Multiple prescriptions causing more liver damage than alcohol?

Three weeks down with five more to go.  I haven't killed or seriously injured anyone, so I guess you can consider it a success.  Actually, I'm having a great time, and I am really struggling with the thought of going back to a classroom and sitting through another year of lectures. (To any professors who might read this, I'm not putting down the PT education model, and I realize that I still have much more to learn.)  It should be a good thing, though, that I like clinic so much, since I'll be spending many more years in that setting than the classroom setting, right?

Anyways, one thing that I have been amazed with in clinic is the number of medicines that patients are on.  I must say, my appreciation of the liver has increased dramatically.  With all this enlightenment on the prevalence of massive prescription drug use, I was intrigued by this article from Dr. Christina Lasich entitled "Top 1o Reasons Pain Medication Use is Increasing."  The article is difficult to summarize, so I'm just going to copy the 10 reasons here. (Don't turn me in if this violates some copyright law. I did link to the original.) 

1. Insurance companies have cut benefits for alternative therapies.
2. The baby boomers are getting older and the joints are wearing out.
3. Many people can't afford the time or money for treatments like physical therapy, acupuncture, and massage.
4. A growing number of physical therapy programs are mediocre and can actually increase pain.
5. The obesity epidemic leads to more people with painful conditions.
6. Less people are willing to slow down for recovery from injury.
7. Medications work in a pinch.
8. Quitting smoking, eating healthy, and exercising are difficult lifestyle commitments.
9. Medication use increases as the population grows.
10. Finally, health care providers are more aggressively treating pain, the "fifth vital sign."

Dr. Lasich seems to be a rare breed in the sense that she prefers physical therapy and conservative treatment over the invasive, poor resulting (although lucrative business) spinal fusion procedure.  Here are the links to a couple of websites she has going. 

www.christinalasich.com  www.gvbacks.com

Tiger Endorses the APTA... Well Maybe He Should

Adding the name Tiger Woods to any article makes it an immediate front-page story. That’s why I’m glad the APTA took advantage of Tiger’s recent ACL surgery to promote the role of PTs in the rehab process following surgery, as well as, the more important role PTs can play in the prevention of injuries. This article does a great job of describing the basics of an ACL rehab program: control swelling, improve ROM, strengthen the muscles surrounding the knee, and improve balance and proprioception. The clinic, where I am currently on rotation, used to have a golf clinic where a PT would analyze one’s golf swing, looking for mechanical imbalances that could lead to overuse injuries of the back, shoulder, elbow and knee. In my opinion, we should focus and market our ability to prevent injuries, not just treat them after they occur. Happy and safe golfing.

Paperwork

Almost 2 weeks in to my first clinical rotation, and I’ve come to a sad realization. There is a lot of paperwork associated with treating a patient. Writing progress notes are by far the number one complaint I hear from every PT that is in the clinic where I’m located, and since I have started writing my own (under close supervision from my CI), I feel their pain. There is a push for everyone’s medical records to become electronic and “stored” centrally, which a study by the Department of Health Human Services found to be effective in cutting medical costs by avoiding errors and improving the delivery of preventative care. It’s easy to talk about it, but according to this article in the New York Times, implementation is a little more difficult. The government stepped in, however, last week by approving a $150 million Medicare project to provide incentives for switching to electronic medical records, and both Google and Microsoft have both begun to provide web-based consumer controlled health records. Hopefully, by the time I graduate Progress Notes will have progressed to the 21st Century and documentation will only be a few mouse clicks away.

Clinical One has Begun

After a year of class I'm finally free, well at least I'm working for free.  I started my first clinical rotation in an outpatient orthopedic clinic this past Monday.  What's interesting about this site for me is I already work there as an outreach athletic trainer.  ATC's don't interact much with the PT side of things, so I'm excited I get to "put on the other shoe" and see the PT side of things.  I'll admit, it is a little hard to tone down the rehab difficulty for the older patients and get out of the "return to sport" mentality.  My CI is great and very willing to teach, although sometimes I wonder if he is a little obsessed with McKenzie.  I guess everyone has to have a guru to follow. (More on this later in the week.)  I'll try to post something interesting about clinic every week, or at least an article I found helpful for me in deciding on how to treat a patient.

Is the Wii here to stay?

There has been much discussion around the PT blogosphere about the Wii and its implications for physical therapy. I tend to hang out in the negative camp, but I do realize the Wii could have positive benefits with both the elderly and patients with neurological deficits. The Robert Wood Johnson Foundation is providing $2 million in grants, which will be awarded to 12 research teams "to help strengthen the evidence base that supports the development and use of digital interactive games to improve players' health behaviors and outcomes." I was unaware there was any solid, current evidence supporting the Wii for rehab purposes, but I guess time will tell if this is $2 million well spent.

I've got to post a link to this video as well. It's a great spoof on Amy Whinehouse's "Rehab."

Blog Comments Redone

So I probably should've done this before my last post, but sometimes I can be a little slow.  As you might have heard Disqus is allowing comments to be a little more than just comments, but a mini-network.  Evidence in Motion has a good explanation of it.  Hopefully it will work and facilitate some good discussions.  Now I just have to find material worthy to discuss.

Manipulations and Free Speech

Wow! A group of University of Puget Sound students posted a video highlighting the beneficial effects of manipulation in controlling back pain.  EIM brought the video some attention, which has now caused quite a stink.  During the credits, two girls who were nicknamed C7 and S4 were pointing out their said dermatomes in a picture of themselves  (a.k.a. one girl had her 3rd digit up and the other girl was pointing at her butt).  Note, the video was taken down and the credits were edited to include only a single picture of the class.  The tragedy of living in a politically correct world.  As you can see from the comments that followed on the EIM blog, the PT profession is in dire straights, and it's not because of the students from Puget Sound.  Feel free to join in the "war of words" either here or there, but regardless of your feelings, be proud of the students for trying to make a difference in their state.  If more of us can have this type of passion for our profession, vision 20/20 will hopefully come a little early.  

PTs and Title IX

Michael Sokolove writes a great article in the New York Times entitled “The Uneven Playing Field.” In this article, Michael looks at the increasing number of female participants in sports, and, as a result, the increased prevalence of injuries, specifically ACL injuries, in these female athletes. What’s great about this article though, is the author looks to a PT for answers about how to help these girls decrease their risk for injury. Holly Silvers, a physical therapist and director of research at the Santa Monica Orthopaedic and Sports Medicine Research Foundation, does a great job marketing the PT profession by first pointing out the girls she saw at risk for overuse as well as acute traumatic injuries to the author. She then goes a step farther, when asked if she could help these girls by saying that “yes, in four to six weeks I could improve [them] a lot. In three months, I could get the job done. I would educate the muscles, educate the nerves. [They] could build strength and change [their] patterns.”
I have a great mentor who always quotes Benjamin Franklin, “ An ounce of prevention is worth a pound of cure.” Now where’s that direct access?

Stress

This article about stress before even getting to school could not be more appropriate for my life today.  Luckily I got in to my PT school of choice, but sometimes the stress I incur makes me wonder if it is worth it.  I just passed my Medical Conditions practical, but how much did I increase my chances for getting CAD by stressing over how to treat someone with CAD?  Maybe I should start playing the Wii; I'm sure it helps with stress.

Traveling the World while Never Leaving Augusta, GA

I just realized that I haven't made a post in over 2 weeks.  It's not from laziness, however, but from being on Spring Break.  Down here in Augusta, we have the great privilege of having our Spring Break during the week of the Master's.  Instead of going to the beach, I decided to drive people around for the week through a local company that housed people from all over the world.  Between a group from Taiwan, who was on their first trip to the US, two guys (check this guy out) from Britain, and a family from South Africa, I had a great time.  I learned first hand though, that driving sleep deprived is worse than driving under the influence, as has been reported.  I am back to the daily grind now, so more posts to come.

Blogs are the new weapon to fight terrorism.

Thought it was interesting that even the military is looking at bloggers.  Hopefully there won't be a blog draft.  Then again, I could use the money to pay off my school loans.  

Response to "Emergency or Opportunity?"

I recently wrote a piece, "Emergency or Opportunity?", that highlighted the current HB 1055 bill that is making its way through Georgia's Senate.  I have just started this blog, so I did not expect many readers to see my post.  I was shocked and very humbled, however, when Paul Higgs, President of the Georgia Athletic Trainer's Assoc, provided an in-depth response to my posting.  

Being relatively new to athletic training (I only graduated and passed my licensure exam this past May) and even newer to the field of physical therapy, I greatly appreciated the time Mr. Higgs took to respond to my post.  It was a great learning experience for me, and I hope it will be enlightening for you as well.  

School Owned PT Clinics?

I am 3 months away from my first clinical education experience as a student PT, but worry and doubt has already set in for my class. One of the biggest worries my class has is they do not feel prepared to go out into the clinic. Again, I have not experienced the current clinical education model, so I am hesitant to comment. I do, however, have experience with another type of education model that I found to be very beneficial. This experience comes from undergrad where I majored in Athletic Training. During this program, I had class from 8-12 everyday, and then I went to the sport I had been assigned to that semester and worked with a staff athletic trainer from 1 until whenever the practice or game was over. It was a lot of time and work, but I loved this model because everyday I could take what I learned in lecture that morning and apply that learning to a real patient. Tulsa Community College is working on using this type of model for their Physical Therapist Assistant program, in addition to the more traditional model of sending students out to various clinics. Suzanne Reese, the professor at TCC behind this idea, feels a professor and student run clinic, " would create a learning environment students couldn't get anywhere else: students and professors working together to treat patients."  Nothing against community colleges, but if they can figure out how to provide the best learning environments for their developing professionals, shouldn't our major PT schools be able to do the same?  It would take some work, but I'm sure students would be willing to help out if it means better facilitation of their learning.

And people think PT is expensive

Direct access for PTs is being pushed heavily by the APTA.  Direct access will not only benefit physical therapy as a profession, it will benefit the consumer.  Don't believe me? Read this experience Rich Karlgaard (scroll about halfway down) had trying to get his son to a physical therapist.  Rich states, "Peter's problem was clear enough to my wife and me... An old flag-football knee injury had hung around too long, which led to muscle atrophy on the injured side. What Peter needed was physical therapy and strength training to build up his weak side."  Too bad it took 3 "specialists" and 2 MRIs (at over $14,000) before Peter could see a PT.   I understand the doctors wanted to be thorough, as muscle atrophy that extensive in an 11 year old is odd, but a physical therapist performing a thorough physical exam could have saved the family both time and money.  Insurance companies take note.  

Emergency or Opportunity?

In the past 24hrs I have received 3 emails concerning GA HB 1055, and the need for me as a PTAG member to take action in stopping this bill from passing.  This bill removes any trace of a connection of the scope of practice of athletic trainers to athletes, making a general statement about participation in exercises or activities, and particularly adding the words, "without respect to where or how the injury occurs."  The problem is, I am a certified athletic trainer as well as a student physical therapist, so part of me is glad that athletic trainers are winning in the fight to improve their marketability as professionals skilled in orthopedic rehabilitation.  I can see, however, the concern from physical therapists that athletic trainers are infringing on PT's scope of practice.  I feel though, that the passage of this bill could be advantageous to both parties if a little reason is used.

Obviously the advantage for certified athletic trainers (ATC) is the ability to treat patients other than athletes and possibly receive 3rd party reimbursement for their services.  This opens a lot of doors for ATCs in outpatient orthopedic clinics.  Believe it or not, this isn't bad for physical therapists, and here are several reasons why.  First of all, ATC own clinics are not going to spring up because of this bill.  Third party reimbursement is still shaky, so oversight by a doctor or (gasp) a PT is most likely needed.  This brings me to my second point.  The goal of APTA's Vision 20/20, as I understand it, is to push physical therapist to autonomous practice with direct access for the general public.  When this happens, as I feel it will, ATCs will be a great asset to the physical therapist.  From 2003 survey results, the average salary for an ATC in a outpatient PT clinic was $40,000.  This is similar to physical therapy assistants, but ATCs can offer much more than PTAs.  For starters, ATCs do not need to have as much PT oversight, as do PTAs.  The biggest advantage, however, is the ability for ATCs to be contracted out to local high schools, community events, etc. for medical coverage.  This not only generates additional revenue for the clinic, it gets the clinic's name out to the public, which will be important for physical therapists when they are an autonomous profession.

Therefore, it is my opinion that PTAG and the APTA should stop and think before urging everyone to cry "foul" towards their congressman.  A little competition can be a good thing, and in the end generally benefits the consumer, which should be our focus anyways.

Can a fruit change PT?

Next time you see a doctor, check their hip.  Most likely you will see a smartphone clipped to their side.  For the medical world, a smartphone is much more than a status symbol, but a powerful tool that helps them check drug interactions, look up billing codes, and even help make a diagnosis.  So far physical therapists have been reluctant it seems to embrace some technologies, but a recent article highlighting the release of the Apple iPhone's SDK and its potential for the development of applications aiding the medical field got me thinking about the possibilities for physical therapists.  How cool would it be to have pictures and descriptions of special tests, exercises, or even anatomy at your fingertips?  I'm just a student, so I would love anything that could make the diagnosis and treatment of my future patients easier.  What's your opinion?

Med Con Practical Demo

Well this might give away my PT institution, but graduation is overrated anyways, right? Here's a link to the video I promised. You can download it from there.  Let me know if anybody has any trouble.

Hello Blogging World

K, so this should be fun. This is my first attempt at blogging, so I apologize if I violate any codes of blogging.  Feel free to let me in on these codes as I break them, and I'll try not to do it again. I must warn you that I'm a "pot stirrer," but I'll try to keep my opinions within reason.  I was given good advice to "stir the pot in both directions to keep it from boiling over" (Thanks Eric), so I'll try and stay balanced.  I'm currently a student PT at an institution that will be left unnamed (I would like to graduate one day), so most of my posts will deal with physical therapy. I'll add some additional flavor here and there though. Feel free to comment.