Today in PT

Power of Three

Have you ever noticed how frequently things occur in a series? One week, it seems like you see nothing but patients with right shoulder disorders, and the next week there’s a glut of patients with pain in their lumbar spines. The other morning, it was my turn to treat a rush of left knees — three patients with knee replacements and three with patellofemoral syndrome; it’s all very strange.

Strange experiences seem to center around the dreaded Rule of Three: Few therapists who have worked in geriatric rehabilitation are ignorant of the number of times three patients in a row will pass away before the census stabilizes again. Some people say that the number three has magical properties, with classical examples including the states of awareness (conscious, subconscious, and unconscious mind), the Holy Trinity (Father, Son, and Holy Ghost), and the three inalienable rights listed in the Declaration of Independence (life, liberty, and the pursuit of happiness). In medicine, we even have the “unhappy triad” of knee injury (ACL tear, MCL tear, and meniscal tear).

What does it mean? I’m really not sure. All I know is that everywhere I look, I see trilogies in our speech patterns, life events, and writings — it seems awkward to make a list using only two or four items, let alone a title (thus, Today in PT?) Come to think of it, I even used the Rule of Three when naming my book, Naked Elbows: A Physical Therapist's Reflections on Patient Care, Intuition, and Healing.

Have you, your family members, or your patients had any interesting or strange Rule of Three experiences? I’m sure you have. As they say, three’s a charm.

Anne Ahlman, MPT

Communication Breakdown

Sometimes I have trouble communicating with my younger, “tight” (or is that cool?) patients. Terms that seem simple and straightforward to me don’t necessarily come across that way to the Millennial Generation. Also known as the Net Generation, iGeneration, Generation Y, and Echo Boomers, these young individuals cut their teeth on technology and are expected to spend about one-third of their lives online. So what’s the problem?

As a Generation Jones member, I still use terms like “clockwise” when describing how to use a BAPS board, which doesn’t really fit into the digital age. For some reason, even simple directions alluding to the points of a compass (North, South, East, and West) also defy comprehension. But I can’t quite bring myself to describe an exercise using directions synonymous with iPod use (“Scroll through your home program to find the rotator cuff exercise, then select a two pound freeweight. Highlight the correct angle of inclination as you press the weight away from your body,” etc.), and I get annoyed when my young patients text each other as I work with them.

Maybe learning styles are different nowadays … or maybe I’m just getting crotchety. Funnily enough, I feel completely at home with patients older than I am; it’s just the young ‘uns who perplex me at times.

What are your solutions for bridging the language divide with younger patients? Do you “speak digital,” or do you rely on simple hand gestures to get your point across when the truncated speech of the future leaves you hanging?

After all, you don’t want to be ‘kward with your young patients — it could make the rehab experience an epic fail.

Anne Ahlman, MPT

Pie in the Sky?

The romantic traditions of Valentine’s Day. The arbitrary billions and elusive details packed inside the new U.S. stimulus package. The superstitions associated with Friday the 13th. The dream of a reformed healthcare system that will give everyone in the country unlimited insurance coverage and access to treatment, all without raising taxes. What central characteristic do these newsworthy items and events have in common? The fact that they’re all seemingly based on people’s hopes and fears, rather than on actual reality.

If you look closely, you'll realize that it’s all “pie in the sky,” a phrase coined in the early 1900s and taken up during the Second World War, which refers to things of a purely fanciful nature. But with a respectful nod to the pragmatists out there I think we need to hang onto a little hope, whether for requited love, a booming economy, a miraculously safe Friday the 13th, or a workable healthcare system. From the factual to the fanciful, people share a need to dream and to try and make the world a better place. So regardless of your political leanings, superstitions, or skepticism, get out there tomorrow and show someone that you care. Who knows? Maybe our combined hopes and good will can overturn the fear.

Happy Valentine’s Day!

Anne Ahlman, MPT

Go Red!

Today is “National Wear Red Day,” a day in which women around the country wear something red, whether in the form of a lapel pin, clothing item, or even a certain shade of lipstick, in an effort to increase awareness about the risk of heart disease and heart attack in women.

The color red unfortunately clashes with my skin tone, so in lieu of wearing something rosy to commemorate the day I spoke with a few of my patients about heart disease instead. One of them, a woman in her 70s, relayed her story to me as I worked on her recently replaced knee. She had been diagnosed with gastric reflux in the past and had obediently taken the appropriate medications and elevated the head of her bed to no avail. There was no family history of heart disease, and she monitored her blood pressure regularly. Then, one day she noticed that her reflux pain had somehow moved into both arms, causing a weird ache that spread down to just above the elbows. Perplexed, she decided to check in with her doctor right away.

Although my patient’s ECG was normal her cardiac enzymes had soared off the charts, so she was rushed into the ER where she was diagnosed with an acute MI that required an angioplasty to remove a blood clot from one of her coronary arteries.

For reasons not fully understood, women are more likely to have a heart attack that results in death than men. One reason may be that women and men seem to experience cardiac symptoms differently — a study in Circulation revealed that up to one month before an acute MI, most women experience unusual fatigue, sleep disturbances, shortness of breath, indigestion, or anxiety. Less than 30% of the women studied reported chest pain — the instantly recognizable symptom of cardiac distress typically found in men.

A recent press release from the American Heart Association reported that although emergency medical personnel respond with equal speed to women and men who call 911, women are 52% more likely than men to be delayed en route to the hospital when experiencing an acute MI, perhaps due to the difficulty in troubleshooting and recognizing cardiac symptoms.

If you haven’t talked to your patients yet about heart disease, do it today — we’re all at risk.

Anne Ahlman, MPT