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.