History and Physical Write Up
Journal Article
A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease
The article I selected was an article published in the journal Nutrition. It was a 6 week, randomized trial of incorporating a low FODMAP diet in patients with IBD. FODMAPs stand for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Seen in apples, dried fruit, asparagus, mushroom, cow’s milk, ice cream, legumes and more. Patients with Irritable Bowl Syndrome are advised to follow a low-FODMAP diet to help reduce any stomach pain, bloating, constipation, or other gastrointestinal symptoms. 55 patients with IBD in remission or with mild disease were randomized into either low-FODMAP diet or a standard diet. The patients disease activity (using the Harvey-Bradshaw Index), fecal calprotectin, and a disease specific quality of life were all assessed at baseline and at the end of the 6-week trial. In the short term, patients diagnosed with mild/quiescent IBD, on a low-FODMAP diet, saw an associated amelioration of fecal inflammatory markers and improvement in quality of life.
Site evaluation: My summary
I presented a 23M, w/ no PMH, Family Hx of ulcerative colitis, who presented to the ED with 1 episode of bloody diarrhea yesterday accompanied with lower abdominal tenderness. Pt also admitted to 2 month history of “stinging” associated with each bowel movement, but no blood or abdominal pain at the time. Patients vitals were stable, he was in mild distress, and LLQ>RLQ tenderness was appreciated with a positive FOBT. His CBC and CMP were WNL. His ESR/CRP and lactate were all WNL as well. CT A/P w/ oral and IV contrast suggested terminal ileitis. Infectious causes of colitis needed to be ruled out along with a planned EGD/colonoscopy. I was lucky enough to able to observe the EGD/colonoscopy of the patient I was following. Both the EGD and colonoscopy were negative and did not suggest any findings correlating with Crohn’s disease or ulcerative colitis. The patient was then taken back to the medicine floor for further care.
I always appreciated Professor Lopez’s teaching abilities and how she is able to have her student’s critically think through cases. She told me I knew more than I assumed I knew because sometimes I would hesitate on answering questions but I she knew I knew the answer and was able to draw the answer out of me by asking specific questions. Overall, the sit evaluation went really well and professor Lopez really gave some important tips on writing my HPs that I will implement on my next rotation for sure and future HP writing as a clinician.
Typhon postings
Self reflection
Exposure to new techniques or treatment strategies
Rotating at North Shore University Hospital was a very fun experience as a PA student. The preceptor Dawn PA-C was very invested in your learning and she really wanted me to take advantage of every opportunity available. I was able to rotate through TAVR procedures, endoscopies, colonoscopies, bronchoscopies, tracheostomies and was able to spend a week on the ICU floor where I saw a bunch of cool procedures as well. I appreciate being able to witness all of those procedures first hand where I was able to ask questions and learn from experienced PAs, NPs, residents, and attending physicians.
Types of patients you found challenging in this rotation and what you learned about dealing with them?
Patients I found challenging were patients admitted to the medical ICU. These patients are presenting with multiple severe conditions that require lots of attention from nursing, PAs, residents, and attendings altogether. I realized that you need to have a deep understanding of physiology to be comfortable treating these patients. There are tons of drugs that are exclusively used in the ICU that are not used on the regular floors (i.e. pressors). Point of care ultrasound was a very common thing where I was able to visualize the heart and lungs to ensure everything was okay. Learning the ultrasound is something that will take time and much more experience is needed to get the hang of it. Another big component of the ICU, is dealing with family members and providing treatment options/prognoses for their loved ones. Its a tough thing to do when you have to deliver bad news to someone and in the ICU there is lots of that. Overall, assisting in the care of these types of patients is an eye opener and I am very grateful for having the opportunity to help.
How could the knowledge I’ve gained here be applicable in other rotations/disciplines?
Lots of our professors and many PAs that I have come across have all said the same thing: “You would want to do a year in internal medicine to really grasp what it means to diagnose and treat diseases.” In the 5 week rotation, although I did not see every medical disease known to man kind, I did see a plethora of issues and how clinicians were able to appropriately respond to properly manage their patients. Once you see many it all, then you can select and choose which sub-specialty you would like to work in because a patient within the sub-specialty may also present with a general medicine condition that you as a clinician need to know how to manage along with their current complaint. Again, I truly enjoyed my rotation at NSUH because I was able to see a lot of things.
How your perspective may have changed as a result of this rotation
The Emergency Department was always appealing to me because of the fast paced work environment and the idea of focusing on treating acute issues rather than chronic ones. Thinking about Internal Medicine, the thought about managing patients who most of the time have more than 3 comorbidities is something perceived as difficult and challenging. Finally being able to rotate through my Internal Medicine rotation opened up my eyes a bit more and it appealed to me more so than before. Yes it is challenging, but its also exciting that you get to learn something new each day. Another positive about the field is that the family members and patients truly appreciate all the work you have done for them when the patient is able to be discharged from the hospital. Now having rotated through a medicine department, I might consider working in medicine to truly grasp the essence of what it means to diagnose and treat diseases with all the potential hiccups along the way that you as a clinician must be ready for to respond accordingly.
