Hospitals and Healthcare

Hello DPT Community,

As I was gearing up for class this summer, I came across an article at cnn.com about how health care dollars are shrinking, but this was unusual. It was unusual in the sense that these dollars are shrinking because of the failing US economy in terms of the stock market. Organizations like the Shriners Hospital for Children make it possible for many children to receive superlative healthcare at no cost to their families. Their website says they are "one of a kind" and indeed in our healthcare system they are. Read why this national treasure is in trouble!

slesh

Spectacular Catch... Horrific Collision

DPT Community,

Last night I sat in horror watching the evening news as Rick Ankiel, former phemon pitcher with the St. Louis Cardinals turned major league outfielder, collided head first into the center field wall making a spectacular catch. Watch the clip and you can see the mechanism of injury for cervical spine injuries that lead to catastrophic injuries for athletes. As of this morning, the radiographic evidence supports that Rick has not suffered a fracture and the early signs are positive that he will recover. Keep Rick in your thoughts and prayers.

I have spent many hours on the sidelines of sporting events. I have witnessed many injuries and led the triage of many injured athletes. From fracture wrists in soccer matches to neck injuries from collisions in football. I have managed athletes with concussions and severe knee injuries. I have evaluated fractured clavicles under shoulder pads. I have cleansed countless wounds and stopped blood from flowing from open lacerations. As I reflect upon the last 20 years of dealing with athletic injuries during competition, the one constant is how time stands still for me. When the event is happening, my training goes into effect and the world seems to slow down for me. I have stabilized many cervical spines with the goal to minimize further damage, and I have hoped and prayed that the injury that I am managing is not catastrophic for the athlete. For those of you wanting to further your careers in the sports realm, emergency preparedness is a must!

slesh

Taking One for the Team

Hello DPT Bloggers,
I was asked a few weeks back by Dr. Jenkins if I would enter a charity event to help raise money for a project the students were doing. The email went something like this... "The Physical Therapy team is planning to do a fund raiser for the American Heart Association Heart Walk (Springfield, MO) and we need your help!!! We are planning on a doing a coin drive with 5 faculty members ... The students will bring in change and place it in the container of the person they would like to see get a pie to the face. The person with the most money in their container will be the "winner" of the pie in the face. However, if you are the "winner" and you would rather not take the pie, you will have the option to match the money that was raised and get out of the pie situation. It would then default to the next highest money raiser, and so on."

Well the grand finale was held on April 8 at noon. The pie was bought (Chocolate, my favorite), and I seemed destined to take one for the team. The team was selling chili and cornbread and even selling deserts as well as raffling the chance to through the pie. I think they would have auctioned off the neuro-lab if I would have let them! Soon, after the festive eating was winding down, Dr. Jenkins, after some mild dramatics, announced the "winner!" It became evident that there was no way around it. The pie was handed to the winner of the raffle and after some documentary photographs, the students had their fun as I took a pie in the face.

All in all, the pie toss and chili earned the group about $300 to go to a worthy cause. I wish them the best in their continued efforts to raise funds for their big walk. If you wish to "take one for the team" and help support them, please contact Dr. Tena Jenkins or Dr. Amber Fleer.

In Her Own Words!

Hello DPT Community,

Recently, a DPT student underwent surgery to alleviate pain she was having. I asked her to share her story so you could learn from her experiences. Here is her story, in her own words:

When I 22 years old and just started PT school, I was working as a PT tech at a local nursing home. One day I was instructed to go get a patient from their room for an evaluation. When I walked in the room the patient was sitting on the bed and I had to transfer him to his wheelchair to take him to the PT room. I asked his wife who was smaller than I am if she is able to transfer him to the wheelchair by herself and she replied. “Yes and my daughter helps a little.” Her daughter looked roughly 9 years old and I thought surely I can transfer him to the wheelchair myself. I am young and have been a college athlete. I was successful with transferring the patient and thought later that day my back felt a bit stiff. I woke up the next morning and could barely make it out of bed for class. I thought okay I have had aches and pains before from playing sports. I will just give it time and it will go away. Six weeks later it hadn’t gone away and it was still feeling very uncomfortable to sit or move. I went to a neurologist and found out that I have a bulging disk at level L4-L5 and a ruptured disk at level L5-S1. I was instructed to do physical therapy which I was doing with my professor’s help. The physical therapy helped my symptoms for about 14 months. I called my doctor and told him that my pain was coming back and physical therapy is just not helping anymore. He allowed me 3 epidural steroid injections. The first 2 lasted approximately 4-6 weeks. The 3rd injection lasted about 4 months. I woke up one morning and rolled over to get out of bed and bam I felt this bad pain in my back and started the same symptoms all over again. I thought okay I will just do my exercises and see if that helps and some Advil or ibuprofen. None of this helped at all and I was in so much pain I couldn’t continue to do my exercises. I found positions that would relieve my pain. I was leaning over to the left to unload that side while sitting and then began to limp because the radiating pain the progressed further and further down my leg each week. After 5 weeks of pain I finally called the doctor and said I have to see you ASAP. My appointment was scheduled one week away and I would just have to take the pain until then. As the pain just kept getting worse and worse and on the day before I was to see the doctor and get another MRI it was unbearable. I was in the most unbelievable amount of pain I had to leave class early and two of my professors had to drive me home. I thought if I can go home and find a comfortable position that I can make it to tomorrow without going to the ER like my professors had suggested. I got home and the pain was worse lying down and I could not find any position that relieved my pain even the slightest bit. I ended up going to the ER that night for pain medicine that didn’t even touch the pain but just made me tired instead. The following day I had the MRI done and saw the doctor right after that. After a short conversation he decided I was having surgery. I asked him when does he want to do the surgery and he said, “let’s do it tomorrow.” I thought “oh my gosh” things are just moving too fast but I knew that there was a big chance of being relieved of my pain immediately after surgery. I expected this because I had tried every conservative treatment that they wanted before resulting in surgery. He performed a hemilaminectomy with a microdiscectomy and when I woke up I was pain free. It was an outpatient surgery and I was required to walk, urinate, and be able to eat and drink and keep it down. During my walk I asked the nurse if we could walk further since I hadn’t walked in 6 weeks without pain. My surgery was on a Wednesday and I went home on Wednesday. The following Monday I was able to return back to school. It was the best I have felt in 2 years. Some slight discomfort was tolerable compared to the intense pain I was in before. I would recommend this surgery to anyone that has tried all options of conservative treatment. It’s has been 2 weeks later and I am doing great!

Baseball, Health Care and Statistics!

Hey DPT Community!

Who would have thought that someone would have rolled three of my loves into one thing to read? Baseball, Statistics and Health Care! This New York Times article look at how we can improve the health care system in the USA!

slesh

Amazing Technology!

OK DPT Community!

This is a much watch! Open this 60 minutes video and watch it. If this technology continues to develop, you will be on the edge of an amazing revolution in rehabilitation. I remember 25 years ago working with patients who had suffered spinal cord injuries giving them a lesson in the pathomechanics of their injury. They would always ask if the spinal cord would just regrow? Of course, my answer was the wires have been cut and there is no way for the brain to communicate with the body. But NOW THERE IS!

Together with you in His service,

slesh

PTJ -- Journal announcement

PTJ PODCAST ALERT!

ELECTION 2008 AND BEYOND: Proposed Health Care Plans; Future of Disability
Research

RELEASE DATE: October 28, 2008

WHERE: http://www.ptjournal.org/cgi/content/full/88/10/DC2

WHO: Anthony Delitto, PT, PhD, FAPTA, Chair, and Alan Jette, PT, PhD,
FAPTA, Member, PTJ Steering Committee; and Justin Moore, PT, DPT, APTA
Director of Federal Government Affairs. Moderator: Rebecca Craik, PT, PhD,
FAPTA, Editor in Chief.

Part 1 - The Presidential Candidates' Health Care Proposals

Delitto, Jette, and Moore provide summary and analysis of the health care
plans proposed by Senators John McCain and Barack Obama. Be informed when
you cast your ballot on November 4. Running time: 17:43 (8,318 KB)

Part 2 - Beyond Election 2008: Disability Research

Regardless of who is in the White House following the November 4th
election, what does the future hold for disability research in the United
States? Running time: 22:19 (10,473 KB)

Note: PTJ and APTA do not endorse, support, or take a position on the
candidates or their health care platforms.

For more PTJ podcasts--including audio abstracts, discussions, interviews,
and clinical summaries--visit http://www.ptjournal.org/misc/podcasts.dtl.
Questions? Contact PTJ's managing editor at janreynolds@apta.org.

Intriguing Reading...

SBU DPT Community,

I saw this story online at cnn.com and couldn't help but watch it. It had so many elements that grabbed my attention, but most notably: an athlete and spinal cord injury. Those who know me best, know that these are my two chief areas of interest as a physical therapy clinician. Indeed, my first two years out of PT school at Mizzou was spent in long term rehabilitation working with patients who suffered catastrophic spinal cord injuries. Lastly and most sadly, this young athlete decided to take his own life because he could not deal with life any longer. Those who are also close to me, know this issue also is very near to me. I hope that we as physical therapy professionals and as servants of Christ, can help all people to appreciate that life is worth living.

Together with you in His service!

slesh

Ronald McDonald House

SBU DPT Community Serves Those in Need!

Five DPT students, Ashley, Jimmie, Tiffany, Clara and Brittney, visited the Ronald McDonald House of the Ozarks to bring a warm, home cooked meal to those living there. With donations from the rest of the physical therapy student body at SBU as well as the faculty and staff, we were able to make homemade pizzas for the 23 people currently staying at RMHC. The people served were all families of children requiring extended hospital stays. Most of those served were new mothers and fathers. Their newborn babies were staying just across the street in the NICU. Everyone served was very grateful for the warm meal and just made fresh baked cookies.

Thank you for all of your help, without the volunteers and the donations, we would not have been able to serve these people.

Brittney

Injuries, Research, Evidence and Promotions

Hey DPT Community,

Here is a great piece on a promotions effort from the APTA tying together an injury issue in PT (ACL), the prevalence of the problem (particularly with female soccer players), a discussion of the research leading to evidence-based conclusions. The handout incorporates the evidence and is an easy to follow program in which, according to the evidence will significantly reduce the onset of this injury for female athletes.

This is exactly the type of integrated effort linking the evidence with identified problems and providing solutions! Read it carefully and see what you think!

slesh

More on Jo-Jo

DPT Community,

Thanks for those of you who are praying for Jordan (Jo-Jo) Farris. She is an amazing young lady inspiring those around her in the face of tragedy. The local television station did a piece on her. Please take a look and work to inform yourself on this disease process. Your learning means so much more when there is context to the pathology. But beyond that, keep praying for this brave daughter of God!

slesh

Prayers for Jo-Jo

Hello DPT Community,

I must first start out by saying since I rec'd this note from a dear friend of mine, I just can't stop crying. Jo-Jo (Jordan) is the 18 year old daughter of a colleague, former co-worker, mentor, and friend. He and his wife, have two beautiful children, and this is her story.

Please take a moment pray for her and her wonderful family.

slesh

HealthCare Bills

Hey SBU DPT Bloggers,

So much is spoken today of the cost of healthcare and with the upcoming Presidential election, much more political banter and rhetoric will hit the headlines and Internet websites. It seems Americans, prefer their politics in chunks of four. Every four years they tolerate the hysteria. Every four years they tolerate the hype. Every four years they listen to a new slate of politicians willing to make promises to change your life for the better. For us, in the healthcare profession, we are doubly concerned. Both our individual health plan and our profession may be impacted by a Presidential candidate's vision of the future. As our society ages, we are concerned about things like wellness, cost of services, and access to skilled and competent providers. Do you know where the candidates McCain (R) and Obama (D) stand on healthcare. How will it impact your health plan? How will it impact your wellness? How will it impact your livelihood?

I came across an interesting article about how the extreme cost of healthcare today and the massive gaps in the health insurance coverage can leave you in tremendous debt. Take a look at this CNN.com article by Elizabeth Cohen "Five mistakes that will land you in medical debt." Are you prepared?

Together with you in His service,

slesh

Update on Disc Replacement Surgery

Hello DPT Bloggers,

Here is an update on the post I recently did on Chris Duncan, St. Louis Cardinal Baseball player, who underwent a cervical disc replacement surgery instead of a fusion procedure which is much more common. This article talks about his immediate results. Time will only tell of this first of its kind surgery on a professional athlete to determine its effectiveness.

Together with you in His service,

slesh

Prosthetic Disc Replacement

Hello DPT Bloggers,

In what is becoming a trend in my writings of late, I found another story of an injury sustained to an athlete and this one is having a unique procedure. You will find in your PT career that many, or even most of your patients, that you treat will have back or neck injuries.This St. Louis Cardinal, however, may have his professional baseball career in jeopardy as they are going to surgically manage a cervical disc problem with the implantation of a prosthetic disc. OK! OK? I am intrigued and wait to hear more about this. Certainly I have read a great deal on disc issues of the spine, but not this procedure, and certainly not one on a person so young.

Together with you in His service,

slesh

Doing It All!

Hello DPT Bloggers,

So, just when you think you haven't seen it all, and just when you think that life couldn't get any worse, I challenge you to read this article and watch this video on a young many who refuses to let cancer and the amputation of his leg get him down!

Adam can Do It All! We must always remember that God gives us the power to be thankful!

Together with you in His service.

slesh

More Injuries in the News

Hey DPT Bloggers,

You may not have remembered this event back in the spring when Albert Pujols of the St. Louis Cardinals lined a ball off the face of San Diego Padre pitcher Chris Young, but here is a story of recovery from the terrible event. As I was reading it, I could not help but think of the PT evaluation process. When you read the article, can you determine what is wrong by the symptoms that the pitcher describes?

Together with you in His service,

slesh

Politics & Physical Therapy

Hello DPT Bloggers,

For those of you who are not astute to the world of politics, a very interesting series of events happened over that past couple of weeks that directly impacts you as a future professional and the entire Medicare System. This system, of course, is part of the landmark legislation passed in 1965 that extended government funded health care to all people over the age of 65 and to those who are disabled. The "pay as you go" funding system comes from a tax placed on the paychecks of current workers and is matched by employers.

You may know that there has been a proposed cap on medicare services, one for Occupational Therapy, and a second combined cap for Physical Therapy and Speech Therapy. In these rule changes a few other items are being included such as cuts in Physician fee structure. For the past decade, the APTA has been fighting the implementation of these rules as it would directly impact the ability to provide services to clients. A cap means a limitation in terms of dollars paid, but that means by default a limitations of services provided. A series of extensions or exceptions have been passed by Congress to delay the implementation.

July 1, 2008 was a watermark date in the history of these rule changes. The extensions were set to expire. On June 24, 2008, the House of Representatives overwhelmingly passed a bill (HR 6331 - the Medicare Improvements for Patients and Providers Act) to delay the process yet another time. The vote was 355-49 which in a sense was a fast track vote to get the process moving quickly and on to the other Congressional chamber. 

The Senate however took another position. Tire of delaying these rules. They decided it was time to fish or cut bait. The process was not to be steamrolled through the upper chamber even though the impending deadline was approaching. On June 26, 2008, Sen. Reid tried to force a vote by cloture which would end debate. The 3/5 vote needed to close debate was not obtained. It looked like the therapy caps would be implemented finally. No more delays. And indeed July 1, 2008 did arrive and the therapy caps and fee limitations were implemented. No more laws to provide exemptions.

Sometimes, life is the best teacher if you just take the time to watch and learn. Not giving up, Sen. Reid continued to work on stopping the debate and force a vote. July 9, 2008 it happened. With a vote of 69-30 the cloture happened closing debate. Many things did happen quickly on HR 6331 that day, but uniquely the Senate left the bill alone and kept it free from amendments. So, together the House and Senate sent the legislation to the White House to be enacted into law on July 10, 2008.

The story does not end there, however. In our country, to become law, bills passed by the House and Senate must be signed by the President. President Bush vetoed the bill on July 15, 2008. It looked like the delaying action would fail. The caps that had been in effect for two weeks would continue. The bill was sent back to the House and the Senate, who promptly and simultaneously (on the same day as the Presidential veto!) over road the veto with the required 2/3 vote! The House vote was 383 - 41 and the Senate vote was 70 26. The bill became law and the therapy caps were once again delayed until December 31, 2009.

Many interesting things happened in this most recent day time drama from Capitol Hill and as future physical therapy professionals, you should be alert and supportive of these legislative efforts. To inform yourself, please read all the APTA publishes on the therapy caps and on Medicare. When called upon, act! Call your Congressman. Write letters to your Senators.

As a student of history, I was amazed at how fast the process happened! I was amazed that we saw overwhelming bipartisan support in the House. I was amazed to see cloture first fail and then succeed. The Senate is notorious for killing bills on the floor with debate (filibuster). Then we got to see the power of the Presidential veto, but more amazingly, and on the same day, in both houses, we saw Democrats and Republicans unite to send an overwhelming message to a lame-duck President about who is really in charge!?!? Possibly too, no Congressman or Senator who is up for election this year wants to be on record for voting for something that cuts Medicare benefits 

Through it all, the billing for Medicare remains a complicated issue that has not been solved, only delayed. Someday, we must come to a real and permanent solution to this issue!

Together with you in His service,

slesh

Bad Break!

SBU DPT Bloggers,

For those of you interested in sports medicine and enjoy watching the pursuits of athletes on the field, here is a bit of a medical story for you to follow. Abby Wambach, a true star in the soccer sports world, fractured her leg in the final match leading up to the Olympics. After a collision on the field, they had to carry her in a stretcher off the field and to a local hospital. Both the tibia and fibula have been reported broken and they are speaking now of a complex surgery, titanium rods, and a long road to recovery.

My thoughts and prayers are with her for a speedy recovery.

slesh

Summer Routine?!?!

Hey SBU DPT Bloggers,

It has been a month since I've logged in and shared some thoughts. I've been on a vacation from work and then went to San Antonio for the APTA national meeting. Just now getting back into the swing of things catching up on all the work that has piled on my desk. This summer also brings a new routine for the entire DPT community at SBU. Many faculty are off enjoying their summer with their families. Some faculty are here on campus catching up on various projects. The Class of 2009 and 2010 are out on clinical rotations working to integrate theory and application into a greater context and understanding of physical therapy. The Class of 2008 is now out away from SBU establishing a study routine to successfully pass the NPTE boards. Some have already been successful and are starting new jobs. Most are still preparing. When you say your prayers, please keep them all in your thoughts. Pray for calmness. Pray for preparation. Pray for them.

Together with you in His service!

slesh