“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. 😉
Watch the video if you don’t feel like reading- — or read if you don’t feel like listening (the best of both worlds!)
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.
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.
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!
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):
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.
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!!
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.
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.
Everyone knows that changes occur when you’re pregnant. Hormones change, you might feel nauseous, you might feel exhausted, or you might even start to feel some increased pain in your joints. Your stomach is growing and pulling your spine into more of a lordosis than it is used to, and it might even be throwing you off balance a little.
How could this be different with NPS?
Well, in regard to the medical aspect of NPS, you must consider a few things. Having NPS puts you at a risk of having issues with your kidneys. It is very important to monitor for any proteinuria that may signify some sort of nephropathy (fancy word for kidney issues). As in any pregnancy, proteins in the urine will increase, but with NPS, there is a chance of already having an elevated number prior to the pregnancy.
While in many cases the proteinuria is benign, keeping an eye on this can help physicians to notice if there are any other symptoms that may suggest some sort of pre-existing kidney condition. If you do feel uncertain about your symptoms in any way, please contact your physician to determine the best treatment.
So why am I talking about kidneys so much? I’m a physical therapist, not a nephrologist after all. Well, you see, sometimes when people have an infection in their kidneys, they may have a specific referral pattern for their pain.
This referral pattern can be in your low back region, maybe even a little in the abdominals and sides of your body, or even into your groin area and the front of your legs potentially. Crazy, right? All of these referral spots are similar to places that a pregnant woman may feel pain due to loosening ligaments. So which one is it? Back and hip pain from the increased laxity of your ligaments or kidney pain? This is very important to discuss with your physician before continuing on with physical therapy and exercises.
Now, besides the loosening of the ligaments, the major cause for back pain is due to your growing stomach pulling your back into a more curved position. The larger area in front of your body pulls your center of gravity more forward and can throw you off balance a little. If you remember reading the general clinical presentation of NPS, you may remember that many people already face hyperlordosis in the lumbar region. Pulling you even further forward can increase this and place someone with NPS at a higher risk for low back pain, or even further injury such as a spondylolisthesis (a break in your vertebra). This is very important to consider when participating in exercises and other activities as some activities may be contraindicated.
Here’s a video to understand the general background about back pain, pregnancy, and nail patella syndrome.. and how they all come together.
This being said, if it truly is just back and hip pain (very common and very likely), I have a few exercises for you here! Again, these are very general and each exercise program truly should be better adapted to your body and your pregnancy. But this can be a good place to start.
Beginner Exercises for Core Strength
As always, remember to get checked out to better adapt and enhance your exercise program if you feel you need more assistance. This is very general and it is best to have someone view your functional impairments in person so that you can have the best treatment program for you!
A few months ago I was told I had to have a Japanese bank account in order to get paid from a small job I did. Google helped, but ultimately it was word of mouth and trial and error that helped me to open my account. To help others out who may be in the same situation, I wanted to give a quick summary of the things you’ll need.
I was told about the Bank of Yokohama right on Blue Street in Yokosuka. It’s just before Yokosuka-chuo on the right side if you are leaving the US Naval Base. I would highly, highly recommend using them. While I obviously didn’t use any other bank, they made it EXTREMELY easy as a foreigner to open an account, not to mention they were very polite and helpful.
Okay – so in order to open up an account, you will need:
1) Your passport (makes sense)
2) Your PO Box address – this is the way I did it. If you don’t have one, I would honestly recommend opening one up. They will mail your ATM card there and they already have a whole form set up to help you with this address. If you don’t want to open up a PO box or use your on-base address – you may need to look for other help online (sorry!)
3) A Hanko (your Japanese name stamp). If you don’t have one of these (I didn’t), you can go to the Kawashima stationery store. If you head back out to blue street from the bank and make a left, it is about a 2-3 minute walk. It will be on your left. You will go upstairs to the second floor and towards the back. If you just keep saying “Hanko” like I did, likely someone will eventually help you (ha!). You can pick out pretty much anything and I believe mine cost me less than 300 yen. Of course, if you want something more personalized (it can be a good souvenir), then you may pay more.
I also brought our orders and military ID.. but if I remember correctly you will not need them. But hey, better safe than sorry!
Once you’re there and you have everything (if you don’t, they’ll tell you), they will help you step by step when filling out the form. It all ran very smooth and they, again, were very kind throughout the process. Once I was done with the form, they handed me a number and I waited my turn. I sat back down one more time while they finished up my passbook and such, but all in all, it took about 30 minutes total, and it was a decently busy day.
So here we are today and I needed to close my account..
Things you will need:
1) The SAME Hanko – this will make life a bajillion times easier, so don’t get rid of that thing.
2) Your Passbook (checkbook thing). If you don’t have this, I think you will need your passport
3) Your Cash Card (ATM card)
If you have all of this, the process again goes very smooth. I think I spent a total of 15 minutes in the bank this time (maybe less). They showed me step by step again, and there were less forms. They kept my cash card (so if you want a picture of it as a souvenir, you might want to take that before) and handed me the money I had left in my account. So so simple and very foreigner friendly (at least to native English speakers).
I hope this helps anyone that was looking for information! Again, I highly recommend using them – it all went so smooth!
And of course if you’re looking for other Japan adventures to check out while you’re in Yokosuka, you can read about some other local(ish) trips we took while here 🙂 — Mt. Fuji, Winter in Japan, More near Yokosuka.
Palawan has been increasing in ranks of islands to visit over the last few years. Many people travel to El Nido and the Underwater River when they arrive. With only a few days to spend exploring, we opted to stay at a resort on a remote island in Honda Bay (another popular destination).
Dos Palmas island resort and spa is a popular spot for a day trip. We ended up spending about 3 days and 2 nights there and I feel like it was the perfect time to do all the featured (and included) activities on the island. It takes about 30 minutes from the airport to the wharf, and then it’s about a 1 hour boat ride to the island itself. The ride itself is beautiful, you pass so many islands in the bay. Some are even just big enough to hold a picnic table and 2 benches – crazy (but also so cute)!
After a long overnight layover in Manila…
Random facts about the airport in Manila: It is in 4 separate terminals-nowhere near each other, not connected at all, and the shuttle to each one is about an hour apart but not even really a set schedule… plan for a taxi if you’re rushing. Terminal 4 – where we flew out of – was very small, older, limited space to sleep if you needed. Terminal 3 was the most like a newer airport that you would think of (lots of restaurants and shops, modern). Terminal 1 seemed okay but we only were in the arrival area here.
….We flew out to Puerto Princesa (PPS) airport using AirAsia (check my blog about our personal flight experiences)
PPS is a nice tiny airport, pretty modern. Dos Palmas had arranged our pickup and they were a few minutes later than our arrival, but generally, everything went very smooth. Our driver explained everything to us when we arrived at Honda Bay (that you have to pay a small environmental fee in cash right there — another heads up). Then we hopped on our boat (again, this was all previously figured out via email to the resort).
Once we arrived on the island, the staff greeted us with necklaces and welcome drinks. Then they gave us a little tour before we headed to our room. It was a beautiful resort, and just what we were looking for in our getaway.
We arrived early in the day and luckily our room was available for us. We headed to the pool and decided to make our first day a relaxing one. It was really quiet (it was a Wednesday) and nice to just lay out, explore the beach, and work on our tan.
The island is small and there is only one restaurant here. Breakfast is included in your stay but you have to pay for lunch and dinner. While the options end up being a little limited, we found that the best tasting food was, to no surprise, the asian dishes. When we tried to get something that was more of a western cuisine, it wasn’t quite up to par. But again, we are in Asia, so that should be kind of expected.
The first night was my husband’s birthday. As we were finishing up our dinner (our waiter Pepito, I think that was his name, was amazing) they brought out a cake and sang to him! No, I didn’t organize this – they did it for him (and other people the next night as well). I thought that was super nice!
The next day was our more adventurous one. We booked an island tour (again, free through the island) and then went snorkeling later in the afternoon (also free). It was all very picturesque and beautiful. The island was deserted except for the few guests that came with us. It was tiny, but there was just enough time to explore!
Many people arrived on Thursday night as compared to Wednesday. There was a huge group, which essentially meant more activities on the island. There was both a fire show and a cultural dance after dinner that evening. Both were pretty neat to experience (see a small clip in the video below).
The next day was our last day. Our flight wasn’t until later in the evening, so we were able to stay on the island the whole day. We relaxed on the beach in the morning, checked out, and then got a massage. One tip that I wish we knew — they put oil in your hair and all over your body during the Swedish massage.. We didn’t think about the fact that we couldn’t shower after (since we had already checked out of our room). So yes, we had to head to the airport like giant greaseballs.
The shuttle was all very well organized again on the way to the airport. The only downfall of the end part of our trip was the chaos we experienced as our flight was delayed 12 hours due to wind (you can read a little more about it here). That being said, we were fully reimbursed for our troubles by Kiwi.com — I completely recommend them for future bookings!!
All in all, if you are looking for an affordable 2-3 day getaway in Palawan – I would recommend Dos Palmas. It was the perfect place to go for our few days.
If you want to see more, check out the video I compiled below 🙂 Or if you’re planning on heading to other places in Asia – check out a few of my other blogs on Japan, Thailand, Bali, Singapore, and Malaysia! Not to mention my Tips on Saving Money (because ya might need that to travel).
Yep, this is a blog about that dreaded “P” word that we all hate… Productivity.
I recently saw a post asking about how people manage to do their documentation all on the clock instead of staying after hours to complete it. There were many different comments and such, obviously each facility is different, but I know many places it is actually illegal to do any documentation OFF the clock. The problem with this is that many therapists then feel pressured because they can’t reach the productivity standard set at their facility (this also varies tremendously and I’m still not sure why…) because they are taking their time with documentation (like the good therapist they were trained to be) as well as actually caring for the patient (say whaaaaatttt?!)…
While I have many thoughts myself about productivity, especially working in acute care (ha), it is still something we all have to work with. Yes, physical therapy does have to be treated like a business in this aspect. We all need to get paid somehow, right? Again, there are many issues with productivity standards across the board.. I’ll leave it until the end of the post to discuss my feelings and opinions (which may differ from yours, but hey, that’s life). In the meantime, I want to discuss a few ways that help me to stay productive. I mainly work in acute care, so I understand some of these things may not fully apply to every setting… but here goes:
1. Wear a watch. And I’m not talking about your fancy Michael Kohrs watch (I mean, that’s fine if you want to… but honestly who wants C. Diff on their watch anyways?). I use a digital watch that I bought from Wal-mart. Sure, I use it for time, but I mainly use the stopwatch. Just before I step into the patient’s room, I hit start. I do my thang with the patient and kind of monitor my watch as I go.
– Is this a quick in and out that probably never needed a PT consult anyways because they’re totally independent? Okay – 8 minutes might be my goal.
– Or are we hitting 35 minutes and it’s about to be 3 units (38 minutes). What else can I work into this session? Is there something I’m forgetting to educate them on?
Please do not take this as “oh I have 10 more minutes until the next unit.. let me talk about dogs.” That is not the case. If you are done with your session, you are done with your session. You need to remain ethical in all circumstances.
BUT, one physical therapist once told me to treat each session as if the patient were going to discharge right after. Did you tell them everything you think they needed to know? Did you go over those 2 steps – whether physically or verbally talk through them? Did you provide caregiver education? A HEP? Likely, there is always something else that can be discussed that will be beneficial to your patient. But again, if not, then you are done your session. Don’t be ridiculous. Yes, it’s your license, but it’s also your patient’s money, your time, their time…you get my point. Be ethical.
2. Be brief. Do you need to talk to a nurse or a physician? Get bedrest orders removed? You need to advocate for your patient? Recommend imaging?
Gather your thoughts, summarize it in 1-2 sentences, and get your point across.
Because like, um, nobody is like trying to spend a bunch of time um figuring out what you’re trying to like tell them. If ya catch my drift..
Be confident in your knowledge and what you are asking. YOU KNOW SO MUCH MORE THAN YOU THINK, I PROMISE. (I mean, unless you already think you’re awesome – keep being awesome, but don’t stop learning and stay humble).
The physician who has gotten paged 5 times in the last 2 minutes and the nurse whose patient just coded.. Yeah, they do not have time to listen to your paragraph long reason as to why Billy Bob needs an X-ray. Be thorough, but be concise. Not only will this save everyone time, but it shows that you know a little something something about what you’re talking about… Which then turns into respect from co-workers in other disciplines… Which then turns into good relationships… Which then likely helps you when dealing with their patients down the road.. Which then helps the overall look of the profession… Sound good?
3. Don’t spend time chatting. If you feel like you are distracted because your favorite nurse is working nearby and you can’t help wanting to chat about your weekend plans. Do yourself and all of the patients a favor and giddy up on out of there. Find another spot to document, move on to your next patient, go do something that will better the people you are there to help.
…Now, if you are there to talk about a patient – that’s another story. Go on wit ya bad self and discuss! 😉
4. Know what to look for in your chart review. Yes, this will take time and practice. What floor is this patient on? Are they ortho or neuro? What are the key lab values and how will they affect the patient during your session? What are the key takeaway points in the chart.
Try to understand how much time you will need to chart review, everybody is different and likely it will change over time. Do you retain information better right when you get to work and do a mass chart review? Is it better for you to chart review as you go through the day? Figure out what works best for YOU and free yourself from distractions while you do it. Be thorough yet be able to summarize that patient quickly if someone asks you about them.
Another thing here – make sure you’re not constantly re-chart reviewing. Sometimes I know I won’t get to a patient until the afternoon. I may do a brief view of the chart when I arrive to work, but I don’t do my day’s chart review until later, because I know I probably won’t remember what I reviewed.. which kind of defeats the purpose.
5. Have a potential schedule in your head. And a back up. And another back up… because let’s be real, things never actually go as planned in the hospital. When do certain floors generally have lunch? I used to plan my patients sometimes based on this. Because I would know I could walk Jim right before lunch and then run over to the next floor where they still hadn’t received their lunch…etc.
Is Mary more tired in the morning? Are there family visits that day, pending MRIs, does someone have a colonoscopy planned (cuz ya probably want to wait until after it’s done…am I right..)?
Have a tentative plan in your head of which patients you will try to see first, whether because they are a BID ortho patient or just based on the fact that nobody else seems like they’ll be ready to participate with you until after lunch… It’s helpful to know where to go first, and second, and then back to the first. You know what I mean.
6. Understand your facility protocols. This is where things will differ based on your hospital, facility, the administration, the therapy department, etc.
How do you bill for co-treats? If you feel like this hinders you at times, ask yourself – is a co-treat really warranted? By all means, I understand it DEFINITELY is sometimes. But maybe not as often as you think. Can you use a tech? Can you do an overlap (where the OT starts and does things for 10 minutes or so, then you come in to do things together, then the OT leaves..). Can you use the bed or some propped up pillows to help support instead of another person? Get creative. But make sure it is the optimal treatment that you are providing!
In regards to your facility and hunting down a physician vs calling them (also considering the physician’s views on this)… What is preferred? If you see the physician on one floor – why not ask him a question then about a patient even if it’s for later in the day? If you’re calling a physician and he doesn’t return the call for 10 minutes – do you move on and write a note in the chart that you tried (and it’s your attempt) or do you keep waiting? I’ve been at facilities that do both. The biggest thing is to try to find something to do during those minutes of waiting – documenting, talking to the nurse.. do something productive!
7. Document however much you can, whenever you can.Depending on your documentation system, if you can document parts of notes and then save the rest for later – why not do that? Especially if you’re waiting 10 minutes for someone to call back, or waiting a few minutes until your patient is clean. Don’t just stand there – get some of your notes done! If you can’t do partial notes and pend them away, maybe at least organize your thoughts and key points from a session on a piece of paper so you can easily transfer it later without straining your brain to remember.
Do you need to bulk your patients and then sit and type after you see 3 or 4? Or do you need to document right after each one? Know yourself. This will take time to figure out and of course it’s not always going to happen YOUR way, but you can definitely adjust the best you can.
8. Utilize your PT techs (if you have them). I understand this may not always be an option. And even if you have PT techs, likely there aren’t enough for every therapist to use one to help all at the same time. I will say this is something I didn’t utilize as much as I could have at times. Need to check if the ortho patients got their pain meds? Send the tech to ask the nurse while you document. Need a hemi-walker? Send the tech. Need a new gown, sheet, etc? Send the tech. Not sure if someone is back yet from MRI and nobody is answering the phone? Send the tech to check. You can even just have the tech do this for everyone on the floor for multiple therapists just to prep everyone and minimize all that walking and waiting time so that you can focus on the treatment.
Their job is to help out – but be careful if you feel like they begin to do something that is an over qualification for their job. Remember, they are working under your license.
9. Don’t waste time on the people who don’t want therapy. Mr. Jones is a frequent flyer and has been here 5 times in the last 3 months. He always yells when you walk in, he hates physical therapy, he says he doesn’t ever want to walk again. Welp, okay then. Definitely give it a try. But if you have seen him every single time before and he is not budging again, why spend 10 minutes trying to convince him? That’s 10 minutes of time you could spend with another patient. Certain people are worth talking to for that long, don’t get me wrong.. But really, the guy who spits at you when you’re not even fully in the door.. Probably not. Sometimes you have to remember that you can only help those who want to help themselves.
10. Understand you’re going to have good days and bad days. That’s life, especially in acute care. Whereas in outpatient, they actually have to make the effort and *generally* want to show up… Acute care is like a constant walking into a half-clothed person’s room who just had brain surgery and being like “Hey, want to get out of bed?” I mean, heck, even I sometimes would probably just want to lay in bed and sleep. Can ya blame them? Be human, understand they are human and you might not be able to talk them into it today (or they may be medically unstable), find an employer who understands this as well.
11. Move with a purpose.Yeah, and I mean fast. If you were planning on taking casual strolls through the hospital when you decided to become an acute care therapist.. I’m not saying you can’t.. I’m just saying if ya put a little pep in your step, you might actually have time to eat lunch. Don’t run, and be safe (duh), but in my opinion, when I am trying to treat the most people that I can the BEST that I can… I need to minimize the time spent walking in the hallways. Some larger facilities already group therapists to one hall or floor, but if that’s not the case, maybe try to plan to stay on one floor for the morning and then head to the next when you’re done. Even just walking up the stairs and taking the elevator multiple times takes up precious minutes in your day (one time I even timed it at a facility just to see..TMI ha)
All in all, being productive just takes time and practice. If you are determined to focus and are able to minimize distractions, you definitely can be productive and not have to stay extra hours to finish typing! Just keep in mind that there are always good days and bad days. Patients vary, workers vary, everything varies – especially in acute care.
One rant I have personally; however, is — why is there not a standard productivity rate for each setting?! I’ve been to multiple different facilities who count different amounts of minutes as different amounts of units.. some weigh evals to be heavier while others don’t. All of this is referring to acute care. But then obviously SNFs are different since they go by RUGs – I can’t even explain that, ha. And I know outpatient facilities range greatly (from the mills to the one on one practices)…
I’m not sure how we can fix this or make a better joint productivity system, idea, thought process.. But I’m hopeful that someday we will! I see too many varying answers (which, I get it, it does vary based on patient population, hospital size, etc). But certainly we can figure out some sort of standard, right?
Anywho, rant over. I hope this helps some of you! I’m sure there are many more tips and tricks out there – so feel free to comment and add on to help each other out 🙂
Okay, so you have knee pain. You head to your physician who takes one look at your knees and – wait, what? You have “Nail Patella Syndrome” – what is that? Where are your kneecaps? … THAT tiny little thing is your kneecap? Uhhh..
Yes, knee pain is very common in the world today. Of course, with NPS, additional difficulties present, making those with NPS more at risk for extra knee pain (ahh). Let’s start with a little history of how the knee works and how having NPS may affect that.
The Knee Extensor Mechanism
This is a big fancy way of explaining how the knee works. The knee joint is only able to work properly with the help of a few important anatomical structures: The patella (kneecap), important ligaments and tendons holding it together, and the muscles surrounding the area.
What happens is your quadriceps muscle (thigh area), pulls on your kneecap via a tendon. Your kneecap is connected to your tibia (shin) via the patellar tendon. The kneecap provides an easier mechanical advantage for your quadriceps muscle to help extend (straighten) your leg.
Think about this *slightly dramatic but ya know* example: Someone is hanging off the side of a cliff (Okay let’s make it Mufasa from The Lion King). If only your arm is outstretched and all you’re pulling on is Mufasa’s head, it’s going to take a lot of strength to pull Mufasa back up, especially battling that awkward 90 degree angle. Now, if you have something in between you that you are each holding onto and pulling on, it’s going to be a little easier because there is a shorter distance between each of you to exert your force and pull.
Try watching this video below for more help with this explanation.
Okay, so now that you understand that.. Let’s figure out how NPS may differ.
You may fall into one of the few criteria listed here.
1) You aren’t affected at all and you never have knee pain. If this is you, awesome! As we know, NPS affects everyone differently. If your kneecaps are normal and you never have knee pain – that’s great. You can definitely still benefit from these exercises below to help prevent any future injury. But in the meantime, keep doing you!
2) You have underdeveloped kneecaps. This is probably the most common thing people with NPS may present with in regards to knees. Smaller kneecaps means a smaller area of attachment for the tendons. This also means it may be easier to move the kneecap in the groove that it sits in – which may lead to … ta da! Subluxation and dislocation – something that many people with NPS have at some point in their lives. This means it is even more important to focus on strengthening the muscles surrounding the knee AS WELL as the hip and ankle (will discuss this in more detail below).
3) You don’t even have kneecaps. This is also fairly common in people with NPS. While there isn’t much out there on being born with no kneecaps, there are definitely exercise programs in regards to what to do after a patellectomy (surgical removal of the kneecap). Whether you are born with no kneecap or you have it surgically removed, if you saw above, you are missing a huge part of the knee extensor mechanism – your kneecap! This makes it more difficult for your quadriceps and other musculature surrounding the knee to keep your knees stable, keep you from buckling, etc. Once again, this means it is even more important for you to work on strengthening!
Strengthening… Seems simple right? One difficulty here is that it is difficult for many people with NPS to gain muscle mass, which makes it even tougher to build up the muscles to surround your joints. BUT – in regards to knee pain from osteoarthritis (that typical “I’m getting older arthritis” that everyone talks about).. the main thing we recommend as physios is to STRENGTHEN the muscles surrounding the joint that is affected. Why? By increasing the muscle mass, you are allowing the muscles then to cushion your joint and take some of the impact and force whenever you walk, run, perform any activity. This means less impact on your knee joint itself. It will definitely take time, but once you begin to increase the muscle mass, you should be able to see some pain relief in the knee joint itself – spoken from someone who has fully experienced this, I promise!
I know I discussed strengthening muscles around the knee, but it is also VERY important to strengthen your hip and your ankle. Many times if your hips and/or ankles are weak, your knee will try to compensate and “pick up the slack.” This causes it to overwork, twist, and just do things it wasn’t meant to do. Which – yes – then can cause other knee pain.
So if you’re just beginning or you’re an avid fitness lover.. I will post a few videos here with exercises to benefit you (because everyone will differ)…
Gentle Knee Range of Motion Exercises
As I said in these videos, everybody will have a different threshold of how many repetitions and holds are appropriate for them. Generally, for stretches, I recommend holding for at least 30 seconds up to 2 minutes if you want. For many of the range of motion (ROM) exercises, I’d say 30 repetitions (2 sets of 15 or 3 sets of 10) would be okay. Strengthening exercises should start off at a lower total repetition if it is new for you and gradually work up depending on how fatigued or sore you are.
Again, if possible, to personalize this better and make these the BEST for you – try to see a Physiotherapist in person. This is more of a basic “get you started” kind of exercise regime 🙂
Oh! And by the way, I do drink protein drinks a lot – plant based for me as it suits my stomach better than whey. This is not my recommendation or saying that you should, but I feel that it works for me and helps me recover better/helps me gain more muscle mass after lifting weights and such!
Now of course, I know many people result to total knee replacement surgeries. While the pain may be so unbearable that you feel you need to have surgery – you have to remember that strengthening and improving mobility before is just as important whether you are planning for surgery or not. It’s actually recommended now to have physical therapy and strengthen your knee as much as possible before surgery so that you may have the most optimal recovery. Joint replacements are no cake walk, that’s for sure! There is definitely pain and a lot of rehab/recovery time. If you’re not sure why there’s so much pain – youtube a video on the actual surgery itself.. it’s eye opening how hard those surgeons have to manipulate, move, and bang on your body to get that new joint in (seriously). Again, sometimes this may be necessary, but regardless, it’s important to focus on exercise before as well as after!
No matter where your knee pain may be coming from.. no kneecaps.. decreased hip strength.. decreased range of motion.. etc. It is so important to exercise and do something! While not geared towards people with NPS, I have a few other blogs that are geared towards both stretching and strengthening in all populations. Check a few of them out here:
#ManageWithMovement on Instagram is a Yoga Challenge that helps to bring awareness to the public about the benefits and role of Physical Therapy in managing pain as well as various facts about opioid use.
“Specifically in the US in 2012, 259 million prescriptions were written for opioid pain medication. Stats show that as many as 1 in 4 people who receive these prescriptions long-term for non-cancer pain in primary care settings struggles with addiction.
We want to educate and talk about how PT, exercise (yoga, running, weightlifting), and holistic approaches to help safely manage pain amidst the environment of the opioid epidemic can be explored.”
Be sure to follow along and check out info from our first yoga challenge #ManageWithMovement as well as our second #ManageWithMovement2 for all the facts!
Want to join in on our next one!? *Yes, you are eligible for prizes for participating! 😉
Keep an eye out on my Instagram account for #ManageWithMovement3 – coming to you sometime Mid-2018!
Rare diseases – there are a ton of them, right? They can often times be difficult to treat just because they are not as common, the population may be widespread, and there just simply hasn’t been much research done to effectively help the people and remain “evidence-based.”
I’ve decided to try to undergo a little series here in regards to helping people with a rare genetic disease called “Nail Patella Syndrome.” Why, you may ask? Oh wait, because I have it too! While this syndrome varies widely in presentation, many factors and things seen are similar.
Those of you who have NPS may not need this brief overview, but I’ll just summarize some typical physical clinical findings and a general presentation. Please remember that EVERYONE with NPS varies in presentation – there is not just “one” type of presentation. Due to other co-morbidities, health conditions, lifestyle factors, etc., nobody presents exactly the same.
Nails – people will generally have abnormal looking fingernails and toenails, especially the thumbnails.
Elbows – people may be unable to fully extend the arm at the elbow, they may also be unable to supinate fully at the forearm due to an increased growth of the radial head (this made it SUPER easy for my partners to palpate my radial head during PT school, ha). On the other hand – people may have underdeveloped bones in the elbow, leading it to be easily dislocated.
Shoulders – not usually talked about, but due to the inability for some to turn the palms up (supinate), the shoulders may become more unstable and demonstrate increased external rotation. Think about it – if you can’t turn your palms up all the way, you will compensate and use what you have next up the chain — your shoulder! Many also present with underdeveloped scapulae.
Back – Generally, people with NPS present with increased lumbar lordosis – meaning a little more curve in the lower spine. This may make the buttocks appear more prominent. This extra curvature could also make gaining weight in the stomach region and pregnancy even more painful in the lower back. With weight in the stomach, gravity naturally pulls your body more forward, creating an angle in your lumbar spine. Already having an angle there may just make the pain a little more evident.
Hips – When I asked my professor about “iliac horns” in PT school, she looked at me like I had 2 heads. Yes, these are talked about being present on diagnostic imaging; however, they generally do not affect anything. Hips, as with most people, may tend to be stiff and inflexible. At times, people may complain of pain in the groin area due to a muscular imbalance in the hip and core region which may cause a hip impingement.
Knees – People may present with abnormally small kneecaps, or at times, no kneecap at all. This can predispose these people for dislocations if there is decreased musculature around the surrounding areas. The small size of these kneecaps and easy dislocation ability may also then cause pain under the kneecap where it improperly glides and/or partially dislocates in/out of place.
General appearance – It may be difficult for this population to gain weight, particularly muscle, especially in the proximal musculature (upper arm and upper leg). While difficult, it is not impossible by any means. It certainly just takes more work and dedication and the proper exercise program.
Fatigue – Many will note chronic fatigue syndrome. Many times this may be due to lack of activity due to abnormal kneecaps, other underdevelopments of the musculoskeletal system, or even fear of getting involved due to social reasons with the abnormality. The more active you are – whatever it may be – over time, your body will build up endurance, allowing you to participate in more activities and feel more energy.
Pain – Many will also complain of general pain, chronic pain, etc. especially at the knee joint and other joints in the body. While people with NPS have a different musculoskeletal makeup, it is at times not all that different. To feel more stable in your joints, you must have more musculature supporting them. The issue here is that it tends to be more difficult to gain muscle when you have NPS.
So, you get a general picture, right? Some people have things worse, some better. The word syndrome defined, per good ole Merriam-Webster, “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.” Meaning NPS is mainly a collection of signs and symptoms that tend to present together and make up this condition. Having NPS doesn’t mean NPS will cause something necessarily, it is just the makeup of the body with NPS (the genetic mutation, the other parts of your genetic history, your diet and exercise habits) that then may cause other things to happen. Don’t get me wrong, obviously abnormal kneecaps and fingernails were caused from the genetic mutation – but you must be careful when talking about certain symptoms that may not be associated directly with NPS.
If you’d like to read up more about the disease, I have provided a few public links below. Again, these are just a few. A quick google search will give you more available links:
So..you have NPS. What next? Stay tuned as I write up a few exercise programs, tips, tricks, and adaptations to help you manage your pain, improve your function, and hopefully improve your quality of life! Not to mention helping you understand NPS and your body a little better 🙂