So it's been 2 weeks and the experience I've had is thankfully the opposite to my previous experience. The instructor is really nice, explains everything, and often praises me instead of constantly criticizing. It's a different hospital and everyone is much nicer than my previous experience. Also there is an electronic medical system, I can't explain how much I really love it.
Now one reason for this is that it's not as busy and there are not as many patients to see since they are fairly complex. I'm in the internal medicine unit and most of the patients are over 60 and have many complex medical conditions. Most come in for acute problems such as falls, pneumonia, heart failure, inability to cope and polypharmacy causing medical problems. Treating many of these complex patients requires a team effort, and everyone is treated equally and everyone's opinion is respected. This is also different from my last experience, where the opinions of PT/OT/social work was basically ignored.
The PT role in acute internal medicine, is to assess mobility and functioning and recommend mobility aids (cane, walker), as well as progress mobility. So in other words, it involves working on transfers (lie-sit, sit-stand) and walking short distances. We usually start with a person barely able to stand, and slowly with lots of encouragement and support (walker, PT), get them to start walking 20-100m. When they can walk independently for 100m and have no other problems, they usually either are able to go home or go to rehab to further improve their functioning.
We are usually able to see 3-5 patients per day, depending on whether they are medically stable to be walking (normal hemoglobin, no orthostatic hypotension). It is usually not that busy and we spent the last hour or so of the day charting on the patients we've seen.
Now compared to my last placement I get a lot less independence and a lot more support which is really nice. We see all patients together with the instructor, or with the OT. Some might say that by this time I should be more independent, and that I would learn more if I was independent, but the truth is I already had that experience, and it was very stressful, exhausting, and unsafe. Also the patients are elderly, and therefore much more frail which means, walking with these patients often requires 2 people anyway.
Now, in general, this is not the type of setting that I'm interested in working. The scope is fairly limited to working with patients for transfers and ambulation, which I don't feel requires any particularly special knowledge. I am more interested in working in outpatient MSK where we will get to diagnose and treat specific injuries. Also I do not enjoy the hospital at all, and am terrified of catching some disease from the patients such as flu, MRSA, VRE, etc. Now some people will ask, why I chose a HCP career, when I am not willing to work with sick patients with varying diagnoses? My answer is I don't mind working with sick patients, but I do have limitations and fears (ie; not being able to breath in a mask) and therefore will prefer not to work in an acute setting (no jobs anyway) and would prefer a more rehab environment where the patients aren't acutely sick (rehab, outpatient MSK).
Now I seem to always have some sort of problems, and unfortunately during this internship, I am still half sick and have not completely gotten over my previous cold. I am not contagious anymore, but it has presented numerous problems for me. I am constantly wheezing and hyperventilating and have gotten to the point of having an acute asthma attack. Now I do my best to hide these symptoms from everyone, but it doesn't always work well. This is definitely not ideal but I feel like I have no choice as I don't have any sick days I can take to get better, so I just have to hope that my lungs will slowly get better and I won't scare everyone with an actual asthma attack.
So those are my adventures, hope everyone enjoys their weekend!
Sunday, October 16, 2011
Friday, October 7, 2011
I hate having to be House...
So in continuation from my previous post, my granfather's strange spells continued and got worse even after stopping the pred and the atropine. The last episode being coughing, shortness of breath, slurred speech, dizziness, and was again relieved by nitroglycerin.
Now I did some more research and realized that stroke is not really relieved by nitro..and the shortness of breath and coughing, as well as symptoms relieved by nitro is more likely to be related to a heart problem, the only thing that didn't add up was the slurred speech....
So a bit more research and what I realized was that the glaucoma eye drops that he was prescribed to decrease his IOP, are actually vasoconstrictors......and in cases where the person has pre-existing heart conditions can cause worsening angina and even heart attacks.....
It finally makes sense, the slurred speech was most likely related to the vasoconstriction of blood vessels in the brain. The drops caused the vasoconstriction which then caused decreased blood flow and decreased oxygen and thereby caused the slurred speech.
In fact, there is a warning to carefully prescribe these drops to people with heart issues. The interesting thing is that most likely all doctors that we go to will deny this and say there is no effect whatsoever, and that something else is causing the symptoms.
So now we are sort of stuck with a dilemma, is the glaucoma a bigger problem than a heart attack?
To most people the answer is simple, since he already doesn't have any vision in his eye anyway and was living with this condition for 3+ years and we've managed to stabilize it, what's the point of treating it right? I mean the reduced IOP is definitely not worth the (higher) risk of a heart attack. Now if only we could find a doctor to whom we could actually explain things to and possibly find a solution...yeah that's a fantasy.
There are other options available such as laser treatment which was fairly effective when it was done the one time, but now we'll need to find a new optho since the old one basically kicked us out. Surgery is another option but there are too many complications.
So now we're back to where we were before, me trying to be House and figure out the causes of the severe symptoms that he's experiencing and whether they could be side effects from the medication and how to manage them. At the same time not having a doctor with whom we can actually figure out what we're supposed to do to decrease his IOP yet not have a heart attack at the same time. Yep I love the medical system.
Now I did some more research and realized that stroke is not really relieved by nitro..and the shortness of breath and coughing, as well as symptoms relieved by nitro is more likely to be related to a heart problem, the only thing that didn't add up was the slurred speech....
So a bit more research and what I realized was that the glaucoma eye drops that he was prescribed to decrease his IOP, are actually vasoconstrictors......and in cases where the person has pre-existing heart conditions can cause worsening angina and even heart attacks.....
It finally makes sense, the slurred speech was most likely related to the vasoconstriction of blood vessels in the brain. The drops caused the vasoconstriction which then caused decreased blood flow and decreased oxygen and thereby caused the slurred speech.
In fact, there is a warning to carefully prescribe these drops to people with heart issues. The interesting thing is that most likely all doctors that we go to will deny this and say there is no effect whatsoever, and that something else is causing the symptoms.
So now we are sort of stuck with a dilemma, is the glaucoma a bigger problem than a heart attack?
To most people the answer is simple, since he already doesn't have any vision in his eye anyway and was living with this condition for 3+ years and we've managed to stabilize it, what's the point of treating it right? I mean the reduced IOP is definitely not worth the (higher) risk of a heart attack. Now if only we could find a doctor to whom we could actually explain things to and possibly find a solution...yeah that's a fantasy.
There are other options available such as laser treatment which was fairly effective when it was done the one time, but now we'll need to find a new optho since the old one basically kicked us out. Surgery is another option but there are too many complications.
So now we're back to where we were before, me trying to be House and figure out the causes of the severe symptoms that he's experiencing and whether they could be side effects from the medication and how to manage them. At the same time not having a doctor with whom we can actually figure out what we're supposed to do to decrease his IOP yet not have a heart attack at the same time. Yep I love the medical system.
Tuesday, October 4, 2011
The type of doctors that make my blood boil
Now I'm not trying to generalize and I know there are good and bad people in every profession (including physio) but, it just seems that more and more meeting good doctors is the exception not the rule and it makes me more frustrated since I then have to play the pretend to be the doctor game.
So, my grandfather is older, has a couple a prexisting heart issues and had a stroke a long time ago, but is otherwise generally healthy (lives independently on his own). Now a few weeks ago, we noticed that his eye got red and swollen, he was complaining of a headache and he couldn't sleep at night. Well we went to the family doc, who spent us to emerg, who then got a referral to optho emerg, diagnosis? severe glaucoma, prob acute angle glaucoma. So the emerg optho (really nice) gave some drops, and sent us on our way to the regular clinic opthalmologist. Here is where the trouble began....
So, let me start by saying my grandfather is not the most cooperative person, and is scared when something is shoved in his eye (no reason whatsoever). So when the optho tried to do anything he would close his eye and become scared. Eventually he managed to do an injection in his eye, and then changed a lot of the drops assigned by the previous optho including adding prednisolone.....anybody see any problems?
Now really there shouldn't have been any real problems, now let me say that at this point, the eye was no longer inflamed and there was no blood in the eye. So we dutifully continued using the prednisolone, and the next appointment after a frustrating session the optho manages to penetrate with a laser and miraculously my grandfather starts seeing out of the corner of his eye. This was fairly miraculous given that he hasn't seen anything for 2 years...
Now it's been 3 weeks, and he continues to take all the 5 different drops including prednisolone (4times/day) and atropine to try to reduce the pressure and the inflammation, and we dutifully continue thinking that the doctor is the expert and we obviously don't know anything.
Then yesterday, abruptly he looses his balance, falls, and starts having slurred speech....you're probably thinking the same thing I am, stroke.
So I think fast, check that he hasn't used his nitro patch today, put 2 patches on him, give him 2 sprays from his nitro bottle, and give 2 aspirins. Thankfully within seconds his speech normalizes and he regain his balance and mobility. Now of course according to standard protocol, we should have called 911 but we have enough experience to know, that in cases of mild TIA the medics and hospitals do nothing except a CT scan which is negative, yes tPA could be used but in general its only used in severe strokes since the risk of bleeding is too high.
So we started investigating what could have caused this interesting and terrifying scenario and I realized my grandmother had a similar scenario after a cataract surgery and was using a lot of eye drops....then we realized that the pred and the atropine aren't supposed to used for such a long time especially if the inflammation has gone......
So we decided to stop using the drops since it's been 3 weeks, there is no inflammation and its obviously doing more harm then good. Now of course, following protocol we're supposed to go talk to the doctor before cancelling meds.....yes of course....well luckily we had a appointment the next day.
Now let me say, this is a busy doctor, really busy, the one who has the 5 minute appointments. So the tech measures the pressure it has dropped, then puts in atropine, he remeasures it..and its high again. We try to explain and ask about our concerns regarding the massive amount of drops he's on, and the risks of using them for such a long time, he disregards those concerns, and tells us that he can't help us since his pressure is still 'high'. Then he tells us he is discharging us from his service and refers us to an eye surgeon.....of course not before telling us that we're idiots, our english is bad, and we don't know anything.
Yes ladies and gentleman, this is a real life account of a highly regarded optho. Now thankfully we have given up a long time ago on trusting doctors for good reason, but hoped that for once we'd be proven wrong.....yeah not going to happen.
I can't even begin to say how many errors this so called optho made, from not cancelling pred which is supposed to be used temporarily, to not understanding the simple fact that atropine raises the IOP and that his measurement was indeed wrong. In addition to completely dismissing all of our concerns and dismissing us from his practice because my grandfather is a supposedly difficult patient, and then recommending a dangerous surgery that is not needed and could cause further complication.
I mean, I get that docs are stressed, overworked, tired, and sometimes make mistakes. But to be this negligent and egotistic is unacceptable, if it wasn't for our quick thinking with the nitro my grandfather could have had permanent brain damage and it shouldn't be up to me to research, understand every medication that is prescribed, their contraindications and then have to decide what meds can be cancelled to prevent more side effects.
There are so many conditions and complications in older adults that can be prevented if docs just thought, is this condition worth treating? Do the risks outweigh the benefits? What kind of counteractions can this med have with all the other meds the person is taking? Should the doses and length of treatment be adjusted for the older adult? What kind of things should the family watch out for?
This and previous negative experiences have unfortunately caused me to never truly trust what docs say and give, since misdiagnosis is quite common, and so is overmedication. I have not once received an honest answer from a doc on the question of 'what kind of side effects should I watch out for' and 'what are the serious side effects from this med'.
Now let me reiterate again, I'm not generalizing and I know there are some really good docs out there that really care about patients and try their best to give them the best possible care, but unfortunately I haven't had a lot of good experiences, and have lost count of the number of times something was misdiagnosed.
So, my grandfather is older, has a couple a prexisting heart issues and had a stroke a long time ago, but is otherwise generally healthy (lives independently on his own). Now a few weeks ago, we noticed that his eye got red and swollen, he was complaining of a headache and he couldn't sleep at night. Well we went to the family doc, who spent us to emerg, who then got a referral to optho emerg, diagnosis? severe glaucoma, prob acute angle glaucoma. So the emerg optho (really nice) gave some drops, and sent us on our way to the regular clinic opthalmologist. Here is where the trouble began....
So, let me start by saying my grandfather is not the most cooperative person, and is scared when something is shoved in his eye (no reason whatsoever). So when the optho tried to do anything he would close his eye and become scared. Eventually he managed to do an injection in his eye, and then changed a lot of the drops assigned by the previous optho including adding prednisolone.....anybody see any problems?
Now really there shouldn't have been any real problems, now let me say that at this point, the eye was no longer inflamed and there was no blood in the eye. So we dutifully continued using the prednisolone, and the next appointment after a frustrating session the optho manages to penetrate with a laser and miraculously my grandfather starts seeing out of the corner of his eye. This was fairly miraculous given that he hasn't seen anything for 2 years...
Now it's been 3 weeks, and he continues to take all the 5 different drops including prednisolone (4times/day) and atropine to try to reduce the pressure and the inflammation, and we dutifully continue thinking that the doctor is the expert and we obviously don't know anything.
Then yesterday, abruptly he looses his balance, falls, and starts having slurred speech....you're probably thinking the same thing I am, stroke.
So I think fast, check that he hasn't used his nitro patch today, put 2 patches on him, give him 2 sprays from his nitro bottle, and give 2 aspirins. Thankfully within seconds his speech normalizes and he regain his balance and mobility. Now of course according to standard protocol, we should have called 911 but we have enough experience to know, that in cases of mild TIA the medics and hospitals do nothing except a CT scan which is negative, yes tPA could be used but in general its only used in severe strokes since the risk of bleeding is too high.
So we started investigating what could have caused this interesting and terrifying scenario and I realized my grandmother had a similar scenario after a cataract surgery and was using a lot of eye drops....then we realized that the pred and the atropine aren't supposed to used for such a long time especially if the inflammation has gone......
So we decided to stop using the drops since it's been 3 weeks, there is no inflammation and its obviously doing more harm then good. Now of course, following protocol we're supposed to go talk to the doctor before cancelling meds.....yes of course....well luckily we had a appointment the next day.
Now let me say, this is a busy doctor, really busy, the one who has the 5 minute appointments. So the tech measures the pressure it has dropped, then puts in atropine, he remeasures it..and its high again. We try to explain and ask about our concerns regarding the massive amount of drops he's on, and the risks of using them for such a long time, he disregards those concerns, and tells us that he can't help us since his pressure is still 'high'. Then he tells us he is discharging us from his service and refers us to an eye surgeon.....of course not before telling us that we're idiots, our english is bad, and we don't know anything.
Yes ladies and gentleman, this is a real life account of a highly regarded optho. Now thankfully we have given up a long time ago on trusting doctors for good reason, but hoped that for once we'd be proven wrong.....yeah not going to happen.
I can't even begin to say how many errors this so called optho made, from not cancelling pred which is supposed to be used temporarily, to not understanding the simple fact that atropine raises the IOP and that his measurement was indeed wrong. In addition to completely dismissing all of our concerns and dismissing us from his practice because my grandfather is a supposedly difficult patient, and then recommending a dangerous surgery that is not needed and could cause further complication.
I mean, I get that docs are stressed, overworked, tired, and sometimes make mistakes. But to be this negligent and egotistic is unacceptable, if it wasn't for our quick thinking with the nitro my grandfather could have had permanent brain damage and it shouldn't be up to me to research, understand every medication that is prescribed, their contraindications and then have to decide what meds can be cancelled to prevent more side effects.
There are so many conditions and complications in older adults that can be prevented if docs just thought, is this condition worth treating? Do the risks outweigh the benefits? What kind of counteractions can this med have with all the other meds the person is taking? Should the doses and length of treatment be adjusted for the older adult? What kind of things should the family watch out for?
This and previous negative experiences have unfortunately caused me to never truly trust what docs say and give, since misdiagnosis is quite common, and so is overmedication. I have not once received an honest answer from a doc on the question of 'what kind of side effects should I watch out for' and 'what are the serious side effects from this med'.
Now let me reiterate again, I'm not generalizing and I know there are some really good docs out there that really care about patients and try their best to give them the best possible care, but unfortunately I haven't had a lot of good experiences, and have lost count of the number of times something was misdiagnosed.
Sunday, October 2, 2011
Feeling better in some ways, worse in others..
It's definitely been a busy week. I'm definitely feeling better (mentally at least) from my last post, which now seems to be a very long time ago.
First update, I passed my neuro unit! I only found out today, which I was stressing about for the last 2 weeks but that's another story. It is definitely a huge weight off my shoulders as I was seriously scared that I didn't do well, since the last test involved a lot of short answers (which I despise). I was basically writing the first thing that came to my brain, and after discussing the answers (bad idea) with some classmates realized that my answers were seriously lacking content. Should learn by now not to discuss answers...since it just leads to more anxiety.
Moving on...the next big thing that happened was I started going to a new Jewish philosophical type course with people my own age, and it turned out I really liked it, and actually learned quite a bit. The course solidified my fears that indeed I don't know what I want out of life...sort of scary, but at the same time at least now that I know the problem I can work on trying to solve it. I've realized that a lot of people share the same issues that I've been rambling and complaining about and there are no simple or concrete answers. I've been trying to find simple solutions and in fact there aren't any...so simple eh? I'll try to make a separate post about some of these interesting philosophies a little later.
The good news continued as I found out that I got a rehab placement for my neuro internship. You would think that as PT's in a big city with lots of rehab centres we would get rehab placements but that is apparently not true. In fact some people might not even get one 'true' rehab placement within their education, which is not really fair as others might get more than 2. What many people do not realize is that you have to know what you want and need, and be willing to try, and most people aren't willing to do that and end up choosing the same 5 places that everyone else does or not getting placed. Anyway, my new strategy is to try to pick good spots but ones that others aren't picking as the top choices since they are too 'far' for them. Now since I live far from the centre anyway, my advantage is everything is far from me, so I can pick things that are 1.5 hours for some people, whereas for me its only 1 hour.
The other big news is that I bought, then changed my mind and cancelled a condo purchase. Yes you read that right, me a student, not knowing where I'll work, live, and whether I'll even find a job, decided that hey, let me try flipping/renting a condo....in a sort of iffy area......not even in downtown.....yeah probably not smartest idea. Now to my and my parents defense it could have worked, and we could have gained 20K in 3 years...but the amount of headache that it could have caused, plus the fact that the 200K mortgage would be in my name...not the best thing that I could think of... I'm still not sure it was the right decision, but the truth is that I never really wanted to live there, and gambling on flipping is not smart especially in a 'developing' area, and renting is too much of a headache. In the end, I decided I don't like gambling especially with large debt loads, and would prefer to buy something when I have more security in my employment and actually buy where I could see myself living...I know a radical concept..
Now the bad news..I have gotten sick...yes the horror of having a cold. I know I know, I'm a baby, but hey to my defense, due to my crazy hygiene (read washing hands 20 times/day + not touching anything anywhere) I haven't been sick in over 2 years, which is actually a record for me! Now of course the record was meant to be broken and this is as good a time as any since I actually don't have classes and have time to recuperate. My hope is that if I give my body enough time to rest hopefully it will actually recover in a week without me having to start antibiotics...I can hope right? The interesting thing is my lungs have actually been cooperating and not acting up and hopefully continue to behave.
So that has been my week in a short post, I'm of course doing research (ie writing stuff) which is too boring and deserves a longer explanation. So now to go back and continue resting. Wishing next week is a little less exciting.
First update, I passed my neuro unit! I only found out today, which I was stressing about for the last 2 weeks but that's another story. It is definitely a huge weight off my shoulders as I was seriously scared that I didn't do well, since the last test involved a lot of short answers (which I despise). I was basically writing the first thing that came to my brain, and after discussing the answers (bad idea) with some classmates realized that my answers were seriously lacking content. Should learn by now not to discuss answers...since it just leads to more anxiety.
Moving on...the next big thing that happened was I started going to a new Jewish philosophical type course with people my own age, and it turned out I really liked it, and actually learned quite a bit. The course solidified my fears that indeed I don't know what I want out of life...sort of scary, but at the same time at least now that I know the problem I can work on trying to solve it. I've realized that a lot of people share the same issues that I've been rambling and complaining about and there are no simple or concrete answers. I've been trying to find simple solutions and in fact there aren't any...so simple eh? I'll try to make a separate post about some of these interesting philosophies a little later.
The good news continued as I found out that I got a rehab placement for my neuro internship. You would think that as PT's in a big city with lots of rehab centres we would get rehab placements but that is apparently not true. In fact some people might not even get one 'true' rehab placement within their education, which is not really fair as others might get more than 2. What many people do not realize is that you have to know what you want and need, and be willing to try, and most people aren't willing to do that and end up choosing the same 5 places that everyone else does or not getting placed. Anyway, my new strategy is to try to pick good spots but ones that others aren't picking as the top choices since they are too 'far' for them. Now since I live far from the centre anyway, my advantage is everything is far from me, so I can pick things that are 1.5 hours for some people, whereas for me its only 1 hour.
The other big news is that I bought, then changed my mind and cancelled a condo purchase. Yes you read that right, me a student, not knowing where I'll work, live, and whether I'll even find a job, decided that hey, let me try flipping/renting a condo....in a sort of iffy area......not even in downtown.....yeah probably not smartest idea. Now to my and my parents defense it could have worked, and we could have gained 20K in 3 years...but the amount of headache that it could have caused, plus the fact that the 200K mortgage would be in my name...not the best thing that I could think of... I'm still not sure it was the right decision, but the truth is that I never really wanted to live there, and gambling on flipping is not smart especially in a 'developing' area, and renting is too much of a headache. In the end, I decided I don't like gambling especially with large debt loads, and would prefer to buy something when I have more security in my employment and actually buy where I could see myself living...I know a radical concept..
Now the bad news..I have gotten sick...yes the horror of having a cold. I know I know, I'm a baby, but hey to my defense, due to my crazy hygiene (read washing hands 20 times/day + not touching anything anywhere) I haven't been sick in over 2 years, which is actually a record for me! Now of course the record was meant to be broken and this is as good a time as any since I actually don't have classes and have time to recuperate. My hope is that if I give my body enough time to rest hopefully it will actually recover in a week without me having to start antibiotics...I can hope right? The interesting thing is my lungs have actually been cooperating and not acting up and hopefully continue to behave.
So that has been my week in a short post, I'm of course doing research (ie writing stuff) which is too boring and deserves a longer explanation. So now to go back and continue resting. Wishing next week is a little less exciting.
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