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!

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!

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.

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?