Today in PT

A Fresh Pair of Eyes

As my colleague prepares to take a well-deserved vacation, I pause to reflect on what happened the last time he went away, when I absorbed a few extra patients onto my caseload. He had been seeing a patient s/p total knee replacement who had poorly controlled diabetes, obesity, a moderate amount of residual swelling, and a delayed start to therapy. Despite this, he had done wonders in restoring this patient to good functional ROM and a reasonable amount of strength. But when I saw her, the patient complained that she still had significant anterolateral knee pain that was preventing her from performing some of her home strengthening exercises successfully, and she was feeling frustrated at not being able to advance her activities.

As I looked closely at and palpated her problem knee, I noticed that the patella was tracking laterally and appeared to be frictioning on the edge of the prosthesis, not a common sight in our practice. Had her muscles gotten seriously out of balance during the delayed start to therapy? Was the swelling shutting down her VMO function so severely that her VL had taken over with a vengeance, dragging the patella into a painfully subluxed position? After explaining my theory to her, I tried McConnell taping — no easy task on such a large and swollen knee — but four glide strips helped centralize the patella and brought down her pain level when trying out the therapy step. Since that day, she hasn’t looked back and is going from strength to strength, taping for her exercises as needed.

Am I some sort of miracle worker? Not in the slightest. What I brought to the treatment table was no miracle but a fresh pair of eyes, something I highly recommend we all try from time to time when we’re feeling stuck on a clinical problem.

Have you had similar experiences with your patients? Let me know — I’ll write back after I’ve had the chance to consult with my colleague about one of my own problem patients before he leaves.

Anne Ahlman, MPT

The Value of Caring Communities

A few weeks ago, my beloved little cat, Thistle, received the terminal diagnosis of chronic renal failure. He had suddenly lost his spark, was dehydrated and losing weight, and was in dire straights with a systolic hypertension of 220 mmHg. Although CRF in cats is treatable to an extent, the treatments designed to get the body back in balance are necessarily delicate and varied. One of the things that has helped me the most, aside from obtaining excellent veterinary advice, is joining an international online community of fellow cat caregivers who also deal with the disease. Being able to share techniques for delivering subcutaneous fluids, troubleshoot ways of giving medications and stimulating the appetite, and having a safe place to voice fears and anxieties has been enormously stabilizing, come what may.

Today in PT wants to provide a similar resource to you, the therapist. This is a safe place to vent frustrations, compare treatment techniques, and renew hope for the future of the profession. So in between caring for your patients, drop me a line and let me know what’s on your mind! Perhaps we can solve it together.

Thistle’s current status? His BP is back to 125 mmHg, he’s got his purr back, and he chased a butterfly around the garden today at lunchtime. My sick feeling of dread has been replaced with cautious optimism and a fresh appreciation of being grateful for each moment I get to share with him, with thanks to my online community for their wisdom and willingness to help during some of my darkest hours.

How is everything going with you?

Anne Ahlman, MPT

Happy Easter!

Whether you celebrate the Easter holiday in the religious sense, in the modern way complete with Easter egg hunts and chocolate bunnies, or if your family honors the traditions of Passover around this time or simply goes on Spring Break, the springtime holiday provides a special opportunity for people to get together.

I know that many of you reading this blog will have traditions quite different from mine — coming from an English background, I enjoyed a visit from the Easter Bunny and decorated brightly colored eggs for the occasion before sitting down to a special Sunday roast with family — so I am interested in knowing just how you commemorate the occasion. Do you participate in egg-rolling (otherwise known as “pace-egging”) events? Will you go to church on Easter Sunday? Do you plan to do some spring-cleaning? Or will you go hiking to search for signs of new life in the faces of springtime wildflowers?

Getting together with loved ones and celebrating Easter can be as therapeutic as a good rehabilitation session. I know those of you out there reading this will have some great things lined up for this weekend, so leave me a comment about how you plan to spend your day.

I’ll write back to you after I finish attending to the ears of my chocolate bunny.

Anne Ahlman, MPT

Winds of Change

I lost some friends last Friday to the seemingly inexorable rising tide of layoffs happening all over the country. It’s a bittersweet feeling to be spared — I ache for my friends, while I’m simultaneously grateful for my own good fortune — but PTs and PTAs around the nation are noticing changes in their workplaces, whether from fewer available medical supplies, leaner schedules as patients hold off on elective surgeries, or from employers trimming rehabilitation services to stay afloat.  

The sadness of the day was compounded by the discovery of a badly stunned hummingbird in the parking lot at work. He was in distress, gasping for breath with closed eyes, and oh, so cold as he hunched miserably in the frigid wind swirling over the asphalt — the ill winds of change had apparently dashed him against the window unexpectedly, and his innocent injury seemed symbolic of the day’s sad events.

Although the little bird looked done for, I took him home at lunchtime on the off chance I might be able to help him recover. Miraculously, after some sunshine, sugar water, and TLC, he revived, warming my heart and giving me fresh hope for the future.

In times of trouble, we all need someone to watch over us and turn to for comfort. With this in mind, I hope that in some small way Today in PT can help any therapists who might be faltering by providing a place to go when searching for a new job or when needing some CEUs to keep their licenses current.

Don't despair; if my hummingbird friend can make it, so can we.

Anne Ahlman, MPT