Ellen Brooks/Dr. Marx - Week 4

Dr. Marx was back in the office this week so I few days shadowing again.  I shadowed both in the clinic and the operating room this week. This week, I continue to be amazed by how much the clinic work relies on treating the whole person rather than just their injured joint. 

This week a patient came in with psoriatic arthritis, an immune disease that causes a build-up of fluid in joints, among other complications. This condition is chronic, unlike the majority of conditions seen by Dr. Marx. He spent the majority of the clinic visit talking about medications, other symptoms, and the patient's mental state. Psoriatic arthritis is a condition that Dr. Marx cannot fix, at best, he can suggest treatments to reduce immediate joint swelling. Despite this, there was still a large focus on general patient well being. 

Another patient came in with a torn ACL. The determined treatment was surgery. Dr. Marx went through the general procedure, risks, and recovery details of the procedure before noticing in the patient notes that the patient had a history of alcoholism and was a daily smoker. Both of these items increase the risks of surgery and decrease the likelihood of a quick and easy recovery. The remainder of the clinic visit was a conversation of how to mitigate these risks and how to navigate quitting smoking. Again, the patient's overall health and wellbeing (both for success in the ACL repair, and overall) was considered.

This week there was a very full day in the operating room. I observed three ACL repairs (two with a hamstring graft, and one with a patellar tendon graft), a shoulder labral repair and open shoulder surgery, a meniscus root repair, a partial meniscectomy, and a comportment fasciotomy. The last case of the day was particularly interesting as the resident noted that there is limited and conflicting evidence for the procedure despite the fact that Dr. Marx has seen success in treating it. Acute compartment syndrome is a traumatic condition where fluids and swelling build up in the muscle compartments of the legs. If this pressure is not released, it can lead to permanent damage and muscle necrosis. There is some data that there is a related condition, chronic compartment syndrome, may also induce swelling in muscle compartments in response to exercise. This condition causes pain and swelling and may be treated by surgery. This chronic condition is poorly understood. Seeing and hearing about this condition showed me how many gaps there are to fill in medical sciences. 

Outside of shadowing, this Monday, I attended the day long CAMEO bone course. We listened to lectures on bone biology, fracture repair, and development from faculty at Cornell in Ithaca and Weill Cornell Medicine. We were also able to tour the imaging and surgical areas. Overall a very neat experience and a very full week!

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