The first patient I saw was a 73-year-old male complaining of inner ear pain. Upon Inspection, Dr. Handy was able to see serious inflammation inside of the ear and deemed it an inner ear infection. This patient was also having some lower back pain. Dr. Handy did a FABERs test and well leg test which were both negative. This patient was also on gabapentin for neuropathy and migraines. I had never heard of Gabapentin before. It is commonly used to treat seizures, but it can also be used for peripheral neuropathy, which is common is a lot of diabetics.
The next patient I saw was a 65-year-old woman in for a routine check-up. She has a history of triple bypass surgery and her chief complaint was leg pain with activity and GI issues. This patient is having a lot of at home issues, she doesn’t have anyone to take care of her and help her around the house due to her late husband and kid being in jail. Dr. Handy suggest her to get a riding lawn mower to not further her leg pain. She later complained of wrist pain. She had a positive finklestein test and positive grind test. Dr. Handy told her she had arthritis and to use a thumb spica splint and soak it in epsom salt.
The following patient was a 61-year-old male with a chief complaint of GI issues and right upper quadrant pain. He explains feeling nauseous during and after meals with vomiting and intermittent diarrhea. Dr. Handy was concerned with the patient having either a perforated duodenum or a ruptured gallbladder. He was sent to the hospital to do more testing. A few days later is turns out he did have a perforated duodenum that was bleeding. His hemoglobin levels were a 7.1, the lowest Dr. Handy has ever heard of. Normal hemoglobin levels are around 13.
The next patient was a 78-year-old woman who suffers from anxiety and major depressive disorder. This woman came off mildly apathetic, but mostly helpless. She has tried every therapy and medication possible. Dr. Handy was highly suggesting she get electro shock therapy. To me, this sounded very strange, but it helps to basically jump start the brain and resets the chemical signals in the brain. Of course the woman was very apprehensive to this. Ultimately Dr. Handy just gave her the information to call and he heavily recommended it to her.
The final patient I saw this day was the youngest patient I saw while doing this rotation. She was 25 years old with muscular dystrophy. She was there for a routine check-up and to have some moles removed. I was able to assist by handing the specimen cups to the medical student. It was kind of freaky to hear the sawing of the skin with the tool.
My next visit to Dr. Handy’s office I saw 7 patients. This day it was diabetic, after diabetic, after diabetic. Everyone had good A1C levels and their glucose readings were good as well. The two more interesting patients I saw that day was on with rheumatoid arthritis and another with a clavicle fracture. The patient with rheumatoid arthritis is a 40-year-old male in for a routine check-up. He had atherosclerosis, lumbar disk degeneration, he is a type 1 diabetic, but he is very active. This was my first time seeing someone with rheumatoid arthritis whose fingers were disfigured. Overall he was in good spirits and liked to talk. I got the sense that he doesn’t get to see many people often. He stayed in the office for a while and talk to everyone. The other patient was interesting. He was a 40-year-old male who is a helicopter EMT. He broke his clavicle in a motorcycle accident a month ago and had surgery to set it. His scar was really big and was having some issues healing.
The next time I when in, it was a strange day. A patient came in and as complaining of chest pain for the last few days, but he thought it was heart burn. His pain was a 7/10. He is a smoker, diabetic and has a family history of heart attacks. Dr. Handy did a ECG on him and deemed it necessary for him to go to the emergency room. He was also given a nitroglycerine patch to help reduce pain. When he left his pain was a 5/10. I thought this was interesting because he didn’t look like he was having a heart attack at all and his symptoms didn’t quite align with heart attack symptoms. Dr. Handy said this is because diabetics have a loss of sensation and many emergent situations do not represent the same as they would in a non-diabetic. The next patient we saw immediately after this man was a 67-year-old woman complaining of severe stomach pain with diarrhea and nausea. She has a history of diverticulitis. She was also sent to the hospital to look for abscess. Dr. Handy made the comment that emergency room visits always come in threes, and sure enough, two patients later we had another patient needing to go to the hospital. This patient was a 65-year-old woman with diabetes. She had a severe and uncontrollable cough. Upon auscultation she had poor lung sounds and it was very condensed. She had a positive egophony e -> a. she was a stubborn patient and was hesitant to go the emergency room. Dr. Handy severely pushed her to go because he was worried she may have pneumonia and with diabetes, this makes everything much worse. Come to find out a few days later she did not go to the emergency room. I thought this day was interesting. I learned a lot about how diabetes can mess a lot of things up in the body and how it can change a diagnosis. I would have never realized the first patient was having a heart attack.
I saw many other patients throughout my time in Dr. Handy’s office. I learn a lot about pharmacology and how to interact with older populations. I also learned a lot about vaccinations. I really enjoyed this rotation overall. Dr. Handy is a really interesting fast paced doctor. It would be interesting to be on of his med school students and have to do what he does for a month. The med student who was with Dr. Handy while I was there was also very nice and helpful. Often times when Dr. Handy was talking too fast for me to understand him I could rely on him to help me out.