True Stories From Podiatric Residency

[krabmas]

Great case... did you get the C, or was it mostly done by vascular?

It was me and the pod attending. No vascular involved.

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[jonwill]

As the SDN Pod forums mature, I'm hoping to see some new first years with some great stories!

 

[gustydoc]

My second day of residency and I got three ankle fractures. As a new first year! I think I picked the right program.

 

[Feli]

My second day of residency and I got three ankle fractures. As a new first year! I think I picked the right program.

I've met SDN pod celebrities gustydoc and jonwill this month... I think I picked the right clerkship

 

[jonwill]

I saw gustydoc in the ER at 2AM this morning picking bullets out of a guys foot. I swear he just lurks around the ER waiting for this stuff!

 

[SportDPM]

Are you guys at DMC?

 

[jonwill]

Are you guys at DMC?

Yes.

 

[gustydoc]

I had two ankle fractures and one gunshot wound that night! I could barely keep my eyes open the next day in surgery, but it was definitely worth it. By the way Jon, did I tell you about the consult I got last Friday afternoon? I was consulted for bilat leg "ulcers". When I got there I removed the dressings and hundreds of maggots poured out onto the floor. I still can't eat rice.

 

[IlizaRob]

I had two ankle fractures and one gunshot wound that night! I could barely keep my eyes open the next day in surgery, but it was definitely worth it. By the way Jon, did I tell you about the consult I got last Friday afternoon? I was consulted for bilat leg "ulcers". When I got there I removed the dressings and hundreds of maggots poured out onto the floor. I still can't eat rice.

That sucks, you guys are doing surgery all day? Losers!! I've been on medicine this month and just wish that I could do it my whole life. I never want to leave this rotation.

 

[jonwill]

That sucks, you guys are doing surgery all day? Losers!! I've been on medicine this month and just wish that I could do it my whole life. I never want to leave this rotation.

Oh man, I wish I were you! I'm finishing up my first month of ortho trauma and still have two months to go. I've done some good cases. I did an Ilizarov frame on a pilon a few days ago.

 

[215512]

MAGGOTS??? Why were there maggots? I've never heard of a disease with them....

 

[dpmgrad]

I had two ankle fractures and one gunshot wound that night! I could barely keep my eyes open the next day in surgery, but it was definitely worth it. By the way Jon, did I tell you about the consult I got last Friday afternoon? I was consulted for bilat leg "ulcers". When I got there I removed the dressings and hundreds of maggots poured out onto the floor. I still can't eat rice.

At least the wound should be clean since maggots technically eat away dead tissue.

 

[gustydoc]

MAGGOTS??? Why were there maggots? I've never heard of a disease with them....

The disease is called neglect. The guys friend brought him into the ER after finding him living in squalor in his apt. IV drug users don't take very good care of themselves. Infected leg ulcers + filthy living conditions and flies = maggots. I only I'd had a camera. Oh well, there is always next time.

 

[gustydoc]

At least the wound should be clean since maggots technically eat away dead tissue.

Ive seen the medical maggots as a student and beleive me these were definitley more of the detroit dumpster variety.

 

[Foot Doc]

just curious, how are your numbers? How many ortho trauma months do you do?

 

[jonwill]

just curious, how are your numbers? How many ortho trauma months do you do?

We do 3 months of ortho trauma our second year. I did nearly 400 C my first year.

 

[Foot Doc]

We do 3 months of ortho trauma our second year. I did nearly 400 C my first year.

I'll have 7 by the time I graduate (4 first year, 2 second, and 1 third).....did a little under 500 C cases first year....already got my numbers to graduate

 

[Robotjim]

I'll have 7 by the time I graduate (4 first year, 2 second, and 1 third).....did a little under 500 C cases first year....already got my numbers to graduate

Im sorry guys but whats a C case? Thanks

 

[Foot Doc]

the level of the case depends upon your involvement in the case....for example, in an "A" case you are basically observing it....in a "B" case, you scrub but only do less than half of the surgery.....in a "C" case, you're basically doing the entire case from incision to closure....you gotta watch it, though, over externships-a lot of programs log "C" cases because they were the only resident in on the case, even if they really didn't do anything but retract!

 

[jonwill]

I'll have 7 by the time I graduate (4 first year, 2 second, and 1 third).....did a little under 500 C cases first year....already got my numbers to graduate

7 Months??? I think I'd shoot myself! We do 3 straight months during our second year (I'm in my 2nd month right now) at the county's level I trauma center. I'm coming off of a 30 hour call shift today and am going back for another one tomorrow. 7 months doesn't sound very appealing

 

[Foot Doc]

its grueling but awesome-ours is a level I also. We have a pod resident rotate with one of the ortho teams every month, so all of the foot and ankle stuff come to us. We see tons of open and closed fractures and pull general ortho call as well. Fortunately, we don't have back-to-back months, we alternate every quarter or so. We've just upped our residents from 2 per year to 3 so it'll cut back the time the PGY-1's rotate on ortho, but 4 months is plenty! We also rotate with a pediatric ortho and a foot and ankle ortho for a couple of months each, so we get our share.

 

[jonwill]

its grueling but awesome-ours is a level I also. We have a pod resident rotate with one of the ortho teams every month, so all of the foot and ankle stuff come to us. We see tons of open and closed fractures and pull general ortho call as well. Fortunately, we don't have back-to-back months, we alternate every quarter or so. We've just upped our residents from 2 per year to 3 so it'll cut back the time the PGY-1's rotate on ortho, but 4 months is plenty! We also rotate with a pediatric ortho and a foot and ankle ortho for a couple of months each, so we get our share.

Yea, this is actually the 1st year that we are doing it straight. It's pretty much the same situation where we get to do most of the foot and ankle trauma because we always have a pod on the team. We used to do 4 non-continous months between our 2nd and 3rd year but recently started taking 4 residents a year instead of three so we've cut down to three months. The continous month thing was at the request of the ortho chief. It has it's pros and cons but I'll survive! We see enough trauma on our own service but I guess repetition is good.

 

[Foot Doc]

case volume rules. There are huge differences between programs that have minimal volume and those that have 3X the MAV...like my director, Dr. Ford, says: "There are doers and writers...those that are doing are too busy to write and those that are writing aren't doing."

 

[jonwill]

case volume rules. There are huge differences between programs that have minimal volume and those that have 3X the MAV...like my director, Dr. Ford, says: "There are doers and writers...those that are doing are too busy to write and those that are writing aren't doing."

I chose my program based on volume. I'm one of those guys that learns by doing. I can read until I'm blue in the face but it doesn't do much good. I need to be in the OR doing it. Maybe you don't need to do 500 bunions to know how to do a bunion, but it sure does help!

 

[Foot Doc]

i think learning by doing is the ONLY way to be good at surgery.....thats just something that you can't get good at by reading about it. Whats up with the other programs in Detroit? We just transferred a guy in from Kern? I've heard nothing but good about DMC. What about Bosford?

 

[jonwill]

i think learning by doing is the ONLY way to be good at surgery.....thats just something that you can't get good at by reading about it. Whats up with the other programs in Detroit? We just transferred a guy in from Kern? I've heard nothing but good about DMC. What about Bosford?

Some of the Kern guys do off rotations at a few of our hospitals so I actually heard about the resident leaving and heading for Kentucky. The programs are hit and miss here. I think there are a handful of respectable programs and some that people should avoid like the plague. That's about as specific as I ever get publicly. To each his own I guess. Some people are really looking for the mellow/slow program. DMC is so big with so much variety, you really can't compare it with anything around here.

 

[Feli]

...Whats up with the other programs in Detroit? We just transferred a guy in from Kern? I've heard nothing but good about DMC. What about Bosford?

I just clerked at DMC and StJohn NS. I also visited Oakwood a few times while I was in town.

-DMC had the highest surgical volume, inpatient experience, and trauma.
-Oakwood was probably the most academic, and clinic was good also. Hospitals are in a pretty good area with a mix of trauma (esp from the airport) and elective patients.
-StJohn had a good mix, and their clinic was strong since residents get to continuously follow a lot of good amount of their own patients from start to finish. If the resident sees the patient at the initial ER/clinic visit, then that resident will do the surgery (C), and they will also be the one to do that patient's post-op checks in clinic (unless they're off service).

I liked all 3 of the programs I saw and will probably interview for them depending on which CRIPS I go to. I think that a lot of the Detroit area programs offer solid training - esp trauma - and would get a lot more student interest if they weren't in... well, Detroit.

 

[krabmas]

Today I assisted a hand surgeon in the pollicization of the index finger. That means that we took the index finger and made it into a thumb. I think this was the coolest procedure I have seen so far.

The other times I have worked with her she actually lets me do surgery on the hand. But this case was on an 11 month old and it is a very rare case so she did all the work. We closed the skin with chromic gut. I've seen the stuff on the suture wall but never seen it used until now.

 

[jonwill]

Today I assisted a hand surgeon in the pollicization of the index finger. That means that we took the index finger and made it into a thumb. I think this was the coolest procedure I have seen so far.

The other times I have worked with her she actually lets me do surgery on the hand. But this case was on an 11 month old and it is a very rare case so she did all the work. We closed the skin with chromic gut. I've seen the stuff on the suture wall but never seen it used until now.

Pretty sweet Kraby. It sounds like a good experience. I'm still on ortho trauma (we do three straight months our second year) and last night, a 21 year old tried to navigate an on ramp from one freeway to another going 85 MPH on his crotch rocket. Needless to say, he came in as a trauma code. He had a closed distal radius fracture, a sacral fracture, a superior/inferior rami fracture, and an open femur fracture. Needless to say, after a little over a month on trauma, I'm not a big motorcycle fan!

 

[Foot Doc]

...I'll still never give up my Hayabusa!

 

[GoldenGustie]

Even since I had a state patrol officer come in and show pictures of a motorcycle vs. semi accident during drivers ed (yes that was 10 years ago) I haven't been as interested in motorcycles. Props to those that enjoy them...I am more of a fan of fast cars myself!

 

[Foot Doc]

Even since I had a state patrol officer come in and show pictures of a motorcycle vs. semi accident during drivers ed (yes that was 10 years ago) I haven't been as interested in motorcycles. Props to those that enjoy them...I am more of a fan of fast cars myself!

..yeah, **** happens to innocent drivers once in awhile, but 99% of the guys I've worked on have been speeding, drinking, or cutting up on their bikes, so I'm not convinced enough yet to give up mine!

 

[Feli]

...yeah, **** happens to innocent drivers once in awhile, but 99% of the guys I've worked on have been speeding, drinking, or cutting up on their bikes, so I'm not convinced enough yet to give up mine!

Exactly.

I know guys who use a street bike for a few sober rides a week, but other guys have too much fun and tempt fate WAY too often. You can probably guess which group are the ones who are MUCH more likely to end up in the ER (or worse, the OR).

I really wanted to buy a Ninja6 or Ninja5 when I came down to Miami (yes, those are ***** bike compared to Haya, but I have limited funds and it'd only be my second bike ever). All the traffic and bad drivers scared me out of it, but depending on where I go for residency, I might get a bike again...

 

[Feli]

Half done with my month at West Penn...

In just two weeks, I've already seen Ilizarov, Agility, advanced PTTD stuff, and lots of other crazy cases. The emphasis of this training program is clearly advanced clinical decision making. It's a neat experience with a lot of real high level, high power, DPMs.

It's so nice to finally have my first day off, though

 

[Foot Doc]

i don't blame you for not ridin in Miami...when I was at Barry, Miami was a ****hole for motorcyclists.....I don't think anything has changed in a year and a half, so I'd wait to get a bike until you get outta there!

 

[Foot Doc]

I'm working with a foot and ankle ortho guy this month and so far we've done 2 total ankles, a few scopes, 4 ankle fusions, 3 sub-talar fusions.....not to mention the other forefoot stuff...and I still have 2 weeks left with him!

 

[Feli]

Sent you a PM, Big P...

 

[jonwill]

I'm working with a foot and ankle ortho guy this month and so far we've done 2 total ankles, a few scopes, 4 ankle fusions, 3 sub-talar fusions.....not to mention the other forefoot stuff...and I still have 2 weeks left with him!

Hey, is my boy, JD your co-resident?

 

[Foot Doc]

Hey, is my boy, JD your co-resident?

yeah, hes one of my 1st years....

 

[Feli]

case volume rules. There are huge differences between programs that have minimal volume and those that have 3X the MAV...

...i think learning by doing is the ONLY way to be good at surgery...

I chose my program based on volume....

... I need to be in the OR doing it. Maybe you don't need to do 500 bunions to know how to do a bunion, but it sure does help!

"We are what we repeatedly do. Excellence, then, is not an act, but a habit. "
-Aristotle

...So I guess you guys are out to become F&A trauma surgeons - and darn good ones, huh?

 

[gustydoc]

So yesterday I was driving to the hospital to do an ankle fracture and I heard a news report on the radio about a guy who killed someone and stole their maseroti, got in a high speed car chase and totaled the car. I went to pre-op my patient at the hospital and he was handcuffed to the bed with two Detroit cops at his bedside. Turns out he was the guy I had just heard about and he was #5 on the list of Michigan's most wanted with an outstanding warrant for murder prior to his latest carjacking/murder. Ortho fixed his femur fracture and then I fixed the ankle. You can't make this stuff up. Just another day as a 1st year resident in Detroit.

 

[jonwill]

So yesterday I was driving to the hospital to do an ankle fracture and I heard a news report on the radio about a guy who killed someone and stole their maseroti, got in a high speed car chase and totaled the car. I went to pre-op my patient at the hospital and he was handcuffed to the bed with two Detroit cops at his bedside. Turns out he was the guy I had just heard about and he was #5 on the list of Michigan's most wanted with an outstanding warrant for murder prior to his latest carjacking/murder. Ortho fixed his femur fracture and then I fixed the ankle. You can't make this stuff up. Just another day as a 1st year resident in Detroit.

Classic!

http://www.detnews.com/apps/pbcs.dll/article?AID=/20080818/METRO/808180388/1409/METRO

 

[SportPOD]

So yesterday I was driving to the hospital to do an ankle fracture and I heard a news report on the radio about a guy who killed someone and stole their maseroti, got in a high speed car chase and totaled the car. I went to pre-op my patient at the hospital and he was handcuffed to the bed with two Detroit cops at his bedside. Turns out he was the guy I had just heard about and he was #5 on the list of Michigan's most wanted with an outstanding warrant for murder prior to his latest carjacking/murder. Ortho fixed his femur fracture and then I fixed the ankle. You can't make this stuff up. Just another day as a 1st year resident in Detroit.

An 18 year old that's #5 on the most wanted list! Wow, brings back memories of my days in Detroit. Enjoy your time while there and check out some of the great Indian restaurants around town.

 

[Feli]

So yesterday I was driving to the hospital to do an ankle fracture and I heard a news report on the radio about a guy who killed someone and stole their maseroti, got in a high speed car chase and totaled the car. I went to pre-op my patient at the hospital and he was handcuffed to the bed with two Detroit cops at his bedside. Turns out he was the guy I had just heard about and he was #5 on the list of Michigan's most wanted with an outstanding warrant for murder prior to his latest carjacking/murder. Ortho fixed his femur fracture and then I fixed the ankle. You can't make this stuff up. Just another day as a 1st year resident in Detroit.

I'd round on that guy as a team - or not at all - especially if he has any "visitors." Yikes.^

...Personally, I'm fairly sold on Det area for my residency training, but this kinda stuff does NOT make it an sell easy to the wife. While I was clerking at DMC, she saw that "48 Murder" TV show, called me, and guess what hospital was featured on it... yep, SGH. Maybe I will have to tell her that all the Detroit PMS36s provide fantastic life/disability insurance plans?

 

[gustydoc]

Told you I couldn't make it up. I really wanted to skip the post-op block on this guy, but I didn't. I have a feeling he will get what he deserves in the long run.

 

[jonwill]

I'd round on that guy as a team - or not at all - especially if he has any "visitors." Yikes.^

...Personally, I'm fairly sold on Det area for my residency training, but this kinda stuff does NOT make it an sell easy to the wife. While I was clerking at DMC, she saw that "48 Murder" TV show, called me, and guess what hospital was featured on it... yep, SGH. Maybe I will have to tell her that all the Detroit PMS36s provide fantastic life/disability insurance plans?

Yea, I always advise the married students that are considering DMC or other Mo-town programs to make sure they get their spouse up here for a visit. As soon as the spouse mentions to friends/family that you are considering residency up here, all the people (most of whom have never been to Detroit) start talking. That's why it's good to get them up here to show them that it's got plenty of safe, nice places to live. I wouldn't suggest living in east/west Detroit though even if you CAN buy a house for 10K!!!

 

[IlizaRob]

So yesterday I was driving to the hospital to do an ankle fracture and I heard a news report on the radio about a guy who killed someone and stole their maseroti, got in a high speed car chase and totaled the car. I went to pre-op my patient at the hospital and he was handcuffed to the bed with two Detroit cops at his bedside. Turns out he was the guy I had just heard about and he was #5 on the list of Michigan's most wanted with an outstanding warrant for murder prior to his latest carjacking/murder. Ortho fixed his femur fracture and then I fixed the ankle. You can't make this stuff up. Just another day as a 1st year resident in Detroit.

That's crazy Gusty. Did you slap him around a bit after he was under the gas?

 

[Feli]

Yea, I always advise the married students that are considering DMC or other Mo-town programs to make sure they get their spouse up here for a visit. As soon as the spouse mentions to friends/family that you are considering residency up here, all the people (most of whom have never been to Detroit) start talking. That's why it's good to get them up here to show them that it's got plenty of safe, nice places to live...

That is good advice^

My wife (Miami native) came up to visit me for an extended weekend while I was at StJohn North Shores. I took her to the beach, shopping, a movie, out to eat/drink on the Nautical Mile, etc. She liked what she saw.

The St Claire Shores and Grosse Pointe in - June - experience that she saw is not exactly a day-to-day representation of the Detroit area. Maybe, for the sake of complete perspective, I will bring her back and show her SGH area in December or January weather? On second though... then again, maybe ignorance is bliss

 

[gustydoc]

That's crazy Gusty. Did you slap him around a bit after he was under the gas?

No slapping, but lets just say his handcuff on his other ankle was put back on very snug.

 

[SharpEdge]

hey guys,

i thought i would introduce myself. I'm a Podiatric Senior House Officer (SHO) (kinda like an intern / resident) in England working in a Podiatric Surgery Unit.

Thought i'd join in on the day to day life of you chaps.

We excised a huge Neurolemmoma (or Schwannoma, whichever you like) from the medial planter nerve of a 23yr old male. At the time we was unsure what it was attached to, think we took out quite a lot of the plantar fascia! cool surgery though

The other day i had a patient attend with sutures in the nail of her hallux, she informed me she had banged her toe and the nail was hanging off. The A&E (ER) doc attempted to suture the nail back to the bed??????