Today in PT

Close Calls

This morning while innocently drinking a glass of mixed orange and grapefruit juice while watching the news before work, I was sickened to see the Australian news clip of a baby stroller rolling off a train platform and falling beneath the wheels of an oncoming train. The mother, who had let go of the stroller for just for a moment to tuck in her shirt, can be seen trying to dive forward and save her baby, but sadly not in time. She looked to be in hysterics – as I’m sure the engine driver was – but the happy ending is that after being dragged 130 feet by the train, the baby actually survived with only a minor bump on his head. It took me quite a while to shake the horrifying image from my consciousness ... A moment’s inattention very nearly resulted in fatal consequences.

As I drove home on the freeway at lunchtime, I was startled to find a little red car drifting uncomfortably close while passing me in the fast lane – I slackened speed so as to be ready for evasive action, and looked over to see why the driver was apparently losing control of his vehicle. Imagine my surprise to find the young driver cruising along in a reclined position with both hands behind his head, steering with his knees! What an idiot – in his efforts to look cool, he was endangering everyone on the road. As I fell back and watched his progress down the highway, he continued to weave in and out of traffic at high speeds, only once removing a hand from behind his head for just a moment to tweak his steering wheel, offsetting an imminent collision. Again, near-fatal consequences, this time from a moment of hubris … I’m only glad we all survived to tell the tale.

Close calls are part of the human condition, and as therapists we sadly get to see the after-effects of inattention and stupid decisions as certain patients roll into our acute care hospitals, rehab centers, and outpatient clinics. Sometimes, it’s hard to feel sympathetic toward someone who has become injured by their own hand, but if you think about it, most of us have had similarly close shaves growing up, and learned from them.

Have you had any close calls lately?

Anne Ahlman, MPT

Physical Terrorists?

Today, a patient who is being seen s/p TKA told me what she referred to as a “PT joke”:
Q: What happens when a sadist gets together with a masochist?
A: The masochist says, “Please hurt me!” and the sadist replies, “No!”

Hmm. How is that a PT joke, again? After all, since patients don’t really want to feel pain they aren’t masochists, and since therapists have to sometimes unwillingly create pain in the name of healing, we can’t be true sadists! Ah, the stereotypes abound … and as I carefully mobilized my patient’s healing knee into flexion, I assured her it was all in the name of Tough Love.

Being a PT demands that the therapist performs a dynamic balancing act of pushing forward and holding back, of encouraging while resisting, and of stressing the body's systems in a way that stimulates strength, endurance, and flexibility, yet doesn’t significantly increase the patient’s pain level — as they say, it may be simple, but it’s not easy. I have to admit, there are times I briefly feel tempted just to comfort and reassure stressed-out patients, holding off on the tough stuff for another day … but I know in my heart I would be doing them a disservice for their future mobility.

Do you know any good PT jokes?

Anne Ahlman, MPT

Speaking Directly

It’s National Physical Therapy Month! And to start the month off with a bang, it looks like we have some cause for celebration: This morning, the Senate Finance Committee unanimously passed an amendment that would add a program to the Centers for Medicare and Medicaid Services Innovation Center to examine the expansion of direct access to physical therapy services for Medicare patients living in rural areas. 

Even if you and your patients live in an urban area that will not directly benefit from this piece of legislation, the amendment represents a small step forward in the struggle for PT direct access across the board — and as a California native and healthcare provider, I find this struggle for direct access particularly stifling and irksome — so I applaud the effort, with kudos to the APTA for facilitating the conversation.

Can you think of other ways to help patients get the care they need, when they need it, and by the provider of their choice? Let me know!

Anne Ahlman, MPT

Body Language

It’s amazing how connected everything is – not just anatomically, but also emotionally. Recently, one of my patients with an upper extremity injury was discussing her plans for an upcoming total knee replacement. She was describing how she was faithfully performing her pre-operative strengthening exercises, looking into a postop rehab facility, and setting up a schedule for her children to come and stay with her during her first couple of weeks home from rehab. As she described how nice and helpful her children were and that she really had nothing to worry about, I noticed that her right hand was progressively tightening into a fist. Very interesting. As my patient went to discuss a different aspect of peri-operative planning, her hand relaxed.

I couldn’t help but point out the irony of this connection to my patient, observing that her hand had tightened up at a pivotal moment during her conversation. The patient burst out laughing, and admitted that even though her children really were great and helpful, etc., etc., she was having a lot of trouble thinking about being dependent on someone else. She explained that she had always been the planner, the list maker, and the one in control, and it was really hard for her to think about relying on someone else for the first time in her life. Her tightening hand had given her away.

What have your patients’ bodies been telling you?

Anne Ahlman, MPT

Sweet Tooth Gone Sour

I was more than a little shocked to learn that the recommendations for limiting daily sugar intake have recently shifted. In a recent issue of the journal Circulation, the authors of “Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement from the American Heart Association" discuss that over the past three decades, the American public's total caloric intake has increased by up to 300 calories/day, with more than half of those extra calories represented by sugar-sweetened beverages such as soft drinks. The newly recommended upper daily limit for sugar intake is 80 calories/day (5 teaspoons of sugar) for the average adult woman, and 144 calories/day (9 teaspoons of sugar) for the average adult man.

Let’s think about it — a can of cola contains roughly 130 calories, the equivalent of 8 teaspoons of sugar, which is well over my new limit — it’s a good thing I prefer diet soft drinks. But that forces me to choose between consuming a dozen strawberries, 24 plain M&Ms, or 4 ounces (less than 3 shot glasses-full!) of white wine each day. What’s a stressed PT supposed to do?

I know that it’s all to the good, and that as a society we are at high risk for cardiovascular diseases, diabetes, and social ostracism for obesity, but the new recommendations have certainly made this PT stop and think.

How will you choose to spend your daily sugar allowance?

Anne Ahlman, MPT

Home for the Holiday

Incredibly, Labor Day weekend is upon us once again. I always find the occasion bittersweet: I don’t know anyone who doesn’t love a three-day weekend, but it symbolizes the end of summer fun and the depressing decline into colder weather and longer nights.

I will be celebrating the holiday at home, far from the madding crowds, getting a few things done and trying to get some rest. Then, next week I’ll be taking a long-desired vacation, so this blog will be silent on Friday. But while I’m away, think about how you would like your friends here at Today in PT to better meet your needs and stimulate your interests. Would you like to see more special feature articles published on a particular topic? Do you want to read more stories of what therapists like yourselves are getting up to? Do you want to see more listings for interesting jobs in your area? Or, are you interested in writing a CE module for us?

Think it over, and let me know.

Anne Ahlman, MPT

Cloak of Invisibility

I have always loved the logical nature of physical therapy practice. As therapists, we’re trained to evaluate and treat, measure and palpate, and observe the responses of multiple body systems from a research-based perspective. But just as giving a successful treatment is based on science, PT is also an art form that requires us to adapt our knowledge to fit the individual variation of each human body and the lifetime of experiences stored within it. It’s all very challenging, yet deeply rewarding.

But pain can be elusive, at times difficult to pin down through observation and testing, and we don’t always find the responses we expect. Many patients are in bad moods because they are suffering from chronic pain, and are frustrated because their condition is seemingly invisible to their loved ones, bosses, and friends. It’s terribly invalidating — there are so many ailments that lie hidden without deformity, gait deviation, or accompanying assistive device to herald their presence. Here, the cloak of invisibility isn’t anything to do with superheroes or Harry Potter, but instead is the dark cover of feeling all alone in the daily fight for wellness.

Part of the PT's job is to validate the patient’s state of being, find the source of their pain, and then empower them to conquer it. So next time you greet your patients with the question, “How are you today?” and they reflexively respond, “I’m fine,” go on to ask how they really feel, and then be prepared to do something about it.

Are you ready to look beyond the cloak?

Anne Ahlman, MPT

Small Stuff

You always hear the expression, “don’t sweat the small stuff,” and most of the time I am in full agreement. But lately, it seems like the list of aggravating little things is ganging up on me and throwing me off balance. For example, just over the past 48 hours:
•    I was awakened at 4:30 am by the chirpy little smoke detector letting me know at regular 30-second intervals that its battery was running low (why does this never happen in the evenings when I’m awake, instead of during the usual 2:00 am to 5:00 am window of time?)
•    My back-door neighbors decided to ignore the rules of the homeowner’s association and painted their house, in plain view of the rooms I use the most frequently, a revolting shade of purple
•    The weather stripping on the top of my car door pulled away, draping festively down into my peripheral field of vision, which forced me to temporarily secure it with duct tape until I can go and buy some appropriate glue this weekend
•    Our grumpiest cat threw up on the keyboard of my recently-purchased laptop computer, causing it to short circuit — now the computer is possessed by random commands, changes in font and view, and rapidly jiggling folders that are impossible to read, not to mention a perverse insistence on sending the people in my address book random emails containing my private information
•    And this morning? As I was driving into work, I noticed that the car started pulling to the right during the final leg of my journey — sure enough, the right front tire was going flat but I had no time to fix it before patient care, leaving me stranded.

Am I being secretly filmed for a reality TV program? <Sigh.>

Each item of aggravation by itself is nothing, especially when placed in the context of important events like mourning the recent death of a beloved member of the family, but it’s all starting to wear me down and deepen my misery, making me almost afraid to leave the security of my bed in the mornings. During times like these, I’m really not in the mood to treat patients … but an amazing thing happens when I turn up for work anyway: I start to feel a little bit better.

There’s nothing like focusing on someone else to help take you out of your own head. Sure, I still need to get a new battery for the smoke alarm, plant screening bushes along my back fence, glue the car’s weather stripping back into place, repair or replace my computer, and fix my tire, but none of that stuff is actually all that important, is it?

Take care of the big stuff.

Anne Ahlman, MPT

Perspectives on Policy

**Spoiler Alert!** Although extremely important, this is rather a dry topic.

I don’t know how many of you have seen the APTA’s position paper on healthcare reform, but it makes interesting reading. In the paper Health Care Reform: 2009 — A Physical Therapy Perspective, the APTA states that it “strongly supports” healthcare reform from the perspective of enhancing insurance coverage, increasing patient access to care, and reining in unnecessary costs. Sounds good, doesn’t it?

Detailed points include guaranteeing patient access to affordable healthcare from their provider of choice, ensuring that rehabilitation services are part of standard insurance benefits packages, instituting direct access throughout the nation, repealing outpatient therapy caps, securing PT reimbursement for wellness and chronic care programs, and expanding health information technology incentives to include PT practice. Again, it all sounds good … but is there any hope these points will actually be included in the bill currently being fought over on Capitol Hill? There seem to be as many ideas of what healthcare reform should include as there are people in this country.

With so much rhetoric, information, and disinformation flying around, now is the time to discuss the facts and make our voices heard to protect our patients and our profession. Whether or not we choose to be members, the APTA is making an effort on our behalf, and that is much appreciated. But it’s time to put aside personal political affiliations and think about what will be the best way for everyone to receive quality care without restriction and without breaking the bank. Now is the time to talk among ourselves, forward ideas to senators and members of Congress, and think seriously about the future. What are the most important aspects of healthcare to you, as a PT or PTA? As a citizen? As a patient? As a taxpayer? As a family member?

The topic is too important to ignore.

Anne Ahlman, MPT

Do All Fish Smell?

There has been a lot of flap this week in the various forms of media about a recent White House statement concerning healthcare reform. In reference to tracking potential disinformation and rumors about the developing plans to reform America’s health insurance system, the White House Blog writes, “Since we can’t keep track of all of [these rumors] here at the White House, we’re asking for your help. If you get an email or see something on the web about health insurance reform that seems fishy, send it to flag@whitehouse.gov.” (Source: www.whitehouse.gov/blog, August 4, 2009).

It seems innocent enough — or is it? Although it is always important to ensure that accurate information is being circulated out there for citizens to base their informed decisions on, the statement smacks of Big Brother — watch what you think, say, and write, or the secret police will come and get you. Perhaps the statement was just poorly worded … but is it no longer OK for patients and PTs to exercise their right to freedom of speech as they discuss the specifics of a plan yet to be fully developed? I think a spirited debate over the pros and cons of a healthcare plan that will affect more than 300 million people is just what we need right now, rather than blind assent.

What are your thoughts?

Anne Ahlman, MPT