Post prac post

I can't believe we're done. I actually had so much fun and feel like I've learnt more than I could have ever imagined. Our supervisor really pushed us to to perform to the best of our abilities and question why we did everything. I feel as though what we've learnt makes sense now and I can finally understand how to implement it. Our supervisor believed in hands on learning and I think that was great for me! I feel really lucky to have been able to go to Bentley. I feel much more confident in myself and like I've chosen the right career path!

week 5 reflection 3

My last day!! Was feeling so excited but worried about the shoulder patient. My supervisor and I did come up with a good plan....not to mention the word posture and try was she was referred for and thought would be her cure, ultrasound. When I saw her she was very glad that i had come around to trying ultrasound! She also obviously does not do any of her prescribed exercises as she came in with the exact same posture, such rounded shoulders, protracted scapula's and a resultant, ginormous thoracic kyphosis!! Anyway, my not mentioning posture and trying ultrasound actually did get her on-side, she didn't yell or roll her eyes once. After that she was more receptive to my ideas and I pointed out the three most important exercises for her to do! I highly highly doubt that she will do them but at least she left in a better place than she has before. (Although she did say she had more pain after the US....... she also found pain relieving positions etc painful so im not sure) I just feel terrible for the girl I handed her over to... The rest of our day was fantastic as well!! The staff threw us a good bye lunch (we have definitely chosen the correct profession...food is big on their list!) We had a mexican themed arvo and taco, buritos and nachos for lunch! It was great and I have to say I was a little sad to go!

week 5 reflection 2

My horrible shoulder patient was due to come in today. I had spoken to my supervisor about how to cope with the situation. (He knew she wasn't so nice as he, and all the other physios, heard her yelling at me last week during the lunch break...she was half an hour late so i had to give up lunch!) He basically told me that i should not take it personally, that he would have done the exact same things as me as the cause of her problem is poor posture...leading to her impingement. She just doesn't want to be the one to take control of the problem, she would like completely passive treatment. Our supervisor also doesn't believe in treating pain and symptoms, because it will have absolutely no effect when she goes home, her posture hasn't changed and so neither will the problem. He suggested however that we should try Ultrasound as a last resort as it was on her referral (which was for frozen shoulder anyway and not correct) . It was what she believed she needed. That way, when she is sent back to the doctor we can at least say we tried the doctors suggestion. She will most probably then have a surgery and be sent back to physio with the same problems anyway as she will still have poor posture!! Anyway...she cancelled her appointment, what a weight lifted off my shoulders. But re-shedualed for my very last day! I definitely don't want a negative spin put on my entire experience so i need a good plan!

week 5 reflection 1

The start of our last week! Its fantastic! Starting from today our supervisor has suggested we do the subjective, objective assessment and treatment by ourselves and then speak to him and tell him what we chose and why! It was a really scary idea at first and i felt a little nervous but i think i handled it quite well. If after the subjective and objective, i needed some time to gather my thought i just said i was going out to speak to supervisor. Once away from the patient i would just quickly jot down a problem list and then my treatment would become clear. If it was a straight forward case though i would stay i with the patient for the whole time. i think that was a good way for me to dal with the situations i was resented with as i could really get my head around what i needed to do and make sure i was doing the right thing.

week 4 reflection 3

I had a patient today with bilateral patello-femoral pain. Her knees sat so laterally...to the point where, on a lateral glide, her patella clunked over the trochlea and essentially dislocates....and her medial glide was nil. We decided that the cause of her problem was insanely tight lateral quads and ITB and under active VMO. Part of my treatment included trigger point release of the lateral quads and DTM of ITB. Her trigger points were so big and tender that they made her cry. I found it quite difficult at that moment. She obviously wanted me to keep going as she found it gave her up to a months relief from her knee pain...but it was horrible. Looking back, i definitely don't think I pushed as hard a I could have because I didn't want to hurt her...but in the long run, that's not going to be as helpful for her. After the treatment her patella's did sit more centrally so I did help her problem to some degree. The rest of the week was the quietest yet....it's amazing how many people re-schedule when it's raining:)

week 4 reflection 2

Today I saw a patient 6 weeks post a R ACL recon and medial menisectomy. I have one other patient who had an ACL recon and she was 8 weeks post so i thought i knew what I'd be in for. My 8 week-er came in with a limp, 1 crutch and nowhere near full range. The 6 week post boy i had today came in with no crutches and walked as if he had never even had surgery! I couldn't believe it!! He was super fit previous to his accident though which clearly makes a huge difference! It just gos to show you can never really assume you know whats coming! Looking back over my treatment I think I did a good Job of educating him. Because his knee felt amazing he wasn't really sticking to the guidelines. I made sure I educated him that his graft was coming up to its weakest phase and that he probably had to be more careful now than ever. He was only 19 though so maybe I was a bit too casual as he is close to my age... perhaps i needed to drum it in a bit more. I also felt that I could have given him a few more exciting exercises as he said he didn't really do his HEP as it was a bit easy and boring.

week 4 reflection 1

week four has started in super busy way... I had my first day of 5 patients and it was insanely scary, but great to know that I could do it. I think it really helped that I had prepared well prior to seeing the patients. I had made a plan for my objective assessment and then changed it accordingly depending on what I saw during any quick tests. For example, one lady I saw had hip pain...but watching her gait i noticed she had absolutely no DF and so then quickly included ankle assessment into my plan. I think that my time management has also significantly improved...i saw 2 patients in an hour...that big for me and my usual 1 hour plus!! I think that now I really need to work on giving good explanations on tests im doing or why im performing certain treatments and how I expect it to help them. Hope you all win money tomorrow!!

week 3, reflection 3

I saw my not so nice shoulder impingement patient again today! Even using a model and my best explanation I could not explain to her how posture can cause shoulder pain. When I asked her if my explanation had made sense she replied "well you're telling me it makes sense" and then refused to even look at me! I also suspected that she may have torn her supraspinatus during the week and explained to her the importance of going to the GP for an Ultrasound. She threw that back in my face with a big NO and said if he was just going to comment on her posture she wouldn't bother going. I have to ask then, why bother coming back to physio? 3 people now have come to the same conclusion and given her the tools to take control of her problem and yet she comes in each time expecting a magic pill or a magic machine treatment. I secrectly thinks she likes being mean to me and making me teary!! I have no idea where to go with her, as doing anything for pain is useless because if she doesn't change her posture she is continually going to be in pain! I had tried my hardest to improve explanations etc and I think I did that to the best of my ability, i'm not too sure that I could have done much else. I think she just didn't want to hear what I was saying. Definietly not my best placement experience!

But on a different note, I did have to smile today. An elderly patient came in and told me that the doctor had diagnosed her with tendinitis. She then explained that it was a "build up of information in her shoulder joint" bless.... showing me again the importance of education again:)

week 3, reflection 2

On Wednesday Arnie and I had to give a presentation to all of the physios. They allocate someone each week as a means of updating their knowledge... as new and different ideas seem to be constantly evolving in the world of physio!

We chose to talk about lasers as Bentley has a new laser machine. We talked about its clinical uses and evidence that supports (or rejects) laser as a treatment. It's obviously hard to find 100% supportive info as few articles review lasers alone. Lasers are used in conjuction with many other treatment techniques, as is with good clinical practice. Many experiments were also performed on rats, which as genetically identical do not reflect our diversity as humans. So, Arnie and I discussed the positives in light of the difficulty in finding supportive finding evidence. The physios then discussed their use of laser, with everyone agreeing on its clinical worth. At Bentley, its common use is in women's health field for things like cracked nipples.

All in all, I think it was a good in service, and a great learning experience to be up there giving a presentation to people who've been in practice for a number of years!

week 3

Week 3 has so far been super busy. Arnie and I are up to seeing 4 patients...so i have massively improved on my time management skills because i had to! It now takes me about an hour to do my subjective, objective and treatment.

I also think that over the past two and half weeks I have improved in being able to identify the cause of the problem, not just having a list of contributing factors. For example, I saw a patient who had significant patella maltracking, her knee cap was almost sitting on the lateral side of her leg! I had the problem of deciding whether to do a trigger point relaese to her tight lateral quads first or medial patella glides to imporve patella alignment first. With the use of passive accessories, particularly an infra-medial glide, I relased it was the quads pulling out the knee cap and not the lateral retinaculum. Thus the cause of her problem was her quads and so became the start of her treatment. After I had finished the release, her patella sat centrally and so I didn't need to do any patella mobilisations! I still sometimes get this wrong of course, a bit like the chicken and the egg!, but it is definetly becoming more clear.

I think I am also looking at and assessing my patient more thouroughly to give me the answers, rather than racking my brains for information I've memorised. Im also thinking about problems and other potential areas for concern rather than jumping straight to treatment ideas.

This week I'm going to try and improve on being able to talk to patients and write at the same time. CUrrently, i'm re-writing notes after each session as they're indecipherable. I think this skill could improve my time managemnt even further!!

week 2

the end of another week...i can't believe how fast its all going! My week has been jam packed with patients, hydro, spinal education classes and a LOT of total knee replacements!! I've learnt the importance and impact of strengthening muscles to stabilise joints and the effect that can have on reducing pain! I also learnt some awesome tips to care for your back around the home...im even making sure im using them!
Im starting to prep for my patients now...we're up to four a day so i think i need to be ultra prepared! I have a patient on monday who is cognitively impaired and also illiterate, so it will be challenging to make a take home exercise program, and pitching it at an understandable level. I also have a paient with dysphagia and another who is hearing impaired. I'm making sure to stand in her visual field and speak clearly. The patient with dysphagia and I are utilising sign laguage (or trying to) and is wife is fantastic. He has chronic LBP but is finding core strengthening and hydro very helpful...

week 2

its been another very busy few days. I've really come to learn that you can never go in thinking you'll know what you're going to see. Arni and I prep for our patients every morning, and each time i have mental picture of what im going to do...and am shocked every time when it doesn't go to plan:) I'm only just beginning to used to it...everyone and their presentation is different.

I've also learnt that physio is a lot about education. For example, I had a patient last week who was 3 months post a bimalleolar fracture. Her doctor sent in her most recent x-rays which indicated her ankle was becoming osteoporotic and was necrosing due to disuse. I was really interested to see what she was doing and how her ankle was coming along. When she walked in I was so shocked to see her NWB with elbow crutches...3 months after her surgery! I asked her why she was still using cruthes and she said she didn't know! she wasn't in any pain but no-one had told her if it was safe to walk! i felt so sad for her. We spent the entire session rebuilding her confidence and retraining her gait...which you can imagine was very poor! hopefully she left feeling better about her ankle and her plan to get her back to her pre-injury condition!

week 2

Today I saw my very first patient again from last week. (the one we queried CRPS with) As it turns out, her doctor had diagnosed her with fibromyalgia, which is very similar to CRPS. I did a bit of research, and it seemed to explain a lot of her symptoms, some of which included headaches, dizziness, muscle ache and stomach probs.. Despite the variety of problems, physio does play a role in that these patients often remain sedentary...so we need to advocate the "use it or lose it" slogan we know so well and come up with gentle exercise programs. Today her referral was just for the wrist (post colles fracture) but i also made sure i emphasised how important it was to keep moving around otherwise the pain and related problems will continue or worsen.

Our supervisor dropped a bombshell on us today....we have to see 4 patients in one day. My time management skills need a bit of a kick or i'm definitely going to struggle!! I saw another 2hour patient today, oh god....

reflection 3

The last day of the week...thank god...ive never been so exhausted...i think it's coz i've never used my brain this much...

The week has been fantastic. I feel like i'm really finding my feet and getting into the rhythm of things. Our supervisor comes back next week (he's been sick) so hopefully he'll be impressed by our newly found confidence:)

Arnie and I have been seeing about 3 patients a day...which has been a struggle Can't believe the senior physios have seen up to 16 patients in a day! I think I definitely need to work on time management...I saw a patient on monday for 2.5 hours!! She liked to chat though...

We're also involved in hydrotherapy on fridays which is actually really good. All of the clients have their own programs and we helped with technique, questions etc..

Some things im going to work on for next week: definitely time management... as well as making my objective assessments much smoother, instead of asking patients to stand up, lie down, sit up and lie down again! I'm also going to go over all my lower limb passive accessories and good positioning, as well as look up some more creative strengthening exercises.
Have a great weekend!!

Reflection 2

Although I'm absolutely loving loving Bentley and everyone there...I had a not so great experience on wednesday. I picked up a patient from the waiting room and from the the first moment with her i could tell she wasn't so happy about seeing a student (which is fair...not too sure how i'd feel) I tried my hardest to get her onside and explain how poor posture can result in shoulder impingement, but she just didn't want a bar of it. She wouldn't look me in the eye and rolled her eyes when i tried to teach some scapula exercises. It completely threw me and i lost the plot! I felt that i needed to keep on explaining myself. Looking back it wasn't that i wasn't being clear it was more that she wasn't listening, and she also expected completely passive treatment. My supervisor suggested that next time i let her know that in order to improve she needs to take control of her problem or there's not much point in coming (in a nice way:) I think i'll definitely need to prepare more for her next appointment and not let myself get so upset by it. I also think I should spend more time on pain control and hopefully get her more onside that way. Luckily my next patient became my new fave...she was an 83 year old lady who had self diagnosed 'chicken legs' ...

DAY 1

I was so nervous to start today and find out what we would be doing. It was so great having Chantelle, Arnika and Kristy there because I think we were all feeling a bit the same way. Our morning consisted of some general orientation... and finding out that Arnika and I would be seeing our very own patients that day! Because it was our first day, Arnie and I were allowed to go in to see our patients together, with one taking the physio role and the other oberserving and suppoorting.
My patient was an elderly lady who was 7 weeks post a Left colles fracture but still experiencing lots of pain. When she came in she was complaining of 12/10 pain with a burning sensation and weakness down both her arms. When we were ruling out any neural integrity problems, it was noticed that she had coarse black hair over her left forearm, which was swollen, warm very dry and with shiny pink skin! Thinking back to 210 (PAIN) we thought about CRPS...and we referred her to her GP and hopefully a pain specialist. It was so interesting...and such an exciting start to our first week. I'm looking forward to seeing her again and am hoping to research some treatment ideas...I've heard that beginning to weight bear through the wrist is a good start...but am hoping to find out a few more.

Pre Placement jitters!

I am a mix of nervous and excited about our first day on prac! Just scared I'll be thrown in the deep end and not too sure what to do... I'm quite certain I haven't retained much 1st year info...my brain had to make room for all the new stuff we learnt this year!!
Arnika and I are working in the out patients department (musculoskeletal) at Bentley Hospital, so i expect the physio's will be working with discharged patients and liasing with a number of other health professionals, including podiatrists, speech thearapists, dieticians etc. Bentley has quite a large catchment area which I understand to be mainly an elderly popultion, so I am expecting to see a number of joint replacements, #NOF and general deconditioning...so i think we will be putting all our gero knowledge to good use!!