This is the rotation I’ve been waiting for - - OMM! For those who don’t know what OMM is, it stands for osteopathic manipulative medicine. This is where the art of “healing hands” really comes into play. . . at least for me.
The week started out slow, working mostly with the Associate Dean of OPP, who specializes in manipulation in children and infants. While I have learned the techniques, we never actually had any infants or children to practice on, so in the clinic, it was mostly observe. However, I did have the opportunity to put my hands next to hers during the treatment, which allowed me to feel the amount of pressure exerted, the release of muscle tension, and how to do manipulation on a child. It was great.
The last two days of the week I worked with one of my favorite instructors. He allowed me total freedom to examine, diagnose, determine a treatment plan and then do the manipulations I had chosen to do. Afterwards he would come in for a minute, talk to the patient, ask them if they felt better(which everyone of them did!), and that would be it. They’d be out the door with their next appointment scheduled.
OMM is only a 2-week rotation and we are supposed to check with our preceptors halfway through each rotation to see how we’re doing and what we can do to improve. When I asked him this question yesterday, he said I am doing great and he doesn’t see any obvious shortcomings that I should work on. And it just happened that yesterday he was doublebooked, so I had a lot of freedom. At the end of the day he said I "had saved the day for him."
Anyway, that’s about it for this week. If anyone has any questions on OMM (also called OMT), then please feel free to ask. I absolutely love it and have to admit that without having OMT regularly performed on this old achy body, I don’t think I would have gotten through the first two years. Anyway, I hope to be able to do a presentation on OMT at next year’s conference, but if you have questions now, like I said, please ask!
This will be a relatively short second week coming up. Monday I won’t be in the clinic because my husband is having surgery. And Friday there are no clinic hours because the 2nd year students are having their practical exam. So I only have 3 days this week. But I will enjoy every minute of it!
Linda,
I am so thrilled for you! You sound like you are on cloud 9 right now. I think your idea of presenting a seminar next year at the conference on OMM is a wonderful idea. I learned so much from the DO residents I worked alongside last summer. The patients really seemed to benefit from the treatments.
Lu
Okay, my OMM rotation ended last week. 
I won’t know my grade for a little while because all four doctors I worked with have to do individual assessments and then the clinical ed department figures out the final grade. I will get any and all positive and negative feedback.
However, according to the doctor I worked with most, the one in charge of the two-week rotations, no one had told him anything negative at all! So I’m hoping for a pretty good grade, but, what really matters to me is that I was able to do a good job and renew my OMM skills.
Now I have two weeks vacation to study for the boards again. I am putting in about 10 hours/day and feeling pretty good. I now have a better idea of where my shortcomings were, and I hope to overcome them.
Wish me luck. And keep me in your prayers on Oct. 11 and 12. I think that’s more powerful than luck!
OMM rotation grade came in and it’s just fine. COMLEX I came and went, and I think it was okay. Then the real fun began!
I started Ob/Gyn Thursday. Then, from 8:00 Friday morning to 8:00 tomorrow morning, my preceptor (and thus me) was on call. I spent a great deal of Friday evening, most of the day Saturday, and about 4 hours today at the hospital. And that may not be the end of it. Like I said, I’m on call until 8 a.m. Monday morning.
So far, we’ve had two deliveries, one C-section that we had induced Friday morning and finally ended up doing the section Friday evening, and one normal vaginal delivery. One patient with a possible ectopic pregnancy, with a history of ectopic pregnancy, presenting with lower abdominal pain and a positive pregnancy test. She was about 4 weeks, so with beta hCG tests from Friday and again today, as well as a pelvic ultrasound, we were able to decide she is carrying intrauterine. Another woman, 36 week gestation, came with with supraventricular tachycardia. Her heart rate was over 200 bpm. Had to use adenosine to bring it under control, and in order to do this, the fetus had to be carefully monitored. She went home this afternoon after being started on toprol.
Along with those patients, I had to round on the other two ob-gyn doctors hospital patients, and there were several. Sent three home over the weekend, along with their really cute babies!
Anyway, I’m just finishing a great dinner prepared by my husband, and then I hope for a quiet evening. I’ll be at the hospital about 6 a.m. to pre-round, then at 7 we have hospital report, and as soon as it’s completed, I’ll round with my preceptor. Then it’s on to the office for a hectic Monday.
This one is a lot harder on me physically than some of the earlier rotations. But I am surely enjoying it and learning a lot!
Second week of ob/gyn is over and since my preceptor is ill today (thus I have some “reading” time), I thought I would catch everyone up on what went on.
To start with . . . PAP after PAP after PAP after PAP . . . I think I can now do them blindfolded (well not quite, since you have to visualize the cervical os)! And then there’s the routine pregnancy visits. It is really great to see the parents’ faces when you use the doppler to check the fetal heartbeat. They just seem to light up.
But the best part of the week was last Wednesday. Wednesdays are surgery day for my preceptor, and, although I came home totally exhausted, it was a great day! I started out with simply observing during a total vaginal hysterectomy with bilateral salpingo-oophorectomy (TVH-BSO). I was amazed to see the uterus, tubes, and ovaries all removed via the vagina. Then we did a TAH-BSO, and on this and all the rest of the surgeries for the day, I was first assist.
After that we went on to a TVTO (tension-free vaginal tape via the obturator). It was amazing to see how you can insert this mesh and it would support the bladder to improve urinary leakage.
We followed that with a D&C with ablation. The entire interior portion of the uterus is literally washed with saline at a temperature of 90 degrees celsius until it has all turned grey. This usually stops a woman’s periods without surgically removing the uterus. Sometimes there may be some breakthrough bleeding, but it is usually very mild . . and without cramping!
Our next surgery was an emergency. A woman came in to the ER with severe lower abdominal pain. Her history showed a tubal ligation 16 years ago, but, because of her age, a pregnancy test was still performed. And, lo and behold, she was pregnant! A tubal pregnancy, which had ruptured. So it was off for an emergency salpingectomy, but when we tried to use the laparoscope, there was too much blood in the cavity, so we had to open her abdominally. A transverse incision was made and, after cutting through the fat and rectus abdominis muscles, the peritoneum was opened. There was a great deal of bleeding involved. After stopping the bleeders, we were able to determine which tube had ruptured and ligate and remove it. My preceptor decided to go ahead and take that ovary as well and send it for biopsy because of the appearance. This patient had a history of cardiac and hypertensive disorders, so she was a high risk. But she came through just fine and went home the next day.
Our last surgical case for the day was a c-section on a young lady we had induced early Wednesday morning. After 10 hours of pitocin, her cervix had still not dilated. She was a very tiny woman, and the baby appeared to be fairly large. So, it was on to surgery. This one was really exciting as I was able to participate in removing the baby from the uterus. It’s amazing how difficult it can be to get tat little head and shoulders out of the uterus when it has been surgically opened. This little one had a cord around its neck, so we had to move quickly. After dad cut the cord, I assisted in the suturing and did the stapling myself. Mom and baby were both doing great the next morning when I made rounds, and went home the second day after delivery. 
Anyway, this Wednesday will be more exciting surgeries. I can see why Natalie loves being a surgeon.
WOW, Linda, What a neat experience you had last Wed. So glad to hear you are enjoying your OB/GYN rotation. It made me “homesick” for Women’s Health (I was an RN there prior to going back to school full time!). Enjoy your next day in surgery!
Lu
Week three has come to an end, and with only one week to go, I realize how much I will miss working with this preceptor. She is a really wonderful teacher as well as doctor!
This week the office time was more of the same: pregnancy checks, PAPs, abnormal bleeding, etc.
Surgery included another TVH and two TVTOs. We also had three tubal ligations (all laparoscopic), one D&C with ablation, and one exploratory lap. On several of these, I was able to do the incision; on two of the tubals, I used the laparoscopic instrument to “burn the dickens” out of the tube; and then there were the routine sutures. Following surgeries, I wrote post-op progress notes and then followed up the following morning with more post-op day one progress notes as well as discharge orders (all of which had to be co-signed by my preceptor, of course).
The week ended with the induction of labor in a 40+ week gestation. After about 8 hours, the baby delivered naturally, and I do mean naturally. . . no spinal anesthesia or anything! And what a beautiful little boy he was. He had absolutely the most gorgeous long eyelashes and stunning reddish-brown hair. Okay. All the babies are gorgeous. But this one I was there to help deliver!
I feel really lucky to have been able to rotate with this particular preceptor. I was the last student she’s taking as she’s moving into another practice about 70 miles away in January.
Anyway, one more week, then it’s on to Internal Med.
Well, it all came to an end yesterday with an absolutely wonderful evaluation. But more important to me than any grade was the tremendous amount of knowledge I gained and the incomparable experiences.
The week itself was more of the same as the previous weeks. More TVH-BSOs, TAH-BSOs, TVTOs, tubal ligations, and, of course, deliveries!! I don’t think I would ever tire of seeing those beautiful little babies come into the world.
BUT, we also had one fetal demise this week. I only got a call right at the end and never really got to know what exactly had happened, but the one thing I did get to experience was the grief that someone losing an unborn child goes through. And while it was an experience that is very necessary to see in order to understand, it is an experience I wish none of us ever had to participate in. That said, the next time I have to experience the death of a patient, whether a fetus, an elderly person, or anyone in between, I will remember that child and family and strive to do everything I can to help those left behind cope with their loss.
While I know I won’t go into ob/gyn, I have come to thoroughly appreciate these doctors. Their hours are long and hard . . . but the rewards are beyond description.
I had patients I became very close to during the last month. Several have given me their home phone numbers and asked me to keep in touch. One even said she would like to call me when she goes into labor so that I can be there when she delivers.
Next week, though, it’s back to the world of adults. Internal medicine. My preceptor is well-liked and a wonderful teacher, so I am looking forward to my 4 weeks with him.
I love this thread! 
It’s stories like this that jerk me back to what I’m really drawn to medicine for.
Linda,
I love hearing all of your experiences, and like Megboo, it reminds me of what I am really waiting for! It sounds like you are having a blast!!
Kathy
“BUT, we also had one fetal demise this week. I only got a call right at the end and never really got to know what exactly had happened, but the one thing I did get to experience was the grief that someone losing an unborn child goes through. And while it was an experience that is very necessary to see in order to understand, it is an experience I wish none of us ever had to participate in. That said, the next time I have to experience the death of a patient, whether a fetus, an elderly person, or anyone in between, I will remember that child and family and strive to do everything I can to help those left behind cope with their loss.”
Yea, after 9 years in Hospice I still don’t know what to say sometimes Empathy is my greatest strengths in these situations. (I’ve found less said is better sometimes too)
Sounds like an awesome experience all around!
Bill.
Internal Med started 11 days ago. . . this is the first afternoon I’ve had off since. The days are long 12-16 hours, my preceptor was on call last weekend, and we have had 5 ICU admits this week. Last weekend I was the only student, so I got to do a little bit of everything!
Most of the time is spent in the hospital. I may see a dozen patients in the office the entire week. But the hospital patients are so challenging. . . I love it!! Trying to balance all a patient’s problems while correcting one problem, or more, . . possibly in different systems. . .well it seems like fun to me. I love trying to put the pieces together while not disturbing the parts that are in place! Does that make sense?
Let me explain what I mean. Take a 74 year old woman who comes in with acute cholecystitis. Surgery, right? Well, yes normally. But this patient also has COPD, CHF, <20% EF, pneumonia, respiratory and renal failure. We cannot get the pneumonia and respiratory failure under control. Now all of a sudden her TROP I levels are increased, indicating an MI. Surgery consult says forget it. She’s just not a surgical candidate. So what about the cholecystitis? She can’t eat, won’t drink. And, oh yeah, she’s also hypertensive and diabetic, hypokalemic, hyponatremic, and a few more hypos. . . And of course she has lots of pain and more than a little dementia.
And that’s just one patient. I’ve also been blessed with younger patients who are now home and doing well. I have had patients admitted from the nursing home who are now under control and have returned. Is that a good thing. Well, for some of them it is. A lot of these patients are still aware of family and friends. They just can’t take care of themselves.
The days at the hospital last weekend were challenging and fun. . . but the best time came later when we had an admission to ICU that required a central line and I watched . . . The good thing is, my preceptor said the next one he might let me put in! Can’t wait!
Anyway, it’s all going great and I am actually enjoying it. I really don’t think there will be any rotation I don’t enjoy!
Linda, how much time do you get to spend with the books, looking things up, researching, and going over the phys, path, pharm and so forth?
I can spend just as much time as I want with my books . . . just as long as its after we finish hospital rounds and clinic. That usually means after 8 p.m. and/or on weekends. And on Wednesdays, I might have a few hours in the afternoon.
For the most part, my preceptor will challenge me each day with something to look up and study that evening. If I have time (and energy), I try to do it that night. Otherwise, I’ll get up a couple of hours early and do it in the morning. And, once in a while, he’ll even pimp me on it. But the good thing is, I learn from it. One day he told me to study A-fib with RVR. Two days later I ended up with a patient in the office with just that problem. She ended up in the hospital, where she became my patient to take care of. Having studied it ahead of time made it much simpler.
Then, no matter how much I do, there’s always more to learn. That’s what I use weekends for!
And this weekend, on top of regular internal med, I am doing in-patient OMT on one of our patients. She has a combination of diverticulitis, ileus, pneumonia, and a myriad of other stuff. Not to mention plain old back tension from lying in a hospital bed all week. So, I am able to help relieve her pain with some gentle myofascial release, articulation with oscillation, and muscle energy. At the same time, I am able to encourage her lungs and bowels to resume more normal function by doing some rib raising and suboccipital inhibition. (Come on guys, just ask me how that works!). I LOVE IT!!
Linda -
I love reading about your clinical experiences. It helps me stay focused on the less than exciting basic sciences, knowing that the knowledge will be needed in the clinical years, and that the clinical years WILL get here eventually!
Amy
Well Internal Med has come to an end. And I really enjoyed every minute of it. Except for the weekend where I lost three patients. I know it was inevitable given their ages and illnesses, but it is still difficult to see them go. They were all really sweet folks.
It was a rough month overall. I worked 17 days straight, with most days being at least 12 hours long. But then I had four days off over Thanksgiving and I felt better.
This month I have been able to assist in chest tube placement, removed an NG tube, assisted in a central line, observed during a stress test and a bronchoscopy, and a myriad of other little things.
But, best of all I was able to develop doctor/patient relationships with people I saw from admission to discharge. From doing their history and physical at admission, to visiting them twice daily in the hospital and writing progress notes and orders (which had to be approved by the attending, of course!), to seeing them sometimes get worse and others get better, and to watching them either go home or pass away. . . every minute of this time and experience was invaluable.
Now it’s on to surgery next week . . . with an absolutely horrible URI to contend with. Still, I’ve been practicing my suture knots and reading up on the surgeries scheduled for Monday (Thanks Nat! You’re the one who made me realize how important it is to go into your surgeries prepared!). So I’ll let you know how it goes!
Quote:
And this weekend, on top of regular internal med, I am doing in-patient OMT on one of our patients. She has a combination of diverticulitis, ileus, pneumonia, and a myriad of other stuff. Not to mention plain old back tension from lying in a hospital bed all week. So, I am able to help relieve her pain with some gentle myofascial release, articulation with oscillation, and muscle energy. At the same time, I am able to encourage her lungs and bowels to resume more normal function by doing some rib raising and suboccipital inhibition. (Come on guys, just ask me how that works!). I LOVE IT!!
Hi Linda,
I know you have lots on your mind right now… but if you have a spare moment I would love to learn more about how OMT is applied, and how it relates to other manual therapies such as myofascial trigger point, shiatsu, orthopedic massage therapy, etc.
I’m enrolled in a massage therapy course right now, which I’m enjoying very much (even all the memorization of muscle insertions, origins and actions, which I’m still rather terrible at), and I am increasingly convinced that osteopathic medicine is the right path for me to take to incorporate these hands-on techniques with traditional medical practice.
So anyway it’s really cool to see someone talk about an actual application of these techniques.
Best regards,
Terry
Terry,
I love OMT so it is not a problem for me to share the knowledge I have. I think the most important things are understanding the principles behind osteopathy. The four main principles are: 1. The body is a unit.; 2. The body has self-healing abilities; 3. Structure and function are interrelated; and 4. Rational osteopathic care is based on the above premises.
So what does that mean? Think about it. If something isn’t functioning correctly, it may be able to be improved if the musculoskeletal system is in alignment. When muscles and bones are where they should be, it improves circulation, lymphatic drainage, etc. These in turn affect many different aspects of our health.
I plan to be doing a presentation at the convention this year about osteopathy and osteopathic manipulation. I will be bringing a portable table to enable me to demonstrate some of the most common techniques and explain how and why they can be used not just for aches and pains, but for problems such as pneumonia, COPD, circulatory difficulties, etc.
Anyway, if you have more questions, let me know and we’ll open another thread dedicated to the subject.
I know. I haven’t posted during this rotation. But with being really busy with surgery, studying for surgeries to be performed, and everything else, I felt it better to just finish the rotation and then make an entry.
I have to tell you. I went into surgery thinking I wouldn’t do very well, but I really loved it and I think I did just fine! I can see why Natalie loves it so much. If I were physically able, I think I would consider it myself!
During the last month I have had the opportunity to learn all about EGDs and colonoscopies. Even got to do one colonoscopy myself, with the help of my preceptor. I had no idea how hard it can be to get that camera around the splenic and hepatic flexures.
Then there is the time in the OR. That was my favorite!! From laparoscopic appendectomies with perforated, abscessed appendices and laparoscopic cholecystectomies to hernia repairs (inguinal, umbilical, and incisional) to the more complicated surgeries such as hemicolectomies and sigmoid resections with end colostomies. My preceptor was a little tough the first week, but after he saw my abilities, he allowed me to do a lot more hands-on.
One of my favorite cases was a really nice lady with breast cancer. We did a lumpectomy with clean margins and she is now very happy to undergo a little radiation therapy as prophylactic treatment to ensure less chance of recurrence.
When not in the OR, there is always the post-operative care on patients that had to stay in the hospital. And that went well. I did several consultation reports and lots of discharge summaries. It felt kind of strange for me to be writing up a surgery consultation, but I must have done it okay, because my preceptor continued to have me do them.
Then there were the clinic days. In the clinic we did several minor surgeries such as cyst or lipoma removals. And there were lots of preop visits where I did the history and physicals.
Overall, it was a great experience. And while I know I’ll never be a surgeon, it gave me an insight into how invaluable they are!
Congrats! It sounds like it was an incredible experience!
Larry