Friday, November 4, 2016
While we can't fix your tight pants, we can fix your frozen shoulder!
This video explains how we can use an ultrasound-guided injection to help fix adhesive capsulitis, also known as a frozen shoulder
Tuesday, November 1, 2016
Conquer the Halloween Sugar HANGOVER
Raise your hand if you ate too much Halloween candy last night and woke up today feeling sluggish & full of regret.
Ok, I can't see you, but I know you're out there! Here are easy tips to conquer the post-Halloween hangover
Drop that candy bar! (or bag, lollie, etc.)
Eating sugar will make you crave more sugar. Halloween is a holiday, not a holi-week or a holi-month. Don't allow your one-day indulgence to become a new habit. You have 100% control of what you put into your body! Make healthy choices today and in the upcoming weeks.Tip- if you are craving sugar, reach for a piece of raw fruit.
Eat whole foods
Adopt a clean eating diet for the next few days (and preferably longer!). Ditch the processed foods and pick up some real, nutritious foods! A mix of high-fiber vegetables and lean protein will help your body reset after the sugar storm.
Drink more water
Adequate water intake is essential for the body's function, but it's especially important after a day of indulgence. Water will help your body process those treats and absorb the healthy nutrients you put back in!
Increase your exercise
Rev-up your metabolism and sweat out toxins with a high-intensity workout. You'll feel better, have more energy and improve your mood, too!
Get some zzz's
Chances are Halloween festivities and trick-or-treating cut into your sleep time. Make a point to get to bed early tonight and allow your body proper recovery time.
Friday, July 22, 2016
The MA to DPT Transformation
I’ve been at Lake Washington Sports and Spine since April 2015, and have loved every minute of working here. So it is bittersweet that I will be leaving in late July to start physical therapy school near Phoenix, Arizona. (Know of any hotspots? I have zero experience with Phoenix.) I have learned so much working as Dr. Chimes’s medical assistant that I am at a loss to put it succinctly into words. However, I can at least try and share some tidbits I have learned through my time at LWSS. The nice thing is that most of these lessons have applications outside the healthcare field. Without further ado, here are a few things I’ve learned, in no particular order of importance. Maybe I’ll rank them later in honor of Dr. Chimes.
-
Become an
expert.
In other words, I want to learn as much as
possible regarding physical therapy, the field/specialty I have chosen to
pursue. I will never be satisfied, as there is always something new to learn.
The biggest mistake I can make is to assume that I know all that there is to
know about a given subject. Already I’ve learned about various subspecialties
in physical therapy I had no idea existed prior to working at LWSS. I’ll never be
an expert in all the specialties, but at least I can be aware of the strengths
and weaknesses in order to become a well-rounded, well-informed physical
therapist.
-
Admit my
knowledge gaps.
This is related to the above point, but an
entirely different idea in and of itself. For example, although Dr. Chimes has some
experience in all medical fields, he understands and admits that he has
definite knowledge gaps. It has been years since he learned about cardiology or
hematology, and to further compound the problem, these fields have changed so
much in the intervening years. This leaves him in the position that he’s not
even sure what he doesn’t know. Did past treatments turn out to cause more harm
than good? Are there new diseases that he doesn’t know about? So when patients
ask about issues outside of his area of expertise, he gives a clear disclaimer
that it is not within his expertise and then refers to another provider who
would know better.
What Dr. Chimes is trying to avoid is the
Dunning-Kruger effect, which is summed up fairly well by one of the authors during
an interview with the New York Times: “… the skills you use to produce the
right answer are exactly the same skills you use to evaluate the answer.” In
other words, without knowing the skills yourself, you cannot determine whether
someone is skilled or not. It then follows, how can you possibly come to an
answer without knowing what question to ask? This is a phenomenon I had never
heard of prior to working here, but it certainly has shaped how I will treat
patients in my future career. I will hopefully get my patients to 100% by
focusing on what I know, and referring to, and working with, other healthcare
professionals with patients who are beyond my scope of expertise.
-
Know which
patients will benefit from my expertise as a physical therapist.
And by extension, and possibly more
importantly, when physical therapy is NOT appropriate for a patient. Being able
to see patients from the perspective of a Physiatrist, where accurate diagnosis
is the name of the game, will help me tremendously as a physical therapist. It
is now clearer than ever that I will need to keep an open mind and consider
alternate diagnoses if the initial treatment modalities I utilize on my
patients do not bring any benefit.
-
Utilize a
differential diagnosis process.
Low back pain is one of the most common
reasons people go to the doctor. However, there are a multitude of causes for
low back pain, and the symptoms often overlap. To compound matters, treatments
for one cause are ineffectual for another, or may even make symptoms worse.
What I’ve learned from my time here is to tease out the unique features of a
patient’s low back pain in order to come to a correct diagnosis. Focusing on
symptoms that apply to several possible diagnoses will not help me determine
the root cause of a patient’s pain.
-
Be as
transparent as possible with my communication.
We have several different iterations of
this idea within the office, ranging from a tidy motto to a detailed flowchart/graph.
It is never beneficial to be vague with my communication style or vocabulary when
talking to another person. Furthermore, not only do I need to be clear with my
communication, I need to confirm that the person I am talking to is ready to
digest what I’m about to say. Having an disengaged audience can, at best, lead
to repetition, and at worst, lead to a complete mishearing of what I have to
say.
The above are just a few of the things I've learned while working at Lake Washington Sports and Spine. The effects of these lessons may not even be felt or become apparent for years down the line, but I know that they will only help me in my future as a physical therapist. I cannot begin to express how grateful I am for my time here.
Friday, July 1, 2016
Wynnie's 4 Hikes for the 4th of July
Searching for ways to stay active this weekend? Look no further!Wynnie (weekday office dog, weekend adventurer!) has four fantastic hike recommendations just for you. Click on the links below for hiking guides & trip reports via Washington Trails Association (WTA).
Monday, June 27, 2016
ClassPass - a passport to a healthier you!
These days,
there seems to be a new workout craze or boutique fitness studio on every
block. After my initial excitement about all of the fun things I could try, I
became overwhelmed by trying to figure out how I could possibly afford to go to
all of the studios I was interested in.
Unless you are rolling in the Benjamins, purchasing a membership to
FlyWheel, Pure Barre, Crossfit and a luxury gym will break the bank (unless you
stop eating, seeing your friends and paying your bills, but that’s a topic for
another blog). So how do we mere
plebeians manage to participate in these fitness trends? Enter: ClassPass.
For those
who are unfamiliar with ClassPass, it is a company that provides access to an
extensive network of fitness studios for a simple monthly subscription. For example, in Seattle, there are over 200
studios belonging to ClassPass and the subscription is
currently around $100 (there is speculation
and reason to believe that this cost may increase over the next few months). What makes this intriguing is that instead of
having to purchase memberships to each individual studio, you gain access to what feels like an endless list of options all while paying just a
little more than a typical gym membership.
I initially
heard about ClassPass from my friend in San Francisco who was taking obscure
classes like paddleboard yoga and aerial silk training (she hung from a piece
of cloth on the ceiling - neat!). I
thought to myself, “that sounds amazing, but I would never buy a membership to classes like that”. Once she explained how the ClassPass
subscription works, I knew it was the right fit for me. I wanted to try all the new fitness trends
without having to choose just one single
studio/type of workout.
Since
signing up with ClassPass I’ve tried FlyWheel (essentially a party on
stationary bikes), Pure Barre (hard in a way I never anticipated), Tabata (HIIT
training to the extreme), Bootcamp (I was sore for days) and a couple Zumba
classes (the old dancer in me loves to shake and shimmy)! Sure, some classes I enjoyed more than others
but that’s exactly what ClassPass is
for! Which instructor keeps me
motivated? Which class makes me want to
don my workout gear and get moving? I always look forward to scrolling through
the app and choosing how I will get my butt kicked on a particular day.
Now, you may
be thinking “Elianna, this just sounds too good to be true. Unlimited classes??
Less than $100 a month?? How can this be?!”
Well, although I still believe that this set-up is pretty neat, there
are a couple caveats that should be mentioned.
First, you can only go to one studio three times a month and that
includes all of their locations. So, for example, if I decide that I like
FlyWheel classes, I can’t go to the Bellevue location three times and then the
South Lake Union location three times.
This also holds true even if I’m not taking the same type of class (i.e.
if one studio offers spin, Zumba and yoga). It’s three times per studio, across
all locations.
The second, latest
caveat to keep in mind is that ClassPass recently increased their prices in New
York City (where the company originated) to $190. Suddenly, the once almost shockingly
affordable membership doesn’t feel like such a steal. ClassPass does
offer a more economical price point if you only attend 10 classes per month.
That said, these price hikes haven’t hit Seattle yet and until that day comes,
I will happily get my sweat on for under $100 a month.
Like any
product, ClassPass has its pros and cons, and like any middleman company, it has
the challenge of making both studios and individual clients happy. Initially, the low cost for unlimited classes was an exercise enthusiast's dream, yet studio owners were understandably frustrated by the lack of commitment from potential members. I assume that the price increase will lead to studios receiving more money per class participant. But that being said, I am not a financial adviser for ClassPass and have no idea where their money is allocated.
I also recognize and appreciate that this model is not for everybody. I have friends who like going to their one class, knowing it will be available to them week after week at the same time on the same day. My response is, "Hey, whatever works!" For me, however, ClassPass has filled a sizable void in my workout regime. With my tendency towards exercise boredom, my fear of making choices by selecting one studio, and my inability to afford memberships at every studio, ClassPass is my fitness lifeline. There certainly may be a day when all of this changes and my workout routine shifts in a completely different direction (and being somebody who suffers from chronic workout boredom, I may welcome this with open arms). Yet, until that day comes, you will find me shaking my tuchus to some Latin American jams, flying across imaginary terrains on my trusty spin bike or discovering some new workout to keep me motivated. Now, the only thing left is for YOU to join me. Want $20 off your first month? Click this link!http://class.ps/d11-0 Happy exercising!
I also recognize and appreciate that this model is not for everybody. I have friends who like going to their one class, knowing it will be available to them week after week at the same time on the same day. My response is, "Hey, whatever works!" For me, however, ClassPass has filled a sizable void in my workout regime. With my tendency towards exercise boredom, my fear of making choices by selecting one studio, and my inability to afford memberships at every studio, ClassPass is my fitness lifeline. There certainly may be a day when all of this changes and my workout routine shifts in a completely different direction (and being somebody who suffers from chronic workout boredom, I may welcome this with open arms). Yet, until that day comes, you will find me shaking my tuchus to some Latin American jams, flying across imaginary terrains on my trusty spin bike or discovering some new workout to keep me motivated. Now, the only thing left is for YOU to join me. Want $20 off your first month? Click this link!http://class.ps/d11-0 Happy exercising!
Thursday, April 14, 2016
We 'Believe in Magic' at LWSS
At 46 years old, I crave Disney Magic as much as anyone. I still vividly recall the effervescent energy
of several cast members during a visit with my then fiancée, now wife Rachel,
20 yrs ago. Their warm smiles and cheery
voice coupled with an “I’d hug you if you were 10 and under” body language
smoothed the path to a world of fairy tale and make believe. One almost couldn’t help but ‘Believe in
Magic’ after a close-up encounter with a cast member, whether street sweeper or
manager. I remember saying to Rachel, “How
do they do it? To a person, the energy
is so positive, the commitment to the guest so genuine appearing, the
willingness to serve…. they create a mood-elevating environment.”
Soon after as I began working as a physician in a group
private practice I learned about the Disney Institute. My physician group hired a law firm to train
us in principles similar to those taught at the Disney Institute or Ritz
Carlton Leadership Center. Their program
taught us that 5 Star Service is never attained, but is always aspired. The idea is that while you may deliver an
experience that is “5 Star-esque,” there is always opportunity to do even
better.
Our medical center, Lake Washington Sports & Spine, the professional
business I started 4 years ago, operates on the principle of always striving to
be 2% better. And we operate on Positive
Psychology principles, suggesting that in medicine we stand to learn much from
the highest functioning among us. Our
mission is to “KPA” or keep people active.
The feedback we routinely receive reflects our intentions. Our patients not only appreciate getting
measurable results (i.e. returning to their desired physical activity) but they
enjoy this improvement in a unique medical practice culture; for example, a
live person, rather than automated phone tree, always answers the telephone, and
we deliberately prioritize the patient over the population (as compared to large
healthcare systems, the government or insurance industry), and we celebrate our
patients’ recovery with a whimsical graduation ceremony.
My family and I just left Walt Disney World. We spent one day in the Magic Kingdom,
another in Epcot, and the final day at Animal Kingdom. Unfortunately, it seems that Disney has
misplaced the magic.
How so? Did the rides
work well? Yes. Was the food adequate? Yes.
Was the park clean. Yes. Were the attractions first rate? Yes.
Well, what then? Where was the
Magic lost?
The cast members.
More specifically, Disney has allowed to disintegrate its
culture of training excellence, and so this gives the customer the appearance
that the magic was lost in the cast members.
Not present during our Disney visit were the routine and common
interactions between guest and cast members that would elevate the mood, and so
lighten one’s weary, having-stood-an-hour-in-a-line-to-enjoy-a-90-second-ride,
feet. During prior Disney visits, when
the ‘magic’ was flowing, instead of heaviness or fatigue of one’s tootsies, one
enjoyed a lightness of presence akin to being proverbially swept up by Alladin’s
Magic Carpet. Disney distinguished
itself from other amusement parks based upon its service culture and ability to
deliver a superior experience. No
longer. Not for me or my family. Walt would be disappointed.
Specific examples of falling short you require? As an extrovert and as someone with a keen ‘energy
sensor,’ I routinely try and make eye contact and exchange greetings with those
around me. The Disney cast members would
rarely make eye contact, their collective countenance was at best disinterested,
and they rarely did exchange a big-hearted greeting. Their energy was flat. This energy was present in nearly all the
staff I encountered. In those staffing
the rides, the attractions, the food courts/carts, and the custodial team. The difference in animation of the Disney
cast members was very clear.
I believe only once did a cast member approach one of my
young children (ages 13, 10, and 6) and ask about their experience or try to
engage them in a moment of Disney magic.
And this person was our handsomely paid private Disney tour guide.
Did my family enjoy our days at Disney World? Yes.
Walt Disney World states that they endeavor to help guests create
memories that will last a lifetime. I
know my kids will remember their first backwards rollercoaster ride on
Expedition Everest (I’m sure not a brainchild of Walt Disney). Isn’t it backwards, however, that they may
not know or remember in 20 years if that ride took place at Walt Disney World in
Orlando or Six Flags Great Adventure in New Jersey? Shouldn’t every child leave Walt Disney World
with a love of Mickey Mouse and friends, asking for Mickey ears rather than a
Star Wars light saber? Perhaps the Magic
has been lost to a new Walt Disney Company mission of earning dollars over
earning lifelong raving fans?
My guess is that this is a top down leadership issue, and
that the leaders of the company are more caught up with demonstrating profits
to shareholders than they are interested in continuing Walt Disney’s passion
for bringing the Magic to people’s lives.
A watered down mission dilutes the team culture very quickly. The absence of cast member “Believe in Magic”
enthusiasm is reflected in their quality of work.
Interestingly, we can draw parallels to what is happening
right now in healthcare where the primary drive is to control costs, not care
for people. Government officials and
insurance industry administrators and executives consistently invoke the buzzword
“quality” in the same sentence when describing their aims of “expanding
coverage and cost control.” It is well
understood that you can strive for two of three, but not all three, when
speaking of accessible, high quality, and low cost health care. Likewise, at least in days past, Disney
rightly focused on two things: providing
excellent (high quality) staff training and customer experience, and ‘magical’
amusements and attractions. And for
this, they charged a premium. The
admission/ticket costs to spend a day in one of the Disney parks has always
been expensive relative to other amusement parks, and now the price exceeds
$100 per person per day. Some have
written articles about how Disney has priced out the middle class (https://www.washingtonpost.com/news/business/wp/2015/06/12/how-theme-parks-like-disney-world-left-the-middle-class-behind/).
But just as healthcare systems have had to drop their focus
on quality to focus on cost containment and access, Disney has dropped its
focus on bringing out the ‘magic’ in each of its cast members through the once
singular Disney training program, in order to concentrate on generating higher
corporate profits.
While I find this sad, my father-in-law shrugs it off,
believing that all things are destined for change. In our world of caring for active people, we
see it as a glaring opportunity to serve a community of people who want and
deserve excellent consultation with a wonderful team and top-notch physicians. I suppose it does follow that Disney’s
mediocrity merely makes room for the next magical visionary whose mission is
our enchantment. Perhaps that’s Elon
Musk with SpaceX? I’m sure the void in
magical experiences will provide a ‘carpe diem’ moment for one so motivated entrepreneur. And I, a self-described fairy tale fanatic,
may be first in line.
Wednesday, February 24, 2016
Opinionated on Opiates and the Treatment of Pain -- Independent and Strong Sports Medicine Physicians and Our No Opiate Rule
President Obama just allocated $460 million to states to bolster resources to treat opiate-abuse disorders. The goal apparently is to reduce opiate-related deaths, which are on the rise, especially amongst middle class whites.
I disagree with President Obama and his advisors when it comes to
managing opiate-related concerns. This
is throwing money at the back end of the problem, tantamount to pouring extra
water on an already extinguished house fire while an arsonist is next door
dousing surrounding homes with gasoline and carrying a lit match. Soon you're gonna have a bigger problem with
which to deal.
The problem is opiates are catastrophically overprescribed. This practice stems from the pharmaceutical
industry led movement that began in the 1990's. I recall enjoying what seemed
to be weekly free lunch provided for by a pharmaceutical company peddling their
opium-derived drug. A well-paid
physician stood in front of me lecturing on the drug while my free boxed lunch
set off 'triple point' endorphins as I ate my delicious sandwich, chips and
chocolate chip cookie, pocketed between 1 and 10 shiny new drug-logo pens, and
naively sat marveling at my having 30 additional minutes of free education as a
school-loan supported medical student in New Jersey that bolstered the idea that "pain is a
"vital sign" to be measured routinely and monitored over time by your
doctor at every visit like your temperature, heart rate (pulse), respiratory
(breathing) rate, and blood pressure.
Pain is not a vital sign. It cannot
ever truly be a vital sign. A vital sign
must be objectively measured, by a reliable and trained health care provider or
medical device. Pain is subjective, and
only measured by patient report.
Opiates are reportedly prescribed to treat pain by physicians or
other licensed non-physicians.
Sadly, I report that I also fell victim to the influence of Big
Pharma. My 'retrospectoscope' now
clearly places my naive self in the very center of the problem. I am fortunate to be a reformed opiate prescriber. Our office does not prescribe opiates. I am often asked by colleagues how we can
'manage' to not prescribe opiates as they admit to wishing to stop prescribing
them as well. I would bet that a clear
majority of physicians would choose to stop prescribing opiates entirely if
they felt it was moral and ethical to do so...the problem is we were taught
otherwise to more aggressively treat pain and prescribe opiates even if
unsupported by evidence. Taking opiates
carries the risk of addiction, pseudoaddiction, tolerance, gastrointestinal
side effects, impaired brain function, and as we know from well publicized
media reports, death from opiate overdose.
Great financial windfalls are enjoyed by Big Pharma, and a growing
illegal black market triggering many patients treated for seemingly legitimate
concerns to divert some or all of their medication for cash.
In an era proscribing to adhere to 'Evidence-Based Medicine' I
should point out that the pain research supports a clear absence of functional
restoration for opiate users. This means
that persons taking opiates for pain do not demonstrate improved function in
their daily life -- perhaps most importantly and objectively measurable, they
do not return to work at higher rates than non-opiate users with pain. As would be expected, opiate users do report
higher quality of life scores. Opiate
drugs contain the same active ingredient as opium (same as heroin) and when
they bind to our cell opiate-receptors provide one with a sense of
euphoria. We can probably agree that
we're likely to rate our quality of life fairly high at a moment of
euphoria?!!!
Opiates treat suffering moreso than pain. Suffering ensues when pain is associated with
a decline in function (e.g. inability to work or play), loss of control, and/or
a decreased quality of life perception.
Opiate triggered euphoria transiently solves suffering. What a wonderful concept for the cancer
patient on her deathbed, or the battlefield wounded who may not survive his
injury -- we can alleviate suffering at such a critical time. However, pain is not suffering. Pain is our bodily response to physical or
psychological distress. We need to
experience pain to inform how we manage and hopefully cure such physical or
psychological distress.
Nowhere is the distinction between pain and suffering more
evident than in sports medicine.
Athletes overall are very high functioning individuals motivated to get
better to return to their sport. When
they present to me relatively early on following injury, they typically have
pain that resolves in a predictable manner with activity modification and
therapeutic exercise. They then return
to play and their pre-injury high level of function. Suffering may develop in the athlete unable
to cope with their functional decline and/or if the athlete perceives a loss of
control or decrement in life satisfaction.
Fortunately, most athletes have a wonderful capacity to heal and often
have strong coping skills and positive life outlook. This helps most athletes avoid pain-related
suffering.
I have learned quite a bit about pain and suffering through my
own personal experience. I had spinal
surgery for a disc herniation and nerve damage in 2007. I dealt with high levels of pain before
surgery and more mild-moderate levels of pain following surgery. However, I escaped the realm of
suffering. I did not once use opiate
medications before or after surgery. How
(or why) one might ask? My pain did not
transition to suffering due to my deep understanding about what my body was
going through. I did not feel worried or
anxious as most people do because I knew why my body hurt and why my leg was
weak and numb. I understood my surgical
and non-surgical choices.
I can understand why physicians and other health care providers
might wish to prescribe opiates to patients who present with suffering. I think we are easily drawn to be overly
empathic in the face of suffering, wanting to use our anti-suffering killer
miracle drugs, readily losing objectivity and forgetting that opiates are not
indicated for non-malignant pain (i.e. terminal cancer). But unfortunately on some level we ignore our
oath to 'first do no harm.' We often
treat our own anxiety, because it is easier to sign an opiate prescription than
to recognize, diagnose, and treat suffering.
I don't know how to treat suffering in a brief office visit...but I'm
very adept at recognizing it.
I agree we need resources directed towards treating these needy
and suffering individuals who now are most often treated with opiates. Funding should be directed to the training of
additional mental health providers who are expert in recognizing, diagnosing
and treating suffering, and appropriate public health messaging. Teach people the difference between pain and
suffering.
While I entertain a discussion on the topic of opiates and the
confounding health messaging by the pharmaceutical industry, our government,
and the media, I am reminded of what I believe to be the true definition of
health care: health care is what happens
in a closed room between a physician (which, by the way, comes from the Greek
word for 'teacher') and a patient.
Health care does not happen in the local, state or federal legislature,
in the boardrooms of pharmaceutical or medical device manufacturers, or in the
offices of media executives -- that is where power is heralded. Let us be transparent and clear. In an age where more doctors are employees of
hospitals or large health-care systems than self-employed, and more often
considered merely interchangeable and 'evidence-based guidelines' technicians
or line-workers, health care consumers are at risk of losing the opportunity to
have individualized medical care provided by unconstrained independent
thinkers. As my fabulous partner and
famously independent thinker, Gary Chimes, often chirps, "people who want
great medical care deserve doctors too."
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