TED Blog: Running on high-tech legs: Aimee Mullins on TED.com

TED Blog: Running on high-tech legs: Aimee Mullins on TED.com

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TED Talks are pretty darn entertaining... I highly recommend perusing the site to find something that interests you, there is a wide variety of topics and once you find your topic you will find something interesting about it. Go now!

I also wanted to share this site: http://www.kiva.org/

It seems like a pretty awesome utilization of the world wide web... making the world a better place? maybe...

I came across a pretty interesting chapter in a textbook that breaks down a lot of mnemonics/memory tools for a bunch of different PT related ideas. One example is the 12 cranial nerves... if you are in a medical field I assume you can recall at least one version of this... or the 8 carpal bones... I will share a few of my faves a few posts from now but for now I would love to hear some unique ones or just your faves... :-D

PS: today is 6 weeks since my surgery, back to work, starting to push a little more with my workouts, especially now that my commute is down to five minutes.

While I Ice...

I am laying on a treatment table with the laptop we use for our documentation. I am in the clinic, icing my knee after a long day of running around and making people feel better, it really can be such a rewarding day at work... every day... how cheesy, I know... I am a little bit on fumes since the last thing I ate was a single french fry I stole from one of the front desk staff during lunchtime since one patient showed up late so I saw him through my lunch hour, before that was a turkey/cheese sandwich at 6 am... its almost 7 pm... I try not to give you the ins and outs of my day but "whoomp there it is"

Anyways, this is my first entry since returning to work following my thoroughly documented ACL surgery. It has been a little tough being on my leg pretty much all day, which PT pretty much requires. The first week I had my old 3 hours of commuting each day which did not help the swelling which was already pretty bad just from the actual work day. I decided to invest money into my knee by subletting a place within 5 minutes of work so as to walk and save myself 2 hours and 50 minutes a day of sitting on the bus or train. Of course the day after I move in one of my best friends calls me to tell me I could move in to his place which is about a third of the rent but still a bit of a travel time... decisions and timing... thats life.

Back to clinical interest; I have had the chance to slowly wean back into a pretty full workload. I am keeping track of my patients every day, getting re/more familiarized with all the referring physicians, diagnoses (some real interesting ones including radial tunnel entrapment, thoracic outlet syndrome, thunder clap headaches, tension headaches, restless leg syndrome as a co-morbidity, greater trochanter of the humerus and fibular fractures, to name a few... and of course quite a few of the very popular ACL!)

With my shortened commute I can actually be well rested for once and dedicate that would-be travel time to improving my quad strength which is my main impairment at this time - going down stairs is still a little difficult because that requires good eccentric quad control. Obviously still a bit of swelling hence why I am icing the knee. Speaking of icing, my time is up here, which ends this post, ciao my beauties :)
I'm hungry...

Change.gov

President-elect Obama has a seemingly progressive website where you can actually vote for ideas...

Under "Open Government" there is a "Citizen's Briefing Book" where you can share your own idea of how you want to see this country changed and vote up or down others ideas... I tried finding PT related stuff

This one isnt getting many votes (only at 30 points, each vote is 10 points, not quite there yet):

Require physical therapy before purely elective surgery

This is a well thought out way to save us 225 mil$ (careful with the language, this is a vote to "Defund" it so it is anti-nccam which makes sense to me)

Defund the National Center for Complementary and Alternative Medicine (NCCAM)

This is one of the most popular ones:
The reason that our country pays more for health care than anywhere else in the world and still has poor health outcomes is that the system is run by profit-seeking insurance companies. Health insurance should not be a for-profit field.

Bottom line is if you care about this country and you believe that the new Prez will actually be influenced by these votes, take advantage of the social network here, web 2.0... should be an interesting 4(8)[12] years coming up...

What We Are Worth

Interesting website that tells you how much you should be paying for various medical procedures, here's a few relevant ones:

1. Approximately 15 minutes of therapy or treatment. $51
2. First visit for PT evaluation. $135
3. Follow up visits for PT evaluation. $72
4. PT with ultrasound therapy. $22
5. They did not have a listing for ACL surgery...
6. "leg" MRI. $552
7. x-ray knee. $37
   

Ultrasound is the real interesting one since it isn't very evidence based... read all the comments too

How much would you pay? More/Less...

POD #23

So this could be my last week of "Vacation"... my walking is pretty normalized, my biggest concern at this point is taking any (figurative) steps backwards (I am all for taking actual backwards steps). Since working as a PT means being on your feet most of the day, swelling is my enemy. Should be interesting how that plays out when I am back full-time.

This weekend I indulged a little more than I probably should have. Friday night was my high school football dinner. As a coach I felt slightly obligated to make an appearance. Of course we always have a good time. And this was the weekend I sent back my Gameready, I would buy one if I had an extra $2,350.00 laying around! The combination of sub par icing along with increased mobility led to a slight increase in swelling, boo!

Another interesting aspect to this operation is the scar. Scar tissue is a natural and necessary part of healing, but you also do not want too much... a fine balance must be matched. So I was looking into products for treating the scar, chicks dont necessarily dig scars on the knees...
mederma keeps popping up as a recommended treatment, so I decided to investigate further; three articles came up in pubmed regarding this cream:

1. Petrolatum-based topical agents constitute standard therapy in the management of postoperative wounds. In this side-by-side, randomized, double-blinded, split-scar study, the onion extract gel [mederma] did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment.
2. Despite the authors' inability to demonstrate a reduction in scar hypertrophy, the improvement in collagen organization noted in the Mederma-treated scars suggests it may have an effect on the pathophysiology of hypertrophic scar formation.
3. Snake oil for the 21st century.

This is another interesting study I no longer have access to (my university cut my access since its been 6 months after graduation - gonna have to have a talking with them).

Vitamin E was another highly touted remedy for scars but here are a few interesting articles regarding that issue:
QUESTION: A few of my patients have been told to use vitamin E cream after surgery or repair of a laceration. What is the evidence for this suggestion, and is this treatment suitable for all patients? ANSWER: Vitamin E is the main lipid-soluble antioxidant in the skin. Several anecdotal reports have suggested that topical use of vitamin E cream can reduce scar formation. Current evidence from the literature, however, does not support that proposition. In fact, studies report some adverse effects with use of vitamin E. Further research is needed before application of vitamin E cream becomes the standard of care.

-Without scientific basis, health professionals continue to recommend vitamin E for use on scars. Such recommendations should not be made in the absence of evidence-based medicine.

This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.

Scar-free healing with gene suppression

New mechanical insights into wound healing and scar tissue formation

How'd you get that scar?

That's all for now... I am going to the pharmacy tomorrow to make up my mind on scar ointments... the evidence hasn't helped me much and the stories I have heard from colleagues and friends have been mixed... anyone want to share their experiences?

POD #17, X-rays

I continue to grow my beard, pics to come in a few days... here are the x-rays from today, including my right knee for comparison which I had to put in a special request for as it is not commonplace apparently... Check out the titanium screws and the missing tibia and patella pieces, yay!

POD #17

My surgeon came back from vacation, so I went and saw him. His office is right by my job, took the express bus in, which takes about an hour and 15 mins... not great for the leg. Went to my clinic and got a decent workout in, iced a little, went to see the surgeon to get my suture out... Very weird seeing him pull that sucker out from one end to the other. He told me I was ahead of most of his 6 week patients and I am only at 2.5 wks, meaning I do not have to see him until 3 months after the surgery. I met his criteria for 6 weeks which included flexing up to 120, full extension, minimal swelling.

Here are arthroscopic pics from the surgery as well as me standing.
Pics 2-5 show just how torn up that ACL was
Pics 6-8 show nice clean menisci
Pics 9-10 show a small horizontal tear along the posterior wall of the capsule possibly in front of the popliteus which was stable enought the surgeon didn't want to mess with it
Pic 12 shows my decreased intercondylar notch space which likely was a factor in pre-disposing me to a rupture
Pics 13-18 show the cleaning up process, with 18 having the nice clean tunnel for entry
Pics 19-22 show the new ACL (formerly a patella tendon)

POD #12, Part Duex