It’s been a couple of weeks since my first post and quite a bit has happened. I successfully conquered my finals and clinic requirements and spent my last few days in Davenport with friends and loved ones. Sunday, Kyle and I loaded my car with the 6 bags full of my belongings and I took off.
It took me about 14 hours to get to Jackson. The drive was pleasant and uneventful. The scenery was beautiful with TONS of trees and I arrived around 11 p.m. I spent Monday unpacking and getting settled into my new room, as well as getting to know my new roommate, Crystal, and her cute little dog, Gizmo. Crystal is very kind, accommodating, quite talkative, and so far has been the epitome of “southern hospitality.”
Tuesday was my big 1st day at the VA. My first shift started at 8 am. Even though the VA is only about 30 mins from where I am staying, I left an hour early to account for traffic and to make sure I had time to recover from getting lost, as my Garmin tends to take me on some wild adventures. Just as I suspected, the Garmin took me for a ride and I ended up having to call Dr. Pavalock to figure out how to get back. Apparently, the Garmin took me to the “bad” part of town but I was able to find my way back and was about 10 minutes late to my first shift. At least I had called Dr. Pavalock, so he knew I’d be late. Great first impression.
So now on to the meat and potatoes…my first day. We saw 6 patients the first day, three of which were new patients. It was very interesting to watch how Dr. Pavalock interacted with and assessed all of the patients. I was comforted by the fact that his new patient assessment and chiropractic assessment were very similar to what I have been doing with Dr. Crisp for the last 8 months of my clinical experience. Although Dr. P is a Palmer graduate, it is cool to see that even after being out for 15 years (I think that is how long it’s been since he’s graduated) his assessment has not diverged much from the core of what he’s been taught. It is reassuring to me that what I am learning will serve me well for years to come. Dr. P has a great sense of humor. I told him that I am from Montana and grew up on a farm/ranch so now I am branded (no pun intended) as a “cowgirl.” Although, Dr. P and has been teasing me about not being a “real” cowgirl because I’ve never used a bull whip and don’t know how to rope animals, lol.
Another interesting note about Dr. P is that he wears nitrile gloves while assessing his patients. I asked him why and he said he wears them for multiple reasons. He first wore them because he had burned his hand on his oven one day and didn’t want to rub his open sore all over his patients while working with them. Pretty gracious of him, don’t ya think? Hee, hee . Then he decided that the gloves were a good idea not only to protect his patients but also to protect himself, so the gloves have stayed. When I get to start working with patients, I will have to wear gloves as well because the patients are used to it and expect it. I am a little nervous about wearing gloves because I’m worried it will make my ability to palpate more difficult but then again when I transitioned from the student clinic to the public clinic I had the same fears about assessing patients without gowning them and its only a matter getting used to what you have to feel through. By the time I’m done I will be able to feel a penny through a phone book, lol.
So onto some interesting cases….day 1 we saw a patient with neck pain and numbness in the fingers of his left hand. The strange thing was that even though he stated his fingers felt numb, while assessing his sensation in that arm he had increased sensitivity to light touch and decreased sensitivity to sharp touch in the C7 dermatome. For those not familiar, light touch usually is the first thing to go when someone has numbness. His right side was normal and his x-rays showed some degeneration at C5/C6. Because the neuro tests came up as so strange, Dr. P did not adjust him and sent the patient for an MRI. The next day the radiologist called and reported that the patient had an infection in the disc between C5 and C6 that was eating the vertebrae above and below it….MAJOR contra-indication to adjusting! Dr. P consulted with the patient’s primary care provider and he is now being managed appropriately.
Another patient presented with low back pain and his x-ray showed the biggest osteophyte (bone spur) off of the front of the sacrum I have ever seen! It even took on the shape of the anterior of the disc and looked like a big claw off the front of the sacrum, almost connecting to the bottom of the L5 vertebral body.
Another patient with low back pain had some modic type 1 changes on his MRI in the L2/L3 area, meaning that he has some bone marrow edema going on due to degeneration. Dr. P was curious about the findings on the MRI and so we went to chit-chat with the radiologist about it as well as to discuss the case of the patient with the disc infection. The radiologist explained the modic types to us and then brought up a very interesting point. The radiologist said that while the modic changes are something to be monitored, it is not terribly concerning and usually resolves itself but there is the potential that the edema/inflammation seen there could develop into an infection and become an osteomyelitis/discitis situation as we saw in the other patient. This was interesting to me because as we learn it in school, the two seem very separated. When you see modic changes, you think of it as simply evidence of degeneration happening in the spine which happens due to normal wear and tear of life BUT what if an organism does get into that inflamed site? So my self-inflicted homework this weekend has been to find out if this has happened and been documented in literature. If it has, how likely is it to happen, what could cause it to happen, and what is the appropriate management?
So far, I have spent at least an hour or two every night looking up various things related to my day and I find it funny that I am doing more homework now than I did at school. As Dr. Crisp would say “Welcome to Practice!” It is awesome though and reassuring that the learning curve is going to be tremendous while I am here.
Well, this has been a LONG blog post so I am going to cut it off now. Thanks again for reading and I’ll update you all again soon. Until then, have a good one!
Alicia Ruiz, 10th Trimester Student