Day 4 Clinic Day 2

Only better way to top yesterday's start of the day was today's.  Yoga on the end of the pier with the sounds of waves, the sun rising, and clear skies.  5 of us did a little P90x yoga and it was amazing!

After pancakes with peanut butter and fresh fruit we boarded the boat for our clinic day. Kim and I went back to Livingston with the other 5 students.  Today school was back and session and we walked into a room with 12 students with disabilities.  We got to learn each students story and after that we did screenings of each student to determine if treatment was needed we treated a few of the patients. 

The one my group treated was a 17 year old female who was unable to read or write due to a learning disability. However she could sew and was doing that in her community.  With some mentoring the students were able to look big picture at the patients needs and came up with a great plan of care to address her thoracic, finger, and balance impairments! 

The rest of the morning consisted for return patients from yesterday who were all doing better including the lady with the wrist fracture who presented with 3/10 pain and maintained the Range of motion gained last visit. She was in shock of how well the wrist was doing and reported she felt much better with our care which was great. The students did a great job educating the local therapist on the treatment techniques to improve his skills as well.

We also had a very challenging patient with low back pain. Her high pain levels, 4 year history of pain, and inability to do more than 2 minutes of walking made me aware that this was not going to be an easy fix. I decided to take the reigns on this case and really work with sound clinical reasoning and think about my interventions to show the students how I would handle this. She improved a little, but I am still struggling trying to think of what would have been best for her. 

On the way to lunch I met a gentleman from Livingston. He went to the University of Illinois for school and returned to Livingston after college.  After talking about Chicago he began to explain to me the changes over the last 4 years in this area. He said that back in the 70s the town of Livingston was all his people (he referred to them as the black people) he said that over the last 40 years the other cultures (he called them the Mayan's and the Spanish speakers) have began to take over the area and racial tension has increased. We also talked about the population shifts, high HIV rates, and assistance from foreign groups. I had a great conversation with this 66 year old man with so much life experience.

 (Blood pressure cuff bag from a past Thrive trip being used by the clinic PT Ronnie)

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After a great fresh fish lunch we headed back to the clinic and treated until 5 pm. 

 (My new favorite hot sauce!!!)

We saw a verity of patients with symptoms from 1 day long to 8 years of pain. We saw as young as 2 and as old as 81.  Seeing this much variety really changes the treatment and thought process from visit to visit and has been a great experience for the students. 

We got back to the compound and I got to jump in the water for 15 minutes before dinner.  We had salads and with my diet it didn't put a dent on my hunger so luckily I got to have 2 more servings and 3 spoonfuls of peanut butter to curve the hunger.

I had a great conversation with one of the students about one of the patients she saw. It was an orthopedic case and I was happy to talk it out with her.  After going through the subjective, objective, and diagnosis we talked about other options and what I would have wanted to know. It was so awesome to see her reason through the case and even come to these conclusions on her own. She is a very smart girl but tends to be hesitant to voice her ideas.  I think that experience will hopefully improve her confidence and carryover to increased confidence in her knowledge and skills and a therapist. She had ideas that were not used by the group but now she may be more willing to speak up for the good of the patient.

After the meal our group had a great reflection on the day. The students had some great insight on their growth and how much this trip has already shaped their thinking, skills, compassion, and self awareness. I am looking forward to even more growth the next few days!

I got to spend another night looking at the stars and blogging.  I now remember why I can see myself living on the beach or in the mountains.  Waking up and going to bed with this nature is rejuvenating. 

Day 3. First day of clinic

Early wake up day 3 with a run and workout. 6 members of the group went for a run and workout. Great start to the day with some cool weather and sounds of nature.

After breakfast half of the group began the trip to perform home visits and the other half of the group boarded a boat to travel to Livingston for clinic. I was in the Livingston group with Kim and 5 students. This village is one that is less often visited by volunteers and has an interesting mix of Spanish and Rastafarian cultures. We are treating in a school that was created by local mothers of children with special needs. They had a problem and found their own solution. They hired a physiotherapist who was still in school and he has been working in the clinic the past 2 years treating the students as well as locals of various ages in the afternoon. SUPT thrive has worked along side him and educated him trip after trip to help long after we leave.

Today the school was closed due to a holiday for a local Saint. However we were still able to treat 8 patients between the two groups.  With 4 1st year students and 1 2nd year student, the strongest kills they had were in the arms and luckily today we had 4 patients with arm elbow or wrist pain. This population allowed the students to jump right in and use skills to treat.  I was impressed with the willingness of the students to answer questions and think outside of the box.

My favorite part of the morning was being able to spend over an hour performing an evaluation on a patient having the students clinically reason the possible diagnosis and treat. Having a slower load that first day allowed for us to really work on the foundational ideas taught in class and carry them over the this environment.

Lunch was right down the street where the leader of the clinics family owns a restaurant.

The biggest change we saw today was in a middle aged lady with a regression in progress after a wrist fracture and cast removal. She was doing well for 2 weeks and then began to get worse this past week during PT care. We worked well to address her impairments and change her symptoms dramatically with manual therapy, educations, and exercise modifications.  She went from 8/10 pain and 20 degrees of wrist flexion to 3/10 pain with 60 degrees of wrist flexion and no fear!

After the boat ride back from clinic we had a few minutes to jump in the Gulf of Honduras before our reflection time, dinner, and church service. 

Somewhere between that time I got to catch up with Olivia and talk about our lives and prepare for life together in a month and a half.  It is great having such a supportive partner for these adventures and our goals for this type of work in the future!

Sitting by the ocean and looking up at the clear sky and huge stars reminds me why I love these cultures and people. The appreciation for life, work, each other, and the environment is overflowing in these areas of the world!

Guatemala 2017 SU Thrive: Travel Day

I have been excited about this trip for awhile now. It fell perfectly after the bulk of fellowship coursework was done. I get to celebrate the end of a tough year with my passion of more physical therapy and travel.

I am also excited to join SU Thrive again. The organization continues to do great work and I am glad to be able to continue working with them.

Today is going to be a long day. It started with a 130 am wake up call to make my two buses to the airport.

The first flight is solo from Chicago to Atlanta where I will meet up with the group to take the second flight to Honduras. We will be in Livingston, Guatemala which is on the southeast side of the country so the quickest way to travel is actually through Honduras. When we arrive mid day we have a nice long bus ride to where we are staying. The rest of the night will consist of some food and getting settled in to our housing. (Pictures to come) 

I am excited to meet the group and begin this great weeklong experience.

I will make sure to take plenty of pictures and blog a story often as I can with my main focus on patient care, education, and making as much of a sustainable impact as possible.

Final Day

Last night was a great time and I even had the luck of running into a friend from Virginia.  We were in the Central Park area and I heard my name called from a voice that was not in my group. I looked up and My friend Kyle was right in front of me! He was doing a mission trip and stopped over in Granada for the night. Unbelievable that he saw me in the crowded area!! 

Saturday morning myself and one of the students woke up early to see a patient for the final time. After all the great patients experiences we had this week, sadly we ended on more of a low experience. The patient with hip pain that we evaluated yesterday answered his door and refused therapy. He reported the pain was worse from the evaluation and didn't want to continue. We tried to explain how we could do some things to reduce the pain but he did not seem to believe this or want to even hear us. We knew he would be sore after the tests and stretches from yesterday but sadly his belief may have been that it was too much. I told the student how this is a great learning experience about education, patient alliance, and dosing of tests/home exercises. We reflected on the experience and how we can both learn from it. After residency and half of fellowship training I have really learned the importance of self reflection as the best way to improve my interactions and skills. It is always humbling when you admit your faults and learn from them. Being early in my career I feel i have a long way to go!

Later in the morning the entire group went to a local retirement home and interacted with about 40 adults who lived in the home. We talked, dances, colored, and just sat with these amazing people. Many of the ladies and gentleman living here either had cognitive deficits or no longer had family who could care for them. Luckily the nuns who ran this center are able to provide great housing and care for this group of people. It was very hard to see the condition of some of these men and women. One guy was so emaciated and sick that every breathe looked like he was fighting for his life. He could not see or sit up from the bed. 

Some of the best experiences come from seeing the not so glamorous sides of things. Not often do people visit senior centers and I am so grateful we had this experience.

We spent the rest of the day exploring and enjoying a lagoon. The fresh water in located in a crater and it feels like you are cut off from the world with 360 degrees of mountains.  I spent most of the time in the water swimming, paddle boarding, and even jumping off of a 15 foot ledge. It was a perfect way to end the trip.

At the end of our time out we met as a group and reflected on the entire time in Nicaragua. 

On the bus ride home I had an amazing conversation with Viva co-founder Carrie. We talked about mission works, global health, and long term goals.  I love meeting people who inspire me to continue this passion!!

I spent the night packing and went to bed early because my taxi to the airport is at 3 am on Sunday! 

Overall, this was a great trip with some new experiences as tons of lessons learned. I cannot wait to tell everyone about it and plan my next adventure!!

Clinic Day 4

Clinic Day 4

Three of us decided we missed working out so we woke up at 5 and did P90x in the church courtyard.

We started before the sun rose and worked out as the streets began to flood for the morning.  It was a great time working out and being in the culture at the same time

The morning was even better because the shower at the home is half outside with no roof. I cannot wait until my home has an outdoor shower one day. 

I went with the same group as yesterday because the other group only had 2 patients and they felt prepared while yesterday's group had 7 patients today with one being an evaluation.

Today was the last day of clinic so we started a little early to make sure we saw all 7 patients. 

We finished our time with the twin girls providing written home exercise programs and having the family perform all of the exercises. We had trouble leaving this home because of how much progress and happiness we had with them.

Next we went to the home with both of the patients with hip pain. The 93 year old father did so well and was able to perform the stand pivot transfer without weight bearing on the affected leg with min A compared to the max A on Tuesday. He and his daughter emphasized how grateful they both felt from this experience.  We were just happy we choose this route for treatment and did not pass over him when we found out his medical history and lack of activity.  Every patient can benefit from something and luckily we found it quickly and treated it effectively.

The other patient reported doing way better after last time so today we added prone hip mobility which improved pain and ROM 20 degrees. We also added some soft tissue message to the quad before the prone stretching which increased motion as well. The student working with this patient did a fantastic job reasoning his treatment and progression as well as using reassessment to dictate care. Seeing this integration helped me believe that my method of teaching was effective to apply the methods learned in their curriculum.

The next home was the patient with Parkinson's who reported being very sore from yesterday.  We expected that as he had not danced in years but he said he could not wait to do it again.  We wanted to dance, but we had a plan of our own and that was to get everyone in the family involved and doing everything so that their was carryover. We also had our community leader speak to each person about the effects of continuing this once we leave and what will happen if it is not continued.  The brothers and cousins did a great job and were very receptive to the education.  We just hope it continues.

While the group was treating the man with Parkinson's, my third group was next door with the sedentary lady. They added some manual therapy for the shoulders, reviewed the HEP, and worked with each person who transfers her regularly to improve form and reduce the stress on her shoulders.

 We had 2 patients left to see and only 1 hour so we split up. 2 students went to see the young man with polio and myself and one student went to evaluate a new patient. He presented with hip and low back pain.  I drilled the student hard throughout the evaluation process but he did a great job thinking his was through the case and finding all of the information he needed.  After the treatment we walked back together and talked about the process transferring from class to the real world and his passion to critically think and grow in the field of PT.  That is all I can ask of a student and felt that I had completed my biggest goal with these comments.

After a late lunch we went to the market to look for some items and the got to see an active volcano with lava.  I have seen a volcano before but never one with actual red lava in the middle! It was pretty awesome

For diner we had a great meal and the night was spent as a group celebrating Three Kings Day which is a huge celebration for many of the people of the Granada community.  

On a side note:

Throughout the day I was asked 4 times if I was a CI and if I took students.  I felt so honored to be asked this by not only my group but students that I did not get to interact with clinically.  This reinforcement supports my desire to teach and mentor as I continue to learn and grow in this amazing field of physical therapy.

One more day before heading home! 

Clinic Day 3

Clinic Day 3

Woke up ready to go back to see patients.   I was back with the original group I worked with day one and we went very efficiently. We started with a quick meeting to game plan progression and treatment plans. The group really had it down and understood how much would

Be too much and what needed more emphasis.  We started with the young girl who had cerebral palsy emphasizing the progression in each position. She did fantastic today and her aunt was very involved.  We also saw her twin sister who may have ricketts with extreme bowing of her knees. The angle was about 20degrees is standing which is pretty severe. We assessed her movement and educated the patient of continuing with the physical therapy consult in country as well as the weight bearing modifications. 

After that we went to the patient who had the broken hip and was non weight bearing. His family member was another one of the evaluations we had to see so two of the students saw the gentleman and myself and one student saw the evaluation.  She was the patient who broke her hip but was able to have surgery.  She is active but has a noticeable limp and is limited with long duration walking and activity.  After the examination we treated using an assess treat and reassess method to help determine the most effective treatment, she reported much improved pain, less compensated trendelenburg, and improve prone knee bend.  We will follow up with her the last day.  The students working with the other gentleman working on standing balance/tolerance on the unaffected leg and his transfers with his family members to improve tolerance. 

The next patient was the best and most rewarding interaction of the day. The stoic patient with Parkinson's was sitting in his chair with a little more of a rock and his family said it was his birthday. We sang happy birthday in Spanish and began the session.  After some manual therapy and thoracic extension exercises we turned the "romantic Latin" music on and began. The students and patients rocked it. He was doing big movements, lateral walking, dancing, and turning.  His movements were smooth with the music. We gave him a rest but after a few seconds a faster song came on and he jumped up on his own and started dancing.  Luckily the students quickly jumped to action and began another session.  After a long session he finally was tired. When we left him he stated that "we have brought life back into him today". Everyone was so happy with the impact these three sessions have had on this patient. So rewarding!!

Another group met up with us after this patient and I went with them to perform an evaluation. The patient was a sedentary lady who spent 80% of her day in bed and 20% in a chair. She was unable to roll. Unable to perform supine to sit without max assist and needed max assist by a neighbor for her transfer.  She had extreme muscle wasting. Her chief complaint was shoulder pain and her motion was about 50 degrees in supone active and 110 degrees passively.  We brought down a pulley and she was able to improve ROM so we left her with one.  We also added rolling into her daily activity to reduce risk of bed sores, improve trunk strength and promote extension. In prone she was unable to lift her head for longer then 10 seconds which is very poor so this position would benefit her greatly.  This group of students did a great job!

After lunch most of the group went on a zip lining and the rest went up to the top of the volcano. I had to join the zip line group and it did not disappoint.  Speed, heights, and upside down are all things I enjoy so it was right up my ally. 

Another great dinner and then one of my groups met up and we worked on evaluation writing.  They had so many great questions and you could really tell how they were thinking from their writing. The organization has 6 groups of therapy students come down to Nicaragua each year so they keep documentation for future groups to review. I set high expectations for the notes and the students are working hard to write strong documentation.  

I spent the time helping them, writing this blog, and talking to Olivia finalizing some wedding stuff.  Very productive day!!

 

Clinic Day 2

Clinic Day 2

Today started with another great breakfast made by our house mom and a walk to the local church. 

Today I went with a second group of students. We have 11 groups of students so the licensed therapists took 2 groups. This group had 3 patients to see today and did not have mentorship the first day so they had some great questions.

Our first patient was a middle aged male who was in a wheelchair. The students did a great job working together to get as much information as possible but I did not fully understand what happened so we had to dive into that a little more. Come to find out he had scoliosis and they did a lumbar and thoracic fusion which lead to paralysis of his lower extremities. This scenario shows how dangerous surgery can be. During the evaluation the students perfected their technique and improved their clinical thinking. We were able to address multiple issues with this patient including core strengthening, gait, foot posture in sitting, and education. We found out that he will be having surgery for the plantar flexion and inversion. He reports he will be having a tendon release and possibly a "screw" in his ankle.  I was shocked and angry at this concept as he had 10 degrees of passive dorsiflexion and the pinning would only cause more problems!! Spent time educating him about this and trying to take control of his healthcare. Sadly this may not help but it is worth a shot. 

After the therapy and Exercise education he reported much more confident and tired. He reported doing therapy in the past with similar exercises but not "feeling it in the same muscles".  I really wanted the students to take this point with them for the future. I truly believe that as therapists we need to emphasize motor recruitment and motor planning. Making the patient aware of correct patterning has a huge impact on body awareness and reducing compensations.  For this patient to have done these exercises such as planks, hip marching and standing hip extension but never feeling glute activation makes sense as to why he was moving the way he was.  After one session he had much improved gait with video observation. We left with a plan to buy equipment to modify his wheelchair to get his foot in a better position and solidify a HEP for when we leave.

The second patient was not available but when we went by his house we looked at the ramp that was built last year and it had eroded so we devised a plan to help rebuild the ramp later in the week and evaluate him on Thursday or Friday. 

The third patient was one they saw the first day. She has Rheumatoid arthritis and a history of 4 strokes that have caused her to limit activity and function. They reported that the first day she was unable to flex her left leg but after some manual therapy and exercise she was able to move it. However she was unwilling to let the students touch her hand which was held in a fist.  She had a very supportive husband and child who informed us that she was having trouble with long nails and a lot of hand pain.  So I decided to give it a shot to see if we could change anything with her hands today. She was resistant to movement yesterday so we decided to put her hand in water to gain her trust and slowly worked on movement. By the end of the session her fist was open to where she could grip a tennis ball! We emphasized education about the importance of passive movement to maintain motion and increasing waking with her husband.

We ended the day attempting to see one more patient but they were not at home. 

After lunch we met with all of the equipment and divided it based on need to each group and then we went to find other materials we needed. However the rain started as we shopped around for materials and prepared for the next few days. We had to go from stand to stand to find all of the materials we needed but it was fun to practice our Spanish and think outside the box with the materials we could get. 

We met up with local children to play soccer again but a few minutes into the game it started to pour so we hung out under tree shelter. We used some of our clinic paper to make paper airplanes, played tag, and made a piñata. We all had a great time together. 

My favorite part of today was talking to the first group from yesterday who stated they saw all 6 patients and felt confident. They said that yesterday gave them confidence and prepared them well.  I was so proud of their effort and willingness to learn and take the advice!b

After amazing home cooked taquitos we all went out to reflect on the days and enjoy ourselves. 

All of the other groups had so many great stories and creative ideas for treatment. Throughout the night I would see groups asking for ideas and working together to help each other. Already so proud of this group of students in their efforts and cultural awareness.