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!