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!

May 15th- Day 10

I finished up my week in the office with Dr. Hennig today. Again I saw a variety of shoulder and knee injuries in patients ranging from 16 to 85! During some of our down time today I was able to ask Dr. He might and his Physician Assistant a few questions I had accumulated about meniscus tears and then it just so happened I was able to see a few patients with tearing in their medial meniscus later on this afternoon. I read a lot about shoulders and knees from the textbook Dr. Hennig lent me and it was great being able to apply my new knowledge to the cases we worked on today!
The coolest part of my day was watching Dr. Hennig perform a Vision Scope of two knees today! A Vision Scope is similar to a normal scope of a knee that would take place in the OR, but is done right in the office with the patient awake, and is used only as a diagnostic tool. It is a fairly new tool and is used on patients who are unable to get an MRI for a variety of reasons. One of the patients had a meniscus tear as well as some arthritis and it was really interesting being able to see both on those within the knee using a small camera that is sent through a large needle into the joint! It was definitly difficult for me to orient myself with what I was seeing within the knee but once Dr. Hennig explained where in the joint we were I found myself being able to identify different structures. I must say although I love being in the OR, which is where all be almost all of next week, I am a little bummed that I only have one day left working in the office with Dr. Hennig, seeing such a large variety of patients!

May 14th- Day 9

Today was yet another fantastic day with Dr. Hennig. This morning I woke up early and made my way to Hillside Surgery Center where I traded my office clothes for a pair of scrubs and spent the day in the operating room! I sat in on three arthroscopic shoulder surgeries, two for anterior instability and one for multidirectional instability. Not only was able to observe a variety of techniques used by Dr. Hennig in order to repair the joint but I also learned a lot about the principles of shoulder arthroscopy. I was able to sit in on the nerve block done before the procedure, as well as watch as the surgical team which included the surgeon, a physician assistant, a scrub nurse, a circulator, and an anaesthesiologist prepared, positioned, and draped the patient. I thoroughly enjoyed watching the surgical team as they completed their organized routine for each patient. I was also able to see a lot of different surgical instruments in action which was really cool because reading about them and seeing them being used are two very different things. After my first surgery I had a break in which I was able to break open Clinical Sports Medicine, by: Darren L. Johnson and Scott D. Mair, a textbook that Dr. Hennig lent me today to read throughout the duration of my senior project. After skimming through most of the text already I must say I am so excited to dive into this, it is jam packed full of information, but it is also at a level that I am able to comprehend versus being full of medical jargon. I must say that the highlight of my day was the last surgery, the shoulder with multidirectional instability. It was really interesting watching an arthroscopic capsulotomy, being able to watch Dr. Hennig maneuver around the shoulder and put in multiple sutures easily kept my attention. I loved spending my day in the OR but it was certainly a long day. I am looking forward to breaking open that textbook again tonight and returning to the orthopaedic office tomorrow morning!

May 13th- Day 8

Shoulders, knees, and hips! That is what my day consisted of in the Doctor's office today! Dr. Hennig and I saw a lot of patients with discomfort in their knees, most of them able to attribute the pain to arthritis in the knee. I was able to observe Dr. Hennig for multiple injections of the knee and learned a few more special tests to check stability as well as mobility of the leg. We also saw a good amount of patients with shoulder issues today that ranged from rotator cuff tears, bicep tendonitis, and even an AC joint separation. It was really cool looking at the AC joint separation on the X-rays which was very obvious but I also being able to look at the patient and see the raised bump from the joint separation.

We spoke to the patient about several treatment options. The surgery would consist of making a tunnel through the clavical and bringing an allograft through the tunnel and down to to anchor the bone. The patient wanted to put off surgery unless absolutely needed so today Dr. Hennig gave him a cortisone injection into the shoulder to relieve some of the pain created by the injury.

We also saw two patient with hip and thigh pain. The first patient was having a follow up visit after having 3 screws put in his left femoral head after fracturing it. The patient was having pain because the screws had backed out of the bone some as the bone settled and the gap created by the fracture had closed. The patient has some bursitis caused by the heads of the screws rubbing on the bursa sac that separates the hip from the IT Band. The last patient I saw today was complaining of hamstring pain and it was determined that the patient had sustained a tear in his hamstring. With the patients permission, Dr. Hennig allowed me to perform palpations on the patient's leg and one could easily feel an enlargement created by a bundle of hamstring muscle on the patients leg. Overall it was yet another educational day and I cannot wait to return tomorrow where I will be able to sit in on a few surgeries! 

May 12th- Day 7

Since I did not go to the office this morning I was able to take the morning off and attend advisory today. It was great to visit with my advisory and also finally see Lindsay and Mel again! I was also able to meet Anders, the world's cutest baby. It was so nice to visit with the new parents and seeing the three of them together as a family!
This afternoon I spent a couple hours in the training room where Chris reviewed how to take someone's blood pressure and gave us the opportunity to practice on ourselves as well as others! I learned that my blood pressure this afternoon was 125/65 which is fairly normal for someone of my size. We discussed Orthotics and how specialists will fit a person with these special soles in order to correct and support their feet. We wrapped up our day learning one technique on how to tape an arch in order to provide support, which I found much more success in taping but I forgot to take a picture of my volunteer's taped arches!

May 11th- Day 6

My first day at Advanced Orthopaedic Specialists with Dr. Hennig flew by! I arrived at the office at 8:30 and begin seeing patients right away. I was able to observe a variety of cases, varying from follow up rotator cuff surgeries, to torn labrums, and recent ACL injuries. I was able to observe Dr. Hennig perform H.O.P.S. (mentioned in my previous posts) as well as learn how to read a MRI from different angles, review X-rays, and find what I am looking for on an ultrasound. Dr. Hennig also taught me a few mobility tests which one patient graciously allowed me to practice on her leg!

This afternoon I was back in the training room with Chris and learned a lot about the different types of electrical stimulation and the different reasons to use each type. Chris then hooked us up to the stim machine and showed us the different ways to engage your muscles depending on where you place the electrical current!

Week 1 Reflection

Although this week did was not part of my original senior project plan, it was still very educational and applicable with my intended exercise science and premed major this coming fall. I started my week of on a great foot renewing my CPR certification and ended my week taping students and working on injury rehabilitation. I had been so concerned going into this week not knowing what I was going to do since I was unable to get into LRGH Orthopedics until this week, but Chris was awesome about helping find things I could do that still matched what I wanted to learn and helped me complete my goal of 15 hours for the week!
I would have to say the highlight of my week would be going into Concord Orthopedics on Wednesday and watching as the Doctor went through all the steps of H.O.P.S. that Chris had just taught me the previous afternoon, and although I felt bad for the patient, I must admit it was pretty cool to witness first hand a vasovagal reaction! The wasn't much of a downside of my week, although I couldn't be in the hospital I had a great time in the training room! I was able to learn a lot with Chris and Kelly that may not have been covered in the Doctor's office. I loved having the chance to learn and practice the technique of taping ankles, wrists, and sometimes mouths, two thumbs up for week one!

May 8th- Day 5

Today was a low key day. I spent a couple hours in the training room with Chris this afternoon and continued to practice my taping. Erika and I practiced taping eachother and with each time I practice I get a little bit better. After that I helped Chris fill the water coolers for the fields and then headed off to practice myself. After practice I met up with Chris at the JV Boys Baseball game. Sadly I missed the player who was hit in the face with the ball and had a laceration on his face that needed to be Steri stripped before he could head off to the hospital for stitches. I was able to practice my wound care on a young spectator who suffered from a bloody nose (epistaxis), as well as clean out and bandage an abrasion on a player caused by sliding. Although I would say today was the least productive day I had this week it was great being able to apply some of the knowledge I have gained throughout the week at the game this evening!

May 7th- Day 4

Well as I finished writing this post I accidentally closed the tab and deleted it so here goes take two...

Today was spent researching. Chris told me to choose a topic of my interest and look more into it. This was a difficult task for me because I am so intrigued by everything revolving around medicine so choosing one specific topic was a complicated process. I finally landed on the topic of ACL repair because although it is one of the most common knee surgeries in the US, there's so much about it I have yet to learn. Well I quickly learned that an enormous amount of research has gone into this particular subject and I was drowning in information. I decided to narrow down my topic and focus more on comparing Autografts (grafts taken from the patient in need of the ACL repair) and Allografts (grafts taken from a cadaver) and the benefits and risks that come with the two. Even with the narrowed topic there was still an immense amount of research done, hundreds of case studies and articles appeared on my screen. Hours flew by and I was still learning new things and I was amazed by how much research has gone into the different types of ACL grafts. With a much better understanding in the area of ACL repair I wrapped up my research for the morning and headed into school.
After spending a majority of my morning glued to the computer, it was a nice change of pace to be back in the training room with Chris this afternoon. I continued to practice my ankle taping, struggling to find the right angles to tape around, but my taping has gotten significantly better compared to my first taping job yesterday. A huge shoutout to David Windsor for allowing me to tape and retape his ankles most of the afternoon!

Take One

Take Two

Take Three

After taping ankles, Chris showed us how to properly wrap a shoulder with an Ace bandage which I caught onto much quicker than the taping. Once we finished up with that Chris went over wound care with Erika, Nathan, and I and then allowed us to practice our use of Steri Strips on our magic marker lacerations.
I finished out my day on the phone with the hospital and I was finally given the green light to spend next week in the hospital to continue with my original senior project!

May 6th- Day 3

This morning I finally was able to spend some time at Concord Orthopaedics! I was able to sit in and observe an appointment with Dr. Casey and a patient describing pain in her left shoulder. First Dr. Casey took a history of the patient and inquired about any certain instant that the injury may have occurred. The patient let Dr. Cases know where she was feeling the pain, what movements would provoke pain, and how long she had been feeling this discomfort. Next we observed the patients movement and range of motion as well as palpitations of the shoulder. We then followed up with special tests including strength testing and more range of motions tests. Through these steps and the patients x-rays it was determined that the patient has Capsulitis, inflammation of the connective tissue, within the shoulder.

Treatment options included a variety of exercises, the option of having a cortisone injection in the joint, and if the pain was to get worse surgery would be an option. The patient opted to have the cortisone injection which was to be administered right there. While the shot was being administered the patient experienced a vasovagal reaction and fainted. A vasovagal reaction is when the body has an overreaction to a trigger which causes a sudden drop in heart rate which reduces blood pressure. Since the patient already had low pressure and was sitting up, blood flow to the brain was restricted which led to the patient fainting. The patient's eyes quickly dilated and her body became rigid but this only lasted about thirty seconds before the patient became conscious. Upon further questioning it was revealed that the patient has low blood pressure to begin with and combined with her extreme anxiety towards shots and her lack of breakfast (low blood sugar), she was very susceptible to fainting.

Later on in the day I was able to work in Proctor's Athletic Training Room with an athlete recovering from a fracture of his Calcaneus (heel bone). He received surgery over the winter and had multiple pins inserted in his ankle/foot. I had the opportunity to work through a handful of exercises with him to increase range of motion, strength, and improve balance. We began by working with the elastic bands and working on the basic motions of the ankle- plantar flexion, dorsiflexion, inversion, and eversion. We then worked on balance and Chris explained proprioception (the ability to sense stimuli within the body regarding position, motion, and equilibrium) in depth. I worked on improving balance with the athlete by having him stand on his injured foot while I threw a ball to his chest. Since the athlete is only in the beginning of his recovery he was easily fatigued by this exercise so we finished his day off with the use of the BAPS board which continued working on motion with and without weight applied to the injured foot.

The last thing I did today was work on ankle taping. Because I had a softball game to attend I was only able to try a few times on my gracious volunteer and it was quite evident that I will need a lot more practice before I can be trusted with the tape. Hopefully with more practice and using the techniques Chris taught me I will be able to improve my ankle taping ability before the end of senior project!

May 5th- Day 2

Today was yet another educational day with Chris Young in the athletic training room. This afternoon Chris, Erika, Nathan, and I began by collecting the concussion headbands used by the men's and women's varsity lacrosse teams and we learned how they work. Chris explained to us how the sensors in the headbands monitor the amount of G force received by a player with any given hit and it is recorded in each players data log. We then discussed the amount of G force that could potentially lead to a concussion (95-100 g) and then we dove into the numerous steps taken in diagnosing someone with a concussion. There are multiple steps and tests that need to be done in order to diagnose a concussion and determine the level of seriousness the concussion is. We reviewed the average number of concussions at Proctor by the sport which led the group into an interesting discussion of the research into why women are more susceptible to concussions which seems directly linked to hormones. Chris ended our discussion on concussions today by reviewing the legal end of what he must do if an athlete is showing signs of a concussion and he explained how because of the large amounts of money being spent on concussion research these laws have changed drastically over the past ten years. As we were wrapping up our work for the day we had an athlete come to Chris with pain in his elbow. Chris used is acronym H.O.P.S. to aid him in the diagnosis of the athletes injury. First Chris took a history of the athlete- what was his sport, was it a sudden onset of pain or gradual, did he remember doing anything to injure the elbow. Next Chris observed the athlete's physical movements of his arm which he then followed with palpitations of the athletes arm. Lastly Chris performed special tests such as a strength test and came to the conclusion that this athlete was indeed showing signs of Lateral Epicondylitis "Tennis Elbow". Chris explained the importance of each part of H.O.P.S. and how it can be used for most of the injuries he sees on a daily basis.

May 4th- Day 1

My first day of senior project was spent with Chris Young and Kelly Griffen, as well as a handful of students working with them, in which we went through a course on CPR, AED, and the Heimlich maneuver. First we reviewed the basic steps a person should do once they determine someone is unresponsive- call 911, retrieve the AED, begin compressions. We practiced the different techniques of compressions and the speed at which to do them. We then reviewed the different scenarios as well as the variations of CPR depending on the size and age of the person in need. We then combined the practice of CPR with the use of the AED (Automated External Defibrillator), which was something entirely new to me. I learned how to properly set up and use an AED and the different methods that again depend on the size and age of the person in need. Lastly we reviewed and practiced how to do the Heimlich maneuver on infants and then on children and adults. Although this knowledge is needed in the medical field, these skills are also very important for everyone to know because you never know when you might be out in a situation where it will be needed.