John 0...Death +2

Lost two patients last weekend, one to CA and the other to a PE that hit him outta no where. I had been working with the two guys really close and I wasn't ready to get this kind of news, it honestly was the last thing on my mind that a patient would pass away! But, a majority of the patients here at the VA are really sick and that's the harse reality that I'm coming to realize. If only Danny was here with his amazing Differential Dx skills maybe the score would be different?

Danny +1... Death 0

So here is a little differential diagnosis quiz for you.

Patient Hx:
2 weeks status post knee scope
Complains of calf pain, does not go away in a week but is no worse
Only gets calf pain with walking, no pain in a dependent position, no pain with resisted DF/PF, skin does not feel warm to touch, no redness, homans sign negative, pain feels like it is deep, stretching doesn't make it better.

What do you do?

Outcome: We sent her to the ER on friday last week to get a dopplar done, turns out she has 3 blood clots, 2 in her calf and 1 in her lung. Pretty crazy!

Another Paslay moment

Just thought I would share yet another "forgot to put my car in park" moment I had on Thursday. Just to preface, I have only seen 3 patients thus far younger than me, including this one. So, I am almost finished with an eval with a 23 year old hockey jock when I sit down in front of him to begin explaining his HEP. I dropped my pen on the floor and as I reached down to get it I catch a glimpse of my zipper fly wide open, flappin in the breeze. I laugh at myself as I'm sitting back up, look up at him for a reaction and slyly place the towel that is in my hand in my lap. No reaction from him, so I try to act professional while I explain him the exercises....while seated. Luckily, my CI came back in the room mometarily and I stepped out and closed the trap. Ugh. I really hope he did not notice, but I'm thinking the chances are slim since it was open the whole time. It's always the little things people, I just can't seem to ever cover all the bases.

Gas and poo....I'm coming out !!!

I don't know what Presbyterian feeds and gives these patients to drink but all my patients are having some issues with their bodily functions. I am just going to tell you about the most funny patient stories. So yesterday my CI and I were getting this man (with a stroke and Parkinsons) into the standing position and I swear he wasn't standing for more than a minute when the patient said, "Oops, I just dropped in my pants." A few minutes later my CI and I looked at each other and thought to ourselves....YES YOU DID. So we had to clean him up and go to our next patient who had a brain tumor removed 2 weeks ago. So I was ambulating with her down the hall and she says, "I think I just farted" followed by "I did fart, and it was big one!". Needless to say that I am gagging at this point because I'm following behind her holding onto the gait belt. Then, today this same lady had more gas and every time I had her contract her glut med she let some more go (literally every time!!) and once again I'm standing in back. So I finally learned my lesson and started guarding in front and then she began coughing in my face. So if I don't make it back to school in March you know it is because I died from all the toxic fumes!!!

LBP or LAIR !?!

Ladies and gentlemen I'm here now to testify to the Waddell signs! I got to see a LBP pt today with another PT to view a new mobilization(it was like some Jeff Rao stuff...the dude got cavitation on his skin CRAZY). Anyways, 32 yo male with LBP that was radiating to the knee on the right side, hurt to do anything, positive straight leg test and PAVIMs. We start the treatment and wait a minute the pain is now going down the left side(red flag). So, I start looking through the guys chart while the other PT was continuing with treatment, just to see if there was any history on this dude. Two more red flags popped up...negative imaging results for injury and my man was 100% SVC(G'vmt is paying him). So I got to do Waddell's, from the sitting knee extension, rotating through the hips thing, and cervical pseudo compression. BUSTED in my books people!!! But the dude still gets to come to therapy its not like we get to kick him out, we just get to baby him along for two more sessions...kind of a let down, oh well we got a chuckle out of it.

PS:
Jacquelyne, I believe those types of wounds are called "Tweener Sores" nasty!! You should ask your CI for clarification as to where the "Tweener" starts and stops, maybe its in the O'sullivan book?

too many bm's to count.....

even though it's only tuesday, poop has already become the theme of the week!  i think i had 3 patients yesterday and 2 today either have a bm while we were in the room or ask to be transferred to the bedside commode and then do their business while we're still there getting everything put back together!  add in all the women that just lift their gowns up to wipe their faces or ask you to check and make sure they aren't getting a rash "down there", and the men that seem to have no qualms about their business hanging out.....it's been a fairly traumatizing experience!  besides the lack of modesty we've encountered, my CI and our other student pt rachel (who's from iowa too, crazy), have been tackling those ortho evals like pros.  we switched teams this week and are now seeing thr's, tkr's, hip fx's, lum and cerv fusions, etc, etc.  i've seen/done enough ankle pumps, quad sets, heel slides, and straight leg raises to last a lifetime.  after 3 evals on my own today, the kinks are starting to get worked out!  i hope everybody is having a great time at their sites, miss you guys!!

Wound Care....

Hey guys! I definitely need to get into PT shape. Each day it's harder and harder to get out of bed because my legs are so tired! On friday, I thought it was going to be a slow day. My CI has been out of town so I've been seeing a couple patients on my own and then following another PT. We were doing paperwork when Kim got a phone call from a surgeon who was actually in the middle of his procedure in the OR. He asked if she would be willing to come into the OR and help him. He wanted her opinion about a potential wound care pt. She let me go with her which was pretty awesome. I got to scrub up! I was not prepared for what I was about to see....We walked in to find a middle aged man with his feet in stirrups. It was a scrotal wound! It was the biggest thing I've ever seen...the wound! It extended from his scrotum all the way to his butt and was probably 8-10 inches wide. The PT I was with put a wound vac on him. I did a lot of handing her stuff and no touching. It was intense. Anyways...it's been going pretty good overall. I definitely miss all of you. FYI: wound care is not for me....