History and Physicals:

Journal Article Summary:

For my article, I presented on the use of propolis extract compared to acyclovir for herpes labialis. Propolis extract is the resin-like material made by bees.The study was a randomized, controlled, double blinded study. There were 400 patients total included in the study, all of which were in the vesicular phase of herpes. They were told to apply either propolis extract or acyclovir five times daily. The results of the study found that the difference in time it took for lesions to enrust or epithelialize was not significantly different between each group. In fact, they found that epithelialization was reached earlier in the propolis group, with a median of three days with propolis compared to four days with acyclovir. The secondary outcomes assessed included pain, burning, itching, tension, and swelling. In these outcomes, they found that the severity of all symptoms decreased continuously over the study in both groups. However, they decreased slightly quicker with propolis extract. No noticeable adverse effects were noted in either group,. This study shows that propolis is a great alternative treatment for herpes labialis. It is an option to consider for people who cannot tolerate acyclovir or are interested in a more natural remedy. That being said, this is a fairly small study with a limited demographic, so more studies are definitely needed to make a definitive recommendation. 

Site Visit Summary:

For my site visit, I presented on a patient who had a complaint of a rash all over her body for two days. This patient said the rash started on her trunk and spread to her extremities. The patient stated she had never had any reaction like this before, and denied any changes to her usual routine. However, the patient mentioned she finished Augmentin for UTI one week prior and as well as received an MMR booster shot. I chose this case because while I can’t definitively say the cause of her rash, I think it’s likely that one of those sources was what caused it. The MMR booster shot can classically give people a rash similar to measles as part of the normal adverse reactions. Augmentin can also cause a reaction for those that are mildly allergic, and she had never used any penicillin before. I chose this case because I found it to be interesting that a 57-year-old female would never have any prior reactions to determine which of these were the cause. We ended up giving the patient Benadryl as well as recommending she follow up with a dermatologist if it doesn’t improve. We also recommended that if the symptoms worsen or she develop difficulty breathing or other anaphylactic reactions, she should go to the emergency room. This case was a good example of the need to sometimes think outside of the box when determining your differentials. These differentials definitely weren’t at the top of my list until after I had elicited a complete HPI. If I wouldn’t have asked specific questions, I don’t know that I would have determined what her reaction was in response to. However, because I elicited a thorough history, I was able to come up with my top two differentials that otherwise I might not have. 

Typhon Case Log Totals:

Reflection:

This rotation, I’ve been at Centers Urgent Care. I have had a great time learning new skills and perfecting my procedural skills. One thing that I found difficult was incision and drainages, because I haven’t had very much experience with them prior to this rotation. At the urgent care,, we did quite a few delicate ones in the vulvar  area and I definitely learned a lot of new techniques to better help with that. I’m excited to continue practicing the skills in the future so that I can continue to get better at them. I also felt this rotation helped me become really skilled at other procedures including splinting, suturing, reducing dislocations, and administering vaccinations. I’m excited to continue working on those skills when I start working.

One type of patient I found challenging this rotation were patients requesting antibiotics. I had many occasions where a patient with a viral upper respiratory infection would request antibiotics, sometimes very adamantly. Patients are often accustomed to receiving antibiotics for their upper respiratory infections regardless of the cause. I think 99% of the time, patients have a viral cause for their infection but have been treated with antibiotics in the past and so are accustomed to it. I had to have many conversations with patients where I needed to educate them on the use of antibiotics. I had to explain to many patients that viral infections would not be effectively treated with an antibiotic, and it would actually be more risky to them if I did so. I had multiple opportunities every day to have this conversation, which is great because I’m fully prepared to be firm and have this conversation with any patient I need to in the future. Some of the patients were very understanding and just had never been told this, while other patients were much more difficult. It was a great learning experience for me to be able to practice different situations in real life.  

One memorable patient experience I had was with a 10-year-old boy who had a laceration on his chin. He needed stitches, but was autistic and very scared. He was sobbing and scared and had a difficult time calming down. I was able to spend a few hours with him walking through the procedure, explaining every part to him, and gaining his trust. He eventually let me clean the wound, give lidocaine shot, and eventually gave him six stitches. By the end when I was doing the sutures, he was so calm and relaxed it was like a different child. His experience was memorable for me because I saw how important it was to make sure that the patient is comfortable and that they trust you. Once you do that, you’re able to care for them the way they need you to. If I would’ve sent him to somewhere like the emergency room, I don’t think he would’ve been able to get the same level of attention and care.

One thing I would want the preceptor and other colleagues to notice about my work during this rotation is that I have worked hard every day and did my part to help the team. I felt like every day I was at the rotation, I did everything I could to help and I did the best work that I could. I felt like I was really part of the team at Centers Urgent Care, and I was actually pretty sad to leave. I learned that I am able to provide high-level care to patients on my own, but with a great team, you can get everything done so much better. We would have never been able to see so many patients so effectively if everyone didn’t work as a team. I had an amazing time there and it was a great last rotation.