Zoo Brew/Save the Roar

I had Friday afternoon off and came home, Shawn made his famous waffles and I made my famous whip cream. YUM! The afternoon was looking better than the morning had started - Wrigley had poo'd on the bed while Shawn was sleeping - not a great way to start by any means. So we were contemplating when to go run and Shawn's phone rings. I am the worst at deciphering half a phone conversation, but Shawn whispers to me "brew fest" and shrugs his shoulders. When he finally gets off the phone he said it was one of the guys at work (one of the supervisors) and he wanted to know if wed be interested in going to a brew fest at the zoo. Now, for two people who don't drink - and beer at that, this sounded like a rip roaring good time - except not. But, this guy has really done a lot for Shawn, a lot - in fact he's one of the sole reasons Shawn started working for AMR when he did as he was being screwed around by the state for licensure. So we looked it up online to get more info. The event's called ZOO brew - all proceeds go to bringing back Lions to the Oregon Zoo. So I was sold - it's for the animals, plus maybe I would get to see some of the zoo.
So we arrive to the zoo get our tickets and our wrist bands and head toward the party, hoping to view the animals along the way but it appeared all the animals had gone inside fro the night except for the fat sea lion that was laying on a rock, some monkeys who had been given a phone book to play with and some brown packing paper. We went to see the polar Bears, but there were none, but instead of the polar bears, in their habitat we saw a hard hat and industrial bucket and plastic crate in there, so our question was - what happened to the person wearing the hat?

Overall the zoo is less than impressive - but then again we are comparing it to the Omaha Zoo - which is awesome! The layout is set within the woods - it really has a lot of potential, just not a lot of sparkle. Oh and did I mention the "Insect Zoo"? A section of the zoo entirely dedicated to insects - like hissing cockroaches, ladybugs and spiders. Hmmm. It was a kiosk/tiny hut with little bug houses - most of the bugs I had in my 8th grade science classroom.

We got really cool glasses that have Zoo Brew printed on them and 9 tokens to taste to our hearts content. Like our usual fashion, we started with Root Beer - it was ok... we decided to go for a little walk to see the elephants. One elephant was outside enjoying the immaculate weather, the other was inside eating. This may seem relatively uneventful but this elephant was special in that it was sporting his extra parts for all the world to see... TICKETS TO THE ZOO$40, TICKETS TO ZOO BREW $60, SEEING AN ELEPHANT'S PARTS HANGING TO THE GROUND (and all the adults laughing while children looked puzzled about the elephant's 5th leg) - PRICELESS

We met up with Shawn's friend and his wife and sampled here and there, they told us about some really neat things to see and do in the area. Afterwards we decided to go to dinner with them (it was like 9:30) we stopped by the rose garden and although nothing is in bloom, it was still pretty, even at night - you could still see Mt. Hood too. Then off to Lauralwood brewery for dinner in a really trendy little area. We had some burgers and fries and called it a night. We got home about midnight and it was then Shawn realized he had no clean clothes to wear for work for today - that made get the giggles. What a day, some good spirits, good company, a little elephant fun and we saved the lions all in one night!

Memorial Day weekend

It was so nice to have the weekend off together, Sat-Sun!! Whoohoo!! We even slept in alittle. The weather wasn't great, and sicne gas hit $4 a gallon we stayed close to home. It was so peaceful and relaxing though. We also rented the movie Juno from the convenience of our couch and No Country for Old Men. Our opinion: JUNO - two big thumbs up!! It was hilarious, dry humor. Already we've found ourselves quoting it once in awhile - which is always a good sign for a good movie in our house. Shawn bought orange tic-tacs the day after - I couldn't help but call him Bleeker. The other movie was, um, well, interesting. There are no other words. Just interesting. Not what we expected and a little more bizarre than we anticipated, but the airgun was pretty darn cool. It also had a bizzare ending...
We also had a thunderstorm this weekend, lightening and thunder the whole thing. I really miss thunderstorms in the midwest the storm here wasn't impressive like many of the storms back at home, but it was still enjoyable. It was the first time Wrigs had ever heard thunder - so she felt the need to bark at each clap of thunder.
We also explored a new dog park close by, it's not like Hondo, but it was nice and not too many dogs. There's a little trail around the park to walk around in a circle and amazingly the dogs stayed quite close when we walked around and even came right to us when called (Shawn's so smart to remember to bring a couple little treats when we go places).
And finally, the Chicago Cubs are kicking butt. 100 years is long enough!

The bee's knees

So far I have not had a whole lot of positives about my rotations, so I thought I should throw out some of the positive moments. I have to warn that a few of these things may be a little graphic in nature - sorry, that's just the way it is.

1. I've been scrubbing in on TKA's (total knee arthroplasty = joint replacement) why this is cool - I get to where the hood and helmet on top of the whole scrubbing in, gown and gloves. There are about 6 steps to a TKA (way simplified: Knee is suspended and a tourniquet is applied, A vertical incision is made from the upper part of the patella (kneecap) to just below the knee joint, about 4 to 6 inches. Traditional replacements are 8-10 inches, 3. About 1/4 inch is sawed off from the ends of the femur and tibia bones to prepare the surface, The under part of the kneecap is trimmed with a saw and fitted with plastic, The prosthesis is sized, then cemented (and/or) pressed into the bone, The deep tissues are stitched, and the skin is stitched or stapled.) It is a very messy procedure - bone and tissue flying here there everywhere - sometimes chunks land on the face shield of the hood and then slide down like a pickle on a window leaving a lovely smear - this was my experience last Friday. The hood itself is a process, first there's the helmet - thank goodness I ran into a girl PA on another case who gave me the wisest advice about the helmets - take out my pony tail. The helmet have a fan attached to the back to help keep you cool, the battery pack fits in the back pocket of the scrubs (so it's really important that your pants are tied tightly). The hood part slips over the helmet which is placed on by the scrub nurse who helps dress you as you enter the sterile field (and by dressing me I mean gown and gloves). It's really difficult to hear in the hoods - and unlike when wearing just a mask - everyone can see your entire face, so I have to pay special attention not to stand with my mouth open while intently watching. Well that's probably more than enough info about TKAs for now - here's a link to one of the main companies we use for the prosthetics: stryker triathalon http://www.stryker.com/en-us/products/Orthopaedics/KneeReplacement/Primary/Triathlon/index.htm

See the pics at the beginning of the post to see the hoods and pre and post op examples...

2. OR fashion. I know this might seem strange but there are really important things to know about scrubs, shoe covers and caps when selecting the ones you will be wearing all day. In the women's locker room there are two sets of shelves of blue scrubs. One set of tops and one bottoms- this is where is gets tricky. There are mens and womens scrubs, both available from S-XXL. The women's pants are elastic wastebanded and tapered - very tapered and the tops have a lovely modest neckline (not a V) with two pockets on the bottom on each side. The men's bottoms have a drawstring and are more of a relax fit straight leg type of pant. The tops have a V neck (not a plunging neckline, but a definite V) and one pocket on the left breast. Hats: women have cafeteria style blue bouffant caps (same one patients get) but they have regular and large sizes, men have the tie caps, and hats that extend to cover a beard. Shoe covers- an often overlooked necessity. There are the regular show covers - one size fits all and then there are the shoe covers that extend up tot he knee - essential when doing a knee arthroscopy when water is pouring all over the place, seriously it's like lake Huron in there when we're done. If you don't wear these - as I have found (although they never seem to be out of them in the locker room) your entire leg will be wet from water and a little bit of your shoes. May not seem too bad considering it rains all the time here - shoes get wet, no biggie, but then you realize the water came from inside the knee during the procedure.

Oh and here's a link of pics of an actual TKA procedure I found... it's a little gorey, be warned

http://www.genufix.com/total_knee_replacement_photos.htm
And here's a link for you to do a "virtual TKA" : http://www.edheads.org/activities/knee/

3. I got to inject a couple knees today one with Orthovisc and the other with Synvisc. whoohoo!!

Ok, I think that's probably enough for one post about a rotation...

Change is a comin'

4 days of heat and then the cool rain came - typical but a welcome change. So one of my favorite things about our new apartment is our breakfast nook. It's a perfect space for our card table turned dinner table (it works for our space). We had the table in the last apartment but it was a part of the "living room/kitchen/dining" area - so it kind of became a great place for mail and odds and ends. So now in our new nook we actually use it as a table (an occasional place to do the ironing). So all this being said, we have been able actually sit down and have a meal together. It's funny how having a place to just sit and eat changes the conversation and improves communication. How did we go so long with out a table?

Yesterday's clinic was uneventful. More suture and staple removal for me an a whole lot of watching - bummer. On the plus side one of the clinical team professors called me after emailing her my concerns and is making a site visit Thursday which I am really grateful for and they are seriously considering changing up my rotation. It's not that I haven't learned anything, it's just not what I (or the program) think should be happening. This is mostly impart to the fact they lost a provider not to long ago and have a few of those patients lingering in the line up, and on the other hand it's just a gosh darn busy practice with surgeries booked 10 weeks in advance. I just think they are took busy of a clinic for a student. I tried really hard to remain objective when talking to Prof. telling her what I was doing and not doing and left out the part about how I think my preceptor is well let's just say won't be winning the award for preceptor of the year but he does try when he can to teach me something. Then again maybe it's me, maybe I'm not showing him I can handle more responsibility. Point is - change coming soon. Today, I have off, both the doc and PA are out of the office and the other surgeon I was supposed to go with per my doc didn't want to sign a million papers for one day, so I will be catching up on my patient logging and reading - too bad Shawn has a 12lead class today but it's really awesome he has that opportunity.
Side notes: So one really awesome thing about AMR is they have all these free classes for their paramedics to attend as part of their required refresher courses for license renewal - all taught by the medical director. They last 4 hours or so, but if you attend just half of them in a year all your hours are covered for renewal - how great is that??

"And I was running" -Forest Gump

Shawn went back to days today - quite a change from nights and since he switched shifts it just so happens that he will have next weekend off which is awesome considering he had this past weekend off too!! YAY! We enjoyed the early summer weather at the pool swimming and running. Running is sort of our new thing, Shawn runs an easy 5K in 30 min and I'm not too far behind him and he ran some ridiculous amount of miles last week. CRAZY! Cardiovascularly we are in the best shape of our lives which is just an awesome feeling. I would never have started running without him - I love my Shawnee! The only downside of the running craze is whenever I feel a slight pain or creek in my legs - especially my knees - I think, gosh I hope I didn't tear my meniscus, I think I stepped a little crooked. I don't know how many people in clinic I've seen with a torn meniscus from walking, running or just aging. That's the worse part about being in healthcare - you start wondering and worrying and thinking about every little thing that goes one with your body that you wouldn't think anything of normally. I swear it's the fastest way to becoming a hypochondriac.

Clinic today was relatively uneventful. Steady and regular patient flow. I got to do my first pre-surgical H&P (history and physical) but it ended up being the most abbreviated H&P I think I have ever seen, let alone done. Every time I started asking questions my preceptor would say, "don't need to ask that" and so I didn't. I wish I had some sort of exciting story to pass along. No real interesting pts either (not to say all patients aren't interesting), there was however a 23y/o recovering heroin addict getting ready to go into surgery (managing that pain control should be interesting) and a 14 y/o with a Salter II (partially through the growth plate) femur fracture from playing basketball and another kid hit his leg with a knee. Ouch. Maybe better luck tomorrow.

NW Weather

Rainy, sunny, cool, warm, HOT! What a range of extremes, although being from the midwest this isn't anything special, but out here, when it's hot it's hot, and with no AC it's tome to do anything to stay cool. Cubby has survived one AC-less summer with highs of 110-112, but little Wrigs is still adjusting - at least she has white fur, but then again that just makes her prone to sunburn so thank goodness for puppy sun block. Speaking of sunburn - it's really easy to do out here, it Can be a warm 80 here and partly cloudy and still manage to burn. Yesterday it was hot, like 85 degrees and today I enjoyed the afternoon off at the pool in a cool 96 degrees. One day we will have a yard and a kiddie pool so the dogs (and kids one day) will enjoy the water too. Shawn and I were only outside for about an hour, and Shawn was a little medium rare from the day before - but that short 60min was enough to make me a little rare too. I think Shawn is glad he is working nights for a couple more shifts during this unusual May heatwave, although it's still warm he doesn't have to haul people in the blazing heat ( I don't think the snazzy looking uniform gives much breathability).
Today I had an abbreviated day in clinic. I was suppose to round with my doc before clinic this morning (I more or less pleaded that I wanted to round with him). We were to meet at 8am. So I arrived just after 7:30 so I could do a little chart review before the Dr. arrived at 8am. But as it turns out, it's shift change for the nurses, so no one want to help me find my pt's chart, and since it's not time for Dr. to be their yet I just stand against the wall and wait. I see my pt's name on the wall and just peek my head in and say hello. We (hahaha, not me, I just watched, but I was a good watcher) did a total knee on her on Tuesday. We chatted a bit about how everything is going only to find out that the Dr. was in to see her about 15min ago...hmmm, is she confused (she was a little on the loopy side) she also had to potty. So I finally tracked down the nurse (it's 8am now - the appointed rounding time) and asked if the Dr. had been in - yep he had, about 7:30, I let her know my pt has to use the restroom and she reluctantly tells me she'll get around to taking my pt to the bathroom. realizing I have pts in the clinic in 15min and I seem to easily get lost I trek back to the clinic to find the Dr. there on the phone, he tells me oh I got up a little early and went without you. I was so upset! I had actually been at the hospital since 7am, and I was watching for his car which he parks in a loading only zone but never saw it. There is no one in the office until 7:15, which is when I drop my bag off in the office, so my question is, did he purposely go without me or did he really just want to get it done? Who knows. We only saw about 20 pts today between 8:15 to 11:15. I got to put more bandaids on, pull the xrays and MRIs off the light box in the room and oh yes I even got to hand out a pre written prescription for naproxen (an anti-inflammatory) and prescriptions for PT. whoo. (unenthusiatically). II had a couple pts today who scoffed at the thought of me going through PA school with remarks such as "oh so you're a glorified medical assistant" and "what a waste to not go through medical school and become a physician" As the head penguin in Madagascar would say: Smile and wave boys, smile and wave - and that's basically what I did.


On a side note, American Gladiators is relatively entertaining, especially since one of the new gladiators is from OR, but I just realized that although the gladiators and contenders are of great physical prowess (and Helga is just plain scary), the referee is a little on the tubby side, seems like they would have chosen someone a little more athletic looking, but I guess it just shows a better contrast...I don't know, just made me chuckle. And the new eliminator is awesome and tougher!

3 full days and then some

So before I jump into talking about myself, which I tend to do I should talk about Shawn and life - since it is our blog although I am pretty sure he forgot about it and will never contribute directly to it. Shawn's working nights, but he's finished his FTO which is awesome, so now he can alternate pts with his partner. He's not too fond of nights, although he picked up a day shift yesterday and thought nights were better - no traffic, although the clientele seemed to be a bit different. He's had 2 field tubes and given lots of meds. The protocols up here are advanced and the area they cover is massive which means very little downtime and lots of calls - 11 the other night in just 12 hours!
Cubs and Wrigs are good, this mini heat wave of 90 degree days are rough on both of them - thank goodness for our floor fan. Wrigs is recovering great from surgery, her scar looks much better. They've adjusted well to the new place and even scoped out the park not too far from us which is really big and hilly - lots of room to run but that means we have farther to trek to keep an eye on them.

So it's day 4 of week 1 of rotation 1. I was with the ortho doc today - we saw 45 pts, holy cow; in one room out another. For school I am required to log all the pts I see and I could hardly keep up writing the basic info down so I can log them - whew. This guy is crazy, in and out in and out in and out over and over. On one hand I think wow, this guy is doing great, he started 30 min late due to a scheduling error and manages to finish only 25 min behind and on the other hand I think holy cow, I would feel so ripped off if this were my doc. $45 for an office visit - or more depending if you are new or established and if the visit is focused, detailed or expanded (stupid level of service charges) and he's only in the room for a couple minutes - but he says all he needs to and answers questions - so he is really good to the patients. Today, we were too busy to for him to actually explain much or let me do anything but put a bandaid on injection sites - but on the other hand I found I listened well today when I got pimped at a "business lunch" by a (7th day adventist) family practice doc in his 60s (he made it a point to let me know his religious affiliation). He asked me what the operative options are for a MCL tear and what I would do if my patient had a lateral collateral ligament tear and why. Anyway, I do feel confidant in locating the ligaments, cartilage, bone, tendons, arteries and muscles of the knee in an MRI, so hurray!

Yesterday I spent half a day in surgery with a huge case - a total revision of a TKA (total knee arthroplasty). It was an awesome case! We started at 7:45 and finished right around 11:30, wow. So this pt had a new knee placed a while back, but it wasn't really placed quite right so Dr. H (the doc I'm following) had to take out the old knee and figure out a way to put in a new one. It seems simple enough but it's really quite complicated. First there's the cement which must be cut out, then there's the bone and tissue breakdown that occurred because of the poor placement, this breakdown means there is no sturdy bone in some areas to adhere the new prosthesis. So all in all there was a lot of leveling out bone, building up bone with cadaver bone chips, and lots of hammering, and drilling to perfectly place a new knee which unfortunately had to have "stems" (pieces that go into the shaft of the bone to hold them in place) but I think the patient will be good as new! While this was great, I don' think it compares to my first day of surgery experience on Tuesday...

The morning started with a TKA (total knee) then a Rotator cuff repair (really wicked tear), then off to another hospital to finish out the day starting with another rotator cuff repair, followed by two knee arthroscopes. Morning went without a hitch and with me staying on my two feet the entire time (no face planting today!) I have to add that the doc and PA were already a little peeved knowing they had such a full surgery day - which wouldn't have been too bad if we didn't have to go from Portland to another city about 20min away, and to add to this insult they hate doing surgery at this other hospital due to the poor medical staff and help available. First case is the shoulder - a 600 lb man who didn't fit on the surgical table. Well the patient wasn't prepped the way he should have been (he was super hairy and they had all the important medical bracelets on his operative arm), then one thing after another seemed to be just a little off - which I have to say is not good for a doc who hates change. The doc and PA went to scrub and the doc says, Jen, have you scrubbed before? I said yes (yeah in a OR during school, once, but no pts were involved) then he said I'm going to need to to scrub in on this case. What?!?!?! I thought, I'm only supposed to be observing.... so he finishes scrubbing and the PA says, as I begin to scrub - you don't need to do the whole 20 scrubs on each plane, just get each plane and hurray up, we are all waiting for you. So I scrub - and as thoroughly as possible, Candy Randolph and Gietzen would be proud and I tromp into the OR waiting for the grumpy scrub nurse to hand me a towel - you know a lady is grumpy when the doc asks for a new scrub nurse. Then I find out my job: I am the arm girl - my job is to hold this ginormous arm (and no I am not exaggerating - it was bigger than my highs together) in downward traction - if I let up just a little bit, the sutures won't be tight and he has to start over, plus I have to rotate the arm medial and lateral on queue with the same parameters. So I'm feeling pretty good, all I have to do is focus on the arm - no big deal...which was all good until about 15min into it when my arms began to shake. My biceps burned as did my forearms. Then I'm told to hold the arm up - above my head - but careful don't contaminate yourself (the sterile field can be a real pain to maintain), so the next 15min involve me holding this huge arm steady above my head. Then back to out and down traction (apparently the position is the same as if you were water skiing - bent knees, fairly straight arms, pulling back with your weight). Sweat dripping and arms trembling I manage to do my job - fairly well (my arms hit fatigue and the doc had to reposition the pt a couple times - but oh well). So for my first time scrubbing in I was actually incredibly useful.