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Established 2011

The Blame Game, Pt. 1

If you blame others for your failures, do credit them with your success?
– Unknown Author

I have to come to understand that when I am working together with a patient in pain, the resolution or reduction of that patient’s symptoms is not the direct result of my input, but is (instead) a product of their own nervous system.

Often, my patients thank me when they begin to feel better; I always remind them that they were the one’s who did all their work while I merely served as a facilitator, educator or coach, but never a healer. I understand this to be the most accurate way to portray my interaction with my patient’s and I think that it resonates with them and (most importantly) reminds them of their new found empowerment.

Recently, however, I have been contemplating why it is that when a patient makes progress, I am eager to give them all of the credit that I understand they deserve, but assign fault/blame to myself when progress is limited (or is, worse yet, non-existant).

This presents as a logical inconsistency that I am no longer comfortable with.

Not Quite Cal

Cal Ripkin Jr was able to set an amazing record in Major League Baseball: he played in 2,632 consecutive games. This was 502 more than second place on the all-time list, 1,325 more than the third man on the list.

While Cal went out every day and played, I need a break once in a while…and I realize now that today is one of those days. So, I leave you with someone else’s words in my stead: a quote from Carl Rogers that relates to my own personal goals as a therapist striving to be great at doing less:

The degree to which I can create relationships which facilitate the growth of others as separate persons is a measure of the growth I have achieved in myself.

Sign Me Up

The opportunity was too good to pass up, and the price was right.

About the Course
Medical Neuroscience explores the organization and physiology of the human central nervous system. This course is designed for first-year students in graduate-level health professions programs. It builds upon knowledge acquired in prior studies of cellular and molecular biology, general physiology, and gross human anatomy. The course provides students an understanding of the essential principles of neurological function, from cellular and molecular mechanisms of neural signaling and plasticity to the organization and function of sensory and motor systems. This course emphasizes the neural and vascular anatomy of the human brain and spinal cord, providing an anatomical framework for localizing lesions within the central nervous system. It also emphasizes the neurobiological foundation for understanding mental illness and disorders of human behavior.

The overall goal is to equip students of the health professions for interpreting impairments of sensation, action and cognition that accompany neurological injury, disease or dysfunction. Students currently pursuing advanced studies in the brain sciences will benefit from this course by learning the fundamentals of functional neuroanatomy and how neuroscience discovery translates to clinical practice.

This course also reminded me of a webpage that I had once bookmarked about a year or so ago: 12 Dozen Places To Educate Yourself Online For Free.

While exploring, I found this a course on listening to music (which, has been a little bit of a theme of mine the last few months), and figured it might be worth my time. Perhaps I might learn something…

Killing “Why?”, Pt. 2

We now live in an age where facts are indeed (in a way) cheaper than ever just because they are so easy to get. The university can’t make money any more just selling facts, because they’re available with the click of your mouse…So we can’t just sell the facts. We have to teach people to think beyond the facts, to think what the questions are. And that is the hardest thing to do.

There is a great story about Gertrude Stein and what was then considered life-threatening surgery and she was asked by her life long companion, Alice Toklas, “So, Gertrude, What’s the answer?” and Stein (in her particular way, of course) looked at her and said, “Well, Alice, what’s the question?” And that, of course, is the key issue.

Learning how to figure out what that question is…[that is] really what we need to teach a scientist. That is what science education should, of course, be about: learning to come to these questions.    – Stuart Firestein

I was one of the lucky one’s, a straight-A student designed to become the textbook therapist (pun-intended). I was taught all of the mandatory questions to ask my patients upon examination and I learned what protocol to follow based on the findings of that exam. In the end, I graduated from University knowing all the facts I needed about physical therapy to pass my licensing exam.

I realize now that I never had to ask the right questions of myself or my patients, and that was the hardest thing to do, not memorizing a seemingly infinite amount of data in a remarkably finite period of time faster than my peers. And therein lies the problem: education has become a race to memorize “becauses” in lieu of exploring “whys”.

Granted, the “becauses” allow the student to pass an exam, the teacher to get their annual raise and the parent to gleam with pride, but it is the “whys” that push us to innovation, progress and understanding. It is the “whys” that define not who we are, but who we aim to be. After all, who wouldn’t rather write history, instead of reading about it in a dusty old book?

I just wish more educational professionals shared the same perspective.

Killing “Why?”, Pt.1

For generations, students have moaned and complained about the “pop quiz”, the quick and little tool wielded by the lazy teacher used to assure that their students are doing as they are told by recalling data from yesterday’s lecture or last night’s reading assignment. It is a symptom of a multi-faceted endemic in the US educational system that includes an outdated model, poor teachers protected by their unions and parents who are part of a culture that expects the rest of the world to do their job (or they simply don’t care if anyone does their job at all).

Then, if we are lucky, we have a few students who somehow make it through a flawed system with what is believed the requisite knowledge for collegiate success: the “straight-A” student. This student is special, for they can memorize and understand information on multiple subjects (not just the materials that interest them, but the topics that bore them as well). The discipline to forge ahead through such boredom at such a young age is worthy of applause after their speech as valedictorian.

Then they are off to college, to learn more facts; ill prepared for what might be next…

A Show Of Support

For the last few months, he has been married to his job more than his wife. He is never around when she needs him, but she pushes ahead with the strength of a successful single mother. In the face of loneliness, she does all the things for her son and daughter that a father should and she never complains about his absence, even to those who are closest to her. She is a remarkable woman, wonderful mother and a very patient wife.

So, when my wife told me she felt bad because she could not help Stacy (who needed to work on a Sunday morning but could not find someone to watch her children), I volunteered.

In two days, I will be watching 4 kids in my home, severely outnumbered for nearly 3 hours as my wife teaches her exercise classes and Stacy fulfills her commitments for a job she cannot afford to lose. It is going to be a very long 3 hours, but it is the least I can do.

After all, if Chuck were home, he would do it himself.

A or B ?

“I am going to miss you coming in. How do you deal with letting go of that emotional attachment that you develop with a patient when you need to stop their therapy?”

(A) I used to work with children with special needs, and the one thing I took from that experience was to never become emotionally involved. You see, there are too many instances where children would spend 6 hours in a nurturing and caring environment carefully constructed by me and my colleagues, only to send a child home to live with a family that seems to love them less than their teachers do. When you hear about teachers getting burned out, that is why. But, if you become emotionally invested in your job (instead of the children themselves), it becomes easier. That is the only way I could convince myself to go back to work each day.

The same holds true now for patients who live with unsupportive families or are held captive in assisted-living facilities throughout the county without their families providing them with the emotional support they so desperately need. I (myself) only have so much emotional capital, and my family needs it first and foremost. The rest goes to my job, but I cannot afford to invest it in each patient individually.

It would break me.

…or…

(B) Please, understand that my investment in your physical progress does not mean I necessarily become emotionally attached to you. Providing care is not the same as caring.

I chose “A”.

Yet Another Failure

Yesterday, Betty felt wonderful after her physical therapy visit. A nurse visited her later and reported that she was “cheerful” and that her blood pressure was lower still (I take this to mean that she is under less stress from pain, but could be mistaken).

Today, however, Shirley did not respond as well.

Shirley has an “arthritic” knee that limits her ability sleep at night; she cannot find a comfortable position to sleep in. She has pain that is located over her anterior thigh, knee and (sometimes) shin. It is pain-free in sitting and supine hook-lying. Her pain is provoked in standing and lying flat in supine. She has full knee extension ROM in the left knee in sitting, but has significant pain when she tries to straighten the same knee while lying on the bed. SLR did not reproduce her symptoms. Hip flexion to 90 degrees in supine (with knee flexed at 90 degrees throughout) becomes painful, but she can assume the same position in sitting comfortably.

I understand that her pain is from mechanical deformation in her nervous system. I understand that her “arthritic” knee cannot signal pain to the brain. I also understand that I may not help every patient, every time. This was the case with Shirley, today.

The good news is that she did not feel any worse when I left today; the bad news is that she did not feel any better.

When I see Shirley again next week, I will continue to try not*

*(hat tip to Barrett Dorko, PT)

Thank You, Pt. 2

Betty tried thanking me for doing almost nothing; she should be thanking others, but she will never know their names.

You see, if not for them, she would have been seen by another therapist who would have called her physician to obtain a prescription narcotic. Meanwhile, I would still be working in an outpatient clinic trying to figure out how the theories of Greenman and Sahrmann fit together, juggling 3-4 patients per hour. Another therapist would  have pushed her through the pain, having never contemplated a deep model of the “care” they provided. I would still be blaming my patients for all of their failures without having heard of chasms, mesoderm, ideomotion, fractals, dissonance theory, emergent phenomena, Occam’s Razor, or mirror neurons; or authors such as Shacklock, Ramachadran, Damasio or Moseley; or concepts ranging from virtual bodies to Motivational Interviewing. I would have never heard of the Neuromatrix and I certainly would not have found the motivation to happily contribute to an unsuccessful, sparsely read blog amongst the 36+ million hosted here on wordpress.com.

I do not know if I am a better therapist for all of my patients because of these people, but I know that I was a better therapist for Betty that one day; for her, they have made all the difference in the world. If she knew their names, she would thank (in no specific order):

  • Bernard, for creating the community
  • Diane, Barrett, Dave and Ian for consistently peaking at my blog
  • Diane, for her HumanAntiGravitySuit (and other materials she offers to readers for no charge)
  • Barrett, for his essays, his daily musings, and a glimpse into my future
  • Jason, for crossing the chasm and sending a PM of support during a difficult time
  • John, for sharing his knowledge and generosity of time
  • Carol, for her clarity
  • Fred, for his kindness and hospitality
  • Ian, Bas and Nari, for their insightfulness, wisdom and experiences
  • Kori, for helping bring the emergent to light
  • Patrick, for his fearless inquisitiveness
  • Corey, for his videos and understanding of context
  • Will, for sharing with us more than a few “diamonds”
  • ANdy, for echoing my own sentiments (even when I cannot find the words)
  • Ken and Byron, for always bringing a different perspective to a conversation
  • Mark and Geoff for stirring the sometimes settled pot

And there have been countless others who have brought something to the conversation in the last year as well. Sometimes an echo-chamber, but never a tea-party, SomaSimple is a place with a wealth of knowledge that is truly amazing, shared by a group of people who have generously shared their ideas, time and energy with a stranger from the heart of Central NY.

If she knew any of your names or how you helped me serve her better, Betty would embrace each of you in appreciation. Instead, I will simply say, “Thank you…from both of us.”

Thank You, Pt.1

When I walked into the home, she had been in severe pain for days. Her blood pressure was elevated (170/110). She was lying on her left side on her couch, crying from the pain.

Sorry Robin, she could not rise to stand without being in agony; an assessment of repeated ROM was not justifiable under the circumstances (nor could she lie on he stomach). Sorry Ron, she wouldn’t let me do an abduction drop test (but you said everyone is positive anyway, right?) Sorry Tim, Julie et al, she has had chronic pain in her low back for years and it will travel down the leg (although that is not her complaint today). Sorry John, she has tin foil over the windows, it keeps all the negative energy out (okay, not all the windows, just one; I do not know why, I was scared to ask). Sorry Shirley, I stopped reading your book at page 73.

Betty would feel better soon. She practiced deep breathing and was encouraged to communicate calmly with her therapist how she felt throughout the encounter. Her nervous system appreciated gentle treatment along the path of the sural and fibular nerves, then the posterior cutaneous nerve of the thigh, the cluneals and dorsal rami.  Once she was able to sit comfortably, her own instinctive movements were elicited with the lightest of touch over each clavicle, her movements were subtle, but palpable and effective(if not corrective).

After one hour, she was walking comfortably with a reduced blood pressure and smiling, she thanked me.

“No need…I did almost nothing.”