August 5th, 2007 by Dr. Val Jones in News
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Russia has been promoting a new sport: the stiletto heels sprint. Although I’d heard of this a couple of months ago, I just noticed some video footage on Yahoo! In this particular race, over 200 women turned out to run 1 kilometer (about 2/3 of a mile) in heels that are at least 3.5 inches high.
It is well known that regularly wearing high heels can result in foot deformities such as bunions and corns. And yet women continue to wear them as they never seem to go out of fashion. If you’re unwilling to give up those heels, but would like to avoid having feet that look like this, here are some tips for you:
1. Minimize the distance you walk in heels. Carry your shoes to work with you and wear flats or sneakers during most of your walking.
2. Wear shoes that are wide in the toe box and do not squeeze your toes together.
3. Put metatarsal pads in your high heeled shoes, to keep your foot from sliding forward (especially if they are closed-toe).
4. Don’t wait too long to see a rehabilitation medicine specialist or podiatrist if you think you’re developing a bunion. Corrective action should be taken as early as possible.
5. If you’re working at your desk, remember to slip off your shoes to reduce the pressure on your toes. Every lit bit helps when it comes to reducing toe joint stress. If your relatives have bunions, you may be at higher risk for developing them too.
As for those Russian women who race in their stilettos, all I can say is that they’ll be keeping the rehab docs, orthopedists and podiatrists in business!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 21st, 2007 by Dr. Val Jones in True Stories
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One day I was consulted on a patient in the surgical
ICU. It is uncommon for rehab physicians
to be called to the SICU, and so en route, I pondered what I might find. Maybe a multiple trauma patient who needs a
walker or chest PT?
As it happened, the patient was a 21 year old male who had
gotten into a fight in the West Village. He was hit on the head with a blunt object, resulting
in a subdural hematoma and severe brain injury.
He was intubated, sedated, and expressing decerebrate posturing (a
really bad sign).
The surgeons had called me because they were concerned about
pressure ulcers and contractures. They
wanted to initiate physical therapy and stretching exercises to make sure that
his Achilles tendons didn’t shorten irreparably as his feet were pointing
downward in the bed. Although I thought
it was great that the surgeons were planning ahead like that, truthfully I didn’t
think the patient would ever walk again, or perhaps even survive the SICU. The level of brain injury was just too
severe.
I wrote orders for daily physical therapy, got him some Multi Podus Boots, and recommended frequent turns in bed.
I figured I’d never see him again as I was scheduled to change rotations
and transfer follow up of this consult to another resident. It was a tragic case.
About 2 months later I began an inpatient rotation and was
listening to the story of several patients whose care was being transferred to
me. As the resident presented the final
one, I thought the story sounded familiar.
A young man out partying with his friends, got into a fight, sustained a
severe brain injury after being hit in the head…
“This isn’t the guy I saw in the SICU 2 months ago, is it?” I asked the resident.
“Yeah, that’s the one!
I remember seeing your note in the chart. The PTs did a great job with his ankles – he could
stand on them just fine when he got up.”
“Dude, no way! When I
saw him he was posturing in the SICU… this guy actually recovered?!”
“Yeah, I know… he’s the first one I’ve ever seen like this. Do you wanna see him?”
“Heck yeah,” I said, “I’ve got to see this with my own eyes.”
My colleague led me down the hallway to the occupational
therapy kitchen. As we got closer, a
wonderful chocolatey smell filled the air.
“What smells so good?” I asked.
“Oh, the patient is making cookies with the occupational
therapists. He’s learning how to cook
and take care of himself.”
I rounded the corner into the kitchen and there was a young
man, handsome and healthy, pulling a tray of cookies from an oven – I could barely believe it was the same
person.
“Hey doc,” he said to me – not recognizing me of course, but
friendly nonetheless. “You want a
cookie?”
“I’d love a cookie,” I said, remembering the last time I had baked them.
“I believe that this is the best cookie I’ve ever tasted,” I
said, looking at the man with tears in my eyes.
He grinned from ear to ear.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 2nd, 2007 by Dr. Val Jones in True Stories
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Continuing on with the car accident theme… A patient came to see me in the clinic. She had been run down by a bike messenger (could it have been my friend with the bleeding leg?) when attempting to step out of a bus onto a cement curb. She had a lot of pain in her shoulder and side, and was taken to the ER where a chest XRay was unremarkable. She was released with a prescription for extra strength Tylenol.
Still in pain, she made an appointment at the hospital’s orthopedic clinic for the next available time slot (she was covered by Medicaid) where she met with a young resident who suspected that she was a drug seeker and sent her away with “reassurance” and more Tylenol.
The woman, knowing that if she came back to the clinic again, she’d probably see a different physician (and could therefore get a second opinion) – made another appointment. The next orthopedic resident read her chart (where the previous resident had written that the patient exhibited drug seeking behavior) and barely listened to the woman’s story. But after the patient insisted he do something, the orthopedist did what most do with “chronic pain patients” – send them to the rehab doc.
And so, nearly 6 weeks after the accident, I met the woman in the rehab clinic. I had read the ortho notes prior to seeing the patients and was nearly convinced from their descriptions that she was a belligerent, drug-seeking nightmare.
The woman was thin and irritable. I asked her why she had come to see me, and she said she thought I was going to do some physical therapy with her. I asked if she could recount the events in her own words, and explain what exactly was troubling her. As the story unfolded, I was saddened by what she described – the endless frustration of being in pain, of being bounced around from one young physician to another in clinics overflowing with patients, and of being labeled as a drug seeker. And all this after a very painful encounter with a hit-and-run bike messenger.
I asked her to describe her pain and point to it exactly. She said it had been slowly improving, but that it hurt most when she breathed in and there was some point tenderness over her 8th, 9th, and 10th ribs. I asked her if she had had a rib series… nope just a chest XRay.
I told the woman I thought it was likely that she had fractured her ribs, and that rib fractures are often hard to see on XRays, especially chest XRays. I also told her that there wasn’t any real treatment for rib fractures, except pain management and time to heal. Her face lit up.
“So you believe me? I’m not crazy?”
“Sure I believe you,” I said. “I’ve fractured ribs in the past and I know how painful it is. When it happened to me no one believed me either. My chest XRay was normal.”
“So what did you do about it,” the patient asked, looking at me compassionately.
“The truth is, I had to sleep sitting up for a week or so, and I breathed very shallowly for a while. Eventually, though, the pain went away on its own.”
“Thank you for listening to me, doc,” she said, tears welling up in her eyes. “Even though there’s nothing I can do about the ribs, I’m glad to know what the pain is from, and that I’m not crazy.”
I wrote a short note in the chart, documenting my impressions. I did not recommend physical therapy for the patient, but to follow up if needed.
Apparently, the woman had one more clinic appointment with the orthopedic team. They read my note and ordered a rib series to confirm the diagnosis. The rib series showed healing fractures of ribs 8, 9, and 10.
I never saw the patient again, but I’m quite sure that explaining her diagnosis was the most therapeutic thing that we did for her.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 17th, 2007 by Dr. Val Jones in Opinion
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– continuation of previous post –
What does a PM&R doc do?
The foundational principle upon which rehabilitation medicine is based, is this: physical modalities (exercise, movement, muscle strengthening) are critical components of achieving the highest level of wellness and functionality. The goal of a PM&R specialist is to maximize a person’s functional ability within the constraints of their physical limitations. So that if a person is an amputee, or has had a spinal cord injury, or stroke – the goal is to make them as independent as possible, using prosthetics, orthotics, adaptive equipment, physical training or family assistance.
The rehab physician works tirelessly to enable the disabled. Whether the patient has temporary (such as after a broken bone) or permanent (such as a spinal cord injury) disability, the rehab doctor wants to seamlessly reintegrate the patient into society, into meaningful work, and into a joyful participation in life to the max.
PM&R physicians are the ultimate integrative medicine specialists – they practice a combination of physical and medical healing techniques, while leading a team of specialists to help their patients achieve their goals (nurses, social workers, physical therapists, occupational therapists, cognitive therapists and psychologists, speech & language pathologists, prosthetics & orthotics specialists, and more).
I guess I could sum it up like this: when the proverbial Humpty Dumpty “has a great fall,” the surgeons knit his bones back together, the internists maintain his vital signs, but the rehab doc finds him some crutches, teaches him how to walk again, gets him cognitive therapy and counseling, helps him reintegrate into society, and stimulates his progress towards physical independence and emotional wellness.
Why did I choose this “odd ball specialty?”
Well, truthfully, I didn’t hear much about PM&R during medical school. I happened to meet a group of exceptionally happy residents in the hallway one day, and I asked them why they were smiling. (My only experience with residents was that they were tired, bedraggled, ill-tempered and hen-pecked – and this group defied the stereotype).
They explained to me that they were “rehab residents” and that’s why they were happy. That seemed like a non-sequitur to me, so I investigated the specialty in more detail, and became convinced that there was no higher call than to care for the disabled. I had been a home health aid in college, taking care of young adults with cerebral palsy, and I spent my summers at a camp for disabled adults, sponsored by the March of Dimes, so this was familiar territory and seemed to be a good fit for my nurturing temperament.
As we look at Americans’ current medical needs, we don’t see hundreds of thousands of war amputees (though there is a steady trickle coming from the war in Iraq), or polio victims – but what we do see is a population disabled by obesity and its collateral damage: diabetes (with its amputations), heart disease, stroke, severe arthritis, and various pain syndromes.
I believe that Rehabilitation Medicine, as a specialty, should adapt to serve the needs created by this new obesity epidemic. We have always been the masters of physical exercise for healing – now we should apply those principles to help Americans lose weight and keep it off. I couldn’t agree more with Dr. Jim Hill, who believes that dieting leads to weight loss, but exercise leads to weight loss maintenance (the real key to long term health benefits).
As I have argued in the past, America needs to be rehabilitated. And I hope that my work at Revolution Health will contribute to improving the general wellness of our citizens.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 17th, 2007 by Dr. Val Jones in Opinion
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One medical specialty has managed to avoid (nearly completely) the public eye: Physical Medicine & Rehabilitation (or PM&R). Physicians who choose this specialty are referred to as “physiatrists” or “rehabilitation medicine specialists” or “rehab docs.” But the truth is that very few people understand what they do, and unfortunately the rehab docs haven’t made much of an effort to explain themselves to their peers or the world at large.
A dear friend and mentor once asked me, “why did you choose such an odd ball specialty?” This rather direct question forced me to ponder my career decision, and to determine how it came to pass that PM&R was given the unhappy reputation of “odd ball specialty.” I’ll begin with a little background about the specialty and then explain why I chose to devote my life to it.
The history of PM&R
PM&R really traces its roots back to the American Civil War (1861-1865). This gruesome battle resulted in over 620,000 casualties and over 60,000 limb amputations. The modern specialty of general surgery developed through life saving trial and error on the battlefield. Massachusetts General Hospital, for example, was performing an average of 39 surgeries/year before the civil war, and this increased to 2,427 in the late 1800’s.
But physicians and surgeons were not prepared for the aftermath of war – tens of thousands of maimed and partially limbless now trying to live out their careers in a disabled condition. One confederate soldier, James E. Hanger, lost a leg in the war, and subsequently created America’s first prosthetics company, still in operation today. Unfortunately for the disabled, though, there was no guarantee that appropriate accommodations would be made for them to be fully reintegrated into society.
With the rise of surgery came a major realization: patients did not do well after surgery if they remained in bed. Conventional medical wisdom suggested that bed rest and inactivity were the most effective way to recuperate, but now with thousands of post-operative patients in full view, it became painfully clear that the patients who did the best were the ones that got up and returned to regular physical activity as quickly as possible.
Following this realization, the University of Pennsylvania created (in the late 1800’s) an orthopedic gymnasium for “the development of muscular power with apparatus for both mechanical and hot air massage, gymnastics and Swedish movement.”
A young Canadian gymnast trained in Orthopedic Surgery, Dr. Robert Tait McKenzie, was recruited to U. Penn to develop a new field in medicine: “Physical Training.” Dr. McKenzie created a medical specialty called “Physical Therapy” and he was the first self-proclaimed “Physical Therapist.” He wrote a seminal book on the subject called “Reclaiming the Maimed” (1918) and continued to practice orthopedic surgery until his death in 1938.
Other major medical institutions followed U. Penn’s lead, creating “Medicomechanical Departments” at Mass General and the Mayo Clinic. Technicians were trained to assist in helping post-operative patients to become active and reclaim their range of motion – these technicians were known as “physiotherapists” and formed the first physiotherapy training program at the Mayo Clinic in 1918.
World War I (1914-1918) resulted in millions of additional amputations, thus flooding the health system with disabled veterans. In response, the army created two medical divisions: The division of orthopedic surgery and the division of physical reconstruction. By 1919, 45 hospitals had physiotherapy facilities, treating hundreds of thousands of war veterans.
And then there was polio. Suddenly a viral illness created a whole new wave of disabled individuals, further stimulating the need for orthotics (leg braces and such) and rehabilitative programs.
World War II (1940-1945) resulted in yet another influx of disabled veterans. All the while the medical community was developing innovative programs to maximize veterans’ functionality and integration into society and the work place through the burgeoning field of Physical Medicine & Rehabiltiation.
Key players in the development of the specialty:
Dr. Frank Krusen developed the first physical medicine training program at the Mayo Clinic in 1935 and the “Society of Physical Therapy Physicians” (now the American Academy of Physical Medicine & Rehabilitation) in 1938. He coined the term “physiatrist” to describe the physicians who specialized in physical modalities for rehabilitating patients.
Dr. Howard Rusk founded the Institute for Physical Medicine & Rehabilitation in 1950 at NYU. Excellent research in the field ensued.
Dr. Henry Kessler founded the Kessler Institute for Rehabilitation, in New Jersey, 1949. More medical research was developed.
Mary E. Switzer successfully lobbied for the enactment of Public Law 565 which mandated that government funds be channeled towards rehabilitation facilities and programs for the disabled.
What’s in a name?
So as you can see, there is some good reason to be confused about the modern specialty of PM&R. It has undergone several name changes, molded by historical circumstance. Today, physiotherapists (they still go by that name in Canada) or physical therapy technicians have become a well known and respected profession: Physical Therapy.
Physicians who specialize in Physical Medicine & Rehabilitation are called rehabilitation medicine specialists or “rehab docs” or “physiatrists.”
-See Next Post for the rest of the story –
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
