Ankle and foot

Fortunately I have not experienced much foot pain, but just enough to know how annoying it can be. Even a few hours with a blister can drastically alter the way we walk and compensatory aching can occur elsewhere in no time. Unlike some of my classmates, I am foot friendly, although I admit I have been lucky so far in managing to avoid any unpleasant encounters! I also like my own feet and I am always happy to have them worked on. I really can't understand anyone who isn't.

I have seen only one or two primary foot problems in clinic, but I have found that it is often beneficial to treat the feet when patients present with hip or knee complaints. This is relieving for them and enables me to revise. I am finding it is true that if you don't use it, you lose it - quite quickly sometimes. It has pleased me that peer feedback has been that my pressure/grip/fixing is a lot firmer now and my treatment feels more effective.

I am a visual learner and I really need information written down in front of me. This means I generate a lot of notes and then spend hours trying to summarise them! My plan this year is to collate all the information I have gathered and arrange it by anatomical area. I am in the process of annotating the second and third year visual aids for technique, with any useful information from the first year handbook, media on demand videos and notes I have taken in class over four years. Then I intend to generate memory jogging technique revision cards - I really need to widen my repertoire and keep using all the techniques we have been shown, not just a few old favourites. I am also making clinically orientated revision cards for anatomy/surface anatomy and examination, including orthopaedic tests - see below for ankle and foot.

Ankle/Foot annotated diagrams; Technique and Clinical anatomy revision cards

I am also compiling information on differentials. I am annotating a differential diagnosis textbook (the origin of VINDICATE so it seems) with information from clinic, two other useful textbooks and old fourth year notes. It really bothers me that there is no definitive well sourced list and so much information given to us is actually not entirely correct! See below for leg, heel foot and toe.

Annotated differentials textbook - leg, heel, foot and toe

Clinic reflection

1/10 My new patient today was a new mother and I felt quite prepared for this, having seen a very acute new mother in my first summer clinic - when I missed lots of questions in the case history! However, when I presented to a tutor this time, I was quite harshly reprimanded for missing some questions I still hadn't thought of and also for not knowing about specific types of braces/supports that can be used during pregnancy. It struck me that there are many questions that need to be asked about the pregnancy itself, labour, delivery and aftercare and I need to know about this, as it is definitely an area of interest for me. I will be taking the obstetrics elective later in the term, but following this experience today, I have requested/begged to be put in the expectant mothers clinic next term. I feel concerned about other specialist areas I may not be exposed to and I am going to give this some consideration.

29/9 My new patient today had a rib lesion and I am disappointed that I asked the tutor to perform the HVT  without even trying it myself. I had not performed a successful rib HVT yet and I was reluctant to inflict my technique on an acute patient. However, I still felt deflated by the experience. Fortunately for me, I had a very understanding tutor who advised me that ribs were EASY and before I knew it, an unsuspecting colleague was laid out on the plinth before me. I was not allowed out of the room until I achieved a rib HVT. I did a lap round the plinth to celebrate.

Clinic reflection

I accidentally swapped teams this year, having originally only asked a few questions about it and then, as if by magic, my colleagues were ringing me up, asking why my name was on the new schedule under a different team! Long story, but hopefully it will work out for the best. I have some close friends in my new team anyway.

I struggled more with my new patient today than I have done with anyone so far on the course. There was a language barrier which didn't help and the patient was an ex heroin addict with a complicated history. I was concerned when he described itching all over, but there were no visible lesions and this was normal for him. The tutor thought that this was common in ex-heroin addicts and a side effect of methadone. I proceeded as usual but felt uncomfortable. The patients' underwear was not clean and I found the whole situation rather bothersome. However, I felt I dealt with it professionally and made a reasonable diagnosis and treatment plan. Tutor feedback was very positive and I was told that I handled a difficult patient well. Result!

Summer sports massage course / ITEC qualification

I will begin by mentioning that I got a distinction in the sports massage course over the summer. Hurrah! I absolutely loved it too and it really filled in some gaps. It was tiring, but I  enjoyed the constant technique and the approach taken, which involved treating named conditions. My hands were happy!

Sports massage certificate - Distinction!

Introduction

I have chosen to construct a blog from the notes that I scribble regularly, as I think this might suit me best. However, I am the world's biggest technophobe - not on facebook, my space or twitter and I don't really want an internet presence at all. Hence, this will be done anonymously! I will worry about how to market myself when I graduate....