January 20, 2018
Written by Jonathan Li (class of 2017-2018)
For my third OREX day, I was able to coordinate a day in the Orthopedic Clinic with Dr. Krosin. Since I had arranged to meet Dr. Krosin at 9 AM and the one hour gap between the morning general surgery meeting and our designated meeting time was not enough to observe a full surgery, I elected to wait in the OR breakroom, reviewing some anatomy on a website a medical student had recommended to me on my last OREX day and talking to some of the doctors and nurses who trickled in and out of the room. At 9, I headed up to the 7th floor, and a nurse at the front desk kindly brought me into the clinic. Dr. Krosin was nowhere to be seen, but Dr. Vogle was in and gave me a brief introduction to the daily routine in the orthopedic clinic and the subspecialties of Highland’s orthopedic surgeons (there are few who specialized in hand surgery and a few others in trauma). Dr. Krosin appeared about half an hour later (the orthopedic surgeons had their own morning round and set of meetings), and we began seeing patients immediately.
Tuesdays are unique in that Dr. Krosin and most of the other orthopedic surgeons spend the day seeing patients in the K7 clinic rather than performing surgery in the OR. Thus, this was a valuable opportunity to see what goes on behind the scenes of an orthopedic surgery and learn about the orthopedic clinic’s services. The pace was much faster than the operating room (patient check-ups averaged roughly 10 minutes), and I did my best to keep up with each patient’s situation and background. Despite the quick pace, Dr. Krosin did a good job painting a picture of the broad categories of services provided by the orthopedic clinic. The primary services provided by the orthopedic clinic include chronic pain management, post-operative follow ups, and pre-operative evaluations.
A good fraction of patients were visiting for chronic pain that did not require operation. In general, these patients’ treatments consist of joint and/or soft tissue injections (i.e. with corticosteroids for anti-inflammatory purposes) every few months. In between patients, Dr. Krosin would comment on the cases and provide advice on entering the medical field. For example, Dr. Krosin pointed out that some of these chronic problems would be better solved with lifestyle changes. As we progressed through multiple cases with patients receiving these injections and leaving with prescriptions for pain relievers, Dr. Krosin also brought up the current opioid crisis and how opioid addictions tend to start. I wanted to press Dr. Krosin more about this issue and how it applies to Highland Hospital, but I did not get a chance to discuss it in much detail. Nonetheless, it was beneficial to begin comparing how the opioid crisis is perceived from someone outside the medical field to that of a physician directly dealing with patients in serious pain.
Another set of patients were visiting the clinic for post-operative care. One interesting case involved a patient who had developed an allergy to the material composing her knee replacement. According to Dr. Krosin, the patient’s specific allergy was quite rare, and a ‘revision’ was in order to swap out the knee replacement with one made from a different material. I found this case particularly interesting because it brought to mind our body’s response to the synthetic/foreign materials orthopedic surgeries often introduce and how faulty responses could lead to pathology. Another patient had recently undergone a dermofascioectomy for Dupuytren’s Contracture. Dupuytren’s Contracture is caused by the abnormal thickening of tissue in the hand and results in difficulty straightening affected fingers (usually the pinky finger and the ring finger), and a dermofascioectomy attempts to solve this by removing the thickened tissue and replacing it with a skin graft to help restore hand movement and finger agility. Unfortunately, the patient’s post-operative recovery was not positive, and physical therapy was prescribed to help with post-operative recovery and restoring dexterity. (https://www.webmd.com/arthritis/ss/slideshow-treatment)
Adjacent to the clinic is the ‘cast room’, where patients’ injuries are examined and their casts altered or replaced as necessary. Some patients in the ‘cast room’ only needed to briefly touch base on their recovery progress while others were being evaluated for surgery. On a few of the checkups in the ‘cast room’, I shadowed one of the orthopedic chief residents, and the resident was kind enough to walk me through a few X-rays he was examining to determine the patient’s recovery and/or whether surgery was necessary. After most of the patients in the ‘cast room’ were taken care of, I followed the resident to the OR, where I observed a thumb amputation to end my day.
All in all, I enjoyed my third OREX day and the valuable perspectives I gained by spending time in the Orthopedic Clinic. I am especially grateful to Dr. Krosin and the orthopedic residents for welcoming my observation and showing me another dimension of orthopedics care.