Week 3 Reflection

This past week flew by! With the exception of Monday, which was spent researching, my days were jam packed with new things. Tuesday, Wednesday, and Thursday were all spent in the OR where I was able to observe the different techniques for procedures including ACL grafts, meniscectomys, rotator cuff repairs, and labrum repairs. Being able to watch similar surgeries in different hospitals was also very interesting, being able to not only compare and contrast the different techniques of the surgeons and the rest of the surgical staff, but also the differences in the ORs themselves, the different  set up and equipment. My favorite surgery this week was watching the ACL with an autograft of the hamstring. I found it really neat being able to see the hamstrings be harvested, and then watching the hamstrings be cleaned and sized for the graft. I also found the allograft of the Achilles tendon to be really fascinating. It's so strange to think about having a piece of someone else's body in your knee, or anywhere else for that matter. I finished off my week with a very busy Friday in the office. I love the office days, especially Friday because I am there all day! Friday we saw 25 patients, and with each and every patient we go through H.O.P.S. (History, Observation, Palpations, and Special Tests), in order to diagnose the patient. I have learned a variety of tests to aid in the diagnosis for so many different injuries, but I have also learned narrow down what type of injury based just on what the patient says and where they describe their pain. I also feel like I have become very well versed on the anatomy of the shoulder and the knee, although we saw many other injuries, a majority of the injuries we saw on a daily basis were shoulders and knees. Through observing Dr. Hennig's different appointments I also have learned a lot about the different treatment options for a patient based on the type of injury, level of pain, and whether or not the injury interferes with the daily routine of the patient. These past two weeks have been so educational and I am sad that it is all coming to a close, but I am feeling very confident in my choice for my future profession!

May 22nd- Day 15

Today was my last day in the office with the amazing staff at Advanced Orthopaedic Specialists in Gilford! My last day was a long one, we saw 25 different patients of all ages and injuries, and at least 10 of the patients we saw today had to be scheduled for surgery due to their injury! Today I saw a variety of cases varying from fused ankles, torn ACLs, broken elbows, torn rotator cuffs, to even a pneumothorax! Every patient was a new story which kept Dr. Hennig, his PA Kyle, the nurses, and myself shuffling around to retrieve cortisone injections, send off for x-rays, or wheel around the ultrasound machine. Although this day has left me exhausted I could not have asked for a better day! I'm so bummed that it was my final day in the office because I had finally fallen into the routine and felt right at home there. As cheesy as it sounds when I walked in this morning I asked the receptionist Larry if I could head right into the office since I had beat Dr. He might there and Larry had responded "Sure why not your part of the family now." That conversation happened this morning whether you choose to believe it or not, and to be honest I did finally feel like I had found my little niche here. Sadly I won't be going back into the office since Monday is Memorial Day but I will get one last day in the OR next week which I am looking forward to!

May 21st- Day 14

Sadly today was very short in the OR back at LRGH. Most of Dr. Hennig's patients were at the hospital today instead of Hillside Surgical Center so I was only able to watch one procedure. I watched another ACL surgery of a young male athlete. The patient chose to have an autograft since he is still young and active and Autografts in athletes have smaller chance of tearing a second time versus allografts. The patient chose to have his hamstrings harvested from the graft, so the procedure was very similar to the one I watched on Tuesday but it was just as interesting to watch the second time as it was the first! Since I was only able to see one surgery today Dr. Hennig has me coming back to the OR next Tuesday so I can see a few more before I wrap up my senior project! I can't believe how fast senior project has gone by, I don't want it to end!

May 20th- Day 13

Today I woke up early and drove through the sleepy town of Andover as I made my way over to Dartmouth-Hitchcock Orthopedic Surgical Center. I watched two ACL repairs, so the surgeries were not much different from the types of surgeries I've been watching in Gilford, but it's always great to see how different surgeons work and the different techniques they use. Today I was with Dr. Ames, the Athletic Trainer, Molly McNeil, and the rest of their surgical team! The first patient's MRI was inconclusive but there was a possibility of a torn ACL. Once we were able to get inside her knee we discovered a partial thickness tear that was rubbing against the head of the femur which was creating the pinching the patient was feeling. We also discovered the patient had grade three arthritis which was causing most of her pain in the joint. Since it was only a partial thickness tear, Dr. Ames decided to just do a debridement of the knee to alleviate some of the pinching the patient was feeling. The next patient tore his ACL quite a while ago and recently decided to get an allograft (a graft from a cadaver). Dr. Ames decided to use an Achilles' tendon, which I was able to watch the tendon be prepped. It had to be cut down to the correct size and it had to be sutured on both sides. The Achilles' tendon was a cool tendon to see because of the shape and size of it. It was really cool seeing my first allograft today but if I had to choose between which procedure to watch in the future I think I would choose the autograft because I am able to watch that be harvested right then and there. Overall it was a great day at Dartmouth-Hitchcock, the OR was very different from both Concord and LRGH, and it was an awesome opportunity to meet more medical professionals in the field of orthopedics!

May 19th- Day 12

I was able to spend my 18th birthday in the OR which was the best birthday gift I could have ever asked for! My day with Dr. Hennig was jam packed full of new and interesting things. The first of the two surgeries I watched today was a torn ACL repair. Since the ACL is located in the knee joint, there is very little blood flow and therefor trying to salvage and repair the torn ACL doesn't work. Instead the surgeon will take a graft from somewhere else. Patients have two options- an autograft or an allograft. An autograft is taken from the patient and the patient has the choice of using his/her patellar tendon, hamstring tendon, or quadricep tendon. Each of these choices have their pros and cons. The other option is an allograft, which is a graft taken from a cadaver. For a young and avid athlete like the patient we had today it is usually recommended for the patient to have an autograft of his/her hamstring tendon, which is what we did today. First Dr. Hennig harvested the hamstring tendon which was really cool to watch. Then after cleaning out the area where the new graft was going to go, a tunnel was made in the femoral head and the top of the graft was pulled through there and anchored down, the graft then went through the joint and the other end was anchored down in the tibial head! The procedure had so many different parts to it and was half open and half done arthroscopic.

The second surgery I watched was a rotator cuff repair as well as a repair of the labrum. Because of the location and type of tear of the rotator cuff, the biceps tendon had to be disconnected and then after the repair of the cuff and labrum, the patient was turned and his shoulder was opened up to reattach the biceps tendon. The end of the biceps tendon was cut off and I was given the opportunity to hold the tendon, pretty cool birthday gift right?

May 18th- Day 11

Today was my off day and although I would have rather been at the office I know I will appreciate it with my next three days all being busy surgery days. Since I had the day off I was able to get out to the barn and ride my horse as well as attend softball practice today, so I was able to keep busy. In my down time I read through my awesome textbook I keep mentioning. I decided to narrow down my reading to rotator cuff repairs as well as the different ACL repairs, since those are the two types of surgeries I will be observing tomorrow, and hopefully having some more knowledge on what's going on in the surgery will help me orient myself tomorrow on what is going on without as much help from Dr. Hennig!

Week 2 Reflection

This week was truly one for the books! I had the most amazing day with Dr. Hennig at Advanced Orthopaedics Specialists in Gilford and Hillside Surgery Center. Monday, Wednesday, and Friday were spent in the office with Dr. Hennig and Thursday was spent in the OR. Even though the OR is by far one of my favorite places to be, I was very surprised by how much I enjoyed the days in the office. When I am in the office I am able to see a wide variety of patients with varying injuries which is super cool because although the OR is fascinating for many other reasons, I'm only able to see 3-4 patients.

Its difficult for me to choose a highlight of my week, I loved every aspect of it. Even when I'm the office between patients it's so interest just looking around and watching all the nurses and doctors buzzing around in their routines. Probably my favorite part of the week was the last surgery I saw on Thursday, a capsule repair on a patient with multidirectional instability of his shoulder. The vision scopes of the knees I witnessed on Friday were certainly a close second though! It is just so mind blowing how far we have come with technology that we are now able to stick a camera in a patients joint without needing to go into the OR. Not going to lie, although it would be costly and a waste of resources I would love to just sit down and have a vision scope of my knee done, and be able to sit their and look around inside of my knee! My low point of my week was definitely Tuesday morning, simply because I was unable to go to the doctor's office for the day.

One of my favorite parts of hanging out all week with Dr. Hennig is the amount of knowledge I have taken in. Between simply shadowing and reading the textbook lent to me, I found myself narrowing down the type of injury the patient could have based upon his/her symptoms! I cannot get enough if it, if I'm not in the office I'm off somewhere flipping through my book. Looking at this coming week I am very excited for Tuesday, Wednesday, and Thursday which will all be spent in the OR, but I am a little disappointed that since Dr. Hennig will not be in Monday, I will only be able to spend Friday in the office, time that I have learned to adore. It's a little bittersweet that this coming week will be my last week with Dr. Hennig because I have had such an educational and exciting week which has gotten me very excited to pursue my own career in Orthopedic medicine!