Author: Jennifer Palmer PT, DPT

Well it had been awhile since I traveled outside of the country (almost a year!) and I was certainly getting antsy for an adventure.. so off to Colombia we went!

People keep asking me – why Colombia? Honestly, Scott and I never really had a “honeymoon” so I wanted to go somewhere warm, but I was afraid we’d get too bored if we stayed at an all-inclusive place for more than 4 days. I looked at splitting up places and traveling between countries (like my usual speed travel), but ultimately we decided on spending 6 days in Cartagena, Colombia with a focus on RELAXING *gasp*!

My expectations of Cartagena truthfully came from different Instagram accounts, pictures of AirBnb places we had looked at, and a few random strangers who said, “So-and-so just loved Cartagena!” After all of this, I was like, welp, YOLO – let’s go!

I’m not gonna lie to you – it was hard at times for me to actually relax during the vacation. Whenever I’ve done my budget travels, I’m always so focused on seeing as much as I can and spending as little money as possible (Check out Singapore, Malaysia, Bali, and Thailand). This was clearly different.

Over our 6 days, Cartagena made it SO easy to enjoy AMAZING food at great prices. Seriously, I was not expecting the food to be great, but it was honestly the highlight of the trip for me.

The first day we arrived, we ate dinner on a beautiful rooftop, tried some fish soup and steak with a Colombian coffee sauce. We walked around outside to hear music playing at the square nearby to us while horse carriages passed by. Talk about a dream! It really felt like a fancy European country, all right in Colombia. We headed to bed early, knowing we had to get up and be ready for our adventure day of island hopping and snorkeling.

We were picked up at 6 AM, right on time, for our island hopping trip. To be honest, it was advertised as a snorkeling trip too, but we really were only able to do about 30 minutes of snorkeling in a guided tour, kind of a bummer. One thing I did notice here, as compared to the southeast Asian countries I’ve been to, was that the tourism industry wasn’t quite as developed yet. Likely because Colombia is still on the rise as places to visit.

We went to multiple islands in the Islas Del Rosario on our trip including Playa Blanca, Isla Baru, Cholon, and Playa Azul. As our guide told us, each one had a very different vibe.

Playa Blanca was the most accessible from Cartagena, which makes sense as to why it was so packed.

Cholon is known to be the “party island.” Since we went on a Thursday, it wasn’t quite as packed, but they did sell some awesome (and overpriced) Pina Coladas in a pineapple. Honestly, the rum was strong, local, and awesome.. but I’d recommend getting a Pina Colada back at Playa Blanca – cheaper and just as good!

Playa Azul was a very chill, relaxing beach that we hung out for about an hour. There were people selling things everywhere, but I think this beach probably had the least amount.

As a sidenote (but also main note): Nothing is free and you ALWAYS need to ask how much before you buy anything from any vendor on the street, beach, or even taxi. “Cuanto Cuesta” is the phrase to know. We actually did get a little ripped off by a person who “thought we bought another girl’s drink,” yet charged her as well AND charged us more than what it cost. Luckily, we were on a trip with a big group and the tour guide confronted him about it. It was definitely a positive to have an insider with us during the trip to give us these tips and talk directly with the locals. They WILL take advantage of you and they are VERY good liars! Just be aware and ask how much everything is before you purchase it so they verify it beforehand!!

The next few days consisted of a lot of the same: walking, exploring, eating, and drinking. Here are a few highlights of the neighborhoods we adventured to and the places we ate at:

We stayed inside the walled city, so just walking around the wall itself was fun! There are so many little streets you can just jump off on and walk down. Each has a bunch of little stores, restaurants, bars, whatever! And it’s all fairly self explanatory since it sits inside the wall.

Getsemani – The “hipster district.” We walked here a few times, tried a few coffee shops, found some craft beer (although we weren’t that impressed with the beer, which is understandable). There are so many murals here, even people painting them as we walked by! It was a cool little area to check out. If you are vegan, you will definitely find eats here!

 

Las Bovedas – Just along the wall near we stayed, Las Bovedas is a series of little shops. This is a perfect area to pick up all your touristy items! Not to mention, there are tons of vendors trying to sell you coffee, snacks, and other drinks nearby if you want to grab a snack!

ALL of the plazas! – We stayed very close to San Diego plaza (did not plan that, haha). Many nights there was live music playing (for donations)… Of course there are plenty of restaurants.. and so many cool/strange statues! Each plaza had its own vibe, which was cool to check out for sure!

This is a pretty horrible picture, but YES you can find a few wild animals in Cartagena! They are all in the Parque del Centenario – very close to Getsemani. We wandered through this area a few times but only saw the sloth once. Big tip is to look for the group of people staring up into the trees…

And then here is just another one of us standing on a random street corner…

Our 4th night there, we decided to book an evening harbor cruise with a 3-course meal. We booked this through Viator (I book most tours through this when I travel abroad). Everything went smoothly using Viator, but I will say it is less developed in Colombia than when I used it in other countries.

The harbor cruise was awesome! The food was great (not the best we had, but definitely still good). The view of the harbor was probably not very different from your typical harbor view at night, but it was a great experience nonetheless for a very reasonable price. I’m sure if we had done something like this back home, it would have been at least double the cost. Check it out here!

That night, we checked out a bar (Bazurto Social Club) nearby that had been featured in a few travel guides I had read. It was awesome to get a feel for the Colombian nightlife and their style of dancing! We definitely tried to fit in, but I think we’ll need some practice 😉

The next day we spent relaxing and recovering in Bocagrande.

Bocagrande – We spent about $100 USD for the day for use of the pool and hotel room at the Hyatt in Bocagrande. This is the more Miami-esque, downtown-kind of vibe. It was nice to just lay by the pool and feel like we were living the “rich life” .. or something like that. The food wasn’t bad, but it wasn’t amazing either. I would definitely try to eat at the more authentic restaurants in the old town area!

The next day was spent wandering around some more coffee shops and restaurants, getting our last few meals in and soaking up the warmth of the country before we headed back! Check out my post (coming soon) to read more about ALL the food and drinks we tried while we were here! – it was seriously the highlight of the trip!!

Overall, if you are looking for a place that offers so many different things (beach, city, culture, art, food, you name it).. Cartagena is an amazing place to go! You could spend a lot of money or you could spend very little. It’s a great place to go no matter what you can afford. Plus, the weather is great (especially in January) and it is still an up and coming touristy area! So most likely you’ll be the first of your friends to go 😉 You trendsetter you!

Oh, and we did get our photographs done while we were here, and I love the few that I have posted, but I can’t necessarily recommend our photographer for the price we paid just yet. I think she needs some time to grow and a little more experience 😉 BUT feel free to message me if you want to know who our photographer was 🙂

Be sure to check out my other posts from places I have traveled to in Asia (Japan, Singapore, Malaysia, Thailand, Bali) if you’re looking for a different type of experience 🙂

Until next time,

Jen

 

 

I’ve gotten many questions recently in regards to paying off student loans. There are a few different options that you can take when addressing this issue, but I will talk you through what I have been doing.

To give you some background, I had undergrad and grad school loans totaling about $160,000 after graduation. People always tell me, “Oh you should’ve gotten scholarships” or “You could’ve went to community college” – Yes, I get it. But the reason I chose my school was:

1) To get my Doctorate in 6 years at a 3+3 program – hellooo one less year of school

2) As long as I maintained my GPA, I wouldn’t have to take the GRE to get into grad school

3) I did get scholarships. Half-off tuition for my first 4 years, 1/3 off for my last 2 years. In addition to some amazing other scholarships (Huge thank you to Central Scholarship) for a few hundred to thousand each year. So yes, this debt is on TOP of those.

And if anyone says the whole “you should’ve worked while you were in school.” Yeah, not buying that either. I worked multiple jobs while in school, of course at a minimum wage rate. I did anything from help at athletic events to answering phones, and on holiday breaks and some weekends I was a cashier back in my hometown. Yes, this is in addition to playing a collegiate sport and being involved with just about every club on campus. As you can see, I was very busy.

So back to the loans. In May 2015, I had about $100 to my name, $160,000 in student loan debt, and a brand new car loan (another $17,000). My car had been a run down car for years, literally car parts fell off on the road, and I had decided the safest/best thing for me was to invest in a car for the long haul. I knew I wasn’t going to end up living near my family, so knowing I had that for safety was comforting, even if it did add to my debt.

I moved to my first apartment in Virginia Beach in June 2015, all by my lonesome. I figured, I’m going to be a PT, I can afford this! Sure, I could, but not with much leftover. I immediately upped my credit card limit (I hadn’t done that since I was 18), and invested in a nice mattress and a $15 folding table from Craigslist. All I needed was a good night’s rest and a table to sit and study at (because yes, I started working before I took my licensing exam). I spent that first month working and studying just about every night until my boards came, luckily I passed.

I was able to start saving about $50/month to rebuild up my personal accounts. I saved a little more these first few months before my official loan payments started since I had my new “big girl” paychecks, but I also wanted to start adding a little furniture to my life. Maybe eat some food, ya know.

I have always been a frugal person, never really buying anything unless I needed it, so the need to save money came pretty easy to me. I learned to focus on things that meant a lot to me, spend a little on that to treat myself, but put a majority of my paycheck to getting out of debt.

First thing was first, my credit card.  This by far had the largest interest rate and the lowest amount of debt, so I wanted to tackle this first. All of my extra money (besides necessities and $50-$100 to savings) went to this initially. I wanted to get rid of it stat. To this day, I still use my credit card, but pay it off immediately. This way, I get the perks of having credit and getting points, but I don’t have to pay that crazy interest! This is important. I would recommend targeting whatever debt has the highest interest rate first!!

Once this was paid down a few months later, I began paying my student loans – only part of what my eventual monthly payment would be, but I wanted to start as early as possible because I knew it would benefit me in the long run. Every day that passes is just another day of interest accruing! So yes, I am also that weirdo who wants to pay the random $20 payments whenever I get it – even if that means I make 10 payments a month – JUST because that $20 could equal $30 next year.. and that’s $10 that I could’ve spent on cute lattes, just sayin.

When my loan payments were about to begin, I made sure I had the right plan. For me, the standard plan was not going to work the best. It was around $1600/month for 25 years (AHH). I could pay that, but I wanted to make sure that while I was starting my career and life, I had a little give just in case I needed it. Plus, my savings account still wasn’t looking great. I opted for the extended graduated plan, meaning I’d start around $600/month. This would then increase by 100-200 every 2 years. I figured I would still continue to pay as much as possible (sometimes the same as the standard amount), but like I said, I wanted to be able to have money just in case something happened!

About 2 months after I began my loan payments, I decided to get a PRN job. This was always on my mind, just because I had almost always worked a few jobs at a time. I just wanted to allow myself a few months to get adjusted to the real world. I already worked full time in an acute hospital, but I lucked out and found a PRN job that was perfect! A few hours here and there when I could, and my boss was super chill (yes, that can be hard to find). I decided that all of my PRN money would go straight to my loans. This could be anything from $50-$300 a paycheck

.

This trend continued for a few months and I was eventually able to get my credit card payment down to 0, my car payment down a little bit, and still pay all of my other bills on time (loans, rent, etc). It was going well, BUT I will say one thing I don’t necessarily regret at all, but would advise, is that you do not live alone for a few years. I’m not saying you have to live with your parents, but at least have a roommate if you can tolerate it.

After a year on my own, I moved in with a roommate while my boyfriend (now husband) was over in Japan. By cutting my rent payment in half, I was able to put a solid extra $400 towards my car and student loans each month. I ended up prioritizing my private loan first (highest interest), the first federal loan I had (small but through a different company because my college switched after my first semester), then my car loan (2^ndlargest chunk), and then my GIANT federal loan.

Certainly, the smartest thing is probably to pay off whatever has the most interest. Which is basically what I did. BUT my car definitely had a lower interest rate than my giant federal loans. That being said, I just wanted to get rid of it.

At one point, I ended up doing a travel job for 3 months while keeping my PRN jobs a few hours back. Yes, I traveled at least once a month to work at those jobs, meaning at times I’d work 12 days in a row. It sucked, but it was fine. I was alone in the mountains and had plenty of time to explore and hike. It was cool, but I could talk about travel therapy a different time.. Long story short of that snippet of life is that: I made a lot of money to put toward my loans. Definitely a perk of travel therapy.

The months to follow consisted of juggling multiple PRN jobs trying to get as many hours as I could before I decided to leave and live in Japan for a few months. While I knew my husband and I would have the funds to make ends meet, I wanted to know that I’d have enough money to put more towards my car and loans, if possible. EVEN if it was only $5 extra. I had saved up about $12,000 alone just to live off of. That sounds like a lot, but when you have to live off of it for 8 months and you have about $1,000 in bills alone (car+loans), it doesn’t get you very far.

In Japan, I super budgeted because I wanted to be able to travel as well. Yes, I EVEN traveled these last few years. I stayed in hostels and went to Malaysia, Thailand, Bali, and Singapore on my own. While I didn’t have to work when I returned to Japan, my husband and I both knew how much it meant to me to be able to pay for things myself. STRONG INDEPENDENT WOMAN YA HEARD. (of course, marriage is about give and take and this was definitely a moment where I had to learn that it was time to let my husband take care of me…again, another story).

I worked as an English tutor in a variety of ways. I taught conversational English, I edited translated papers prior to MDs presenting them in International conferences, I taught anatomy to Chinese Medicine lover, and I even taught English at adventure camps. I wanted to make money and make the most of this experience – my loans ALWAYS hovering over me in the back of my mind.

Flash forward to now, I’ve been in San Diego about a year and have had multiple different jobs. I have been out of school for almost 4 years, paying on my loans this whole time. I have gone from $160,000 in student loans to $99,000 (although my interest is still 5.3% which means I pay about $530 in interest only every month! So yes, think about all that interest I paid off already…). I have no credit card debt. My car is paid off.

Since I have been in San Diego, it has been incredibly helpful to live off of one income instead of two between my husband and me. All of my income goes to my student loans. I fully understand this is not a luxury that everyone has, but here are some things I can recommend knowing what I have been through and what I am still currently going through:

• Live with a roommate. Your friend, a stranger, your boyfriend (if it’s the right time lol) – whatever. It will save you money.
• If you qualify for loan forgiveness by working for a non-profit, apply for it, but don’t bank on it. That’s 10 years and I BET you could pay it off sooner if you really dedicate yourself.
• Treat yourself, but don’t get crazy. Put that $5 towards your loans instead of that latte every once in awhile, that’s a treat in itself.
• If it makes sense for you to consolidate, do it. But make sure it’s the right company and that you aren’t trying to get PSLF – because it may not qualify after you consolidate.
• Pay off whatever interest is higher. I have my giant loan now and instead of paying towards all of it each time, I am paying directly towards my large, high interest (6.95%) loan. This means my interest that accrues each month drops since it is such an outlier. SUPER helpful!
• If you can find a trustworthy company that can refinance your loans for a lower percentage, GO for it. I personally think I should but haven’t looked into it enough yet to do it. We will see!
• COUPON!!! I use so many silly apps, answer surveys, watch random things for pennies -no joke, I wrote a blog on them here. And then I just put this $20 at a time to my loans. It’s simple and makes me happy 🙂
• Breathe, try not to cry. But then if you do cry, remember you’re not alone. This sucks and I think everyday about what I could be doing with all my loan money. (Last year I paid $11,000 in interest ALONE on top of the $14,000 I paid to my principal balance. And yeah, we only get $2,500 deducted from taxes..)
• Something else might work for you—I have heard of people investing instead and paying things off later. You do you, but don’t forget about your mental health! My anxiety about everything alone makes paying these silly things off SUPER worth it.

You are NOT alone in this battle. I hope my journey has given you some insight!! I am super hoping to pay my loans off totally in the next 3-4 years. That’s my goal!! We got this!!

Feel free to email me, DM me, comment, whatever – if you have any questions/comments 🙂

Until next time,

Jen

When thinking about what you’d want more – improved quality of life vs feeling burnt out, the answer is almost always very clear. A better quality of life, of course. Nobody wants to feel run into the ground, under appreciated, underpaid, etc. to the point of hating or quitting their job. That’s common sense. But what if I told you there are actually issues in emphasizing this superior quality of life mentality?

While there are pros and cons to all companies, it’s pretty astounding to me that improving employee quality of life could actually cause issues within a healthcare system. Hear me out on this one.

I feel honored to have worked in a variety of facilities within the last 3.5 years of practicing as a PT. Specifically, I have worked in larger hospital systems on both the east coast (Norfolk, Virginia) and the west coast (San Diego, California).

If you know anything about the differences between the east and west coast, just know this one- California values quality of life way more than any other place that I have lived. The labor laws entitle employees to multiple paid breaks throughout the day, a need to take a 30 minute lunch break or get paid extra, staffing ratios are way better (especially with nursing!). In Virginia, you don’t get these paid breaks throughout the day, staffing ratios are lower, and there is much more demand for productivity when treating patients. Again, these are specifically comparing these two states that I’ve worked in, but I imagine it carries over to multiple other states as well pending labor laws and culture.

Reading this, you’re probably thinking – okay, so how could it be a bad thing that staffing ratios are up and employees are entitled to breaks!? That’s crazy! Well, this isn’t across the board with all facilities – it is definitely dependent on the health system you’re in, but I can say I have some experience with a few of them now.

Recently, I left a facility that I had heard AMAZING things about even when I lived on the east coast. “The benefits are great!” or “My aunt works there and she loves it!” I heard endless good things and decided I had to check it out once I moved. I was hired and worked in one of their facilities for 8 months before I decided I couldn’t do it any longer.

So what happened?

I had a 15-20 minute commute, I had been given free scrub tops for my position, they gave me multiple free things throughout the year, the hospital had a bunch of free workout sessions at lunch, a gym that I could use… what’s not to love?

Well, from the beginning, I noticed everyone was pretty relaxed at the facility. That chill Cali vibe. I figured I could get used to it. My first 1-2 months were focused around figuring out the documentation, finding my way around/between the various floors and settings.

The things I began to notice around month 2:

• Everything I did was communicated to the “lead therapist” who then contacted the physician. Or I talked to the nurse. I had never been introduced to a physician, NP, or PA. I didn’t even know where the phone list was. Why? Because that’s not a thing at this facility. Staff PTs hardly ever spoke to the physicians or mid-levels directly. Yep, that means little to no autonomy. And yep, that means when the physician/NP/PA walked in the room, they definitely did not acknowledge who you were or show much respect (I know this happens everywhere depending on the person, but definitely more emphasized here). This also meant that whenever a lead therapist wasn’t present, the staff therapists claimed it wasn’t their role to call the physician because it wasn’t “part of their job,” at times leading to a delay of care.
• Patients wouldn’t get seen/treated because people just didn’t want to/needed breaks. And it was pretty unlikely for another therapist to help another out, because most of the time, they wanted to leave early. Oh, and the priority to see patients was based on “who we got paid more for” not who needed it most based off diagnosis and presentation (YIKES).
• Poor evidence-based care. Everything seemed very behind the times. I’m not sure the reason for this, but I have a few speculations:
  • Most of the employees come to work for a paycheck, they highly value their home life more than work. And don’t get me wrong–this is SO okay!!! BUT – in a healthcare profession, when your job is to advocate and assist patients, this can be harmful to patients if you’re not at least somewhat dedicated to your role.
  • Related to above, the bare minimum is done because nothing more is expected of the workers – and management doesn’t necessarily encourage more education and more progression. Employees didn’t take students, and when volunteers came to observe, nobody wanted them either. Many times when I asked why something was done a certain way, the answer was, “well that’s how we’ve always done it.” **NEWSFLASH** Healthcare is ALWAYS changing – if you are doing something because that’s how you’ve ALWAYS done it- chances are you are very outdated.
  • When I brought up the need to see certain patients at a higher frequency due to certain neuro diagnoses, evidence, and patient response, I got feedback such as, “we’re not staffed for that, so can we decrease the frequency of those patients?” And “We don’t get paid as much to see them, so we only see them 3 times a week.”

*slowly begins to pull hair out*

I know these may seem silly, but being in a profession where we get PAID because of having these patients as our “customers,” some of this boggled my mind. The employees are getting treated better than the patients! Yes, I understand we need employees to be healthy to treat patients, but there is a very delicate balance that needs to be found. And YES I understand patients will come based on how you treat them – but to me, not providing the best, evidence-based care, is harmful and a true disservice to our patients. It’s truly not hard to treat the patients well AND provide evidence-based care, especially if you have a dedicated team of employees who work together to provide this.

We can’t keep delaying patient care because we don’t feel like doing extra work. I understand you can’t do extra work every single day, but sometimes we just have to go above and beyond – we need to advocate for our patients and stand up for them, not treat them like a dollar sign.

We can’t keep doing the same thing over and over – that’s a disgrace to the profession and healthcare overall. Be open to new ideas, change, and evidence, learn to progress with the profession and stay on top of your continuing education in a variety of realms. This is a profession with never-ending learning, don’t forget that.

I can walk out of the hospital. I can choose the hours I want to work so I don’t get burnt out. I can change my job. (Trust me, I know this is hard because of student loans, I have PLENTY). These patients can’t change how you treat them, the care they receive, the knowledge behind what you are doing. Treat them how you would want to be treated, they need you. End of story.

If you are feeling burnt out, find an alternative. What can you do that you love? Can you change your position around to make you happier? Will your manager help you re-organize this? Can you find a new position that requires less working hours so you can give it all you got for a few hours and then focus more on home? By doing the bare minimum at work, not only are you suffering from not wanting to be there – but the patient is suffering, those around you are suffering, and the profession is suffering. We need to keep moving forward, help yourself to help others. It is hard work changing jobs and searching for one that best suits your needs, but to make you overall happy – that work is 100% worth it. (I fully understand that this is difficult especially when there are financial barriers, really, I get it).

So back to my rant of how this improved employee quality of care can be harmful.. For me, it hurt me that I was consistently going above and beyond and working harder than almost everyone around me. I felt like I was trying to drag other employees forward to be better, trying to inspire a group of people who did not seek motivation or inspiration. I truly cared for my patients and wanted the best for them. I noticed many patients who were not able to advocate for themselves and therefore were pushed off to the side. They weren’t given the appropriate chance because they didn’t have the financial means of others, or they weren’t able to progress as quickly so others didn’t have the patience and want to take their time with them.

I know this sounds heartless and a bit of a direct blow coming from me, but if you aren’t fully dedicated to this profession, you are harming this profession. As physical therapists, we need to advocate for what we do, show our importance, educate others on how we can help them. By falling into the norm, you are allowing our profession to regress while other disciplines keep moving forward.

Next time you head into work, I hope you remember why you’re there, why you got into this profession. Life happens all around work, but for just a few hours, you are there to make a difference in someone else’s life. A difference you were educated and trained for, and a difference that nobody else can provide. Dedicate yourself for those few hours, help those patients, remember what you are there for. That being said, don’t beat yourself up if you slip up now and then. Just keep trying to do the best you can, for your patient. The reward you will feel internally for helping others will be much more than a free water bottle or a phone case. It will reside with you for years. Search for that type of gift from your work.

If you are ever in a position where you don’t feel like your current job is helping you improve yourself, improve the profession, or even worse – just not listening to you. Don’t be afraid to get out. Listen to your morals, follow your ethical compass. You are wanted and needed. And don’t forget one of my favorite quotes, “If you’re the smartest person in the room, you’re in the wrong room.”

Get out there, find what you love, and use that to help others! I know if you are able to achieve this level of success, you won’t feel burnt out.

Feel free to reach out or provide any comments, suggestions, or alternatives you can think of! I try to stay as open-minded as possible 🙂 Find all of my contact info here.

Until next time,

Jen

Check out my other blogs including Simple Ways to Save Money, Observing a Japanese Day Rehab, and Life as a Small PT!

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The world of Nail Patella Syndrome can be scary and intimidating at times for yourself, your child, and your family. While most of the time, NPS is genetic and passed down from a parent, there are also times when it presents spontaneously and your child may be the first one to have it in the family. In any of these cases, having a child with NPS may leave you questioning what to do? Diagnoses and treatments change every year and likely the healthcare world is vastly different from when you were a child.

First things first, find a healthcare professional who knows what you’re talking about. Nail Patella Syndrome is not common, it is a rare disease. More and more clinicians are becoming aware of rare diseases; however, it will continue to take time. And heck, even if your healthcare professional does know about it, that doesn’t necessarily mean they will know which direction to go in regards of treatment. They will likely use the best evidence out there (which is, again, lacking) to provide the most adequate treatment. My hope is that you can use this article (as well as the others) as a resource when it comes time to talk to your physician, PT, other clinicians!

As a physical therapist, we are taught about many developmental impairments that may delay or impair function in children. Of course, NPS is not one of the main syndromes we focus on; however, as a profession, we focus less on the medical diagnosis and more on the functional impairment based diagnosis. We consider the background of what is going on medically, make sure we are aware of any precautions or restrictions, and then treat each individual appropriately. As we are all different human beings, it is important to remember that no child with one syndrome will present identical to another child with the same syndrome. In fact, there may even be times when one child may present more similarly to a child who has a different medical diagnosis. It is important to consider this and then move onto our specialty and focus on functional movements.

Here are a few things to keep in mind when working with a child with Nail Patella Syndrome (Fong Disease):

Clubfoot or “Pseudo-clubfoot”: Pseudoclubfoot ? This may just have been made up by me just now – but I believe it is really a thing. Basically, it may appear similar to clubfoot, but by definition and presentation, it is actually anatomically different. You see, clubfoot (congenital talipes equinovarus) presents with foot deformities where the mid foot and forefoot are medially spun in regards to the hindfoot. Muscle contractures may be present in this, but it may also depend on how severe clubfoot is and whether it is a fixed deformity or flexible. A great link that provides some insight on clubfoot is seen here: https://www.orthobullets.com/pediatrics/4062/clubfoot-congenital-talipes-equinovarus

Typical clubfoot is treated more with the Ponseti method. Other deformities (as I call “pseudoclubfoot”) may appear like clubfoot with abnormalities at the foot and ankle; however, the rotational component may be coming from higher up at the tibia or femur. This is important to recognize early as it can drastically change medical and physical treatment as well as improve the outcome for a child. Treatments here can range from very conservative- just letting the child grow up and hope the cartilage and bones naturally align (if it is not that severe), to casting, to other surgical repair or external fixation. Again, if the rotation is coming from somewhere other than the foot, it is important to recognize this early and perform appropriate clinical tests (tibial torsion test, femoral ante/retroversion test) to determine the best treatment. Check out this link for other rotational deformities you may see!

Toe walking – This may be present and may be for a variety of reasons. Whether it be due to a contracture (muscle shortening), neurological, or by choice, the best thing to do here is to talk your physician and physical therapist. Surgery may be an option, but likely conservative treatment will be chosen first pending the severity. Again, this is a very case-by-case basis.

Congenital Hip Dysplasia – Some children may be born with their hips already dislocated or just very unstable and on the verge of dislocating. Keep in mind, this may not be present initially at birth. It may take a few appointments to realize this – therefore, it is important to take precautions as necessary (proper swaddling and positioning, etc) to decrease the risk of any potential dislocations.

Learn more about the basic presentation of various hip dislocations and treatments at THIS website or also here.

Small or absent kneecaps – Alike to everything else, this should be looked upon on a case by case basis. With no kneecaps, this will generally make the legs, quads specifically, very weak as there is more force required to straighten the leg. Even with underdeveloped kneecaps, it may be difficult to build muscle mass in the quads due to the decreased amount of force able to be placed through the muscle and tendon which then attach to the kneecap. Just because your kneecap is missing/small does NOT mean you cannot walk. Please don’t think this! It may be difficult, sure, but everyone is different! Talk to your physician and PT about this!

One of the biggest takeaways from these numerous lower body deformities .. Does it affect their FUNCTION? This is something specifically that you will discuss with a physical therapist, as again, our goal is to look at the overall functional mobility. One impairment doesn’t mean someone can’t do something. It simply means that we need to find a way to make it work. Our bodies are amazing things and are able to adapt and create patterns without us understanding why/how.. Don’t give up hope!

Another huge takeaway is checking to see if your child is hitting the normal developmental milestones. This is important to discuss with your physician.

Of course having a child who is in braces, casts, etc. for part of their childhood or undergoing another specific treatment may be delayed in crawling, walking, or other milestones. The good news is that generally there is no cognitive delay or impairment associated with NPS, meaning many of those milestones may be delayed due to physical impairments, but likely the child will catch up. And, of course, they won’t be “behind” in cognition due to NPS. Check out more about milestones HERE.

I hope this gives a little insight into what to think about when having a child and/or raising a child with NPS. Remember – everything should be a case by case basis. Nobody with NPS presents the same, and some may have very mild deformities that don’t limit a child at all! Don’t define yourself or your child based on a syndrome!

Be sure to check out a few of my other posts on NPS and stay tuned for more in regards to pediatrics! And, as always, if you have any questions, suggestions, or comments – feel free to message or email me! 🙂

Other NPS posts: NPS Overview, Your Knees and NPS, NPS and Pregnancy.

Until next time,

Jen 🙂

Since I’ve head a few people ask me about what I do for exercise, I thought I’d write up a post for you all here!

Okay, so this is basically what I do for exercise. Each are not exactly in this order, but I generally follow a similar guideline each day, especially for leg day…

Day 1 – Arms & Abs Pt 1: This day I focus mainly on biceps/triceps.

• Start off with 10 minutes of cardio warm up (I usually do the elliptical just so I can get my arms in with the workout).
• Optional: Row machine for 2-3 minutes for more cardio and to warm up the arms
• Lat pull down: 3 x 10 reps (if you go heavier, you may only be able to do 6-8 reps)
• Dumbbell bicep curls SUPERSETTED with tricep kickbacks/extensions: 3 x 10. Supersetting helps improve cardio PLUS you get your workout done faster 😉
• Dumbbell Lateral raises (for deltoid muscle) SUPERSETTED with standing lateral external rotation. 3 sets of 10 Lat raises, 2 sets of 15 external rotation
• AB WORK: I usually go to the assisted dip/chin up machine and perform a few of the following:
  • Hanging pike raises (however many you can do)
  • Hanging tucks side to side
  • Hanging tucks straight forward
  • Supported on dips handles – flutter kicks
  • Supported on dips handles – tucks
  • Supported on dips handles – tucks side to side

Day 2 – Leg Day Pt 1: I will usually do one heavy lift on this day, the other on the next. Let’s make this one squats.

• Start with 10 minutes of cardio. I usually get on the bike or stair stepper for leg days.
• HEAVY LIFT – Squats. I do a “ladder” technique
  • 10 reps bodyweight squats – check my form
  • 10 reps with the bar
  • 8 reps with some added weight (pending what you can do)
  • 3-6 reps x 3 sets of the maximum weight
  • 8 reps with added weight
  • 10 reps with the bar
• Here’s the kicker – in between each of those sets when I rest, I also do 10 reps of lunges on each side, so yes, I superset that as well:
  • Forward lunges
  • Backward lunges
  • Side lunges
  • Skiier lunges (crossover)
• Next I move onto the smaller muscles and more isolated machines
  • Leg extension machine 3×10
  • Prone hamstring curl 3×10
  • Hip abduction/adduction machine 3×10
  • Hip thrusters (as long as I can find a non-awkward-space) 3×10

Day 3 – Yoga + Run: I also do yoga throughout the week, and I’ll be honest – I don’t always run. BUT it’s a good idea to do some cross training in the middle of the week! Whether that be yoga, running, hiking, whatever! Yoga has helped me SO much when it comes to arm strength!

Day 4 – Arms & Abs Pt 2: This day I focus mainly on my upper/lower back.

• 10 minute cardio warm-up (elliptical)
• Optional 2-3 minute row machine
• Lat pulldown 3×10
• Low Rows 3×10
• Overhead press 3 x 10 (or however many I can do)
• Pull-ups, assisted or not – however many you can do
• Pull-ups/rows at an angle 3×10
• AB WORK: I usually go to the assisted dip/chin up machine and perform a few of the following:
  • Hanging pike raises (however many you can do)
  • Hanging tucks side to side
  • Hanging tucks straight forward
  • Supported on dips handles – flutter kicks
  • Supported on dips handles – tucks
  • Supported on dips handles – tucks side to side

Day 5 – Leg Day Pt 2: Other heavy lift (deadlifts):

• Deadlift with similar ladder technique as squats
  • Bar only – to check form
  • Add weight as able and complete a set of 10, 1-2 sets of 6-8, a set of 10 (or just however many you can do) – KEEP GOOD FORM ESPECIALLY FOR DEADLIFTS! Lighter weights are totally fine.
  • Superset with lunges in between
    • Forward, Backward, Side, Crossover/Skiier Lunges
  • Leg extension machine 3×10
  • Prone leg curl 3×10
  • Sidesteps with theraband (for hip abduction and more booty work!)

Day 6 – OTHER/RANDOM THINGS/WHEN ALL THE EQUIPMENT IS TAKEN/PERSONAL PT:

• Kettlebell workout!! I do this when all the leg day equipment is taken..because usually the kettlebells aren’t 😉
  • Kettlebell Swings: 2-3 sets of 20 reps
  • Kettlebell Sumo Squats: 3 sets of 10
  • Single leg deadlift (try these first without kettlebell.. you will likely need a lower weight. Really focus on stabilizing core here prior to adding weight! It’s a good balance activity)
• Personal PT workout for hips (I do this because I’ve had knee injuries and I want to prevent further injuries!)
  • Clamshells: 2 sets of 20 (both sides)
  • Bridges: 2 sets of 20
  • Single leg bridges: 2 sets of 15 (squeeze your booty first here-not your hamstring! People have a tendency to cramp up easily because of that)
    • On ground
    • On bosu ball for extra strength/balance requirement
  • Personal PT workout for arms
    • “Sahrmann Slides” – to help improve the movement of your scapula and help balance out your arm/shoulder muscles
    • Push-up plus – can do the push-up part, or just protract your shoulders and push into the ground to help activate your serratus muscle (again helps to improve scapular mobility and control)

After each workout, I try to either drink a protein shake (plant-based for me, but whatever you choose!) or eat a protein bar/cookie (highly recommend Lenny&Larry cookies, plus they always have a sale..) within 30 minutes. If it’s not that early, it’s okay, that just tends to be the most optimal time for GAINZ 😉

I will do my best to post pictures and videos soon. But in the meantime, hope this helps! Feel free to message/email me if you have any questions 🙂

Instagram: @jennpalmer19
Email: jnpalmer19@gmail.com

Until next time,

Jen

Hi all!

In honor of Vegweek – I wanted to provide 2 more vegan recipes for anyone to try (they are easy, I swear).

I’m pretty bad at taking pictures of my food both as I’m making it and before I eat it… Mainly because I’m hungry and impatient… but I managed to snap a few pictures of two recipes Scott and I have been using pretty frequently lately.

First is … BBQ Tempeh! Um – WOW – have you ever tried tempeh?? The texture is amazing and we love it way more than tofu. It has more of a “meat” kind of consistency too, so for the people missing it – this might be a good option for you!

We buy our tempeh from Trader Joe’s. You do have to be careful as tempeh is a fermented product – make sure it’s still okay to eat! Some mold is actually okay, but when it starts getting too black, ya better throw it away.

I’m also not super great at following recipes with exact measurements.. but here’s the best I can do (cooking is supposed to be fun and half winging it anyways, right?)

1. Cut the tempeh into slices.
2. Grab a ziplock bag and throw them in there.
3. Pour whatever seasoning you want – I simply use BBQ sauce that I have (vegan), throw a little pepper in the bag as well, and a tiny bit of apple cider vinegar. ** You can use whatever you want – if you want to let it marinate in some sort of oil with spices or a dry rub – go for it!**
4. Place bag in the fridge for about 30-45 minutes. The longer you let it marinate, the better it will taste 😉
5. Preheat the oven while you’re at it — like right when you put the bag in the fridge or so. I set mine at 350 for this!
6. Once you’re all ready, place your tempeh on your baking sheet (I put aluminum foil on top of mine). Drizzle a little extra sauce or seasoning on there, too!
7. Bake for 10-12 minutes, then flip to the other side for another 10-12 minutes.
8. Ta -daaaaa, you’re done! Let it cool!

We tend to serve this over rice or quinoa, with a side of veggies and maybe some fruit for dessert 🙂 I end up getting the rice or quinoa prepped while the tempeh is still marinating in the fridge, but you can do as you please!

A few pics of the product (literally a few, my bad…)

And up next – something we eat frequently.. your “Basic Buddha Bowl”

Truly, we have found that eating vegan tends to be eating a lot of things out of a bowl. There are so many different combinations you can create and throw into a bowl. This is one example of ours!

Ingredients (use what you want): Sweet potatoes, quinoa, vegetable broth, red and green bell peppers, onion, garlic salt, black pepper, coconut oil, mushrooms, garbanzo beans (use any type of bean if you’d like), spinach, avocado.

1. First of course preheat your oven. We set ours to 450 degrees.
2. Prep those sweet potatoes of yours. I just rinse mine and then stick a bunch of holes in it with a fork. We usually put about 4-6 on our baking sheet depending on the size (on top of aluminum foil as well).
3. Cook those bad boys for 35 minutes – but start checking them around 30. They should be easy to cut into with a fork. Again, this varies on the size.
4. While those are cooking, get your quinoa going! This usually takes about 15 minutes to cook. We use red and white quinoa and it is always a 2:1 ratio of liquid:quinoa. We like to use 1 cup of vegetable broth and 1 cup of water with our 1 cup of quinoa (hopefully that makes sense). The veggie broth just gives it a little extra flavor, but it’s definitely not necessary.
5. AND while that’s going – quinoa doesn’t take a ton of effort, really – you want to start sautéing your other veggies in a pan! So throw in those peppers, onions, and mushrooms first. Add a little coconut oil and some spices (garlic salt and pepper for me) and get to cookin’ !
6. I usually have the pan on medium-high here, let it start simmering a little – maybe 5-6 minutes or so. Then I’ll add in the spinach and a tiny bit more coconut oil. Keep cooking but keep an eye on this – and remember your spinach will shrivel up to tiny little pieces (so ya might want to add more)
7. Everything should be finishing up around the same time.. Go ahead and add your beans (I use canned because I’m lazy and it’s easy) to the sautéed veggies and heat them up for a little!
8. Once everything is done, let it cool a little. Cut up an avocado if you want- we just had one ready to eat so I said YOLO and did it.
9. Take your sweet potato and place it at the bottom of your bowl. Cut/smash it up a little. Pour your quinoa over top of it. Throw the veggies on top of those. Top it off with your little avocado if you desire.. and voila!
10. This should make a few meals – I usually put some in Tupperware for the next night 😉

**I’ve also added salsa, tomatoes, and just other random veggies to this. Try whatever you like!! There’s no “real” way to make these**

Here’s a few pictures of the masterpiece (lol):

Anyways, happy veg week and I hope you all enjoy some plant-based foods! If you want to check out some other recipes that I have followed or made items from (again-easy and quick), check out these links here: Going Vegan in Japan and What Eating Vegan Did for Me

Stay tuned for some other vegan blogs- including a shopping trip with us and some other ways to save money (in addition to these)!

Until next time,

Jen

“Did you fall on your elbows?” The nurse practitioner asked me as she did a quick visual scan of my appearance at my employee occupational health visit.

Did she mean any harm by saying this? No, of course not. Does it make me feel a little awkward? Yes, definitely.

“No, it’s actually from a rare disease I have,” I explained back.

Her pause and stare made it clear she didn’t know how to respond after.

“Oh, okay, well then I can mark you down as having something congenital. But you’re still doing really well in this screen.”

Well that’s a relief, because for a moment there it seemed maybe the appearance of my odd-looking elbows could have made the functional health screen head in a different direction. Or maybe not. But what am I to think now?

As both a physical therapist and a human who has a rare disease, I experience both sides of this awkward situation. Ya know, when you say something that you didn’t mean to be harmful but maybe it came off that way…

How could we have worded this better: “Did you fall on your elbows?” –? To some this may make the conversation get ugly – “Well why did you point that out?” Or others, it may make them feel embarrassed and not want to confide or give you all of their health information anymore…

First off – is it even important in this functional occupational health screen? It wasn’t noticed until after I already performed an upper body gross screen with manual muscle testing – all with flying colors. It wasn’t until after as we were chatting some more that this was noticed. Do we need more training in these functional screens? More education? It’s possible.

Maybe she felt really comfortable with me, I always think I’m fairly easy to get along with and talk to. Maybe she thought I left out an injury on my form. Maybe she was just curious.

I’m not sure – but again, the muscle strength was already there AND the (minimal) decreases in my range of motion were not noticed until I pointed them out.

You see, with a rare disease, deformity, illness – anything that isn’t super common, the patient generally has to do more of the explaining to the practitioner. I pointed out that I did not fall on my elbows, but since I have Nail Patella Syndrome, I did indeed have large radial heads which also limit full elbow extension and forearm supination. Again, was this noticed during the upper body screen? Nope. It never has been. Or if it has been, nobody has ever said anything.

So where is that fine line? How do you politely and appropriately ask someone about something that seems peculiar/abnormal without offending them and without asking about more than you need to know.

I don’t have answers here, this is more just a reminder to watch what you say and process what you are saying to patients before you do. Luckily for me, I am not offended easily and am open to conversation, but I can’t say the same for all the others with rare genetic deformities.

And with that being said, of course there are clinicians and people in general out there who are still not as mindful of these things. Those who think that one way is the only way and that in order to perform at your optimal level – you must be “perfect” – with that “perfect” range of motion, “perfect” form. Newsflash y’all – everyone and every body is different. Our bodies are made to perform the best they can with what we have.

Yes, certain improper forms may predispose people to injuries, especially when awkward repetitive actions or techniques are performed. But in your “abnormal” person with a deformity – how do you treat that? You make sure they are functional, right? Help them improve themselves to the best of their ability.

Someone asking me if I fell on my elbows does not upset me now, but as a child – whether it was people asking about my elbows, accusing me of being anorexic, making fun of my thumbnails, or heck – even pointing out my giant calf muscles (I know, who gets embarrassed about that..but I was a kid) – these things can hurt. And they can linger through life.

I’m not saying that I’m perfect with this. I know I still have patients where I try not to offend them but then something comes out and I realize I said it the wrong way. Just thinking of different ways to ask questions, getting to a patient’s eye level, speaking with the proper tone of voice, and showing caring gestures and welcoming body language can help – and I can’t stress the importance of it enough. Building relationships between patients and clinicians is a huge part and foundation in helping everyone thrive in this crazy healthcare world we have now.

Be compassionate, think before you speak. Don’t end that relationship before it even gets started. And hey, do yourself a favor and keep educating yourself, keep practicing, and don’t forget to forgive yourself if you make a mistake. 😉

If you’re interested in any other PT thoughts that I have, be sure to check out a few of my other blogs: The Generalist PT, Becoming an Acute Care PT, tips with Productivity in Acute Care, and the Struggles of being a Small PT. Or if you want to learn a little more about the rare disease I have – check out NPS and Knee Pain and NPS and Pregnancy.

And of course, be sure to join in with the GlobalPTConnect fun on Instagram to join PTs sharing their days around the world! Or just check out my time visiting an Outpatient Japanese Clinic and a Singapore Physical Therapy School. 😉

Until next time,

Jen