Friday, May 3, 2013

Ten Rules for Therapists and Doctors

I feel like I have seen way to many doctors and therapists (of all kinds) in trying to "recover my stride" and some things hit me today about how some "get it" and some have "no clue". Here is my lists of what can make a therapist or a doctor "stand out" in their field and what makes them look like they really don't care about the patient.

1) If you don't know the answer, ask around for help. Now I don't know what goes on behind the scenes with all therapists and maybe they talk a lot, but I was most impressed with one PT I went to about 15 years ago when my hip got "stuck" right at the tail end of my marathon training season (hint: never run a 25 mile workout in Nike Shox-actually never run in Nike Shox). She worked for a couple of weeks trying to get me running.When she couldn't figure out what was wrong despite all our efforts, she had all the other PTs in the office check out my hip. They couldn't get it working either, so she researched at home. She found a figure four stretch that immediately brought relief to my hip capsule and I was back to running pain-free that afternoon. She was also the PT who said of me, "You were so born to be a runner, and so not born to be a runner." Unfortunately, she moved away, but she set the tone for how awesome a PT person could be.

2) Do hand out written or illustrated handouts for exercises you want done. Better yet, create videos of your instruction. I know therapists are busy, but how hard is it to give a handout. I forget the exact mechanics of a stretch or movement real quickly particularly when I am given more than one thing to remember. The M.A.T. guy I went to last fall, spent a couple of minutes filming the many movements he wanted me to do for my feet and back. I still have to watch the videos to get things right or I would be messing up all over the place. He just handed me the camera and I filmed his demonstrations and explanations. Then he sent me the video. Last month I just took the video on my camera. If you want me to get better and to do things precisely, this is a great idea! Better yet, show your enthusiasm for what you do on a website or blog. After finding this website, I made sure she was my PT pre and post hip surgery. I knew she cared about helping and informing patients.  I drove an hour each way to get to her office. She has since moved to Arizona, which is too far to drive.

3) Explain what you are doing and why. Explain the reasoning. I love information about how my body works and what you are looking for or trying to do. When I have the M.A.T. work with Greg, I was getting a running commentary of everything he was doing, as he explained each muscle he was testing and how it worked. I can't remember half of what he said, but I could match things up with what I have read or studied and found all this knowledge fascinating. I am trying to be involved, so please don't think I am not interested in your thinking or that I am a dummy. I am your student.

4) Listen to my questions and feedback. Again, I will reference Greg and his M.A.T. work. The first thing he asks me before a session is about what I feel is going on and what do I think needs work. Usually we are on the same page, but is nice to know he is listening and paying attention to my feedback changes the course of his work that day. Now here is an anecdote from today. I went to get trigger-point injections in my glutes Ever since my surgery, I have mentioned to many people including my surgeon's office during last week's appointment about the high up tightness in my adductors. No one seems to address that issue, yet still almost two years post hip surgery, I have a hard time lifting my left leg. I have to "assist" it when getting in and out of a car and some mornings I can barely put my socks and shoes on as well as my pants. The only thing I got out of the surgeon's assistant last week was that I could pursue an MRI at some time if I wanted. I would like to know "why" and what is going on as this seems to happen to many hip surgery patients. It didn't help that while I was waiting in the surgeon's office before the appointment, I was checking a "Arthroscopic Hip Patient" Facebook page that has members from around the world and two patients where not happy with the quality of care of my surgeon and later needed revisions. Oops, not the material you want to read in the waiting room!  Now, I have faith that my surgeon did a good job with me (but maybe the office is avoiding something he missed). Thee adductor thing seems to be a real problem and they seem to not be interested in it. I told them it feels like a bone is stopping my adductor from moving or causing it to quickly weaken.  I had x-rays taken before the appointment that the assistant looked at and I was supposed to bring a copy to my new therapist at her request. I forgot to pick them up and they hadn't been mailed. I saw the therapist yesterday, so I picked them up while getting the trigger-point injections today to bring next week. I saw some notes on the the x-rays that were never explained to me and they were basically the same notes from last fall's x-rays that were also included. These were not explained to me. Nor was my higher left hip. See the images below. it is quite noticeable!

1. Mild left hip osteoarthritis and left hip joint space narrowing.
2. Minimal right hip joint space narrowing.
3. There are pubic symphysis osteophytes. (and I think it was mentioned a narrowing here too on the recent x-ray which I left on my desk at school)
4. There is minimal narrowing of the bilateral sacroiliac joints.

Anyhow, I don't want to spend any time worrying about more things being wrong, but when I read these and typed them into Google, I got a some pages talking about Osteitis Pubis or Sports Hernia and I recall reading pages of these on the running message boards back when I was trying to figure out if I had a labral tear. The interesting thing is the new therapist told me these bones were misaligned last week and we did some Muscle Energy Technique work to realign them. Something is going on, but the surgeon's office just ignored the reports or didn't share them with me. When I look up osteophytes, it sounds like they are bone spurs. Well, I mentioned something felt like bone, was rubbing against my adductors, could that be it? I appreciate doctors not wanting patients to self-diagnose, but I was the one who pursued the labral tear when other doctors didn't even mention it. I am now curious is something else is going on?

5) Don't just treat my as your paycheck. Speaking of labral tears, this reminds me of an chiropractor who did ART (Active Release) work whom I visited during the summer of 2010. I had to stop running due to my hip. When I started seeing him that July, I though he was very knowledgeable, I kept mentioning a labral tear and he said, "No." He kept doing ART that had no real effect. Some days, I felt good, some I didn't, but my hip kept getting progressively worse. Finally at the end of that August, I called to cancel an appointment  because I was convinced it was a labral tear and I couldn't run any more and his work wasn't helping. He said that I should come in anyhow and at the end of that appointment he said that I have two more visits left and he would like to try some new things. I went in and whatever he tried did not work. At the end of the last appointment that my insurance would cover, his last words were, "Maybe, you do have a labral tear after all!" Over one year later, I got a letter from his office that those last three visits were not covered by insurance and I had to pay up the difference from the copay to his full price. He is also the guy, that when I asked for a recommendation for a  massage that summer and I needed someone real good, he recommended his secretary. She was a nice lady, but was the worst massage therapist I have ever had. She barely pressed on my muscles and kept asking if she was working too hard. If you want to  know who not to go to in Manchester, let me know. I'll tell you. This guy was not interested in anything but accumulating as many office visits from patients as he could. I got suckered by another chiropractor many years ago, back when my insurance didn't cover them, he convinced me to come in on his plan for 10 weeks or so where I could come in up to 3 times a week for about $100 a week. I would be fixed, he said. He did so much work and pushing on my back that I was just exploding sometimes after being in his office. My nerves were just completely shot. He got a nice family vacation paid for out of the deal and it fixed nothing for me. I guess this is more of a warning to be aware of the shysters out there!

6) Let me know you care. First off, today I was able to see my physiatrist when I realized that I had developed another trigger-point in my glutes. Earlier in the week, I was told by her office that she was going on maternity leave and wouldn't be able to see me, but they would see if someone else could do it. Later, the office called back said that she wanted to see me today, even though it was her last day of work until August. That was very helpful as she knew where to look for the trigger points and my history with them. She found a large trigger point very deep in my glutes and hopefully the shot will help it relax. Also, if you take the time to research something or report back to me later on a question after you thought about it, then I know you are a top-notch and caring professional. This doesn't happen often, but I want to feel like you care about my condition as much as you care about an elite athletes injuries. I can't recall this ever happening with my injuries, but I know a pediatrician in Nashua that my kids have had, who has called at times out of the blue to check on the condition of my kids and if they were doing better after a sickness or an injury. Good guy! Take the ART chiropractor above, who earned a lot of money off of me and the (at least) two runners who went to him that summer at my recommendation, before I realized his treatments weren't working and his focus was on getting me in to the office as often as he could. After telling me, "Well, maybe it is a labral tear," they guy never called to ask what eventually happened with me. He could have learned a lot about labral tears from me, and maybe saved another athlete from going to countless ART sessions without fixing the problem. Oh wait a minute, that might interrupt the flow of money going into his pockets. You would think, that after so much time and effort treating someone, he might want to find out what eventually happened.

7) Do not treat me, just like you did the last guy. I hate the cookie-cutter approach where everyone gets the same menu of exercises. I had a guy like this for PT last year and at other times in the past. They act like they know everything, and don't listen or belittle any questions or thoughts you have. And they certainly don't see the whole picture of how the body works as a unit.

8) Don't rush me through my visit. I can tell when you aren't paying attention or trying to get to the next patient as quickly as possible.

9) Are you up to date on your reading for your profession. Many times I ask a doctor or therapist about something I have read and I might name a prominent person in the field of therapy or muscle movement and they have no clue what I am talking about. I also might mention things like Postural Restoration. M.A.T., ART, or other newer techniques and the therapist has never heard of these. They can't know everything, but if it is your profession and if you don't know the newer and more cutting edge techniques then maybe all you know is your cookie cutter exercises. On the other hand, I am currently at my present therapist, because my chiropractor in Nashua mentioned something new called ARPwave that might be helpful and I found this place in Woburn that does it as well as M.A.T., M.E.T., and other new and interesting techniques.

10) Never be this guy! One of my most top ten read posts through the years on this blog deals with the Egoscue therapist who admitted to me during my first expensive session, that he was doing Egoscue because his friend told him it was good money! According to my stats on Blogger that is nearly 30,000 hits about my negative experience (and lots of negative publicity for Egoscue). I want to know how much you love what you are doing, not how much money you can get out of me!

Anyhow here are some images of my hips. I hope my new therapist can tell me more.

Sep. 2012 Notice the tilt and higher left hip.
I am standing straight in these x-rays.

April 2013 same tilt. Talk about consistency!
That is one thing my new therapist said we are working on (the up-down of the hip)
Can this really be changed? and no wonder I have hip problems.
I had a chiropractor about 15 years ago take x-rays and when he put heel lifts under
my right foot and took new x-rays the left hip went up even higher.
He was completely baffled and just gave up.
Left hip joint April 2013.

This new book from the author of The Entrepreneurial Patient blog is a must read book for anyone with hip problems and is thinking about about arthroscopic hip surgery or has had arthroscopic hip surgery for a labral tear or FAI.


Kiki said...

have you tried swapping lifts to the other foot? You may have sciatic impingement and this may ease it. Easy enough to try it, whether or not it works . . .

Jim Hansen said...

Kiki, Strangely enough I tried that once a few years ago, before I had hip surgery and while playing around with a heel lift for awhile. It worked for a day: