Category: Personal reflections

13 Apr 2012

Why???

Why?  Why?????? Why would I want to take on such a large project as a membership website?  I’m crazy!? (Yeah, it’s true…I’ve come to terms with that!)

 

But here’s the thing.  When I started dabbling in animal rehab, there were no formal courses available on the subject.  I took as many courses as I could from CHAP (the Canadian Horse and Animal Physical Therapists Association), but they were all horse-based and just smatterings of information – not exactly ‘how to’ structured series of courses.  So I read voraciously to round out my knowledge!  I accumulated textbooks.  I spent time shadowing an already successful practicing equine physiotherapist – Lesley Kerfoot.  (In fact I was at her facility the day I went into labour with my first child!  “Nerd”, I know!)  I tried my hand at assessing the ranch horses and my own dog.  I then started seeing horses of family & friends.  I did dissections with other like-minded self-learning individuals.  I started seeing dogs.  I started giving lectures.  I became involved with the executive of CHAP.  I just did it. It was all very much like the universe was pushing me in this direction.

 

Animal rehab / physiotherapy became a passion of mine… but it wasn’t an easy learning process.  I made mistakes, and occasionally, I looked like a fool, but I learned from these events.  And I continue to learn!!

 

I feel very fortunate to have been given the opportunities I was given (or perhaps just to be in the right place at the right time along the way).  I am so passionate about this field.  My hope is to help others along their learning journey – and to make it a little more expedient than what I had to go through to acquire the knowledge I have today.  I like to translate human physiotherapy information to the canine patient.  It’s not always a direct translation!  I also like to read veterinary research and look at it with my physiotherapist view point to see how that information could also be interpreted from a physio / rehab perspective when applying it to animals. Traditional vet medicine doesn’t view information in the same light.  I LOVE making these connections, findings, and insights!  And I want to share that information as widely as I possibly can – for the betterment of the profession of animal rehab, and for the betterment of animal health care too!!

Dogs in particular are such amazing creatures in how they interact with humans and play such a huge role in people’s lives.  I think the universe is just awakening to how incredible these animals are.  I feel strongly that animals come into our lives to strengthen our own learning journey in life.  They impact our lives in so many different ways, that it’s hard NOT to look at them as angels here on earth!  Yes, yes, I know – hard to do when you are wiping up muddy footprints from your floor, throwing out your chewed up running shoes, or yelling, “COME!” for the 10th time out at the park!  But it’s good for your soul!  I really believe that! 

 

Drop me a line.  Tell me what you think!  Laurie@fourleg.com

 

Cheers!

 

Laurie

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16 May 2012

The Underwater Treadmill Question

The UWT Question…

 

QUESTION:

I am looking into starting my own rehab practice within a referral/emergency hospital. We are debating on whether the purchase of an UWTM is necessary to have or not. All of the local competitors have them. I figure that you can rehab dogs just as well without one and they are so costly to purchase. Is the cost justified? I think the perception of the non-rehab-certified veterinarians is that you NEED a treadmill to do rehab and if we don’t have one, they may not refer to me. I think it would be great to help the older, overweight, or arthritic dogs and get them moving in the water.  Of course the neuro cases would also benefit.  So, my big question is, ‘Do these machines pay for themselves and how long does that take generally?’  Thanks!

 

 

ANSWER:

Well this really is a big question!  I worked in this field for 10 years before getting an underwater treadmill… and yes, I did get dogs better without it!  However, I do think that the perceptions account for something intangible, which is why, when my business partners and I created The Canine Fitness Centre, we put in an UWTM.  All in all, I think it boils down to – IF you are going to have a physical facility, then the UWTM / pool is a real and perceptual benefit.

 

From a real perspective, when you have a physical facility located within a referral & emergency hospital, you are likely to be referred many of the more difficult cases (neurological cases, post-operative cases, and cases with significant mobility issues).  These cases all benefit from UWTM therapy.  From a perceptual benefit, I’m afraid that referring veterinarians and even the public might think that a clinic that has access to an UWTM is better prepared to treat their animal in need of rehabilitation.

 

The unfortunate thing is that these machines don’t pay for themselves quickly, as not all cases SHOULD go to the UWTM.  I think that many clinics try to make the UWTM pay for itself by putting inappropriate cases into the UWTM!  I think that you need to plan on 5 or more years to pay it off (if you are not treating it like a ‘magic dishwasher!)

 

Now, if you have a small in-house practice or a mobile practice, then an UWT would be overkill.  Small facility or mobile rehabilitation practitioners would do well to niche themselves appropriately – either keeping to in-house referrals, sporting dogs, or geriatric cases for example.

 

Let me know your thoughts at Laurie@fourleg.com.

 

Cheers!

 

Laurie

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30 May 2012

My 2012 Favourite Textbook List

I am regularly asked about my favourite text books.  So I have come up with a list of my favourites - and ones to make note of!  I am a textbook junkie and my office walls are lined with books - so this is not an exhaustive list by any means, but the ones that I think are essential.  So here goes:

 

My ‘Must Have’s’

 

  • ·      Evans HE.  Miller’s Anatomy of the Dog 3rd Ed.  Saunders.  1993.
  • ·      Done, Goody, Evans, & Stickland.  Veterinary Anatomy The Dog and Cat.  Mosby 1996.
  • ·      McGowan, Goff, Stubbs.  Animal Physiotherapy Assessment, Treatment, and Rehabilitatition of Animals.  Blackwell Publishing. 2007.
  • ·      Millis, Levine, Taylor.  Canine Rehabilitatation and Physical Therapy.  Saunders. 2004.
  • ·      Olmstead ML.  Small Animal Orthopedics.  Mosby. 1995.
  • ·      Piermattei, Flo, DeCamp.  Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair 4th Ed.  Saunder Elsevier. 2006.
  • ·      Messonnier SP.  Veterinary Neurology.  Butterworth Heinmann. 2000.
  • ·      Aloff B.  Canine Body Languate A Photographic Guide.  Dogwise Publishing. 2005.
  • ·      Elliott RP.  The New Dogsteps.  Howell Book House. 1983.

 

 

 Other Related Books – with pros and cons

 

  • ·      Lindley S, Watson P.  BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative Care.  British Small Animal Veterinary Association. 2010.
  • ·      Bockstahler, Levine, Millis.  Essential Facts of Physiotherapy in dogs and Cats.  BE VetVerlag.  2004.

 

 

‘Human’ Textbooks

 

  • ·      Butler, Moseley.  Explain Pain.  Noigroup Publications. (Australia) 2003.
  • ·      Jam B.  The Pain Truth… and Nothing But!  Advanced Physical Therapy Education Institute.  2010.
  • ·      Sluka KA.  Mechanisms and Management of Pain for the Physical Therapist.  International Association for the Study of Pain.  2009.
  • ·      Tuner, Hode. The New Laser Therapy Handbook.  Prima Books.  2010.

 

 

 

  • ·      Magee, Zachazewski, Quillen.  Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation.  Saunders Elsevier. 2007.
  • ·      Magee DJ.  Orthopedic Physical Assessment 5th Ed.  Saunders Elsevier. 2008.
  • ·      Magee, Zachazewski, Quillen.  Pathology and Intervention in Musculoskeletal Rehabilitation.  Saunders Elsevier.  2009.

So, I’d love to hear from you!  Do you have an absolute favourite to share?  Drop me a line at:  Laurie@Fourleg.com.  And hey!  If you’re not a member yet at www.fourleg.com, what are you waiting for?  Come join the BEST online canine rehab & physio education there is out there!  I’d love to have you on board!  

Until Next time...

Cheers!    

Laurie

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12 Aug 2012

About My Summer so far!

So, this tardy little blog is simply about what is going on in my life!  I don’t journal, I don’t go out drinking with friends… so you folks are it!  You’ll have to ‘listen’ to it all – or click away now! 

 

I am swamped!  Last month was brutal!  It started off with a sudden firing of one of our rehab assistants (details NOT to be shared)… but lets just say, I feel less ‘taken advantage of’ now!  Then both my business partner and our office manager went on 3 & 4-week holidays at the same time.  And at the tail end of the month our receptionist went on a 1-week holiday.  Leaving us severely short staffed!  Nothing blew up and nothing burnt down… but Holy Dinah!  Treating patients for 9 hours a stretch and solving little clinic problems / answering questions between each one, over lunch, and at the end of the day just about gave me a nervous break-down!

 

On top of all of this, the clinic lost one of our fabulous therapists!  The Alberta Veterinary Medical Association told the rehab vet that had been with us for 2 years that she could not work at the clinic because she was a vet and the Canine Fitness Centre Ltd is not a vet clinic.  So we had a mutually saddened parting of ways at the end of July!  (If you have not done so already, I would recommend reading the proceedings from the talk that she and I gave on Interprofessional Collaboration.  It’s available on the Free Stuff page.)  It was enlightening for us to do the research for this talk, and was plain to see that vet medicine (and in particular the associations / regulatory boards) have much to learn about this topic.  As was pointed out to me last fall by a highly regarded veterinary researcher – Physical Therapists are the first group of professionals to approach the veterinary profession with the desire to work collaboratively… and the vets (vet associations, etc) don’t really know what to do with them.  Never the less, we were too far ahead of the curve and were told that we could not play together in the sandbox… unless the vet owned the sandbox, controlled the sandbox, and told all the other players what to do in the sandbox!  The whole ordeal has been extremely stressful.

 

Then to top it off (a bit of ‘silver lining’ to the situation), we brought on a new rehab therapist – A physiotherapist… since I am allowed to hire them!  She just started this past week, and I want her to be successful!  We have demanding clients with very high expectations (many sporting-dog owners & breeders), and vets that have come to expect a lot from us as well.  We’ve sort of pushed her off the high dive platform into the deep end!  Poor gal has 3 or 4 new assessments a day!  Anyways, the part that applies to me – is that I created a newsletter to go out to all vets (Calgary and within a 2 hour radius of the city) 1) to introduce the new therapist, 2) to let them know about some of the not-so-common-things we treat, and 3) offer lunch and learn sessions.  So I busily created a newsletter (yeah Mac for some great templates), cut and pasted content (i.e. the TMJ blog posting), and proposed some topics for the lunch and learns.  What I forgot is that with all of the extra-work that I had created for myself (creating, folding, taping, addressing, mailing, etc) that I might actually get vet clinics taking me up on the lunch and learn topics!  Oops!  Guess I just added to my own stress levels.  BUT… I wanted to share the topics I put out there (for your use too if interested):  Conservative Cruciate Management; The Physio Assessment & Pathofunctional Diagnosis; Assessing for TMJ Dysfunctions; Vestibular Rehabilitation; Geriatric Rehabilitation; Soft Tissue Assessment of the Canine Shoulder; Concepts & Approaches to Neuro-Rehab; The Post-Operative Cruciate; Rehabilitation and Pain Management.  So – it looks like I better get busy with this!!

 

But wait… there’s more!  I also committed to teaching a session to the vet students at the University of Calgary.  They need a shorter session this time – so I’ll have to change up my whole previous lecture/lab.  No worries!  I just need time to do it.  I’m thinking of making it all about FUNCTION.  “You’re next patient just had a rear limb amputation… what compensations would you see… what would be your treatment goals… how might you accomplish them?  That’s what I’m thinking of anyways!  Then, stupid me, also agreed to do a talk for a local kennel club… any topic I want, but related to the peri-partum bitch would be best!  So for this I decided to go with ‘conditioning your bitch before and during pregnancy, post-partum conditioning, urinary incontinence, and the importance of puppy evaluations.’  I wanted to call it:  ‘Yo Baby Bitch to Yo Ol Bitch’ but that’s maybe not professional… (Likely shouldn’t have blogged it either!)  Oh well.

 

Anyways… my gardens need weeding, my lawn needs mowing, my windows need washing, the kids keep messing up the house (and didn’t notice the day the dog had diarrhea all up and down the hallway while on their watch), my regular exercise routine has gone out the window, I am having to adjust to working different days of the week now, and the list continues!  As they say: “Don’t stop the carnival!!!”

 

Until next time…

 

Cheers!

 

Laurie

Laurie@FourLeg.com

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10 Sep 2012

Leap of Faith

Have you ever had the feeling that you were meant to do something, to take action, to make a change… Something specific to you!  It’s a feeling that just takes over, but it would be a huge shift.  A huge change in your life.  A leap of faith! 

I’ve had that – many times in my life actually!  Most recently, I have made a big decision.  One that has been causing me tremendous angst – but I took a leap of faith!  I resigned from my teaching position at the Canine Rehab Institute.  This decision was not made lightly, but it honored that little voice in my head. 

Are you waiting to take that leap of faith?  Leave your current job, open a clinic, start your clinic’s rehab service, start a new project, change your work structure to allow you to practice rehab… for example?  Good!

Now, right now, sit down and write out what you are thinking you want to do.  Then, write out or list what is stopping you!  (oh yeah… there will always be something stopping you or slowing you down!)  next, perhaps the most important step, write out what you would ‘need’ in order to take your leap of faith & a few action itmes that you could start with to take this leap.  At some point, when you tackle a few of these action times… your ‘leap’ becomes a no-brainer! 

There is a familiar saying out there:  If you always do what you’ve always done, you will always get what you’ve always gotten.

 

So….

What is your big decision?

What are you struggling with?

Are you dragging your heels?

Do you just need a little motivation to steer you towards your next step?

 

As always – let me know your thoughts!

Drop me a line any time!

Cheers!

Laurie

Laurie@FourLeg.com

PS  You’ll notice I had to remove the comments section from the blog.  To many spammers!  Unless you all want Louis Vuitton bags and Viagra!  You’ll just need to e-mail me directly… and if I get enough feedback on any one subject, I’ll post a compilation of replies – so that we can keep our community chatting!

 

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06 Oct 2013

What I learned this week

So, if you have been following my e-blasts and/or Facebook posts, you will be aware that I have spent the last week in Germany and then Austria.  I was shown wonderful hospitality and friendship… and I would not hesitate to return!  I even learned new phrases!!  

But all of that aside, I thought, that I should put my own self to the test to think:  What did I learn from my latest adventures, travels, & teachings… So here are my thoughts  (mind you I have had 1 glass of wine and 2 glasses of "stürmen"… which is not what was written on the bottle, but what I was told in English as a translation of "storm" - basically the fermented fruit juice, just before it becomes wine… sweet, tasty, alcoholic, and VERY drinkable…but not quite wine!  The kind of thing you could drink by the pitcher!!!).  So here is what I learned:

 

  • We all are having similar issues (all over the world):  General practice veterinarians do not understand rehab or when they need to refer or how to work with non-veterinarians or other vets with 'different training' (other than surgeons… because most vets are trained by surgeons when in vet school).  
  • We still need to work together… no ONE practitioner knows it all
  • We need to better educate the surgeons and our (potential) referring general practice vets.
  • We need to get CLINICAL research published… because the researchers in the universities don't perform rehab or adequately understand what needs to be researched that will be clinically relevant.
  • Savvy dog owners want our services and need our services and deserve our services… and we cannot let them down!
  • Adversity and being able to deal with unscheduled changes in plans can oly make you stronger… like missing your buss and having to figure out not only where you have to get to, but how!!
  • I should only be photographed from the shoulders up!

 

So, that's it!  I need to get to bed now… I have a 6:20 am flight to catch!  I really enjoyed meeting everyone over the two courses this week… perhaps another time, I will have to add additional learning learning... about a new hip joint mobilization, new eccentric exercises for supraspinatus and subscapularis and about the coracobrachialis muscle.

 

Until next time... Cheers!

 

Laurie

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09 Nov 2014

Don't be a VOMIT!!!

Check out this blog… all human information compiled by a brilliant ‘humans-only’ physio from Canada and used with permission to spread this message.  Good things to know for yourself… and if you’re a FourLeg Member – you could see the Veterinary research I compiled in the latest FourLeg Newsletter!

 

VOMIT – Victim of Medical Imaging Technology

c/o http://www.aptei.com (Bahram Jam, DScPT, M.Phty, BScPT, FCAMT)

 

VOMIT: Hip

Reference:1. Chu Miow Lin D, et al Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2011 May;19(5):543-9. 
 2. Silvis ML, et al High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011 Apr;39(4):715-21.

There is only a weak association between joint space narrowing seen on hip x-rays and actual symptoms.(1) 

In fact one study showed that 77% of healthy hockey players who had no pain, had hip and groin abnormalities on their MRIs.(2) 

Translation: Do not panic if your hip x-ray or MRI shows cartilage tears or narrowing, it is NOT a sign of permanent pain or disability. 

VOMIT: Knee

Reference:1. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008 Sep 2;9:116.  
2. Kaplan LD, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005 May;21(5):557-61.

Studies have shown that when x-rayed, up to 85% of adults with no actual knee pain have x-rays that show knee arthritis. This means that there is little correlation between the degree of arthritis seen on x-ray, and actual pain.(1) 

In fact one study showed that 48% of healthy professional basketball players had meniscal (cartilage) "damage" on their knee MRIs.(2) 

Translation: Do not panic if your knee x-ray or MRI shows degeneration, arthritis or mild cartilage tears, it is NORMAL! 

VOMIT: Foot

Reference:1. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot Ankle Surg. 2012 Mar;18(1):39-41.

Although there is an association with plantar fasciitis and heel spurs, it should also be known that 32% of people with no foot or heel pain have a heel spur visible on x-ray.(1) 

Translation: One third of all people have a heel spur and have no pain. 

VOMIT: Shoulder

Reference:1. Sher JS, et al Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5. 2. Connor PM, et al Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7.

MRI studies of adults who have no shoulder pain show that 20% have partial rotator cuff tears and 15% have full thickness tears. In addition, in those over the age of 60, 50% (half) of those who had no shoulder pain or injury had rotator cuff tears on their MRI that they did not even know about.(1) 

A study on professional baseball pitchers showed that 40% of them had either partial or full thickness rotator cuff tears and yet had no pain while playing and remained pain free even 5 years after the study.(2) 

Translation: Do not panic if your ultrasound and/or MRI shows a rotator cuff tear, it is NOT necessarily associated with shoulder pain!

VOMIT: Thoracic Spine

Reference:1. Matsumoto M, et al Age-related changes of thoracic and cervical intervertebral discs in asymptomatic subjects. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1359-64.  
2. Wood KB, et al Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 1995 Nov;77(11):1631-8.

An MRI studies of healthy adults with no history of upper or low back pain found that 47% had disc degeneration, 53% had disc bulges and 58% had disc tears in their thoracic spine. 

Amazingly 29% of these healthy adults had a disc bulge that was actually deforming and pressing on the spinal cord, yet they did not even know about it.(1,2) 

Translation: Do not panic if your x-ray or MRI shows "problems" with your discs, they are simply common and NORMAL findings. 

VOMIT: Lumbar Spine

Reference:1. Cheung KM, et al Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976). 2009 Apr 20;34(9):934-40.
  2. Takatalo J, et al Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine (Phila Pa 1976). 2009 Jul 15;34(16):1716-21.  
3. Chou D, et al Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine (Phila Pa 1976). 2011 Oct 1;36(21 Suppl):S43-53.

Studies have shown that lumbar disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of those between the ages of 50-55.(1) 

Another study showed that among healthy young adults aged 20-22 years with no back pain, 48% had at least one degenerated disc, and 25% had a bulging disc.(2) 

Leading Physicians at the department of Neurosurgery at the University of California strongly recommend AGAINST the routine use of MRI for low back pain since they found NO LINK between degenerative changes seen on x-rays or MRIs and low back pain.(3) 
 

VOMIT: Cervical Spine

Reference:1. Okada E, et al Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J. 2011 Apr;20(4):585-91.
  2. Matsumoto M, et al Prospective ten-year follow-up study comparing patients with whiplash-associated disorders and asymptomatic subjects using magnetic resonance imaging. Spine (Phila Pa 1976). 2010 Aug 15;35(18):1684-90.

An MRI study of healthy adults and seniors found that 98% of all the men and women with no neck pain had evidence of "degenerative changes" in their cervical discs.(1) 

A 10 year study of compared the MRIs of healthy people to those with neck whiplash injuries. Basically immediately and 10 years later both group had similar MRIs with 3/4 having neck disc bulges.(2) 

Translation: The far majority of all healthy adults get neck degeneration (arthritis) and disc bulges meaning they are a NORMAL aging process! Therefore neck arthritis or mild to moderate disc bulges cannot possibly be a reasonable explanation of your neck pain, or else 98% of people would have neck pain.

  

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28 Dec 2014

LEH - 2014 Year in Review

This week I have been reading and listening to blogs and audios that relate to goal setting for the New Year… and we’ll get to that next week.  But this week, for my own sanity (and perhaps for your benefit too), I want to review my year.  The first aspect in setting goals for the next year is to reflect upon the year that you had.  Good, bad, and ugly.  Celebrate your successes, acknowledge your shortcomings (and don’t beat yourself up for them), and simply think about all that you have been through, done, become, shed, etc.  So here we go!

January started with gratitude for my existing businesses – the growth of FourLeg.com and a strengthening of the Canine Fitness Centre.  I created a vision board for the year that I hung in my office.  Not all of my goals were fulfilled… but I succeeded or came close on some.  Here were my goals for 2014:  Get fit, put in hardwood floors, spend more time with my husband, kids, and out at our cottage, focus on happiness and enjoy my surroundings, be able to do things on the family ranch (take over some decision-making control), grow FourLeg.com to over 300 members, practice serenity, reduce my mortgage to certain amount and grow my bank account to a certain amount, go for massages, make money in many different currencies (and travel), have a line up a patients at the Canine Fitness Centre and hire two additional therapists, speak to a huge room of people, be a people-connector for others, win an award, sell 1000 copies of Successful Practitioners in Canine Rehabilitation and Physiotherapy, create a new centre called YYC Dog Sport & Wellness and a new group for Allied Animal Healthcare Practitioners.  Phew!  When I read this list… I sure didn’t get much accomplished!  And as such, perhaps my 2015 goals should be more balanced, realistic… or something else!  But I digress… that topic will be for next week!

What did I do?  I taught 8 courses and in doing so traveled to Calgary (my clinic), Las Vegas, New Jersey, Germany, Sweden, Switzerland, and California.  I attended two conferences, taking me to Edmonton (Canada) and Oregon.  And, I took my family on a vacation to Hawaii to a beautiful little beach house that we have been so fortunate to be able to visit twice now!  So, I guess I ‘got out of the house’ a time or two. 

FourLeg grew and I was delighted to continue to grow the educational library of information for members.  I didn’t hit 300 in members… but I didn’t push for it either.  I was pleased to create two course series: Myofascial Triggerpoint Mini Course and the Massage 101 course that is just finishing.  (The latter will be available as a course for purchase for non-members soon-ish...). 

I did get fitter… but not ‘smokin’ bomb-shell’ kind of fit.  Ah well.  I maintained my fitness regimen by going to the gym 3 days a week and in October, I switched it up by adding yoga.  Now I go to the gym twice a week and yoga twice a week.  However, my summer of learning to drink martini’s did not further the ‘smokin-hot’ fitness goal and I need to get back on track in 2015! 

My clinic, The Canine Fitness Centre, continued to grow this year.  We had some staff turn over, lost a therapist (it was a good move for her… so no hard feelings) and gained another.  I am happy to say that we have a really nice team right now. 

This summer, we did manage to get to the cottage every weekend.  It tends to be a nice ‘forced’ relaxation.  The summer was broken-up by going to Oregon for the International Symposium in Veterinary Rehabilitation & Physical Therapy.  I was an exhibitor this time and was so nervous about not going as a speaker.  I was afraid that I’d be alone in a corner, banished as an outcast!  Fortunately, plenty of people came to talk to me… so it was a success in that regard!  However when it was over I found that I was rather burnt out.

From mid August onward… I just sort of carried on in robot-mode.  I found it hard to get back to people about future teaching dates.   (Sorry to Antke, Sabine, Karen & Nycki, and others I may have forgotten.)  I found that thinking about anything other than what I had to get done week-to-week was difficult.  To help, I took up yoga as I mentioned above, I’ve tried an online meditation course, and I changed up my clinic working hours.  But to be honest, I’m still not quite ‘right’ just yet, so I’m looking forward to creating my goals for 2015 to help bring back my spark!!   And I have great suggestions on how to create goals that matter (and I’m not going to talk about S.M.A.R.T. goals… this will be totally ‘new’… it was to me – so I hope you like it too!) I’ll be doing mine this week!

There we go! So until next week… Cheers! 

Laurie

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10 May 2015

Help! I can't get my charts done!

My last question is, were you ever bogged down in your medical records? I end up spending all my free time completing them and never have time any more to keep up on journals, your website, etc.  maybe there is a section on the website you can direct me to.

L.

----

As for the medical records... I find that I have to do them almost immediately after the patient is gone - or I am left with 10 - 15 charts to do at the end of the day when my brain is fried!  Sometimes I will stop what I'm doing in the treatment, give the dog a break and write some stuff down.  The owners are usually okay b/c I tell that that if I don't write it down now that I'll forget by the end of the day... and the dog sometimes needs a break anyways.  And I confess that sometimes to just get away and a bit of time to myself, I'll take a chart to the bathroom and do it in there between patients!  (Too much information???)

Lastly, you might be surprised at how basic my charting is.  In my case, it's just me (or occasionally one of the other therapists) that needs to see my charts... and the rule of thumb in physio is that you assess and treat what you find that day anyways.  So looking at the chart to see what was done last just provides a 'guideline' for the treatment you may do that day.  For example:  

S: Going up and down stairs now, Still won't jump into car

O/E: Decreased tenderness iliopsoas.  Pelvis level, mild tenderness L7 with transverse pressures

Rx: Laser 10 J/cm2, 50% multiple sites to iliopsoas & L/S, PEMF 15Hz x 30min, Mobs L7, Myofascial release iliopsoas, Home Ex: Feet up stretch forward for cookie.

Simplify!  When I have an intern that's shadowing for their rehab certification, I tell them to tell me which patients they want to copy the notes for and that I will do an extra detailed job of the notes... otherwise, what I wrote above is about all that I do.

Beyond that... we also build in buffer time between patients.  We know we're going to run late.  So while we have the appointments set up to be 1/2 hr appts, we schedule them ever 40 minutes.  That way we don't get behind, and there's a chance we'll get charts done.

Hope that helps!!

Laurie

 

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14 Jun 2015

Mental health benefits of canine rehabilitation

While searching for blog topic ideas to ‘steal’ for my clinic’s blog, I found a great blog / article that I wanted to summarize and expand upon for you.

The blog I found was about how canine rehabilitation is healing for both the body and the mind.  Now this is a topic that I feel strongly about as well.  We have tons of dogs that come into the clinic delighted and happy to see their therapist or our UWT staff or to greet anyone in the vicinity.  Many owners exclaim that they simply tell their dog… “We’re going to see Auntie… [Insert name of staff member here]” and their dog gets all excited!  P.S.  I am Auntie Laurie to all of my patients… owners call me this, I get e-mails or Facebook messages addressing me as ‘Auntie Laurie’… I love it!

So perhaps the visit to the clinic is about more than the therapy and feeling good afterwards… but also about the ‘outing’.  We know that senior citizens are encouraged to get out, get a hobby, volunteer, go play bingo, get on the bus to go to the casino (I never understood that one), or when living in a care facility, to go to the recreational activities.  Why?  Because social outings make for good mental health!  And happiness and feeling connected to others helps us to deal with chronic pain and may even prevent some illnesses.  So why not for our dogs too?  I once had a client with a 13-year-old Golden Retriever with chronic musculoskeletal pain and kidney disease.  The dog was finding it hard to move, so he purchased one of those bicycle carts that you put kids in, and he would drive her around to her favourite spots: the park, the ice cream shop, and around the neighbourhood.  She loved it, and at each stop, she’d get out and make her rounds!  Mental health benefits?  You bet!!!   And we know that a happy mind is able to deal with stress much better than an unhappy mind!  So for some of your chronic patients, be sure to make a fuss, give treats, and take some time to attend to their mental health as well!

But I went off on a tangent already with that last paragraph.  What the original blog was getting at was more about how rehabilitation itself can provide unintended mental benefits.  For example being able to suggest or provide mobility aids (i.e. braces, wraps, carts, etc.) could be enough to give someone’s pet a little freedom once again.  Suggesting home adaptations (i.e. ramps, steps up to a bed or couch, strategically placed runners for slippery floors, booties, or ToeGrips) could help an animal to maintain a positive outlook on life.    Moving around their environment independently, exploring, or return to activities that had once been too difficult is a huge boost in quality of life for any animal! 

And then of course there is the benefit to the human.  I don’t think that this can be overlooked.  I have received countless hugs and expressions of gratitude for not just helping a pet with his or her physical ailments, but for also being a support for the owner as well.  We know that animals are an intimate part of many people’s lives.  And many people have a good deal of sadness, grief, guilt, or anxiety about seeing their pet in pain or struggling to function.  Not only can we help with these physical issues, but we can also provide hope, support, empathy, understanding, encouragement, and friendship to the owners as well.  And that is a wonderful gift!

So my main messages with this blog:

  • Empower the pets by helping them with their pain & decline in function
  • Think to suggest mobility aids or home environment adaptations to allow for some independence at home
  • Make a fuss over every dog
  • Be sure to talk with the owners and be a support for them as well

 

(Want to see the original blog post for my inspiration? Check out: 
http://www.havenlakeanimalhospital.com/blog/tag/canine-rehabilitation/ )

 

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01 Nov 2015

Blog - Things that Matter

On Monday morning last week, I received news that my oldest son’s good friend Anders Newman, 18 years old, had died while out hiking the day before.  Devastating!   Anders was that kid that you wanted your kid to be friends with, a boy you wanted your kid to be like, and a person that you could instantly recognize as being wise beyond his years.  He was an exemplary human being!  So kind and compassionate, generous and caring, smart, talented and a real cutie too!  Ander’s death made it pretty difficult to focus on much else this week and I had plenty of clients ask if my allergies were acting up. (No, just crying a lot.)

But things did get done, and I did accomplish some things.

  • I did a kick-ass webinar for the Private Practice Division of the Canadian Physiotherapy Association.  It went fabulously well.  Even the organizer said it was the best one he’s ever hear!  
  • I muddled through a couple of workdays.  Many clients had to gently question me on things like:  “What did you think of his neck today?”  (Oh, brain of Swiss cheese, I forgot to check his neck!)  Thank goodness my clients are so understanding.
  • We toke many a client on a tour of our new clinic.  We’re getting tons of great feedback!  Consensus is that despite the fact that it is pretty much the same size as the previous clinic, it FEELS so much bigger.  (Better utilization of space!)
  • It took me three attempts, but I finally managed to film the Bell’s Palsy video for next week.  Hopefully the audio is functioning normally from here on in!
  • I managed to go to yoga twice.  Those were the only two hours I could manage to shut off my brain and the bubbling emotions I had to try to control.
  • Wednesday, my husband Peter and I emptied the remainder of my old clinic.  In particular, we moved out the wooden storage shed we had in the warehouse (for storage) and took it to the farm.  We were like ancient Egyptians rolling the thing towards the door using 5 pieces of pipe.  Then we loaded it onto the flatbed truck.  It ended up being 12 ½ feet up (still okay for getting under bridges), but Peter looked like some half-witted hillbilly driving his shed out west to go camping!!!  Thank heavens it was dark by the time we were finished up that day… because I think we would have needed a permit to move something that tall!
  • On Friday I was able to watch my younger son play football.  But with the whole school in mourning, their team was rather lack-luster – and they lost, without much of a fight.
  • Saturday was the funeral, and it was an amazing outpouring of love, admiration, and praise for the young man.  The common thread throughout each tribute was how Anders had touched so many people’s lives.  How his ability to relate to people had enriched everyone he met.  How he seemed to have time for everyone.  And because my family and I were people ‘bettered’ for having known Anders, I wanted to make some points of learning in this blog, inspired by the life of Anders Newman.
    • Relate.  Relate to your clients on a personal level.  Get to know them as human beings.
    • Relate.  Related to your patients – the dogs.  Talk to them.  Tell them how wonderful they are.  Spend a moment or two each treatment to just admire them.
    • Relate.  Relate to your co-workers.  Take the time to get to know each of them personally and if you can, try to leave each interaction you have with these folks, making them feel better or happier in some way.

So the summarized take home message is really, make each of your relationships matter and make each interaction worthwhile.

Laurie

Anders Newman 

Posted in: Personal reflections Tags:

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13 Mar 2016

Pain management & why you should get physio first!

This is a blog that I am repurposing and expanding upon from my Canine Fitness Centre website.  http://www.caninefitness.com/index.php?pid=35

(Feel free to link to this article from your own blog.)

I had no idea!  I just came upon a blog that stated that March 1st was national Get Physical Therapy First day in the USA!  Who knew such a day existed? 

It was a ‘human physical therapy blog’, and it went on to talk about the top 5 reasons to get physio.  Here’s the synopsis

  1. If you experience dull, recurring pain this is likely a case where physio can be instrumental.  Without it, pain may linger and most likely return repeatedly.
  2. Little injuries.  Physio for minor injuries was previously just reserved for high-level athletes.  They needed it to function at their best.  But why not you as well?  The main goal of this type of treatment is to prevent major injuries and to keep muscles healthy and strong in order to support the injured area.
  3. Your neck is killing you!  Yes, everyone with a desk job or those of you that spend a good portion of your day with your arms out in front of you (i.e. any healthcare worker!)  You folks are at a higher risk of neck and back problems, and if left unattended, can often result in postural adaptations.
  4. Achy arthritic joints.  Your therapist has the best skill set for prescribing exercises and managing pain.
  5. A serious sudden injury that is causing acute, sharp pain.  In this case a physio can help to resolve the issue or guide you towards the best fix (i.e. sometimes that might be recommending a surgical consult).

Original source:

http://www.clinicient.com/blog-insight/blog/getpt1st-top-reasons-to-visit-a-pt-first

And at the bottom of the blog, there was a link that said “More Reasons” and when I click there, what showed up was a list of 10 injuries / conditions that really do warrant physical therapy:

  1. Fibromyalgia.  (Now, as far as we know, dogs don’t get this.  But then again, we’re not 100% sure in human medicine what fibromyalgia is all about… I think researchers could look at that to be honest, why don’t dogs tend to get Fibromyalgia?)
  2. Arthritis.  (Yes, we can help all arthritic dogs to some extent!)
  3. Sports injury prevention.  (Yes, all canine athletes should see us!)
  4. njury rehabilitation. (Hands down… nobody else addresses this!)
  5. Desk job.  (Dog relevance?  Hmmmm…. Maybe not!)
  6. Repetitive use conditions (I would put supraspinatus & biceps tendon issues into this category in dogs, especially in the agility or flyball athletes.)
  7. Acute or lingering pain.  (Pain = needs rehab.  Check!)
  8. Swelling or other changes – especially after a workout. (Good thought!)
  9. Fall prevention.  (So from a canine perspective, I would look at this as a need for geriatric dogs, & neurologic dogs to need rehab)
  10. Adolescent conditions. (For us, I read hip dysplasia, elbow dysplasia, and the need for quarterly checkups during the growth of a puppy to a young dog!)

Now, if I were to expand upon this blog, I would point out that rehabilitation can provide pain management that can augment medication, and/or deal with issues where medications could be counter productive (i.e. NSAIDS & tendinopathy lesions), or reduce the need for medication.  So I’d make one whole category read:  Non-pharmaceutical pain management.  People & dog owners are looking for that!  

And what’s at risk if you don’t deal with pain?

Sudden injuries or dangerous situations (i.e. a suddenly torn knee ligament or putting your hand on a hot stove element) should cause pain as a way to protect the body.  You either stop moving or using the joint in the case of the knee ligament, or you pull your hand away from the element in the case of the hot stove.  This is when pain is good as a mechanism to protect you from further injury.  If you deal with the injury and manage the pain, then it should go away and all should be well.  But in some cases where pain is not adequately managed (and sometimes when the system goes awry), you can end up with chronic pain.

You may not be familiar with the terms ‘wind-up pain’ or ‘central sensitization’.  These are medical terms that describe a phenomenon where the body gets so used to signaling the brain about pain, that the body starts to ‘over-deliver’ the pain signals & the brain ‘over-registers’ the pain.  Thereby making minor pains seem like big pains, and sometimes even non-painful stimuli (i.e. petting) to be misinterpreted as pain.  When this happens, literally EVERYTHING becomes about the pain!  And when that happens, it’s hard to reverse.  

So what can be done when it comes to your rehab patient?  

Advocate for treating injuries when they’re smaller and before they become big issues.  Advocate to better pain management adjunctive medications after surgeries.  I am continually surprised by how many general practice vets are not as ‘in to’ pain management as I think they should be. You may be familiar with the standard NSAIDs that are prescribed, but either speak to the regular vet or ask your clients to discuss with their regular vet adjunctive medications such as Tramadol, Gabapentin, or Amantadine.  There are 3 ‘additional’ pain medications (i.e. they combine well with NSAIDS) that can help to manage pain in the post-operative stage for any surgery.

Start rehab soon after a surgery or major injury.  Physio / Rehab is all about gradual or staged intervention.  For example after a surgery our primary goal is pain management, settling of inflammation and helping the injured tissues to heal. Only after we accomplish these do we move on to strengthening or functional retraining.  We still hear from clients that their vet told them that it’s too early to go to rehab / physio.  What this tells me is that the regular vet doesn’t understand how physical therapy is ‘staged’.  So it’s our job to educate our referral sources.

Wishing you and your fur-balls a pain free week!

 

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24 Apr 2016

Cool stuff from the STAAR Conference 2016

So, firstly, I have to say that the STAAR Conference is the most fun and most educational canine rehab conference that you could ever plan to attend!  This year was no exception!  Already there have been so many e-mails and posts about the fabulous time had, and what struck me was how many of the dog-volunteer-owners were right in on it being so appreciative of having their dogs participate!

So, as an instructor, I get very little time to see anyone else’s workshop, but what I can tell you about are some of the interesting cases I saw!

One of my workshops was entitled Interactive Case Management – What is it now and what do you do?  Maybe that was a bad title.  Anyways, it was a really fun workshop.  It was a short lecture (assessment tips, goal setting tips, treatment tips) and then we have a number of dogs come in – some for me to assess in front of everyone, and some that everyone had the chance to assess.  Great on the spot learning!

One case was a fascinating little dog – history of being brought into rescue unable to stand, and taken in by a very determined couple.  He’d undergone rehab and can now walk on is own, but this little fellow was the ‘wonkiest’ little thing I’ve ever seen.  He was ataxic in all four limbs, had a strange head bobble, and legs that just seemed to be screwed in wrong!  So the first place I wanted to look was at his neck.  His upper cervical spine to be exact!  There are tests that can be done to test the alar ligaments, transverse ligament of the dens, and integrity of the dens (odontoid process).  I was very careful, in fact, I didn’t test these structures looking for the typical signs, instead I just assessed for resistance within the range that I would expect to feel resistance.  Well, let’s just say that I don’t think that this dog has a full dens or perhaps there’s laxity in all of his little ligaments.  He’s doing great though, and I hope that his therapist will keep me updated!

Another case was a pit bull that had been rescued from a dog-fighting ring (he was a bait dog and had notable scarring over his neck).  His owner had noted that he had had surgeries for bilateral patellar luxations, but that his rear end weakness seemed to be progressive.  Additionally, there was an account of this dog having troubles and being panicky when he would lie on his side or roll on his back – seeming to be unable to get his feet under him.  On evaluation, his neck and back were unremarkable, and one therapist did some craniosacral work on his cranium, and he has been in the massage class where they did some scar massage / mobilization, both of which seemed to help a bit.  Since his issues seemed to be localized to his brain, and his strange behaviour when on his back seemed to implicate his vestibular system, we decided to try the Dix-Hallpike Maneuver to see if we could ‘set off’ some nystagmus and/or trigger the vestibular system.  Well, ‘hot dang’, we set him up, flipped him back onto me, and ‘voila!’ Nystagmus!  So, with this dog, his history does not really indicate the ‘otolith’ theory as being the root of the issue, but rather a processing disorder.  And while I’m not an expert in vestibular rehab, I was able to provide some ideas for home therapy for this dog, but better yet, there was a local therapist (who specialized in human vestibular rehab) at the conference that was going to be able to offer some more detailed treatment advisement.  So exciting!  Again, I’m hoping to be updated on that case as well!

In the spine courses, we saw many dogs with axial skeleton dysfunctions that were helped with manual therapy.  And, owners that were ecstatic for their dogs to be receiving treatment.

In my Hip Dysplasia Workshop, we saw a 9-week old puppy with hip pain (already!!!) – likely from playing too rough, and a number of old dogs with hip arthritis.  Everyone was given some treatment and advisement.

And lastly, in the Business & Marketing round table, we had a great discussion on creating a multi-step plan for marketing to your referring veterinarians.  (It’ll make a great FourLeg audio one day!)

All in all, it was a really fun & fabulous conference!  Thanks to everyone that attended and I hope to see even more of you next year!

Until next time… Cheers!

 

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02 Jul 2016

What is the value of the ENERGY in your MEDICINE?

This week I had some interesting discussions with my clients.  They started with, “So, you don’t have anyone shadowing you this week!”  

Now we don’t have tons of interns, but we do likely have more than average.  As well, we don’t mind having interns, but it does change the dynamics within the clinic and the appointments.  What was interesting about my conversations this week is what the dog owners noticed!

Firstly, let’s set the stage.  At my clinic, 99.9% of the time, owners bring their dogs to their appointment and stay with them.  That leaves us with roughly 30 minutes for me to do the treatment and talk with the clients.  My hands feel what’s going on, I ask questions about how the dog has been doing, and I go to work, but as I do, I am visiting with the clients the entire time.  “Do you have any plans for the summer?”  “How did your daughters wedding go?”  “Did you go to the dog show in Cochrane?”  “Did Xena get pregnant?” “What cool photos have you taken lately?” “Is that fire still burning up in Fort Mac, and what’s the air quality like?” “What is the housing market doing these days?”  “Ohhh, I see you got a pedicure!”  And so on!  It sounds a bit like a ‘soap opera’, but these are real things I said to my clients this past week!  People are so interesting!  I love the chance to learn about and catch up on people’s lives, 1) because it’s interesting, and 2) because I care!  Turns out, they miss that interaction as much as I do, when the dynamics are changed at the clinic.

So when you have an intern, there is more time spent showing, teaching, answering questions, supervising, and discussing with the intern.  It’s just more ‘clinical’ when there’s an intern.  The dogs receive the same great treatment, maybe even better than normal because in some cases four hands are working at the same time!  But the clients miss out!  They missed ME and our conversations, and they missed the ‘energy’ that normally surrounds the treatment!

One of my clients is a really interesting woman who does energy healing work and crystal singing bowl performances (which are amazing)!  Typically we get into some really cool philosophical discussions.  So this time we got talking about the ‘energy I create in the treatment room’.  She had noted that, ‘the energy was very special as evidenced by how much her dog loved to come see me and would just immediately lie on the mat as soon as he came in the room.’  She said he is normally very aloof with anybody other than family.  So what is it that’s going on?

I’ve always had a theory about healthcare practitioners.  There are some that are technically great.  You can go to these people, they can give you a massage, or fix your neck, or send you for further diagnostics based on their exam, but somehow you feel like something is missing from the interaction.  You don’t feel cared for or validated as a patient (or human being perhaps). There are some that have great interpersonal skills but are lacking the technical components.  You might really like them, and they can get you somewhat better, but their ‘toolkit’ is limited.  Then there are those that have both; great technical skills & interpersonal skills!  Having both is what you should strive for!  The Canadian Physiotherapy Association has a Leadership Division, which members can be a part of.  They focus on ‘soft skill’ acquisition, and it’s important to have that skill set!

But let’s get back to energy.  Have you consciously thought about what kind of energy you are putting into your treatments?  Everything is energy.  The laser, ultrasound, PEMF & shockwave transmit different kinds of energy.  The effectiveness of manual therapies can be explained in terms of neurophysiology, but what sets off the cascade of neurophysiologic effects?  The application of a mechanical energy to the body tissues!  So why do we not typically acknowledge the metaphysical energy that a healthcare practitioner can purposefully (or unconsciously) transmit to a patient or the energy that a practitioner (or clinic) can create as a general atmosphere?  Should this not also be a goal? Can it not make a different in the overall effectiveness?

Now I am not going to say that everyone should run out and take a course in reiki.  I don’t think you actually need to do that to transmit a healing energy. But I do think that people need to slow down a bit and be a little less clinical.  Talk to the dog, talk to the owner, pet the dog between the selection of different modalities, apologize to the dog if you find a sore spot, be empathetic, accept doggy kisses, breath deeply, create a calming energy within your own body, genuinely appreciate the dog in front of you, and set your intention for healing.  Every touch should be a transfer of energy – and yes, I am serious!  Try it!  If you are in the right state, your hands should feel warm and a little tingly!

Now in regards to the energy you create in the room.  Sure, we could talk about atmosphere and lack of clutter, and warm paint colours, but I don’t care so much about that! I do however want to talk about engaging with your clients.  Getting to know them and making the appointment something that they can look forward to as well!  Ideally everyone at your clinic should be making the effort to get to know the dogs and the people.  Make an effort to remember what people do for a living, the general age of their children or grandchildren, their hobbies, etc.  If your memory is shot, then put a sheet of paper in their file (or document it somewhere on their electronic file) and write in these little things.  I promise, it will make a difference!

So if 33% of any treatment success can be attributed to the placebo effect, and technical skills alone do not equate to full success, then perhaps the missing ingredient (or maybe the unspoken component) in any treatment, is the energy transfer!  So I challenge all of you to go out and make this week a ‘conscious energy transfer week’!!!  And let me know what you notice!

Until next time, CHEERS!

Laurie

 

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17 Jul 2016

My Week - July 16-16

Hey there everyone,

This past week has been exhausting and chaotic!  My Borzoi breeder is an amazing and kind woman.  She does so much for other people, so when she needed a place to live, I said, "let me know if you need somewhere to park your trailer while you are between houses"...

I am happy to be able to do this for her, but right now, MAN, am I tired!

Check out the chaos here:

 

Posted in: Personal reflections Tags: Borzoi , mud , chaos

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07 Aug 2016

Reality Check

What do you do when the dog owner either can't see or is dissatisfied with the improvements their dog is making?  This is a bit of a tough dilemma.  On one hand you question yourself, your diagnosis, your treatment plan, and your assessment of the dog (this is where objective outcome measures come in handy).  On the other hand, you struggle with getting the owner to see that improvements are being made or have been made and to keep them encouraged and positive.

The inspiration for this blog came from a podcast I recently listened to( http://www.themanualtherapist.com/2016/07/untold-physio-stories-s2e1-being-tough.html )  where the story being told was of a PT/Physio treating a 16 year old girl whose mother seemed to be the biggest barrier to the daughters response to treatment.  It reminded me of some of my past human patients and of one particular dog-owner client.

So the dog in question is a large breed 12 year old male dog.  He had a TPLO with complications causing some degree of residual neurological deficits in the leg.  He was also found subsequently to have a brain tumour (radiation completed) and a lumbar disc (which I think is a non-clinical finding).  And did I forget to mention the elbow arthritis?  He's been a healthy, rarely lame, strong, big boy up until the stifle surgery.  With all that's happened to this dog, I've been fairly pleased with his rehab, but I think he's hit the ceiling of his recovery.  The surgical leg is not 100% but it improved more than I ever thought it would!

The trouble comes in the fact that the owner keeps asking, "What more can be done?"  Now, I'm all for providing every opportunity for healing, but I also think that there needs to be some amount of realism as well.  What does one do to help owners see the reality of the situation and to appreciate the blessings while not having them feel as though you are giving up on their dog?

So I think the answer comes in two parts.  The first part is to actually try different things to help with healing (within reason… for example, I'd not suggest a surgery as a 'guess' that it might help).  Any conservative management regime that can do no harm would be advocated.  By doing so, you are proving that you have tried, have thought outside the box, have exhausted your ability.  Perhaps you even make a referral to another complementary healthcare provided that can offer services different than yours.  Simply put, you put in the effort!  Secondly, you have the reality conversation.  But it's not a depressing conversation, it should be a conversation about seeing the blessings.  Seeing how much function their dog does have.  Seeing how the dog still has a great quality of life.  Helping the owner to appreciate the dog they have as compared to the dog he was when he was younger (or before an injury or ailment).  It can be hard for some people to come to this point.

I am reminded of another case.  I had told the owners that their dog likely had some arthritis in his knee.  They were devastated!  "He'll always have pain!  He'll never be able to go on day-long hikes with us!  He'll always need supplements and/or medication!"  My reply was, "There are far worse things in this world than arthritis.  I have it, you likely have it, and most people will get it.  It's manageable.  It's not life threatening."  These people were not convinced until we headed back out to reception and in the waiting room was a paralyzed dog that was happy as all-get-out to come for therapy with his equally happy owners, who were heralding, "Hi Auntie Laurie, look who's here to see you!"  I made a fuss over the paralyzed dog and then returned to my arthritis dog owners and gave them a 'see what I mean' look.  They actually said, "I see what you mean now.  Thank you!"

So my challenge to you is to think about the following: Given a similar situation, how might you facilitate that change in mindset for people?  How would you get an owner to be realistic and positive all at the same time?

I welcome your replies!

 

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21 Aug 2016

Olympic Realizations

         

Have you been glued to the television?  It’s been hard to pull away from all of the Olympic action!  Of course, I love watching the Canadians, but it’s been awesome watching some of the other countries do well.  I find that I’m also loving watching anytime that Brazil plays as well, because it’s awesome to watch and hear the crowd get so passionate about cheering for their home team.  But what I want to tell you is about how Canadians view Olympic medals.

Every night, my hubby and I watch highlights of the Olympics for the day and watch how the Canadians did.  So, if you look at the medal standings, nobody else can touch the number of medals racked up by the USA.  But does that make the rest of the teams failures or losers?  NO! They are still top in their country.  They are still competing with the very best in the world.  They still deserve to be celebrated.

Now what struck me was on day 5, when the TV announces exuberantly announced that Canada had won a medal EVERY day of he Olympics.  We were five for five!!!  And I found myself feeling so full of pride!  Then I went online to see where we stood in the medal standings, just to realize that we were #22 in the medal standings.  Hmmm.  But I found that I was still happy and proud and so delighted for our athletes.  As I write this, we are #10 in the total medal standings (#20 in gold medal counting), but this Olympics has seen Canada win more medals than we have EVER won in a Summer Olympics.  

So I wonder to myself, is this just a Canadian thing?  Are we just easy to please for a personal best?  As excited for a bronze medal as we are for a gold?  Delighted to have qualified?  Eager to announce that ‘Athlete so-and-so’ made the best debut in a certain sport as compared to any Canadian before him.  Proud to mention each and every athlete and how they did in their sport that day, even if it was a non-qualification?  This is how I found the Canadian Broadcast Corporation to be announcing the Olympics for Canadian viewers.  Is it just a Canadian thing?  No, ‘rah, rah, we’re the best’.  No leaving out athletes that didn’t medal.  Just a pride for what we did accomplish – no ego – no arrogance – just happiness.  And I thought to myself, ‘What can I take away from experiencing the Olympics in this way?’

This made me think about competition, and more specifically competition in business.  So one way of looking at competition is to believe that the goal is to win all the time:  “Be the best, destroy the rest.”   But whom does this serve?  It only serves your ego and your greed.  Now don’t get me wrong.  I do want you to be your best, and to do the best you can, and to continue to get better, and provide better and better services, and to grow your business.  These are all worthy goals to strive for!  Do not get complacent!  However, can’t there be more than one winner?  If all rehab facilities & practitioners delivered top quality service, wouldn’t it be the animals that are the real winners?

This leads me to the following:

1) I remember talking to a businesswoman a number of years ago, and she said, “I wonder if I would have as much passion for doing this if my competition didn’t exist?”   We discussed it for a while, and we came to the conclusion that ‘no competition’ might not be as exciting.

2) Another ‘new-to-rehab’ person just e-mailed me 2 nights ago.  She was tickled pink (aka. Happy) because at a recent agility trial, she had a booth and saw a number of injured dogs and had worked collaboratively with some massage therapists to treat the dogs in a very wholistic way.  She was over the moon (aka. Happy) with her success at the event and the collaboration she had with the massage practitioners.  

3) The last point I want to bring forth stems from the multitude of e-mails I’ve received over the last few years.  I’ve received dozens upon dozens of e-mails from practitioners thanking me for teaching them something, or for a piece of information learned on FourLeg that helped them to treat a particular patient of theirs.  “Without your teaching, I never would have known where to look or how to fix that problem.”  So, let’s put that into the achieving a ‘personal best’ for that practitioner.

And when we put it all together, here’s what the Olympics has made me realize.  

  • Be grateful for your competition.  They force you to strive to be better, and in the end, more animals are being served because you both (or all) exist.
  • Can you collaborate?  Can you make your services about ‘patient centred care’ and look at what others can bring to the table for the best interest of the patient?  Can everyone win?
  • Strive for your personal best.  Learn more.  Do more.  Be more.

On that note, Yah Canada!  Number 10 in the world (or #20 if you only care about gold) of the Olympic summer games!

Cheers!  Laurie

 

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18 Sep 2016

Shiny object syndrome!

Shiny Objects

My husband once convinced me to crawl up into a tree (actually a willow bush – but ‘tree’ sounds better) to look inside a magpie nest.  He had told me that looking into the nests of crows and magpies was always interesting because these birds liked to collect things.  As a kid, he and his brother would do this and had found bottle caps, pop tabs, shiny rocks, pieces of twine, plastic, and various other ‘treasures’ in the nests.  What did I find?  Nothing!  The willow bush couldn’t be climbed without destroying it… so I just had to take his word for it!  Maybe only 70lb kids get to see inside of magpie nests!

But what does this have to do with your animal rehab practice?  Well it actually ties in nicely with last week’s blog post about massage, manual therapy, and dry needling for neck pain.  I want to talk about ‘shiny object syndrome’.  

All of us have been through it.  We learn a new technique, and every patient the next week is a guinea pig to practice on!  Find out about a new drug, and every potential patient has it prescribed.  Is that bad?  Well, yes and no!  For the purpose of this blog, I’m only going to talk about therapeutic techniques.  (Getting all gung-ho about a new drug has the potential to be a bit more dangerous.) 

Okay, so let’s say you learn acupuncture, or dry needling, or you purchase a shockwave, laser, or alpha-stim unit, or you watched one of my videos and now want to do a certain manual therapy technique.  You’ll want to try it, test it, play with it, refine it, and eventually make your own decisions about it.  That’s natural, and quite frankly, I think it’s good for people to assess things on their own terms and in their own hands.  That’s how you learn what works for you. That’s how you differentiate between ‘hype and propaganda’ and ‘what really works’!  Do this, and don’t feel bad about it!  

Quite honestly, this is how I created my manual therapy courses.  I went through the human techniques, studied my canine anatomy, tried things, refined things, decided what worked (and in what variation) and then wrote it down, and created the courses.  Value added!  Experimentation justified!  Betterment for my patients and the patients of students I’ve taught!  

But what happens when you get stuck on one particular theory?  One guru?  One technique?  In this case, you limit yourself.  You sacrifice the totality of wellbeing you could be offering!  So lets say you take a Traditional Chinese Medicine course, and now you begin treating in this new fashion. You may find that you have great success with numbers of patients.  You may find that that cases the previously stumped you are now are doing well when you address the ‘wind in their liver’.   Yay!  But you may still have cases that stump you!  You may have cases that just don’t ‘respond like they should’!  Hmmm… what do you do then?  THEN, you may need to have a different set of tools.  THEN, you may need to be more open-minded to other things, other ways of thinking, other therapies, and other tools!  

The same thing could happen with modalities such as shockwave or laser, therapies such as massage or trigger point dry needling, techniques such as chiropractic or osteopathy, concepts such as homeopathy or traditional Chinese medicine.  So what are you to do?  

LEARN, PRACTICE, & TRY.

EVALUATE, DECIDE, & CONCLUDE.

And then, only then, should you formulate your opinion of when you use what and when, and why you would chose one technique, therapy, or theory over another. THAT is what makes for best patient care.  

No ONE tool is a panacea.  No ONE technique serves all needs.  The more you can learn and the more tools you have, the more patients you can effectively serve.

So this is a bit of a rambling way of saying, ‘learn lots of different things’, ‘don’t get hung up on just one way of treating’ & ‘be open minded’!

Mic drop!  Laurie out!

 

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02 Oct 2016

Confessions of a Junkie!

Junkies

 

I just can’t help myself.  At first I say, “No, you don’t need that.”  But then I get more and more interested.  Then I want it.  Then I justify getting it.  “It’ll help me.”  “I’ll use it later.” “You can never have too many.” “It’s deductible!”

 

Wait!  What?  It’s deductible?

Yes!  

I’m an education junkie!  What did you think this blog was going to be about?

 

For years, I have been justifying the purchase of textbooks.  My most recent expenditures have included books or texts on Kinesiotaping, Vestibular rehab, and Exercise prescription.  Stay tuned for video training or education on those subjects!!

 

I’m also addicted to online courses.  I love Mindvalley Academy (http://www.mindvalleyacademy.com/).  They have a lot of personal growth courses, and more recently a business and career steam of courses.  (‘Easy sale’ that I am, just signed up for that, and have started listening to the audios from the book “Think and Grow Rich”.)  Another recent purchase of mine was a course called Amplify, it’s about creating workshops (which I already do, but how might I do something different, or what can I do better?)  Oh, and then an e-mail came across my desk from a Canadian kid (in his 20’s… I call them kids now), and I signed up for his course called The Abundance Factor (spoiler alert, it’s all in the mind)!  As well, the Canadian Physiotherapy Association sent out an e-mail giving all members a link to a free video on Concussion management.  I don’t treat many (or any) dogs with concussions… but I really enjoyed learning how physios are part of treating patients with concussions.  And a bit ago I came across an advertisement on Facebook for an online education company called Physio Webinar Club.  There, I watched a video on kinesiotaping.  It was very well referenced, and I look forward to sharing some wisdom with you folks on that one day.

 

Okay, so those are just some of the things I’ve RECENTLY consumed!  I have countless others that I’ve bought or taken in the past.  Some I’ve never opened:  like a course called “Get 10000 Fans” – it’s about using Facebook for marketing; or “Live and Luxurious” (silly name) – it’s about creating coaching programs; and I’ve not yet consumed all of the content on “Total Product Blueprint” – which teaches you how to create 10 different income streams of informational content for your business.  Then there are the ones that I bought and decided they weren’t for me:  Webinar Jam (MAYBE I can make it work one day), or Click Funnels (nope, not going to use that), or 6-Minutes to Skinny (Darn, maybe I should dig that one out again)!

 

And of course, there are the memberships!  I subscribe to GKIC Marketing (Gold member), which gives me a newsletter and an audio CD monthly.  I am also a member of Profit Club, which is run by an Australian Physio.  He provides a monthly audio and content on his website about running a health care business.  Then lastly, of course, are the professional journals I get as a member of the Canadian Physiotherapy Association.

 

Phew! Just compiling the list of stuff I’ve purchased recently, and the courses I am waiting to consume, I’m feeling a bit neurotic.  Maybe I’m just an addict.  Maybe I’m just compulsive and gullible.  Quite frankly, I just can’t get around to reading, watching, consuming all of this material!  However, I wouldn’t change a thing!  I love having access to it all, I love learning, and I love owning textbooks!  So my challenge is to make time to consume just a little bit every week.  I know I feel great about myself when I do, and my brain delights in new information.  And that too is my challenge to you!  

 

There are so many blogs on FourLeg – over 220 to be exact!!  There are so many Training Videos, Audios, Newsletters, & Articles for members.  Challenge yourself to tackle just one or two a week, and you’ll be amazed at how your brain expands with new information and ideas!

 

So, that’s it for me!  Hubby and I finished watching all of the Game of Thrones DVD’s, so now it’s time to dive into one of my online courses – or read a textbook.  And on that note, this nerd is signing off until next time!

 

Cheers!  Laurie

 

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25 Dec 2016

Tough time of year

anxieties

This is often a tough time of the year for many folks.  1) Christmas can be stressful and sometimes lonely, and 2) for those of us in the northern hemisphere, it’s also closely related to the winter solstice, aka the shortest day of the year!

I decided to write on this topic because I’ve recently have 3 or 4 conversations with folks about anxiety and depression.  And if 3 or 4 people are brave enough to bring up the topic then there are others of you out there hiding in the woodwork, just not talking about it!  So here goes!

 

I suffer from seasonal affected disorder (this time of year is not good… and by January/February I feel like running away forever).  What has worked for me:  The LED SAD light (when I remember to use it), taking 6000 IU of Vitamin D (6000 is widely reported, it’s not just MY suggestion), tanning every week also seems to help, even if just 10 - 15 minutes / session (I did this often back about 10 years ago when it was worse), I would also suggest Magnesium-citrate supplements (500mg) & Calcium supplements (1000mg) (taken at night, they're good for chronic pain and sleeping).  Then for me, lifestyle-wise, I find I feel better if I can get outside for a bit each day during daylight, and I also feel better if I sleep in until the sun is up (so I tend to not wake up until 8am this time of year!!!)  When things are really bad, I find that St. John’s Wort seems to help take the edge off.   (P.S.  As a side note, did you know that depression is hereditary and is carried on the same ‘gene’ as alcoholism?  My Grandmother suffered from SAD, & I have oodles of alcoholics in my family.  Oddly enough, I have always felt that if I didn’t reign in my drinking to things like the STAAR conference, holidays, or a couple of glasses of wine on occasional weekends, that I could easily go down that path.  Mostly, I don’t drink much at all anymore.)

 

One person asked me about the Alpha-Stim.  Alpha-Stim is the brand name.  When used via the earclips it is called Transcranial Electrical Stimulation, and is essentially Microcurrent to the brain.   MUCH of the research done with the transcranial application was done on / for vetrans.  Vetrans with chronic pain, addictions, anxiety, depression…  And it was useful.  That’s why I started using it with the dogs with anxiety in the clinic!  Helped a lot!!!  If you were to google search Alpha-Stim you could find units that were earclips only (vs the kits with the probes and self-adhesive pads).  It’s worth a shot for those of you wanting to try something natural (and deductible as a business expense!)

 

A friend of mine is really feeling affected right now.  She said what usually works for her is LOTS of sleep, HEAVY exercise, down time, & being away from people for a while.  She also finds the Vit D helps.  She passed along a book that was recommended to her to help with ‘destructive/distorted thinking’ when things get bad.  "I went to a counsellor who recommended a book called 'the Feel Good Handbook' (or workbook?). Anyways, it is all cognitive behavioural therapy and how to recognize (and change) distorted thinking. I found it to be really awesome - and if I'm having a particularly low time I refer back to it. It really helped me."

 

The other day at yoga, I was saying that my neck hurt and so I requested that we do a lot of head down poses so the weight of my head could traction my neck.  The instructor piped up that head down positions allowed the blood to rush to the head, which turns out to also be a good anti-depressant!  So, time to touch your toes and just hang out there for a while!  In addition to having blood run to my head, I also find yoga to be one of the few places and times where my mind doesn’t race with thoughts of “what’s next on my ‘to do’ list?”  

 

Doing a quick google search on natural remedies for depression, I also found:  Fish Oil supplements, and eating foods high in omega-3 fatty acids (i.e. sardines, wild salmon, herring, mackerel…), coconut oil, and increasing your protein intake.  And I guess caffeine is not so good!  (That one hurts me to say!)  Some additional supplements I found recommended:  5-HTP (can help with anxiety, but in some folks, can cause it… so you’d have to test it… and don’t take it if you’re on an anti-depressant), SAMe (which could decrease the effectiveness of birth control pills!), L-Theanine (it’s found in green tea), and L-Tyrosine (if you need an energy boost).  Everything I read had a disclaimer to check with your physician if you are already taking other medications.

 

Beyond that, my oldest son has had Anxiety since he was in elementary school.  (At 5 years old, the poor kid was worried about where he’d live when he was an adult!)  We finally got referred to a Psychiatrist who diagnosed him with “ADD Inattentive Type”.  The anxiety part wasn’t really recognized at the time of diagnosis, but it’s there.  (He was always bad in the fall when things were new, then would get better by later in the year…and his diagnosis was in June of his Grade 4 year.)  I tried all sorts of natural stuff with him beforehand. We tested / tried 2 different medications before landing on ‘Concerta’.  Throughout this Jr. High years, we would have him take it during the weekdays but not on weekends.  Then we would take him off during the summers.  We would get him to see if he could do days without it - because I had a negative view of permanent medications!  What was interesting was when he got old enough to actually be able to describe what he was feeling.  He could say what he was noticing and at what points in the day he would lose his concentration (i.e. when he would come home and wasn’t able to concentrate well enough to do homework).  That’s when we upped the dose (since he was also getting bigger).  The last Dr. visit I attended with him, I thought it was cool because when the Dr. asked if he felt he needed a higher dose, he said "No, this works.  I feel like I can concentrate well all day on this.”  And the dose is about 1/2 of what it could / should be for his weight.  Along the way he’s been able to tell us that he needed it for weekends when he was trying to do his homework, and that it would help him focus at work too during the summer.  My whole point for this last story is that I had to get over my view of drugs for mental health conditions.  I watched how not being on Concerta really affected my son, his ability to work, his ability to be successful, use his time wisely, and most importantly to feel good about himself.  I realized that MY thoughts (that he should be able to ‘get over this’ and not need drugs) was only hurting him and damaging his self-esteem more… because he NEEDS it!  (Admittedly, when I got to realizing this, I felt pretty bad!) I don’t want this to sound like I’m pushing drugs… I just think it’s important to not stigmatize the need for them sometimes!

 

Okay… so have a great Christmas & Happy Hanukkah! (Cool that they’re similar dates this year!)

 

And “Don’t worry… Be happy!”

 

 

Laurie

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01 Jan 2017

Marketing Review - My Clinic, Now What About Yours?

Time for Review

Hey Gang,

 

This week, I felt like I should write some kind of a year in review blog, or be inspirational, or something.  But I just wasn’t finding my inspiration, until I came upon the following blog:

http://www.themanualtherapist.com/2016/12/3-business-competencies-pts-need-to-know.html

 

The blog was about business competencies PTs need to know.  So, to cut and past the nitty gritty from the blog:

1. Marketing. A company’s website is the only digital footprint they have 100% control over. Many businesses rely upon social media, ads, or other outlets. Still, those are platforms owned by other companies. Beyond this, so very many physical therapy businesses have little regular content creation, do not advertise, rely upon word of mouth/digital media, and do little more than water the fickle referral source. Sadly, what we are finding is that there are a lot of sales behaviors going on… to get more people through the door. Little is being done to build the brand of a practice or even the brand of the Physical Therapist.

2. Public Relations. We tend to be quiet professionals — a feeling of weirdness comes across us if we are to promote what we do… as if it was the world’s greatest thing ever. Our most basic physical therapy content and knowledge base IS mind-blowingly-the-world’s-greatest-thing-ever to the general public as soooo many of them suffer from MSK concerns. If we don’t have community presence, we will have no community representation. If we are not well represented, then we will have little to no community engagement. We need to get out there!

3. Sales. Personally, I see sales as a customer centered conversation on presenting solutions for their needs. We need to recognize within ourselves that sales is presenting a solution & removing the “Nos” so that people can get to “Yes.” We never see top brands such as Apple or Disney, waver on their price points no matter what the market is doing. Why? Because, they stand strong in the value they ring.

 

Okay, now that alone is great information, but what I thought might be more interesting to you is to share what I do for marketing at my clinic, The Canine Fitness Centre.  This is an exercise that I do with each and every intern that comes through my clinic (because one of the self-evaluation questions for interns going through the final step of the Canine Rehab Institute program, is to ask / learn about what the clinic does for marketing).

 

As part of our New Client System:

•Each client’s vet receives the initial assessment report.

•(Soon to be implemented), each client will receive a ‘report of findings’ telling them what we found, what treatments we provided, what treatments we might use in the future and a recommendation of number & frequency of future appointments.

•The dog is then sent a letter in the mail welcoming them to the clinic, and providing them with a $5.00 “CFC buck” which they can use at the clinic for their next appointment or for product sold at the clinic.

•They are then added to our e-mail list so that we can contact them about promotions, blog posts, and clinic news.

 

Daily Marketing Systems:

•We try to post on Facebook daily… or schedule posts.  When the post is about something happening, or available at the clinic, then I’ll ‘promote or boost’ the post.  This means that I pay $5.00 to Facebook for the post so that it gets in-front of more of our FB viewers.

 

Monthly Marketing Systems:

•We try to post an informative blog monthly (and then promote it on Facebook and by e-blast)

•We send ‘lumpy mail’ thank you’s to the vets that sent us medical information or a referral for a patient to come to see us.  (Lumpy mail just has some small item in it (i.e. a package of gum) with a thank you note and ridiculous phrase related to the item.)

•Other referrals sources (i.e. groomers, daycare facilities, existing clients) will also receive a thank you note with a $10 gift card or something.

•Therapists are given a drop-off report every month to contact patients that stopped coming.

•For a year now, we have been instituting a monthly promotion.

  • Refer a friend
  • Free nail trims
  • ‘Fur-sibling’ new assessment discount.
  • Vet clinic staff initial assessment discount
  • Fluffy to Fit program (2-month program)
  • UWT Special pricing (2-month program)
  • Senior’s Exercise Class
  • Access to my online Preventing Hip Dysplasia course
  • Sale on my Massage Your Own Dog Online Course
  • Christmas ‘cookie’ give-aways 

Quarterly Marketing Systems:

•We have an informative Newsletter that goes out to most of the Calgary and area veterinary clinics

 

Periodic Promotions:

•We will periodically promote products (sale items, new items, novel items.)

•We have tried to target grooming shops to provide them information about our canine rehab clinic and about our human physio clinic as well.

•We also promote the human clinic to our canine owners (since the human clinic targets dog owners)… which means we can cross post the human clinic blog posts.

•Additionally, we have tried to have a few booths at different events over the year (a regional agility trial, & a canine Christmas market).  They take effort and man-power however! 

 

Online Presence:

•I have spent plenty of time working on our website. The goal was to answer questions, speak from the ‘you’ perspective (i.e. you will received…), providing information (articles, videos, & the blog).

•We have instituted an online presence manager (someone that checks that questions on FB are answered, comments on yelp are replied to, our google reviews are adequate.  We also have a sign in the clinic asking clients to review us on Google, Yelp, or Facebook.

 

Next year we have some new things we will be implementing.  From the business seminar I attended in November, we will begin using the One-Minute Practice Manager System.  This is an online system where you track new patients and ensure that all things are occurring… New Patient Register, Tracking promotions, Tracking expenses, Managing communications, Therapist Goal Setting, Admin checklists, etc.  There is another program that I am considering.  It is a little box attached to the phone lines, and it monitors and measures the answering rate.  So, I had my clinic assessed, and we are answering 80% of the calls that come in (PT clinic average is 73%.  The goal is 95%).  It also measures time to answer calls.  Ideally you want all calls answered before 3 rings.  Of the calls we answered, only 50% were answered within the first 3 rings.  So actually, I’m not too disappointed in this, but according to the call evaluator, there is room for improvement.  This could be an area to look into as well!

 

Beyond this I a believer that customer service is critical to a good business. The customer’s experience should be exceptional – from how the owner is greeted and how they are interacted with at every point of contact, to how their dog is treated (as a dog and as patient).

 

And off the top of my head, that’s it (or most of it)!  That has been my business marketing in review.  Looking for marketing ideas as well, check out my workshop at www.staarconference.com!

 

Have a wonderful 2017!  Cheers!

Laurie

 

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14 May 2017

NOVEL PAIN MANAGEMENT STRATEGIES

Temporomandibular Pain

So I hadn’t thought about using my own personal story as a blog post, but then I listened to a Physical Therapist’s podcast about a patient who had Temporomandibular Pain.  (http://www.themanualtherapist.com/2017/04/untold-physio-stories-s4e10-who-wants.html)  Facial pain, neck pain, headaches and difficulty eating were all found in the patient described.  She had physical dysfunctions with the jaw and neck and received manual therapy and exercises, which helped her neck pain, but didn’t help her facial pain.  She had however incidentally found that eating ice cream or yogurt made her face feel better.  So the therapist prescribed for her to eat these foods several times a day!  Maybe it would reset her nervous system.  She reported back that the yogurt wasn’t as effective as the ice cream (not cold enough)… but she was afraid to eat ice cream all day long as she was already starting to notice a weight gain.  So the physical therapist suggested for her to eat frozen blended bananas instead - a spoonful or two several times a day.  Well, golly!  That worked!  It took away her facial pain!  She was cured of the facial pain!

 

Now, as I’m scrolling through the listings of blogs I check out weekly / biweekly, I thought ‘WOW, someone else had this experience!’  So, my story, is that two summers ago, I cracked a tooth.  Not a visible crack mind you, but it quickly turned into an issue with cold and hot sensitivity.  Well, I toughed it out for about a month until I thought, ‘Something is really wrong’.  That’s when I went into my dentist.  He couldn’t see a crack, but painted the tooth with a sealant that should reduce sensitivity.  NO GO!  NO change!  So I went back in.  This time, he drilled out the existing filling, found the crack, buffed it out (who knew you could do that!), and refilled it.  He casually mentioned, “If this doesn’t work, you might end up like my wife.  She needed a root canal.”  

WHAT!??  I’m not getting a stupid root canal for this!!!

So, I’ve not been back to the dentist since, and unfortunately the pain remained the same.  I simply learned to eat food all on the left side of my mouth.  I avoid very cold foods.  I learned to tolerate hot food.  Totally normal, right?  

WRONG!

Turns out I’ve also started to develop more neck pain and some jaw achiness on my right side as well.  I tried some ‘happy thoughts therapy’  (I made that up).  And every time I’d eat something, I’d try to chew on BOTH sides of my mouth but focus on and think about the left/good side sensations and taste.  I tried thinking happy thoughts while chewing on the right side; “Isn’t it beautiful out right now?”  “I’m so happy I’m heading home”, “How luck am I to live in the country”, etc.  Well, that sort of helped.  Sort of.  It didn’t help AT ALL unless I was very conscious about it.

 

Then a few weeks ago, I was driving home and eating my celery and almond butter.  (Behind the scenes explanation:  I work 11 hour days on Tues & Thurs, and pack enough food to eat for my ride home as well.  Now, I know that dipping celery into almond butter MIGHT be considered distracted driving… but I’ve gotten so good at it, I don’t need to look down to do it!!)  Anyways… I dipped the celery in the almond butter and quickly popped the goopy end into my mouth, bit off a chunk, and a large bit of gooey almond butter coated the offending tooth on the right side of my mouth.  I was immediately panicked (usually, that would cause pain), but because it was so gooey, there was nothing I could do to remove the ‘offending’ goop fast enough.  So, my brain went into counter measures, and said, “Just enjoy the flavour instead”.  And I did just that!  To which I realized… I have forgotten to be tasting food with the right side of my mouth!  It’s like the taste buds were rusty!  And just like that, my tooth pain started to dissipate.  I continued to eat very flavourful food on the right side of my mouth and focus on savouring the taste.  In fact, now, I only have a bit of pressure sensitivity (like you do after getting a new filling… and since I didn’t use that tooth properly after the filling two years ago, it’s not been pressure desensitized or ‘reshaped’), but the cold sensitivity is almost gone!

 

It’s a long winded story with the moral being:  What are happy, pleasure causing things, that you can add into your therapy for canine patients?  Does licking peanut butter while doing a new exercise help the brain equate ‘happy’ with the exercise, or reduce pain signalling?  Maybe mixing up therapies so as to intermingle more uncomfortable therapies with relaxing / comforting ones could be beneficial.  Maybe use the TENS Machine or Alpha Stim as pain management strategies prior to exercise or in conjunction with manual therapies.  Maybe dogs get better faster than humans because their therapy sessions typically include treats!  Food for thought!  (Literally!  Ha ha!)

 

Until next time!

Cheers!   Laurie

 

PS  For more info, Members can check out Video Training 130 to see my “Back Pain Dance”.  

And for those, not wanting to see my dance, you can check out this cool video I found about Pain by one of my favourite physiotherapists, David Butler:

https://www.facebook.com/noigroup/videos/10154605323433527/?hc_ref=PAGES_TIMELINE

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11 Jun 2017

Do you use SOAP? Not me! No SOAP for me!

No SOAP

I hate SOAP. I don’t use SOAP.

I use my own charting categories, and I’ll suggest you might like to do the same!

Did I make you raise your eyebrows at the title?  Just a little?  Likely not!  Ah, disappointing…

 

Okay, so when we have interns come to our clinic, they are asked to provide an example of a SOAP note.  I always tell them, we don’t use traditional SOAP notes.  I don’t think they fit an outpatient practice.  Subjective and objective make sense.  Subjective is what the owner tells us happened, how things are going, what they’ve been doing, observing, etc.  Objective is what you find on your clinical evaluation of the dog (gait & movement analysis, what’s painful on palpation or ROM, or movement testing, what’s tight, atrophied, and your objective measures, etc.)  Sensible stuff!  But beyond that, I would like to make suggestions / alterations to the A & P parts of SOAP.

 

Classically, (and I dug out an old text book from 1990 to get this right… a whole text book on SOAP notes!!!), the A is for Assessment, where you would fill out a summarized list of the major issues from the S & O sections.  Okay, so this is likely dandy as part of your initial assessment, but it’s a pain in the butt to do with every charting input.  In our initial assessments, we use PT impression or PT Diagnosis.  That’s where I’d write out my thoughts 1) Suspect OA left shoulder and maybe put some bullets below:  Pain on end ROM flex / ext; Reduced end ROM flex; Off-loading LF leg.  And we’ll often have multiple findings i.e. 2) Rib and T/S dysfunctions, 3) abdominal motor control and timing deficit.  I could add in my goals etc. as well (in my initial assessment primarily).  But let me get back to a follow up treatment note.

 

In my follow up notes, I’ll use Subjective & Objective, and if there is something new that has come up or a change in my thinking of what’s going on (or a subtle nuance to what I think is going on), I’ll add in “I” for Impression.  Then I like to go with Rx (meaning treatment).  If you prefer you could use Tx for treatment.  Here I write what I did during the treatment THAT DAY.  I include therapy type, dosage, body part treated, etc.  Laser 2J/cm2 Superpulsed, Mobilizations T/S (dorsal glides and Transverse Pressures) – Grades 3 - 4.  (P.S.  I hate charting ‘amounts’ of manual therapy… it’s a ‘feel’ sort of a thing.  But that’s another topic.)  

 

If the dog had a fabulous response to my therapy (or in the case of a neuro dog) and I was to describe how the animal was after the treatment (or how he was during the session), then I’ll add a category for ‘Outcome’.  I think this is important.

 

Plan for me, means 1) What I plan to do next time, 2) What I’ve prescribed as homework, 3) When I want to see the patient again, 4) Anything else I PLAN to do (i.e. send note to referring doctor, email client exercise sheet, etc.)

 

All in all, I don’t use SOAP.  I use SOIRxOP!  And I feel ‘clean’ just the same!  If you’ve been struggling with SOAP, I hope this might work for you as well!

 

Cheers!  Laurie

 

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