Sunday, November 6, 2011

Shadow Redux....the shadow knows!

I got to shadow Sheila again today in her primary care practice set in a picturesque small town. 

Sheila and I definitely see eye-to-eye.  And at four foot eleven and 3/4 inches, I enjoy seeing eye-to-eye with anyone that I can!  (Yes, I got an official measurement today when I had my MMR titer drawn, and I am holding firm at this height!) Sheila and I shared our common love of granola bars today as she chomped her fiber plus and I had my almond crunch bar (my current favorite).
Definitely a setting I would not have had the privilege to see if it were not for Sheila.  And what an interesting slice of life she sees in her practice.  Primary care is so much on the front lines of patient care and PAs are definitely in the trenches.  The growing need for primary care that faces all of us and certainly those of us entering a medical workforce is well addressed in this article in The Hastings Report Bioethics Forum.
Sheila checked a diabetic patient with leg pain and varicosities in the calf.  As she spoke with the patient about the importance of examining the soles of her feet with a mirror, she checked for a positive Homan's sign and later educated me on this.



I learned today about Homan's sign seen demonstrated in the video above.


A fair number of the patients seen in this practice are diabetic smokers who suffer with varying degrees of COPD.  It is a real dose of reality to observe Sheila's professionalism as she manages their symptoms, treatment and medication smoothly and seamlessly in the time allotted to each visit.

Our friend the Sun.

Due to the lower amounts of sunshine people in Western New York are exposed to, serum Vitamin D levels are a part of a routine physical work up here along with the standard CBC, UA, Chem 24 that I am more accustomed to.   An interesting subscript to regional differences in primary care.  In Louisiana, we spend more time trying to protect ourselves from over exposure to the sun.

This is one of my concerns about my new home in Buffalo--the dome covering gray skies that seem to be an intermittent part of fall here.  Are they going to be a permanent part of winter here?  I am already having sun and garden withdrawal that I am tempering with numerous cuttings, houseplants and grow lights.

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