This week I was with the senior back surgeon in the practice. As far as ortho goes backs and hands are the areas that I know the least about so I was looking forward to this week. The first day with back guy was about what I expected. We did office visits all day which was boring but I did learn a good bit from him. I learned that back pain basically has 3 origins: disc, vertebra, or muscle. (I guess you can throw tumors in there too.) Disc problems generally cause the numbness, burning pain, and tingling with bending in certain positions. Vertebra can cause similar symptoms but can be from degeneration, fractures, or spondylothesis. Muscle pain usually hurts in one general area and doesn't have nerve type pain. That is in no way an exhaustive list of causes of back pain but the average person's diagnosis would be one of those.

My last day with the back guy was in the OR and boy was it a long one. On first glance the schedule looked pretty nice, only 2 cases! I should have known better. Nobody who has OR time for the day only schedules 2 cases unless they think they will use all their time. We had 2 lumbar fusions on for the day. I have done a whole lot of joint replacement surgeries but this was my first back surgery so I wasn't exactly sure what to expect. The first case was a 4 level lumbosacral fusion on a 50 y/o female who had a previous lumbar decompression done years ago and also had a bone stimulator implanted years ago. Oh, and she was around 250lbs. I later learned that that was a significant thing to note. When I feel my own spine I can feel it pretty well, it's right there just under the surface. This wasn't the case on this lady. It took us 3 hours just to dissect down to the spine and find all the landmarks we needed to do the actual fusion itself. We were looking down into a 7 inch deep 12 inch long hole. That only exposed the spinous processes, not the entire vertebra. After 2 hours of meticulous placement of screws and rods and digging around under her butt fat for 30 minutes to find and remove the bone stimulator we were finally ready to close...6 hours later! I don't know if you've ever stood in one place looking down into a hole for 6 hours but it gets tiresome. And this was only the first case. The second case was an even larger lady but fortunately she was younger and had not had any previous back surgery nor did she have a bone stimulator that needed to be removed. This procedure went much like the first except it included a discectomy and was only a 2 level fusion. During this operation the doctor told me to take the probe and "poke this". So being the good student that I am I did as he said and her left leg jumped right up off the table. He told me to do it again, so I did. He asked what I thought I was doing to cause that and I answered that I was poking the L5 nerve root. SCOOORE 5 points for LeAnne. That was the most fun I had all day. Makes you want to run right out and sign up for a lumber fusion doesn't it? :)

I might have to do more back stuff at my other ortho rotations but for now my back days are over. Thank goodness. I do not see a future in back surgery for me.

I'm half way through the first orthopedic surgery rotation. I have finally figured out that I really like this specialty, which is a big relief considering I chose to do a specialty in it. Ortho surgery is tough stuff, meaning physically demanding. It's not so mentally exhausting because it's all geometry and physics. I have seen a variety of different ortho surgeries now but knee replacements are still one of my favorites. I think I like them because they are so physical and gory. For the most part they are pretty straight forward. It's next to impossible to mess up a knee replacement. They use pre cut metal pieces to cut the bone to the perfect shape. Essentially it's a stencil that's used to cut out puzzle pieces. Then you just glue all the pieces in to the permanent position. They use the same tools that a carpenter would use in his woodshop; power drills, mallets, chisels, power saws, nails, and screws. I can see why it's predominately a man field. It's pretty cool when you use a power saw to cut through bone and instead of sawdust and wood chips flying it's bone dust and bone chips. We have to wear these suits to prevent infection. They look a lot like nuclear suits that you would wear if you were going into a reactor. It's surprisingly a relatively non-bloody procedure especially considering you are essentially amputating a leg and putting it back together. They use a tourniquet so the blood flow is cut off to the limb. After all the parts are glued into place they let the tourniquet down and then it gets messy. But up until that point it's fairly blood free. The only complaints I have about knee replacement operations is that they take 2 hours for one knee and a lot of the time we do 2 knees during the same operation. 4 hours of holding legs gets really tiring. A typical OR day is between 12 ands 14 hours. My body feels like it has been through a massive workout at the end of the day. This exhaustion is strangely a rewarding feeling. If I decide to work in orthopedics when I'm all done I'm going to have to workout frequently just to be able to do my job. My next OR day will be spent doing back surgery. I have yet to see that so I'm pretty excited!

*Obviously the girl in the picture is not me but that is exactly what we wear for joint replacements.

Orthopedics #2

Today was day 2 of orthopedics. I'm doing my first ortho rotation at a huge practice. I will rotate through 14 different physicians and PAs over the next 6 weeks. I had a warning from some other classmates that this was going to happen so it's not a total shock. I realize it's only been 2 days but I'm not really a fan of being with this many clinicians. It's impossible to gain someone's trust in 2 days. So far I've done only observation and I have a feeling that's pretty much what the next 5 1/2 weeks are going to be like. We see a lot of patients during the day. Today we saw 55 patients in 10 hours!! And I thought my old physical therapy job was always overscheduled at 40 patients a day. This is pretty much the norm throughout the entire practice. We hand out cortisone injections like candy and schedule knee scopes like they are party invitations. Tomorrow is an OR day, I haven't been there yet so I'm looking forward to it. We have three cases: one patellar bursa removal, bilateral total knees, and an achilles tendon rupture repair. I've only ever seen the TKRs so I should learn something and be entertained. I don't know the doctor very well so I probably won't get to do anything cool like run a saw or hammer something but just watching in the OR is better than just watching in the office. Orthopedics and sports medicine is what originially got me interested in medicine and it is where I am the most comfortable. I decided to do a specialty track in it so for the next 18 weeks I will be doing three different ortho rotations. It's a little disheartening to have it start off like this. I hope things become a little more interesting or this is going to be a very very long 4 months.