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.
Wednesday, June 30, 2010
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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