Sunday, April 29, 2007

Been a while...

Wow, I have really been slacking on the posting. I guess the weather got nice and I took advantage. Sitting inside facing a computer screen takes the back burner to mini golf, wiffleball, baseball, softball, tennis, etc, etc. What's been going on?

Clinic - very good, but almost done. 2 weeks left with an inservice this Tuesday. It is a case study on a patient with cauda equina syndrome. You know, there is VERY little literature on the best techniques for Tx, or prognosis, or progression, or presentation of traumatic CES. As far as treatment, I'd say you treat the impairments to maximize the function - basically PT bread and butter. BUT, you then have to start the whole discussion of whether improvement is from neurological return or therapy induced. Hard to say...and it depends on each case. So, that is this week, with just 9 total days left of this second clinical.

School - Not much on this front...but we've sent in our top choices for the year long internship. We have to send resumes and cover letters, then wait to see if we're offered interviews. After the interviews, the students rank the places they looked at, the places rank the students they saw, and the clinical coordinators make a match. I am mostly looking at splits (half IP, half OP) and my top choices are MGH and Brigham and Women's I think. I also am going to apply for the one with Harvard University's sports med clinic because that is what I want to do in real life so even if I have to do an IP rotation, at least I can get the experience interviewing there. Classes start up the week of May 21. I'll be in DC that week at the APTA House of Delegates and Advocacy Academy. (See next bullet)

APTA stuff - Yes! This gets its own bullet! :) I have been going to the MA delegation meetings and am fascinated by the discussion, strategy, and good humor at each meeting. I cannot wait for the state assembly meeting this coming week.

Family - The fam is doing well also. Ben is choosing between law schools, finishing up college and graduating the 12th of May I think. Jon is finishing up prep school and graduating the 18th of May I think. Lydia, Kitty and CJ are all not quite as close to being done for the summer...sometime in June. Mom and Dad are getting ready for a bike tour in NY next weekend.

Sports - Softball started again and my shoulder didn't even pop out yet! My neck was very sore the next day though and I had a headache. I am much to young to be this old. It is sad actually. Tennis is a new favorite too. I didn't get to play this weekend, but it is becoming something a few of us do together...getting ready for the next ACE (armatures competing and exercising) tennis tourney that we set up to do at lunch when classes are back in session. Some people are trying to get a whole system going with kickball and wiffleball too. It should be a good summer.

Ok, now I am tired of this. Good update though.

Hope all is well! Good luck to those finishing up clinic, classes, etc!!

Tuesday, April 17, 2007

Thinking...

With the tragedy in VA yesterday I wanted to write something, but words at this point are meaningless...at least mine are. My prayers do go out to all who have been hit by this senseless violence. Even while deeply saddened that something like this could happen, it makes me realize how amazing people can be in times of trial. Stories of heroism, quick thinking, sacrifice leave me wondering what I would do if put to the test. There is no way to know. But to think that the same person who might cut you off on the highway could be the kind of person who would help you out a window to safety...or the same faculty member with whom you had a disagreement might barricade a door and give up his/her own life to save a classroom of students. Human beings can be capable of poor judgement, cynical thinking, or horrendous acts such as this shooting, but human beings can also be great in moments when greatness is needed most. God Bless VT.

Thursday, April 12, 2007

Oh wow.

Sorry to have a few very "all about me" posts. But when I talked about reaching by jumping, I think I also mentioned falling. Here come the falls.


First, there was the fall into the toilet by my phone.


Then I fell asleep through the alarm.


That afternoon I had less of a fall and more of an electrocution by an estim unit.


The next day, I almost fell, tripping down the hall...


But experienced LOTS of falling rain and falling hail on my way home.


I really hope that is all there is. I am not in the mood for any more falling....still holding on tight!



Tuesday, April 10, 2007

Down the Toilet.

Today started off great. My midterm review went very well, I saw a bunch of patients, and headed off after work to catch my college team's softball game vs. Wentworth downtown. They even won and I caught up with some of my friends who are still on the team. That is where it turned bad. I hopped on the T and the driver insisted I owed him a dollar...untrue. Then I hit Wendy's since I was STARVING (hadn't eaten in almost 8 hours) and while going to the bathroom my phone fell out of my pocket and into the toilet. Super. Now my phone is soaked, I am out of money and I still have to get home. Well, I did get home, but I have to deal with the busted phone. Hopefully it dries out, but we'll see. Anyway, even though I doubt a lot of people read this... if you need to get in touch with me, email me. Yeesh.

Monday, April 9, 2007

Letter of Intent

I wrote this up today for an application for a stipend to help fund my trip to DC in May. Here is most of it. It gives you a window to the serious Laura. :)

I am very excited to attend the Advocacy Academy in Washington, DC this year. Throughout my two years at the MGH Institute of Health Professions, my interest in legislative affairs related to physical therapy has grown. While maintaining solid standing in both my academic and clinical education, I have become involved in other activities to strengthen the professional aspect of my education. As community representative for the Institute’s PT Club, I have been involved in events to promote community awareness of physical therapy and fundraise for the Pittsburg-Marquette Challenge. Our most recent event raised over $3000 for the Foundation for Physical Therapy, drawing in students from two other PT programs and members of the general public. We provided PT students with information on membership in the APTA and how they can be more active, as well as giving information about the profession of physical therapy to those community members who were part of the event.

In my role as student liaison, I have worked to make my classmates aware of current bills before congress and encourage them to take action regarding that legislation. I believe that students need to take a more active role in advocating for their profession, and in turn, for their future patients. If we as future clinicians can assume ownership of professional responsibility, the progression of physical therapy as a profession will be in very capable hands for decades to come. Through this realization, I have found a passion to become more involved in the APTA, and a desire to extend that enthusiasm to others. I think that student involvement often breeds further student involvement, and to help with this, I want to build a foundation that would most enable me to work toward this goal.

I am hoping to be slated for Student Assembly in October. If I am able to run for office, it will be of utmost importance that I am able to understand where the profession of physical therapy stands regarding federal and state issues as well as within its own professional association. I have recently started attending the MA delegation meetings and plan to attend the national House of Delegates prior to the Advocacy Academy. It will be an excellent opportunity for me to learn how to be an advocate, so that I can efficiently represent the students to the APTA, and as I progress as a professional, represent the APTA to federal and local lawmakers.

As a student member in the APTA for almost two years, I have come to see the importance of membership on one’s professional association. Beyond the benefits of publications and career advancement opportunities, it provides a way for a person’s voice to be heard nationally. It is an exciting time to be in physical therapy with regards to advances in research, practice, and education. The association has played a very large role in these areas, but it is important that the profession is able to utilize these advancements to capacity. It is the act of members serving members that makes this happen.

In the last year, I have seen this service of members to members and non-members alike at National Student Conclave in Dallas, and CSM in Boston. At Conclave I was able to attend many sections on clinical practice, advocacy, student assembly, and professionalism. With CSM in Boston, I was able to fill each day with a variety of events including the forum on the regulatory designator and the PT-PAC luncheon. The meetings served, in large part, as sparks to ignite what was already a growing interest in matters of the association into a passion to take an active role in the APTA. I see attendance at the Advocacy Academy as preparation for my own participation in advancement of the physical therapy profession.

Easter!



What a weekend! I made it home Friday night in time for the Good Friday service at my church. It is very dramatic. The pastor reads through the story of Christ's crucifixion with hymns interspersed. Then at the end, he reads the last seven things Christ speaks as he is dying and after each one some lights are turned off in the sanctuary. Finally he reads the last words and all the lights are out. Then people get up and leave without saying a word to each other.

On Saturday we all worked to get ready for having Easter dinner at our house. Lydia and I went looking for her outfit and to escape some chores. :) Jon brought 2 friends home from the Naval Academy Prep School and they got in around 11:30pm. We talked until about 2am and finally I went to bed only to get up at 6:30am so I could get a shower. 2 showers with 10 people needing one in the morning was my motivation. Then we did the Easter basket deal and all got ready to go to breakfast at church. All the men in the church make a huge breakfast with pancakes and eggs and sausage and bacon and hash browns etc etc etc. It is so fun to come in and see everyone all dressed up. Church was great too. Then we went home to host 10 more family members for Easter dinner. By the time dessert rolled around we were ready for naps. BUT that didn't keep us from playing a 9 inning game of wiffleball then hanging out in the living room telling stories of when we were little and got in trouble ... or how we got out of trouble. Jon and his friends left at 8pm and Lydia, Kitty and I watched home videos of when I was 4 and Ben was 3. We were soooo cute. :)

And now it is back to clinic tomorrow. Whew.




Thursday, April 5, 2007

My new suit

That title gave everything away. I got a new suit today. The process of finding a suit was not very fun for me...but at the same time, it was super. Granted, I was pleased the sun decided to shine on my venture...but it was colder than I had expected this morning so I took the T. It was crowded and stuffy and basically the green line during rush-hour. But I did make it to Filene's Basement without too much trouble. Note to self and others - try never to go there again with a backpack. I hit too many people with it and spent a great deal of time apologizing. Anyway, enough with all the bad stuff. I walked into the suit section and realized why they print on their bags "I just got a bargain!" Lots of great suits for less! I grabbed about 4, which turned out to be a lot to carry, and a couple shirts to try them on with. The first 3 I tried on had those old-lady-up-over-the-bellybutton waists which I am not really a fan of. It was also VERY hot in there. I wanted to try on swimming suits and not business suits. In the end, the first suit I grabbed off the rack first was the one I ended up with. It is perfect! Seersucker, navy pinstripes, good waist on the pant - a very comfortable combo. AND it was 25% off. Sold! Well, it wasn't sold yet, but the lady who rang it up was also very excited about my purchase, commenting on what a good looking suit it was, and so versatile, just change the shoes or don't wear the jacket, etc. She was a fan. I am too.

Wednesday, April 4, 2007

New Legislature

There are a few new bills before Congress. PLEASE, read through this and get in touch with your congressmen. I know it is long, but it is important. AND, if you don't think these are, please comment. I would love for anyone who disagrees to state why so I am not just preaching to the choir. (That does not mean that I will preach at you instead. I would like to know what people are thinking.)

The following is the result of discussion between myself and another PT student Eugene Babenko.

HR1134 - The Physical Therapist Student Loan Repayment Eligibility Act.
Enabling physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program by adding PT to the definition of primary health care services.

HR 748/S. 450 - The Medicare Access to Rehabilitation Services Act
Repeal the cap on therapy services for Medicare beneficiaries once and for all. If Congress does not take action by January 1, 2008, the therapy cap will again be imposed on Medicare-covered physical therapy, occupational therapy, and speech language pathology services.

HR 1552/S. 93 - The Medicare Patient Access to Physical Therapist Act
Recognizing the ability of licensed physical therapists to evaluate and treat beneficiaries requiring outpatient physical therapy services under Part B of the Medicare program and eliminates burdensome requirements, such as a physician's referral or certification of the plan of care, as permitted by state law.

If you would like to take action, please head to the Legislative Action Center.

Or click:
www.apta.org/advocacy

If you're not totally convinced I urge you to keep reading.

With regard to HR1134, I think any legislation being passed that acknowledges the PT profession as a primary health care service is a vital step towards VISION 2020. This specific bill is a great continuation of the multiple efforts of our profession to reach out to the under served. In addition, student debt is an overwhelming aspect to becoming a PT and has been cited as a barrier of many potential candidates entering the profession. Short of academic institutions lowering their tuitions this bill is a vital component in helping to relieve this problem.

Unfortunately, often times students are so focused on their studies that they are unaware of important opportunities to realize how governmental affairs can affect them. The Legislative Action Center that the APTA provides for its members has been a key to getting students involved in the legislative process.

With the introduction of HR 748/S. 450 and HR 1552/S. 93 students really do need to take a more active role in advocating for their profession, and in turn, for their future patients. Having all three bills currently in congress would be a great accomplishment for the advancement of Physical Therapy. If we as future clinicians can assume ownership of professional responsibility and realize the magnitude of this, the progression of physical therapy will be in very capable hands for decades to come.



Tuesday, April 3, 2007

No more observation!

First of all, I miss my CI. She's been at RIC for a course on Amputees and Prosthetics since Thursday and will be back tomorrow. The clinic schedules out a month in advance, so in March they fill April. I guess they didn't plan ahead for me to take over her schedule and so I was put with other therapists in the clinic for Thursday, Friday, Monday and Tuesday (today)... This is not to say they aren't great therapists. I saw lots of stuff - the Locomat, pressure mapping for w/c seating, different methods of w/c control, I did a new CVA eval, helped with lots of patients for gait or the standing frame... but... I did a lot of observation. Which at first was great. It is always good to see other therapists and their styles. But it got pretty boring. I am very excited to start my caseload again! Hopefully I'll have 4-5 treats, an eval and a discharge. Also, my CI and I are going to help out with a pump trial...baclofen for increased tone I think.

Today I also participated in my first live draft for fantasy baseball. It was fun because a few guys from college set it up and I got to talk to them in the draft chat room while we were picking our players. My 12y/o brother (Christian) helped me figure out who I wanted to snag in the first few rounds. Actually, he gave me a list of the top 10-15 players for each position. I wanted him to be my co-owner since I get busy and forget to look at stuff, and he knows baseball better than I do, but he didn't want to do it... So, I had to settle for second best. ;)

Monday, April 2, 2007

Opening Day!

"You always get a special kick on opening day, no matter how many you go through. You look forward to it like a birthday party when you're a kid. You think something wonderful is going to happen." - Joe DiMaggio


It is true. As we finished up with our last patient today around 4:30, some of the staff had come into the gym to work out and turned the game on. Just hearing the sounds in the background made me remember spring and summer and early fall. I have to settle for Red Sox games here in Beantown... but I am a baseball fan first and it was exciting. It was cold and raw as I walked around North Station and smelled Half-Time Pizza, so I hopped on the shuttle and the driver had the game on over the speakers. I got a shiver down my spine when the royals scored 2 runs on a double in the corner - really, a shiver due to excitement, not cold. And the Yankees won. :) If you can't tell from this post, I am a huge baseball fan. My entire family plays baseball, except my mom. My brother Ben (22) plays for Franklin Pierce in NH - they went to the DII world series last year. Jon (19) is at the Naval Academy Prep School playing ball and will play at Annapolis next year. Lydia (17) and Kitty (16) both played tball and will play wiffleball with us all summer long, and CJ (12 - almost 13) plays babe ruth and is trying out for his Jr High team even though he is just in 6th grade. I played little league and babe ruth - i made the sr league team too but someone didn't give me the message until a couple months late. Hmmm. Then I switched over and played softball in college. It was just DIII, but it was fun.



I am also very pleased that I finished filling out the midterm section of my clinical performance instrument (that 24 point self evaluation that we're supposed to compare with our CI at midpoint in our clinicals.) Which brings up that we are actually at half-way this weekend. I do not feel as if it has been that long, the time is flying by and it is a bit scary. I am sure around week 7 it will seem very long, but for now I am racing, trying to keep my feet under me as things speed past or around or something like that.

Sunday, April 1, 2007

A little something about the "heaht"

So I have been discussing an EKG for the last 40 min or so...and some time last night. I just thought I could put some thoughts together here since it isn't for school and then if anyone has feedback to offer please add! Below is the EKG and I can't make it bigger with it staying clear, which is unfortunate.




I am almost 100% sure this is bigeminy. Now, what you would do as a PT in this situation depends on how the patient and his EKG respond to exercise. In this case, he is getting it at the 3rd station of exercises, and his systolic BP has dropped over 30 points (if I remember correctly.) As far as why - I think it is because BP = CO x PVR. With a PVC, stroke volume decreases with each ectopic beat, decreasing CO (which = HR x SV) thus decreasing the BP. And so I would stop the exercise, keep an eye on his EKG as well as his symptoms and report the arrhythmia to the MD. I don't think in this case it is too out of the ordinary to see this, because, in the history I have not disclosed yet the patient is s/p an MI. Arrhythmias after an MI are more common for a few reasons. One is that an MI really changes the chemical balances within the heart, which can change the contractility. Another could be due to the area of the prior infarct. Perhaps conduction fibers were damaged/killed, perhaps changing automaticity or rhythmicity of the myocardial cells. I might not have the pathophysiology completely correct here, and certainly there is a great deal more, but this helped put my thoughts in order. Thanks Kate Grimes and Cardiopulm and SIM-ma'am.
Whew, bed time...


Here we go again...

The only two blogs I have ever read with interest were blogs of substance. The first author works for the National Review and I have since lost where his blog is. The second actually blogs at a blog spot - http://studentpt.blogspot.com/. Bo, (the author of the student PT blog to which I am referring) has inspired me to begin to blog again. If you are looking for fantastic and in depth comments on PT, politics, books, stamps, life, or more... then go over to that one. If you want to follow my attempts then stick around here.

"To reach by jumping" is what my last name "Doskocil" means in Czech. My great-grandmother and great-grandfather came over from what was then Czechoslovakia when they were children. We are from the Bohemian part - not Slovakian. And that is my family explanation for the day.

However, the blog title has a multi-focal purpose. I feel as though life is made up of lots of little jumps, some longer than others, landings may be hard or soft, sometimes you fall, sometimes you fly, sometimes you end up where you thought you would, and sometimes it takes more jumps than you expect to get where you were trying to go. Anyway, this blog will be about the day-to-day or day-year jumps I am making, or that people around me are making. I will try to make it informative and interesting for everyone who reads this. It is worth a shot right?



And so I jump. . .



..