Wednesday, December 31, 2008

POD #12

Live stream from times square, pretty cool (big brother is watching):

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 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


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, 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