Quality of Life vs Burnout: A Real Healthcare Dilemma

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*

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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,


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


NPS and Pediatrics – Part 1


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

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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 🙂

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My Basic Workout Schedule

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…

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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!)


  • 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 🙂

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Email: jnpalmer19@gmail.com

Until next time,



BBQ Tempeh and Basic Buddha Bowl

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.

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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**

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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,



What We Say Vs. What They Hear

“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…

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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.

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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,


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What Eating Vegan Did For Me

Watch the video if you don’t feel like reading- — or read if you don’t feel like listening (the best of both worlds!)

Hey guys!!

Some of you may have recently seen my Instagram story about my blood work levels – but if not, that’s also why I’m writing about it here 😉 (duh)

If you’ve been following along, you may have seen that my husband and I transitioned to a vegan diet and lifestyle when we were back in Japan a few months ago. Click HERE if you want to read a little more about that first.

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So anywho… what sparked me to write this blog? Well I am beginning a new job over here in California and I had some blood work drawn up. Just a simple “wellness check” that a lot of companies do nowadays. I had happened to have my yearly blood work ran back in October, just 2 months before we decided to start eating vegan.

At this point in time, we were both eating pretty healthy – mainly chicken and vegetables and the occasional night out to eat sushi or some other Japanese cuisine. And yes, a few beers or Chu-his (Japanese alcoholic drink) here and there. We worked out a lot, we drank protein shakes, ate lots of fruits and vegetables, and we had even already been drinking almond milk to cut down on the dairy intake. We were eating “healthy” according to the typical workout/gym stereotype. My body looked the same as it always has (I don’t think I’ve grown since 7th grade, seriously) and I thought we were doing the right thing.

Here are my few blood work results from then:

Cholesterol: 166 mg/dL
Triglyceride: 63 mg/dL
HDL Cholesterol: 51 mg.dL
LDL Cholesterol: 102 mg/dL
VLDL Cholesterol: 13 mg/dL
Cholesterol/HDL Cholesterol: 3.25

For the most part, everything looks okay. My LDL cholesterol and Cholesterol/HDL Cholesterol are right on the border of being low risk to moderate risk. Everything else isn’t too bad at all.. fairly healthy for a 26 year old!

Handmade bracelets made by women in Nepal!

Fast forward to when we transitioned to Vegan – the first few days were rough, not gonna lie. We felt groggy, out of it, just kind of “bleh” while we detoxed ourselves. After about 2 days, we started feeling normal again. BUT one thing you have to keep in mind when you switch to all plant-based food.. You’re increasing your fiber intake. And what does that mean? Increased fiber means increased farts (someone had to say it – it’s the truth). But let me tell ya, nothing makes a relationship stronger than an apartment smelling like straight fart all the time (haha!). Luckily for us, this only lasted about 2 weeks while our stomachs adjusted. There are different tips for this – some say eat more cooked veggies to help your body digest it easier, but some say go full on with the raw so it can adapt better and quicker.. Try what you want!! We just kind of ate food, because food>farts. Scott also started having a TON of energy after about a week- me, I like naps, so I’m not really sure hehe.

It was tough being in Japan (again check out the post for our first simple recipes that we used — we didn’t have an oven and we didn’t speak Japanese soooo) to start – but we kept at it. Once we got to the states, we had access to many more options and it has been WAY easier.


Okay, so here we are – April of 2018. Vegan for about 3-4 months with some occasional slip ups (this happens sometimes when eating with family and friends — sometimes there’s a little melted cheese on something or there just are only vegetarian options and you’re starving.. YOU’RE HUMAN, DON’T FORGET THAT).

My recent blood work results (wasn’t a full workup so it’s limited, but CHECK the difference):

Total Cholesterol: 111
HDL Cholesterol: 49
Cholesterol/HDL Cholesterol Ratio: 2.3
Blood Sugar: 84

Trust me, I wish I had more values to look at for both – I’m so MINDBLOWN by the difference. It’s insane. Literally this is what has changed in these last few months: worked out the same (possibly less since we just moved and such), cut out the other dairy, egg, and meat and their products, replaced those with beans and more veggies/quinoa/tofu/tempeh/whatever we could find, was super stressed out in life because of moving from Japan>MD>California with a cat (LOL – video/post coming soon), also stressed about not having a job, again..MOVING.

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My bodyweight and figure has stayed the same – this was never intended to be a weight loss thing for me (HeLlOoOO VeGaN iCe CreaM), just a health thing. So again, side by side – check this out:

Cholesterol Oct 2017 to April 2018: 166->111
HDL Cholesterol: 51->49 (this is the good cholesterol)
Cholesterol/HDL Cholesterol Ratio: 3.25 (almost moderate risk)->2.3

Still healthy, just HEALTHIER!

These results don’t lie you guys, I’m in shock too. I will be posting some additional recipes that we’ve been doing (now that we have an oven..and more ingredient options..) AND a trip to the grocery store with us so you can see what we buy to stay healthy, on a budget, but also treat ourselves. If you’re looking for other ways to save money – check out my other post I wrote!

As I’ve said before — I’m not here to preach. Eat whatever you want. I’m just here to objectively show my results. I’m so amazed and I hope this opens your eyes up! Message me (@jennpalmer19 on instagram) or comment if you have any other questions or requests!!

Until next time,


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Japanese Outpatient Clinic Experience

As I approached my last few days in Japan, I was honored that one of my students who I was helping to teach English to wanted me to visit his very own physical therapy clinic!

I had been working with Masahiro for a few months on conversational English, grammar, some medical terminology, and a few general patient-therapist conversations. It was an awesome experience not only helping him learn English, but also seeing that lightbulb go off when there was a connection made, especially during some of the medical terminology.


Masahiro had his own outpatient clinic in Odawara, Japan. He told me that while he went to school in Tokyo and many of his colleagues stayed there, he moved a little south to open his own clinic. He also loves to surf, so moving closer to the beach is a no-brainer!

“Groundwork” (the name of his clinic) was on the 4th floor of the building we walked to, in a single office room. There was a desk, a mirror, a set of parallel bars, a plinth, some weights, and a bunch of other typical outpatient goodies. Now, I know Japan has different health insurance, a different framework, etc… But clearly his clinic is for one-on-one treatment.

For one last English session, Masahiro “treated” me as a patient, using as much English vocabulary as possible to help improve my “glut med issue” – which wasn’t supposed to be an issue, but my balance was a little off, ha! He performed a few manual techniques, analyzed my gait, performed a few manual muscle tests, and gave me a few exercises to do. All with the English we had worked on together! It was so rewarding to see that!

When I asked Masahiro about his normal schedule of patients, he said he sometimes has patients as late as 10 PM. Crazy, right!? While that is late, it’s not all too surprising if you understand the nature and culture of Japanese people – they’re always working. I’m talking 60 hours a week as the norm sometimes. This obviously can be an issue with work-life balance, and it is something the Japanese people are trying to work on, but again, a 10 PM appointment is fairly normal to them.

Masahiro also stated that physical therapists in Japan are not looked upon as highly/paid as much as those in the USA. Granted, they also are still at the Bachelor’s level as compared to the Doctorate in the US, so I’m sure that in itself is a big difference. Not to mention there are varying levels of autonomy and they still require a referral from a physician at all times.

Handmade items from Nepal

Overall, the outpatient clinic was quaint, tiny, but effective. Masahiro told me that most of his friends have similar clinics if they are in private practice. Of course, there are bigger gyms and rehabs as well. Again, it was a great experience and so rewarding to not only network with another physical therapist on the other side of the world, but help him out with his English while learning a little about different treatment techniques from one another.


If you’re interested in checking out my other experiences abroad – be sure to read my other blogs: A Day at a Japanese Day Rehab and Visiting a Singapore Physio School. Or if you just want to check out other real-talk-PT blogs, check out The Generalist PT, what it’s like to be an Acute Care Therapist, and The Struggles of Being a Small Physical Therapist.


Hope you enjoyed reading! Be sure to message me if you have any questions 🙂

Until next time,