Case 1- 2011: A 32 year old female with complaints of left upper limb pain, numbness, and weakness, for the prior 18 months.

The patient is a 32 year old female with complaints of left upper limb pain, numbness, and weakness, for the prior 18 months. Numbness involved all of the digits, especially the medial 3 fingers. Clinical exam revealed normal findings, except for palpatory restriction over the left PMM, left shoulder protraction, and a positive thoracic outlet stress test with hyperabduction. Electrodiagnostic study was normal.



Resident’s Blog: PGY-2 Begins

The idea for this blog was born on one of many conference calls we have with fellow members of the college while brainstorming of ways we can help the medical students to get a flavor of what Physiatry is all about. So starting at the very beginning of the PM&R residency seemed to be the most appropriate and since I am a new PGY-2 at NYU medical center PM&R program, I volunteered to start this blog about my experience as I am going through my training.  I will try to put new posts up at least twice a month and welcome your comments and questions.  That being said, off we go.

I can’t believe it has already been one month since I started at NYU but the time flies when you are enjoying what you are doing. I still remember the first day worrying about starting on the Cardiac Rehab floor as my very first rotation. As a fourth year medical student I rotated through MSK, SCI and stroke rehab floors but never cardiac. Nonetheless, by now I had the internship experience of dealing with CHFs, MIs and the likes. So how different could it be? It’s not, BUT yet it is. The medical management part of CHF and arrhythmia is similar but the approach and the goals of the complete care plan are different. Now that the patient is past the acute stage of her disease, we have to work on resolving her functional limitations secondary to it. This involves a 360 degree multidisciplinary approach of the physiatrist working closely with nurses, physical and occupational therapists, a psychologist, nutritionist and a social worker. Interestingly enough, I never fully appreciated the full importance of the multidisciplinary meetings as a student as I do now that I am a resident.  If you feel the same, it will definitely change for you as well once you are in your residency.

What came as a surprise to me was the very first lecture I got from my attending on exercise physiology. That brought back painful flashbacks from the biochemistry lectures but at the same time put the Krebs cycle in a completely different prospective that directly applied to the planning of our patients’ care. Suddenly understanding aerobic vs. anaerobic metabolism became so much more relevant. It is very important to make sure that patients suffering from heart disease don’t exercise beyond their anaerobic threshold since this will lead to lactic acid build up and ultimately ischemia.  Now that you have a bit of a flavor for cardiac rehab, I encourage you to read more on the subject.  Specifically look up the Fick’s equation and try to make sense of it. After years of playing sports and going to the gym, I feel that only now I truly understand what determines the level of fitness in a person.

In my next post, I’ll talk more about my daily experience on the cardiac floor and the other educational activities in the program. Until then, study hard but make sure to get some exercise in as well to keep your heart healthy.



Author Bio: Alex Levchenko is a PGY-2 in PM&R residency program at NYU Medical Center. He received his medical degree at the New York College of Osteopathic Medicine and his bachelor’s degree from New York University.  He has been an active member of AOCPMR since 2008 and served as Vice President of the AOCPMR Student Council in his last year of medical school.