• (function() { (function(){function b(g){this.t={};this.tick=function(h,m,f){var n=void 0!=f?f:(new Date).getTime();this.t[h]=[n,m];if(void 0==f)try{window.console.timeStamp("CSI/"+h)}catch(q){}};this.getStartTickTime=function(){return this.t.start[0]};this.tick("start",null,g)}var a;if(window.performance)var e=(a=window.performance.timing)&&a.responseStart;var p=0=c&&(window.jstiming.srt=e-c)}if(a){var d=window.jstiming.load; 0=c&&(d.tick("_wtsrt",void 0,c),d.tick("wtsrt_","_wtsrt",e),d.tick("tbsd_","wtsrt_"))}try{a=null,window.chrome&&window.chrome.csi&&(a=Math.floor(window.chrome.csi().pageT),d&&0=b&&window.jstiming.load.tick("aft")};var k=!1;function l(){k||(k=!0,window.jstiming.load.tick("firstScrollTime"))}window.addEventListener?window.addEventListener("scroll",l,!1):window.attachEvent("onscroll",l); })();

    Saturday, May 13, 2006

    Taking care of feet



    Theodore Roosevelt once said about the importance of taking care of your feet, "Sound hearts are not much good if the feet won't stand." Any infantryman who has put a ruck on his back and worn combat boots would attest to the same. I believe that second only to the maintenance of one's weapon is taking care of one's feet. That was reiterated by my preceptor on day one. My mentor here, we'll call him "Dr. L", blew all of my expectations away as a civilian Doctor. Typicaly, physicians I've worked with, so far, on the civilian side have had no interest in applying his/her knowledge to a military setting. I don't think it has been intentional, but rather, naturally, one would gravitate to his/her strength which in most cases is civilian medicine for most doctors. It takes either a lot of experience in war medicine, or a good imagination and in-depth research to take the scope and knowledge of an M.D. and transfer it to an SF Medic in a way that best prepares him for what he'll see. Dr. L has shown this to be his mission for me and my battle buddy, "Sgt B" while we are here on the resevation. Dr. L isn't former military but his enthusiasm and knowledge, particularly of the SF mission, is umatched by even some of the military doctors that I know. Dr. L's plan is to make sure we get training in various different scenarios from truama, to delivering babies, to going out to homes in rural North Dakota for treatment, to dealing with translators (which we will certainly need here), to the simple things like feet, and more complicated things like surgery. Day one was feet. Dr. L said, "Guys, I know you may want to go straight to the OR or ER, but I think we should start with an often overlooked area for the soldier- the feet. You guys have already had your trauma rotations, so now we're going to focus more on clinical medicine because most of the time you'll be treating indigenous village folk in order to build rapport and gather that valuable human intelligence. And it will be you, the team medic, who will be getting this intel after you've taken care of a son, daughter, or chief with simple clinical procedures." I was impressed by this conversation and many others throughout the day. I am very fortunate to have such a dedicated preceptor, he is more dedicated to us than to anyone else in the hospital, he makes it very clear to everyone that we are priority one, and he makes it clear to us that we are to actively seek out his colleagues for their valuable knowledge. The physicians here have all been excited to meet us, and even on day one I was invited to come to a Brain Trauma Conference at the community college outside of town with the ER doc, which was today, and was great. Anyhow, back to the feet. What did we do? We did a lot of wound care with diabetic patients whose feet ranged from literally rotting off, to simply paring down callouses and seeing if an ulcer was about to open up. We also did some ingrown toenail removals, all along talking about how to treat infections, trench foot, plantar warts, blisters, gangrene, and when to recognize the need for amputation. Very good training. With every procedure and patient Dr. L would apply his favorite SF mantra "See one, do one, teach one." We would watch him do a procedure, then we'd do the procedure ourselves, and then we'd have to do some role playing and explain step-by-step how to do the procedure. Looks like it's going to be a great learning experience here.

    13 Comments:

    At 5/14/2006 8:48 AM, Anonymous Anonymous said...

    Wow, it's so interesting / exciting that you get to do so much. The hands-on work must be awesome!

    I had to get a shot in my big toe once. Worst. Pain. Ever. (okay not really, but I still remember it to this day!) :o)

     
    At 5/14/2006 9:22 AM, Anonymous Anonymous said...

    Awesome! What is going on in the photo?

     
    At 5/14/2006 10:56 PM, Anonymous Anonymous said...

    My ex (Air Force) had such horrible feet problems... he always had ingrown toenails or blisters etc...

    I use to work for a Podiatrist... nasty job I tell ya... ingrown toenail removal and burning the warts off... GROSS... there were days that all we smelled in the office was burned flesh from the wart removal!!!

    Glad you are getting the training you want and deserve! :)

     
    At 5/14/2006 11:39 PM, Blogger Jake said...

    kath- come on, it's not that bad!

    anon- it's and ingrown toenail removal.

    shayna- you worked for a podiatrist? i bet that was nasty. you gotta do whatcha gotta do.

     
    At 5/15/2006 12:19 PM, Anonymous Anonymous said...

    Ugh, Jake, I am so disgusted. This is why I overlooked medicine...

     
    At 5/15/2006 4:58 PM, Anonymous Anonymous said...

    Was that ingrown toenail a case you did?

     
    At 5/15/2006 5:07 PM, Anonymous Anonymous said...

    No, seriously, it was bad ~ *innocent look*. I've been in worse pain, but fingers and toes are intense.

    The pic is not so much gross as... very real. Guess that's the point!
    :o)

     
    At 5/16/2006 12:27 AM, Blogger Jake said...

    cowgirl- lightweights for sure, they should see the average foot after a good ruck march. you're right about that duct tape working on warts, that's an old army trick. speaking of which, are you sure it's not "100 mph tape" from the army instead of NASCAR? just like all our other little weird names for things, like "the front leaning rest", "hook and pile fasteners" to name a couple. one last thing... keep the bailey's away from the cup of joe.

    christina, christina- but you'd make the best little doctor, i know it. you'd be one of those ER docs who come down off mt. olympus when things get crazy and save lives, while everyone else is standing around peeing their pants. doesn't that sound fun?

    anon- unfortunately no, but i did bring my camera so i'll try and take a pic of some procedures i do, but it's kinda hard. i mean, would you be okay with me taking a pic of your toenail during an appointment? i think i'd be okay with it as a patient, but that's bc i'd make sure to get paid for my services.

    kath- you're making me believe that girls don't actually have a higher tolerance for pain than us fellas. i've always been skeptical of such data... junk science- pfft.

     
    At 5/16/2006 10:05 AM, Anonymous Anonymous said...

    Ah, yes, but just because I said it was intense doesn't mean I cried/screamed/couldn't watch/wouldn be scared to go through it again! haha. Not that I have a higher pain tolerance of say, someone like you or my Marine, but I think everyone is different. There is no "guys can handle it better" or vice versa. It's all in the mind. And I know many men with very weak minds ;o)

     
    At 5/16/2006 5:08 PM, Blogger CJ said...

    Cool stuff--though I have to say foot care is not high on my list of "nursing fun stuff". =) Very glad you have such a great doc to learn from. Tell him to clone himself while he's at it, would ya?! Take care and hope you learn a ton.

     
    At 5/17/2006 1:38 AM, Blogger Jake said...

    cj- thanks so much. first time here? be sure to check out these blogger friends of mine, they are a wily gang.

     
    At 5/18/2006 6:19 PM, Blogger BarnGoddess_01 said...

    ewww feet gross me out, all feet, including my own, I feel sorry for the girl who gives me pedicures....I think Ill tip her better from now on.

    Holy smokes, Ive been missing out over here, got some reading catching up to do!

     
    At 5/19/2006 6:55 PM, Blogger Jake said...

    barngoddess- that's funny. yes, you do have soe catching up, but i only post on average 1-2 times a week so plenty of time.

     

    Post a Comment

    << Home