Week 2

Can't believe how fast the week flew by. Although, I still have Saturday morning rounds tomorrow. This week was a continue of "floor" medicine. IM is definitely more about thinking rather than doing ("procedures"). I spend half the time with the patient and the rest of the time looking at labs, consultation reports, and writing a SOAP note. I rely heavily on my PDA. It seems that there's a lot more types of procedures and a lot more abbreviations than what we learned from school.

One lunch meeting, they had a procedures session. They had a brief lecture on how to do certain techniques (like punch biopsy) and the rest of the time we spent practicing those techniques on cows tongue, raw chicken, or an orange. It was cool except I had to leave early for afternoon report. I had a chance to learn how to do an actual punch biopsy the correct way.
1. Stretch the skin with one hand where you plan on doing the biopsy. This is so that the hole will become more elliptical shape once you let go of the skin.
2. Push in the punch straight down with a slow back and forth twisting motion.
3. Remove the punch biopsy tool and get a pair of tweezers and grab the "skin sample". Then, with a pair of scissors, cut the "sample" off from the bottom.
4. Then put in one suture to close the wound.

They also had a cryotherapy spray can to practice freezing, a cauterizing tool for burning, suture stuff, and how to shave a small, flat skin lesion superficially to send off for biopsy.

Today, there was a diabetes clinic that I had to go to. I got to learn from an endocrinologist about how he approaches patients. He saids that he and the patient are a team and they have to work together to get better (especially with diabetes). The patients really like the doctor. I got a better idea on how some of the oral hypoglycemic drugs and insulin works. He also explained the important things one should do on a physical exam for a patient with diabetes. Here it is:
1. Check the eyes (retinopathy)
2. Check for carotid bruits (diabetes = heart disease)
3. Listen to heart and lungs.
4. Check the abodomen.
5. Check the feet (dorsal pedalis pulse, posterior tibialis pulse, and popliteal pulse; also, do the microfilament test or sharp/dull sensation on the feet (neuropathy); inspect the feet for callouses, ulcers, claw toe deformity, swelling, muscle strength & ROM of feet, and ingrown toe nails).

Another thing about diabetes that, so far, 2 doctors have already mentioned to me (which means it's probably important to know): Diabetes is a macrovascular dz and a microvascular dz. Macrovascular is the heart and brain. Microvascular is the eyes (retinopathy), kidneys (nephropathy), and amputations/feet (neuropathy).
Macrovascular dz requires atleast 2 drugs (like glucophage & TZD) for treatment whereas microvascular dz requires one drug for treatment. Actually, any person who diabetic must be started on a minimum of 2 drugs (maximum is triple therapy). Also, a blood glucose of >200 at any time automatically means they are diabetic.

A side note about TSH levels. Normal is actually 2-3. The doctor learned this when he was an intern and the attending was the one who discovered TSH (I think that's what he said?).

Next week: I get to work in the ICU !