throat, feel lymph nodes, listen to bowels, then rx some drugs based on a guess.

Today I was back on pod b/c I was on call. This AM we had a non-union of the 1st MPJ with a Wright Medical MPJ fusion plate that pussed out and dehissed. This has been occuring for 4 months and toe is not fused. We opened her up, resected the non-union, put in osteoset w/ vancomycin and gentomycin, and a minirail to hold it out to length. We also took some cultures of course.

Hydroset rules!!!

 

[krabmas]

tonight I was working in the ED. That is what we do when we are on call over the weekend - 20 hours in the ED over 3 days.

man comes in by ambulance after falling from a 10 foot ladder while cutting a tree. what do you think happened?

nope - not b/l calc fractures.

just the R had a calc fracture - toungue, joint depression, sustentaculum displaced dorsally/superiorly to the medial malleolus. good stuff.

then the L had a choparts dislocation with a displaced 4th met base fracture thru the joint, 4 and 5 mets displaced from the cuboid. And the navicular was dorsal to the talus - sitting on the talar neck and fractured in 3 fragments.

did the guy have palpable pulses you ask? when he came in - yes. by the time I saw him he was lying flat for 3 hours no ice no elevation. non-palpable DP left all other pulses still palpable. DP was dopplerable. lots of swelling.

We tried to close reduce the left foot to relocate the navicular. unsuccessful.

To the OR we went. ORIF w/ ex-fix minirail.

Next will be the calc fracture and the 4th met fracture. the attendings will be tag teaming - 2 feet at the same time - with multiple residents.

 

[Ski Bum]

today i was called in and saw a sweat case of tinea pedis...treated it with OTC lamisil and will have the pt follow up...things are so intense here in residency. So many toes, not enough time in the day to cut all the nails and cure the pandemic of athletes foot...we do all we can out here.

 

[jonwill]

today i was called in and saw a sweat case of tinea pedis...treated it with OTC lamisil and will have the pt follow up...things are so intense here in residency. So many toes, not enough time in the day to cut all the nails and cure the pandemic of athletes foot...we do all we can out here.

Tinea...the silent killer!

 

[krabmas]

today i was called in and saw a sweat case of tinea pedis...treated it with OTC lamisil and will have the pt follow up...things are so intense here in residency. So many toes, not enough time in the day to cut all the nails and cure the pandemic of athletes foot...we do all we can out here.

out of control

 

[densmore22]

today i was called in and saw a sweat case of tinea pedis...treated it with OTC lamisil and will have the pt follow up...things are so intense here in residency. So many toes, not enough time in the day to cut all the nails and cure the pandemic of athletes foot...we do all we can out here.

Are you getting to do some good stuff out there? I mean, are you satisfied with what you're doing as an R1?

 

[krabmas]

I start internal medicine Monday followed by infectious disease. No cutting for two whole months

why not? I am on ID and I got to drain a neck abscess yesterday

Today I saw a lung transplant patient with aspergillus infection in his transplanted lung. And a woman in the process of undergoing organ failure one organ at a time. She has a cardiomyopathy (2 siblings died from this already) she was on the list for a heart transplant and had to be placed on a biVAD (bi-ventricular assist device). The device got a psudomonal infection at the skin-device interface. Then she developed pseudomonal septicemia. The pseudomonas is resistant to almost every medication. But it is suseptable to levoquin. She was on imepenem for a while before the sensitivity came back, so it had some time to go rampant. She is on a ventilator thru a tracheostomy, the biVAD, her kidneys have failed (no more urine output), her liver is currently failing (platelets going down and bilirubin going up), her abdomen is distended to the point that she looks 6 months pregnant. They might withdraw support tomorrow.

 

[jonwill]

why not? I am on ID and I got to drain a neck abscess yesterday

Today I saw a lung transplant patient with aspergillus infection in his transplanted lung. And a woman in the process of undergoing organ failure one organ at a time. She has a cardiomyopathy (2 siblings died from this already) she was on the list for a heart transplant and had to be placed on a biVAD (bi-ventricular assist device). The device got a psudomonal infection at the skin-device interface. Then she developed pseudomonal septicemia. The pseudomonas is resistant to almost every medication. But it is suseptable to levoquin. She was on imepenem for a while before the sensitivity came back, so it had some time to go rampant. She is on a ventilator thru a tracheostomy, the biVAD, her kidneys have failed (no more urine output), her liver is currently failing (platelets going down and bilirubin going up), her abdomen is distended to the point that she looks 6 months pregnant. They might withdraw support tomorrow.

GEEZ, thanks for brightening our day!

 

[Ski Bum]

Are you getting to do some good stuff out there? I mean, are you satisfied with what you're doing as an R1?

I am being sarcastic...i am having a blast and staying busy

 

[Stafocker]

I'm in China working with Special Olympics International - Healthy Athletes

Next week: Anesthesia (in Pittsburgh, PA, USA)

 

[densmore22]

I am being sarcastic...i am having a blast and staying busy

I figured you were being sarcastic. That's a program on my to extern list whenever I get to be a 4th year so I just was curious.

 

[jonwill]

Where is everyone? Probably working. I finished Internal Medicine last week. Now, I'm on Infectious Disease for a month. What am I doing here again??? Oh yea, I'm a podiatric surgery resident. I'm going to have to be re-trained next month

 

[krabmas]

Where is everyone? Probably working. I finished Internal Medicine last week. Now, I'm on Infectious Disease for a month. What am I doing here again??? Oh yea, I'm a podiatric surgery resident. I'm going to have to be re-trained next month

That's how I feel, Just when I feel like I am getting the hang of cutting people they send me away to lose all power, coordination and technique that I developed.

This weekend I was on call and saw:

Gas Gangrene of a foot - took to OR and amputated toes 3-5 and met head 3 and 4. He will return to OR for TMA. This was caused by a diabetic stepping on a nail. He did not feel it for about 2 days. He took it out, went to Urgent Care received 4 abx. Then 3 weeks later went to our ER, b/c BS was 570 and usually is 160-190. He was admitted w/ cellulitis, podiatry got the consult 2 days after his admission. The x-ray had gas bubbles in the 3rd and 4th toes and was not read for days. Luckily we get the images on the computer and don't need a radiologist's dx.

In the ER I saw a guy on coumadin suffered fall and head trauma w/ head lac. I sewed up his head and after the CT we found out that he had 3 intracranial bleeds. He was admitted.

Saw a calc fx, ankle fx, tib fib fx, colle's fx, 5th met fx. I love fractures, because then I get to apply splints!

 

[jonwill]

Saw a calc fx, ankle fx, tib fib fx, colle's fx, 5th met fx. I love fractures, because then I get to apply splints!

At my program, we like to actually fix the fracture (except the colle's)!!!

 

[krabmas]

At my program, we like to actually fix the fracture (except the colle's)!!!

We try to practice concervative care here. jk

The fx will be fixed eventually. There is no rush to take them to the OR the same day.

 

[IlizaRob]

I saw a patient who came in to the ER today with onychogryphosis. Oh man, had we gotten to him a little later, he would have died. Good times, good times.

 

[jonwill]

I saw a patient who came in to the ER today with onychogryphosis. Oh man, had we gotten to him a little later, he would have died. Good times, good times.

Did you say, "Call a code and get the cart!!!"?

 

[crhoody12]

Just curious...Has anyone delivered or participated in delivering a baby? One podiatrist I shadowed said during his residency at one point, he was the only doctor around and had to do the job. I think that would be just an amazing experience.

 

[NatCh]

Just curious...Has anyone delivered or participated in delivering a baby? One podiatrist I shadowed said during his residency at one point, he was the only doctor around and had to do the job. I think that would be just an amazing experience.

I've helped deliver two! Messy, messy, messy.

Nat

p.s., They're both still messy.

 

[Stafocker]

Just curious...Has anyone delivered or participated in delivering a baby? One podiatrist I shadowed said during his residency at one point, he was the only doctor around and had to do the job. I think that would be just an amazing experience.

....or devastating

I've heard from other residents that have done this. Apparently, they can come out quicker than you'd expect and slippery that you expect.

 

[jonwill]

After two months off service, I'm finally back. I did an Austin/Akin with arthroplasty skin-to-skin today and it never felt sooooo good!!! We've got a great gig people.

 

[jonwill]

Lesson of the week:

Ice = A lot of ankle fractures

 

[Feli]

Lesson of the week:

Ice = A lot of ankle fractures

Heck yeah... a lot of fractures of any kind. You might see some other good stuff also with the roads getting bad. Why do you think I did my MI clerkships in the summer?

Simple old driveway ice was even what did poor old doc Atkins in.

 

[jonwill]

Heck yeah... a lot of fractures of any kind. You might see some other good stuff also with the roads getting bad. Why do you think I did my MI clerkships in the summer?

Simple old driveway ice was even what did poor old doc Atkins in.

Yea, we also had an 18 year old try and steal a Jeep. He got it but was chased by police. He hit some ice and rolled it which resulted in an open ankle fracture. My co-resident was called in at 3am to take it to the OR, clean it out, and put traction on it. So now we got this guy in the hospital being guarded by the police. I'll probably get to do the ORIF on Monday.

 

[gustydoc]

He was thrown 30 yards from the jeep when it rolled. He's lucky an ankle fracture was all he ended up with. By the way after three months externing I think I should do the ankle. Well it was worth a shot anyway.

 

[krabmas]

Heck yeah... a lot of fractures of any kind. You might see some other good stuff also with the roads getting bad. Why do you think I did my MI clerkships in the summer?

Simple old driveway ice was even what did poor old doc Atkins in.

it was sidewalk ice. there are few drive ways in Manhattan

 

[krabmas]

I got to do a choparts amputation skin to skin yesterday!

very exciting for me, not so much for the patient.

 

[jonwill]

I got to do a choparts amputation skin to skin yesterday!

very exciting for me, not so much for the patient.

Hey, they didn't need their forefoot anyway

It was a bunion day for me yesterday. I did do two IPJ fusions which I had never done before.

 

[Stafocker]

I got to do a choparts amputation skin to skin yesterday!

very exciting for me, not so much for the patient.

Dude, i did a TMA in skin to skin this week. I rocked the mic, rightttttt.....

 

[Feli]

...I did do two IPJ fusions which I had never done before.

Do you mean 1st IPJ?

Hard to imagine you haven't done dozens of hammertoe PIPJ arthrodesis procedures already. Heck, at some programs, that's basically all first year residents are allowed to do.

 

[jonwill]

Do you mean 1st IPJ?

Hard to imagine you haven't done dozens of hammertoe PIPJ arthrodesis procedures already. Heck, at some programs, that's basically all first year residents are allowed to do.

Yea, 1st IPJ fusions. I can do hammertoes in my sleep by now! I tried to avoid programs that don't let 1st years do a whole lot. Everybody learns differently and some people like to see a lot before doing it. I'm one of those people that learns by doing. I've got nearly 150 C cases already and I've only been on podiatry for 4 months.

 

[Feli]

Yea, 1st IPJ fusions. I can do hammertoes in my sleep by now! I tried to avoid programs that don't let 1st years do a whole lot. Everybody learns differently and some people like to see a lot before doing it. I'm one of those people that learns by doing. I've got nearly 150 C cases already and I've only been on podiatry for 4 months.

Yep... I figured it was HIPJ, but just thought I'd ask. What type of fix do they use there... single lag screw? I've read a bit about that procedure but never seen a case... or even a patient where it was really indicated (aside from an advanced OA where it was pretty much auto-fused already lol).

You are right that the programs really are different in how they approach residency training in terms of volume, stepwise progression, etc. That issue of Clin PM&S was really a neat perspective from some program directors. It's tough for me to say how I learn best; I'm hoping to figure that out by interviews a year from now . I tried to visit a variety of styles next year... high/low volume, high/low trauma, high/low weekly academic requirements, high/low student involvement, etc.

 

[jonwill]

I was called to the ER at 3AM this morning for a young man who accidentally dropped a rotary saw on his foot. The hallux was gone and the 2nd digit was about halfway lacerated with a comminuted proximal phalanx.

 

[Stafocker]

A guy on NYE was bored and lonely so he shoved a broomstick up his ass. He was bleeding from his rectum during and after examination. Funny part was that he waited 2 days to come to the ER.

I asked him "why did you wait?"

his response "I had to clean up. it looked like a crime scene."

He ended up perforated his colorectal junction and we admitted him for surgery..... the end.

 

[iyyi]

Did anyone else see the story about the man bringing grenades into the ER at Detroit Receivig Hospital(DMC)? Jonwill do you wear a flak jacket?

 

[jonwill]

Did anyone else see the story about the man bringing grenades into the ER at Detroit Receivig Hospital(DMC)? Jonwill do you wear a flak jacket?

No, I didn't hear about that but it doesn't suprise me We do a lot at Detroit Receiving. The ER there is crazy!

 

[gustydoc]

I'm not suprised at all. Last week I was at the DMC clinic and the nurse told me they had a bomb threat a week ago. Twice in less than a month. Only in Detroit.

 

[krabmas]

I am on my medicine rotation now - no cutting for me.

We practiced Central lines in a Sim lab - pretty cool, I'm def ready for the real thing.

Then between the 2 nights that I've had on call so far I admitted a 2cm pericardial effusion w/ RA collapse that just missed going into cardiac tamponade.

A guy with a PE after a 12 hour car ride and no other history.

A no ST elevation MI (NSTEMI).

And a r/o stroke, AMS, rhabdomyolysis.