12/19/2018 0 Comments Gen Med Rotation ReflectionDuring my two week rotation at Dr. Handy’s office, I was able to grow my understanding of holistic healthcare. Dr. Handy truly cares for each and every patient he comes in contact with, so it was nice to see that the idea of caring for the whole individual doesn’t have to stop with athletic training. The biggest take away that I had from this rotation was that if a patient has one thing, then they have two things. A patient has two things wrong, he or she probably has three things wrong. Comorbidity after comorbidity.
A patient that specifically stuck out to me was an eight year old female with diabetes; however, it didn’t stop there. She also had epilepsy and hypothyroidism, and she came to the office that day because she was having cold symptoms. Her mom made sure to bring her in at the first signs of illness because her other conditions made even the slightest cold exponentially worse. Dr. Handy prescribed her with antibiotics for an upper respiratory infection, and he told them to come in ASAP if those did not help. I was also able to listen to my first mitral valve prolapse. Dr. Handy told me that the patient had this heart condition before entering in to the office, but then asked me to listen to the patient’s heart without telling me what to look for. I reported that I had heard what sounded like three beats, and learned that I was correct in what I heard. This was a huge stepping stone for me because I have always struggled with hearing and understanding the heart sounds in class. I have a particular interest in cardiology, so this was very encouraging. I was able to sit in while Dr. Handy had an appointment with a patient that was HIV+. The man seemed to have a misunderstanding that he still had HIV because he kept noting that his disease was undetectable on the blood test. Dr. Handy took time to educate his patient on what that meant. He was very gentle, but also clear and stern. The patient also had diabetes, erectile dysfunction, and a heart murmur. The check up showed that his diabetes was being handled well, and his murmur was being maintained well also. Many of Dr. Handy’s patients were also struggling with psychological conditions along with their physical ailments. The main diagnosis was either depression or anxiety. Through my shadowing I learned a quick acronym to help assess depression: SIGECAPS. This stands for sleep, interests, guilt, energy, concentration, appetite, psychomotor retardation/agitation, and suicidality. This was something I was able to take with me into many of my classes. Lastly, I was able to walk away from this rotation with a deeper understanding of medications. I learned how many medications work on the body, thus showing me how they accomplish what they are meant to do. I also have lists of medications for common illnesses or conditions that I will be able to refer back to in the future. In combination with my physiology class, I am much more confident in my pharmacology knowledge than I was 6 months ago, but I know that I have much more learning to do.
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12/9/2018 0 Comments Reflective Journal #15This semester I have been grateful for the progress I have seen. My junior year I really struggled with finding motivation to continue in athletic training with zeal because I knew that this field was not where I wanted to spend the rest of my career. Even though I still want to go to physician assistant school, I have been able to be content this semester. This isn’t particularly an example of educational progress; however, this has been the progress that I have been most proud of this semester. As I have mentioned in previous journals, I am very thankful for Cole and Alex for investing into me like they have. In addition to the preceptors I had this semester, I really enjoyed the other students that I was placed with this semester. I feel like they care for athletes similarly to me. They place a lot of emphasis on getting to know the athletes and creating a relationship with them, so it created a fun and fruitful atmosphere in the AT clinic this semester.
Outside of gaining some of my passion back for the profession, I feel like I have been able to fine tune some areas of my clinical practice. I have become much more confident in doing my evaluations, and I have been able to grow in understanding what parts of the evaluations are most relevant to the current problem. In retrospect, I feel like it has taken me more time to find the information that I needed to make a diagnosis. Now it is much easier for me to filter through the information that I receive from the athletes to coax the conversation to the areas that I need. I also feel much more comfortable in creating rehabs. This semester, Cole would allow me to look at previous rehabs for an athlete and create a rehab on the spot that would flow well with the previous exercises. This pushed me in terms of my comfort zone, but I know this has definitely made me a better clinician. Additionally, Cole would ask me why I was doing what I was doing, which pushed me to think about the in’s and out’s of my practice. Overall, I feel like I have been able to not be so high strung in the clinic which I know has been able to relate back to the athletes that I am around. 12/2/2018 0 Comments Reflective Journal #14This past week I had the opportunity to start a freshman football player’s rehabilitation from a previous fibula fracture. The athlete had a contact injury that resulted in a fibula fracture, which then required two surgeries to fix the surgery. Unfortunately, his rehabilitation was scheduled to begin during Thanksgiving Break, so upon his return to school, he was already behind. I was somewhat unfamiliar with his case, so before we started rehab that day, we went over everything that had happened. I found out that over Thanksgiving Break, he had done small amounts of running. He has been cleared for activity, but is still experiencing mild discomfort while walking for long periods of time and complains of numbness on the top of his foot from the surgery.
The first rehab we did was very successful, and I was able to make many conclusions about his current state. He did not physically appear as if he had suffered from a lot of muscle atrophy, but the strength difference was extremely noticeable. This was highlighted during single leg squats to a box. His unaffected leg was so simple and effortless for him, while the affected leg was very difficult to perform the exercise on. Additionally, he complained of a lot of increased stiffness in the affected leg, which may have increased the difficulty of this particular exercise. I also had him perform some balance exercises to find a baseline of where he was ranged on proprioception. He was pretty impressive balance wise and worked very hard to perform well, specifically on balance exercises. After a few more exercises, we ended the session with a light jog because he really wanted to run some more since he had worked on that some over break. However, during the jog, he obviously favored his injured leg much more than the other. Through this rehab, I was able to keep the session very informal and lighthearted, while also being able to get a really good idea of where he was in the process. Something that I had not put much thought into previously was the level of insight that the athlete had to where he or she was in rehabilitation or their abilities to perform. After speaking a lot about level of insight in my abnormal psychology class, I have tried to incorporate that more into my clinical practice. This athlete in particular does not have very good insight into the depth of his condition; he believes that he is much farther along that he is, even though he is performing fairly well. In the future, I plan to look much more into how the athlete thinks he or she is doing, and base some of the rehabilitation techniques off of that answer. |
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April 2019
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