The Dreaded “P” Word

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! πŸ˜‰

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)

10% off with code “x3jennyfur10”

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 πŸ™‚

PS if you are interested in acute care, be sure to check out my blog on being an acute care therapist. And if you’re small (like me), I have one for that too πŸ˜‰

And be sure to check out my recent post on being a PT without any specialty (The Generalist PT)… The “Jen of all trades” if you will.. For now at least πŸ˜‰

Until next time,


Knee pain and NPS

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..

Sound familiar?

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

Beginner Strengthening

Advanced Strengthening

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 πŸ™‚

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:

Benefits of Resistance Training

Dynamic Stretching

More Hip Strengthening

I hope this article and these videos helped! Feel free to leave a comment, email me, or send me a message if you have any other questions πŸ™‚

Stay tuned for the next blog!

– Jen

1-800-PetMeds Free Shipping $49


NPS (Nail Patella Syndrome) – General Clinical Presentation

Hey Everyone!

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:

Nail Patella Syndrome

Click to access v040p00153.pdf 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 πŸ™‚


Keep an eye out for the first blog — NPS and Knee Pain!

Until next time,


The Generalist PT

It’s 2018. I’ve been out of PT school for about 2.5 years now. Time flies, right? I can’t believe it. I’ve been working in acute care mainly, a little PRN help in SNFs and outpatient facilities… Ya know, the typical post-grad-need-to-pay-off-my-loans thing. Meanwhile, I feel like everyone around me is getting certified in a million different things. I mean, I’ve been doing my continuing ed (and some extra), but I still feel like I’m behind because I don’t have any certifications…

But do I want any? I’m honestly not sure. Each certification is hundreds to thousands of dollars, and of course certain ones require that you get approved before you can sit for the exam. It’s a lot of time and money to dedicate to something that I’m not 100% sure and confident that I want. But what do I do then? Am I falling behind? Am I going to be able to keep a job without adding letters to my name? Am I overreacting? Probably, but maybe not. I truly feel like so many PTs around me are doing residencies and fellowships and publishing articles and doing these amazing things. And for that, I applaud them (and you if you’re one of them). Frankly, I think I’m a little jealous that others know exactly what path they want to take in this career. I want to make a difference, but I want to be in it 100% – not just to add some letters or pad my resume. Not to mention I’m still drowning in over 100k of student loan debt.. and trying to experience life a little here and there..

These questions and thoughts go through my head on a very regular basis. I have looked at various certifications that I think would be good for my “life goals” but continue to have a difficult time deciding which one I want to choose (commitment issues, much?). Truthfully, I feel like I want to continue learning and improving my skills as a “General PT.” I think I made this up – but basically, I want to be like the “family practitioner” of PT. I want to learn as much as I can about a variety of things so that I can be that primary care PT who can help with differential diagnosis so that the patient can get the appropriate treatment – whether that be from me or not.

I want to work with a team of nurses and physicians and other healthcare workers to derive the best plan for a patient – whether they are a pediatric patient or geriatric patient, total knee replacement or post-CVA. I want to understand and learn as much as I can. I want physicians to look at me and ask me questions when they are deciding the best plan of care, so that they have my respected perspective on it too. I want to collaborate, I want to help.

I want to keep taking continuing ed on clubfoot and the Ponseti method and then next month take it on traumatic spinal cord injuries… and then in a few months on treating Parkinson’s. I want to confidently know the difference between an allergic reaction and cellulitis when a patient walks into my clinic. I want to understand the McKenzie method and other ways to treat low back pain – never settling with using only one tool, one technique, or one specific method.

I want to be able to read diagnostic imaging, maybe hopefully down the road (pending the state), even order it. I want to be able to determine if someone just had a stroke or if they just have facial droop from Bell’s palsy. I want to be able to notice that a patient’s back pain is caused by something that needs medical treatment instead of physical therapy treatement. I want to be an expert in differential diagnosis. Not just good, but great.

I essentially want to be that New Grad PT… but better. I want to not be pigeonholed into one category – afraid that I may lose my manual skills (which truly has already happened only 2.5 years out after mainly working in acute care), afraid I might forget how to talk to a 2 year old and be creative during treatment, afraid I may only want to do repeated extensions for everything musculoskeletal, afraid I may keep repeating the same treatment for every older person who has a fall without personalizing it.

I want to interact with people all over the world in the PT profession. Because even though I know I will always want to stay up to date generally, maybe there is something else out there, somewhere else, where my skills are in need and can provide the greatest benefit. Maybe I just haven’t found it yet.

But how? How do I demonstrate this on my resume? How do I keep improving as a generalist PT? Are there any certifications for differential diagnosis and understanding pathologies at this primary care level? Are there any interdisciplinary courses that are offered that involve all members of the healthcare team? So that we can learn and grow together?

I think this is okay to feel like this. Again, I’m not sure, but I think so. But how do we change this? How do we make these thoughts and notions about being a generalist PT feel okay? I’m simply not ready to step into the neuro world, or the ortho world, or the pediatric world, or becoming a yoga therapist… I’m not ready to fully dedicate my life to one area. And, yes, I know this doesn’t mean I can never take courses in those again, but it does mean I will be characterized by the OCS, CSCS, COMT, or the GCS or whatever letters appear behind my name. People may feel that because I did a residency with the geriatric population that I am only equipped to treat them – and completely leave out my love for the sports population. I don’t want that.

This blog isn’t meant to have answers. Mainly questions and insights for us as a profession (and other professions) to build and grow together. And for other “generalist” PTs that may feel lost to know that you are not alone. I’m not advocating for certifications or not – I’m simply saying I am personally not ready to commit, and I’m not sure when I will be. But until then, I want to keep improving my skills to show that we, as PTs, can be great as generalists.

It shouldn’t be frowned upon to be a generalist, as long as we are improving ourselves in whatever way will lead us towards our goals. And again, I’m not saying it is frowned upon necessarily, but I do know that I personally feel pressure all of the time from the advancing PT world to pursue one specific area. I’m not ready for that, and it’s okay. I’m allowing myself to feel okay about it. I know I will do my best to make a difference however I can.

Until then, I will keep seeking opportunities, progress a little, fail a little, and learn as much as I can. And I hope you will too.

– Jen

Travel on a Budget: 2 Days in Kuala Lumpur, Malaysia

After my few days in Singapore, I headed to Kuala Lumpur in Malaysia.

I took the bus from Singapore to KL which ended up being about 6-7 hours total, with 2 stops at customs/immigration, and a rest stop in the middle. Many people recommend flying as it is not much more expensive (maybe $60 compared to the $20 I spent), but truthfully, I was happy for a relaxing day where I could just look out the window and admire the Malaysian countryside.

I came to realize quickly that there are SO many places to go in Malaysia (Malacca, Penang, the islands, etc), but due to my short timeframe and budget, I only spent about 2 days in KL before heading back to Japan.

Upon arrival at KL Sentral (where my bus happened to take me), I stopped at the ATM and took out 200 Ringgits. This is equivalent to about $48 USD. I truly wasn’t sure how much I would need, so I figured I’d better be safe than sorry!

When I went outside of the mall area, there were taxis galore. I had read somewhere that taxis and Uber are very common here. The train system is also, and is likely cheaper; however, it isn’t quite as common as, say, Japan.

I was super thankful my hostel host sent me a list of directions and estimated taxi fares to get to the place. This is something I HIGHLY recommend, especially here. In many Asian countries, as I may have said before, if you are blonde, people stare. And people obviously know you are a foreigner and they WILL take advantage of you. Haggling is common here, and I am also very thankful that I learned a bit during my previous trip to Bali – AKA how to say no and make sure you are very confident in what you are asking/saying. You can be nice, but be careful because, again, they may try to take advantage of you.

My taxi fare was supposed to be approximately 5 Ringgits to my hostel. Example number one of why this was beneficial to know. I walked outside and the taxi drivers were waving me down. I showed them where I needed to go on my screenshotted map. They looked at it for a minute, conversed a little, and then said “25 Ringgits!” I initially felt a little confused, and said, “My host said 5.” No joke, they laughed at me. They kept saying “25, 25.” To which I said, “let me check.” So of course, I reread everything and realized I needed to find another way to get there. One taxi driver then approached me and said, “How about 15 Ringgits?” To which I again said no thank you and walked away.

I’m not going to lie, I felt a little frustrated. I decided to just wait a little and see if I could get some more Wifi and try to get an Uber (luckily this mall had Wifi). I also realized maybe I should try to see if someone could fix my SIM card, since it had stopped once I made it across the Malaysian border…and well, it was supposed to roam (AH!). This would be super helpful for catching an Uber.

I decided to ask some people at a local SIM card place. What I noticed, and maybe it was because I was a foreigner, or maybe people just had a bad day, I’m not sure. But when I asked about the SIM card, one lady was very short with me and said “no we can’t help you” while the lady next to her smiled and said, “maybe the information desk can help you.” It truly seemed like there were two types of Malaysian people – the ones who stared/talked rude to me and the ones who were SUPER friendly and nice. I know this happens everywhere, but I’m just letting everyone know about my trip without sugarcoating anything. Even though I was a little upset about rude people (what did I do to them!?), I had to remember that I needed to respect their country, their people, and their culture. This is their home, after all.

Once I went inside and was directed to the IT area for my SIM card, EVERYONE was yelling at me to help me – again, nice – but a little overwhelming and made me feel a bit uneasy. And of course, they only wanted to sell me something, so once I asked if they could give me advice, they said no. So, again, frustrated, I decided I better go try to get to my hostel.

I found an Uber for 8 Ringgits (that’s more like it) and decided to go with that one. My Uber driver was super nice and said how much he LOVED his job. He even gave me his business card, such a sweet man. Once I got to the hostel, I had to wait a little – because this was a “check in by appointment only.” It was legit the fanciest hostel I had ever been to. Mainly because it was surrounded by a lot of really nice hotels and apartments, with a fancy restaurant on top. Luckily, I was able to check in right away despite a little confusion.

My hostel room cost about $30 USD a night. So a total of $60 for two nights. It was steep, for a hostel, but I decided I wanted to splurge a little bit.. Mainly because when will I ever get to stay somewhere with a rooftop infinity pool ever again!?

So far: 8 Ringgits ~$2, hostel was $60. So $62 USD

The first night I ended up just chilling and relaxing there, went up to check out the infinity pool for a little before I came back downstairs to shower and get ready for bed. They had a few snacks at the hostel (Weetabix, animal crackers..) that I ended up eating throughout the evening (in addition to a granola bar and some chips I brought from Singapore). Was it the healthiest? Nope. But hey, it’s what I had. I could’ve went downstairs to the convenience store but I was just that lazy. Sacrifice.

I woke up the next morning with the plan on going to the Batu Caves for breakfast! I called an Uber using the Wifi, hopped in and headed on my way! My hostel owner told me to make sure to get a coconut here because they are “the best,” and so is the breakfast.

The drive was only about 20 minutes or so, and the Uber was only $2 when it was converted back to USD (again, I made sure to ask the hostel guy how much it should be…super helpful). Once you get to the caves, it is all free (unless you pay for parking). I was also told to go in the morning before it got too hot because, yes, you will likely be sweating after climbing all of those stairs.

I probably spent about an hour walking up and down the stairs, mingling with monkeys, hanging out inside the cave. I’m sure you could take longer if you wanted, but I was getting a little hungry and thirsty. I headed back down the stairs and saw a coconut stand close to the entrance. 5 Ringgits! AKA just over $1 USD, woohooo! I watched the guy cut it right in front of me and sipped on that beaut for a solid few minutes. I’ve only had fresh coconut in Bali and I can’t quite remember enough to compare, but regardless, it was an awesome coconut.


From there, I decided to wander a little to find somewhere to eat breakfast. There were a few shops with some local candies and treats, but other than that, nothing really caught my eye. I finally walked by a place and was waved in. At first, the guy was trying to explain things to me – it was Indian food. I decided to ask for a menu. The STRANGEST thing happened – he motioned like pushing me away instead of a “come here” motion. He walked away and kept pushing the air away. I thought maybe I offended him, I was so confused. 30 seconds later, he grabbed the menu and brought it back out to me. My heart had stopped because I wasn’t sure what I did. Turns out, I guess it just meant to wait there? I’m not sure – but if this happens to you, don’t be afraid! haha

I ordered some sort of crepe thing on the menu as well as an iced coffee. Guess how much this cost me? 5 Ringgits! Another $1 USD, woo woo! And let me tell you, this was hands down the best iced coffee I’ve ever had.

The toughest part of going to the Batu caves without a SIM card was that – ahh, I didn’t have WIFI!? How could I call an Uber?! I had asked my hostel guy (he knows everything, I swear) and he said the restaurant people would likely let you connect just to get an Uber.. but honestly, I wasn’t sure. Again, being a foreigner sometimes scares me, honestly. It can be tough, but you just have to be confident in yourself (or pretend). I ended up wandering a little to see if I could get a free Wifi connection. Magically, after walking closer to the caves, I hooked onto some. I was able to call an Uber quickly, and then walk to the entrance to wait for him (even after I lost the WiFi). Amazing, right? Also kind of lucky, but hey, it worked. Once again, this Uber was about $2.

I headed back to shower and chill out (the beds were super comfy, so why not just lay there for a little and let everything recharge?) My breakfast was kind of late so I didn’t really plan on eating until 4 PM – like an early dinner. And since I still had a crap ton of cash, I decided I would let myself splurge a little bit.

Around 4, I headed out to a mall close to the Petronas Towers. It didn’t have wifi like I had hoped, but it had a few restaurants that I could pick from. My Uber here ended up being about $1USD.

I was told to try Laksa while I was here, so I found a place inside the mall to eat this. I wasn’t sure which kind to try, so I just got the basic. Now… I’m not the spicy food kind of person (you might ask then why the heck I was in Southeast Asia?!) and I didn’t know this was going to be spicy.. but I guess I should have assumed that (duh).


So, I ate it. Well, I sipped it. And then I took large gulps of my iced tea. It was spicy (to me), but delicious! I kept eating as much as I could but eventually had to buy another iced tea (I’m that lame). My meal in total cost me about $5 USD.

Running total: $74 USD.

I still had some time to kill before it got too dark out. I wanted to make sure I saw the Petronas Towers in the light, but then wanted to be at the light show at night – around 8 PM. So, I decided to wander the mall and treat myself to some dessert. I couldn’t help it! The food was too good!

I ended up with this crepe/cake kind of thing. I think it was French inspired, but my tummy loved it regardless. It cost me around $6 USD with the coffee and cake (there was a special I took advantage of- obvi).

After I relaxed for a little, I took my short walk across the street to see the infamous Petronas Towers. One thing I want to warn people of – is if you’re on the first floor and need to go to the bathroom, they will charge you. On a budget, I could definitely head up to the next floor to go πŸ˜‰ haha.


I headed out back and relaxed for a bit in the park. There were tons of people around and it was definitely a cool vibe. I ended up sitting across the pond area so the towers were in the background during the light show. It was definitely neat, but to be honest, I thought the Gardens By the Bay one was better for sure. I would still recommend you go see this light show, though!

Exhausted and without wifi after the show, I decided to head back to the mall because I knew there was a Starbucks there. I grabbed a bag of chips (about $1 USD) and hooked onto their wifi. Yes, you had to actually buy something to hook into their wifi. From here, I ordered an Uber to head home, once again, about $1.


It was about 9:30 or so when I finally returned. Being the grandma that I am, I decided to pack my things and head to bed. I would have to get up early to head to the airport tomorrow. I planned on calling an Uber again, but, of course, the cheaper option would be to take the train (not sure how long that would take or how much).

My Uber to the airport ended up costing me about $20, bringing the total to $95. Again, I’m sure if you used the train, it would have been much cheaper. They also warn you about Kuala Lumpur traffic. I didn’t hit any (I left around 9), but beware. I wanted to make sure I left super early even though it should only take about an hour to get to the airport. Once I got there, of course I ended up eating breakfast and heading to my gate, normal airport things.

My last breakfast was Teh Tarik and more kaya toast with soft boiled eggs (similar to what I had in Singapore). I still thought it was too sweet for me, but delicious and I definitely recommend you try it. It cost me about $3.


So total including all of my transportation during my 2 days, I spent about $99 USD!

Again, without the taxi back, that could have easily been $79+ the train fee. And of course, if you wanted to spend more or had more time – go for it! Just letting you know what I spent πŸ˜‰

Hopefully this helps in your KL journey… and if you need advice on any flights or other tips to save money here and there – check out my blogs on those πŸ™‚ Or check out my most recent blog on a short trip to Palawan in the Philippines.

Happy travels!


My Day at a Singapore Physio School

During my recent travel to Singapore, I was fortunate enough to connect with a physiotherapy school and be able to visit.


How did this connection happen, you ask? Well, I am just one big ole Instagram creep who looked up hashtags and found them. Yes, it is true. I knew I wanted to visit a few countries again in Southeast Asia, but this time, instead of doing only fun travel things like I did in Thailand and Bali (which were awesome), I wanted to have fun but also travel with a purpose (and a budget..because, loans, duh).

After connecting on Instagram with a student at Singapore Institute of Technology, he forwarded me along to one of the professors at the campus. As my plans were finalized, we had continued emailing in prep for my visit! On October 26th, despite the fact that Dr. Benjamin Soon, PhD (the professor who I met with) was waiting for his wife to give birth, he STILL met with me — seriously, how cool and nice!?

Ben prepared a whole presentation for me on what they do at SIT (Singapore Institute of Technology). All in all, the curriculum was very similar as compared to the US. SIT has classes in trimesters, along with over 30 (it might actually be 40, but my brain forgot) weeks of clinicals in the end of their program. The courses were all very similar, ranging from the general musculoskeletal, neuroanatomy, kinesiology, up until they took a few electives in their later years as well as a health promotion type of class that focuses on global health.

Because Singapore is a small country, and there are only a few colleges (I believe 6 is what he told me). They rely greatly on other countries to help teach. I found this pretty awesome, as it allows students to obtain a more worldly perspective on the profession. The sister school they work with is in Ireland, and they have professors fly in from Hong Kong, England, and other countries to help teach courses. Healthcare and Physical Therapy can be so different in each country – it’s pretty amazing that they have the chance to understand it from multiple views, all while learning the basics that we all need to know to thrive as a physical therapist.

What I felt was interesting is that, like many other countries outside of the US, there is no undergraduate degree. It is instead a straight 3 years of PT school. Many will begin school right after high school (junior college for them) and continue on, finishing up their schooling in a few years. In Singapore, it is actually a requirement that men serve 2 years in the military following high school (something I didn’t know), so they may end up getting a slightly later start on college than their female counterparts.

We discussed different healthcare perspectives – different types of insurances, Medicare, repayment/reimbursement systems, and the overall similarities and differences in our profession in our respective countries.

When it comes to payment for services, he stated that when a patient visits the clinic, they are charged a fairly standard fee, all of which goes back to the clinic. To me, this is very similar to a cash-based physical therapy practice in the US.

While there is a basic standard “insurance” kind of thing (hard for me to explain) in Singapore, there are also those who may voluntarily pay more – since they either make more or have opted into having additional insurance. To better explain, I will give the example Ben shared. If I go to the hospital to have a procedure done, but I don’t have great insurance or have to rely on the basic/governmental support, I may go into a room that I will share. The luxury of my stay will be less and maybe I won’t have a TV or I will have a snoring neighbor, but the quality of my procedure and the access to the healthcare will all be the same. Now if I make more money and I want to pay a little extra, or I have better healthcare, I can pay a little extra and have a private room – yet again, still have the same care. If that makes sense?

When we took a tour of the facility, I was very impressed by the space and equipment the school had. They even had an Anatomage table, which I had never heard of before, and honestly, now I want one in my living room – ha! The downfall that we talked about was, since there are so few colleges in the area, this class had many students (up to 100). It lacked the intimacy and the ability at times to really see up close what was being presented (manual techniques, etc). They did have larger TVs for those people in the back to see, but this could certainly be a difficult learning environment.

As the program is still growing and just beginning, Ben discussed different connections with the local hospitals and the networking between facilities that occurs – very similarly to how we may network with clinics and hospitals for our clinical placements as well as using cadavers, etc.

Foodstirs, Inc

One last thing that I found super interesting was the use of Chiropractors in Singapore. Per Ben, chiropractors are not commonly used at all. He stated that physical therapists are respected much more in their country. While chiropractors are trying to make a name for themselves, they don’t even have an association there, therefore it is difficult for them to progress. It’s interesting how large of a role the legal and lobbying aspect can play when it comes to the popularity of a profession.

Ben also informed me that in some countries in Europe, cervical traction (for all professions) is banned – crazy, right!? He said it is hardly used in Singapore anymore because of this. Maybe this could also be an influencer in the willingness of someone to visit a chiropractor?? It really makes you wonder what we, in the US, are doing right vs wrong when it comes to educating the public. Not putting down chiropractors-as they are good for certain things- but what is it that we need to do as a profession, as the APTA, as all of us practicing clinicians to differentiate ourselves and educate the public on the differences between us and chiropractors…? (*food for thought*)


While there are pros and cons to every PT program – I thoroughly enjoyed having this opportunity to see another country’s approach to our profession. Although the global approach is more of a necessity for them in order to have enough professors to teach all of the courses, I feel as though this gives them an entirely different type of education. And while it is only a 3 year program – I am sure they are in much less debt after 3 years than I am now after 6. Granted, they also make less when they start just out of school. Just some things to consider!

My tour and trip to SIT was so cool and I will be forever grateful. Thank you SIT for having me!


Did you check out my experience at a Japanese Day Rehab, yet? See yet another approach to our amazing profession!

Until next time,


Travel on a Budget: 3 Days in Singapore

While Singapore was not my first solo traveling trip, I was surprisingly nervous to go. That being said, I also googled a few things and learned that it is a very safe country to travel in. I didn’t have a ton of money to spend here – as I am only working part time at the moment and my student loans show no mercy towards me. So, I stuck to a budget with a goal of spending around $100 USD once in the country (flights not included).

This goal was a little more difficult in Singapore (as compared to my 2 days in Kuala Lumpur, Malaysia), and I did end up going a little over. But I now also see places where I could have not splurged as much – or even places I could have a little more.

My flight from Tokyo was, of course, the cheapest and most direct one I could find. I really didn’t want any layovers for this trip since I knew the two major cities I would be going to are also huge airports that host a lot of layovers. I flew Delta on the way there (will update my flight blog soon!) and it was great. They actually let you have free messaging on longer flights now!? So I could keep in touch with people on the ground via Facebook Messenger, iMessage, or WhatsApp. It was a nice surprise, for sure.

I landed in Changi Airport (named the best airport for many years – apparently it has a slide, which I sadly didn’t get to see) around 12:30 AM, just after midnight. When I booked this flight, I decided to forego a hostel for that first night, especially knowing that there could have been a flight delay, essentially paying for a bed I wouldn’t be sleeping in. Not to mention, the train system (MRT) doesn’t run all night long – so I would have to take a taxi to my place. Still not super expensive, but it wasn’t something I wanted to do.

I had slept a little on the flight, but I knew I would need to find somewhere in the airport to nap for a few hours. I left the arrivals area, grabbed a SIM card (it was the StarHub Happy Prepaid card – worked great in Singapore, but it wouldn’t let me roam once I left the country – which I had bought it for that reason, AND customer service couldn’t help me out… just as a heads up). I walked around a little and found a carpeted area where a lot of people were sleeping, so I joined in.

Foodstirs, Inc

So – as I will later explain in my blog from Kuala Lumpur – I had only one carry-on bag and it had to weigh <7kg. Delta did not restrict me, but my flight back on AirAsia would. And the time of my return back to Tokyo will make it difficult for me to check a bag, as I likely would not make the train home in time. So, again, I have one book bag filled with a few outfits, some granola bars, my neck pillow, and some toiletries. I will go further into the packing specifics on another post. πŸ˜‰

So I slept a few hours, probably like 2.5 before I got up and found a charger. I knew the MRT would start running around 5 AM or so, and I wanted to get out of the airport and start exploring! I started following the signs to the MRT, got a little lost, asked one security guard (who kind of gave me a snide “it’s not open yet”) -like yes, I know, but it will be in 20 minutes and I still need to get there so — duh. The other one was very kind and laughed and tried to explain it to me. As I headed back the way I came, a man in front of me stopped and – yes- took a picture of me. There was nobody behind me at this point in time, and if you didn’t know, cell phones produced in Asia for some reason cannot have their pictures muted. So yeah – I heard it. It was strange. BUT – this is my warning for any blondes traveling in Asian countries. It happens a lot more than you think. It’s usually friendly, but sometimes it just creeps ya out. Like in this instance, when I just walked incredibly fast past this man then.

I found the MRT finally – it wasn’t tough really, just had to follow the signs. I bought an MRT card from the main desk area – again, very simple and there are signs. You can buy a ticket if you think you’re not going to take the MRT often, but it’s definitely a cheaper option than a taxi, and very easy to navigate in my opinion (even easier than Japan for me, because it’s in English!!) If you buy the MRT card, you can also use this on the buses, which I did often.

So.. Current price total: SIM card $32, MRT card: $12 — $44.

With my fancy new card, I hopped on the MRT out of the airport towards Merlion Park – one destination I wanted to see. I ended up hopping out at the River Walk area (can’t remember the stop) and did that while walking to Merlion Park. The sun was just beginning to rise – it was such a beautiful time to see everything! Mostly everything was quiet besides the few runners and bikers that I saw.


The best thing about all of this beauty — it’s totally FREE πŸ™‚



After hanging out at the park and wandering around a little bit, I had an appointment of my own across the city. Something you could do while in this area is check out Chinatown as it’s fairly close.

My little trip consisted of meeting with a Singapore physical therapist. Before I met with him, I had a late breakfast/brunch – “Singapore style” – of Kopi with Kaya toast and soft boiled eggs. It was definitely good – but phew – it was kind of sweet for me! They really like their butter. That being said, it also kept me full for awhile. Something I didn’t know is that many people put soy sauce in their soft-boiled eggs (I eventually tried this in Malaysia and it was really good!).


My breakfast? $4. That brings the total to $48 (Singapore dollars)

After my few hours visiting the local university, I finally headed back to check-in at my hostel – and walked quite a ways. My hostel total was about $15 x 3 nights — $45 (different websites give different deals – so be sure to check that out!). Another money saver to check when booking is – do they give free breakfast?? Mine did. Although it was only bread/toast with jelly or Nutella and coffee/tea – you better believe I ate SANDWICHES before I left each morning πŸ˜‰

Running total: $93

Since I was pretty exhausted that night, I decided to just shower and relax and walk around the area a little bit. I ended up finding a 7-11 where I grabbed some water and a few snacks (about $7 for 2 bottles and chips) and a hawker center that looked decent?! People were staring, so I just acted confident, as always, and ordered a rice and steamed chicken meal – which I heard you should do. So, rice, steamed chicken, and miso soup. How much? $3.50 !! WINNING!

Total: $103.50

I went back to the hostel that night and planned what I was going to do the next day. I decided to go to Little India and then see Gardens By the Bay – one of the highly rated attractions. Best part about it? You can go see most of the Gardens for FREEEEEE (such a great word, am I right?)

The morning started out rainy. Again, I had a lovely breakfast of Nutella and peanut butter sandwiches (hehe). I stocked up with my carbs before I hit the road. With the SIM card, it was super easy to navigate everywhere. One thing I did learn though – is to make sure you make it OBVIOUS that you want a bus. They will not stop. I had one pass me twice. I also don’t even think it was trying to come over, but hey, whatever. It happened to another guy too – so it wasn’t just me. They don’t wait for anyone here!

Anywho, so Little India was a cute little area. I just walked along and window shopped – knowing I had no room for expansion in my backpack. There are a lot of cheap things in this area – so if you want to spend a little, go for it.


I ate lunch at an Indian place. Azmati and chicken curry. It was really good! The other thing about Asia though, is that there are NEVER napkins out freely – I swear. Many people bring their own napkins. So here I am, napkin-less, being stared at, half-dying from the heat of the curry (I can’t handle a lot of spice), trying to make sure it’s not on my face or in my hair yet still feeling like it’s everywhere…yeah, you get the point. It was all very delicious and.. $5 ! woo woo!

Total: $108.50

I then headed out and went to the Gardens by the Bay. I wanted to time this right, because I knew there was a light show at night, but I still wanted to explore the Gardens during the day. To me, there is PLENTY to do in the free area that can entertain you for hours. It wasn’t hard, and I didn’t even get to see everything. I ended up buying the access to the others ($22 on a discount website for Cloud Forest and the Flower Dome) and splurged a little. But, truthfully, I regretted it. It was great, and if I had been there longer, I think I could’ve enjoyed it more. But for one day to do everything, it was a little overwhelming and kind of redundant. Stick to the free things if you only have a day, for sure.



As you can see, the trees were beautiful, and the gardens, again, were amazing. It was a very relaxing time just wandering and looking around. Not to mention the light show was awesome! Hands down the best light show I have ever seen. Again – all free!

Total: $130.50

After the light show, everyone booked it out to the MRT. I ended up staying back a little and just hung out. Oh, by the way, the port-a-potty they had also had a plant in it!? Crazy, right? Made me laugh.

I still hadn’t had dinner by this time, and I was hungry. Just because of time – I ended up stopping at the 7-11 on the way home. I grabbed a sandwich and, yes, some more snacks. Probably ended up totaling $7.

Total $137.50.


The next morning, I woke up and wasn’t too sure what to do – but I knew I wanted to enjoy the sun (and heat) a little bit. Of course, I ate my free breakfast πŸ˜‰ and then decided to head to East Coast Park around 11 AM or so. I wasn’t in any rush, so it wasn’t a huge deal when I left. I used my google maps and took the bus to the park. It was definitely a hot day — I wish I had wore my bathing suit instead, haha.

I chilled out by the beach for a bit. This park is less of a swimming place and much more of an activities kind of place. Many people rented bicycles and there was even a fitness park! I ended up doing a little workout before I left. After about an hour, I decided to go for a little stroll to find some water or something cold.



My lunch ended up being some frozen yogurt. Not the healthiest – but I’m an adult, right πŸ˜‰ haha. It was filled with fruit and just hit the spot! And it was $5!

Total $142.50

After I was done relaxing in the heat, it was already 2-3 PM, so I headed back to the hostel. I decided to shower once I got back and take a little nap (because I love naps, and that heat drained me!)

Now this is where I ended up splurging. I went to find Chili Crabs (which I knew would be a little expensive).. I ended up spending $30 on the crabs and $2 on my smoothie. Being from Maryland, I felt like I had to at least compare these Singapore crabs (they’re actually from Sri Lanka) to the crabs I’m used to. They were good, but they were sweeter than I am used to. And of course, they didn’t have any old bay seasoning. The way they are cooked, they ended up being extremely easy to break apart and eat.


This puts my total at $174.50 Singapore dollars. I ended up stopping at 7-11 again after to grab another bottle of water and a Milo drink for the morning (just to try it). Totaling $3. So, $177.50.

Of course, I had to be up early for check out in the morning to head to my bus. I snagged a few sandwiches and headed to the bus station (which I had chosen to be nearby). It was a little confusing to get there – but I gave myself extra time to find it, luckily.

My total cost of my Singapore trip was $177.50 Singapore dollars, which converts to about $130 USD. Things I would recommend to anyone for next time: Don’t book the extra things at Gardens By the Bay. That alone will save you $20 or so. Also, if you don’t want to splurge on the crabs – Don’t! Again, that will save you $30 right there. So maybe instead you would eat a $5 dinner. If I hadn’t spent money on those 2 things, I would have saved about $45 on my trip, which would mean I would have spent $132.50 Singapore dollars AKA $97 USD! You can also save money by not purchasing the SIM card (take another $30ish dollars away). Wifi isn’t always accessible, but everything is in English and you can usually ask someone or find a coffee shop with access!

And of course, you can DEFINITELY splurge if you have the money! I just chose not to πŸ™‚ This is just a guide from what I recommend.

Geckos Latest Offers

Another note, I ended up taking a bus to Kuala Lumpur. It cost me about $20 Singapore dollars when I booked in advance. If you book there, I believe it cost people $30. Many people fly as it is quicker, but it can cost $50 or more. Again, not a bad price – but I enjoyed seeing some of the countryside as I traveled between countries. I think I left around 9:30 AM and arrived in Kuala Lumpur around 4 PM.

Stay tuned for my Kuala Lumpur on a budget blog! I spent even less in Malaysia than I did in Singapore. So awesome!

Until next time,


Japan: To Yokosuka and Beyond

While I’ve traveled many places this past year, there’s one place I now call home – Yokosuka, Japan! Whether you are stationed here for the military, living abroad here (or nearby in Yokohama or Tokyo), or just traveling temporarily, I’m sure you will be looking for things to do!

I have been to a few places now in the local area, all at a relatively cheap price. One of the places we traveled to recently was Arasaki Park.


Arasaki park is about an hour via public transportation from Yokosuka, even quicker by car, according to Google maps. It’s great for families and a great place to spend your whole day if you desire. When we arrived, there were tons of families with tents and picnic blankets camped out for the day, just enjoying the weather.


You can either sit on the beach, at a picnic bench, in the grass, or go explore the beautiful cliffs!


The trails weren’t difficult, except maybe one where there were chains provided. However, you don’t need to conquer these difficult paths to see the beauty!

Another thing we recently did, available on the Yokosuka naval base, was rent paddleboards for a few hours. On base it was super cheap, my husband was even free. You just have to go to the Green Bay Marina to check it out.

Not in the military? Paddleboarding and kayaking are available at many harbors – google your town to see what’s available near you!

Another trip we took, just a short 45 minutes from Shioiri station in Yokosuka (possibly quicker from Yokosuka-Chuo as long as you’re on the limited express), was to Kawasaki. We have headed here twice now and plan to return again. Similar to Yokohama, Kawasaki is just a little smaller, but very modern and filled with tons of restaurants and shops.


In the summer, the More’s Beer Garden is open. For 3800 yen each, we enjoyed a BBQ and all-you-can-drink! We easily got our money’s worth, not to mention it’s on the rooftop of More’s so it was a nice view. It wasn’t crowded at all around 4PM when we arrived, but once we started leaving around 6PM, people started to gather.

IMG_3831 3.JPG

Another place we ate at was J.S. Pancake Cafe in LAZONA. These pancakes were beautiful and delicious – seriously the maple butter ones might have been the best pancakes I’ve ever had.

Finally, a place we explore often… Yokohama! Yokohama is a 30-40 minute train ride from Yokosuka and has TONS of things to do. One thing you can do in the fall is go to Oktoberfest.


Like many other Oktoberfest celebrations, there are tons of beer options, both local and from Germany, and lots of vendor food. It was a nice day to kick back and relax and enjoy some good beer (in some really big glasses…or not, whatever you decide).

Another place we checked out in Yokohama is the Kirin Brewery. You can take a free tour of the brewery, taste hops and malt, and then you get 3 FREE samples at the end. And I mean legitimate samples — like FULL glasses. The catch is, you only have 20 minutes to drink them. Challenge accepted? πŸ˜‰


Just want to go for a walk in Yokosuka? Be sure to check out Verny Park, the park that runs right next to the JR Yokosuka station, very close to Shioiri station and AEON mall. It’s a beautiful little park along the water with tons of benches, plants, and space to do whatever you want! Yoga included πŸ˜‰


Looking for other things to do in Japan? I previously wrote two different blogs on places I have been in Japan, one on some general areas and another on our adventure up Mt. Fuji.

Be sure to check those out as well- and check out my blog on Simple Ways To Save Money (because we all know traveling isn’t cheap) to help you budget for your upcoming trip!

Until next time,


Foodstirs, Inc

Frostbite on the way up, Sunburn on the way down: Mt. Fuji Night Hike

Hiking Mt. Fuji is one of the main reasons younger tourists come to Japan nowadays. As my husband and I began our research, we found there were a decent number of blogs, youtube videos, and lots of Instagram posts describing each person’s experience.

While my husband had hiked it once before, I had not. And to be honest, he didn’t even remember much of it as he did it with a tour group. We looked up and researched as much as we could. We noticed the average time is 6-7 hours to hike up the Yoshida Trail, with about 3 hours down. We are fairly active people; however, just before our hike, we had a 2 week vacation in the states where we did almost nothing other than eat and drink a lot of horrible things. And by horrible, I mean, horrible for your body. Taking all of this into consideration, we assumed it would probably take us around 7 hours to get up the trail, especially with the altitude difference. Plus, we didn’t really see anybody writing about how “easy” it was to hike.

We decided to hike through the night so that we could see the sunrise when we got to the top. After reading and seeing a few Instagram posts, we noticed that it was dropping to the 30-40s at the top, so we made sure to pack adequately (hat, gloves, scarf, jackets, and I even packed sweatpants to go over my thicker leggings). We bought headlamps off Amazon for about $10 each to wear as we hiked, since it would be dark the entire time.


Our journey to the mountain started off a bit rocky. We left from Yokosuka around 2 PM with an assumption to get to the mountain around 6-7, according to Google Map and the directions we had screenshotted from my phone. We decided to head to Shinjuku to catch the bus that takes you straight to the 5th station. Of course, after arriving to the station, we realized the bus was completely booked for the rest of the evening. Poor planning on our part for sure. From here, we had to re-screenshot directions and we ended up missing one train and waiting 30 minutes for another, which was the wrong train. Luckily, a super nice Japanese lady wrote everything down for us and told us when to get off so that we could get to the right train station (Otsuki). We ended up waiting another 20-30 minutes for another train, and after hopping on there, then getting off at Otsuki, we hopped on yet another train and made it to Kawaguchiko just before the last bus left for the 5th station. Basically, it was a whirlwind of a day. I, of course, was freaking out but luckily Scott kept it cool the whole time.

Geckos Latest Offers

From Kawaguchiko station, the bus ride to the mountain is about 45-50 minutes. We were exhausted, not only from traveling the whole day, but also from jet lag from the day before) and finally were able to catch a short 20-30 minute power nap. The bus left the station at 8:10 PM and arrived around 9 PM, which was definitely later than we were hoping. We were a little nervous we wouldn’t make it to the top for the sunrise (around 5 AM), but we were just happy to at least FINALLY make it to the mountain.

At the 5th station, they are able to lend you a lot of things and you can even buy oxygen for when you reach the higher altitudes. We didn’t end up buying or renting anything, so we can’t really speak to it, but it’s available!

We began our hike around 9:15 PM with hopes to make it by 5 AM, just a little less than 8 hours. The beginning of the trail is all pretty flat and even a little downhill. You actually start above the clouds already – I felt my ears pop on the way up on the bus! We arrived at the 6th station fairly quickly and took a very quick rest/bathroom break along with plenty of other hikers. Determined, we didn’t rest long and kept on our way. Between the 6th and 7th station (if I remember correctly) is basically just a lot of zig-zagging and walking up ash at a steady, slow incline. In our opinion, this was the worst part. I’m not sure if it’s because we like climbing more or if it was just the beginning, but we ended up stopping every 2-3 full zig-zags to catch our breath. We ended up making it to the 7th station by 11 PM…Only 2 hours!


When we got to the 7th station, we realized we had been passing just about everyone and recognized nobody else around us. We heard others saying that it takes about 2.5 hours to get to the top from the 7th station. At our pace, that was probably accurate.. AKA we needed to slow down, especially as we climbed the altitude. It was starting to get colder at this time, so I put on my sweatpants and another jacket. We ended up taking a 50 minute power-nap/rest, again, with other hikers nearby, at this station. We decided it was only going to get colder at the top and we might as well just relax for a little because we were pretty confident in our ability at this time.

Once we woke up – around 11:50, we decided to begin ascending the trail again. We got to the next little mountain hut and saw they had cup of noodles and hot tea. We didn’t really want to stop again – but hey – what the heck! So we each got some hot, lemon tea. I swear it was the best tea I’ve ever had. That’s probably because I was so cold, but it was so worth it. We sat for about 10-15 minutes finishing our tea and warming up a little before we really began again.

Between the 7th-8th station is where we really “took off.” It’s basically rock climbing/really big rock steps that you have to climb up. We were passing people right and left. It was the booty workout anybody could dream of.. so much hip extension (nerd alert). But seriously, this part was fun. We got a little tired and would take breaks, but it was way better than the first part, in our opinions. We got to the 8th station pretty quickly, but I can’t remember the exact time.

We took a solid 10 minute rest at the 8th station. Once you get past the 8th station, it’s almost like a combination of part 1 and part 2.. Long zig-zags with slow inclines but smaller rocks that aren’t really climb-able, if you know what I mean. It’s definitely tougher/more annoying, plus you start to hit 9-10,000 feet and your breathing starts to become more shallow. We took a 5+ minute break at each mountain hut, and as we got higher up, we took a break just about every 1-2 minutes.

While we didn’t necessarily feel nauseous, super dizzy, or pass out.. I can definitely say I had a headache when I first started; however, I tend to get headaches when the weather is colder, even in the 50s. Once I put my headband/ear-warmer on, I was fine the rest of the way. Our hearts started pounding with just a few steps when we got to the top, but again, we tended to move faster than others. We really started taking a lot of rest breaks because we knew we still had plenty of time.

We made it to the top just before 3 AM, so it took us a little less than 6 hours to get to the top. Don’t forget our 45-50 minute nap in the middle also! Overall, it was definitely tough, but it’s obviously doable in 5 hours if you’re in shape, especially if you’re more conditioned to higher altitudes (we flew from the east coast of the USA to Yokosuka, which is just above sea level.. then hiked).

Once at the top, we rested for a little. There is a mountain hut; however, it wasn’t open. We thought it may not open until 5, but it actually opened around 3:30 AM for food/drinks. It was kind of confusing and didn’t help because everybody swarmed in. You kind of just sat in a few rows and they took your order for simple things. I got a coffee for me and a corn soup for Scott. In case you haven’t had the corn soup before, it does come in a can. Some people around me were kind of weirded out by this. They actually sell the corn soup at train stations, which is where we first tried it.

Scott and I ended up taking turns getting up and walking around, because since we were up there around 3, we had a front row seat for the sunrise! We obviously didn’t want to lose our spot, but it was so cold that we had to get up and move a little. Once 5 AM rolled around, there were tons of people surrounding us, and the sun began to rise!


It ended up being a little cloudy, but it was still such a beautiful sight. We were still freezing, but also mesmerized by a sunrise above the clouds. We hung out for about 45 minutes watching it rise until we walked further over to check out the crater.

We probably stayed up on the mountain until about 6:30 AM, then began the trek back down. Our fingers and toes were numb and everything else was just cold. It was a beautiful sight on the way down, though. Especially since we were unable to see the scenery on the way up in the dark. We took breaks walking down also, not because of fatigue, but because it was definitely tough on our knees/ankles (are we that old?).

You’re literally sliding down ash and rock in a zig zag pattern, but lots of people were actually slipping too. I think I would have rather climbed back up, to be honest.

It took us about 3 hours, as predicted, to get back down. There definitely were people who passed us, but again, I guess we just have old and achy bones.. Back at the 5th station, we checked out a few shops and then got in line for the bus to take us back to Kagurachiko station.

We were exhausted, I was legitimately concerned for Scott because he had barely slept on our flight over and the jet lag was pretty crazy. We got back to the station, went to grab some food, and then came back to make sure we got bus tickets for the next day. We were able to get tickets from Kawaguchiko to Yokohama station, which is so much closer to where we live. And way more convenient.

Finally, we headed off to our hotel. Check-in wasn’t until 3PM, but we got there around 1PM. We waited in the lobby for about an hour and they brought us our room key an hour early! They probably felt sorry for us, but hey, we took it.

The hotel was super nice and I definitely wish we could have spent a little more time there. We ended up showering and then going right to sleep. We woke up once around midnight, but then slept in again through until around 6 AM. We slept at least 12 hours total, it was amazing.


The breakfast at the hotel was included in our stay. Everyone was wearing their robes from their rooms, it was pretty cool. I definitely would have worn mine if I had known. The breakfast was a buffet-style, but still pretty fancy.


As it was a spa, resort-style place, they also had private and public baths that could be used. We checked them out but ended up just heading back to the room to relax a little longer instead. The hotel does have a shuttle bus you can schedule, and it’s free! We just didn’t know that ahead of time.

Our trip home was, luckily, uneventful and much quicker. It was a great trip overall! Very rewarding, fulfilling, and then relaxing. πŸ™‚

Hope this helps you plan your future Fujisan hike!! Or I just hope you enjoyed reading this πŸ™‚


Until next time,



That Time I Observed a Japanese Day Rehab

During my recent travel to Japan, I had the amazing opportunity to shadow a Japanese day rehab. While I had emailed the World Confederation of Physical Therapy and the Japanese Physical Therapy Association months prior to my trip to Japan, I found it was difficult to get much of a response to set up a time for me to shadow and/or share my experiences with physical therapists in Japan. Luckily, through my work in Norfolk, VA, I had worked with an OT (stay with me here…) who had connections to a PT who initially became a PT in Japan, then met her husband and moved to the US. She then connected me with her old PT colleagues in Japan, who were then able to coordinate a time for me to observe (after a bit of a scheduling conflict). It was not exactly an easy task to coordinate, but for me, it was necessary!

In Japan, the public transportation system is top-notch. Luckily I had navigated this multiple times and kind of felt like a pro (kind of). I was able to take a train and then meet up with one of the PTs, then we got on a bus together to head to the clinic. Now I’ll be honest, I have never been to an Adult Day Rehab in the states, but I learned quite a few things at this Japanese Day Rehab that were pretty awesome!


Of course I initially was introduced as the American PT coming to observe for the day. All of the patients waved and smiled (just about all of the Japanese people I have met and interacted with are the nicest people!). We arrived around 2 PM when they were all having a seated group warm-up. Generally speaking, these patients were in there 60s and up, all of different functional levels. The facility had 3 PTs, 2 techs, and I believe it was one RN (or equivalent) and 2 CNAs. It looked much like an outpatient facility, but also had more area for the patients to socialize and spread out. Immediately after their warm-up, the patients spread out into their respective areas. Some went to the bikes, some started their home exercise program, and then others went to sit on the couch to watch TV or the table to drink coffee. Everyone was busy! The patients, techs, CNAs…everyone! But despite being so busy, everyone took so much pride, had smiles on their faces, and treated everyone respectfully.

In one corner, the PTs each had their own patient. From what I had heard, each patient had 20 minutes of one-on-one time with the PT. Then, each patient would have their own exercise program that they could perform on their own or with help from the techs/CNAs (I could never really tell which one). Timers would be beeping and techs were running to stop them, and then someone would need an hot/ice pack while sitting on the couch watching TV, and then someone would need help transferring from their wheelchair to the mat. These techs and CNAs were all over the place and on point!! It was amazing. Everyone was working together, and documenting in each patient’s book.

At one point, I looked up and saw a lady who was of a very low functional status in the corner with a CNA having her oral care done. Again, while she wasn’t with the PT, she could have other necessary things done! Not to mention take a rest after and watch some TV. I mean people were actually taking naps between sessions (whatever works, ya know!) They even had a metronome station where patients would sit and improve their coordination. The patients would record their scores on each piece of paper.

It was pretty amazing the independence the patients had, their willingness and motivation to get better. Not to mention the motivation all of the staff provided to them. The atmosphere of the rehab center was very relaxed, and again, allowed for many things to happen at once. The patients also genuinely looked like they were enjoying themselves. You could see some of the old ladies who were the “troublemakers” and always laughing, and then the others just enjoying talking to each other in front of the TV. It really seemed to make therapy an enjoyable experience (not that it isn’t, but you know what I mean..).

I observed the afternoon session, which was about 3 hours long. At the end of the session, everyone helped take vitals of all the patients and write them down in each patient’s book. The patients got to take them home with them! Not totally sure, but maybe it was their exercise program, how they progressed, what to do at home?! Then, every patient was brought to their respective car and the physical therapists/CNAs/techs drove them home! Yes, they took them in their cars and dropped them off at home. That’s one way to get people to come to therapy πŸ˜‰


Now I am very aware of the differences with insurances and policies and the differences in the way we practice between the USA and Japan, but I think, regardless, it was great to see our profession at work in another country! I really appreciated this opportunity and all those who made it happen for me.

I encourage everyone to attempt to shadow/observe a PT clinic in another country! The only way we can all get on the same page globally is to share our knowledge and experiences with one another. We all have different cultures, different practice acts, different people that we treat, yet we are all working towards the same goal!


Until next time,