Whilst on my paediatrics placement i had a three year old patient Jack whom i saw on a weekly basis. As with all paediatric patients the aim was to involve the parents as much as possible, however in this particular situation it was a case where the parent was too involved to the extent where it interfered with our treatment sessions.
The mother of this patient was extremely proactive when it came to management of her son’s disability. The mother had been to see just about every specialist available and had sought every form of alternative treatment available. She would also do quite a lot of research on her son’s condition and the available treatment. While this may sound like a good thing often the information she found on the internet and the principles of the alternative forms of treatment, contradicted the goals of our treatment and the information that we provided her. For example she had bought a full body jumpsuit for Jack that was designed to provide trunk support for her son (who had global hypotonia) and therefore allow him to have better peripheral control due to the proximal support. Although the jumpsuit appeared to be beneficial in some situations (Jack’s sitting posture improved slightly although he still had no independent sitting balance) both my supervisor and myself noticed that it greatly restricted Jack’s mobility and seemed to reduce the amount he interacted with his environment. In the few instances that i saw Jack without the suit he was able to roll in both directions on the floor, would actively reach with both arms for toys and was very verbal. While in the suit Jack would rarely roll, was unable to consistently reach for toys, was not verbal and generally appeared to fatigue very quickly due to the restriction provided by the suit. Both my supervisor and i agreed that the suit did provide some benefit and was a useful piece of equipment in certain situations, but we also thought that Jack would benefit from some treatment sessions without the suit on. When we suggested this to Jack’s mother she was very uncooperative and would insist that Jack needed the suit during the treatment sessions.
I often felt like telling this mother to let us do our job, but through speaking with my supervisor i realised that this would have been particularly unadvisable. My supervisor explained that although the mother may not completely understand what we were trying to achieve, if she didn’t agree with our management then it would never be effective because the most important aspect of paediatrics is getting parents to implement strategies at home.
Thursday, October 30, 2008
Enough is enough
I recently completed my paediatrics placement at the centre for cerebral palsy. Overall I found it to be a very good placement and thoroughly enjoyed my time there. However there was a period of time where I found myself overworked and stressing out.
On this placement my patient load was relatively low, as we were required to make home visits which often added half an hour of travel time each way. On an average day I would see about three patients, and usually never more than four patients a day. As a result of this low case load my supervisor deemed it necessary to give me additional work to keep me busy which was reasonable as initially there were often periods during the day where I had little work to do. However I think my supervisor misjudged the amount of spare time that I had, as she gave me so much additional work that each night I had to stay behind until the cleaners kicked me out at 730, to get the work finished. As a result my working days saw me leave home at 7 in the morning and returning after 8 o’clock at night. On top of this I also additional uni work to do and also worked part time on the weekend.
At the same time that I was at the centre there were several other OT ad physio students there from Curtin and Notre Dame, however none of them had the same supervisor as me and none of them seemed to have as much work to do as myself. When I talked to the other students about how much work I had they were shocked and told me I should just tell my supervisor that I was overloaded. This was something that I didn’t want to do as I wanted to maintain a good relationship with my supervisor, however it eventually reached a point where I had to speak to her as I was just too loaded down with work. To my surprise my supervisor was completely understanding of my situation. Apologising for overloading me, she said that she had only given me so much work because she thought that I might have been getting frustrated by the small patient load that I had.From this experience I have learnt the importance of communication with your seniors even when you feel that you might be saying something that they don’t want to hear. Although I still believe that it is a good idea to keep a good relationship with your seniors I think you have to be able to represent yourself to them without being too confrontational.
On this placement my patient load was relatively low, as we were required to make home visits which often added half an hour of travel time each way. On an average day I would see about three patients, and usually never more than four patients a day. As a result of this low case load my supervisor deemed it necessary to give me additional work to keep me busy which was reasonable as initially there were often periods during the day where I had little work to do. However I think my supervisor misjudged the amount of spare time that I had, as she gave me so much additional work that each night I had to stay behind until the cleaners kicked me out at 730, to get the work finished. As a result my working days saw me leave home at 7 in the morning and returning after 8 o’clock at night. On top of this I also additional uni work to do and also worked part time on the weekend.
At the same time that I was at the centre there were several other OT ad physio students there from Curtin and Notre Dame, however none of them had the same supervisor as me and none of them seemed to have as much work to do as myself. When I talked to the other students about how much work I had they were shocked and told me I should just tell my supervisor that I was overloaded. This was something that I didn’t want to do as I wanted to maintain a good relationship with my supervisor, however it eventually reached a point where I had to speak to her as I was just too loaded down with work. To my surprise my supervisor was completely understanding of my situation. Apologising for overloading me, she said that she had only given me so much work because she thought that I might have been getting frustrated by the small patient load that I had.From this experience I have learnt the importance of communication with your seniors even when you feel that you might be saying something that they don’t want to hear. Although I still believe that it is a good idea to keep a good relationship with your seniors I think you have to be able to represent yourself to them without being too confrontational.
Wednesday, October 29, 2008
Parenting 101
Recently on paeds prac I found it extremely difficult when young children are hospitalised due to irresponsible parenting. A young girl sustained a C1/2 spinal cord injury due to a MVA as a result of the mother being high and crashing into a tree. Due to the mothers state she sustained no injuries however her perfectly normal daughter is now unable to spontaneously move any limbs and is only able to blink eyes and mime words through facial expression. The mother now racked with guilt very rarely visits her daughter who has been welcomed into the hospital family.
This situation for me was very confronting as I was to treat this girl and liaise with the family. I had to put all personal feelings aside and be professional in front of the family. No matter what I though about them for the events that occurred I had to treat them the same as any other parent and still provide all the advice and education that I would any one else. It was extremely difficult not to be judgemental but I had to maintain professionalism and constantly think of providing the same service I would normally provide.
This is one of the more upsetting aspects of our job but necessary none the less
This situation for me was very confronting as I was to treat this girl and liaise with the family. I had to put all personal feelings aside and be professional in front of the family. No matter what I though about them for the events that occurred I had to treat them the same as any other parent and still provide all the advice and education that I would any one else. It was extremely difficult not to be judgemental but I had to maintain professionalism and constantly think of providing the same service I would normally provide.
This is one of the more upsetting aspects of our job but necessary none the less
Inspirational Children
Recently on a prac at PMH I came across a truly inspirational child who is able to maintain a positive outlook no matter what she is thrown. This girl is 10 years old and has recently acquired a spinal cord injury at T8. However this has not slowed her down in the slightest. Everyday she strives to challenge herself whether it’s being able to make it the full way up the ramp in her wheel chair or swimming unaided in the pool in her first attempt. She sees the positive in every situation and it is this incredible strength that has given the family joy in this terrible situation.
She has motivated me to see the positives in every situation her strength and motivation has inspired not only the ward but the whole hospital. She is always going up and down the lift visiting other kids bringing them joy. She has an amazing spirit and has motivated me to see life the way she does.
She has motivated me to see the positives in every situation her strength and motivation has inspired not only the ward but the whole hospital. She is always going up and down the lift visiting other kids bringing them joy. She has an amazing spirit and has motivated me to see life the way she does.
Multidiscplinary team
Recently on a prac at PMH the true importance of MDT became apparent. I was placed on the ward for children hospitalised due to obesity in endocrinology. For me I didn’t even realise kids were hospitalised for obesity… is this problem that bad. As the weeks progressed we run endo clinics comprised of education for parents while the kids do 1 hour exercise then an hour education for the kids. The topics each week vary from a physio, dietician and social worker all presenting the relevant info about obesity and how to combat it.
In these kids this education all though for some of us common sense is vital for changing habits and changing lives. It was great to be a part of this team setting as I can now fully understand how many aspects contribute to one problem. Now I realise how important all aspects of the puzzle are in combating obesity and will use the help of others when treating these patients in the future
In these kids this education all though for some of us common sense is vital for changing habits and changing lives. It was great to be a part of this team setting as I can now fully understand how many aspects contribute to one problem. Now I realise how important all aspects of the puzzle are in combating obesity and will use the help of others when treating these patients in the future
Multidiscplinary team
Recently on a prac at PMH the true importance of MDT became apparent. I was placed on the ward for children hospitalised due to obesity in endocrinology. For me I didn’t even realise kids were hospitalised for obesity… is this problem that bad. As the weeks progressed we run endo clinics comprised of education for parents while the kids do 1 hour exercise then an hour education for the kids. The topics each week vary from a physio, dietician and social worker all presenting the relevant info about obesity and how to combat it.
In these kids this education all though for some of us common sense is vital for changing habits and changing lives. It was great to be a part of this team setting as I can now fully understand how many aspects contribute to one problem. Now I realise how important all aspects of the puzzle are in combating obesity and will use the help of others when treating these patients in the future
In these kids this education all though for some of us common sense is vital for changing habits and changing lives. It was great to be a part of this team setting as I can now fully understand how many aspects contribute to one problem. Now I realise how important all aspects of the puzzle are in combating obesity and will use the help of others when treating these patients in the future
Tuesday, October 28, 2008
code blue madness...
Recently whilst on my neuro placement I experienced an interesting situation in an outpatient setting. A patient was preparing for a rehabilitation session by removing his shoes and sitting on the plinth. This patient is independent in doing these tasks and at this moment in time the closest staff member was eating lunch in an office along side the treatment room. A fellow patient was in the room and when seizure began, loud calling was responded to immediately by the physiotherapist. The senior physiotherapist and students attended to the fitting patient, who remained conscious throughout the seizure and was now convulsing uncontrollably on the ground, by applying pressure to the wound on his head. The patient was then positioned in a stable position on the ground in supine away from harm and comforted as the involuntary muscular activity subsided. From this position, I asked my supervisor who to call... it was then deemed that it was a medical emergency, 55 was dialed and a code blue declared. TEN MINUTES LATER... the medical emergency team arrived. Despite the late arrival, blamed on inability to find our location, the team entered some what disorganised. The crash trolley did not arrive until another 5minutes later... 15minutes after the medical emergency was called. The other issue I raise was bedside manner. As a physio student, we are analysed and critiqued all day long so it is only natural that we pick apart every situation we are faced with... especially when blogging is needed:) The bedside manner of the medical team was, shall i say, suboptimal. This was the patient's first ever seizure and anxiety levels were flying high! All it would have taken was a "Hello, I'm Dr Smith, You are going to be ok". Throughout the entire ordeal, the entire medical team remained on their feet looking over the patient on the floor. The patient was not aware of the medical professionals' role, let alone their names. As we all know, we don't know what a seizure can mean. This patient may have been having another stroke for all we knew and everyone should have assumed the worse and acted over cautiously. This however was not the case, a fantastic learning experience and valuable lessons to be learnt by all, experienced and inexperienced. I have taken a lot away from this situation and am thankful that this learning experience did not cost the patient their life.
Sunday, October 26, 2008
Team meeting
Whilst on my neuro and cardio placement, I was required to attend multidisciplinary team meeting. Those present at these meetings included the consultants, the registrar, the resident, the speech pathologist, occupational therapists, physiotherapists and the liaison nurse. Each patient on the ward was discussed in detail and all staff members were asked for their discipline specific input. I was required to present the physiotherapist point of view on the patients I had been seeing. To a student with limited experience, especially in the field of neurology, this can be a daunting task when surrounded by very experienced professionals. I must admit that I was quite nervous sitting there waiting for the consultant in charge of your patient to say ‘Physiotherapy’ at which point your expected to provide valuable information to all those at the table about the patient’s condition.Despite the initial fear, these meetings were incredibly valuable. It helped me to see how each of the different health professions use their individual specialties to work together to ensure the best outcome for the patient. It also made me think about the real practical value of physiotherapy in these patients. Does physiotherapy have an impact on the other health professionals treating the patient? The answer is a resounding yes, sometimes the physiotherapist ensuring that the patient is safe to walk outside is all the consultant needs to be able to discharge them, other times the physio working hard to get the patient to be able to transfer with one person assist is invaluable to the nursing staff. The thing I also found enlightening from these meetings is how much our opinion as physiotherapists and as health professionals is important to the consultants and other medical staff treating the patient. The consultants really look to us and to the occupational therapists to understand what the patient’s functional status is, and as such make a decision about the discharge plan for the patient. These meetings are also important in the sense that the allied health professionals see the patients every day of the week, whereas a consultant can not, there are times when the physio may notice a slight decrease in strength of a patient or the OT may notice a slight change in their cognitive function. This type of information may not be picked up by the medical staff but may be an indicator of a serious change in condition that needs further investigating.These meetings helped me to understand that even though we may not have studied for as long or have the same rank as a consultant or those others around the table; our input is just as important to the patient outcome. If I was placed in the same situation again, I think I would approach it with more confidence and a personal sense of equality with those around me.
Open mindedness
On a geriatric placement at a day hospital a female patient presented after a fall. The assessment revealed high scores on the TUG, berg, clinical test of sensory integration and the dynamic gait index and her gait pattern was normal for a lady her age. Manual muscle testing revealed weakness and poor endurance of her pelvic and shoulder girdle muscles. When questioned, the patient reported a noticeable increase in general fatigue within the last 6 months, preceded by the onset and slow progression of fatigue over the past 2 years. My clinical observation and assessment of this patient led me to suspect an underlying neural pathology. An undiagnosed pathology was also suspected by her medical practitioner and she is currently undergoing investigative tests.
When treating this patient with physiotherapy I treat her impairments but am vigilant with continual assessment and modification of her treatment as necessary in accordance with her subjective and objective response. I take this extra care because I want to help her rather than exacerbate her symptoms such as fatigue. I pay extra attention to her clinical presentation because this is all there is to guide treatment as her pathology is unknown.
Upon reflection I think it will improve my skills as a clinician to pay this extra clinical attention to all patients regardless of their diagnosis. No two people are the same even with the same diagnosis. Also, while much is known about the human body and pathology, much remains unexplained and I believe that keeping an open mind even when a diagnosis seems certain and being attentive to clinical signs and symptoms can only enhance practice.
When treating this patient with physiotherapy I treat her impairments but am vigilant with continual assessment and modification of her treatment as necessary in accordance with her subjective and objective response. I take this extra care because I want to help her rather than exacerbate her symptoms such as fatigue. I pay extra attention to her clinical presentation because this is all there is to guide treatment as her pathology is unknown.
Upon reflection I think it will improve my skills as a clinician to pay this extra clinical attention to all patients regardless of their diagnosis. No two people are the same even with the same diagnosis. Also, while much is known about the human body and pathology, much remains unexplained and I believe that keeping an open mind even when a diagnosis seems certain and being attentive to clinical signs and symptoms can only enhance practice.
Tuesday, October 21, 2008
post traumatic stress disorder
Hi Guys,
On my recent clinic I came across a fellow who was a former SAS member. I’m not sure if you guys are aware but these guys are the most highly trained soldiers in the world and take on the most isolated and dangerous work. This fellow was a Vietnam Vet and was now 65. Prior to meeting this fellow I had a discussion with some staff about him and they let me know of the situation. He had many psychological and emotional issues including the condition post traumatic stress disorder. He was on multiple meds and had a lot of surgery including lapband surgery and bilateral knee replacements. He had been attending the clinic for years for a variety of things. I was told he didn’t like strangers, didn’t like people getting too close to his personal space and didn’t like to be surrounded by lots of people. For these reasons it was sometimes hard to get him proper rehab because the gym and pool usually had a number of people using it at the same time. I began very cautiously with this patient and got advice of one of the more experienced physios, he thought it best that I stay clear of a lot of the hands on treatment as he thought much of the pain was of psychological origin. The poor fellows wife had just been diagnosed with breast cancer and after assessment it was a general consensus of the physios in the clinic that it was a cry for help as there wasn’t too many physical signs suggesting a mechanical origin of this pain and subjective nature of this pain was very random and a pattern could not be identified.
It was made clear to me by the owners that this fellow was a patient who should be given “special” treatment ie was a long term patient who was to be treated very gently. After a few private sessions which I viewed as more placebo/patient pleasing treatments than anything else involving some EPA, hot packs some gentle mobs and education, the patients condition improved. During these private sessions with the patient I worked hard on talking to this fellow, getting a feel for him character and really just trying to gain his trust and a mutually respectful relationship and slowly dropping subtle hints on were we needed to go with treatment. This was because after a few sessions it became clear to me that the this guy really needed to begin on a rehab program including gym and hydrotherapy asap, due to all these co-morbidities he had become very de-conditioned and was really in need of some general strengthening and endurance exercises. The reason I had to be so subtle and gentle with this idea of this sort of treatment was 1st the patient really wanted to be treated with EPA etc and secondly he was not very keen on been in the gym/pool with other patients around him or even a PT for that matter. Anyways after about a week and a half he actually said to me that he’s happy to go into the gym and pool and he also didn’t mind me been there. Getting him to do what I wanted is another story but I eventually succeeded with that via gentle education and compromise haha. He told me some amazing stories regarding SAS training and war, which I found very intriguing.
The main point I want to highlight with this blog is the importance of building a good patient/professional relationship even as in the case at the cost of “real” treatment. Because in the long run the gym and hydro sessions were going to help him far more than anything else and to get him in there I really needed to “trick” him into it. I have never really dealt with a patient of this sort previously and it made me very aware of the posttraumatic stress stuff. I feel much more prepared to treat this sort of patient in the future. I think the keys to this sort of patient is; patience, compromise and gentle confrontation of negative thought processes.
Yay last blog!
Thanks guys.
On my recent clinic I came across a fellow who was a former SAS member. I’m not sure if you guys are aware but these guys are the most highly trained soldiers in the world and take on the most isolated and dangerous work. This fellow was a Vietnam Vet and was now 65. Prior to meeting this fellow I had a discussion with some staff about him and they let me know of the situation. He had many psychological and emotional issues including the condition post traumatic stress disorder. He was on multiple meds and had a lot of surgery including lapband surgery and bilateral knee replacements. He had been attending the clinic for years for a variety of things. I was told he didn’t like strangers, didn’t like people getting too close to his personal space and didn’t like to be surrounded by lots of people. For these reasons it was sometimes hard to get him proper rehab because the gym and pool usually had a number of people using it at the same time. I began very cautiously with this patient and got advice of one of the more experienced physios, he thought it best that I stay clear of a lot of the hands on treatment as he thought much of the pain was of psychological origin. The poor fellows wife had just been diagnosed with breast cancer and after assessment it was a general consensus of the physios in the clinic that it was a cry for help as there wasn’t too many physical signs suggesting a mechanical origin of this pain and subjective nature of this pain was very random and a pattern could not be identified.
It was made clear to me by the owners that this fellow was a patient who should be given “special” treatment ie was a long term patient who was to be treated very gently. After a few private sessions which I viewed as more placebo/patient pleasing treatments than anything else involving some EPA, hot packs some gentle mobs and education, the patients condition improved. During these private sessions with the patient I worked hard on talking to this fellow, getting a feel for him character and really just trying to gain his trust and a mutually respectful relationship and slowly dropping subtle hints on were we needed to go with treatment. This was because after a few sessions it became clear to me that the this guy really needed to begin on a rehab program including gym and hydrotherapy asap, due to all these co-morbidities he had become very de-conditioned and was really in need of some general strengthening and endurance exercises. The reason I had to be so subtle and gentle with this idea of this sort of treatment was 1st the patient really wanted to be treated with EPA etc and secondly he was not very keen on been in the gym/pool with other patients around him or even a PT for that matter. Anyways after about a week and a half he actually said to me that he’s happy to go into the gym and pool and he also didn’t mind me been there. Getting him to do what I wanted is another story but I eventually succeeded with that via gentle education and compromise haha. He told me some amazing stories regarding SAS training and war, which I found very intriguing.
The main point I want to highlight with this blog is the importance of building a good patient/professional relationship even as in the case at the cost of “real” treatment. Because in the long run the gym and hydro sessions were going to help him far more than anything else and to get him in there I really needed to “trick” him into it. I have never really dealt with a patient of this sort previously and it made me very aware of the posttraumatic stress stuff. I feel much more prepared to treat this sort of patient in the future. I think the keys to this sort of patient is; patience, compromise and gentle confrontation of negative thought processes.
Yay last blog!
Thanks guys.
Monday, October 20, 2008
Scarey
Hi Guys,
On my recent clinic in a private practice I encountered an interesting fellow. Let me explain is case.
He was approximately 50 yrs of age, his appearance was that of a big burley labourer/rugby player with a big deep voice which he swore a lot with, the sort of tough stereotypical country aussie bloke you might imagine.
He came in to me with a referral from his GP. The referral was very brief, something along the lines of this pt has headaches possible a result of a stiff sore neck post a blow to the head your opinion would be appreciated. Then a list of PMH included throat cancer, septicaemia in both shoulders and a few other less serious things.
On Subjective examination, the case began to seem very complicated. It turns out whilst working in Kalgoorlie a 40kg fence feels on top of his head. He was taken to the hospital and treated for concussion and had a MRI which came back clear. He returned to work, but continued to have splitting constant headaches beginning in the bilateral temporal region and moving posteriorly. He had been unsuccessfully treated via meds for this. He also complained of memory loss. Eventually he was sent back to perth for Rx as his work MATES refused to work with him because they said he was a danger to them and a danger to them, as well as stating he “wasn’t the same”. He didn’t really think he had a sore neck at all, and just complained of these “F****ing headaches”. He suggested that he had numbness in his hands + tingling feelings. He also complained of dizziness, diplopia, dysphagia, nausea and photophobia. He had not had a CT scan or MRI or a review by a neurologist. I cant quite recall his meds. He really just wanted to stop the headaches and get back to “digging holes”.
On Physical exam he had markedly reduced neck movements limited by pain, a possible positive VBI sign, altered sensation but could determine sharp blunt and could localise LT and it felt the same throughout. Strength was ok, however had weak deltoids bilaterally, however it was believed this was due to the shoulder issues. Upper Cx ligament tests were negative.
PAIVMS of Cx region were very stiff and sore and muscles were very tight. Day one because I was very nervous to do much with him due to mechanism of injury, plus all the rest of it and the fact we couldn’t contact his GP for 2 days I just did some soft tissue work and Cx traction to be safe and sent him off for a through the mouth upper Cx Xray (this came back “normal”). 2nd time I got my supervisor in with me and we did some gentle unilateral mobs of the neck which increased his headache. The next day we saw him and he mentioned he was having more trouble swallowing his food than previously. At this stage he became my supervisors’ patient. As we got to know him he opened up a lot, told us about suicidal thoughts, depression, frustration, highly strung, impatience, problems at home, thoughts of hurting others etc. On discussion we began to suspect a large psychosocial component of the presenting complaints.
A few days later we were able to talk to his gp, he also seemed to think along similar lines to us. He had organized him an MRI which came back fine and a review with a neurologist. At this point our treatment became more aggressive as there definitely was issues with his neck and all the testing didn’t suggest any serious pathology. Also we began the hard task of dealing with the emotional aspects of his pain. Which really just composed of understanding, warmth, encouragement and advice on relaxation, gentle exercise, diet and tried to influence some of the negative thought processes. We also got him in for hydro in the heated pool.
This is were I left this patient as my clinic finished. I found this patient very challenging but also a great experience. It made me very aware of Cx instability, VBI stuff, the scans we can refer for and also docs have at the disposal to rule things out, also helped with my skills in talking to gps and other PTs. I got shown techniques to Ax alar ligaments integrity etc and also dealing with psychosocial influences . I think this help me to consider the balance between been overly cautious and negligent. Next time I will definitely feel more confident when I am confronted with similar patients.
Thanks Guys
On my recent clinic in a private practice I encountered an interesting fellow. Let me explain is case.
He was approximately 50 yrs of age, his appearance was that of a big burley labourer/rugby player with a big deep voice which he swore a lot with, the sort of tough stereotypical country aussie bloke you might imagine.
He came in to me with a referral from his GP. The referral was very brief, something along the lines of this pt has headaches possible a result of a stiff sore neck post a blow to the head your opinion would be appreciated. Then a list of PMH included throat cancer, septicaemia in both shoulders and a few other less serious things.
On Subjective examination, the case began to seem very complicated. It turns out whilst working in Kalgoorlie a 40kg fence feels on top of his head. He was taken to the hospital and treated for concussion and had a MRI which came back clear. He returned to work, but continued to have splitting constant headaches beginning in the bilateral temporal region and moving posteriorly. He had been unsuccessfully treated via meds for this. He also complained of memory loss. Eventually he was sent back to perth for Rx as his work MATES refused to work with him because they said he was a danger to them and a danger to them, as well as stating he “wasn’t the same”. He didn’t really think he had a sore neck at all, and just complained of these “F****ing headaches”. He suggested that he had numbness in his hands + tingling feelings. He also complained of dizziness, diplopia, dysphagia, nausea and photophobia. He had not had a CT scan or MRI or a review by a neurologist. I cant quite recall his meds. He really just wanted to stop the headaches and get back to “digging holes”.
On Physical exam he had markedly reduced neck movements limited by pain, a possible positive VBI sign, altered sensation but could determine sharp blunt and could localise LT and it felt the same throughout. Strength was ok, however had weak deltoids bilaterally, however it was believed this was due to the shoulder issues. Upper Cx ligament tests were negative.
PAIVMS of Cx region were very stiff and sore and muscles were very tight. Day one because I was very nervous to do much with him due to mechanism of injury, plus all the rest of it and the fact we couldn’t contact his GP for 2 days I just did some soft tissue work and Cx traction to be safe and sent him off for a through the mouth upper Cx Xray (this came back “normal”). 2nd time I got my supervisor in with me and we did some gentle unilateral mobs of the neck which increased his headache. The next day we saw him and he mentioned he was having more trouble swallowing his food than previously. At this stage he became my supervisors’ patient. As we got to know him he opened up a lot, told us about suicidal thoughts, depression, frustration, highly strung, impatience, problems at home, thoughts of hurting others etc. On discussion we began to suspect a large psychosocial component of the presenting complaints.
A few days later we were able to talk to his gp, he also seemed to think along similar lines to us. He had organized him an MRI which came back fine and a review with a neurologist. At this point our treatment became more aggressive as there definitely was issues with his neck and all the testing didn’t suggest any serious pathology. Also we began the hard task of dealing with the emotional aspects of his pain. Which really just composed of understanding, warmth, encouragement and advice on relaxation, gentle exercise, diet and tried to influence some of the negative thought processes. We also got him in for hydro in the heated pool.
This is were I left this patient as my clinic finished. I found this patient very challenging but also a great experience. It made me very aware of Cx instability, VBI stuff, the scans we can refer for and also docs have at the disposal to rule things out, also helped with my skills in talking to gps and other PTs. I got shown techniques to Ax alar ligaments integrity etc and also dealing with psychosocial influences . I think this help me to consider the balance between been overly cautious and negligent. Next time I will definitely feel more confident when I am confronted with similar patients.
Thanks Guys
Tuesday, October 14, 2008
my rural placement
I recently completed my rural placement. I had a very interesting experience on the prac. It was a great placement and I saw a variety of area in physio such as gerontology, musculo, neuro, antenatal and post-natal, etc, basically every area in Physiotherapy. I worked alone most of the time, which was good challenging for me. As you know, normally we work with at least one of supervisors and sometimes I feel like they are assessing me and I have to change my opinion to supervisor view. Even though supervisor view is correct I think we have to think about it, not like getting answer immediately. For me the time is a bit longer. But this placement was I have more freedom and I can treat my patient without anybody. It helped a lot for my clinical judgment, not supervisor view. I can think about my clinical judgment by myself. I have taken a lot of confidence away from this placement, especially in terms of my self-clinical judgment.
Sunday, October 12, 2008
Bit of a shock
I recently had my cardio placement at SCGH in ICU. Having spoken to many students about this placements i heard that a lot of people had found it quite confronting as the patients are often quite close to death. On starting this placement I found that i had no problems dealing with this fact, as most of the patients are intubated and as such no real relationships were established between the patients and myself. However on one morning my supervisor told me to go and see a patient called Jason. Not expecting anything out of the ordinary I went to the patients bedside and discovered to my shock that it was someone that i knew. It took me a while to be sure because the sedatives totally relaxed the muscles in his face and none of his normal wrinkles were present, however his family had put photos up which confirmed that it was a guy who i knew as "Squiz". Squiz was a regular at a pub that I frequented and although i had never gotten to know his real name i knew him quite well. It was at this point that i bagan to find ICU a bit confronting as now it was someone I knew who was close to death. Fortunately Squiz was doing quite well and looked like recovering but i remember finding it very bizarre to be treating someone i knew. I found it very weird to think that i had done a full treatment but when Squiz woke up he would have no idea that i had been there.
Although quite confronting at the time I'm glad that I was treating Squiz because unlike his other friends who knew very little other than that he was sick, I was lucky enough to have the full picture and could see that he would probably recover. Having said that if the situation had been that he was unlikely to recover i think i would have preferred not to have been treating him.
Although quite confronting at the time I'm glad that I was treating Squiz because unlike his other friends who knew very little other than that he was sick, I was lucky enough to have the full picture and could see that he would probably recover. Having said that if the situation had been that he was unlikely to recover i think i would have preferred not to have been treating him.