Spotlight You

The Finality of Saying Goodbye

2011-03-19T10:30:00.003-04:00

I can never do it... I never say goodbye. Last week, I should have.

The beauty of this community lies in the interconnectedness many of us have with each other. I know, everything is supposed to be "private." I enjoy the banter many of you have with each other as you arrive and leave the clinic. Your quick communications updating each other on those in our community always intrigue me. Many of you probably don't realize, I hear the "send a card," "so and so's coming home," or how someone's kids are doing. I think that's what makes this community special. The genuine caring attitude consistently lives in our community because of you.

Liz called me yesterday after receiving an email blast from the Williamston Chamber of Commerce. I was saddened by the news. Clif McChesney passed away Thursday.

Clif and I only go back to the late 90's. Our paths converged when he needed physical therapy services. If my memory serves me right, neither my skill nor my knowledge could help resolve his pain. I always felt badly that I didn't have any answers or suggestions for him - only questions. To this day, I still wonder if that particular problem was a result of working with lead based oil paints day in and day out. I never found an answer, so I'll never know. Although I know I felt inadequate from that first interaction with Clif, I know he couldn't have felt the same about me because over the years through various other physical issues, I was consistently chosen by him and his wife to meet their physical therapy needs.

My world revolves around physical therapy. Every once in a while, a patient will somehow bring me into a new world and open my eyes to something I have no experience or background or knowledge. Clif and Jane, his wife, didn't do this only for me, but they did the same thing for our community! Think of Art in the Park, the Williamston Theatre, back when Cappuccino Express was around and all the art hung on it's walls and now the art hanging in Gracie's - Clif was a huge supporter of artful expression.

You know, Clif had a passion in art. I can confidently say, Clif and his teachings influenced many artists at Michigan State University. Through his artistic work, he touched the lives of others. Clif's passion and talent took him places I know I'll never be. I remember during some physical therapy sessions hearing stories from when he was in Japan. I loved teasing him too - believe it or not, Clif wasn't comfortable in large crowds... or speaking to groups. That little intricacy about Clif just cracked me up. I had never experienced attending an art exhibit until the early 2000's when Clif and Jane invited me to Old Town to a gallery where their work was being showcased. I remember having no idea what to expect. I knew they both loved art and I knew they had such huge passion in art, I decided I wasn't going to miss an opportunity to learn more about what they loved. When their work was on display and they were showcased, there are people coming and mingling. It struck me as funny that Clif wasn't comfortable in that kind of situation (although he did it a lot)!

A couple of years ago, Clif was back in for physical therapy services. As we were problem-solving his current situation, I thought I had a brilliant idea. "Clif, maybe you need to have the painting you are working on at a different height. You know... like raised up using sawhorses." Again, Clif gently educated me on his technique and style. The paintings were like 10'x15' and the perspective and technique were to be taken from a standing position while looking down at the ground. The technique involved painting with a brush from a standing position (thus a lot of bending forward). Clif knew I just didn't get it when I chuckled and said, "Maybe you could change your technique and hang it from a clothes line! Think of what an unstable surface would bring into the technique!" That idea was a no-go too...

Maybe a year ago, I met Clif and Jane at the Williamston Fitness Center. They both wanted to exercise year round, but needed some assistance on which machines and how to use the machines. Clif continually worked at improving his ability to function. He did both cardio work and weight training. I frequently saw them arriving as I was leaving from my swim workout. I was always touched by their commitment with this aspect of their lives. They didn't put themselves into a box and follow the typical belief system of people of their age. They weren't afraid of the physical work involved with becoming stronger and believed it was good for them. (They believed right, of course.)

Over a week ago, Clif was coming back to see me in the clinic. This time, I really, really knew I couldn't help. Things were so vastly different. This time, there was no joking or teasing. This time it was serious. In my heart, I will always, always wonder if I could have said something differently. I called and spoke to Clif a couple of days after I saw him in the clinic, because I just had to know how he was doing. Sadly... my last conversation with him involved me chastising him (in a kind way). I called again this week to see how Clif was doing and I was delighted when Jane told me Clif was hospitalized. I had that mental sigh of relief - he was in good hands and I had full confidence the right people were working with him.

I was wrong... and I never got to say goodbye. I never got to tell him I appreciated being introduced to his work. I never got to tell him I enjoyed seeing him and Jane whether it was in the clinic, at the fitness center or in the community. If I could tell him something now, I'd tell him the Northern lights, sunrises and sunsets are going to change because I think God is going to put him in charge of creating even greater beauty for the beginnings and endings of our days. Goodbye, Clif.... you will be missed.

Three Things that Make Me Worry

2011-03-11T21:39:00.006-05:00

     I know, I know... worrying is an energy drag. Sometimes, I can't help but worry. I worry over things in which I have no control.

     The one thing that will always, always cause me to worry is when you don't attend your scheduled appointment. For some of you, I know you live alone. For those of you who live alone, the game plan is for Liz or me to wait 30-60 minutes and then attempt to reach you by phone. If you don't answer, Liz or I will attempt to reach your emergency contact. Depending on the result of that conversation, 9-1-1 may be be activated. I can't imagine anything worse than needing help and having no avenue to get help. Let me tell you, when I call, there is nothing better than hearing your voice which calms my worry and fears.

     Trust... believe it or not, those situations where you take a stance and really and truly only want me to be your physical therapist is scary. There are some of you I have known and treated for a variety of issues over the years. We know each other at a bit deeper level than just you coming in for physical therapy services. Basically, what happens is I begin to care more deeply than what is "recommended" in the medical world. I'm not saying I don't care about everyone I treat, but there's something different when we already know each other. I worry about letting you down and not meeting your needs or expectations.

     Recently, I've had more worries on my plate than normal. I was excited to hear someone was going to be returning for physical therapy services. I just saw him in the community at the fitness center in November and he was exercising and really making progress on his own. I was curiously sad he needed services again, but was happy to connect with him and his wife again. My worry alarms went off when he refused to be seen by any other physical therapist. And then, when I saw him again, my heart sank and my worry alarms clanged. He and his wife live alone out in the country. The gentleman couldn't walk more than 20 feet without becoming short of breath. He had gained quite a bit of weight... but he appeared more bloated than obese. He was very unsteady on his feet. Shockingly, he wasn't able to stay alert as I talked with him. I know physical therapy isn't fun, but by no means do I tend to place myself in a category of being boring during any conversation! When he did speak, his speech pattern was different and he was more difficult to understand. Do you know how difficult it is to not be able to be to help in situations like this? And then... to find out Medicare doesn't cover services in a rehabilitation facility unless a minimum of a 3 day hospital stay occurs! Yeah, I worry... he and his wife are in a situation where it is almost guaranteed someone is going to be hurt. The best I could do was share the multiple issues facing this couple and the safety issues with staff at his physician's office. That was horrible too because his physician was out of the country for over a week! The only recommendation the couple can afford is home health services - but that isn't enough for their situation. So... I worry.

     When I make a recommendation that will cost you a lot of money, I worry. I know doctors do it all the time when they order various tests and prescribe certain medications. I just don't like to be the one increasing your costs. Sometimes though, you and I both know what I am recommending is going to be beneficial. Sadly, in some cases where obvious benefit will occur, the insurance company won't pay for the recommendation. The WalkAide is one device that can be helpful for certain individuals. Most insurance companies do not cover the device and the only way to change benefit policies is to fight denial after denial after denial. I worry because in trying to help you improve your life situation, my recommendation also adds tremendous stress and financial burden.

     So, I worry when I think you may be in an emergency situation or something horrible may happen to you... I worry that I may not be able to meet your expectations and I worry when I knowingly I cause increased stress and financial burden even though I am confident my recommendation will substantially improve your life situation.

What worries you?

photo by The Opus via Flickr

A Physical Therapist's Perspective on Daily Unknowns and Gait Belts

2011-02-20T10:46:00.002-05:00

Believe it or not, some of you receiving physical therapy services immediately put me on mental alert. I worry that I might not be able to provide services safely. I worry about "what ifs." In my heart, I know it is crazy to worry and it is better to have a game plan for those "what ifs."

Many of you are prescribed multiple medications for various conditions - like diabetes or high blood pressure or heartburn or high cholesterol. Every once in a while, someone has a history of seizures. Seizures are serious events... and scary too, especially for someone who has never seen one happen.

I'd like to tell a story about "Josh." I had the pleasure of meeting Josh a few years ago. He was a Vietnam veteran who sacrificed a lot for all of our freedom. The things he did and the things he saw changed him for life. Upon his return to the States, he had post traumatic stress disorder. Shortly after his return to the States, he was seriously injured in a car accident. The multiple fractures and head trauma continued to affect his life many years later. One serious condition he had as a result was grand mal seizures. Neither the medications nor the implanted stimulator really stopped him from having seizures. Josh immediately put me on mental alert and sounded off my "worry alarms."

As many of you know, I ask 20 million questions. Sometimes I ask questions due to my innate curiosity... sometimes I ask to help better understand your situation. Well, I got the low down from Josh. Generally speaking, what you see above is what happens after a seizure: 911. Josh made his wishes very, very clear. I was not to have Liz even think of doing a 911 unless he was injured from having a seizure.

One of the activities Josh performed in the clinic focused on standing balance. He lived most of his life in an electric wheelchair, but he did need to walk short distances and needed to be able to stand for short periods of time. He wasn't safe with these out of the wheelchair activities due to a recent injury while having a seizure. While outside his home, he somehow broke his leg when he fell during a previous seizure. So, yes, I worried - I knew he had a high probability of having a seizure in the clinic while I was treating him and I worried if I could keep him safe.

Of course, I was right in my mental prediction. He actually had 3 seizures one of the days while I was treating him. Maybe the worrying was a good thing, because the other steps I took in my worrying was planning how I would react. More often than not, when working with someone to improve balance, I use something called a gait belt. I know, it doesn't look like much, but that one tool has saved quite a few patients I have worked with from hitting the floor at full gravity acceleration!

Seriously, we all know that I'm not a large person and I need to do what a smaller person has to do to 1) keep patients safe and 2) reduce the likelihood of injuring myself in the process. Many of you are in situations where you care for others. I'd like to think you have the exact same 2 goals: keep your loved one safe and don't injure yourself in the process. More often than not, the person you care for hates the gait belt and "poo-poos" it. Let me continue the story, so you and your loved one can have a better appreciation for the gait belt.

While I was working with Josh doing some balance activities, I was behind him (using a gait belt). What I vividly recall was, all of a sudden, Josh stopped moving and kind of froze in the standing position. He didn't respond to my questions and then lost consciousness and had a seizure. Unlucky for me, I couldn't see his face and when he didn't respond I began having little alarms going off in my head warning me that something wasn't right. Lucky for me, the gait belt was on snugly and I could feel his legs buckling. At first, I thought he was dinking around and trying to do a short squat, but very quickly, I realized this was no joke. I had to react... I held the belt, brought him into me, slowly lowered him to the floor and then protected his head. He had two more seizures that very same day with me. The second one he had while walking to the bathroom. Again, the gait belt came in handy. I knew very quickly that something felt wrong. Again, I did the exact same procedure. He was safely lowered to the ground and he didn't have an injury. The third time (by now I'm a pro at knowing what it would feel like just before he had a seizure) happened on the sidewalk outside the clinic as he was headed to the van. I will admit, this time I was mentally begging for the seizure not to happen. That short, brick wall... the pointy, decorative outside light... the concrete... the curb. I most definitely was frazzled. It was summer time. I felt horrible that as I lowered him to the ground his skin ripped on the concrete. He had a nice scrape on his calf. So, then I worried about infection... An ambulance wasn't called - it wasn't one of his wishes.

Hopefully, this story will help you realize how helpful a gait belt can be. If you don't use a gait belt for your loved one, you really won't be as aware that your loved one is becoming unsteady and beginning to fall. All you have to help your loved one keep upright are your loved one's arms. Things happen so fast... there is a high chance you will injury your loved one as you yank on that arm. There is a high chance you may injury yourself too because by the time you react, your loved one is already headed to the floor - you'll bend and you'll pull. Predictably, you'll hurt one of your muscles, hurt your back or even lose your balance and fall in the process.

For some reason, lately I've been treating quite a few of you who are caregivers for your loved ones. You've inspired me to write this because no one seems to like the darn gait belts. In all seriousness, for those of you in the community who read this and want to learn how to use the gait belt, just give me a call and I'll take time to meet with you to show you. You and your loved one's safety are important to me. If you aren't in the area (or prefer self-learning), this video nicely demonstrates the use of a gait belt moving a person from a bed to a wheelchair. This video is more lengthy and does a nice job describing additional details that will interest you.

photo by colbolt123 via Flickr

Top 5 Reasons for Not Seeing a Physical Therapist

2011-02-02T12:55:00.001-05:00

The coolest thing about physical therapy is being a part of your lives, even if for a short stint of time. During that time, I learn interesting things. From multiple conversations and digging and questioning, I've learned what held you back from choosing physical therapy services.

Reason #5: Cost

Definitely a valid reason. Things really are tough for all of us right now. Your life and your body: you are special and important to many people. You touch many lives on a daily basis. If you don't take care of yourself, how can you be there for those who depend on you? Sometimes it is worth paying money for expertise. If you have the right individual providing the expertise, you actually save money. You save because you don't continue to shop around searching and trying all sorts of things.

Reason #4: No Guarantee of Results

You are absolutely right... there is no guarantee of anything in the the health care world. I can't guarantee physical therapy will give you the desired results. To let you in on a secret, I worry about that too. I really don't want to waste your time or your money. Reality - physical therapy isn't the answer 100% of the time. So, what should you want? You need a physical therapist who really tries to determine if physical therapy is an option for you. If physical therapy isn't an appropriate option, then you need a physical therapist who can think, recommend and have a discussion with your physician to help you get the services you need.

Reason #3: I Thought I'd Get Better

Now that is most definitely a valid reason. It's very true too! You've lived in your body long enough to generally know what happens after you injure yourself. You know that generally injuries heal and they just become a memory. It is difficult to give general advice... how about a quick rule of thumb? If you know you hurt yourself (but not serious enough to go to an emergency room), use ice for the first 48-72 hours. After 72 hours you can use heat (don't be ridiculous and burn yourself, you know what kind of heat I'm talking about). Generally speaking, you should begin to feel substantially better within 1-2 weeks. For sure, around the 4 week point, you should be reaching normal. From my perspective, if the situation isn't resolving adequately by the 4 week point, then it would be a good idea to see a physical therapist. I highly doubt you'd need intensive physical therapy. Thinking about many who were in this kind of situation, chances are all you would probably need would be me using my hands on your body, giving you a few activities to work on and advising you on how to successfully to get back to life. The people who have had physical therapy at about this time after injury tell me they feel stupid and feel they are wasting my time. Don't feel that way! Those of you in this type of situation are so fun to treat and I love seeing your eyes light up and your reports of all the neat changes as you are able to do more and more activities. If you want to save money, it's a whole lot cheaper doing physical therapy at this point in time compared to 6 months later...

Reason #2: My Doctor Didn't Suggest Physical Therapy

Your doctor has to know all sorts of stuff! Do you know how long a doctor is in school? Let's just say years and years! Well, your doctor is going to be very focused on making sure you don't have scary things causing your symptoms. Doctors are human and they are working in a very fast-paced environment. The simple fact is sometimes your doctor is thinking a mile a minute and physical therapy just isn't right there in the forefront. The option of physical therapy just gets lost in the mental shuffle. The doctors in Williamston are very supportive of physical therapy. As you discuss your options with your doctor, ask about physical therapy. I'm willing to bet you'll be pleasantly surprised by your doctor's response. If you've injured yourself or have pain, I'm willing to bet that 9 times out of 10 your doctor will happily refer you for physical therapy services. Just ask about physical therapy if your doctor doesn't suggest it.

Reason #1: I Thought Everything Was Normal

This one is a tough one... after many conversations, pain is what brings many of you to physical therapy. For some of you, I find it intriguing that you didn't notice little things that happened before you had symptoms of pain. Take for example knee pain and arthritis. From various conversations, many of you needed your memory jogged on this topic. It seems that before you had knee pain, you had little changes. You might have had a little more difficulty getting out of a chair. At some point in time, you started going down the stairs sideways or one step at a time. Your comfortable walking pace got slower. It is intriguing to me how your body just adapted and compensated without you really noticing it. And it is interesting to me that pain didn't come first. I honestly don't have an easy answer for you. I do know that if you happen to be aware of changes like those mentioned, it would be good to see a physical therapist.

Am I forgetting any other reasons?

When a Physical Therapist Assumes...

2011-01-12T21:41:00.002-05:00

No matter how much education one acquires, learning should never stop. Through many of you, I continue to grow and learn.

One day, a gentleman who was very active in our community, chose Red Cedar for his physical therapy services. Of all the types of doctors who refer, I was immediately struck by how this particular doctor thought about more than just his specialty. The doctor was a podiatrist, which isn't unusual, but he decided to refer the gentleman for services because the gentleman was having difficulty getting around his home and in Williamston. The difficulty in getting around had nothing to do with his feet! This gentleman was also undergoing dialysis a few times a week. So... he was weak.

By assuming, I cost this gentleman 4 weeks of his time. You all know I kick back and talk with you the first time I meet you. Of course, I'm sure you wonder why I ask so many questions... well, my brain is going a mile a minute trying to process and understand your situation AND understand what you need help with... to then figure out the little things I need to see or feel to then come up with a plan with you to help you get back to life. I can still remember touching upon the topic about dialysis with him. He seemed so confident when he said he was doing great with dialysis... and I dropped the ball and didn't ask anything further. I assumed he understood the dialysis treatments.

Well, after 4 weeks of treatment, sadly, he was worse on all the tests I used to note progress for him. I was dumbfounded! He attended... he worked hard... and no improvement, but worsening? I most definitely wasn't going to just give up. Something wasn't right. I went back to square one; did some deeper thinking and... decided I messed up when I just accepted he understood everything he needed to know about dialysis. I assumed... I could kick myself for assuming.

I contacted the nurses where he received dialysis and had them fax his before and after treatment numbers. They said the numbers on his report indicated he was "drinking himself to death." Okay, not literally "drinking" as in alcohol, but "drinking" as in too much fluid intake. That didn't make sense to me with what I knew about him. He really was someone who would implement change. I mean, he was instrumental in the Labor Day Bridge Walk in town; he really tried to get the community out and walking because walking is good for the heart!

So, I got online and did a bit of research to familiarize myself with the type of dialysis he was receiving and learned specifics on how he was to manage the situation at home. The next time I saw him, we sat down and had a lengthy discussion. He wasn't "drinking" himself to death... he was trying to combine the idea of getting nutrients WITH his fluid intake. He and his wife decided that soups would be a good "2 for 1" kind of deal. That was the issue - apparently, the nurses, when they educated him about fluid intake, didn't educate him on salt intake! Bingo... So... we talked about nutrition and how to stay within the dietary recommendations for someone on dialysis. Amazingly, once he changed his diet and substantially reduced salt, the numbers in the reports the dialysis nurses would send me were in a much more acceptable and normal range. He wasn't "drinking" himself to death at all - he just didn't have all the information he needed to manage his situation adequately.

Perceptions and assumptions. The nurses had the most erroneous perception of this gentleman. If they had only tried to really get to know him, they would have known he wasn't intentionally "drinking" himself to death by not listening to dietary advice. By assuming, I made an error believing he had a handle on the dialysis aspect of his condition and he was responding adequately to those treatments.

I will always remember Frank (page 4) and the lesson I learned from him. May he rest in peace.

Things That Make Me Smile

2011-01-10T13:31:00.002-05:00

Yeah, mismatched socks make me smile... so do crazy, wacky socks that don't go with the apparel I am wearing. But... other things make me smile too!

For example, "Jason" had a knee replacement 3-4 years ago. His situation was most definitely not what anyone undergoing a knee replacement would like to have happen. He had a complication - infection. When this happens (thank goodness I haven't seen it a ton of times in my career), rehabilitation is hard and long. The final results aren't generally fabulous and wonderful. Frequently enough, I see "Jason" as I drive toward the main intersection in town. He's always walking his dog. I can't help but smile - knowing how hard he worked to get to how I now see him walking - no limp with near normal motion. No one would even know he had such a time after his knee replacement, except for probably him and me. I smile...

What makes you smile?

photo via Flickr by pzed

Confessions of a Physical Therapist

2010-12-27T16:50:00.002-05:00

Dear “Lucy,”

I must apologize for something that happened many years ago… I still remember your story vividly. I remember how you described your pain – in such simple terms: “I feel like I’ve been run over by a truck – from the moment I wake up until I go to bed.”

I remember your diagnosis – one that was completely unknown to me at the time (back in the day when there was no internet) – fibromyalgia. Of course, not having the internet isn’t a valid excuse for my lack of expertise… but times were different then. It wasn’t easy to search for research or information and it most certainly wasn’t easy to connect with colleagues for help.

I couldn’t imagine what it must have felt like to hurt like you described… and I believed my role was to eliminate your pain permanently.

Lucy, you got the worst treatment interventions from me. At the time, I actually was kind of scared to talk about pain… I mean, what was I supposed to say to you? You felt like you’d been run over by a truck! The only thing I knew about pain, at that time, were the supposed modalities that supposedly reduced pain. Ultrasound, hot packs, electrical stimulation and myofascial release/massage made up the bulk of treatment sessions with you. If I bombarded your body with all sorts of things that felt good, your pain would just have to go away, right?

Years later, “Lucy,” you continue to lurk in my memory. You paid money for my lack of expertise… sure, you got some short-term relief, but my treatment sessions gave you zero long term benefit.

Current research doesn’t support a darn thing I suggested. I completely avoided the topic of pain – YIKES… and I didn’t even consider the importance an individualized exercise program would have for you!

I am sorry for my inadequate recommendations… I wish I could educate you on pain… and I wish I could tailor an exercise program to help control your symptoms.

Over the years, I have come to realize why I have heard some doctors state they “practice medicine.” The same can be said about physical therapists.

Lucy, I know I short-changed you. Please realize, it wasn’t intentional – I was doing the best I could with the knowledge and resources available to me. I “practiced” with you and from that experience I learned and grew. Now I continually challenge myself to strive to do better.

I have come to realize all I really do is “practice.” Times change, information changes, research changes… which means “practice” evolves.

Your Experiences Transform You

2010-12-15T13:57:00.003-05:00

The webs that we weave. Yes... we weave webs. So often I read Facebook relationship statuses that simply state, "it's complicated." Guess what? Your life experience sort of complicates matters when you decide to begin physical therapy services.

Got your cup of java? Settle down and learn about "Joe." Joe's web was very complicated... and was very much dependent on how well he'd be able to unweave some of his web to eliminate his back pain. Joe was a young man in the Army reserve. The quandary I was in... I knew physical therapy would help him, but in getting him back to life, that meant he was most definitely headed to Iraq. What if he died? How would I handle such news? He had a wife and two young kids... and how responsible would I feel if he died? I mean, I could stall my normal philosophy of care and make the benefits of physical therapy longer to achieve - which would mean he wouldn't be able to head to Iraq. He began services with a deadline of 3 weeks to be back to normal and ready to serve our country. Those of you who know me know I ask whatever is on my mind. Well, Joe was determined to head to Iraq and he was willing to do anything so he could serve. Because of his attitude and his strong desire to serve, I had to forget about me and truly focus on getting him as close to 100% as he could be.

Joe's story: Joe was young - late teens/early 20's. He was carrying his young daughter down the stairs when he fell. In the process of keeping her safe, he injured his back. A physician (not in our general area) prescribed narcotics, advised he lie on the couch, suggested he might need surgery, ordered an MRI and described all the things wrong with this soldier's spine. Let's just say that Soldier Joe didn't do too well following those recommendations for 6 weeks. His fear and anxiety were out of the ball park. He literally limped in... couldn't stand or sit for any length of time... and most definitely wasn't picking up his daughter and carrying her. How the heck could I ever unravel the web and help Soldier Joe be able to function at a high enough level to serve our country? In order for Soldier Joe to serve, he had to pass his physical performance test. I'm always confused about the specific details, but it generally entails sit ups, push ups and running. A predetermined number of repetitions need to be performed in a certain amount of time. For both Joe and me, the goal was an overwhelming goal to accomplish in 3 weeks.

I know from treating many patients that back pain is scary... back pain doesn't scare me. Soldier Joe didn't have any symptoms that even suggested he'd need back surgery. He didn't have any problem or changes with toileting... he didn't have any numbness or tingling in his private parts... his leg wasn't weak... his leg wasn't dumb (in other words, it worked just like it always did). I also knew the only way for him to be able to serve in Iraq would strongly, strongly hinge on trusting the evidence on back pain, trusting my recommendations and performing a few specific activities that generally help reduce symptoms. But the web... the web that was woven - how strong was it? It isn't easy for people, in general, to disregard the recommendations of a physician.

Soldier Joe was running 2 miles within 2 weeks... he was able to perform his physical performance test for me almost within the requirements within 2 weeks. Two weeks became the magic number because his schedule changed and he headed to Iraq sooner than scheduled. Before he departed the clinic, the last time I saw him, he asked one simple question, "How come my doctor didn't suggest physical therapy sooner?" Sadly, the only response I could provide was, "I don't know."

(And for those of you who don't like a hanging ending... Soldier Joe served our country and returned home safely and injury free.)

photo via Flickr by artmakesmesmile

Uniqueness

2010-12-04T10:00:00.001-05:00

Memories of two patients continue to be etched in my brain.... memories from many moons ago. It was their experience and the timing of their experience that has helped me evolve as a clinician.

My "No Fear" patient was a 20 something year old male. The whole world was ahead of him and his life took a huge change after an automobile accident. In all seriousness, he was lucky to have survived the accident. He brought in pictures and told me the full story of just what happened during that accident. Now, what sticks out in my mind are the substantial losses this guy experienced - a spiral effect of sorts. His car was his "baby." It was totaled and trashed. His girlfriend broke up with him. He had been a bouncer at a local bar and he lost his job. On top of that he had no health insurance... and sadly, no auto insurance. He was in a wheelchair unable to walk due to the multiple bone injuries and was beginning services to learn to walk again. At the time, I couldn't come to grips with his situation... it seemed so bleak to me. I didn't know at the time if he was just plain stupid or an inspiration. His tattoo of "No Fear" said it all... he will forever be engrained in my mind as the "No Fear" boy. His attitude - oh, my goodness, I am still blown away to this day by his attitude. The car would be replaced and he'd alter the new car way better than the trashed car. Girlfriends come and go... he'd have a new girlfriend in no time. Okay, so he couldn't be a bouncer now, but he stated he'd be back at the bar doing what he enjoyed to do, but for now, he'd find a more sedentary job (and he did). And the cost of the hospital and surgeries and physical therapy... he would pay that off in time. And, yep, you guessed it, he walked again. He hardly ever complained about pain to me... he focused and worked hard... and yeah, he walked.

Contrast this with another gentleman. He too was in an automobile accident. He was probably even more lucky than the "No Fear" boy. Besides the same injuries "No Fear" boy had, this gentleman had also ruptured a major artery in his leg. His story is different. He had health insurance.... he had automobile insurance... his wife stayed by his side... Although it was so long ago, I remember thinking how great it was he had so much going for him (you see, I had "No Fear" boy as a comparison). My role was exactly the same for this gentleman as it was for "No Fear" boy.

Something was different though. I need to call the second gentleman "Pain Man." With "Pain Man" I was so excited... I had fresh memories of "No Fear" boy. Working with people to get them back to life is very invigorating for me. This time things were different. "Pain Man" had a lot more pain. Sure, he walked again, with pain and with a cane. "Pain Man" became like family - he was in physical therapy month after month. He worked hard too... it just took way longer for results. His pain fluctuated. He never felt anything like he did prior to the automobile accident.

Over the course of time, I learned something that was different than "No Fear" boy. The reason for "Pain Man's" accident was because of a drunk driver. The drunk driver came out of the accident unscathed. To my knowledge, the drunk driver never contacted "Pain Man," never acknowledged how a choice affected another person and never reached out and apologized. "Pain Man's" whole life was turned upside down and completely changed all because of a drunk driver. In hindsight, I kind of think "Pain Man" had a lot more mental turmoil. I've never been in his shoes, so I can't say, but I know forgiving is never easy... trying to move forward without focusing on losses can't be easy either.

Your stories matter. I know sometimes I ask what seem to be dumb questions... and I know sometimes it may seem as though I am probing. Your stories though... your stories help me to help you. "Pain Man" still haunts me - I was young. I was too fearful to probe... too fearful to get too close (if that makes sense). I will always ponder whether I could have changed anything I did or said to have helped him to have moved forward with better results.

photo via Flickr by StreetFly JZ

Post Thanksgiving Excitement

2010-12-01T00:23:00.002-05:00

Very infrequently do I share my cell number. It's not that I don't want phone calls from anyone, it's just that you could say my cell is used more often for outgoing calls than it is for incoming calls. My lack of communication habits via my cell phone does create anguish for my family. Seriously, there is a time and place for conversing ... when I'm at work, driving or doing something in the community that just isn't the time to be yapping on the phone.

Well... my heart went out to a particular patient prior to the Thanksgiving holiday. There is nothing worse than having pain, being afraid and having no one to walk you through what you can do to alleviate your symptoms. I know this... and decided to share my number. (I didn't tell her, "good luck in actually truly reaching me," because it really wasn't the time or place to let her know that I prefer to make calls and not take calls.)

Well... this patient did awesome over the holiday! I really, really was more cognizant of where my phone was and did keep my eye on it for any potential missed messages. The last few days, I thought about her quite frequently. I was wondering how she was doing... if her pain was subsiding... if her muscle tension was reducing. My curiosity sometimes gets the best of me. I came really, really close to calling her just to see how things were going. But I didn't. I didn't because I knew that one action just might be misinterpreted. I most certainly didn't want to convey that I didn't think she could improve! I didn't want her to perceive that I didn't have the utmost confidence in her ability to manage her discomfort.

So, today my curiosity was quenched. If I had decent rhythm, I would have broken out into a happy dance! There are so many patients, just like this lady, who amaze me with their ability to trust and change. Pain isn't fun... pain is scary... pain sometimes takes on a journey because of what is said and how it is said. Words and perceptions... what an impact they can have!

This lady will be back to life and graduate from physical therapy way sooner than she probably ever dreamed. I won't forget the smile on her face or the ease of her movements as she walked in the clinic. I especially won't forget her excitement as she shared her ability to have a great holiday due to her success in managing her symptoms. When I see patients work hard and have this kind of success and excitement, I'm proud of them. I wish I could have some kind of gong for them to gong or a plaque or trophy to take home. Cheesy, I know...

From her, I will keep first and foremost in my head the importance of words... what is said and how it is said. Words matter.

photo via Flickr by Rob Hogeslag