Project Outline

Audience Objectives:

1. To understand the importance of self-health and self-care

2. To understand how The Bone and Joint Clinic of Baton Rouge incorporates their mission
statement and cultural competency into clinic every day.

1. Introduction
a. Caitlin Galvin, Bone and Joint Clinic of Baton Rouge, Medical Assistant,
currently working for Dr. Rohr
b. Background of you
i. My gap year was a huge growing experience for me. I learned so much
about myself, what I was capable of, and I learned that I could do so much
if I really set my mind to it and making mistakes only makes me better.
c. Why I chose this MA position
i. Since Orthopedic surgery is concerned with the musculoskeletal system of
the body, this job really called out to me since I used to work with the
spine. I wanted to explore more options of the body.
d. Bone and Joint
2. About Bone and Joint Clinic
a. History and Background
i. They treat severe spine diseases or injuries, bone breaks and fractures,
infections, disorders, and/or tumors. The history of The Bone and Joint
Clinic begins in 1948 as the first orthopedic clinic in Baton Rouge. This
was a big deal in South Louisiana since there was no other close-by
orthopedic center.
b. Mission statement
i. The mission statement of The Bone and Joint Clinic reads “Above all else,
Bone and Joint Clinic of Baton Rouge Inc is committed to the care and
well-being of the people we serve. In recognition of this commitment, we
will strive to deliver excellent, cost-effective healthcare in the community
we serve. Bone and Joint Clinic of Baton Rouge Inc will never sacrifice
ethical and compliant behavior in the pursuit of business objectifies.” The
mission statement also reads, “In pursuit of our mission, we believe the
following core values are essential and timeless: Respect, Integrity,
Excellence, and Teamwork.”
ii. Everyone of all ages, race, gender, religion, etc. are welcome at The Bone
and Joint Clinic. They practice and make sure everyone working there
knows that cultural competency is. (Translator)
c. Staff
i. There are now over 16 practicing physician specialists who are assisted by
100 other specialized and certified employees. These include Medical
 Assistants, Nurse Practioners, licensed Physician Assistants, orthopaedic
technicians, and registered radiological technologists
d. Satellite locations
i. 4 locations and opening one more in August

3. About Dr. Rohr

a. Orthopedic surgeon who specializes in podiatry
b. Background Info
i. Grew up in Tennessee and originally was interested in PT
c. Interview Questions
i. Why did you choose Podiatry?
1. Shadowed Podiatry during his time in school for Physical Therapy
and loved it
2. Active with your hands (keep him entertained)
ii. Have you always wanted to work in the medical field?
1. Yes, I always wanted to do something medical especially Pre-med
iii. What was your professional experience leading up to becoming a doctor?
1. 4 years of undergrad at East Tennessee State
2. 4 years of med school at Scholl college
3. 3 years surgery in residency at Emory in Atlanta

iv. What career path would you have chosen if you never became a doctor?
1. Investment banking – advising (stocks)
d. What do you hope for your future career as a podiatrist?
i. “To be finically independent, and to help patients”

4. Daily Tasks/Roles
a. Basic daily tasks
i. Opening clinic
1. Each day I am required to open clinic by restocking, turning on
computers and x-ray screens, making sure the rooms were clean
and tools were sterilized, inserting, and refilling the correct
injections in the exam rooms, printing out the schedule for the day,
and preparing surgery folders in the morning. During the day, I
brought back patients to the rooms, completed a basic exam, and
took their vitals, and completed online patient forms. I completed
any tasks and assisted in procedures during the day and cleaned up
afterword’s
ii. Procedures
iii. Checking vitals, asking how their previous DME is working, asking how
their previous shot or medication was going, asking if their medications
have changed and double checking what they are allergic to. Sulfa is
something we look out for.
iv. Providing Durable medical equipment
v. Checking for blood thinners (What to check for in New patients)
 1. This is crucial to know for procedures and surgery
vi. HBP and/or diabetes
b. Surgery and MRI - waters view
i. Makes sure they have not been around any metal or griding
c. BAKO diagnostics
d. Coding fee bill
i. This is how the doctor gets paid
ii. Record of the appointment
e. Closing Clinic
5. What to look for
a. New patients
i. Previous Procedures gives us more information about their medical history
and what they are at risk for
ii. Blood thinners are extremely important for us to know with any patients.
If someone is taking blood thinners, whether it is a prescription or an
aspirin, this affects how we go about procedures. SX day is important -
significant loss of blood and life threatening. (Unlikely to happen because
we have pre-anesthesia nurses that call and double check everything is
good to go)
iii. H.B.P is noted because it increases your risk of serious health problems.
iv. Level of pain gives me and the doctor an assessment of what’s going on
and how serious the problem is. it helps me know what to tell Dr. Rohr
and what the patient is going through. if the person is still in severe pain
before leaving their appointment, sometimes we consider administering
them to the nearest hospital depending on the situation. (Infection vs
broken foot) steroid shot…
1. Tissue damage and needs immediate emergency help
2. Broken foot doesn’t need Emergency help because we are the ones
accessing the pain…it won’t immediately decrease in pain because
healing bones takes time.
v. Diabetic
1. Very important because those with diabetes are always at higher
risk for foot problems. So, Dr. Rohr can prevent any serious foot
problems if he takes care of it immediately and access any nerve
damage.
2. Monofilament foot screen test is a foot screening device used to
assess loss of protective sensation. If there is a loss, then there is
nerve damage. It helps identify patients at risk of developing
diabetic foot ulcers. The monofilament foot screen test screening
has a 10-gram filament.
b. It is also important for revisits, especially post-ops, how the pain score is and if it
has improved. It is important to note everything the patient has or has not done
during the week or 2 weeks during the checkup that the doctor asked them to do.
6. In-clinic procedures
a. How to set up for a procedure
b. Numbing shot works. No pain, just pressure.
c. Ingrown
d. Nail removal
e. Wart/corn/callus removal
f. Topical prescriptions used
g. Phenol – when and when not to use it – nail ablation

7. Tools used for procedure

8. Prescriptions used
a. Phenol: organic compound that is used for ingrown and nail procedures. This is
used for ablations. Used for preventing recurrence. Have to be careful when
applying due to serious after burns because they can cause 2nd to 3rd degree burns
if not cleaned out correctly.
b. Ciclopirox: is a topical solution that treats skin infections, such as ringworm,
athlete's foot, and dandruff like Onychomycosis which is a fungal infection.
c. Mupirocin is a topical solution that we give to patients after in clinic procedures.
It treats skin infections and calms skin lesions.
d. Silvadene is made with Sulfa, so we stay away from this if a patient has a sulfa
allergy…very important. If they end up being allergic to Mupirocin too, we just
tell them to use a topical OTC ointment like Neosporin. Silvadene Cream is
essentially better because it is used to treat AND prevent infections on areas of
burned skin. IMPORTANT for phenol procedures.
e. Mobic: Anti-inflammatory
f. Celebrex is the same as Mobic but uses a different enzyme. They both promote
the release of prostaglandins which reduces pain and inflammation.
g. Medrol Dose Pack: Stronger
h. Betadine: liquid disinfects and treats minor skin wounds. It is an antiseptic used
for skin disinfection before and after surgery. This is what makes that
orange/brown color on the skin.

9. Public Health issue/Project

a. The Public Health Issue
i. 25.8% of people living in Baton Rouge suffer from Diabetes. Pretty
significant amount and considering this data was collected in 2017, it has
only increased.
ii. I was surprised to find that not many people knew to take their readings
daily and didn’t know the extent and severity of uncontrolled diabetes
could lead to (NOT ENOUGH INFO AND PREVENTION)
iii. My main concern was that they were not getting the information and help
that they needed, especially if they were livening alone.
1. Majority of patients were diabetes patients and that was the main
reason they were there. (Main cases we saw, delt with diabetes)
iv. The patients with DM, had poor self-care
 v. I noticed that not enough information was being handed to them as they
left the appointment
vi. It was really concerning that they didn’t know how to take care of
themselves
10. Date of Diabetes in BR (these are just the parishes that our satellite locations are in)
a. Ascension
b. West
c. East
d. Livingston

11. Why podiatry when it comes to diabetes

a. How the feet are affected
b. The best way to protect your feet is by controlling your blood sugar levels every
day. This will help keep nerve and blood vessel damage from getting worse. The
next step is to keep the skin of your feet healthy!!! You can check this by
regularly seeing your PCP and podiatrist.
c. Why podiatry can help (on sheet)
d. At home – self-care tips (on sheet)

12. Planning
a. Help from Dr. Rohr and Aislinn
b. What was done (Slides of the Project)
i. The brochures
ii. How Dr. Rohr helped – Gave me info and talked to the patient
1. Dr. Rohr is new and there was not a lot of infographics for patients
to take home like other doctors

c. Proposed implementation
i. Gave the brochures to patients and everyone said it was excellent
d. Why you chose this idea for my project
i. Talk about Henderson Patient and how he really made you realize the
severity of the situation and that nothing was really being done to further
help him after surgery’s
ii. I wanted to create something simple yet helpful for patients to take home
and not be overwhelmed with a bunch of words on a pamphlet.
e. Recap the public health issue and reason for the project

13. Example case

a. Gentleman that came in with a chief complaint of his left toe (third distal phalanx)
b. BAKO results and Hospital results
c. X-ray (indicates bone lysis to the 3rd digit on the left foot – this is a Bone
infection)
d. Clinic notes
e. Explain A1C rules
i. Klebsiella Pneumonia
 ii. Citrobacter Freundii
iii. Pseudomonas Aeruginosa

14. Hospital Diagnosis

a. Pathology results were also taken at the Hospital. They came back with positive
results of Gangrenous Necrosis and Acute Osteomyelitis.
i. Gangrenous Necrosis is death of body tissues due to lack of blood flow
(this is actually very rare)
ii. Acute Osteomyelitis is an infection in the bone which gave Dr. Rohr a
clear indication that he needed to amputate his 3rd digit on his left foot.
b. Sent in Augmentin antibiotics due to a previous Aerobic Culture which stated that
he had beta hemolytic streptococcus, group b (This clearly is not good and proves
that his body struggles to fight infections)
c. The hospital took some tests and helped his WBC go down in a matter of 5 days -
which is good.
d. MRI was taken at the Hospital since the x-ray was showing bone lysis and they
needed more detail. The MRI stated there was Inflammation to soft tissue and
Edema enhancement.

15. Consents and HIPPA

a. Why consent forms are important
b. HIPAA: Health Insurance Portability and Accountability Act
c. HIPAA rules
i. List a few
16. Dos and Don’ts in the exam room
a. Dos
i. How to properly sterilize
1. 15 minutes in Cidex
2. Before you leave for the day
3. Clean tools thoroughly
ii. HIPPA protocol
iii. Respect for the patient
iv. Always arrive on time – no matter what job you have
v. I learned to always ask questions if you are unsure because a simple
mistake in the medical field could be dangerous
b. Don’ts
i. Perform any physical therapy
ii. Asking personal information – that doesn’t deal with their situation at
hand
iii. Cannot suggest or prescribe medication – Only doctor can do this
17. Surgery Prep
a. Explain what you must do before scheduling
b. Giving out consents – Ask them if they take any blood thinners and to stop taking
it 7 days before their surgery date
 c. List the facilities
i. Orthopedic Surgery Center is where they usually take place unless
insurance doesn’t cover it and if the patient is not using general or MAC
anesthesia
d. List the important and most common procedures
i. Bunionectomy: surgical procedure that moves toes back into the correct
position. The procedure balances the muscles around the toe joint to make
sure that the bunion does not grow back.
ii. Acute Osteotomy: surgery performed to remove parts of bone in your foot
or ankle that might be causing pain or limiting your mobility. The surgery
helps relieve pressure on the foot and ankle caused by the bone deformity
or injury.
iii. Amputation of a digit
iv. Endoscopic plantar fasciotomy: surgical technique for chronic plantar
fasciitis.
v. Excision of a ganglion cyst
vi. Hammer toe repair or Interphalangeal fusion
vii. Hardware removal: Hardware removal is surgery to take out devices used
to hold your broken bones together while they heal. These devices may
include pins, screws, plates, or wires. You may need hardware removed
because you have pain or an infection

18. Overall take of the internship

a. Talk about why you loved it there and the good that came out of it
b. Why I hope to work there for the future continuing after the internship
c. Why GCSU students for PH should consider this for their internship
d. How this led you to consider future job/school options
e. Self-improvement
i. Confidence
ii. Academical increase
iii. What I wish could have been different

19. Citation page

a. LA department of Health
b. Bone and Joint Clinic page