Day 1- First Rotation in Asheville VA

Asheville VA Medical Center is very beautiful, clean and new. I was so impressed as I walked in the VA today.

I was introduced to Dr. Snyder as my preceptor for the week since Dr. Fleenor is off for his Birthday.

Wendy, Dr. Schmidt's secretary, took care of all the administrative stuff such as finger printing to get my ID and receiving 6 sets of new scrubs with my name on it :).

I'm official now and can see patients.

First day was definitely a good day.

I'm going to blog about everything that I learn everyday.

The first patient had severe renal disease- so the first question Dr. Snyder asked me was- what do we need to watch out for? The answer was how much medication we give him and more importantly the anesthetic.

I observed Dr. Snyder lay a flap and perform a surgical extraction.

I was then on my own to see another patient and extract tooth #16. This patient presented with facial swelling on the left side of his face. This tooth was a little difficult to extract as the PDL was almost non-existent. I learned that non-opposing teeth with no occlusal trauma start to lose their PDL as it's not used for proprioception. After the extraction, Dr. Snyder prescribed antibiotics because the infection was diffused and not localized.

Next patient was a very nice man who had to have four teeth extracted before having radiation therapy for cancer. Although he was not in any pain, the important thing was to get rid of all infections and extract questionable teeth. The extractions were pretty simple as the teeth were also periodontally involved. The patient did really well and was very appreciative.

My next two cases were interesting as Dr. Snyder had me go back and forth between operatories to anesthetize each patient and then perform extractions. One of these patients needed tooth #31 extracted and he explained to me that he has taken out all of his upper front teeth himself but just couldn't get far enough to take this one out. He presented with He was a big guy who liked to talk a lot and he told me all about his previous girlfriends, etc. Finally I was able to get started but it was extremely difficult to get him numb because of the presence of inflammation creating a lower pH (more acidic environment). The non-ionized (base) form of local anesthetic is capable of diffusing across nerve membranes and blocking sodium channels. A decrease in pH shifts equilibrium towards the ionized form, delaying onset of action.

Finally when I extracted #31, the patient was so relieved and confessed to me that he initially thought that I wouldn't be able to extract his tooth. But he thanked me and said he was glad it was out.

Overall, I had a great day today and learned so much. Dr. Snyder quizzed me along the way and that helped me learn more.