Wednesday, December 31, 2008

POD #12

Live stream from times square, pretty cool (big brother is watching):
http://newyears.earthcam.com/ts/

I received the new Perspectives magazine and the new PT journal today. PTJ had a great article about eccentric training early after ACL reconstruction, they always have something great... and Perspectives which is a magazine especially for New Professional PT's had a great "perspective" from a good friend of mine, Evan O. Nelson, who was the president of the student assembly when I was on the nom-com. He is one of the most poignant and eloquent individuals I have ever had the pleasure of knowing and I wanted to share this quote with you all as an idealic goal for patient care:
My goal is to progressively attain higher levels of clinical competence as I develop into an expert clinician who integrates multiple data sources and considers all body systems before skillfully applying an intervention to enhance patient function.
My walking is getting better, real tests will be this Friday and most of next week when I start my arduous travelling to work (as a patient for now), get the sutures out, and possibly look for a close by apartment to cut out the 3+ hours of travel per day that probably isn't good for recovery.

Here's to 2009!

Monday, December 29, 2008

My Hard Drive Is Dying!!!!

I won't even begin on the mess that is now the Jets... or has it just always been a mess... no matter how much things change, they still seem the same, grrr... go yankees!

I had no idea Obama smoked... I truly despise cigarettes... I know, I know, what did they ever do to me... pish posh, they just kill people, and have TAR in them, how can you suck TAR into your lungs... I did know he rooted for silly teams though...

On top of everything else... my hard drive of my laptop is on the verge of death, so my recovery is not as fun without a laptop... gonna back everything up and hope it lasts longer than not... hope everyone is enjoying a smoke free day

Sunday, December 28, 2008

Post-Op Day 8

Quick notes:
On the recovery process... swelling has min improvements, I havent bothered taking circumferential measurements as I would likely do for a patient mainly because I would rather compare my left to my right any day of the week. I am close to doing a straight leg raise, and can control the leg down eccentrically which is a great feeling. Still having a little trouble with lift off though, especially without any extension lag (keeping it completely straight). Pain is still present and will most likely be there for a while, moreso because of the patella tendon they took out with the bone fragments... cutting bone hurts for a while. Walking is improving everyday. I barely need the one crutch but keep it with me. I have only left my house 3 times since the surgery, once to go to PT and that was cabs door-to-door, and the other two to my buddy's house around the corner to play some Madden. I will be going back to my job to get some PT this week, at least twice, which is quite a long journey.

I still believe in the JETS but am ready for them not to make the playoffs... they honestly do not deserve to be in the playoffs... it ain't easy being green :( But if they were to somehow end up winning the division and had a home game, I will (bum leg and all) be on line for playoff tickets monday morning wherever they may be selling them. Come on Brett, it all comes down to you... and let's go Buffalo and Jax too!!!

Because of the Vicodin causing drowsiness, my sleep schedule is a little weird. I did just receive an interesting e-mail from a young man describing himself as "an avid reader of my blog," which I did not know existed :-D

He is applying for PT school, and wanted to know some of the issues facing new grads, so here is some of my vicodin induced ramble and feel free to add any issues I may have forgotten or add to what I have put in:

- Loans!! Most of the programs out there cost close to 6 figures... there are few scholarships out there and most of us aren't wealthy enough to finance these degrees, so we are stuck with sizable loans that have sizable interest rates that just keep growing. I always say PT is not a profession you get into for the money, mainly because the salaries do not reflect how much we are paying for school. You tell people you have a doctorate and they expect you to be making 6 figures but there are few PT's pulling that off especially within those first few years of graduating.

- Too many choices, not enough experience... As much as one may cover in a doctorate or even in a masters program, it still isn't enough. Based on my experience with other new graduates, it still takes a long while to become an independent practitioner capable of providing top notch care. There are a bevy of job opportunities out there where they just need a PT no matter how many years experience they have and you get thrown to the wolves with little to no mentorship. I propose that a residency similar to that of the medical school model is quite necessary to create top quality therapists in an effective manner. This is especially true for an outpatient orthopeadic setting as the clinical hours of most programs is now between 30-70 weeks, usually on that lower end, and of those hours there is a divide of settings which opens you up to new experiences but for someone like me who really wants to focus on ortho, I ended up with 20 weeks of an ortho setting, not nearly enough. This is why I was originally pursuing a residency in Ortho which would have been a year long focus in the setting, and now have taken a position with a high level of mentoring that is very similar to a residency.
Furthermore, travelling PT is another amazing option but again may require some time working before you can dive right in to this. You sign contracts with an agency and end up working all over the country for short periods of time. You are meeting a need, getting to travel around and have some great experiences, and I believe it is actually a bit more lucrative.
You can work in home care, acute care, outpatient, rehab, a spinal cord injury center, a sports setting, cardio, academia...
A unique feature of the PT profession is just how many different options we have. You can follow tons of different paths to specialize in. You can pursue Board certified specialty in Neuro, Ortho, Peds, Sports, Womens Health, cardio/pulm, clinical electrophysiology, and geriatrics. Most of these have residencies or even fellowships. That is just within the APTA, outside of that the AAOMPT is a main organization focused on Manual Therapy. Some people get McKenzie certified (my understanding is this is the most common used treatment for back pain by PT's in North America). There are Mulligan, Maitland, Paris, Sahrmann, IPA, and a slew of other continuing education options. If you like research you can go back for a PhD in a PT related field. Bottom line is there is a lot of choosing to do, so it helps to know exactly what you want to do and get a head start on it.

- Staying involved in the profession. Too many people take for granted what the APTA has done for them. They will complain about the cost of membership... but I will use the very cliche phrase: "what about the cost of not being a member." At this time only about 40% of practicing PT's/PTA's are members and the APTA struggles to get things done on this budget. It actually loses money with student membership but obviously encourages them to get involved early to see the benefits. There seems to be a huge drop off from student membership to professional membership. What's more concerning to me is the active involvement of practitioners. There are clinic owners who are willing to pay for their employees membership and the employees reject this; it boggles my mind. We are in quite a turf war over many rights that we deserve. Things such as spinal manipulation and EMG are challenged state by state. The NATA is suing us, we have to deal with Chiropractors, MD's, and even personal trainers infringing on our ability to practice PT. In the military system PT's have free reign to order and interpret radiographs and provide various medications. I am not saying we are in sync with our education to allow us to do this in a civilian population yet, but these turf wars only hurt the bottom line. And defensible documentation ties in here as another huge issue. We need to show that PT is the best first choice for musculoskeletal care, and to date we have not been able to blow anyone away with our previous attempts at a sales pitch. The idea of meeting VISION 2020 (talk about that to the admissions board, they eat it up ;) and combining the best evidence, being autonomous practitioners (we need residencies for that), direct access (we need insurance companies to believe in us, back to evidence, cost-effectiveness).

The APTA's main purpose is to advance our profession, how any PT or PTA could not be a member, even if they disagree with some of their tactics is beyond my comprehension. With 40% of our profession behind them they have managed to be a strong voice on capitol hill, now imagine how much stronger we could be if we had a majority of our profession or just how much we could accomplish above 90%... oh what a dream...

- As a clinician there is a lot to learn. Knowing that insurance reimbursement seems to be getting slimmer and slimmer is not a fun fact, but a real one. Check out bulletproofPT.com for some idea of what's going on there. Unfortunately, so many rules and regulations change so frequently many practices need to have a person committed just to this aspect of the business. As a man passionate for patient care I recognize the necessity of this but hope that we can get back to dedicating more time to treating patients, and streamlining documentation to be as thorough as need be.

The Vicodin kicked in a while ago, but now has me up against the ropes so I have to call it quits here... hope some of this drugged up ramble makes sense and helps you out. I am probably going to post this on the blog maybe a little cleaner... but probably not.

As I said in the beginning (I think)... showing an admissions committee you have invested time into knowing the profession, investigating it, really knowing what you are getting yourself into, and most importantly showing a genuine passion for it will take you wherever you want to go within this profession. I love it because as much BS as may be present within the healthcare system, PT (especially in a quality outpatient practice) can be one of the best ways to get a person out of pain, help them prevent pain, and get them back to living their life which is a mighty powerful thing.

Going to pass out now... lemme know if you have any more questions... always glad to help.

Tuesday, December 23, 2008

Post-Op Day 5

Went for my first day of PT today at the clinic where I did my 3rd affiliation. I knew I would get some quality hands on work along with some quality nuero muscular evaluation and retraining.

Focus is still on getting swelling down, maintaining and increasing my flexion/extension (extension is more important to maintain). Waking that quad up is the most difficult part. Did a little versa climber too for cardio and a more functional range of motion exercise, getting the timing/rhythm down helped with neuro muscular re-education too...

I am sure at some point I will get into the open versus closed kinetic chain debate... in the meantime here is the most recent pubmed article on the subject, if anyone has access to the journal of knee surgery I would love to be able to get access to this article, thanks!

In other news... the Jets are still very upsetting to me because they simply shouldnt be in the position they are in and all the question marks are just silly, bottom line is I blame the coaching staff for not playing to the teams strengths (give LEON the ball!!! - that Titans game was the last time the team looked good)... le sigh... At least the Yankees got Marky Mark Tex... they sure know how to spend the money

Timothy Dalton is a poor Bond... I am making my way through all the Bond films... almost done... at least there were only two Dalton films... here comes Brosnon, hopefully a better fit... Who is your favorite Bond? Mine is Connery hands down...

Merry Holidays to all and to all some good health!

Sunday, December 21, 2008

Post-Op Day 3 (POD3)



Please keep in mind I had a decent amount of vicodin in my system at the time of this video :-D

The Jets of course blew it... and I could not be more upset... just adds insult to injury... ouch/grrr

Other things I use for my self-rehab include an NMES machine (nuero-muscular electrical stimulation) to help wake up the quad muscle after the surgery made it quite useless. Switching that off with some high volt (electrical stimulation as well) to help with some pain modulation. Doing some range of motion exercises to replace the CPM (link as promised in the video). Along with these modalities I have been doing heel slides, standing end range extension and seated hip flexion, tried my first prone hang today. I really am looking forward to being able to complete a straight leg raise with that operated leg... gee willigers

Here is that study I was discussing relatively incoherently in the video about a rabbit and the CPM...

Back to the meds... maybe they can help me forget the Jets :(

Friday, December 19, 2008

Post-Op Day 1



So the video is from the night before surgery... as I say in the video... right now I am one day out from surgery... taking vicodin...

Here is a video of a similar ACL surgery

There is a decent amount of pain and parts of the leg are still numb... just trying to relax and get the muscles going... ill keep you updated

Wednesday, December 10, 2008

MRI Fun

I figure if I put the word "fun" at the end of each of these posts it will make it more pleasant...

So I got my MRI today... total rupture of the ACL... take a look for yourselves:
I also was able to make all the MRI images into little movies and uploaded them to youtube.com, should have links soon... you should just be able to look up my username: bobzero11 (old high school thing)

So now comes picking out a surgery date and such... woo... and the very important prehab and prep, buying all the things I will need for recovery like ICE!!!

Just wanted to update you all... back to studying the article I am presenting to journal club tomorrow:

Muscle Strength and Range of Motion in Adolescent Pitchers With Throwing-Related Pain

Implications for Injury Prevention

James E. Trakis, DPT*,{ddagger}, Malachy P. McHugh, PhD§,{dagger}, Philip A. Caracciolo, MPT{ddagger}, Lisa Busciacco{ddagger}, Michael Mullaney, DPT§ and Stephen J. Nicholas, MD§

Sunday, December 7, 2008

Weekend Fun

Being a jets fan has never and never will be easy... :-( darn my loyalty

ACL/LCL injury is still up in the air, need insurance authorization to go for the MRI, then working out the schedule with work... then getting a second surgical opinion as my first ortho surgeon first wanted to aspirate my knee which is ludicrous and then did two tests, without even looking at my other leg and was ready to cut me open (go figure)... he is the New Jersey Nets surgeon so I am sure he is fine with his snips and cuts, but I need a little more... unfortunately not many surgeons take my insurance that I got for 3 months while waiting for my jobs insurance to kick in... oy vey

A bit of debate coming out now about whether ACL injury means surgery... for now I am just going to keep doing my homework and strengthening that leg...

In other news I was in PT magazine actually about 2 issues ago talking about web 2.0 and this months PT journal featured a great article from one of my coworkers along with the owner of my clinic, check it out here.

Lastly, the government wants to know how we can fix healthcare... I have said it before and I will say it again... UTILIZE PT!!!

Wednesday, December 3, 2008

Torn ACL...

So I havent posted in a while... been real busy with work and traveling to and fro... also it turns out I may have torn my ACL... more to come... and below is a post I had started a while back... enjoy...

A few things that upset me in life (small stuff):
People whose voice mail greeting says "You have just reached XXXX, please leave a message"... I clearly did not reach you otherwise we would be having an actual conversation.

Smokers in general... but more so smokers who throw a lit butt on the ground and don't step on it... I never hesitate to go over and step on one of these lit up cigarettes.

Scam artists on craigslist when I am just looking for a nice place to live!

Blogs that claim to be about one thing but drift off on weird tangents... hmmm, sounds so familiar...

The fact that I am constantly thinking of good blog posts... but by the time I get to my computer the feelings have faded or thoughts lingered elsewhere...

People who take fun things a little more seriously than everyone else... or people who dont take important things seriously enough

Tuesday, November 25, 2008

Too Early

I left my house about 20 minutes later than normal, but that's okay, it's why I give myself an extra half hour window on these early days. I haven't mobile blogged in a while but right now I am too alert to sleep but too tired to read anything.

So, the new clinic is pretty darn great so far. I know I need to do something about the commute or stop whining about it (in case I haven't mentioned, it is 3 hours a day with two bad turnovers from a late shift to early shift).

This is a pretty fast paced clinic. It is mostly ortho, and there are two floors. 4th floor is focused more on spine and upper extremity and the 8th floor gets the rest :)

I am on the 4th and we do get a variety of patients including many referrals from my old employer the Hospital for Special Surgery. There are pre and post ACL patients, total knee's and hip's, hip scopes, even have a total reverse shoulder, along with the infamous cervicalgia, sciatica, and LBP (low back pain for those not hip to the abbreviations). Unfortunately, we do not always use 'patient-first' language as you can see by that last sentence, as long as no patients/clients are affected.

I have two great mentors right now from whom I am just learning so much - it almost makes the nerd part of me giddy. Then again I only had about 3-4 hours of sleep and it is too early for giddy (plus I am sans coffee as yet).

There is a lot to read and get familiar with, but with each repetition and new case I can start getting closer to the PT I wanna be for my patients (and all my moochy friends who want free therapy).

The biggest thing I keep learning from my patients is how important prevention is, because the majority of their issues can be avoided with prehab (seeing a PT before they get hurt). But it seems to be in our culture (especially here in new york) to wait until you can't really function before seeking help. Stop toughing it out and get smart about your body (you only get one) - let the experts take care of you... you have surgery, you have drugs, you have us... choose PT!

Monday, November 17, 2008

Muscle of the Week x 2

Since I have fallen behind a little with this segment and it was actually requested, time for catch up...

Real quick, I went to a wedding in Eunice, Louisiana this weekend and had a great cajun experience. A lot of travel:

flew to atlanta and spent thursday night there, drove to new orleans and spent friday night there, drove to eunice and went to the wedding and spent saturday night there, sunday at 6 am we took off driving reversing the trip, one hour time change and flew out of atlanta 6:40 pm, got to my actual house about 10:30 pm... luckily I start work today at 11...

Psoas major
Latin m. psoas major
Gray's subject #127 467
Origin Transverse processes of T12-L5 and the lateral aspects of the discs between them
Insertion in the lesser trochanter of the femur
Artery lumbar branch of iliolumbar artery
Nerve Lumbar plexus via anterior branches of L2-L4 nerves
Action flexes and rotates laterally thigh
Antagonist Gluteus maximus
MeSH Psoas+Muscles


Multifidus
Latin musculus multifidus
Gray's subject #115 400
Origin Sacrum, Erector spinae Aponeurosis, PSIS, and Iliac crest
Insertion spinous processes of all the vertebrae except the atlas
Artery
Nerve Posterior branches
Action Stabilizes vertebrae in local movements of vertebral column
-acting unilaterally, lateral flexion and rotation to the
opposite side; acting bilaterally, extension and hyperextension of the spine;

These two muscles have recently been implicated in Unilateral Back Pain. The idea of the "core" is one that is probably not fully understood to the lay population or even many professionals. The core is the series of muscles around the trunk that helps to stabilize the rest of your body. In my short clinical experience it seems that proper core muscle training can relieve many symptoms of low back pain as well as improve performance of almost any activity. I would love to write a lot more... but I have to run to work... have a great day!

Sunday, November 9, 2008

2 weeks in an outpatient practice

Wrap-up of my two weeks in an outpatient PT practice...

I learned way more in 2 weeks than 3 months in the hospital. The difference between outpatient and acute care is fairly significant. The real exciting aspect of outpatient care is the large amount of variability. Every patient is different. Not saying that isn't true at hospitals but there is only so much variability when you have protocols to follow and only see patients for a few days at the most (the ones you see any longer generally can't do much anyway hence why they are in a hospital).

I really wasn't able to blog much because of time/fatigue/studying/reading.
.. also I had too many thoughts... So I will get better at sorting out the most relevant to get to you the reader.

Here is a sampling of patients.diagnoses I saw:
Acl repair
ankle Fx ORIF
ankle sprain Grade 2
Ankle sprain Grade3
Knee DJD-B
Knee DJD-U
Knee OA
cervical strain
Hip Fx ORIF s/p
elbow Fx
Foot Fx (MT, forefoot)
Humerus Fx/lymphedema
ITB/glut med strain
Knee scope (ligs/menisc)
Labral/biceps
Lumbar DDD
Lumbar strain
Meniscus repair
peroneal tendon inj.
pop. bypass art. graft
RC repair
RCT release/lat epic
Sartorius/Vmo strain
sciatica
Shldr impingement
thor. Strain
TKR
ulnar n. replacement/txfr

The single most common was "lumbar strain" (15x) aka low back pain which are not true diagnoses as the problem can stem from the disk, the facets, the muscles, etc. I did count the same patient if I saw them twice. I performed at least 7 initial evaluations and discharged only 2 people. I am keeping a log of the amount of patients I see and diagnoses, as well as initial evals and co-morbidities that may affect the treatment. This log is partly for my own growth and reflection and also because I eventually want to become a board-certified specialist in both orthopaedics and sports and they do ask for generalized patient population statistics, but why not be as accurate as possible?

It was a very diverse patient population from those recovering from ankle sprains and training for mixed martial arts to older patients who only spoke spanish and recovering from a total knee replacement (the TKR procedure seems to be more and more prevalent everytime I look up).

I have been told I will be starting my new job with a focus on working with spinal pathologies and upper extremity issues. A lot to learn/review. My biggest issue with the job is going to be working out travel and scheduling (currently looking for a new place to live, which in NYC is not the funnest thing ever)... More to come.

Wednesday, November 5, 2008

Over Thinking

Firstly, upon the request of MummyDearest, because I love my peoples, I will bring back the muscle of the week feature and maybe go every other week :-D

Couple of other updates... Congrats Obama, now fix health care by utilizing us PT's!

As much as I love competition, try and add to the PT Elevator Pitch competition and you could win some nice dinero...

I volunteered at the NYC marathon for the 3rd year in a row in hopes of running it next year... good time had by all... except for the one 68 year old runner who made it to the finish line and then passed away, may he rest in peace
Lastly, I have been having a pretty amazing learning experience and fun time overall working at BBW, and next Monday I start my full time position and cannot wait to get my hands in there... can you feel the excitement?

Thursday, October 30, 2008

It's Been Awhile

I have been real busy learning up as much as I can... actually in between patients right now at my temporary outpatient ortho clinic (last patient had bilateral knee arthritis, the spot right now is a no-show, and the next patient has degenerative disc disease of the lumbar and cervical spine).

The more I learn, the more I realize how little I know... but I love outpatient practice, this really is my passion... when I was in the hospital I enjoyed it but it still felt like a job, a 9-5 (or 8-4 as it were). It isn't work if you are enjoying yourself and I am... I think I need to drop the muscle of the week thing as it doesn't seem too useful for anyone, maybe I will get back into it when I am a little more settled in.

November 10 I start work full-time so my schedule should be more regular and I can really get cooking... I already have to set up my continuing education for the next year, a lot to learn, and it will never stop... I hope my excitement is coming through... back to my patients, have a great day everyone!

Thursday, October 16, 2008

Two quotes for the day

With all the political hoopla coming down to the wire I found (in the process of cleaning out my closet) a few quotes I wanted to share:

We need a PT culture that cultivates and promotes activism. Thomas Jefferson said:

"We in America do not have government by the majority. We have government by the majority who participate."

Being a PT and not being a member of the APTA, is like being a driver and not having your driver's license... -Greg Johnson, IPA course

That's all I got right now... I am doing a lot of reading... back to it!

Monday, October 13, 2008

Muscle of the Week - TIbialis Posterior

I thought I would try to bring this feature back to this blog... as I get much more immersed in "ortho PT culture"

So lets start it up with the muscle I recently injured (likely strained), the tibialis posterior (sometimes known as the posterior tibialis)

Origin: interosseous membrane, posterior surface of tibia inferior to the soleal line, posterior surface of fibula

Insertion: tuberosity of navicular, cuneiform, cuboid, metatarsal 2,3,4

Innervation: tibial nerve L4-5

Action: inversion and plantarflexion

This muscle stabilizes the arches of the foot
It functions during gait...and eccentrically controls the amount of pronation (@ the subtalar & midtarsal joints)

Friday, October 10, 2008

MRI interpretation

One of the high school football players where I part-time coach sent me a question regarding his MRI reading. While I am not a radiologist I was glad to help him interpret this statement:

The anterior talofibular ligament is thickened with decreased T2 signal intensity representing chronic sprain.
The rest of the MRI was "normal" as per the report/player.Quick anatomy lesson... we are talking about the ankle here...
Anterior means the front... talofibular ligament is how most ligaments are named, putting together the two bones that the ligament is connecting, in this case the talus (half of the major ankle joint) and the fibula (the skinny bone on the outside of your leg)
Decreased T2 signal intensity representing chronic sprain... T2 refers to the type of MRI taken; on T2 water/liquid shows up white representing well vascularized structures like a healthy ligament (as seen in the MRI above, the red arrow is pointing to a normal ATF ligament - that is a view of a slice from above most likely). When there is "decreased signal intensity" this means the ligament has been without vascularization or fluids for a while (chronic) and may have become more solid than normal.

Lastly a sprain is damage to a ligament (strains refer to muscles) and comes in varying degrees of damage. It seems our football player has not had any major tear/rupture, so play ball!

Wednesday, October 8, 2008

Kinesiotaping in Brooklyn

To: My injured brethren, sisters and family

From: Richard "Imhotep" Symister, MSPT, CSCS

Re: Kineostaping

Date: October 8, 2008

Greetings.

Within the past year, many of you have expressed concerns regarding aches, pains, strains and undiagnosed orthopedic injuries. Recently I have had the opportunity to study and use a relatively new procedure call kinisiotaping (If you tuned into the Olympics this year, you may have seen the some the Japanese volleyball players sporting this tape --- http://kinesiotaping.com/olympic-watch.php).

Kinesiotape functions to accomplish a few things:

  1. correct muscle function
  2. improve circulation of blood/lymph
  3. decrease pain
  4. reposition a subluxed joint

On the Saturday 10/25, I will be performing FREE kinesiotaping to anyone interested. The more the merrier, since this will allow me to assess the efficacy and performance of the kinesiotape, while also hopefully relieve some of your pain symptoms.

If you are interested in participating, call me @ (917) 751 7634 and we’ll discuss whether or not I think kinesiotaping might help you.. There is no obligation and, again, the service is completely FREE!

If you'd like more info on kinesiotaping, check out:

  1. http://www.kinesiotaping.com/what-s-kinesio.php#
  2. http://www.expertvillage.com/video/47464_chiropractors-kinesiotape-demonstration.htm

And please, if you know of others who may benefit from this procedure (dancers, musicians, athletes, weekend warriors, etc.) feel free to pass this along.

Richard Imhotep Symister, MSPT, CSCS

Co-Director

Brooklyn Body Works Physical Therapy, P.C.
190 Union AveBrooklyn, NY 11211
(718) 387 7420
Bbwphysicaltherapy.com
"We get your body working better!"

Tuesday, October 7, 2008

Inury and a New Beginning


Last Saturday I ran in my 3rd half-marathon of this year (and of my life - above pic is from the Urbanathlon)... I have been a bit distracted with all my job search/board prep amongst other things... I hadn't been running too much leading up to this half-mar because the Queens half-mar I ran left me with runner's toe, so I rested to try not to lose the toe nail...

So on Saturday I was running the race with my buddy Dan (in the midst of fireman training in DC aka he runs a lot). He had beaten me in the last two half-mars so I really wanted to get him in this one. I was running pretty well with him up to mile 12 (of 13.1), I had plenty of energy and know that I have more of a kick at the end than he does so I was smiling that I had him... and then just before mile 12 (at which point my time was 1:37) I felt a little twinge in my left calf, tried to fight through it but it started to feel like it was gonna rip off/cramp so I stopped and Dan took off...

I tried to stretch... tried to rub it down... I knew it wasn't a cramp but was hoping it was, because the alternative was a contractile tissue lesion aka something wrong with the muscle or tendon... I ended up trying to suck it up and jog out the last 1.1 miles but every push-off felt like it was gonna do much more damage so I walked the rest of the way, but did get a pseudo-jog going for the last few hundred feet since they had the cameras and all the crowd... couldn't just walk across the finish line... sad thing is my time was still better than the Queens one where I wasn't hurt, go figure... got ice on it as soon as I could, and then there was a long walk to the train and subway/bus ride home... I did not have my PT hat on for all this as much as I should have, but my reaction was to rest, ice, compress, elevate (RICE), gentle stretch, heel cushion to shorten the injured muscle.

Today was the first day I really went anywhere, it just so happened I was going to attend an in-service on kinesio taping (the tape that all the olympians had on in Beijing). So 3 other PT's conferred with me that it was in fact a posterior tib injury and I got a little heat and e-stim (which I am not a huge fan of but realize it has some benefits). We tried the kinesio-tape but it had minimal effect, albeit nothing about my injury is what kinesio-tape is really indicated for...

Funny thing is I had previously signed up for the Staten Island half-mar this coming Sunday which would be 8 days removed from this injury... I really want to do it so as to help qualify for next years NYC marathon but will not push it so as to make things worse...

The good news is I did get the job at STAR PT and will be accepting this position... yay!

Wednesday, October 1, 2008

Job Juggles

As indicated by the picture... I am all up in the air...

With the risk of one of my potential employers knowing about my other possibilities, I share the following with you, because I believe in transparency for health care and in my personal/professional interactions.

Currently I am doing some part-time work (about one day a week while I get oriented) at Brooklyn Body Works - an outpatient practice in Williamsburgh, Brooklyn. I have committed to cover two full weeks at the end of October while one of the owners/PT's is on his honeymoon. So this commitment has to factor in to my decisions. I personally feel inclined to "keep my feet wet" with my manual therapy skills and stay sharp with examination/interventions, because as great as reading non-stop and studying is, it simply is not the same as working with real patients and all the curveballs that happen in real life.

The rest of my time is spent on working out and studying for the board exam which I will not take until I am fully prepared this time (that $400 price tag warrants that if nothing else).

But I have to figure out what I am doing with my life... so I have been juggling out the options out there.

So last week I interviewed at two places on the same day, knowing little about either as they were both recommended by a colleague (STAR) and a professor, respectively.

The practice that was recommended by the professor actually offered me a position the next day and wanted me to start pretty soon. It seemed like a good work environment and I know my professor enjoys working there. But it would have been a similar commute as HSS which was nutty long. With no disrespect to them I was more excited about the position that my colleague recommended. So I unfortunately had to decline the offer they made to me and I had a follow-up observation day with STAR PT so I can get to know them a little better and vice versa. It was a great day that I spent there, I very much am excited about the possibility of working in such a warm and friendly environment with a large emphasis on mentorship (they are actually in the process of setting up an ortho residency which is something I really want to do). Bottom line is they let me know they were interested in working with me and I will be meeting with them next week to discuss details.

Now for the other options which mainly circle around the fact that I could use a little change from NYC:
  • An ortho residency in Jacksonville, FL which I am waiting for my letters of recommendations to get returned before completing the free application, so I add an option with no real risk...
  • Moving to Boston with one of my best friends, his wife, and their son (my godson). There is going to be a job fair next Friday and I have reached out to a few people I know in Boston as to available positions and housing. Oddly enough one of the practices that just got back to me is also named STAR PT (cue dramatic music)... Now, I am a pretty die hard Yankee and Jets fan and a New Yorker through and through so Boston has a natural rivalry with me, but I am capable of looking past that as I hear overall it is a great place to live.
  • Traveling PT... which would probably have me moving around to a few different cities throughout the US every few months. I am waiting to hear back from one of my other colleagues who has taken part in this type of unique experience to discuss some pros and cons (he is from Boston so he can't fully be trusted... but I will also get some valuable info about that silly town)
It's def. better to have a ton of options than very few or none at all... bottom line is I need to find the best mix of continuing my evolution as a clinician with the highest potential for my own quality of life... because a happy Bo is a productive Bo

I am excited for what comes next but still have that darn licensing exam hanging over my head...

Tuesday, September 30, 2008

Two products I am considering...

I like to have all the PT toys... tools... to try out, to potentially recommend to my patients/clients in the future... you gotta experience as much of it yourself (part of the reason I beat my body up running)

Here are two products I am considering trying out:

http://www.posturejac.com/posturejac/myweb.php?hls=10039

http://www.zonepilates.com/

And as cheesy as the infomercial style of the video on their site is... this is a pretty useful and practical product that I just got in the mail and am pretty happy with so far... I love pull-ups

Any products you guys like/recommend/hate (ideally related to PT)?

Friday, September 26, 2008

POPTS Clinic Interview

My mother set up an interview for me through one of her tax clients (she's an accountant). So I trekked over to Richmond Hills, Queens - about 1:45 each way for me via public transportation (maybe one day I will get a car... just trying to save the environment ;).

I knew very little about the "practice" until I got there. The location was not in the best part of Queens (and as much as I dislike Queens there are some real nice areas). Outside the office it said "Medical Office" with rehab as one of the listed services. As I sat and waited for the office manager to arrive I simply could not envision myself employed in this very sterile and cold environment.

When I sat down with the office manager he quickly broke into what the position entails: 5 days a week, 10 hours a day, 60-80 patients a day, all no fault insurance, I would have two aides to help me out. He showed me a chart and explained how each patient got basically the same treatment: ice or heat, electrical stimulation, "some massage" and he described how easy the documentation was. He told me he was ready to fire his current two PT's he had on staff to have me as the sole PT. The two PT's he was willing to let go had over 10 years experience each according to him. Please keep in mind that I just graduated, I only have a permit and not yet a license, the man did not even "interview" me, my presence and shirt and tie (I can look quite sharp) was enough for him to hire me on the spot. My first major question to him was "who owns this practice?" Lo and behold, it was a physician who "makes an appearance about once a week, if that."

Clearly I was a cheaper source of labor. The best part of all of this was the office manager, who was not a PT, and his complete lack of awareness of the regulations behind PT permits and licensure, along with clear issues with other aspects of the law. The particular regulation he was not informed of is the following:

Supervision of a permittee by a licensed physical therapist shall be on-site supervision and not necessarily direct personal supervision except that such supervision need not be on-site when the supervising physical therapist has determined, through evaluation, the setting of goals and the establishment of a treatment plan, that the program is one of maintenance as defined pursuant to title XVIII of the federal social security act.

Needless to say I took the job on the spot... JUST KIDDING!!! This was a clear abuse of "quality Physical Therapy" and part of the reason our health care system is all screwy... people cannot get better with this "mill" of rehab. My next step regarding this "business" is to figure out the most appropriate way to report this clear referral-for-profit situation to the state board.

I actually was at a Brooklyn/Staten Island district meeting of the NYPTA last night and the speaker was from the state board of Physical Therapists. She described the difficulty with anectodal evidence in reporting these situations is that often times it is not enough for the state board to begin an investigation, to which my response was... what other kind of evidence can we really provide - patient accounts, the stories of people who were foolish enough (or greedy/unethical [let's call it what it is] enough) to work at these establishments...? It's just a sad situation that needs a solution, but I need to deal with this after I pass my boards... stupid boards...

Tuesday, September 23, 2008

Urbanathlon Craziness

I dare you to even look at this course and the obstacles:

http://www.menshealthurbanathlon.com/course.cfm

I just ran 55 flights of stairs to prepare and ouch!

The best news is the following day I am signed up for a marathon tune up which is 18 miles!

Although I will only be medically volunteering for the NYC marathon for the 3rd year in a row, I should be able to qualify to run next year's race which is a mini-dream of mine.

Hope you got your workout in today!

September Blues

I'm actually not blue, I'm quite the opposite (whichever color that would be...)

But I did end a pretty good position at HSS and then I failed my board exam, then all the funk surrounding the NYJets and Yankees... As for my exam, I took it before I was prepared and only to appease my employers at the time which was doubly foolish since they are no longer my employer. My biggest advice to anyone who is lacking common sense like I was (and hopefully no longer am) is to wait until you are ready and make sure your practice exams are higher than the 75 percent you need to pass (mine were not).

I have not failed many exams in my life, but I like to roll with the punches. I have plenty of excuses but at the end of it all that doesn't mean much. Bottom line is I still have my deep rooted passion for working with individuals to help improve their health, movement, and functional capacity. As far as my clinical abilities I am confident that I am more than competent. In my three months at HSS my patients gave me some really positive feedback as did my supervisors and that is the major litmus test for me right now. I realize for my sports/ortho focus I have a million and one more things to learn and smooth out and am excited to continue that process. In fact that is what I am doing with my time off, just reading and learning more and more along with studying for the boards properly.

I am also exploring my job opportunities. I will be doing some part time work at one outpatient clinic in Williamsburgh Brooklyn and am interviewing at a few others. Traveling to other cities is also a possibility. While it is hard to leave NYC, the capital of the earth, I am sure other cities have something to offer :-D
I am truly in that "new professional" stage of my career where I have oh so many possibilities. Should be a fun ride.

Friday, September 5, 2008

Final Tune Ups


Firstly, my time at HSS is over, sad to say, but that is what it is, and that is all there is to say until at least after I pass my exam, and who knows when that will be, I know quite a few people who just missed the passing grade, gulp...

License exam is in a few days... just need to get a few things straight that always seem to be pesky in my brain (usually because it is of little interest or little practical use in clinical settings)

1) Levels of measurement: nominal-yes or no, one or the other... ordinal-ranking scale with no equality btwn each category... interval-distance btwn each # is =, scale and 0 are arbitrary... ratio-has an absolute zero

2)PNF patterns, although seemingly useful for most major conditions, are just one thing I have yet to wrap my little brain around.

3)There will likely always be a nerve innervation or two that I forget... but this morning I blanked on the thoracodorsal nerve innervating the lat. dorsi... duh!

4)Modalities, especially TENS settings, i.e. sensory-level stimulation is characterized by a relatively short phase duration of 20-100 microseconds... I just haven't used most modalities pretty much in all my time in PT... and I have not committed the brain power to memorizing as much of this madness as possible... but I will try just so I don't fail by one question or so...

5)Conduction aphasia... I am good with Broca (difficulty speaking) and Wernicke (diff. understanding)

6)For the record, IER has much better explanations/rationales than Scorebuilders (not sure why that link has the book so expensive) but the latter has a clearer and fuller look into most of the actual information, especially the "other systems".

Alright, this post was drawn out over a few days... but now that the JETS won and I have less than 24 hours... I am going to cram a little more, watch a movie and let the PT gods decide what they want to do with me... hopefully they are kind

Have a great one, world!

Thursday, September 4, 2008

Body in Motion



Pretty cool website I stumbled upon when researching "thomas heel" (I especially like the runner one)... as a PT ya gotta love the body in motion... even if it is a sculpture that is not moving at all

Tuesday, September 2, 2008

More on running

On my morning commute I see a lot of people running/jogging. One thing I always look at when observing other runners is the trunk rotation. Simply look at where the arms would (or worse, do) cross. A long while ago, in the very scientific journal 'Men's Health', I read a piece of advice that if you were to extend your arms out while jogging that is only when the wrists should cross. Any extra trunk rotation is wasted energy.

Think about it. The idea of jogging is to go straight forward, why would you include any motion going sideways? Take a look next time you see a runner or are a runner...

Monday, September 1, 2008

Down to the wire

Studying is fun... not!

There are easy things to get, like the fact that women who are pregnant have an influx of a chemical called relaxin (which sounds like relax) which oddly enough "relaxes" the joints and ligaments to make the woman's joints more mobile to allow for an easier delivery, and the chemical can stay in place for up to 3 months after delivery.

Then there are ridiculously complex topics and topics that you really need to see for yourself or force yourself to learn because otherwise they make no sense! Almost anything that is an eponym fits that bill. Things like wound care and spinal tracts are just not areas of interest to name two...

Anywho... I will report back how the rest of studying is going...
I would like to throw out that I am really enjoying my time at the Hospital for Special Surgery despite up to 4 hours of commuting a day, I have some great co-workers throughout the hospital and some awesome patients, and I learn new stuff everyday, its a pretty awesome first job

Thursday, August 21, 2008

Running support

Recent articles supporting the benefits of running throughout the lifespan:
http://www.insidermedicine.ca/Archives/Running_for_Longevity_Weight_Loss_and_Type_2_Diabetes_Childhood_Trauma_and_Alcohol_Use_2767.aspx

http://blogs.usatoday.com/betterlife/2008/08/running-away-fr.html?csp=34

http://www.medicalnewstoday.com/articles/118052.php

http://www.medicalnewstoday.com/articles/118030.php

http://www.thecamreport.com/2008/08/12/benefits-of-running-in-the-elderly/

http://www.medicalnewstoday.com/articles/117929.php

http://www.sciencedaily.com/releases/2008/08/080811195633.htm

http://news.bbc.co.uk/2/hi/health/7554293.stm

http://healthfinder.gov/news/newsstory.asp?Docid=618244

And I am usually the one cracking some bad jokes but I thought this was in poor taste, tsk tsk OT student with tons of energy to blog all throughout the night:
http://otstudents.blogspot.com/2008/08/how-to-determine-if-you-should-go-into.html

No Internet!!!

So to cut my commute by about 3 hours and 50 minutes daily I have managed to apartment sit for a friend of my mother's near my hospital, unfortunately I have no way of finding out the wireless password and the ethernet doesn't seem to work for some reason so it's been rough goings as far as updating... I have been updating my "shared items" on the bottom right hand of this page which has some really interesting stuff every day, I get that all through my phone very easily...

I ran (figuratively) back to my long commute today to pick up my new rollerblades (which are too small and a pain to return via mail:( and my new tennis racket (my first one ever really-new game for me, got a long way to go)...

Still been running (literally), and will undergo a V02 max test next Monday which is exciting.
Been watching a bit of history at the olympics, between Phelps and Bolt I am amazed, much moreso by Bolt who if you divide out his "40-time" from the 200m would equate to a 3.53 or something crazy low like that when the top rookie to run it at the combine this year was at about a 4.27... if anyone can fathom these numbers kudos to you and kudos to those olympians, world records being shattered

Back to my board prep for a minute though... I took another Practice Exam/Assessment Tool (PEAT) from the fsbpt and improved and achieved the score I told my professor I expected to... I am 2/2 at predicting within one point of my score which has to count for something... hopefully the day of the real exam I predict a minimum of a 77 or so since 75 seems to be passing nowadays (I have heard rumblings that there is a bit of a tiny curve?).

One thing I found very helpful in taking the exam was drawing a little human on my dry erase board (that is what is provided for the exam to jot down whatever helps you throughout the exam). Many questions force you to picture a lot of anatomy so it helps to have that little guy/gal to help visualize what the question is trying to trick you into... or I trick myself into...

Upon review of the questions I got wrong (and even most of the ones I got right) I realized that I like to overthink questions a bit... which I kind of always knew... as I tend to ramble also I think that ties into it... and at work they tell me I am too thorough and can leave some superfluous things out of my instructions, still trying to be efficient... the more feedback I get the better I get at it... although my patients seem to enjoy all the extra tidbits :-D

At work today we were given a clinical competency exam (the 3 newer employees) which was fairly interesting, had somethings I had not seen clinically and some I have seen once or twice but should be much more familiar with... it is such a great learning experience being there though... can't applaud them enough on the educational aspects of the environment...

Anyway, from all the figurative and literal running I have to get back to shower and study... more to come on the study tactics and I bid you all adieu!

Tuesday, August 12, 2008

Board Prep

Thank you to my reader from the U of W for this topic... as a general rule I love feedback and questions and am willing to share what I got up in my brain with those willing to listen.

The National Physical Therapy Exam is the exam that if/when I pass will allow me to be licensed in the state of New York.

Not all states have temporary licensure, however NY is one of those states thus I currently have a temporary license which allows me to practice/treat patients.

The exam itself is 250 (4-choice multiple choice) questions with 5 hours alloted for all of them, which leaves about 75 seconds a question. 50 of the questions are experimental but you never know which they are. The topics covered are: Musculoskeletal, Integumentary, Cardiopulmonary, Neurological, Other systems (with an increased focus recently placed on genitourinary, gastrointestinal, and women's health to reflect the changing face of PT).

Two years ago at one of the major APTA conferences I purchased the O'Sullivan review book. I am still using that book at this point mainly reading through the exam questions/answers/rationales in the back of the book to skip the process of taking the practice exam and getting the questions wrong... then going to learn it in the back of the book. I find this to be a great use of my time, although none of the questions are likely to find their way to the actual exam. From what I have heard the book practice exams are more difficult than the real exam. The other rationale for my skipping the test taking is I am confident in my ability to take exams, if this is not a strong point for you then take as many practice exams with as real a simulation to the real thing as possible! The exam is a computer-based one and there are a few breaks, and a whole process for different sections (closing off and bathroom breaks, etc.) with the ability to 'flag' a question you may want to return to later.

Another point of interest is that you should be able to score a minimum of a 75 on 3 straight practice exams before taking the boards to statistically "gaurantee" a passing score on the real exam as per a few recent studies and trends noted in academia.

More to come, just gotta run right now (literally, 1 hour in central park, talk to ya'll soon)...

Monday, August 4, 2008

Nice Day Off

here is the video of me pitching that I had pictures of in an earlier post:


today was nice, I went and played catch (football) with one of my buddies and then hit some golf balls at the driving range, improved my chipping and putting... got some decent studying done for the boards believe it or not and had a football coaches meeting to close out the day... now back to my Tuesday-Saturday work week... off to sleep!

Sunday, August 3, 2008

Sunday PT

As someone who isn't used to working at all, working on a Sunday is a unique feeling... it's 6:40 AM and I am waiting for the train (trying rollerblades for the non-train part of my commute).

As a recap I work in acute care ortho setting where almost all patients just had some sort of orthopaedic procedure performed. The majority are total hip or knee replcaements followed by spinal surgeries and a variety of other interesting surgical procedures that require some assistive device training, gait/transfer training, safety and patient education, therapeutic exercises and range of motion.

For the first 6 days of the week therapy is provided twice a day and on sunday's only once.

The weird thing this week for me is I had yesterday off and will have tomorrow off. So it's almost like having two weekends...maybe?

I normally have Sunday and Monday off but I became a godfather yesterday so I had to take the day off. Which did give me a chance to take part in the new york road runner's long training run in central park where I ran 10 miles in just under 80 minutes with an average HR of 170. Then I ran back to my friends place to shower and ran to the train to get to the godfathery-thingy.

In other news my boards are fast approaching... that's really all I have to say about that :)

Have a great sunday... football is coming!!! yay...

Friday, August 1, 2008

Balance & Symmetry

Homeostasis is a term often brought up when referring to the ideal state of the human body.

The body as a unit has a balance between structure and function. Many engineers and architects seem to have a great understanding of these concepts, and ultimately the body is a lump of clay that is molded over the years. The longer your movements (your functions) are out of balance, the more deep rooted an imbalanced structure becomes.

Little things like brushing your teeth with only one hand can take up but a tiny portion of ones day but are furthering the use of one hand versus the other. Holding a bag always on the same shoulder rather than switching it up can actually limit your arm swing when walking because (women in particular) have the tendency to hold a bag in one hand when walking. Everytime you slouch you go further into the forward-head/caveman posture. Usually people are just not aware of these imbalances until it starts to hurt, and usually by then it is too late. Even having a dominant hand, one you use for the majority of tasks, tends to leave that dominant shoulder lower than the other and that sides 'upper quarter' more loose simply from being more active.

So this is my call to you to add balance to your life, not just left to right but front to back as well. An ounce of prevention is worth more than a pound of cure. Every little bit counts. Don't say I never warned you :-D

Monday, July 28, 2008

Function

One of the main goals in Physical Therapy is the restoration of function. Here are some milestones we are looking to achieve with total hip and knee replacements (respectively).

Source Norkin, C. C., White, D.J. (2003). Measurement of joint motion: A guide to goniometry (3rd ed.). (not exactly the proper way to cite, but its the best I got at 5:34 AM and yes I realize and I want those who do not know that a textbook is a secondary source since they are citing other resources and bringing it all together, but convenience is good too)

Hip flexion range of motion (ROM) required for functional activities:
-walking on level surfaces: 0-44°
-ascending stairs: 47-66°
-descending stairs: 66°
According to Magee, ideal functional ROM of the hip include 120° into flexion, 0° of abduction, and 20° of lateral rotation (or external rotation - I wish they would just call it one thing!)
-sitting in a chair: 112°
-putting on socks: 120° flexion, 20° abduction, 20° lateral rotation (sartorius muscle!)

Knee flexion ROM necessary for functional activities:
-walk on level surfaces: 63.1°
-ascend stairs: 92.9°
-descend stairs: 86.9°
-rise from chair: 90.1°
-sit in chair: 93°
-tie shoes: 106°
-lift object from floor: 117°
-putting on socks: 117°

I was going to put pictures of all these so you could all get a visualization along with these but instead I wanted to put me pitching broken down versus Brandon Webb of the Arizona Diamondbacks, enjoy :-D

PS, this is not my best biomechanics ever, I opened up my hips too early and pointed my lead knee inwards as the two most obvious problems, see if you can find some more (click on image to enlarge)!


Monday, July 21, 2008

PEAT

So I am finally registered for my licensure exam, have to take it by September 9 or I lose my money... I am pretty behind on my studying-particularly of those obscure areas of PT that I don't see much at my job or any of my previous clinical experiences (I am an experiential learner)

Off to take the supposed 'most realistic' practice exam available in the form of the PEAT which is offered by the FSBPT (the same org. that administers the real exam)... at the end you get a thorough breakdown of your weak areas... but they can never tell you how good of a guesser you are. This will be my first full in-depth practice exam, which should set me up nicely for the next six weeks or so of intense studying... hello starbucks!

Monday, July 14, 2008

America's Past-time


I wanted to share with you an experience or two I had this weekend... that is after all what this blog is for.

My mom wanted me to send one of her friends to an "orthopedist" for her back pain. I talked with this woman on the phone. As she described the types of physical therapy she had tried, I asked if she happened to know whether or not they were owned by medical doctors... and lo and behold she had been to a few POPTS. There she had received the opposite of quality care that I believe PT is about. Along with being cramped by the mass of patients/clients, all she received was some electrical stimulation, hot or cold packs, and maybe massage. No one ever really evaluated her or explained what could be going on with her. She discreetly explained to me it felt like they were out to make money and had little to no concern for her condition.

I explained to her that this is an unfortunate aspect of the health care field, especially one that gives physical therapy a poor image in the consumer's eyes. There were three to four clinics I recommended to her in Brooklyn that would be convenient for her to get to and where I know she will get quality care, a thorough evaluation of her condition, with the focus being on her and not her wallet (or purse?). This is a conversation I have had in the past with many patients who had already found the quality care of the clinics I happened to be working (affiliating?) at/with. The APTA and a few states in particular (South Carolina comes to mind) have been trying to battle what is now referred to as "referral for profit" (this phrase was thought to better capture the issue we are dealing with here).

Take a look at some of the documents the APTA has on this and a litany of other issues we are facing in this wonderful profession... It stinks that as a PT - and I think I speak for more than just myself - you genuinely want to help people feel better, function better... and have to deal with so many other professions looking to just make money (not to pigeon-hole entire professions, but I call it like I see it kids) as well as dealing with the tremendous cost of education to help people out. I did not get into this profession to make money, whats more is I did not get into it to battle with Chiro's, Athletic Trainers, Personal Trainers, MD's, physiatrists, and the list goes on... So for now, I will keep doing all I can do to help out as many patients/clients as I possibly can and hope that my and many other PT's efforts on the lobbying front come through so that health care can be more transparent and we can alleviate some of the ridiculousness that goes on in our health care system. At this point I am just ranting and need to pull back so I leave some room to study for my licensure exam...

Speaking of the licensure exam, I did take another break from completely studying this weekend as I volunteered at the MLB All-Star Fan Fest which was held here in NYC! Above and below are two of my fun pictures from the event, if you get a chance to come by this year or in the future, I highly recommend it. There are a few PT related things... i.e. the physical challenges that people have not been warming up for and thus I have heard "my arm is killing me" or "ouch, my hammie". The challenges include batting cages, throwing a baseball for video analysis (which is very cool) and for speed, fielding fly balls, a home run derby, a race from 3rd base to home that they time (my best times which are sad were 4.50 and 5.80 backwards - its 30 yards, so I am not yet ready for the big leagues :(

Until next time... stay healthy!!!

Friday, July 11, 2008

Delayed post

Express bus blogging just isn't the same as the train for some reason... Could be because the blogger website isn't working right now on my phone (neither is myspace, oh no-sarcasm). So I am blogging into my email server to allow this to get published at a later time.

Been pretty busy with orientation to work, went to the poconos with my sister's family, been training aka running for two upcoming races, going to be volunteering at the all-star fan fest this week which should be tons of fun.

We had the hospital-wide orientation monday and tuesday, which included fire safety, benefits review :), cultural competency, harassment (not education about it, they actually harassed us... JUST KIDDING), a few other fun points of interest and the heart of excellence training program which every new employee goes through and consisted of 'team building' exercises and a focus on the qualities that make a quality employee within the healthcare field. Of course as a big PT nerd I was ready with the APTA Core Values:

Accountability
Altruism (which was the first time in any of the orientations this was said)
Compassion/caring
Excellence
Integrity
Professional duty
Social responsibility

It was a worthwhile experience. And I was sad to find out that I could not be a medical interpreter for the hospital because although I speak Russian I cannot read or write it whiich is a prerequisite for the 60 hour training program (I came to America when I was 3 and haven't had many chances to read or write it despite living so close to Brighton Beach. But they seem to have a quality program and overall the hospital seems to do most things right which is probably why they (we) are ranked NUMBER 1 in US News & World Report for Orthopaedics and #3 for Rheumatology.

Off to get my PT on, talk to ya'll later, have a healthy day!

Thursday, July 3, 2008

Poconos

Lot happened since my last post. Many mobile mistakes that caused losses of entries, hope it doesn't happen here...

So we will go backwards a little:
Today, had a pretty great day, I am up to 11 patients a day and saw one of them twice (not gonna go too far into the details of my whole day just yet)... got my first pay check as a PT and goodness gracious great balls of taxes, they took out a small fortune for taxes, that is just frustrating as heck (hope I get some of that back when I file my taxes, c'mon uncle sam!)

Yesterday, I served jury duty, sat in the waiting room with free wi-fi, had my laptop, was there 8:30-2:30 with an hour for lunch in there, they didn't need me so I can't get called back for 8 years, yay kings county! Found out I'm gonna be a godfather ('never go against the family...' brando)

Basic review of the course I took this weekend, it was pretty awesome, simple as that, the instructor(s) was(ere?) awesome. Did my VO2 testing and have started a structured running program based on the results. I believe my VO2 max was about 48 whereas Sean Avery of the NHL-NY Rangers (i think he may have just signed somewhere else) (he was tested by the same guy as me a week earlier) he was a 58 - but he trains for a living! Anyway, I got this great new program and I am siged up for two awesome races (one end of August and another a month later)...

Gonna stop here so I can focus on walking through Coney Island to get home - isn't it nice following my every move :)

addendum, haha, forgot that I named this post because I am going to the place in the title for the weekend with my sister, brother-in-law and the 2 and 4.5 year old kiddies for some major studying for the boards... Happy 4th everyone!

Friday, June 27, 2008

Addendum to FOI

Forgot to add my excitement about my lunch break today... in lieu of relaxing and enjoying a meal, I will be taking part in some VO2 testing (google it for more info-on phone no link capacity, sorry).

Basic info is as follows:
Get a couple of monitors on me including a chest strap Heart Rate monitor and a mask over my face that makes breathing a little dry (to say the least). Up on a treadmill, start at 3.0 mph, 0 percent incline, every minute goes up 1.0 mph until 9.0 mph, then the incline increases every minute by 1.0 percent (as I recall). Go to failure (some places have a mattress behind the treadmill because to get the best readings you really need to go to failure. I did do this test once before and felt good doing it (but I didn't go to failure - wanted to be able to walk home :)

Since I am trying to get a little more serious about running, mar/bi/tri/urban-athlon's this is going to help me determine my ideal heart rate training zones which is great since I recently purchased a Heart Rate monitor (an Ironman Triathlon-Timex model). Similar to the one Bruce Banner is wearing in Incredible Hulk. I am wearing it now on my commute to the course. It involves a chest strap and displays my HR on my watch right above the time - just shot up to 90 when a rude lady sat next to me on the train (Bo angry!), but I'm lowering it down to my normal resting (commuter resting which is a little higher maybe) of 65 - blogging seems to relax me too :)

I will try to update you guys on every change in my HR, just kidding, I will however try to give you a summary of FOI day 2 and the results of the VO2 test.

HR currently 76.