Tuesday, May 29, 2007

Practical Exam

So my 5 activities I had to perform earlier today were:
  1. infraspinatus tenoperiosteal deep friction massage (lost 8 points for not being close enough to the tendon - I was a 'lil nervous - our professor is an intimidating 'lil greek man)
  2. mulligan flexion for L3
  3. mid-thoracic "locker room" distraction manipulation - standing
  4. mulligan for lateral epicondylitis
  5. taping for lateral rotation of the patella (lost 8 points for not manually placing the patella into medial rotation or even neutral and not identifying the pre/post tests which would be squatting or climbing stairs, this is pretty bad on my part)
I did good on 2-4, but in the end am not happy with my performance as I should not have lost any points had I been a little bit more confident and better prepared.

But moving along, as I listen to the recorded lecture of the class I missed about the McKenzie concept. We have only 4 more days of this class left, it just flew by. A quiz this Thursday and the final next Thursday (the final is 46% of the final grade) with a lot of case studies in between. Should be a fun ride...

Monday, May 28, 2007

A Memorial Post

Hope everyone is enjoying their Memorial Day off and hope everyone remembers why it is we have this "holiday."

Last week was very interesting for me. Got down to the end of the House of Delegates of the APTA. My buddy from MGH did a very in depth run down of the proceedings.
Also, the APTA published a few of the results on their ptbulletin.com page. As I have a tendency to do on this blog, I will avoid my opinions directly for or against main decision making body of PT. Generally I support their track, and short of a possible vote and voice I may one day have and the grassroots opinions I may influence, despite all of my "activism" as some may call it, I still have very little influence on any of the motions so for now I am monitoring the process and will hopefully one day have a greater influence on the direction. This brings me to a great quote that I received after attending the Advocacy Academy and PT Day on Capitol Hill down in DC:

We in America do not have government by the majority. We have government by the majority who participate.
Thomas Jefferson, 1787.

The event seemed to be a great success and was a great experience for me personally. Apparently we got 57 co-sponsors on the 3 bills we wanted co-sponsored which is pretty impressive for a one day turnaround. Even more so when you consider that Congress had major votes that same day and a 10 day vacation starting after that vote... hopefully a lot more co-sponsors come around on behalf of our profession and our patients. Very exciting process and I highly recommend the Advocacy Academy experience to anyone who wants to understand how the government works (I am sure APTA will host another one next year).

Now I am off to study for my practical on manual therapy skills for tomorrow... all the best to you all as always :)

Tuesday, May 22, 2007

Plans

Whenever I wake up I have to do the following in pretty much this order (gonna try to work eating somewhere in there):
  1. Make my arrangements for Denver, home of PT 2007
  2. Go workout after my hour and change commute to school
  3. Take a quiz that covers the Mulligan techniques, Deep Friction Massage, and the two case studies we walked through last week. After the quiz we have 3+ hours of taping lab (it was recommended that I shave around my ankle, knee, and elbow, but I will just tough it out...)
  4. Run to catch the bus to D.C. --> get to D.C. at midnight
One of my professors (real funny guy, btw) recommended that I start adding videos to this blog, so here is one I found that deals with Mulligan taping techniques which will be part of the lesson tomorrow (I think...). Mulligan techniques are very trial and error and are by nature difficult to support with research thus this makes the techniques difficult to work into my philosophy at this time, but I will still learn all I can about it. Enjoy the video (it's less boring if you don't actually listen to the guy... :) Just kidding, it is pretty darn interesting stuff.

Saturday, May 19, 2007

Grad Party

Ran 11 miles yesterday, it hurt... but I still had a lot of energy when I was done, just wanted to put less stress on my joints. Makes me question if distraction of the joints could help the effect of ground reaction forces after a run.

Going to a graduation party for one of the students who just got their DPT from our program. It should be a good focusing point of how close I am to the end, as if I needed another one of those.

Enjoy the weather wherever ye may be.

Tuesday, May 15, 2007

Clinical Decision Making 1

For the next month we only have one class in my program (the title of which is the same as the title of this post). Then we get a week off and have a 9 week clinical, followed by 4 classes in the fall and then 2-11 week clinical experiences. Exciting times.

I would like to congratulate everyone who just graduated not just from PT school but from any level of schooling... congrats!

Back to the present class... It is very musculoskeletal based and the second part of the class in the fall is supposedly very evidence-based. For this class we have done a lot of manual skills including manipulations and mobilizations, very exciting stuff although having so much of it done on me for practice has led to a little soreness in my own spine. But as we tell our patients, this can be a normal result and is more indicative that a change has been made within the tissues around the spine. I'm also sore from my tetanus shot (supposed to get one every 10 years as part of my physical).

Speaking of me :) I recently signed up for the NYC Marathon. I am #171778 so my entry into the event is based on a lottery. I believe they accept about 37,000 people and there are many people that have guaranteed entry so my chances are a little slim, but I am training nonetheless. Updates to come... hopefully.

STAY HEALTHY!

Thursday, May 10, 2007

'Vacation' Part Duex aka Patience

This is a continuation of the entry below entitled 'vacation'... I was giving a run down of what was discussed at Lobby Day in Albany, NY just to catch you up. For the record this is attempt two at this post as I wrote a whole entry but because I did not let the page load all the way when I started the entry I lost it all... hence 'patience'...
- Unfair co-pays was another issue we discussed there. Certain companies consider PT under 'specialist' rates which can be $25-40 per visit for the patient. These are the same co-pay rates that neurologists charge. When you see most 'specialists' it is for around 3 visits for the whole episode of care, whereas with PT it can be 3x/wk for a few months. Not many people can afford to pay $75 a week and thus end up not coming in for the care they need. This co-pay setting is very prohibitive. What's more is many primary care practioners co-pay rates are in the $10 range. We as PT's could be considered a 'practitioner of choice' when it comes to musculoskeletal issues.

Bottm line from Lobby Day is there are a lot of issues with reimbursement. Not getting paid at a reasonable rate leads to people not being able to maintain what they would like to be able to do and many PT clinics end up incurring huge financial losses every year until they go out of business.

So now that the worst semester of my academic career is over, there is a lot to do moving forward, I'll keep you all updated :)

Wednesday, May 09, 2007

'Vacation'

I am writing this on my phone (treo 650 - I love technology), thus I am really hoping no one calls me while writing this or I will lose all that I write... anyway...

Yesterday I had a long and productive day. Let's back track the events of the last few days first though...
Saturday night was my programs semi-formal, good times lasted into the night...
Sunday went to Mt. Sinai in the city where my cardiopulm professor works to take my final and practical early...
Monday took my Pediatrics final, finished up the evidence based practice narrative review, handed in my portfolio and then swam...
Monday night signed up for Netflix (that's a big step in my life sadly)...
Tuesday at 4 30 AM left my house to meet the Brooklyn/Staten Island district to leave for Albany. We met with numerous assemblymen/women to 'lobby' for the following:
- support a bill the midwives put forth to give them the ability to refer to PT - this is a vital step as many women after giving birth (or even in preparation for this step) need PT. Women's health is a rapidly growing specialty within the PT world. Currently most of the states in America do have some form of direct access (meaning in order to see a PT you do not need a referral) but there are still many problems within the reimbursmenet aspect of this. Only physicians, nurse practitioners, physician assistants, dentists, and podiatrists are the only medical personnel that can refer to PT now.
- Workers compensation rates for PT's have not changed in over 11 years so we pushed a bill to at least allow for a review of this process yearly.
- Utilization issues with certain insurance companies and their claims. Some companies have an '80 percent rule' that states if the patient has reached 80 percent of their opptimal function that is enough. The example we kept giving is that if someone has to walk 5 blocks to get to the bus to go to work and they have only reached 80 per. of that and can only walk 4 blocks, they will not reach the bus thus not getting to work... Phone won't let me write..

Friday, May 04, 2007

My Own Injuries

Part of the reason I went into PT was because of an ankle injury in high school. Now that I am almost a PT I am getting injured more and more it seems... In my swimming training I probably jumped back into it too quickly and pushed myself too much and thus have caught a VMO (one thigh muscle) and calf cramp in separate sessions. Last week I sprained my right ankle pretty badly and playing softball this last night I sprained my left one (not as badly). I would diagnose myself as a chronic ankle sprainer... also had some bicipital tendinitis probably from overworking my arms in the last two days. I think I need some more protein in my diet to help my muscles recover faster. I feel the knowledge I have gained about the human body is helping me deal with these injuries and giving me a good perspective. By no means am I asking for sympathy for my minor complaints, just thought it would be good babble for this bloggle (I like making new words).
Anyway, here are some of the topics I am covering for my cardiopulm final/practical:
  • Reading, interpreting, analyzing EKG strips
  • Measuring chest wall excursion
  • Postural drainage, chest PT, vibration/shaking
  • Assisted cough techniques/facilitation of breathing
  • Mechanical ventilators...
  • Max/Sub max exercise testing/prescription/screening, reasons to stop the test or stop exercise (e.g. SBP of 260/DBP of 115), calculations of VO2, target HR, etc.
  • Precordial EKG lead placement
  • Auscultation of the lungs (Virtual Stethoscope link), breath sounds
  • Taking BP & HR (both w/in 45 sec.) while pt. is on bike/treadmill
  • Examination of the Cardiac pt. (Borg scale, Par-Q), taking a history
  • Exercise physiology
  • ACSM guidelines (e.g. contraindications to exercise, risk factor stratification)
  • Analyzing Lab Values (e.g. ABG's)
  • and much much more... oy...

Thursday, May 03, 2007

Pilates & Children

The two aren't directly related for this post...

Yesterday I got to try pilates for the first time ever. It is something I had wanted to do for a long time, still haven't tried yoga directly. My university offers fitness classes that are very helpful in getting a good workout in. As a health care professional and soon to be PT especially I find them very helpful for generating new ideas and gaining and sharing new knowledge. So far I have only taken the total body class which was pretty intense and now the pilates class. Pilates has a major focus on core strength which seems to be vital for so many aspects of health and function. Unfortunately I also got bad news yesterday: I was too late in registering for the triathlon I wanted to compete in... but I will continue training (probably not as hard since I don't have a direct goal now... I am lost without a goal...) and I will look for the next best challenge, I will keep you all updated.
Now as a review for my pediatrics course here are the topics we are responsible for on the final:
  • Developmental Coordination Disorder - "The Clumsy Child"
  • Muscular Dystrophy and Related Disorders
  • Child Abuse/Neglect Reporting
  • Spina Bifida
  • Orthopedic Management in Pediatric PT
  • Mental Retardation (MR), Attention Deficit Disorders (ADD/ADHD)
  • Autism and Pervasive Developmental Disorder (PDD)
  • Management of Cerebral Palsy
  • Documentation in the Pediatric Setting
  • Sensory Integration
  • Traumatic Brain Injury (TBI)
  • Treatment Planing and Treatment Approaches
    • Conductive Education
  • Child Tx Based on NDT principles
  • GMFM and Gubbay Tests of Motor Proficiency
    • Gubbay is a standardized test for children btwn. 8-12 y/o and includes the following activities:
      • Whistle through pouted lips
      • Skip forward five steps
      • Roll ball with feet
      • Throw, clap hands, then catch tennis ball
      • Tie one shoelace with doouble bow (single knot)
      • Thread 10 beads
      • Pierce 20 pinholes
      • Posting box
And I have cardiopulm. to study for... next few days not so fun... next time gonna spread the studying out more... haha

Tuesday, May 01, 2007

Questions asked, answers received

A friend of mine needed to interview a health care worker outside of her field so for some reason she chose me... here is how it went:

Q: What in your life lead you to your profession?

A: My ankle injury in high school led me to consider the medical field as a career path. I tried to intern with a chiropractor and an orthopedic surgeon but neither field fit. The ortho. surgeon had mentioned the great PT that he was sending them to so I looked into it a little further. I liked what I saw and ended up switching from being pre-med at one school to transferring to a pre-PT program in upstate NY. Although the "pre-PT" program did not provide a great deal of PT related work, it got me to where I needed to be: PT school. I tried other fields during my undergrad. education to make sure I was heading down the right path. I became a certified EMT, worked with athletic trainers, looked into massage therapy, but nothing seemed to fit as well as when I volunteered at various PT clinics.

Do you prefer outpatient care as opposed to inpatient care?

I think the inpatient care setting is too restricting for a PT, which serves a great purpose early in ones career. There seem to be too many protocols to follow and doctors orders to meet. In outpatient there is much more freedom and generally the patients are much more functional thus creating for many more possibilities with treatment. Overall, I hope to be involved in a sports outpatient setting as I grow more into my place in the field.

What do you love most about your job?

The big draw for me when I was deciding on the field and the one that keeps me happy every morning is the patients. PT is one of the few health care fields where you get to spend upwards of an hour with a patient in a very personal setting. To be the one that helps them reach their goals is a great feeling. Furthermore, I greatly enjoy the health aspect of it. I think so many people end up regretting the way they took care of (or didn't) their bodies earlier in life. For many people this may have been due to a lack of understanding of just how easy it can be to be healthy. I hope to spread that message and find that the field affords me with this opportunity very often.

What is you least favorite part about your job?

Documentation and the political battles that exist for PT's. There are many legislative issues that are currently out there that are vital to allowing us to treat patients properly. Currently one bill that is under consideration on a federal level would grant athletic trainers and lymphedema certified specialists the right to perform PT interventions when their education does not fully justify this privilege. There seems to be a constant battle with chiropractors for the right to perform spinal manipulations and there are overlying issues with PT practices that are owned by physicians, chiros, podiatrists, even nurse practitioners to name a few that refer to their own PT for personal profit. This brings into question many ethical issues and thus is something we as a profession are fighting against.
With the documentation aspect of the field, it is frustrating but necessary to justify to insurance companies everything we do for the patient. Often times this requires doing a great deal of research and many times under that there is a lack of it. This has branched into one of the major tenets of what PT's are trying to be a part of: Evidence-Based Practice. With the proper research we can make strides in helping our patients get better quicker and justifying why we chose the intervention that we chose. I find it a novel challenge to educate these companies and politicians that what PT's do are sincerely with the patients best interest in mind. This is something else that I love about the field I am in: PT's are often very genuine and passionate about their patients getting better. It is just the most enjoyable feeling to spend time at any of the professional activities that are held within the realm of the American Physical Therapy Association. Being around thousands of people who share this passion for patients is very exciting.

What was something you learned this year, which you did not know last
year with regards to Physical Therapy?

Every day I seem to learn more and more of the political battles that exist over this profession. It is difficult to write about one thing here as I learn every day something new that goes into this highly dynamic field. Within the main professional organization of the APTA alone there are 18 special interest sections that all focus on various aspects of the field and under those 18 there are 42 various special interest groups that get more specific. There is constant new and groundbreaking research being published and the biggest challenge of the field is keeping up with it all or limiting yourself to what is most pertinent to your practice.

What is the biggest misconception about your job?

Not many people, even most practicing PT's don't realize that the profession which is now a doctoring profession affords the PT a great deal of autonomy. This is one of the 6 main tenets of the APTA and where they see the field headed in the coming years. VISION 2020 covers autonomous practice, direct access, the doctor of PT as a recognized degree, evidence-based practice, practitioner of choice, and professionalism. As far as misconceptions go, I think practitioner of choice is the one tenet that most deals with people not understanding what a PT can do. Many within the field feel that we need to market ourselves as the Musculoskeletal specialists, possibly throwing neurological, cardiopulmonary, and even integumentary in to the mix as these are the 4 main systems of the body that we deal with. When people think toothache they think dentist, when they think of back pain they probably think chiropractor now, but this is something that we want to change for many reasons...
Believe it or not this is the short version, I can go on and on, but I'll leave it here for now... :-D hope this helps