Tri-7 Wk6 Day 427 - First Pediatric Patient!

Whew! I've been home less than an hour and we're already closing in on 11:30 p.m. which normally wouldn't be so bad on a Friday night but I have to be back at the Double Tree hotel tomorrow by 7 a.m. for Irene Gold then need to be back at Logan by 9 a.m. for my SOT class. Irene Gold is starting an hour earlier than normal and they're skipping the lunch break tomorrow to help get everything in and accommodate our teacher's return flight home to Arizona. That means when it's lunch time for SOT I can run back over to the Double Tree for another hour of Irene Gold Board Review. I'm not sure how long SOT will last tomorrow but, I'm hoping it's not any later than 5 p.m. I do have an assignment I need to finish up before I go to bed tonight.

So ...what happened today? Geriatrics was our first class. I'm glad I record that class because there's too much good information that comes at you too quickly to get any other way. Dr. Bub brought in his Pogo-Stick today and a few people tried it out. He sure has a way of making a point. I tried it in the hallway after class :)

Our next class was Activator! I finally got a chance to use my Activator tool on a patient. I swear to god that stuff is just AMAZING. Proprioceptive touch, mechanoreceptors ...it's just amazing that you can touch people in a certain spot and watch their legs even out. We use a special table in activator class which allows a person to go from their natural standing position onto a vertical table by simply leaning against it. We then press a button on the floor to lower the table and the foot piece the patient stands on. Once the table is flat and the patient is prone we compare leg length by holding the feet in a predetermined manner and compare the heels of the patient. There's almost always one leg showing that's shorter than the other. The legs are usually not uneven as a result of one leg actually being shorter than another but rather from the pelvis being rotated a little forward or a little back. We then touch four areas around the patients knee, and after each touch, we check the leg length again. We touch the medial part of the knees then the lateral parts of the knees. Usually, touching the medial part of the knee on the short leg side will cause feedback from the brain to cause the legs to become dead even. The evening up of the legs from a simple touch only last about a minute but, it tells us exactly where to adjust with our activator. It's really fascinating and I really need to learn much more about it.

Our Physical Therapy II class was next and we had a 20 question test. It was, literally, the same exact test he went over in class the day before but, even though we had all the answers I don't think there were too many people who actually scored 100% so they could skip the final next week. Having the answers ahead of time doesn't really do much good if there isn't sufficient time to get the material memorized. I admit, I had about 30 minutes last night after I got home and before I went to bed to look over material but figured that wasn't enough time to memorize all the material. At that point, nobody knew for sure that the review exam the teacher showed us in class was going to be the exact same test so I didn't bother with it and didn't worry about it.

This sort of makes me wonder about teaching philosophies. Had I known what we went over was going to be exactly what we were going to be tested on and if that test were handed out or somehow made available then I'm sure I would have gotten the thing memorized. The motivation and confidence level would have been high. I don't know but, if it's a set of fact we need to memorize then why not tell us exactly what you want. Seems like a lot more useful information would get memorized by more people. Just a thought.

My first afternoon patient was a little earlier than anticipated but things went well. I'm getting a lot of useful feedback from all the doctors on staff who go over our SOAP notes and diagnosis. With the trip and having to redo a part of comp boards this was only my 2nd full week in the student clinic so I think I'm doing alright. The first week or so I had to remind myself that it's not like I was getting whipped or anything but, it was all still a bit nerve racking. 726.12 is the IDC9 number one teacher wanted me to look up for Biceps Tendonitis and that same teacher also told me about a specific book he wanted me to get and to read the chapter on TMJ. Today, I got a lot of useful feedback on writing the S portion of my SOAP notes. The S stands for subjective and it's whatever the patient tells you but, I need to view it more as a history and have to be sure to ask the right questions to help elicit information from the patient necessary to treating them properly. I'm also getting a bit more used to the treatment plans and diagnosis. A few patients have commented that it seems a little rough but, the way I'm thinking is the only time I need to worry is when the teachers stop sharing information and guidance with me since that might be an indication that they've given up on me. So far, so good. :)

The surprise came around noon when I got a text from one of my patients asking if they could bring their infant daughter in to the clinic. We're talking a person scarcely over 1 year old. Kind of a scary proposition at first but, I sought out some of the best people I could find and Dr. Perillat said if I had them come in after 2:45 that she'd be be able to help me through it. The whole thing was rather amazing. I've got HIPPA regulation in the back of my mind but I believe the main thing is to not give out identifying information. On an academic level we can say that when an infant falls on their head that both the cervical and thoracic spine can become subluxated. The thoracic spine is kind of amazing on an infant. There usually isn't much vertebral body rotation but rather a dorsal or posterior movement of the vertebra which is quite obvious on an infant. Even a layman could run their fingers down the spine and tell when you've reached the vertebrae that's pushing out towards the back.

While we were waiting for the doctor I started taking a basic history. All I could think of at the time regarding examination was to check the cranial nerves. I figured the eyes were a good place to start and hoped to elicit some tracking of the eyes and responses to sounds. It sure was different looking into some absolutely huge, sparkling blue eyes of a child as opposed to the adults I've always worked with. The lateral tracking was good so I was able to confirm the abducens nerve (CN XI) was still functioning as it should and there was also response to sound. Dr. Perillat made the actual adjustments (thank god) and it was very interesting to note deviation of the gluteal fold, just as we had learned in class and in our books. There was also extension of the thighs and we could see the left leg go up higher than the right leg. When the right leg was lifted it would only go up so high then the pelvis would begin to tilt with the leg so we knew there was restriction or a subluxation in the right ilium. Once adjusted, the normal range of motion was restored.

One cool thing about working on an infant or, even an animal, for that matter is the fact that there isn't much in the way of a placebo effect. Either the adjustments work, or they don't.

OMG - it's well after midnight and i'm still up. I've got to get *some* sleep tonight. I may have to fill out my SOT homework tomorrow morning because these eyes are fading fast.