Been using this technique on some of my kiddos. One of the therapists took the class. Very interesting. It's similar to strain-counterstrain treatments. That's where the original idea came from
http://www.totalmotionrelease.com/index.html
Sunday, October 17, 2010
"Insidious Toe-walking"
I hate insidious toe-walking. Some argue that there is no such diagnosis. If a child is toe-walking, there is a reason. Something is wrong if they are on their toes. Let me tell you, some kids, it is so dang hard to tell why the heck they are toe-walking. It makes no sense. I had an onslaught of toe-walkers come in. Three evals in one week (which is a TON for the setting I am in by the way) and they are all toe-walkers. Only one of them appears to possibly have any sensory issues and she is 13. 13 years old and just now she finally got sent to PT because she is toe-walking. Her pediatrician has been telling her mother since this girl was 10 months old that she would grow out of it, the orthopedic who saw her 4 years ago told her to do calf stretches. Seriously? What 9 year old kid is going to do calf stretches everyday, especially when they hurt. This girl is in a ton of pain. Whatever. So frustrating. She ended up seeing a different orthopedic surgeon this last week and she is going to have surgery. Which is good...but anyway, back to toe walking. Another little girl comes in- she's almost three and not only does she walk on her toes, she walks on her tippy toes- like a little ballerina without toe shoes. She has the ability to walk flat footed, but as she fatigues she goes higher and higher up on her toes. What the heck? And then, the other girl is 6 and the first time I treated her after the eval, all I had to do to get her to walk with heel-toe progression is put a "squeaker" on her foot so every time she put her heel down it makes a squeaking sound and she walks heel-toe for the entire session. What in the world? I don't understand toe-walking.
Thursday, September 30, 2010
Poop
Poop. I hate poop. And yet...poop is an integral part of my daily life. Why?
- I am human. I have to poop. It's unfortunate, but true.
- Pediatrics. Ah pediatrics. The kids poop. We have one who my CI explained to me (before I met him) that basically he is constantly pooping because he was a conjoined twin and his bowel was incomplete or something so he has no muscle to control it. So, what comes in comes right back out. These poor kids. It can't be any fun at all and I don't say it to be mean, but man. Poop. Yuck.
- I think at least half of the kids I work with are in diapers. If they poop during or before therapy we have the privilege of changing it. Poopy diapers go out in the garbage can in front of the clinic. One time we tied the diaper in a grocery sack, but there was air caught in it. I didn't have to actually change the diaper, but I was the one to take it out and it almost didn't fit into the garbage can (it's one like you find at the park that has a top on it and openings to stick your garbage in). Oh I was so dreading having to untie the bag and let that odor back out. I made it fit.
- viruses and germs. We had one mom call in today and told us that she was going to pick her son up from school because he had diarrhea. She was calling to see if she should bring him in to therapy today. Uh...how about??? NOOOOOO!!! First, if it's a stomach bug, we don't all want to be pooping all day (see the next comment for more information on that) and second we don't want an accident. Can I emphasize that?? We don't want an accident. It happens. Poop happens. But let us be honest. I don't want to be cleaning it up from our gym floor.
- My CI is the manager of our clinic. As such, she has her own office (everyone else shares an office in the front). It's great and dandy and all except that her office sits right next to the bathroom. It's a small clinic, not a big deal right? Oh wait, except whoever built the building made a "minor" error and the bathroom is vented into the back office. Every time that someone poops the smells just comes right in. Awesome. And then if you try to cover it up with spray that seeps right in too so you get a nice mix or apple cinnamon glade and poop. Wow.
- Kids with decreased muscle tone or strength tend to have decreased tone/strength of their involuntary as well as voluntary muscles. This mean they get constipated easily. Solution? Deep tissue massage to the large intestine. Usually we don't reap the benefits of this in clinic (usually the poop makes it out after the end of their session), but it still makes poop a part of my daily life.
- Pooping in the front bathroom. This is the patient bathroom. I don't know if it's the kids of the parents, but a couple of times a week I will walk into the front office and the smell of poop is so strong from the patient bathroom that it fills the hallway too. Awesome. Sometimes this comes from people actually pooping there or sometimes it is just the changing of a diaper.
Sunday, September 19, 2010
The Breakdown...
Alright guys...I'm a crier. Can't deny it. But, generally, I don't cry about clinic. I made it through our part times and the first full time without any breakdowns. Even if I was way stressed or upset, no crying. Do not want to cry in front of people. I finally broke. Darn it. Two very stubborn children, and an exhausted Thursday morning just pushed me over.
Child number one is an 8 year old adorable red-head who is as stubborn as the red-headed stigma would indicate. She comes in at 8am which is just too early for her because she's never quite awake. We call her "baby jaguar". I am not sure when, but at some point she decided she was baby jaguar and her mother is mama jaguar. Sometimes my CI also becomes mama jaguar and I have since been deemed auntie jaguar. She is a riot. She cracks me up, but can be so hard to treat. Honestly the session with her didn't go badly, it was just exhausting. Trying to figure out how I am going to accomplish my goals for the session, get her to wake up, then cooperate, manage the time...bleh. And Thursdays are hard days cause they are our Fridays. To add to this scenario, her mom is one of the local pediatricians. She's a really nice woman, but my relationships with the parents is really weird because...I don't really have one because my CI always goes out and talks to the them and kind of takes over the conversation, so I really don't know what this MD mom thinks of me and I don't have the opportunity to...get comfortable with her, so I want things to go well with her daughter.
Child number two is also adorable and is one of my favorites. She is baby doll perfectly cute. Shes got blond hair that goes to just above her shoulders and is Shirley Temple curly. It's always perfectly styled with a bow, she is the perfect size of chubbiness- not to big, not too little- and her mother puts her in the most darling clothes. She about 2 and an only child and she acts like it! :) She is sweet and a good girl, not mischievous, but she knows exactly what she wants and wants to do everything her way. Between being stubborn and being 2, she's got determined down pat. My treatment session with her was....a disaster. So frustrating. I got therapeutic stuff done and I made it through the session, but it was so disorganized, all over the place, and totally in her control and not mine. I was so frustrated. On top of that, I have been sick for most of the time that I have been here and during that hour I was feeling especially drugged up and disconnected, you know those sudafed commercials where the person gets a cold and has the sinus pressure and their head becomes a balloon? That was me- I finished with her and had an hour break so I told my CI I was going to get out for a minute and went to the local Rite Aid to just get away for a few minutes. Then I came back and it turns out that my CI had been taking notes on these treatment sessions and gave me feedback. She was totally nice and it was helpful, but I was already so discouraged that the last thing I wanted was feedback. It was all constructive and there was positive feedback in there too, but I just broke down and bawled. It was so ridiculous. She said she has only ever had one student that hasn't broken down crying while in their peds rotation (and the one that didn't cry she didn't like). I was hoping and planning that I would be student number 2, but apparently not. And apparently pretty much everyone in peds has days that they just break down and cry. One of the OT's the other day was talking about a treatment session with a boy and it wasn't going well and he was in timeout so she put him in the ball pit to sit for time out (sensory processing difficulties) and she said she crawled in the ball pit with him and put herself in timeout cause she was mad and it was not good. So, there ya go. If you want to work in peds be ready for tears, and out of control emotion. It's intense. Still love it- most days- but it's intense.
Child number one is an 8 year old adorable red-head who is as stubborn as the red-headed stigma would indicate. She comes in at 8am which is just too early for her because she's never quite awake. We call her "baby jaguar". I am not sure when, but at some point she decided she was baby jaguar and her mother is mama jaguar. Sometimes my CI also becomes mama jaguar and I have since been deemed auntie jaguar. She is a riot. She cracks me up, but can be so hard to treat. Honestly the session with her didn't go badly, it was just exhausting. Trying to figure out how I am going to accomplish my goals for the session, get her to wake up, then cooperate, manage the time...bleh. And Thursdays are hard days cause they are our Fridays. To add to this scenario, her mom is one of the local pediatricians. She's a really nice woman, but my relationships with the parents is really weird because...I don't really have one because my CI always goes out and talks to the them and kind of takes over the conversation, so I really don't know what this MD mom thinks of me and I don't have the opportunity to...get comfortable with her, so I want things to go well with her daughter.
Child number two is also adorable and is one of my favorites. She is baby doll perfectly cute. Shes got blond hair that goes to just above her shoulders and is Shirley Temple curly. It's always perfectly styled with a bow, she is the perfect size of chubbiness- not to big, not too little- and her mother puts her in the most darling clothes. She about 2 and an only child and she acts like it! :) She is sweet and a good girl, not mischievous, but she knows exactly what she wants and wants to do everything her way. Between being stubborn and being 2, she's got determined down pat. My treatment session with her was....a disaster. So frustrating. I got therapeutic stuff done and I made it through the session, but it was so disorganized, all over the place, and totally in her control and not mine. I was so frustrated. On top of that, I have been sick for most of the time that I have been here and during that hour I was feeling especially drugged up and disconnected, you know those sudafed commercials where the person gets a cold and has the sinus pressure and their head becomes a balloon? That was me- I finished with her and had an hour break so I told my CI I was going to get out for a minute and went to the local Rite Aid to just get away for a few minutes. Then I came back and it turns out that my CI had been taking notes on these treatment sessions and gave me feedback. She was totally nice and it was helpful, but I was already so discouraged that the last thing I wanted was feedback. It was all constructive and there was positive feedback in there too, but I just broke down and bawled. It was so ridiculous. She said she has only ever had one student that hasn't broken down crying while in their peds rotation (and the one that didn't cry she didn't like). I was hoping and planning that I would be student number 2, but apparently not. And apparently pretty much everyone in peds has days that they just break down and cry. One of the OT's the other day was talking about a treatment session with a boy and it wasn't going well and he was in timeout so she put him in the ball pit to sit for time out (sensory processing difficulties) and she said she crawled in the ball pit with him and put herself in timeout cause she was mad and it was not good. So, there ya go. If you want to work in peds be ready for tears, and out of control emotion. It's intense. Still love it- most days- but it's intense.
Thursday, September 16, 2010
Funnies...
Nicole referring to a child earlier in the day who is 12 months old and is expected to have some kind of UMN/brain damage (which can't be seen on the MRI) that is causing her problems...
"Oh yeah, the baby we saw earlier, the one with the brain."
The other day I was in the hallway right next to the "gym" and I hear one of the OT's say to the child she is treating:
"You got an 'H'; h for fabulous."
Hmmm...
Today we were talking about PT and OT and how we don't like the idea that PT in lower body, OT is upper. It doesn't really make sense. We were talking about how BOS impacts ability to perform ADL's and such and my CI says
"Right, if you just knock out my knees, I wouldn't be able to hold on to these folders."
"Oh yeah, the baby we saw earlier, the one with the brain."
The other day I was in the hallway right next to the "gym" and I hear one of the OT's say to the child she is treating:
"You got an 'H'; h for fabulous."
Hmmm...
Today we were talking about PT and OT and how we don't like the idea that PT in lower body, OT is upper. It doesn't really make sense. We were talking about how BOS impacts ability to perform ADL's and such and my CI says
"Right, if you just knock out my knees, I wouldn't be able to hold on to these folders."
Sunday, August 1, 2010
Blushing...
Definitely my most awkward moment in clinic thus far....
Pt profile: 27 yr old male, neck pain. MD dx: myofascial pain syndrome. Onset of injury: 1 yr.
Pt is a 27 year old very hot and attractive male presenting with neck pain. Patient presents in waiting area with profoundly slumped posture and apathetic look on his face. With introduction pt responds appropriately, smiles, is friendly, accepts treatment from SPT initiating session. Upon further examination, SPT determines that beyond being extremely attractive, the patient has a gorgeous body. hmmm....SPT does not recall a chapter in Magee or Dutton referring to patients who appear extremely sexy. Never mind. on with the exam.
Pt history taken, no other significant comorbidities. Pt is in excellent health other than persistent neck pain, insidious onset, complaints of muscle tightness, decreased ROM.
SPT must perform posture and spinal exam. "Danger Will Robinson"...SPT is professional. She can do this.
"Can you please...take off..your shirt...so I can take a look at you shoulders and neck?"
SPT starts blushing and suddenly forgets how to speech English which means medical language and the practicing of phrasology in lab is definitely gone! Ah- don't look he's your patient, but dang he's built. No transference, no transference...but...dang, it's not everyday a young, healthy, built, male comes in for PT. Yikes. Professionalism.
Initial Eval. Complete. Clean room. Breath. It's your job. Weird. He's hot. Weird. It's your job. Weird. I just asked a 27 year old sexy man to take off his shirt. Weird. Dang. English, English. I couldn't speak. Flustered. Haha. Thank goodness it's the END of the rotation and not the beginning. CI observing the flustered blushing SPT=not goodness. Whew. Wow. Glad that one's over.
Two days later. SPT walks into clinic. Approached by coworker, PTA, young female (slightly younger than SPT).
PTA: " Nicole D_____ ________" (name withheld for legal purposes).
SPT: "Oh, yes. I remember him."
PTA: "He was on my schedule this morning at 7 am. Oh-My-Gosh"
SPT: "Yeah, he's kind of attractive huh?"
PTA: "Uh....yeah. Like, really hot."
sigh of relief. phew. I'm not the only one who gets like this.
PTA: "I had no idea. He was my 7am. I walked in first thing this morning, walked out into the waiting room and had to walk to the back to pull myself together. He's so hot. WHY DID YOU PUT HIM ON MY SCHEDULE??? SO EMBARRASSING!"
Hahahaha....oh so glad we could commiserate. The joys of PT.
Pt profile: 27 yr old male, neck pain. MD dx: myofascial pain syndrome. Onset of injury: 1 yr.
Pt is a 27 year old very hot and attractive male presenting with neck pain. Patient presents in waiting area with profoundly slumped posture and apathetic look on his face. With introduction pt responds appropriately, smiles, is friendly, accepts treatment from SPT initiating session. Upon further examination, SPT determines that beyond being extremely attractive, the patient has a gorgeous body. hmmm....SPT does not recall a chapter in Magee or Dutton referring to patients who appear extremely sexy. Never mind. on with the exam.
Pt history taken, no other significant comorbidities. Pt is in excellent health other than persistent neck pain, insidious onset, complaints of muscle tightness, decreased ROM.
SPT must perform posture and spinal exam. "Danger Will Robinson"...SPT is professional. She can do this.
"Can you please...take off..your shirt...so I can take a look at you shoulders and neck?"
SPT starts blushing and suddenly forgets how to speech English which means medical language and the practicing of phrasology in lab is definitely gone! Ah- don't look he's your patient, but dang he's built. No transference, no transference...but...dang, it's not everyday a young, healthy, built, male comes in for PT. Yikes. Professionalism.
Initial Eval. Complete. Clean room. Breath. It's your job. Weird. He's hot. Weird. It's your job. Weird. I just asked a 27 year old sexy man to take off his shirt. Weird. Dang. English, English. I couldn't speak. Flustered. Haha. Thank goodness it's the END of the rotation and not the beginning. CI observing the flustered blushing SPT=not goodness. Whew. Wow. Glad that one's over.
Two days later. SPT walks into clinic. Approached by coworker, PTA, young female (slightly younger than SPT).
PTA: " Nicole D_____ ________" (name withheld for legal purposes).
SPT: "Oh, yes. I remember him."
PTA: "He was on my schedule this morning at 7 am. Oh-My-Gosh"
SPT: "Yeah, he's kind of attractive huh?"
PTA: "Uh....yeah. Like, really hot."
sigh of relief. phew. I'm not the only one who gets like this.
PTA: "I had no idea. He was my 7am. I walked in first thing this morning, walked out into the waiting room and had to walk to the back to pull myself together. He's so hot. WHY DID YOU PUT HIM ON MY SCHEDULE??? SO EMBARRASSING!"
Hahahaha....oh so glad we could commiserate. The joys of PT.
Saturday, July 24, 2010
Update
All right guys. It's been a long time since I blogged and I must admit, a lot has happened. It's kind of lonely out here and I don't get to share my stories, so I'm going to write a lot, but I'll break it down so you don't have to read it all at once...especially those of you who can't read for very long (any guesses at who that is? :) ). So, here the run down on the last few weeks of clinic. It has been good overall, but definitely challenging.
Curve Ball Number 1
Midterm evaluation, curve ball #2
Midterms were a never ending nightmare for me. Mostly because they came in the middle of all that I just described. Between our coworker being out (and actually, two other coworkers had family members pass away the same week) and all the layoffs, things were crazy and stressful. Then there is CPI web. My CI emailed DeLeo a long time ago with all of his information, but he never got a response from her. I thought our "assisting your CI" form was a form we could give them so they could send in the information. I sent it to him and was reminding him of it daily, but it just wasn't getting done. I didn't think it was a big deal. DeLeo called for my site visit and first was irritated because she couldn't reach me directly. I didn't think about it until that morning, but they have the number for the CCCE not my CI, but I never got an email or anything asking for more information, so I assumed it wasn't that big of a deal. When she got through she started the conversation by asking "first, were you aware before today that your CI wasn't going to be there today? Why didn't you tell us this, that your CI wouldn't be there the day of your site visit." Ummm.....my CI is here. He is standing at the desk right behind me right now.... ... "Oh. I was told that your CI isn't there today." "uh. He is. he's standing right here." Let me just tell you, that is not the way to start the site visit. Scared me to death. Then we talked about CPI web and DeLeo made it clear that I was supposed to give her all my Ci's info, that was now my responsibility. I think that's weird since I had to ask him for all the information before I could send her the email...whatever. I didn't get access to my eval until that Monday, didn't get to start it until Tuesday and then everyone got laid off. Both my CI and I had the vast majority of it complete Tuesday and finished it Wednesday, but hadn't signed off on each others. I was getting emails everyday from the program that were stressing me out like crazy about getting it done. I was seriously starting to get afraid that they wouldn't let me pass this clinical or something. I finally sent an email to Dr. B telling her that the week was crazy due to unexpected curve balls (read previous section) and also asked if in the future, if they were sending emails like this if they could please include the CI because it was a lot of pressure on me to go in every morning for two weeks now and bug him about getting this done. She called me that evening and we talked it through a bit and all was fine (so glad it wasn't DeLeo I was dealing with at that point cause I don't know if it would have been smoothed) but let me tell you. It was more stress than it was worth.
And now: The patients...
Biceps rupture
"hello Mr. smith, I see you are in here for shoulder problems. Can you tell me what happened."
"Are you sure you wanna know?"
"Yep. Lay it on me, I need to know."
Ahh yes, you can always be a bit surprised. Turns out the man was having sex last year and he torn/ruptured a tendon. He couldn't remember which one, but I am pretty sure it was his biceps. So he says, I was having sex and it just started to hurt, but I just kept going anyway. He starts to demonstrate the movement for me. Wow. Didn't really care to have that part. It wasn't graphic or anything, but this 70 something year old man, big tall, burly, black, is showing me how he's having sex. And he keeps saying "I just couldn't stop. I just kept going anyway." hahaha. My CI still cracks up about it every time. It was so funny guys. How you rupture your biceps having sex...I just don't know. And why the man couldn't control himself...well...yeah. It was quite the eval.
A Tattoo to remember
Shoulder eval. The incident gives you a good idea of what this guy is like. Mind you, he's gotta be in his 40s. I can't remember exactly his age. He tells me that he was drunk this night and his friends convince him (while he's drunk of course) to drive his motorcycle up this flight of stairs without a board under it. He manages (I don't know how) to get all the way up the stairs, but biffs it on the way down. He falls off the bike face down, the bike falls on his back, fractures his ribs in 9 places and fractures his scapula. Brilliant.
Its now 4 or 5 weeks out and he's cleared for therapy. Honestly, he's not that interesting of a patient, but this is the part that is worth talking about. I tell him to take his shirt off during the eval so I can look at his shoulder and scapula etc. He stands up to do it and kind of slows down and says...uh...I hope you aren't offended by my tattoo. Right. Chances are I'm not going to be too impressed if he starts off like that, but whatever. Not my body, not my husbands back I have to look at (he is married), I have to see his shoulder so whatev. turns out on his back he has this huge tattoo. Covers both shoulders. There's a castle in the background. A wizard on his left and a naked woman on his right. Why he thinks it's cool enough to get a tattoo like that I don't know, but I'm focused on the eval so I don't pay much attention. He comes in for his second visit and I start doing scapular mobility and soft tissue work. I'm not doing a lot of active stuff with him since his fractures aren't fully healed so I have a lot of passive stuff I'm doing. I didn't really realize at the eval, but the naked women in right on his R scapula so I'm staring at it while I'm doing this work. And then I see the whole thing together and realize what it is. Left side, wizard with wand sending smokey magicness out of it that flows over to the woman on the right and bursts into flames, right under the naked woman who is tied to a stake. The guy has a tattoo of a naked woman burning at the stake. wow. And that's what I get to look at every treatment. fabulous. I don't know. Maybe it's just me, but really? Weird. Ugghh. Nope turns out I don't really appreciate it. My CI cracks me up sometimes. First time he said "You should have said to him, why do you have a tattoo of a naked man on your back?" because he can't see it. Maybe you could freak him out and he'd think its wrong. yeah....not. But it would be awesome if it worked out that way. The other thing he teases me about every time I treat this patient is making the woman dance. He's like, you can just play with his tattoo. Make the wizard move and talk and she can move back. So I get to imagine a dancing woman burning at the stake. Wow. I just don't understand some people.
Is this patient appropriate for physical therapy? (Halvaksz would be so proud!)
This is by far my favorite story so far. I wish I could have taken a picture because it was wild. So this patient comes in 1 week following a fall...actually multiple falls. First of all, we're working with a new person at the desk who transferred over from the outpatient rehab unit that's in the hospital itself, they do all the neuro stuff (got to be honest. Wish I was there. For some reason, the program told the hospital I had to do OP ortho, which is weird to me since I'll be doing OP in SC and I did OP ortho in VA and I don't even want to do OP...but so it goes). So anyway, she's over on our side now. I went out to the front 2 or 3 times to see if my pt was there, but they kept telling me no. She wasn't there. Finally, about 30 minutes late, I get a page that my pt is ready. What? 30 minutes late and i still don't have the chart. I go out to get it and see who my patient is. This woman and her daughter have been sitting there since I arrived, which is 45 minutes ago. Guys. I felt so bad for this woman. They just sat there for 45 minutes and I was in the back the whole time, just doing random stuff because it was my first patient of the day so I didn't have any new paperwork to be doing. Anyway...
This poor woman is in all kinds of pain post fall(s), but I was supposed to treat her neck. She's a bit older, in her 70s and she has a lot going on. She lives alone, but her daughter lives near by and does a lot to take care of her. The woman fell a week before at home and her daughter was out of town until...a day or two before she came in to therapy. The lady was taken to the ED by a friend that night and then fell again (I think) that weekend so she was back to the hospital. They sent her home both times. They looked at her neck and nothing was fx'd. She had had multiple spine surgeries if I remember correctly, so her spine was their primary concern. That and a head injury. The CT was clear, but I'm pretty sure based on what they told her that she had a minor concussion. This is all manageable. she really had a loooong history of stuff, but I was still feeling good about everything. I finish all that and have her change in to a gown.
I go back in and start doing a posture assessment. First thing I'm drawn to, her R shoulder is sloping down. Now, pretty much everyone who comes in for this kind of thing has a sloping shoulder, that's not surprising. That's the side of her neck that hurts, but man alive. Her shoulder is more like a ski slope type sloping. It's way down. So I note that and keep going. I have her raise her arms to watch her move. Remarkably, she's able to get the right one over her shoulder, but not her left (hx of RTC injury). So then I just have her stand and I start looking at her clavicle. There's a big bump sticking out so I start to look at it. The daughter sees and says, oh yes. We forgot, she had a clavicle fracture years ago. She never did anything about it. Later she was told that she should have had surgery and it just didn't heal right so there been this big bump there ever since. But I keep looking at it and the daughter says...huh. That looks different than the last time I saw it. That doesn't look right. Even compared to what it was before. At this point I am quite concerned. My next question reflects why. I ask "so when she broke it, did they remove a part of the clavicle then or later when she had shoulder surgery. Did they take a piece out?" The answer is even more concerning. "No, she never had any kind of surgery on it." As I look a little further I realize what has happened. Her clavicle is broken in half. I assume that is where the fracture was. But now, post fall...the clavicle is in two totally seperate pieces. I can see the fractured medical part of the clavicle. It's still in the skin, but it is sticking out in a wicked way. The medial portion is completely displaced, which then explains the ski slope of a shoulder. Her shoulder is no longer connected to the sternum by the clavicle. That piece of the clavicle is now hanging out somewhere in her brachium. You can sort of make it out, but not exactly. At this point my brain is screaming "not appropriate for PT, not appropriate for PT." I have a very clear picture in my head of what's happened, the woman isn't having any signs of nerve damage, she's maybe got a bit of vascular problem, but nothing really significant. I'm pretty sure I don't want to evaluate her neck, but I have the woman look in the mirror at her shoulder to tell me if it is different than the last time she looked at it (she hasn't really looked in the mirror since she fell.) When she does she sort of freaks out. It's not like it was before at all. There used to be an indentation between the two pieces of bone, as in, she used to be able to hook her bra strap on the lateral piece of the clavicle to keep it up, but she said she had noticed her bra strap kept slipping this week. ( note: a. I think it's awesome that she could hook her bra strap on her clavicle b. yeah, no wonder her bra strap is slipping, her shoulder is depressed a good 4 inches, it's like she doesn't have a shoulder connecting to her arm. straight slope down.) So I explain to them that I think that she needs to have her shoulder x-rayed and looked at by the physician. I'm concerned about moving her neck around because if that bone moves, it could damage some vessels and cause serious problems. However, before we proceed like that, I want to go get my instructor (I am a student, I could be wrong) and make sure that what I think is correct. He's seen a lot more than I have. I go and try to find him and of course I can't. I'm in a hurry- not that worried about the patient. I am really pretty sure of myself, but this woman has been here well over an hour and now she's not even going to get treated, she's getting sent somewhere else. I honestly feel bad for her. I finally find him. He looks and her and agrees. We call the doctor (who is in the same building, but of course all they can do for her is leave a message for the doctor. They have to go all the way home and come all the way back). Really, I need to find out if there's a way to actually send urgent cases more directly to the doctor. I should have been more assertive. We let the daughter call and then I talked to them, but I should have called to see if I could directly get a hold of a nurse cause frankly. if that bone did move and hit those vessels we are talking serious emergency. Anyway. We asked the patient to call us and let us know what happened, but we haven't heard anything. Wow. I realized the importance of yes, no, yes with referral. 2 ER visits and a visit to the PCP and I was the first one to even look at this. You couldn't miss it if you looked.
The end. i have more stories, but don't feel like writing anymore. Plus I know that Rach isn't reading. :)
Caton Manor Week 5
During this week, it was pretty simple. The first new patient is a 64 y.o. male with long-term COPD who is O2 dependent and a recovering heroin addict who fell down 15 steps. He is a very nice man and ready to work :-). The other patient is not so much fun...I call him "Mr. Cranky-pants" to my friends, haha. He is a 52 y.o. male s/p L transtibial amputation with a R big toe amputation and a diabetic foot ulcer under the 1st ray. He is also on methadone like the other patient for recovering drug addiction. He is obese and has diabetes. Overall, he has a terrible attitude, difficult, complains continuously and is rude. First, he is sleeping in his room because he stays up all night watching tv because thats when the movies are on....and in the time that I tried to say "well, would you mind if we talk about changing your sleep schedule so you are awake during the daytime and asleep during the nightime", he had already fallen back asleep. And then, when I asked him "are you okay? are you tired?", he yelled at me saying "yeah, I'm fine, I'm not sleeping". Ridiculous! Basically, I have to push back when he pushes me and let him try to do things on his own and then offer help eventually. The problem is that he ends up getting like an hour and a half of my time, when he is only supposed to be treated for 45 minutes. And most of the time is spent with me trying to explain things to him because he is just being difficult.
My CI is still letting me be pretty independent and she is still very busy and disorganized, but things are getting done. I helped with wound rounds this week...not as scary as the first time.
Dr. Birkmeier came on Tuesday for my midterm eval...it went well. My CI said that I am exceeding her expectations and do really well with the patients. Yay!
My CI is still letting me be pretty independent and she is still very busy and disorganized, but things are getting done. I helped with wound rounds this week...not as scary as the first time.
Dr. Birkmeier came on Tuesday for my midterm eval...it went well. My CI said that I am exceeding her expectations and do really well with the patients. Yay!
Friday, July 9, 2010
Caton Manor Week 4
One of the main things that I learned this week is that I'm not a big fan of getting 5 patients to treat at the same time. I think that its kinda rude to the patients because they end up sitting around for so long waiting for instruction or one-on-one care. Basically, the main problem is that nursing does not follow the schedule that is given to them from rehab and the tech does not pay attention to the list he has for which patients are treated by which therapists. Sooo...I am working a lot on my concurrent treatment skills...haha. I've talked to the other therapists about this craziness and we all work together to tag team patients which is nice. Its just amazing to me that certain people have difficulty following a simple plan. I understand if kinks happen and you need to be flexible...but actually using a foundation system would be a good idea for all...maybe I'll work on this more my "improvement project"...haha.
I also learned that venous stasis ulcers on LEs can bleed a lot...even pass blood clots. On Wednesday, I was able to work with the OT to get the patient with sarcoidosis with paraplegia and changing levels of consciousness (hallucinations/delirium) to sit up at the edge of the bed. He was a Max Ax2 but his tolerance increased to 20 minutes which was great. And then, I looked down...there was a pool of blood at my feet. Due to his long hx of steroid tx for the sarcoidosis, he has thinning skin at 56 y.o. resulting in numerous wounds on his LEs and sacrum. He was in a state of limited consciousness and didn't even notice his leg which does have sensation. Basically, the blood flowed because of the dependent position of the limb. Nursing was notified and we are not planning to sit him up for a couple of days now.
I have three new patients! First, 49 y.o. male s/p acute stroke of the MCA resulting in R sided weakness. Initially, I was told that he only spoke/understood French...and he has expressive aphasia. I was like "oh man, how am I supposed to do this eval". Basically, I went in, started do like the chicken dance to demonstrate what I wanted him to do. And then, nursing informed me and the PT that he does understand English...I was like...what? Haha. Oh well, I got the initial eval done, he still didn't understand why I wanted to look at this R side which "didn't work" based on our language we developed. The second patient is a 40 y.o. male at end-stage HIV/AIDS. I wish that Dr. Harris-Love could be there to help! He is incredibly weak, very thin (skeletonish), moves slowly, but attentive and alert. He likes to roll his eyes at instruction, haha...but I think he likes me because he has expressed appreciation when I take the time to explain why we are doing things. Also, there is a 78 y.o. male s/p L TKA...he is completely different from the last patient with the TKA. He has so much less pain! However, today...I was worried he had a DVT....so guess what I used. Thats right, the Wells Clinical Decision Rule. From my tally, he was positive....but according to the PT who looked at this further, she ruled him to not bee positive because he rated his tenderness pain only 3-5/10 and it was not significantly warmer from his other limb. I was still a little nervous about it...but you would be too I think when he calf is tender, size difference of 3 cm, s/p major surgery...etc. But, his swelling did fluctuate during the activities and he tolerated treatment well.
I have the new patients because two of my patients went home last week (mainly due to insurance reasons...sadness). The 59 y.o. with severe arthritis, gout and the L TKA and the 30 y.o. with jaundice and generalized weakness, etc. both went home. Their stories are still so interesting to me.
And then, today, I learned that I'm terrible at duck-pin bowling. I went on the rehab outing to a bowling alley in Glen Burnie. And well...I'm just no good...haha. But it was fun. Its kinda made me nostalgic though. Bowling is something to do with friends or family, and I have not been in forever. So I kept daydreaming about the other times I have been bowling. I can say that all of the people in the rehab dept at Caton Manor are quite enjoyable. :-)
How are all of you doing? P.S. the count down has begun....crazy! We are half way done!!
I also learned that venous stasis ulcers on LEs can bleed a lot...even pass blood clots. On Wednesday, I was able to work with the OT to get the patient with sarcoidosis with paraplegia and changing levels of consciousness (hallucinations/delirium) to sit up at the edge of the bed. He was a Max Ax2 but his tolerance increased to 20 minutes which was great. And then, I looked down...there was a pool of blood at my feet. Due to his long hx of steroid tx for the sarcoidosis, he has thinning skin at 56 y.o. resulting in numerous wounds on his LEs and sacrum. He was in a state of limited consciousness and didn't even notice his leg which does have sensation. Basically, the blood flowed because of the dependent position of the limb. Nursing was notified and we are not planning to sit him up for a couple of days now.
I have three new patients! First, 49 y.o. male s/p acute stroke of the MCA resulting in R sided weakness. Initially, I was told that he only spoke/understood French...and he has expressive aphasia. I was like "oh man, how am I supposed to do this eval". Basically, I went in, started do like the chicken dance to demonstrate what I wanted him to do. And then, nursing informed me and the PT that he does understand English...I was like...what? Haha. Oh well, I got the initial eval done, he still didn't understand why I wanted to look at this R side which "didn't work" based on our language we developed. The second patient is a 40 y.o. male at end-stage HIV/AIDS. I wish that Dr. Harris-Love could be there to help! He is incredibly weak, very thin (skeletonish), moves slowly, but attentive and alert. He likes to roll his eyes at instruction, haha...but I think he likes me because he has expressed appreciation when I take the time to explain why we are doing things. Also, there is a 78 y.o. male s/p L TKA...he is completely different from the last patient with the TKA. He has so much less pain! However, today...I was worried he had a DVT....so guess what I used. Thats right, the Wells Clinical Decision Rule. From my tally, he was positive....but according to the PT who looked at this further, she ruled him to not bee positive because he rated his tenderness pain only 3-5/10 and it was not significantly warmer from his other limb. I was still a little nervous about it...but you would be too I think when he calf is tender, size difference of 3 cm, s/p major surgery...etc. But, his swelling did fluctuate during the activities and he tolerated treatment well.
I have the new patients because two of my patients went home last week (mainly due to insurance reasons...sadness). The 59 y.o. with severe arthritis, gout and the L TKA and the 30 y.o. with jaundice and generalized weakness, etc. both went home. Their stories are still so interesting to me.
And then, today, I learned that I'm terrible at duck-pin bowling. I went on the rehab outing to a bowling alley in Glen Burnie. And well...I'm just no good...haha. But it was fun. Its kinda made me nostalgic though. Bowling is something to do with friends or family, and I have not been in forever. So I kept daydreaming about the other times I have been bowling. I can say that all of the people in the rehab dept at Caton Manor are quite enjoyable. :-)
How are all of you doing? P.S. the count down has begun....crazy! We are half way done!!
Thursday, July 1, 2010
Caton Manor Week 3
Yay...now I'm in real time. The week started out with learning that the patient with the lung mass unfortunately was discharged to the hospital. It is believed that the mass progressed to being cancerous and her illness is from this progression. Also, I learned that she has stated that she is okay with this situation and that she has lived a good life being 93 and all. This is very sad because she is a very sweet lady. But unfortunately, this is the nature of this type of facility. The patients here have very intense conditions. Some of the other patients I have met have hx of being a pedestrian who was hit by a car (2 patients in fact! one s/p TBI, the other is recovering from drug abuse, B tibial fxs, L humeral fx, CV2 fx, L hand edema), individual who recovered from a 3 yr coma from assault & has resulting all extremity contractures since he had no coma tx, female with dyskinesia from long hx of anti-psychotics, male who shot himself in the face 4 yrs ago and recovering from an infected facial reconstructive surgery...and so on. I'm sorry if these stories are too much; let me know please. These are just some of the crazy things that come to Caton Manor.
On the other hand, the other patients that I have are doing well and I'm seeing a positive progression in their abilities. For instance, the 99 y.o. woman...who is adorable...she can sit EOB unsupported for 15 min and can follow verbal cues to lean forward to relieve her back pain and not push backwards. And she remembers my "beautiful voice"...haha that made my day on Tuesday. Also, I had the best Max A transfer from W/C to bedside with her ever! The 59 y.o. woman with severe arthritis and L TKA and climb stairs safely. On Tuesday, I also got a new patient who my CI eval'd. She is an 82 y.o. woman hospitalized for severe asthma attack, who was D/C back to her apartment which had been flooded by a water heater explosion from upstairs, air dried by fans and then had to go to Caton Manor because of difficulty breathing. Rehab's vote is there is mold causing her problems. She is a sweet lady who I'm working with on increasing her endurance, etc.
I have another new patient who I eval'd today (Thursday). The patient is a 56 y.o. female with spinal stenosis s/p decompression and fusion for L2-L5, end-stage renal disease, kidney transplant x2, DM Type 2, OA, RA, HTN. She is very high functioning and going home on Saturday.
Alright, so back to Wednesday...wound rounds at 5:30 AM...oh man. I really don't like wounds too much. There were three patients who I remember in particular. The first patient of the morning was 50 y.o. woman who is obese, LE edema, decreased strength, severe keratinosis, and the largest sacral wound which was just scary. You could see things that you really wish you couldnt. And it just looked so painful. And it wasn't her only wound! She had another deep under her belly skin folds. Okay, the next memorable patient is my patient who is 53 y.o. man with neurosarcoidosis and resulting paraplegia. His skin is thinned because of his longstanding steroid txs resulting in many wounds. He had 4 wounds on his L LE, 2 on R LE and 3 on his sacrum. There were just so many that it because difficult for the wound MD to describe all of the locations. And finally, there was a 50 y.o. man who has heart & lung problems, hx of severely painful LE compartment syndrome, s/p B fasciotomy which the incision sites did not heal...there was even a skin graft that failed. The skin graft donor site has also remained open. Sooo painful. Anyways, it was interesting to see what % were granulation, slough or necrosis according to the MD.
On a fun note...I danced with a patient!! My 72 y.o. woman s/p multi-infarctions. I have danced/side-stepped to music with her yesterday and today :-) It was fun. She continuously would chuckle to herself about the fact that we were dancing. But she enjoyed it. She has the best smile about it too, haha. She is hard of hearing so she cannot really figure out the beat to the music...but no worries, its helping with her coordination. I still have to email Klima about this :-)
Hope you have been having a great week! Have a nice 4th of July weekend!! :-) I'll be heading back to CT again.
On the other hand, the other patients that I have are doing well and I'm seeing a positive progression in their abilities. For instance, the 99 y.o. woman...who is adorable...she can sit EOB unsupported for 15 min and can follow verbal cues to lean forward to relieve her back pain and not push backwards. And she remembers my "beautiful voice"...haha that made my day on Tuesday. Also, I had the best Max A transfer from W/C to bedside with her ever! The 59 y.o. woman with severe arthritis and L TKA and climb stairs safely. On Tuesday, I also got a new patient who my CI eval'd. She is an 82 y.o. woman hospitalized for severe asthma attack, who was D/C back to her apartment which had been flooded by a water heater explosion from upstairs, air dried by fans and then had to go to Caton Manor because of difficulty breathing. Rehab's vote is there is mold causing her problems. She is a sweet lady who I'm working with on increasing her endurance, etc.
I have another new patient who I eval'd today (Thursday). The patient is a 56 y.o. female with spinal stenosis s/p decompression and fusion for L2-L5, end-stage renal disease, kidney transplant x2, DM Type 2, OA, RA, HTN. She is very high functioning and going home on Saturday.
Alright, so back to Wednesday...wound rounds at 5:30 AM...oh man. I really don't like wounds too much. There were three patients who I remember in particular. The first patient of the morning was 50 y.o. woman who is obese, LE edema, decreased strength, severe keratinosis, and the largest sacral wound which was just scary. You could see things that you really wish you couldnt. And it just looked so painful. And it wasn't her only wound! She had another deep under her belly skin folds. Okay, the next memorable patient is my patient who is 53 y.o. man with neurosarcoidosis and resulting paraplegia. His skin is thinned because of his longstanding steroid txs resulting in many wounds. He had 4 wounds on his L LE, 2 on R LE and 3 on his sacrum. There were just so many that it because difficult for the wound MD to describe all of the locations. And finally, there was a 50 y.o. man who has heart & lung problems, hx of severely painful LE compartment syndrome, s/p B fasciotomy which the incision sites did not heal...there was even a skin graft that failed. The skin graft donor site has also remained open. Sooo painful. Anyways, it was interesting to see what % were granulation, slough or necrosis according to the MD.
On a fun note...I danced with a patient!! My 72 y.o. woman s/p multi-infarctions. I have danced/side-stepped to music with her yesterday and today :-) It was fun. She continuously would chuckle to herself about the fact that we were dancing. But she enjoyed it. She has the best smile about it too, haha. She is hard of hearing so she cannot really figure out the beat to the music...but no worries, its helping with her coordination. I still have to email Klima about this :-)
Hope you have been having a great week! Have a nice 4th of July weekend!! :-) I'll be heading back to CT again.
Wednesday, June 30, 2010
Caton Manor Week 2
As promised here is last week's stories :-) I started the week with two more evals and quickly realizing that my CI is not very time efficient. She is a very nice lady and gets excited about simply things which I will further explain; but, every day I stayed late from 30 minutes to 1.5 hours overtime. The reason for the extra time in clinic was simply because my CI has regular meetings during which I cannot treat any patients since the other PT has her own full caseload. So, I sit twiddling my thumbs waiting for my CI to come back, just sitting with my patients in the rehab gym explaining to those who would understand why we are not doing anything. The nice part is that I get to observe how the other therapists operate which has helped guide me with managing my patient caseload which I was quickly bumped up to 6-7 patients whom I regularly treat mostly on my own with my CI within earshot.
One thing that I learned this week is that I am going to be doing an in-service for which I am to provide food on either sarcoidosis or normal pressure hydrocephaly (NPH)...any thoughts? Apparently, there has been an increase in the patient population with both of these diagnoses. Also, I have been put in-charge of July's Theme Day which is supposed to be my CI but as the other therapists put it..."she takes the best route to do the least amount of work". Just to clarify, I do like her, she is very supportive which I appreciate for my first internship...however, I am nervous because she doesn't truly challenge me and she is disorganized. We will see what happens. Anyways, I am noticed that they like to celebrate/have special days for a lot of things at Caton Manor. So, a theme day is a day once a month in rehab where one of the therapists decorates and has special activities for treatments. For instance, on Wednesday, it was Luau Day where everyone had flower necklaces, some grass skirts, there was a beach ball for passing activities like hot-potato group activity, a magnetic fishing game for standing balance and coordination, a giant blow-up starfish ring toss (which I still use for one of my patients), stick-the-hand on the palm tree and arts & craft fish decorating. There was also popcorn, sugar free candy and italian ice for prizes for the patients participating. It was fun! So, for July...I'm thinking "Summer Drive-In" theme. When I suggested that, my CI got sooooo excited and went on and on talking about Bengie's Drive-In in Baltimore for about 20 minutes during our staff meeting, haha. And then, Friday was Fun Day which is when the staff of the facility have a cook-out and bring their children to hang out with the patients.
Now for my caseload...I have some fun patients:
(1) 99 y.o. female s/p R subdural hematoma, chronic on acute, who I eval'd during the first week. She is still cute when she giggles to herself. She is an intense pusher...its impressive...but her upright sitting tolerance has finally improved, she gets drowsy easily and has difficulty with coordination. L side more affected.
(2) 93 y.o. female with lung mass (now believed to have progress to cancerous since she has been sick everyday since and d/c to the hospital), O2 via NC, hx of breast CA, edema in B hands & LEs
(3) 59 y.o. female s/p L TKA secondary to OA, gout, obese, lives alone, insurance does not want to pay for SNF, severe generalized arthritis casuing spasms in B forearms/hands
(4) 56 y.o. male with neurosarcoidosis with paraplegia, s/p UTI, difficulty speaking, UE & chest tremors, anal fistula, lymphedema, multiple sacral & B LE wounds, thin skin secondary to steroid tx
(5) 72 y.o. female s/p multi-infarct CVA to parietal lobe/basal ganglia/insular region, chuckles to herself all the time saying "I'm just laughing at me", poor coordination, safety concern...all around my favorite patient right now :-) I'll talk more about her later
(6) 39 y.o. female s/p ARDS, severe jaundice, asthma, Hep C, alcoholic hepatitis, long hx of alcohol abuse, bipolar disorder, her eyes are as golden as her dyed hair
(7) 60 y.o. male s/p 45 min. seizure on the street, had been reported missing for 3 days, bipolar disorder, schizophrenia, difficulty with balance and gait pattern including trunk sway and Trendelenberg like whoa...haha
All of them are very interesting and I enjoy working with them! As you can see, most of the patients at this facility have intense histories. My CI asked me to come in for the 5 AM wound rounds on Wednesday but I asked if I could come in during week 3 so that I could arrange with a certain someone if I could stay with them the night before :-) I'll let you know how that went.
One thing that I learned this week is that I am going to be doing an in-service for which I am to provide food on either sarcoidosis or normal pressure hydrocephaly (NPH)...any thoughts? Apparently, there has been an increase in the patient population with both of these diagnoses. Also, I have been put in-charge of July's Theme Day which is supposed to be my CI but as the other therapists put it..."she takes the best route to do the least amount of work". Just to clarify, I do like her, she is very supportive which I appreciate for my first internship...however, I am nervous because she doesn't truly challenge me and she is disorganized. We will see what happens. Anyways, I am noticed that they like to celebrate/have special days for a lot of things at Caton Manor. So, a theme day is a day once a month in rehab where one of the therapists decorates and has special activities for treatments. For instance, on Wednesday, it was Luau Day where everyone had flower necklaces, some grass skirts, there was a beach ball for passing activities like hot-potato group activity, a magnetic fishing game for standing balance and coordination, a giant blow-up starfish ring toss (which I still use for one of my patients), stick-the-hand on the palm tree and arts & craft fish decorating. There was also popcorn, sugar free candy and italian ice for prizes for the patients participating. It was fun! So, for July...I'm thinking "Summer Drive-In" theme. When I suggested that, my CI got sooooo excited and went on and on talking about Bengie's Drive-In in Baltimore for about 20 minutes during our staff meeting, haha. And then, Friday was Fun Day which is when the staff of the facility have a cook-out and bring their children to hang out with the patients.
Now for my caseload...I have some fun patients:
(1) 99 y.o. female s/p R subdural hematoma, chronic on acute, who I eval'd during the first week. She is still cute when she giggles to herself. She is an intense pusher...its impressive...but her upright sitting tolerance has finally improved, she gets drowsy easily and has difficulty with coordination. L side more affected.
(2) 93 y.o. female with lung mass (now believed to have progress to cancerous since she has been sick everyday since and d/c to the hospital), O2 via NC, hx of breast CA, edema in B hands & LEs
(3) 59 y.o. female s/p L TKA secondary to OA, gout, obese, lives alone, insurance does not want to pay for SNF, severe generalized arthritis casuing spasms in B forearms/hands
(4) 56 y.o. male with neurosarcoidosis with paraplegia, s/p UTI, difficulty speaking, UE & chest tremors, anal fistula, lymphedema, multiple sacral & B LE wounds, thin skin secondary to steroid tx
(5) 72 y.o. female s/p multi-infarct CVA to parietal lobe/basal ganglia/insular region, chuckles to herself all the time saying "I'm just laughing at me", poor coordination, safety concern...all around my favorite patient right now :-) I'll talk more about her later
(6) 39 y.o. female s/p ARDS, severe jaundice, asthma, Hep C, alcoholic hepatitis, long hx of alcohol abuse, bipolar disorder, her eyes are as golden as her dyed hair
(7) 60 y.o. male s/p 45 min. seizure on the street, had been reported missing for 3 days, bipolar disorder, schizophrenia, difficulty with balance and gait pattern including trunk sway and Trendelenberg like whoa...haha
All of them are very interesting and I enjoy working with them! As you can see, most of the patients at this facility have intense histories. My CI asked me to come in for the 5 AM wound rounds on Wednesday but I asked if I could come in during week 3 so that I could arrange with a certain someone if I could stay with them the night before :-) I'll let you know how that went.
Tuesday, June 29, 2010
Caton Manor Week 1
Alright, alright. I am still crazy behind...but I still wanted to share these stories with you. So, for the rest of the first week, my CI was away in Boston for the APTA Conference. Therefore, I pretty much observed with the other PT for the rest of the week and started getting my hands dirty.
Wednesday, I completed my first initial eval with her assistance of a wonderful little lady. She is 99 y.o. s/p subdural hematoma at the R parietotemporal/occipital junction which is chronic on acute (meaning its gotten bigger, but there was no noticeable active bleeding while she was in the hospital). She has been diagnosed with dementia for a few years now. This little lady could barely stay awake, remarkable generalized weakness, could not follow commands and was all-together cute because she would look at me and then just chuckle to herself for no reason. There is more to come about her later :-)
Thursday, I did mostly observation, became a pro at the modalities machines in the clinic (diathermy, US, etc) and learned more about what the PTAs could do. Oh! I nearly got sick in the morning though. I assisted with a sit<>stand transfer of a 50 y.o. woman who is obese, keratinous skin, severe generalized weakness, large sacral wounds and LE swelling. She had not been bathed yet though and well, I was directly in front of her when she stood and surrounded by the curtain dividing the room. I had to breathe slowly and swallow. Luckily, no one noticed. She is a difficult patient because she has the potential to do things, but once it becomes uncomfortable she wants to stop. So that was my other saving grace, she sat back down in about 10 secs. If she stood any longer, I might have had a problem...which is unfortunate for her.
One modality that I have not mentioned is PENS (aka patterned electrical neuromuscular stimulation). Apparently it patterns normal wavelengths of the muscles better than NMES, IFC, TENS, Russian and basic e-stim. Additionally, it is focused on Type II muscle fibers for power. Yeah, umm I dont know about this. I looked on PubMed for info...there is only a single case study on it. The rest of the info is put together by the company of the patented machine.
Friday, the most interesting day of the week, basically. My CI volunteered me to help out with the activities dept Father's Day lunch outing that happened. To put it simply, I had no idea what I was really supposed to be doing. It was completely disorganized basically. But I pushed a patient down the block to lunch, got a free lunch (after explaining that I was from rehab and still being mistook for the waitress multiple times) and helped feed a funny patient who told me I just needed to remember the Donald part of Donald Duck's name to remember his name. But at the lunch, which was yummy, they showed a video for the gentlemen. Needless to say, I wasn't sure if I was supposed to stay anymore.
If you are curious, here is a link to one part of the 45 minute video: http://www.youtube.com/watch?v=2VUEXJ6SKpQ&feature=PlayList&p=360B5168559D8479&playnext_from=PL&playnext=1&index=25
Thats all I have to say about that. Haha.
Talk to you again soon!
~Liz :-)
Wednesday, I completed my first initial eval with her assistance of a wonderful little lady. She is 99 y.o. s/p subdural hematoma at the R parietotemporal/occipital junction which is chronic on acute (meaning its gotten bigger, but there was no noticeable active bleeding while she was in the hospital). She has been diagnosed with dementia for a few years now. This little lady could barely stay awake, remarkable generalized weakness, could not follow commands and was all-together cute because she would look at me and then just chuckle to herself for no reason. There is more to come about her later :-)
Thursday, I did mostly observation, became a pro at the modalities machines in the clinic (diathermy, US, etc) and learned more about what the PTAs could do. Oh! I nearly got sick in the morning though. I assisted with a sit<>stand transfer of a 50 y.o. woman who is obese, keratinous skin, severe generalized weakness, large sacral wounds and LE swelling. She had not been bathed yet though and well, I was directly in front of her when she stood and surrounded by the curtain dividing the room. I had to breathe slowly and swallow. Luckily, no one noticed. She is a difficult patient because she has the potential to do things, but once it becomes uncomfortable she wants to stop. So that was my other saving grace, she sat back down in about 10 secs. If she stood any longer, I might have had a problem...which is unfortunate for her.
One modality that I have not mentioned is PENS (aka patterned electrical neuromuscular stimulation). Apparently it patterns normal wavelengths of the muscles better than NMES, IFC, TENS, Russian and basic e-stim. Additionally, it is focused on Type II muscle fibers for power. Yeah, umm I dont know about this. I looked on PubMed for info...there is only a single case study on it. The rest of the info is put together by the company of the patented machine.
Friday, the most interesting day of the week, basically. My CI volunteered me to help out with the activities dept Father's Day lunch outing that happened. To put it simply, I had no idea what I was really supposed to be doing. It was completely disorganized basically. But I pushed a patient down the block to lunch, got a free lunch (after explaining that I was from rehab and still being mistook for the waitress multiple times) and helped feed a funny patient who told me I just needed to remember the Donald part of Donald Duck's name to remember his name. But at the lunch, which was yummy, they showed a video for the gentlemen. Needless to say, I wasn't sure if I was supposed to stay anymore.
If you are curious, here is a link to one part of the 45 minute video: http://www.youtube.com/watch?v=2VUEXJ6SKpQ&feature=PlayList&p=360B5168559D8479&playnext_from=PL&playnext=1&index=25
Thats all I have to say about that. Haha.
Talk to you again soon!
~Liz :-)
Tuesday, June 22, 2010
Week dos
Hey guys! So it sounds like everyone is having exciting adventures in clinic (or not so exciting as the case may be). My experience has been pretty cool - Since all the patients are medicare, my CI said that I can't ever reach "Entry level Independent" sigh I guess advanced beginner will just have to do. That's okay with me though I don't think I could handle these patients on my own just yet. I've seen more bodily fluids this week than I ever thought I wanted to, but the really weird thing is I think I love this job. I think it is pretty close to what I will want to do. Interesting - I'm okay with poop. I also got a whole respiratory therapy intro - I'm official guys -I've suctioned (really scary by the way, the patients start coughing and choking and they give you warnings about poking a hole in their trachea) When the respiratory therapist told me to do it the first time I was like, really are you sure about this. So, other than that I haven't done too much on my own, mostly observing right now - doing exercises with the patients, lots of transfers, some coma emergence - which is really just being mean and shouting and clapping at the patient, and a little bit of wound care (my fave) Okay well that's it for now. I'll keep you guys updated. MISS YOU all!
Monday, June 21, 2010
Start of Week 2
So more and more each day I am with my CI, I can see why he hates one of the other PTs. I am not really a fan of the other PTs there but do love the PTA, Patti. As much as I hate to admit it, I truly appreciate good documentation. The one other PT documents ROM measurements in percentages (yes, percentages) and has a ton of goals (record of 47 for one initial eval) plus she's not the most professional and has that fake-happy attitude...I think the most annoying thing is how she lets the timers run out, beeping for a really long time - silly, I know, but really really is starting to get to me. The other PT does some weird things and her assessments don't say much about what is actually going on with the patient and documents exercises not really well (I have no idea what she does with them but certainly doesn't do any manual therapy is for sure). The PTA, Patti, is pretty cool and really smart. I can see why everyone gets along with her.
Today presented some more unique patients...one initial eval pt is an overweight gentleman who apparently has a herniated disc in his lumbar spine from picking up a groundball since he coaches and plays baseball; he flat out told us that he didn't care what we had to say about the causes of his symptoms and what we were attempting to do with therapy - he just wanted a quick fix and doesn't really care about the exercises. So it'll be interesting to work with grumpy I guess. He's kinda like another patient we have who refuses to do any real exercises - just wants heat and stim for his neck pain even though he has muscular and joint restrictions in his ROM.
Had some more patients in aquatic therapy today, however, still learning about the routines they do and where to start patients out. One gentleman started feeling nauseous near the end of his session so that was cut short - very odd but guess we'll see if it happens again, I was so ready to grab the little trashcan for him to throw up in, haha.
I don't think I knew there'd be so many patients with partial menisectomy procedures that were such lazy people...my CI has warned me about being optimistic about them. And as much as I hate to admit he's right, he probably is...learning a lot about insurances and what (not always, but usually) the type of insurance along with MOI leads you to assume about the patients coming into the clinic.
O, and lumbar disc replacement? Yea, have a pt with that who also happens to be a PT...she's pretty advanced but "has pain still" (MOI was transferring a pt using stand-pivot transfer). She likes me but pretty sure she can do more than what she leads people to believe...plus no real info on her surgery as it's still in clinical trials really. Fun times.
Another interesting patient (there are a couple actually, that I like). A lot of patients with Parkinson's Disease which is cool to use Neuro stuff and a patient with a hemiarthroplasty/total shoulder replacement is another interesting case. Learning a lot of manual techniques and figuring out the best way for me to do them as my CI is a lot taller and has bigger hands than I do (plus about 60lbs).
Looking forward to doing some marketing with my CI and learning more about the billing/insurance stuff.
Today presented some more unique patients...one initial eval pt is an overweight gentleman who apparently has a herniated disc in his lumbar spine from picking up a groundball since he coaches and plays baseball; he flat out told us that he didn't care what we had to say about the causes of his symptoms and what we were attempting to do with therapy - he just wanted a quick fix and doesn't really care about the exercises. So it'll be interesting to work with grumpy I guess. He's kinda like another patient we have who refuses to do any real exercises - just wants heat and stim for his neck pain even though he has muscular and joint restrictions in his ROM.
Had some more patients in aquatic therapy today, however, still learning about the routines they do and where to start patients out. One gentleman started feeling nauseous near the end of his session so that was cut short - very odd but guess we'll see if it happens again, I was so ready to grab the little trashcan for him to throw up in, haha.
I don't think I knew there'd be so many patients with partial menisectomy procedures that were such lazy people...my CI has warned me about being optimistic about them. And as much as I hate to admit he's right, he probably is...learning a lot about insurances and what (not always, but usually) the type of insurance along with MOI leads you to assume about the patients coming into the clinic.
O, and lumbar disc replacement? Yea, have a pt with that who also happens to be a PT...she's pretty advanced but "has pain still" (MOI was transferring a pt using stand-pivot transfer). She likes me but pretty sure she can do more than what she leads people to believe...plus no real info on her surgery as it's still in clinical trials really. Fun times.
Another interesting patient (there are a couple actually, that I like). A lot of patients with Parkinson's Disease which is cool to use Neuro stuff and a patient with a hemiarthroplasty/total shoulder replacement is another interesting case. Learning a lot of manual techniques and figuring out the best way for me to do them as my CI is a lot taller and has bigger hands than I do (plus about 60lbs).
Looking forward to doing some marketing with my CI and learning more about the billing/insurance stuff.
Week 2, the beginning
So last week about half out patients either canceled or didn't show. It was weird. My CI, James, says that never happens. It was just me I guess. :) So, these are the interesting people I saw today. One lady was an initial eval. She was coming in for an eval to start aquatic therapy. There is a PTA who does all the aquatic therapy from our clinic, so she can't do the evals. The script (and yes, they are really scripts, not referrals) just said "back pain" and the paperwork didn't show where her back pain was. I couldn't find the medication list, but looked at her PMH and noticed a lot of boxes checked, so figured we'd have plenty to talk about. So we go to start the eval and her husband asks if we are going to be asking questions and when I say yes, he says he has to come back too. When the eval starts its really kind of odd, like I'm starting to wonder if he is abusive or something because he won't let her talk. But, as the eval goes on I realize that's not the case at all. She got to add her two cents as time went on, but it turns out she has a lot of psychological problems. Apparently she went to the hospital a couple months ago for back pain and was diagnosed with delirium, then they decided instead it was bipolar. Then as we continue talking I find out she has fibromyalgia, arthritis in i don't even know how many joints, random undiagnosed swelling/edema in all her extremities, HBP, four previous spinal surgeries and currently back pain that peripheralizes to all four extremities with numbness and tingling and other point tenderness just below her R scapula. Wow. I made it through the history and came to the physical exam part and just looked at my CI and asked if he would do the physical exam. I had no clue where to go with her. Especially since I couldn't even do it with the idea of testing what I would want to treat since she is only in for aquatic therapy. I blanked.
Then I had a pt who looked like an easy one. She's about 16, in for knee pain, on the down hill slope of therapy. Easy right. Progress her a bit. Continue plan of care. No biggie. Oh wait. I walk into the waiting room to get her and she's bawling and she's there with some random man who we think is maybe her biological father, but she's in foster care so I'm not quite sure where he came from. Anyway, we are walking back and she starts describing this "incident" that happened yesterday while she was playing kick ball and it sounds like she probably dislocated her patella. Yet again, I am freaking out, somehow I've forgotten how to be a PT in the last few months while I was sitting in class. Awesome. My CI yet again jumped in and saved the day. Final patient of the day. A patient in his 20's who has back pain post car accident. All I know about him (besides reading his chart) is the PTA who treated him last Friday was so mad at the other PTA, who treated him earlier in the week, because he initiated the optional piriformis soft tissue work...aka butt massage...and the patient is "creepy" in her own words. She was seriously not happy cause apparently he stared at her while she was massaging his butt. Awesome. So glad my CI handed this one over to me. :) I thought of Halvaksz and how I should throw my assumptions/judgments out the window. It works for a while. But it turns out the guy really is weird. It would surprise me if I found out he ISN'T on drugs. I evaluated whether he really needed the soft tissue work cause he's definitely getting better, but he really did need it. So butt massage here I come. Can we just say...some people's butts really stink. That man stinks. Awesome opening to week 2!
p.s. Rach, if you made it this far, I'm impressed!
Then I had a pt who looked like an easy one. She's about 16, in for knee pain, on the down hill slope of therapy. Easy right. Progress her a bit. Continue plan of care. No biggie. Oh wait. I walk into the waiting room to get her and she's bawling and she's there with some random man who we think is maybe her biological father, but she's in foster care so I'm not quite sure where he came from. Anyway, we are walking back and she starts describing this "incident" that happened yesterday while she was playing kick ball and it sounds like she probably dislocated her patella. Yet again, I am freaking out, somehow I've forgotten how to be a PT in the last few months while I was sitting in class. Awesome. My CI yet again jumped in and saved the day. Final patient of the day. A patient in his 20's who has back pain post car accident. All I know about him (besides reading his chart) is the PTA who treated him last Friday was so mad at the other PTA, who treated him earlier in the week, because he initiated the optional piriformis soft tissue work...aka butt massage...and the patient is "creepy" in her own words. She was seriously not happy cause apparently he stared at her while she was massaging his butt. Awesome. So glad my CI handed this one over to me. :) I thought of Halvaksz and how I should throw my assumptions/judgments out the window. It works for a while. But it turns out the guy really is weird. It would surprise me if I found out he ISN'T on drugs. I evaluated whether he really needed the soft tissue work cause he's definitely getting better, but he really did need it. So butt massage here I come. Can we just say...some people's butts really stink. That man stinks. Awesome opening to week 2!
p.s. Rach, if you made it this far, I'm impressed!
"Just another manic Monday.....whooooa, whooooa..."
I forgot to mention how eventful my past 2 Mondays have been. First off, I had been at clinic for about an hour the first day when an 87 y.o. grandma decided to hurry back to her son in the waiting room so he could get back to work. In the process of rushing, she tripped, threw her cane at one of the techs, hit her head on the pedal of the bike, and landed on her shoulder. My CI ran out to her and she had an instantaneous bruise on her head from the bike, and when Christie grabbed her hand and the lady moved her arm, Christie felt her shoulder go back in place. I felt so bad for her; she was in the middle of the floor and just kept saying "my arm really hurts." We got ice for her and got her comfortable, and I should mention that Christie called 911 shortly after making sure she was stable. A very eventful morning. Turns out she fractured her humerus and will be back to PT to treat that....we'll see how that goes.
So to add to the drama, today a pt came in that comes to PT from jail (don't ask me how that works bc I dunno). Apparently he's had 3 lumbar spine surgeries and was progressing well, but when he came in today he looked like he was in a lot of pain. He couldn't even lie 90-90 for heat or anything and he had some numbness in his L LE, so the PTA advised him to go to the emergency room since we couldn't do anything for him today based on his sxs, but he wants to wait the hour for his sister to get there so she can take him. So I'm workin w/other pts and walkin back to the office to grab a file, when I see him waving at me in the corner of my eye from a room in the back (he's not my pt so I was wondering what was up). I went back there and the poor guy was leaning to the right, sweating perfusely, and was like "I messed myself and I can't control it, will you get Karen?" I was just like "uhh, yeah hold on I'll grab someone" and of course I'm internally freaking out bc obviously a big red flag. So I see Christie first and tell her and she tells me to call 911. So I'm calling 911 and telling Karen about her pt at the same time and when I'm talkin to the lady on the phone, she's asking me a ton of questions about his breathing, if he's vomiting blood, is he stable, and on and on....and finally I'm like "have y'all dispatched the ambulance yet?" and the lady tells me no that they have to ask some more questions. By this point Christie's comin to the phone bc we were playing telephone bw me on a corded phone, Kelli at the door of the office w/Christie and the pt in her line of sight, and Christie.....just yellin across the room all the questions this lady is askin me. So Christie gets on the phone says "yes, yes, ok, ok, yes, thank you" and hangs up. I was just like - "she didn't ask you more questions?" She said no and that the lady was tryin to tell her what to do so she just agreed w/her since she already knew what to do. It takes them another 10 minutes to get there (the fire department is across the street, literally), and then these volunteer ppl have no idea what they're doing so Christie takes over and tries to transfer the guy to the stretcher. He lost strength and sensation in his L LE, and when she got him on the gurney he was yelling out in pain....I felt so bad for him and all of the other pts were concerned for him, too. They took him to the ER and he got an MRI but we never heard what happened to him beyond that, despite calling at least 5 times. The only thing that was suspicious about it was that he was sitting on the curb outside before treatment, smoking a cigarette, and he looked like he couldn't tolerate sitting at all by the time he came inside. Christie thinks he might have been exaggerating to get out of jail for a couple of days, but I don't know how you could fake losing B and B control....except if he had diarrhea for some reason. I guess he had already conned the PTA once before about some stuff. Who knows, either way, I felt bad for him.
That's my Monday drama. Some of the regular pts were raggin on me that it was when I started comin that this stuff started happenin on Mondays.....so I told them I'd be sure to hang close to them the next few Mondays. Ha. Seriously though, it's a lil crazy. Oh and I made a lady cry during a knee eval today, too, so you know it turned out to be a great day.....right.
Hope y'all are having less eventful weeks....
Rach
So to add to the drama, today a pt came in that comes to PT from jail (don't ask me how that works bc I dunno). Apparently he's had 3 lumbar spine surgeries and was progressing well, but when he came in today he looked like he was in a lot of pain. He couldn't even lie 90-90 for heat or anything and he had some numbness in his L LE, so the PTA advised him to go to the emergency room since we couldn't do anything for him today based on his sxs, but he wants to wait the hour for his sister to get there so she can take him. So I'm workin w/other pts and walkin back to the office to grab a file, when I see him waving at me in the corner of my eye from a room in the back (he's not my pt so I was wondering what was up). I went back there and the poor guy was leaning to the right, sweating perfusely, and was like "I messed myself and I can't control it, will you get Karen?" I was just like "uhh, yeah hold on I'll grab someone" and of course I'm internally freaking out bc obviously a big red flag. So I see Christie first and tell her and she tells me to call 911. So I'm calling 911 and telling Karen about her pt at the same time and when I'm talkin to the lady on the phone, she's asking me a ton of questions about his breathing, if he's vomiting blood, is he stable, and on and on....and finally I'm like "have y'all dispatched the ambulance yet?" and the lady tells me no that they have to ask some more questions. By this point Christie's comin to the phone bc we were playing telephone bw me on a corded phone, Kelli at the door of the office w/Christie and the pt in her line of sight, and Christie.....just yellin across the room all the questions this lady is askin me. So Christie gets on the phone says "yes, yes, ok, ok, yes, thank you" and hangs up. I was just like - "she didn't ask you more questions?" She said no and that the lady was tryin to tell her what to do so she just agreed w/her since she already knew what to do. It takes them another 10 minutes to get there (the fire department is across the street, literally), and then these volunteer ppl have no idea what they're doing so Christie takes over and tries to transfer the guy to the stretcher. He lost strength and sensation in his L LE, and when she got him on the gurney he was yelling out in pain....I felt so bad for him and all of the other pts were concerned for him, too. They took him to the ER and he got an MRI but we never heard what happened to him beyond that, despite calling at least 5 times. The only thing that was suspicious about it was that he was sitting on the curb outside before treatment, smoking a cigarette, and he looked like he couldn't tolerate sitting at all by the time he came inside. Christie thinks he might have been exaggerating to get out of jail for a couple of days, but I don't know how you could fake losing B and B control....except if he had diarrhea for some reason. I guess he had already conned the PTA once before about some stuff. Who knows, either way, I felt bad for him.
That's my Monday drama. Some of the regular pts were raggin on me that it was when I started comin that this stuff started happenin on Mondays.....so I told them I'd be sure to hang close to them the next few Mondays. Ha. Seriously though, it's a lil crazy. Oh and I made a lady cry during a knee eval today, too, so you know it turned out to be a great day.....right.
Hope y'all are having less eventful weeks....
Rach
Sunday, June 20, 2010
Calvert Week 1 (Rach)
Sooooooooo, as Liz and Nicole know, last time I was updating my grandpa laptop died on me. I'm hoping that doesn't happen with my new comp, which I love so far :) Who knew you could have multiple applications open and still have your comp be fast?!?! Def a bonus with watchin the World Cup online....which has been really interesting if you haven't been following. A lot of the dominant teams are losing games, which I kind of love, I have to admit.
ANYWAYYY, to the clinic aspect....I like it a lot (think Dumb and Dumber). I can't tell y'all how much my mood has improved not sitting in a classroom all day, ha; I was gettin to be miss grumpy-pants last 2 semesters! Soooooooooooooo much better to be hands on and interacting with patients. My CI, Christie, is pretty cool but has a massively dirty mouth and mind. She gets 80-something y.o. grandmas and grandpas talkin and jokin 'bout their sex life. It's pretty entertaining; I'm laughing most of the day. It's a pretty weird atmosphere bc it has a small-town feel, but it's not that far from 495....it's interesting. Everybody knows everybody and it seems to be a family affair and hang-out spot. Previous pts can come in, pay $2, and workout for as long as they want so we get some ppl that just hang around all day and crack jokes at everyone. They do a lot of hands-on work with pts, but what I don't like is that they pass off all the ther ex to the PTAs and techs. I talked to Christie about it bc it's definitely an area where I'm lacking, and she said she'd make me prescribe some exercise this week. It'll be good. After a couple evals last week when I was tryin to find some decent exercises out of the giant box of cards they have, one of the PTs (Tai...pronounced like "tie") came up to me and was like - you're over-thinking it! You know, you gotta have the perfect exercises for each pt.....ha. As far as manual therapy, I'm learning that we really didn't learn a lot at all. I've learned like 3 muscle energy techniques for the pelvis that we never went over, and some myofascial stuff that's pretty interesting. I was iffy at first about Christie....she does this thing where she'll ask me a question, I'll answer, and then she'll be like "are you sure it's not this?" or "what about this? does it do this too?" and when I answer again I get a "hmm, ok." Apparently it's what one of her profs used to do to her, so she does it to me in a very non-threatening, but second-guess yourself kind of way....if that makes sense. It's annoying, but good at the same time bc I'll go back and look up the answer, and then I don't forget. I come back and am like "HA, I was partially right." Haha.
As far as interesting patients.....hmmm....I see lots of grandpas that just stare blankly at me when I ask what their goals for therapy are (my grandma would kill me for ending a sentence with a preposition like that...sorry, A.D.D.). One interesting guy was 87 and came in for general strength and conditioning. He was pretty hunched over and walked w/a cane that was way too high for him, but he sort of had a shuffling gait like P.D. but w/o the festination. He shook a little, too, but it was inconsistent and barely noticeable. Apparently he's bein treated for seizures so I'm wondering if that's what's giving him the P.D.-like sxs. He was super sweet, though. He always answered my questions with "yes ma'am" or "no ma'am." Cute lil guy :) I'm still tryin to figure out how hard to push pts. I've already made 2 cry (although Tai says they're criers in general) and I didn't even feel an end feel when I was moving them. One lady had B ankle sprains and I was workin on her bad one and I made her jump 'bout 2 inches off the mat. Ha. She was nice about it and raggin on me a bit, but then I just kept workin and made her sweat, haha. Sounds mean, but you'd have to meet the lady; she has a good sense of humor and just messes with people. Next time I saw her she was like - stay away from my ankles (in a kidding way). Ha. I guess the only other interesting pt I can remember is a lady w/fibromyalgia and came to PT bc she's been falling. She also has B knee flexion contractures (dunno how bc she's in her 40s and ambulatory), but she CANNOT sit still. I was mobing one knee and my CI the other, and the lady was still wiggling her leg back and forth. It was interesting trying to mob a moving leg.
Oh yeah, my 2nd eval last week (2nd day) was w/a lady who's deaf, hypoglycemic, has IBS, and is on a ton of other meds. She came in for neck pain and when I was doin sustained positioning, we didn't know if her nausea was from the test or bc she hadn't eaten in a couple of hours. And when I was doing PAs, upglides, downglides, and palpating her neck, EVERYTHING hurt. I had no idea what to do w/this lady. Tai was like, "well, she's one of those where I just treat what I find." I was like "sooooooooo, her whole neck in every direction?" She shrugged. Ha. The killer is that she's already been doin postural stuff bc she came in for her shoulder last year and they started her on that stuff then. No idea. Suggestions? I don't even know if my goals were realistic for her....guess we'll find out. Felt bad for her, though, bc she hadn't been sleeping well at all. Every position was uncomfortable, pretty much. Oh well...
OK, I'm gonna stop writing bc I know I get tired reading long posts and this is long. Ha, I'm such a hypocrite....but y'all love me anyway, right? :) EVERYONE WATCH THE US VS ALGERIA GAME ON WEDNESDAY!!!! We have to win to advance to single elimination.....come onnnnn defense! OK, seriously done writing now. Good luck to everyone for week 2!! (Nicole, you need to add Ame as a contributor so she can write and not just comment....please)
Peace,
Rach
ANYWAYYY, to the clinic aspect....I like it a lot (think Dumb and Dumber). I can't tell y'all how much my mood has improved not sitting in a classroom all day, ha; I was gettin to be miss grumpy-pants last 2 semesters! Soooooooooooooo much better to be hands on and interacting with patients. My CI, Christie, is pretty cool but has a massively dirty mouth and mind. She gets 80-something y.o. grandmas and grandpas talkin and jokin 'bout their sex life. It's pretty entertaining; I'm laughing most of the day. It's a pretty weird atmosphere bc it has a small-town feel, but it's not that far from 495....it's interesting. Everybody knows everybody and it seems to be a family affair and hang-out spot. Previous pts can come in, pay $2, and workout for as long as they want so we get some ppl that just hang around all day and crack jokes at everyone. They do a lot of hands-on work with pts, but what I don't like is that they pass off all the ther ex to the PTAs and techs. I talked to Christie about it bc it's definitely an area where I'm lacking, and she said she'd make me prescribe some exercise this week. It'll be good. After a couple evals last week when I was tryin to find some decent exercises out of the giant box of cards they have, one of the PTs (Tai...pronounced like "tie") came up to me and was like - you're over-thinking it! You know, you gotta have the perfect exercises for each pt.....ha. As far as manual therapy, I'm learning that we really didn't learn a lot at all. I've learned like 3 muscle energy techniques for the pelvis that we never went over, and some myofascial stuff that's pretty interesting. I was iffy at first about Christie....she does this thing where she'll ask me a question, I'll answer, and then she'll be like "are you sure it's not this?" or "what about this? does it do this too?" and when I answer again I get a "hmm, ok." Apparently it's what one of her profs used to do to her, so she does it to me in a very non-threatening, but second-guess yourself kind of way....if that makes sense. It's annoying, but good at the same time bc I'll go back and look up the answer, and then I don't forget. I come back and am like "HA, I was partially right." Haha.
As far as interesting patients.....hmmm....I see lots of grandpas that just stare blankly at me when I ask what their goals for therapy are (my grandma would kill me for ending a sentence with a preposition like that...sorry, A.D.D.). One interesting guy was 87 and came in for general strength and conditioning. He was pretty hunched over and walked w/a cane that was way too high for him, but he sort of had a shuffling gait like P.D. but w/o the festination. He shook a little, too, but it was inconsistent and barely noticeable. Apparently he's bein treated for seizures so I'm wondering if that's what's giving him the P.D.-like sxs. He was super sweet, though. He always answered my questions with "yes ma'am" or "no ma'am." Cute lil guy :) I'm still tryin to figure out how hard to push pts. I've already made 2 cry (although Tai says they're criers in general) and I didn't even feel an end feel when I was moving them. One lady had B ankle sprains and I was workin on her bad one and I made her jump 'bout 2 inches off the mat. Ha. She was nice about it and raggin on me a bit, but then I just kept workin and made her sweat, haha. Sounds mean, but you'd have to meet the lady; she has a good sense of humor and just messes with people. Next time I saw her she was like - stay away from my ankles (in a kidding way). Ha. I guess the only other interesting pt I can remember is a lady w/fibromyalgia and came to PT bc she's been falling. She also has B knee flexion contractures (dunno how bc she's in her 40s and ambulatory), but she CANNOT sit still. I was mobing one knee and my CI the other, and the lady was still wiggling her leg back and forth. It was interesting trying to mob a moving leg.
Oh yeah, my 2nd eval last week (2nd day) was w/a lady who's deaf, hypoglycemic, has IBS, and is on a ton of other meds. She came in for neck pain and when I was doin sustained positioning, we didn't know if her nausea was from the test or bc she hadn't eaten in a couple of hours. And when I was doing PAs, upglides, downglides, and palpating her neck, EVERYTHING hurt. I had no idea what to do w/this lady. Tai was like, "well, she's one of those where I just treat what I find." I was like "sooooooooo, her whole neck in every direction?" She shrugged. Ha. The killer is that she's already been doin postural stuff bc she came in for her shoulder last year and they started her on that stuff then. No idea. Suggestions? I don't even know if my goals were realistic for her....guess we'll find out. Felt bad for her, though, bc she hadn't been sleeping well at all. Every position was uncomfortable, pretty much. Oh well...
OK, I'm gonna stop writing bc I know I get tired reading long posts and this is long. Ha, I'm such a hypocrite....but y'all love me anyway, right? :) EVERYONE WATCH THE US VS ALGERIA GAME ON WEDNESDAY!!!! We have to win to advance to single elimination.....come onnnnn defense! OK, seriously done writing now. Good luck to everyone for week 2!! (Nicole, you need to add Ame as a contributor so she can write and not just comment....please)
Peace,
Rach
Friday, June 18, 2010
Clinic, Week 1
I don't know about all of you, but I am dead tired. Dead tired. Like all I want to do is sit on the couch. Clinic has been interesting this week. It's been really weird to get used to my CI. He treats a lot of spine patients and I just keep thinking of Halvaksz...I don't know that she would be impressed. We use modalities with pretty much every patient, few joint mobs (especially on spine patients, we use them on extremities more), and NO MANIPULATIONS. No one in the clinic like manipulations at all. Kind of crazy. I feel like my clinic is sort of old school. I don't think any one here thinks direct access and we probably get more prescriptions than just referrals. It makes things interesting.
Favorite stories of the week: Day 2, I asked my CI in the morning if I could treat some patients. You know me, I have to get my hands on, so one day of observing was all I could handle. He let me do some treatments and he had two evals, so I was going to do the first one. I walked out into the waiting room and gave my perfect introduction "Hi, my name is Nicole. I am a student physical therapist. I''ll be working with you today. Is that ok?" "No."...Awkward silence. She went on to tell me she needed a "real physical therapist". I told her that there would be a therapist in the room the whole time, he would be supervising, I wouldn't be working alone. He walked up and supported me in that, but she was dead set. No way. so I handed the chart to my CI and we walked in to the back so he could review the chart cause he hadn't reviewed it yet. We walked back out and he said "Ok. You ready". Her response: "Well I don't know."...Awkward silence again. After a bit of asking, she expressed "concern"- "Is she going to be watching?" My CI said, yes, she is here as a student, she will be observing- he really wasn't keen on not having me observe. After some really awkward talking through it, we finally went back to the room. My CI started asking questions and the women got ALL mad because "she wrote this all down on the paperwork." After a massage, she was way nicer. Interesting. She was really rude to the PTA who treated her later this week too...until the end. After the massage. She's kind of...one of a kind.
I don't know that I got any other awesomeness this week. My brain is a bit...overloaded. So I don't have much else to say. Yeah. There ya go. Intro to clinic. I get sort of nervous every time that I go and introduce myself to a patient now.
Favorite stories of the week: Day 2, I asked my CI in the morning if I could treat some patients. You know me, I have to get my hands on, so one day of observing was all I could handle. He let me do some treatments and he had two evals, so I was going to do the first one. I walked out into the waiting room and gave my perfect introduction "Hi, my name is Nicole. I am a student physical therapist. I''ll be working with you today. Is that ok?" "No."...Awkward silence. She went on to tell me she needed a "real physical therapist". I told her that there would be a therapist in the room the whole time, he would be supervising, I wouldn't be working alone. He walked up and supported me in that, but she was dead set. No way. so I handed the chart to my CI and we walked in to the back so he could review the chart cause he hadn't reviewed it yet. We walked back out and he said "Ok. You ready". Her response: "Well I don't know."...Awkward silence again. After a bit of asking, she expressed "concern"- "Is she going to be watching?" My CI said, yes, she is here as a student, she will be observing- he really wasn't keen on not having me observe. After some really awkward talking through it, we finally went back to the room. My CI started asking questions and the women got ALL mad because "she wrote this all down on the paperwork." After a massage, she was way nicer. Interesting. She was really rude to the PTA who treated her later this week too...until the end. After the massage. She's kind of...one of a kind.
I don't know that I got any other awesomeness this week. My brain is a bit...overloaded. So I don't have much else to say. Yeah. There ya go. Intro to clinic. I get sort of nervous every time that I go and introduce myself to a patient now.
Tuesday, June 15, 2010
Clinic Day 2 at Caton Manor
Day 2 was better than Day 1. The day started with actually hitting traffic so only arriving 7 minutes early, instead of an hour. Today, I learned about how the computer system works (which was really straight forward) and helped with treating real patients. The morning started with helping to get a patient out of bed (~60 y.o. woman, obese, sacral wound, hx of polio resulting in R LE deformities and true leg length discrepancy, L LE lymphedema and severe skin breakdown, severe general deconditioning). It took 3 people (including me!) to transfer this patient from supine<>EOB<> stand. Simply put, my nose and my stomach made a connection this morning during the transfer which was not pleasant...but I was able to keep it professional and nothing bad happened (I was not hungry for hours though). This afternoon, I found out that my CI is going to be in Boston for the remainder of the week so I will be working with a different physical therapist who is really nice. Additionally, I was informed that I will be getting my first patient TOMORROW! My CI said "this patient will be your baby to take care of." Oh dear! I haven't even seen how they do initial evals at this place...I'm a little nervous. Another excitement of the day was the last patient who I saw with my CI. The patient is an 88 y.o. man with Alzheimer's and a severe psych hx (very sad actually). The family was present and there were some statements that were concerning to my CI in terms tone and context in reference to family interactions with the patient. Basically, I learned what a real situation looks like when there are concerns of abuse in the family. And then to end the day I got to leave an 1.5 hours early because my CI had lots of paperwork to finish so she wasn't treating patients before she leaves for Boston tomorrow! And that's my story... I'm still nervous about tomorrow :-/ but it will be a learning experience and thats a good thing, right?
Monday, June 14, 2010
Hello!
So, I just figured out how to do this....after I already wrote what I wanted to say as a "Comment" to Clinic Day 1 by Nicki. Sorry for the confusion! Best wishes on tomorrow :-)
Clinic Day 1
Not exactly off to the best start here... It's midnight, so technically it is the first day of clinic. What am I doing up? If only I knew. I haven't been able to fall asleep. Lame. Then a rather significant thunderstorm rolled in. Even better. Last night the thunder was so loud that it kept waking me up. There were a lot of flashes of lightening, but it was much further away. Lying in bed, pondering what I should do when I hear a loud horn. It doesn't go away. In my head, I suddenly remember tornado horns. I haven't even thought about them since....my late childhood. Ah...am I hearing a tornado horn? And if I am...what exactly does that mean? What is it that I am supposed to do? Huh. I called my brother and he got online and sure enough, he found that there was a tornado warning here in Topeka. Awesome. We made a plan for what I should do if the horns go off again. Weird. So, now it's after midnight. There was a tornado, somewhere close enough that I heard the horns. Not even close to sleep. Great start to clinical rotation numero uno!
Wednesday, June 9, 2010
Blogger Account
So, to be able to blog on this site, I think you will require a blogger account- most especially because I think it will be best to have it be a private blog. I have no problem with whoever we know seeing/reading it, but I don't want random people to be able to find it through searches etc. I could see that going not so well, so there is a way to make it so anyone we choose can look at it. We'll have a post on that one step at a time. If you already have gmail than you have a google account, but if you have something else for your email (including gw's email) You'll need to make a blogger account/google user account. You can do so by clicking on this link: https://www.google.com/accounts/NewAccount?service=blogger&continue=https%3A%2F%2Fwww.blogger.com%2Floginz%3Fd%3D%252Fcreate-blog.g%26a%3DADD_SERVICE_FLAG&hl=en&sendvemail=true&followup=https%3A%2F%2Fwww.blogger.com%2Floginz%3Fd%3D%252Fhome%26a%3DSERVICE_ONLY&naui=8
and filling it out. You don't have to have gmail. You can use whatever email you want. Then I will add you as an editor on the blog so you can make posts too! So let me know what your google account ends up being.
Hooray.
and filling it out. You don't have to have gmail. You can use whatever email you want. Then I will add you as an editor on the blog so you can make posts too! So let me know what your google account ends up being.
Hooray.
And so we begin...
To start our official sharing of experiences: I've arrived in Topeka. I saw the place I am supposed to live which is literally across the street from the hospital which will sort of be awesome cause I can walk there. And...there's open space and no traffic to deal with. My CI's name is James. Turns out that I really don't have a problem making friends with guys, but for some reason, having a CI that is a guy makes me nervous. Weird. Other randomness....I dunno. Here's the blog! Following is directions to be contributors...I think they will work but if you have problems or questions let me know.
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