Transitions

It has been over a year since I have been able to tend to this blog and I am finally able to get back into it! things have been taking off for me like crazy. Little recap for you all:

• got married in a small, steampunk ceremony
• got appointed Clinical Liaison of the Balance and Falls SIG for AGPT
• became Eastern Regional Coordinator for the State Advocate program for AGPT 
• was elected secretary for the Gerontological Society of America's Emerging Scholars and Professionals Organization 
• presented at APTA Combined Sections Meeting in New Orleans, Louisiana 
• became a GeriEDGE task force member
• got tired of a 3-4 hours round trip commute (hooray Chicago traffic) 
• transitioned from inpatient rehabilitation to the home health setting 
• now work for 2 online continuing education groups  

All good things really, but a lot of change and a lot of time consuming projects!

Now, onto business! I am stepping back in to work focus on this blog and we have some great content coming out in the next few months! We will be talking about the pros and cons of social media use as health care providers, the importance of self-care, and weather or not to change your last name when you get married (which is a pain for those that are already licensed!). Its going to be a fun ride for the rest of the year and we look forward to causing quite a stir along the way!

Intimidation Shaming: How It Can Ruin Professional and Mentoring Opportunities

Intimidating. This word has a negative connotation in our language, and rightly so, because it's definition is "to scare someone into doing what one wants." Its Latin root, intimidare, literally translates as "to frighten." However, I am surprised how many people use this description, this action, this negative connotation improperly.

Recently this one word has kept popping up in my life and I can no longer ignore it. I have heard it before and I am sure I will continue to hear it throughout my life. Intimidating. I have not only been called intimidating, but I have also been told that I am not easily intimidated by others. I honestly started hearing this word so often in so many different contexts that I decided to do some investigatory work and figure out what the buzz is about this word! Here goes:

To intimidate is an action. In the present tense. However, being in the present tense means that the person who is performing the action is actively doing something to scare you into performing a task or action. 

On the converse...

Being intimidated by someone is entirely different. I once had a professor in undergrad who everyone feared. She was a short Icelandic woman who took nonsense from no one and worked hard every day of her life to get to where she wanted to be. Was she intense? Yes! Was she intimidating? No! She offered extra office hours to review test questions and tough materials. She went out of her way to allow me to contract my capstone through the Honors Program, which meant I had to develop a research question, which took hours out of her week to mentor me and supervise me through it. She pushed me hard and didn't take no as an answer, but she never intimidated me into anything. However, my classmates didn't feel the same way. Because of her no-nonsense attitude, my classmates feared her. 

Courtesy of  Pinterest

But, herein lies the difference. My professor never did anything malicious to anyone to get them to do anything. She wanted us to succeed, but she never attempted to scare us into anything we didn't want to do. It wasn't that she was intimidating (active), but instead people were intimidated by her (passive). These are two very different events and by accepting this fact, we have the opportunity to not only affect our thinking, but also our interactions with others. I call this "Intimidation Shaming." It's when you project your inadequate feelings to make other seem more menacing instead of owning up to your own short comings. 

Now, I know that some people might argue that the intent of the interaction is obsolete, but there are several philosophers that would disagree with you greatly. Intent is everything, and in the absence of malicious intent, the word "intimidating" is what is truly obsolete in this instance. 

I invite you to ask yourself these questions the next time you come across someone who is "intimidating": Is this person actively doing something to making be feel inferior? What proof do I have? Is this a perception that I have on them based on my reception of our interactions grounded in malice? Why do I think this person is intimidating? 

Instead of pulling out and playing the victim card, try to investigate the situation a little more clearly. Take ownership of the situation. How do you feel about this person so that you are perceiving them this way? Did they do something to you or did they do something you didn't like? Are you envious of them in a way that would make you resent them? Are they pushing you too hard to perform? 

If you find that a person is intimidating you because they are highly successful, doesn't it make more sense to seek those individuals out to mentor you so you can learn from their success rather than demonizing it? How much stronger could we be as a field if we stop fearing and start pining for answers to these questions? 

By asking yourself these questions, you might learn something new about yourself that you can carry into future interactions with friends, co-workers, or even mentors. Last but not least, a mantra for you to repeat in your head if you ever find yourself at the center of this intimidation shaming: "If I was truly intimidating you, you would know." 

Connect the Ages!

In November 2016, I had the unique opportunity to participate in a media campaign as part of Connect the Ages, a grassroots organization dedicated to connecting young people to careers in aging. Connect the Ages was founded by Amanda Cavaleri, who has dedicated her life to fighting isolation among older adults, vowing to connect generations, thus forming lasting bonds which help to enrich the lives of both older adults and their younger counter parts.

She has launched her first video of a series which highlights not only the rewards of careers related to the aging population, but also the benefits that these can provide to society as a whole. By getting students invested in our rapidly aging population at the earliest of ages, we can create a world in which stereotypes, disproportionate healthcare services, and social isolation cease to exist.

You can find Amanda's Tedx Talk here. It is quite inspiring to hear her ideas on how to combat ageist views within a "youth-obsessed" society.

More videos to come! Get involved, get together, and connect the ages! 

LinkedIn: https://www.linkedin.com/company-beta/11066579 

Facebook: https://www.facebook.com/CONNECTTHEAGES/  

Instagram: https://www.instagram.com/connecttheages/  

Twitter: https://twitter.com/connecttheages  

Website: https://www.connecttheages.com/ 

Ethical Discussion: Public Displays of Medical Conditions and Your Responsibility in Addressing Them

I was at a Hibachi Grill with my fiancé's family when I noticed something different. It wasn't enough for anyone else to notice, it seemed, just enough to peak my interest. As many of you know who have been to these establishments, the chefs cook on a hot grill in front of your dinner party and commonly interact with the dinner-goers. They squirt water or sake in your mouth, have you catch hot food off of the spatula, etc, etc. But in this instance, a man across the room at a different table wasn't interacting quite like everyone else. While everyone at his table was laughing and interacting with the chef, this man was stoic without reaction. He blinked quite sparsely. He didn't react with any sort of emotion, nor reacted with the members of his party. His chewing was mechanical in nature with food spilling out occasionally. He neither looked engaged nor particularly disengaged, he just simply was existing at the dinner table, quite possibly without any knowledge of his surroundings.

Then it happened. The chef began challenging people at the table to catch remnants of the food he had cooked out of the air with a toss from his tools. Everyone was laughing an enjoying himself and then it came time for the man to participate in this feat. First toss. He didn't react. Everyone laughed and jeered. Second toss. He didn't even blink this time. His party continued to tease him. Third toss hit him square between the eyes. No reaction. The man continued to chew and spill his food. And the chef moved on. At the end of the meal as they filed out, the man demonstrate difficulty initiating movement from sitting to standing, was unable to don his coat without help, and shuffled out of the restaurant with his family, festinating at the beginning of his attempt to leave.

This was quite possibly one of the most cringe worthy-experiences I have experienced in a social context. This man obviously had something wrong with him. Without objective measures, my highest suspicion was possible Parkinson's Disease. This event made me ponder. What is our responsibility in this matter? Do we educate? Do we intervene? Do we engage at all?

Now, I would hope that if this man's family was aware of his condition, they wouldn't have laughed and jeered in the manner that they did at his inability to catch the food from the air. I'd like to think that they would have either educated the chef, asked him to stop, or maybe even avoided the situation all together. But maybe not. Maybe they were aware of his diagnosis and were determined to live a normal life, despite the symptoms and the stigma. Maybe this was a discussion that hasn't occurred yet, and without a consent to treat provided by the patient (and I consider education a treatment), I am outside of my legal boundaries to act otherwise.

With the opportunity that the intervening physical therapist could be hailed as a hero, that same person has as equal an opportunity to be hailed a villain.

There was a recent article floating around on the DPT student Facebook page about a PT who was on a flight and was able to identify and treat a case of BPPV in a flight attendant on the flight. She was hailed as a hero, but she had a very unique set of circumstance in this situation. First, a medical doctor was present on her flight and was able to assist the PT in clearing the patient of any cardiovascular or neurological conditions. This gives her extra credibility in the eyes of the public who aren't familiar with the services that direct access PT can provide. Second, this PT has extensive training in management of balance and vestibular disorders and was comfortable intervening. Without this training, injury could result to the patient, thus making a bad relationship worse. Third, the individual who was experiencing the condition was able to be educated on her care, and provided a verbal consent to the treatment provided.

Image courtesy of:
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This was a near perfect situation and leads to little discussion on the pros and cons. However, if even one of these components is less than perfect, it's a recipe for a hefty lawsuit where even the best intentions can get you into trouble. If you are intervening to inform a patient that they might have Parkinson's, you are breaking several rules. First of all, that person never consented to your treatment, and education is an intervention. Second of all, as a PT, while we can screen for conditions such as Parkinson's Disease, CVA, and other impairments, we technically don't diagnose them. This makes your actions an automatic violation of scope of practice, demonizing our field as overzealous and giving the AMA more fuel to use against us in our campaign for full and unrequited direct access. Lastly, while Good Samaritan laws exist in many states, these truly are reserved for emergent situations. And even then, you need to ask the individual if they desire your assistance, and if the answer is no, your hands are tied at that moment. Good Samaritan laws vary from state to state, and people are still able to sue around them.

This is an important issue to discuss, revisit, and continue to digest in our field. As our field shifts, our role in the eye of the public will as well. When people ask for an individual with medical training to assist in an emergency, not even their 6th choice is that of a physical therapist, despite our extensive training in school. My fiancé is also a DPT and didn't even realize the situation until I pointed it out to him. I attribute this to our differences in training. I work in inpatient rehabilitation and am used to identifying medical emergencies and symptoms of diseases that might be developing in people who are already medically delicate. He works in the outpatient manual therapy setting and isn't as attune to treating every change and behavior as a potential crisis. This is similar to an endocrinologist treating patient for a heart attack. They don't have the skills necessarily and neither will we at times.

Our experiences lead to our actions and will continue to build the public's opinion about us, so let us work towards building a positive interaction by being mindful of our actions and the perceptions that others have of us.

Head First: What I Learned from Jumping In as a New Grad DPT

When I was a student in PT school, I wasn't comfortable jumping in first. I was never the student to volunteer first. I never wanted to be the "patient" in the class demonstration. I never wanted to answer questions that the teacher posed first. Since I have graduated, many of these things have changed, but some have not.

I am still a shy person. By no means have I transitioned from being an introvert to an extrovert. I still enjoy my quiet nights at home to recharge. I like reading by myself. Large crowds of people continue to make me nervous. But my harnessing my ability to control my anxiety in those uncomfortable situations, and learning to take control in those uncomfortable moments for me, I have been able to grow and expand into several realms of the PT world that I never thought I could access before. In my short 8 months as a licensed physical therapist (and 3 years of immersing myself in PT culture as an SPT), I have had many experiences that I previously didn't think that I was capable of.

Below is a list of ideas to help you get more involved in our physical therapy profession based on the successes that I have had thus far.

1. Join a section with the APTA. I have been a member of the geriatrics, neurology, and research sections of the APTA since becoming a student member at the start of my DPT schooling. It has connected me to professionals within the fields that I am interested in, and has also lead to opportunities to serve and volunteer within those groups. Being a student section member also allows you to explore that realm of physical therapy, assisting you in researching not only the opportunities in that field, but also the general vibe and feel of the group. Neuro feels much different from geriatrics, which are both entirely different than research. I was an ortho section member for a year during my orthopedic semester for PT school to get access to the resources, but decided I wasn't interested and did not re-join the following year. 
2. Volunteer for committees. Many of the connections I have made have been through experiences I have had on committees as a student and now young professional. Many of the sections have committees or SIGs (special interest groups) that you can sign up for/serve on, even as a student or new graduate. Most groups really like having the fresh perspective. It is also an opportunity of you to work had and impress people within the field who you otherwise might not have met. Through working on the Academy of Neurologic Physical Therapy awards committee, I have been able to meet several individuals who have very unique experiences and opinions outside of my own, which has allowed me to grow as a newbie. 
3. Join groups outside of the APTA. One of the connections that I gained, which has helped to solidify my involvement in the Academy of Geriatric Physical Therapy, actually started through a different group. I currently serve as the clinical liaison for the Balance and Falls SIG of the AGPT, which is a recent development thanks to a contact that I met through volunteering with the Health Sciences Section welcome crew through the Gerontological Society of America. I met Mariana, the chair of the SIG, as I was sending out a welcome email for GSA's HS section. I noted that she was a familiar name based off of the materials I regularly receive from the AGPT and met her not at an APTA conference, but at the GSA Annual Scientific Meeting in New Orleans this past November. We connected at GSA, and she inquired if I was interested in joining the Balance and Falls SIG leadership board as the clinical liaison (as a new grad... Which is so cool) and I accepted. Having a person in my professional circle that is even more motivated than I am (she is only 4 years out and could easily be mistaken as a 10 year seasoned professional) has helped to push me and keeps me moving forward and avoiding burn out. 
   
4. Apply for it... Even if you aren't/don't think you are qualified. Sometimes you just need to lay it all out on the line. My personal example comes from the time I applied as chair of the GeriEDGE committee on research and practice. Was I qualified? No! But they sent out several emails to the AGPT members asking for applications, extending the deadline more than once, so I figured I would give it a shot. Obviously there are many people out there who are way more qualified and experienced than a new student, but I applied and got a response within a week. They explained that while they were looking for someone with more experience, they would be happy to welcome me to the group, and thus, I was in. 
5. Shake things up! As the co-chair in Illinois for the AGPT state advocate program, my first line of action was to establish a Facebook group for communications among AGPT members within our state. What seemed like a simple task resulted in a two month long discussion including a formal proposal within the AGPT board of directors. While my ingenious idea to start easy in this new role soon snowballed into a branding, licencing, and image discussion, my name is now out there among the higher-ups. 
6. It's not what you know, it's who you know. Through my involvement in the APTA and GSA, I have been able to rub elbows with many of the giants in the fields I am interested in. I am on a first name basis with Tim Kauffman. I had tea with Desmond O'Neill at a luncheon. I am also on the radar of several giants within the social media realm from my work with the Balance and Falls SIG. Being involved means staying involved, because these connections lead to not only further opportunities, but also accountability to stay involved.

So take a chance! Volunteer. Sign up. Raise your hand. You might just find a new niche and meet some cool new friends. If you are not currently a member, I recommend joining the American Physical Therapy Association. Once a member, you can join the many sections the group has to offer. Each section has special interest groups, or SIGs that can help you further focus your efforts as a physical therapist.

A Survival Guide for the Introvert for CSM: Tips for Surviving and Thriving at Large Conferences

As I have mentioned in a few previous posts, I am an introvert. My coworkers, classmates, and acquaintances might disagree, but my family and friends know that I really, truly, and passionately am an introvert at my core. I would like to share a little about how I survive large events as an introvert so that I might be able to give the tools to fellow introverts in order to not miss out on the awesome opportunities that CSM and other conferences can provide to us as physical therapists.

First, let me start by emphasizing that I think that the terms introvert and extrovert get mixed up a lot, as they are not descriptions based on how you act, but descriptions based on how you recharge and like to spend your "me time." I love nothing more than a fresh cup of coffee and a new book in a quiet space. I will always opt to stay home and watch a movie rather than going out to see one at the theater. I avoid eating out on weekend nights due to the busy surrounding tables, noise, and often long wait to be seated. I minimize my interactions with others to strictly digital mediums as I am able to on my days off in order to be ready to face another week at work, where I work with...you guessed it! People.

I am most likely getting two reactions right now from two different kinds of folks. The introverts thinking, "That is so me... How do you survive a large conference if you can't handle crowds?" and the extroverts exclaiming, "That is so not me... How do you survive a large conference if you can't handle crowds?" In this blog post, I will explore a few of the survival habits I have at conferences, such as the upcoming CSM, so that you introverts can take good care of yourself and you extroverts can take better care of the introverts you love.

So here they are: my top 6 techniques for not only surviving but thriving at conferences in order to maximize you time spent there, but also maximizing how you take care of yourself once you are there.

1. Take scheduled breaks. When you register for a conference, they usually have a sequence of events and have you sign up for sessions. When I do this, I build in purposeful breaks throughout my day, and I take them whether I think I need them or not. This keeps me moving forward and able to participate in things that I need to attend later in the day. I also consider meals to be breaks. I plan out ahead of time where I will eat so I have a game plan of what I am eating and how to get there so I feel a little more control in this crazy short time in my life. It also helps fuel my self talk such as "You can do this... Only 30 more minutes until lunch and then you can chill." 
2. Take unscheduled breaks as your body tells you that you need them. Sometimes your body may be telling you that you need your space at an inopportune time. Since conferences typically derail your normal biological clock (sleeping at weird times, eating different foods, not following your normal workout routine), the introvert in you can also be disrupted by those innate changes. When I attend a conference, I always label which sessions I MUST go to, which I WANT to go to, and which are OKAY TO MISS in the event I need to disappear.  By pre-labeling my sessions as such, I don't feel guilty when I need to find a quiet corner to think or go back to my room to take a nap, as I already pre-filtered them as a non-essential. 
3. Be unashamed of your need for space. I used to apologize for needing rest and sneaking away. I used to make up excuses for bouncing out of events early, and now I am able to be more honest with people about my actions. I have found that people react just fine when I respond to their questions with, "Large crowds wear me out so I went to take a nap to recharge." Normally they reply with a "Man I wish I took a nap! I am so tired!" You might just be the trend-setter that leads to scheduled naps among your squad at these shin-digs. I know I have instigated a couple already. 
4. Stick to your normal habits as much as possible. Like I mentioned in bullet point 2, conferences throw your normal internal clock for a complete loop. Stick to your habits as they have gotten you to this point so far. If you go to bed at 9pm, then go to bed at 9pm during the conference, regardless of what is planned at that time. If you normally have a protein shake every morning, then bring your ingredients (as travel restrictions allow) to continue that ritual. I have a friend who is an ultra-marathon runner and she will get up early to get her run in before the start of the activities to keep herself moving and firing like normal. I also only room with people who I know have the same habits as me (need for quiet, early riser, early to bed, etc) in order to ensure I can stay at my best for this event. If I can't find a comparable roommate, I eat the cost and pay for a room for myself. It is more expensive, but I am paying to be able to participate more fully in this already expensive experience. 
5. Know that by taking care of yourself, you are allowing yourself to participate more fully in the conference events. Your need to go take a nap mid-day is not a sign laziness, you are simply recharging so you are able to attend a later, more important event. I used to feel really guilty breaking away form my group to take some personal time, but now I know that doing so allows me to interact with them on a more quality level, since I am not a walking zombie as the day carries on. 
6. Hang out with someone who will look out for your introvert self. Often times, my friends and coworkers start to notice that my energy is draining before I do. As I always have an internal dialog running, I don't always notice when I become less talkative... But those around me do. The people you surround yourself with can point out to you when you need a breaks sometimes before you even realize it, and they can help you regulate yourself before you spiral towards the safety of your inner (very cozy!) turtle shell. This tip is particularly important to me. When my now-fiancée and I went to Disneyland, he was able to point out when I needed a break (usually I stopped talking for a bit and then got cranky because I was tired/hungry/whatever), and then we took a break together to just sit on a bench, drink some water, and eat a churro. It led to a more quality experience for both of us, as the whole point of the visit was to spend quality time together anyway. 

By following these "rules," I feel that I am able to participate more fully in the conference experience (or any experience resulting in a crowd-level attendance). I am able to be outgoing andsocial on a more quality level, leading to meaningful interactions. Said interactions are able to occur on my terms, thus allowing me to feel more in-control of a sometimes, and mostly, out of a control situation. I hope my fellow introverts will be able to attend CSM in a more powerful and meaningful way to continue to foster your professional growth by using these pieces of advice.

Forever an introvert,

Heidi

Why I Introduce Myself as Heidi, Doctor of Physical Therapy

A really hot topic in today's field continues to be the use of "doctor" as a descriptor for those of us that hold a DPT degree. Two clearly divided camps exist between its use or non-use within our field. While I used to be in the camp that was vehement about not using it, I slowly transitioned into using it in my introductions and have seen some unexpected results. Here, I will share my experiences as I transitioned from a non-user to a user with this simple word and how it has changed my clinical practice.

At first, I was set against calling myself "doctor" as I felt that it was too confusing for most of my patients. I didn't want to be looped in with medical doctors and cause any unneeded confusion among the general public. However, as I started my clinical practice, I began to use my DPT degree more as a "get out of jail free" card when I met a barrier to providing patient care. When I met a new prosthetist that didn't take me seriously and condescendingly called me "hun" and "sweets" throughout our time together with a patient, I corrected his tone by stating that the only endearment he was allowed was "Doctor Heidi." Our relationship improved immediately. When physicians try to talk me into documenting that certain patients are safe to use a specific assertive device (when they are not), I remind them that as a Doctor of Physical Therapy I receive ample education into the fitting and appropriateness of device prescription. The disagreement comes to an end. When a patient asks me when I am going to go back to school and get my nursing degree, I explain my schooling and degree a little more in depth. Now on this last instance, I started to notice a shift in how my patients viewed physical therapy, and this is where I started to have my transformation, too.

I decided for 2 weeks to introduce myself to every new patient as a "doctor of physical therapy" to see what the difference was in our interactions. As this was obviously not an IRB approved experiment, I have no data to back up my claims other than that of the anecdotal kind. Nevertheless, what I witnessed was incredible.

The most importance difference I witnessed was the buy-in patients had in their care. Not only were they more compliant with precautions, attending sessions (patient still have a right to refuse treatment, even in the inpatient setting with a 3 hour compliance rule), as well as adhering to the home exercise program, but they were prouder to be working with me. A few of my co-workers don't hold the same credentials and while a degree does not a clinician make, it sure made one hell of a difference to my patients.

What I most feared what that patients would confused me with their attending medical doctor (I work in an inpatient rehab setting). However, before I could give my explanation of the difference between the two, patients were already asking questions. The first one usually being how many years of college it took, followed by "similar to a medical doctor" after I explained the process. I feared my patients wouldn't know the difference between an MD and a DPT, but I underestimated them. Even though I work with older adults primarily in this setting, because they are familiar with the health care system, they already had at least the scaffolding for the framework of the difference.

Another difference was the pride that was displayed by patients as they described to their families that they were being treated by a doctor of physical therapy. Occupational therapy and speech therapy soon were discarded, even though they were just as essential in these cases to the patient's progression and return to their prior level of function.

Seeing as we are not the only field that is taking on the title of "doctor" (pharmacy, dentistry, etc), it seems that patients are becoming more familiar with the idea of the title demonstrating a level of education, not necessarily a vocation.

Attitude is everything and the more pride you can instill in your patients, the more of a positive influence you can have in their care as an adjust to your clinical skills.

Now to be perfectly transparent, there are other similar aspects about our appropriation of medical culture that I do not agree with. Namely, I see the white coat ceremony as pretty useless. As a disclaimer, I don't feel that the culture of the medical doctor is one that we should strive to completely replicate or replace, but I do feel that through careful consideration and debate, there are parts of it that are helpful is progressing our field to be come competitive in this evolving healthcare environment.

Ageism: What It Is and How to Fight It

As a member of not only the Gerontological Society of America, but also the APTA's Academy of Geriatric Physical Therapy, I feel that I have a unique outlook on the aging process. At my current job, the majority of my patients are considered to be "older adults," with many of them pushing 100 years old. As an active component of the GSA and AGPT, I feel that I have a different perspective on my patient population than many of my contemporaries do. Without connection to professional societies, it is easy to develop poor clinical habits, but the worst habit of all to adapt is to discriminate against someone for their age. The level of discrimination that I am talking about is subtle and pervasive in our health care system. This isn't an out right "We don't serve your kind here" but an almost unnoticeable adjustment in clinical care for our older adults. This veil of discrimination is part of a larger problem called ageism, and as health care professionals it is easy to fall into line with the social attitudes many people have about aging. But as healthcare providers, we should also act as change agents for our patients who are older adults to change not only their attitudes about aging, but also to convey to our co-workers that ageist tendencies are unethical  and downright illegal even in the simplest of forms.

Here are a few questions to ask yourself to make sure you aren't harboring ageist tendencies:

1. Am I adjusting my treatment parameters because of their impairments, or because of their age? I have heard it time and time again from coworkers in multiple settings about how old someone is and how they need a "break" because of it. I'm sorry, but that patient is here to work. If they are not capable of participating in therapy at this time than you either need to adjust what you are doing or consider an alternate plan of care that is appropriate for their deficits, not their age. 
2. Are you avoiding more difficult activities because of the patient's age, or because they truly aren't ready for it physically? I have heard clinicians across the spectrum complain and whine that cannot do a certain activity with a patient because of their age, but that is ageism. Now, saying that someone is not ready to do an activity because of their muscle weakness, or endurance limitations is much more solid and objective clinical reasoning. 
3. Are you using age as an excuse for not rendering services? There is also the idea that if someone is older, debilitated, and has a care-giver that they do not need to learn how to do for themselves... and this is WRONG. Whether the patient opts to do an activity with or without the care taker is their prerogative, but your prerogative is to at least give them the option to be able to do it on their own. This decreases caregiver burden/burnout and empowers your patient with an increased level of independence, however small the task may be. 

Should we consider age as a factor when evaluating our patients? Sure. But it should be used as only a single piece in the complex puzzle that is the care of our patients. Age should not serve as a giant stamp on our patient's foreheads, warning all who come into contact with them that they can't handle physical therapy. Here are a few ways that it is respectful and clinically relevant to our practice as physical therapists to include age in our plan of care:

1. Aging comes with certain comorbidities that should be addressed, but remember that many of those comorbidities (osteoporosis, osteoarthritis, etc) can also occur in much younger populations if all conditions are right. You don't get these issues because you are old, you get them because body processes aren't working appropriately. This doesn't mean that you aren't more likely to develop them as you age, but it also doesn't mean that you will automatically have them either. 
2. Older adults could have different values and goals than their younger contemporaries in the clinic, but there is also the possibility that they don't! I have met older adults who can be staunch republicans and in the next bed have a raving democrat for a roommate! Values and goals are relevant to the experiences that the person undergoes as they develop their sense of self. A suffragette will have vastly different ideals that someone who grew up on a plantation in the south. 
3. Using age to stratify for outcome measures is not only appropriate, but statistically supported. Many of our outcome measures for older adults are stratified by age groups, so it is appropriate to utilize these numbers based on these delineations in order to best identify how our patients compare to healthy individuals. This allows us to promote evidence-based practice and goal setting to return our patients to their prior level of function. 
4. Finally, it is important to celebrate the triumphs of our older adult patients without quantifying the statement by age. When a patient demonstrates a task well, don't say, "well that is pretty good for someone your age" because it is no different than saying "Not bad for a girl." If the second phrase angers you, then the first one should as well. 

Above all, please remember: Being "old" is not a disease. Age is not a clinical impairment. Let's empower our patients instead of stigmatizing them! 

Protecting Your Profession: Standing Up for Physical Therapy Is the Same Thing as Standing Up for your Patients

Education is perhaps the most powerful tool we have in our arsenal. We use it to help patients understand their condition and the importance of their treatment, but how consistent are we in educating them on our field as a sovereign entity? As a physical therapist, it is easy to forget that not everyone knows what we do or how we relate to other healthcare providers. Occasionally I get a question about our field that I think to myself "Are you kidding me? How dumb can you be?" However, after taking a step back, I realize that not everyone has the exposure to our field as those of us who actually live and breathe the profession. Below are some of the questions/interactions I have had:

"When will you go back to school to get your nursing degree and move up in the world?"

Doctor: Give them a walker.

Me: They aren't safe to use one at home. I am not prescribing one.

Doctor: Well I want them to have one. 

Me: Okay then, you prescribe it. 

Doctor: I need you to write in your note that they are safe to use it. I'm the doctor. 

Me: And I am a Doctor of PT. Now that that is cleared up, back to our issue: they are going to fall with the walker, so if you would like to be liable for the lawsuit, be my guest. 

"Aren't you just a glorified massage therapist? The doctor said all you do is massage?" 

Initially these questions made me angry as I felt personally offended, but now they make me angry because I realize that we still have a long way to educate the general public on our services. So many ailments can be treated with physical therapy and people aren't gaining access to our services simply because they don't know about them.

Not only are we not doing a good job on educating the public, but we are also not doing enough to educate other healthcare professionals on what we do. I still meet OTs that make snide comments that we "go for walks for no reason" and doctors that are shocked we can improve lung perfusion with breathing exercises as I wean patients off of supplemental oxygen. While some comments are made in jest, we should treat them as serious as intentional transgressions against our field's character. If we aggressively treat this issue, then we will be seen as a serious field and the symptom of the pain associated with poorly educated members of society with quickly diminish.

I recommend rehearsing a monologue in order to calmly respond to these prompts. Having your elevator spiel ready at a moment's notice is handy for reacting to these issues. Educating our patients, fellow healthcare workers, and society at large is our greatest weapons for managing these changes in our systems. If people knew just how beneficial and widespread our services are, there would be no question about the necessity of them. We could survive any reform or shifting care paradigm because we would be in demand like never before. It is up to use to ensure the future of our field, and education is our secret weapon.

Anatomy of a Blog Post: From Abstract Creativity to the Internet

I have been hosting this blog for nearly half a year now, and I have had a few questions about my creative processes, so I figured I would write a post on how to create a post. I resisted the urge to call it "Post-ception" as I didn't want any copyright issues popping up, but corny title aside, I am writing about how I write. I have had a formula that I discovered early on in high school and has carried me through graduate school and beyond. Thankfully for me, it works for both creative and formal writing pieces, so I am sticking to it! Here goes:

1. It all starts with a single sentence or phrase. It might not be the title, it might not be the thesis, and it might not even be the most poignant part of my post, but it serves as a spark for the flame of creativity. I type it out first, bold it, and keep coming back to it throughout my writing. It keeps me grounded and on-topic. 
2. I don't write chronologically. To prove my point, this is actually the bullet point that I wrote last. I move throughout the the text, editing as I go and rearranging as I see fit. Usually the paragraph that I write in the last half of my time spent is the first paragraph of my post, which makes sense to me because by then I know the tone of the entire post and can write a more appropriate introduction to set the stage for the drama I create. 
3. I often write several posts at once. Right now I have 3 windows open for 3 different topics. As I come up with ideas, I realize that an idea I am developing in one post is better off as it's own idea. While this may seem a little scattered, it lets my mind move fluidly and unhindered, allowing the creative juices to spill from my mind and onto the page. 
4. I listen to music that inspires me and take frequent dance/singing breaks. I have participated in both of these arts and I feel that by letting my mind do what it wants like an ADHD child, I am able to articulate my thoughts more crisply. The soundtrack of Hamilton has been my main inspiration as of late. Sia's new album is another I like to jam to as I type.
5. I don't always finish in one sitting, but most of the time I do. The times that I do walk away from it and stew are the times when I don't get beyond more than a paragraph. I learned to abandon topics that aren't coming easily to the paper (or word doc) early before I invest a lot of precious time into them. If it isn't flowing from my finger tips, the topic either isn't ready or it isn't made to be. And I am okay with that fact. I don't sit down to write until I have at least a few hours to dedicate to the task. I have been known to sit for hours until 20 page term papers are done. I also wrote my literature review, as well as my thesis for DPT school, in one sitting. This time is of course interspersed with random dance/jam breaks. 
6. I let ideas sit in my brain for weeks on occasion before setting aside time for the activity of writing it out. I really capitalize on the concept of subconscious processing to allow more ideas to form. The longer I wait, the faster I am able to write. 
7. I dress for the occasion. If I am writing a professionally invigorating post, I wear business casual. Seeing as this is more of a creative post, I am currently wearing my mermaid yoga pants, a brand new haircut, a punk band shirt, and a single sock. It's odd, but it's working for me currently. 
8. I edit very minimally. I look at spelling and grammar, clarify confusing statements, and delete duplicate thoughts. I really only make the adjustments my editor requests, as I know that my process helps with a lot of the other issues authors run into.

Creative people are often seen as inherently quirky, and I suppose the way that I approach writing a blog is much the same way. Seeing as Van Gogh chopped off his ear and Darwin married his cousin, I think I am in a pretty good place. If you are looking to understand more habits of creative people, the Huffington Post write a neat article explaining several things that highly creative people do different. It might help explain a lot about your abstract relatives or even give you a few ideas on how to foster your own creative spark! 

Legacy: It's Not What We Do, but What We Leave Behind

As I turn 26, I am noticing that a lot of people at my age are in a turning point of their life. People are getting married, having children, and starting career paths. Coming from the Millennial Generation, we are often seen as the "me" generation... and for good reason; what with the advent of social media, it is hard to not to be lambasted with images of "look where I vacations" and "look what I am eating" and "look at my accomplishment." People measure success in different ways, however I believe that true success is measured not by what we are doing, but what we leave behind from those efforts. Events such as marriages, having children, or creating a DPT program happen to more than one person, and it is what you do to make this experiences special that create true success.

One example of this is holding titles/offices. Any one can hold a title, but it is what you do with that power that matters. For instance (at the chance of being political here), the title of President. Anyone can be president, but it is what you do with that title that you are measured for your success. History is a documentation of what was left behind, and greatness is determined by those historical artifacts. Think of a president of the United States. Right now. Any president. My guess is that you chose Washington, Jefferson, Lincoln, JKF, FDR, or maybe even Obama. It is also my assumption that the names Filmore, van Buren, and Harrison probably didn't cross your mind. That is because, unlike the former, these individuals didn't leave much of a lasting impact. Now that is not to say that they weren't good at their job, but relative to other POTUSes, these guys weren't exactly political icons. Another difference between these two groups are that the POTUSes that were in power during the greatest times of adversity had the opportunity to engage with and react to the challenges presented to them, thus leaving a memorable legacy.

With the ever-changing landscape of health care reforms, we as physical therapists have the same opportunity to leave a lasting impression on our fellow health care workers. We are presented with unprecedented challenges right now to which we can either respond with strength and passion, or we can wait 20 years to wave an "I Participated" pennant. If we allow ourselves to be defined as what we are doing, such as simply attending PT school, or completing a PT residency, or treating patients, we are only filling half of the puzzle. We must see our actions from the perspectives of future minds who will look at us and see what we left behind. What did we do to create a lasting impact on the field? Simply existing and showing up isn't enough. Anyone can hold an office or say they are "super involved," but unless you have the evidence to back up your claims, people are going to call you on your null hypothesis. We must thirst for change and strive for lasting impacts.

In short, don't make people just look, make them focus. Saying that you held an office is not nearly as impressive as the programs you implemented or the practices you affected. You may have a laundry list of a resume, but that will eventually mean nothing. Resume-building is important, but once you reach a certain level of superiority, people start to look at what you are doing instead of the fact that you have that status. History will forget you if you do only enough to look impressive on paper. To quote the play Hamilton, history has it's eyes on you... so now that it is looking, what are you going to do to make it focus in on you?

The Genesis of Genius: When McMillan Lectures all Make Sense at Once (Book Review Part 1)

On my flight home from the GSA Annual Scientific Meeting in New Orleans, I picked up a book in the airport, having exhausted my stash of scientific journals that I brought along with me. The title of the book is The Geography of Genius: Lessons from the World's Most Creative Places by Eric Weiner. Weiner is a journalist who is on a mission to determine why "genius flourishes in certain places at specific times" in an effort to essentially find an algorithm for intelligence uprisings. Throughout the book (I am only half way through it at this point), he travels the world to speak with experts, temporaries, and prodigies of the most genius minds in history. His travels take him to Athens to explore the ancient and most profound philosophers, Edinburgh to immerse in the medical and other scientific advancements of Scotland, Hangzhou to bask in the glory days of the Song Dynasty, and many other adventures. He takes an in-depth look not only at the personal lives of individuals who we as a culture now deem as "genius," but also at the political, environmental, and sociocultural dynamics taking place at the time of the uprising of these great minds.

I found this book most interesting because of how I felt it related to the field of physical therapy. While a physical therapist hasn't been deemed an official genius to the greater community of the world (to my knowledge anyway), we have many individuals within our microscopic infrastructure and related-community who would qualify for the title based on their life's works in either the clinics, the research lab, or often times, both. 

Two Mary McMillan Lectures were called to mind thus far in my indulgence reading. The first of which was Alan Jette's 2012 lecture entitled Face Into the Storm. In this lecture, Alan makes several interesting and inspiring points in relation to managing the many challenges that physical therapy was about to face at the time. However, the most pertinent lesson that I internalized from attending the lecture was that the field as a whole must face into the incoming storm and not run away, but rise up to meet the challenges head on.  This pedagogy, according to Weiner's discoveries thus far, is a cesspool for breeding an influx of genius within the field. Many ideas are birthed in the face of adversity. Just as the need for good hand hygiene was the window of opportunity between post autopsy and pre-delivery events in the medical field, limited insurance reimbursement and rapid health care cuts led the way for the inspiration of many community based programs as well as health and wellness initiative for the physical therapy field. 

The second lecture that presented a parallel to my readings was Lynn Synder-Mackler's 2015 lecture entitled Not Eureka. In this 46th lecture, Lynn describes how the greatest moments of discovery are not necessarily known immediately and are not often a big event initially. In act, the greatest discoveries and moments of genius tend to occur with a quite moment followed by  a solemn "well, that's funny." A subtle change or shift in the winds can result in needing to adjust your trajectory to a solution, often leading you down the novel and rarely-traveled path of ingenuity. Many scientific discoveries are not considered major until years of discussion, attempts to discredit them, and other new theories begin to support this existing paradigm (think spherical earth theory). 

The two most important ideals established in this work of literature are the following: 

1. Genius is a Process. That is right, with a capital P. It often doesn't happen all at once and the efforts of the individual are often not rewarded until years after the death of the individual (which might be why we have no certified PT geniuses as we are still a relatively infantile field). Also, a major part of the process of genius is a collective cultural response to the works of said individual stating the status of "genius", as society as a whole often has to see the worth and relevance to the ideas. 
2. Genius is often a unique response to a unique challenge which is necessary to continue to drive forward progress, survival, and stability for the human race. The reason I say human race is that we don't often describe animals as geniuses, and the ones we do are somehow able to successfully mimic human qualities anyway (such as Suda the painting elephant or KoKo the gorilla) therefore, genius seems to be an explicitly human or human-esque title. 

I highly recommend this book. It is witty, information, and has enough fun side tangents to keep this piece of non-fiction from being too dry and boring. It is also a good reminder that when the going gets tough, the tough better get going to the library because genius is only a train of thought away. 

Beyond APTA Involvement: Is there worth in membership to groups outside our clique?

I recently got home from a whirl wind trip to the Gerontological Society of America's (GSA) 2016 Annual Scientific Meeting in New Orleans, Louisiana. While I was only present in the city for a measly 36 hours due to the constrictions of having starting a new job (PTO what???), it was still an unprecedented, highly inspiration 36 hours which has led to the culmination of several new blog post ideas as well as many new networking relationships and activities to keep me busy throughout at least the first half of 2017. Each conference has a theme, and this year the theme was "New Lens on Aging." The thought behind this theme, which was carefully and most appropriately selected by our outgoing chair, Nancy Morrow-Howell, was to take a new look at how we view the science behind aging. However, I feel that this theme had a subtext to it that wasn't expected by myself, or perhaps any of the conference goers.

I feel that as healthcare, academic, and research professionals, we all wear our unique set of lenses when it comes to how we view aging. My physical therapy-shaded glasses will be different than the filter provided in the lens of that of an MD, public health official, or even that of the patient/client we are all simultaneously assisting. In order to be successful in our endeavors to aid and assist those who are aging, each lens is a small part of the greater image that is aging, and without the entire team, we fail in even the best intentions for this diverse population.

I have been a member of GSA for 3 years now. I initially joined as a way to gain access to their extensive database of interdisciplinary research as I was embarking on my primary thesis at the time for my Doctor of Physical Therapy degree. What I discovered in this organization was beyond just a data blitz. It was also mentor-ship, friendship, and collaboration with individuals from around the world which has shaped me into the young researcher and clinician that I am today in the field of human aging. Surprisingly though, most of these individuals who has inspired me within the realm of GSA were not physical therapists. I have found that through my involvement with other groups, I have connected to people who are also involved in APTA who I might not have met otherwise through the APTA alone.

Interdisciplinary collaboration: this recent buzz word is a new trend in medicine and medical management of our patients. The paradigm has shifted to include opinions from all sorts of professionals within the health care system including even spiritual care staff. Within GSA world, this interdisciplinary conversation takes place among clinicians and academics, grad students and field experts, social workers and doctors, and on and on and on. These relationships foster the growth for improving translation of knowledge from the lab to the patient experience.

As for the main stem of my thesis in this post, the answer is "it depends" on whether or not membership in groups outside of the APTA is worthwhile. I feel that it depends on the group. Someone else who isn't as driven by this pedagogy might not find the same value.

Nevertheless, I implore you to look into at least one professional association outside of the APTA in order to broaden your scope of practice and gain new insight into the world you love (be it geriatrics, neuro, sports, ortho. or whatever else). You might even have some fun and meet some neat people along the way.

47th Mary McMillan Lecture: Inspiring Lasting Change or A Social Media Blip?

At the APTA NEXT 2016 conference, Dr. Carole B. Lewis, PT, DPT, PhD, GCS, GTC, MSG, FAPTA gave the 47th Mary McMillan Lecture titled "Our Future Selves: Unprecedented Opportunities" in Nashville, TN. I was not in attendance, but once the event was over, I was bombarded on social media about the importance of care for our aging population. My initial reaction was joy. "Finally," I thought, "People are getting what I have been talking about for the past 3 years!" But that elation was quickly turned into cynicism. The people advocating for change the most were people whom I had grown to know as having a general distaste for the geriatric population; some of whom had downright ageist viewpoints and had complained about having to work with a geriatric patient instead of a young, recovering athlete in the clinic. Suddenly, I felt catapulted into the Twilight Zone and waited for what seemed like ages for the Tower of Terror to suddenly jerk downwards until everyone's feet were back on solid ground and minds were returned to their rightful place.

You may ask yourself, what is wrong with a renewed focus on geriatrics? How could a sudden interest in one of the most difficult populations to obtain appropriate care for be a bad thing? After all, there is strength in numbers right? Yes and no. I am thrilled that this topic was brought to the forefront of our minds. Its important and relevant to all issues related to healthcare. My issue is not with the message which was flawlessly presented, but with the reaction of the PT masses to the topic (or to any major announcement really). There are two types of change agents: those that garner short term results and those that garner long term results. Most of the positive results are incurred short term in a reaction like this, which is not not the solution that we so dearly need right now.

Now, let us dissent....

I'm not saying you can't be interested in or can't explore other realms of PT. For example, I'm not the biggest fan of pediatrics, but if a worthwhile petition to improve service provision to the population comes my way, of course I will sign it. Will I go out of my way to make sure I hunt down every other PT I know to sign it? Mostly likely not. And that is okay. If we all reacted this way to everything, then nothing would be special and no one would be specialized, which is an absolute necessity in our field. 

This is similar to the high school student who is aiming for Ivy League schools and signs up for as many extra-curriculars as possible. They don't really like what they are doing, but they see it as a way to get to the next step of what they want to do. The goals in the PT world can be anything from an executive position in the APTA to the glory of all those likes, re-tweets, and social media attention. What ever the underlying motive, if its not an altruistic one, then that individual is sure to crash and burn eventually.

Growing up, my parents had a saying: "If it isn't fun anymore, then don't do it." While this is an over-simplified mantra, and there are a lot of things that aren't fun but should still be done (dentists appointments, paying taxes, etc), there is a lot of merit to it and it has lead me to the successful and happy person I am today. I tried pee-wee basketball, hated it, and never went back. When dance became too stressful (Dance Moms is real, y'all!), I switched studios and eventually stopped to focus on school. When Academic Decathlon turned out to be just as ridiculous as it sounds, I left. When I had to quit a job because of an insufferable co-worker,  I found another position that I was even more thrilled to participate in. These may sound like a lot of instances in which I quit, but I don't see it that way. For a short period of time, all these things gave me joy and pride. But then, as circumstances changed, so did my happiness. It was then time to pick up a new hobby or adventure to make sure that I was taking care of myself.


This is why when I see someone tackling issues that I know they actually don't care about, and they are just getting caught up in the hype of "should do" instead of "want to do." I pity that individual. I am a huge proponent of "If I don't want to, then I won't." I can't be made to do anything I don't want or need to do. If it isn't necessary to my survival and/or job, and it's not interesting, then I won't participate in it. Pressure from peers, or even my own mother, can't even change my mind. I feel like this ends up making my convictions stronger in the end because all my actions are backed with the passion to fuel them to success.

I also witnessed a similar instance occur after the previous Mary McMillan lecture. Students whom I had known for years were suddenly interested in research and calling themselves "clinician scientists" when just the previous day they were complaining about how having to complete a research project to graduate from their program was a colossal waste of time. (For reference, our program only required one project and several students in the program - myself included - were able to complete several successfully in that time, so I have no patience for the "waste of time" complaint.) It was equally as amusing as it was annoying watching people get all riled up with the rest of social media and the conference goers only to see them slowly drift back into their old habits.


Now I can relate to the whole research thing. When I found out my senior year of undergrad that I would have to conduct a research study to fulfill my honors capstone requirement, I was pissed. I hated research. It was boring and monotonous and I wasn't interested. However, after creating my own study, carrying it out, and presenting the results at a research symposium, I was hooked and hungry for more. While I consider myself dedicated to the scientific method, this relationship has only been official for the last 4-5 years. I am no means an expert, but in that time I have conducted several other studies and have demonstrated that I am dedicated to this lifestyle.

Look, no one is doubting the fact that research seems cold and heartless. Research doesn't care about your feelings or woes. It simply exists as a venue for information discovery and dissemination. The scientific method is a well-oiled machine with no room for your bullshit. At the end of the day, the results are the results and your job is to figure out how best to present and connect them to the existing paradigms we currently operate under. It's an entire beast in its own right and it is not to be messed with. I don't think that people really understood that when they all jumped on the bandwagon in the summer of 2015.

Now to be perfectly clear, this poor sustainability of action resulting from the lecture topics is not the fault of any of the lecturers, the conference committee, or the APTA as an institution. Their purpose is to showcase their passion and message to the crowd at the conference, in hopes of inspiring lasting change and social engagement. My qualm is with the people who take the message, run with it, get tired, and put it down to rest in some ditch in the middle of nowhere.

While NEXT and CSM are great for information dissemination and networking, gone are the days of deep discussion and face-to-face contact in the advent of social media. Using social media to convey a message about something as important as the renewed focus on geriatric care or clinical research results in these vitally critical topics being handled as superficially as the relationships garnered on social media platforms. Sure we get the instant gratification of a topic trending on Twitter, but do we actually see lasting policy change to benefit clinicians and their patients? Not commonly. The facade of "I care about everything" is then shattered and debunked as humanly impossible. Moreover, the dreams of individuals who actually care about these things are often left deferred and no real change is garnered to ensure to future of physical therapy.

In the advent of social media, people get all jazzed up for a few days/weeks/months and then nothing comes of it or people forget about it as the next big thing comes around. Case in point: the ALS ice bucket challenge. People got super into campaigning for raising money for the foundation and then they forgot about it. This was evident through the number of posts I see currently with the link to the research that was actually conducted with the money raised paired with "I forgot about this" statements.

If you are going to make a lasting change, great! But if you pledge, push, and advocate for it, then make sure you follow through. One of my biggest pet peeves is to see someone get excited about something that I am excited about, only to see them back off and change their mind a week later after the conference hype has settled down. The best way to make a lasting change is to align it with interests you already have established. For instance, as a sports PT, you can still advocate for geriatric physical therapy, but that lasting change will come if you actually carry that attitude over to your clinical practice. Examples of this include volunteering as a medical professional for the Senior Olympics or holding a movement/health screen for seniors interested in starting a sports recreation program. When you extend your advocacy efforts too far beyond your prevailing interests, you often don't have enough support or resources to continue to foster growth in that area.

In conclusion, your time is valuable. Don't waste it on an endeavor because you feel like someone is expecting you to or it is what your peers are doing. The only conviction that matters is your own. I don't care if everyone else thinks that something is the best idea ever; if you are not convinced, then its time to figure out why so you can direct your attention to something that reaps lasting benefits for not only yourself, but also your patients.

All memes were created by Heidi Moyer using Meme Generator. 

Pelvic PT Part 3: Patients Who Don't Fit the Usual Boxes

Introduction

During my first semester of physical therapy school, my class was fortunate enough to have a guest lecture from one of eleven Board Certified Women’s Health Specialists in the state of Texas. It was during this lecture that I was first introduced to the practice of pelvic floor physical therapy (PT). Learning about the effects of pregnancy on the body and the hormonal and biological differences between men and women that influence their risks for various ailments fascinated me. For example, ACL injuries are 2 - 10 times more common in female athletes than male athletes playing the same sports¹. Additionally, there is an established relationship between knee laxity and hormonal changes during a menstrual cycle² in addition to a link between testosterone and improved athletic performance³. Prior to this lecture, I never considered the idea of something like our sex hormones having such a great impact on our musculoskeletal health. I became curious about how the exposure to both testosterone and estrogen would affect people who are transgender. This extended into a broader interest in the topic of trans health care, including the biological and psychosocial components of providing high quality service.

Before exploring the topic further, it is important to have a basic understanding of the terminology associated with this demographic.

Sex - biological characteristics of chromosomes and anatomy (ie. male, female, intersex, etc.)

Gender - societal and cultural categorization based on one’s sex (ie. boy, girl, etc.)

Cisgender - describes one who identifies with the gender assigned to them at birth

Image courtesy of advancedreportingtimes.wordpress.com

From Transgender - describes one whose gender does not match the sex they were born with (may be abbreviated trans)

Transwoman/MTF - born male and identifies female

Transman/FTM - born female and identifies male

Top surgery - breast removal (FTM) or augmentation (MTF)

Bottom surgery - reassigning one’s genitalia to the anatomy they identify with

Gender identity - the gender that someone associates with internally

Gender expression - the external gender that someone shows the world through appearance and behavior

Sexual orientation - the gender(s) that one is attracted to. (Transgender is not a sexual orientation.)

Gender 101. Trangsender Health Information Program, Provinicial Health Services Authority Web site. http://transhealth.phsa.ca/trans-101/gender-identity. Accessed Aug 13, 2016.

There can be many combinations of the terms above. Someone could feel male, but live outwardly as a woman. Also, gender and sexual orientation do not always add up in a heteronormative fashion. A person could be cisgender and bisexual (an XX female attracted to both men and women) or transgender and lesbian (an XY MTF woman attracted to women) or any other combination. Furthermore, not all people who are transgender have surgery or undergo hormone therapy, but this does not change their gender identity.

Why does it matter?

For many health care providers, there is high emphasis placed on maintaining respect and tolerance for all patients, regardless of their beliefs or lifestyles. However, for some unique populations, providing high quality care must extend beyond tolerance and into awareness. The July 2016 issue of the APTA’s PT in Motion magazine displayed “Managing patients who are transgender” on the cover. There were some fantastic examples of why it is important to be aware and knowledgeable about patients who are trans. One physical therapist, Daniela Mead, states, “If someone who identifies as a woman comes in reporting hip pain and I don't know that she is biologically male, I'm not going to screen for something like prostate cancer … because that's not going to be on my radar.”⁴ Dr. Kimberlee Sullivan, a PT and clinic-owner in Austin, TX, explained that physical therapists will see patients who are post-op MTF sex reassignment surgery to address pain and scar tissue. PTs work with this population with vaginal dilators to prevent stenosis so that they are able to have successful intercourse. “Since pelvic PTs have more creative liberty in regards to discussing sexuality and function; they are in unique positions to have a profound impact,” says Dr. Uchenna Ossai, a Board Certified Women’s Health Physical Therapist at Houston Methodist. 

There are many other instances in which someone’s status as transgender could impact the pathology a PT addresses with their intervention. For example, some people who are FTM practice binding their breasts, which can lead to compressed ribs, collapsed lungs, and back pain⁵. If a patient who is FTM undergoes removal of both breasts, PT could be indicated to improve scar mobility, prevent keloids, and maintain upper extremity range of motion during healing. A survey from the Williams Institute at UCLA claims that “Fifty-four percent of respondents reported having some sort of physical problem from trying to avoid using public bathrooms, all of whom reported that they ‘held it,’” including dehydration, UTI’s, and kidney infections⁶. In regards to being efficient primary care clinicians and screening for non-musculoskeletal causes of symptoms, it is important to consider a sexually transmitted infection in the case of groin or low back pain. In one study, the prevalence of both syphilis and HIV were more than twice as common in the transgender group compared to the cisgender group⁷.

During the subjective interview with a patient, physical therapists screen for cognitive and emotional conditions that may interfere with PT or warrant a referral to another professional. For this reason, PT’s should be made aware that mental health disorders, often secondary to ‘minority stress’ are higher in the LGBTQ community. According to the National Alliance on Mental Illness, suicidal ideation is experienced in 38-65% of transgender individuals⁸. There are other psychological components specific to this demographic, such as gender dysphoria, which is diagnosed when one displays “a marked difference between the individual's expressed/experienced gender and the gender others would assign him or her,” often to the point of causing significant distress and social/functional impairments⁹.

The transgender population also carries with them some distinct barriers to health care access, including PT. Currently, only 18 states have laws to protect a person who is trans from being fired solely on the basis of their gender identity¹⁰. Considering how many people obtain health insurance through their employer, a patient may harbor anxiety and fear of losing access if they are terminated. Furthermore, there is no nation-wide legislation in place requiring health insurers to cover transition-related to health care¹¹. If a patient is paying for most of these services out of pocket, they may not want to spend additional time and energy on PT because it is perceived as less necessary.

What can we do?

As a second year PT student, I have noticed that there is absolutely no mention of this demographic in my curriculum. Considering that the research on this (incredibly diverse) group of people is scarce, that is somewhat understandable. But the best method to increase awareness for our patients who are trans is starting early education! Even just one lecture by a specialist to expose students to the idea and provide them with more resources would be excellent. Creating more resources for practicing clinicians by way of continuing education courses and seminars would also help spread information. Something that could be done locally within your own clinic could be allowing in-services on trans healthcare to be given by interning students or employees. Since the resources may be limited and it may not seem like a pressing topic because the population is small, it could be as simple as creating a work environment where these discussions are welcome.

There are so many other efforts that PT clinics can employ to put patients at ease. The article in PT in Motion mentioned having a rainbow flag in the waiting room to let patients know they are in a safe space. “While I was shadowing at a clinic in Seattle, some of the PT’s wore a small pin to indicate peace and acceptance of other cultures. Another idea could be intake forms with more than one gender choice to include transgender and genderqueer. You as an individual employee may not be able to accommodate patients by providing gender neutral bathrooms, but if they already exist at your facility it wouldn’t hurt to know where they are located and offer it to patients. This may make them feel more comfortable and convey respect, helping to build rapport.

If you are a clinician, or future clinician, who would like to make a conscious effort to practice this awareness but don’t know where to begin, have no fear! There are so many things you can do in your day-to-day interactions with patients to convey that you are trying to open up your world view. For example, if you have a patient who you know or suspect is transgender/non-binary you can start with pronouns. If they came into the clinic with someone, you can wait for their friend/family member to address them as a certain pronoun. I use ‘they/them’ since it is gender neutral until I have a better idea of how someone identifies. If you are unsure, it is okay to privately ask them! This is far less triggering than misgendering someone. “I believe in a professional medical setting, they should always ask how their patient identified. When my primary care physician's nurse found out I was on testosterone, she immediately asked me what my preferred name was. It was a great feeling,” states Elliott T., a transman from Ohio. “My doctor on the other hand offhandedly asked me why I was on testosterone. Even though he's had transgender patients before, it was very obvious that he was not educated or trained on how to approach the subject.”

Dissenting Opinion

As with any controversial topic, there are opposing viewpoints. Some health care professionals believe that the field has become too politically correct (PC). From this perspective, it is thought that being PC is sugar-coating problems and inhibiting a clinician from addressing the impairments at hand. For example, Dr. Dominic Carone claims that “...we should not abandon the use of scientific terminology because someone does not like the stigma attached to it. The problem that emerges when we start to substitute euphemistic phrases for scientific terminology is that we start to de-emphasize the seriousness of the problems.”¹² In his article, he is primarily talking about using the words ‘unhealthy weight’ rather than ‘obese’, but he also gives many other examples including cancer, anorexia, and diabetes. Similarly, a clinician may choose not to pay extra attention to the unique aspects of all patients because it is too time consuming and detracts from time that could be spent treating. One could also argue that using person first language like ‘person with a disability’ rather than ‘disabled person’ makes no fundamental difference or is negating an important part of someone’s identity.¹³

Summary

Ultimately, being mindful of different life perspectives only serves to benefit you and those you treat. If all of the other suggestions seem too far-fetched or difficult, I challenge you to do something simpler. Even if you disagree with other sexual orientation and gender non-conforming lifestyles, you can practice awareness by not making assumptions about your patients. Although the apparent shock at discovering someone’s differences may not be malintended, it can come across as embarrassing to the other person. This can hurt the therapist-patient relationship and hinder outcomes. As PT’s we strive to care for others and help restore or improve function to promote optimal health and quality of life. This includes all patients, regardless of their gender identity or sexual preference. If there is something you could start doing to be an even better therapist, why not give it a try?

Disclaimer: I can only correctly represent the part of the community that I identify with. The views expressed are my opinions and may not be generalizable to all LGBTQ persons. I am thankful to be given a platform to address a topic that is so rarely discussed, but if I have made any errors or misrepresentation, please forgive me.

Please visit Part 1: It's Not Just for Women and Part 2: Training the Pelvic Floor Musculature...Are Your Patients Missing Out? of this series for more information on pelvic floor health in general and how to implement techniques to train this unique muscle group without your patient populations. 

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Sources

1. Timothy E. Hewett P. Why women have an increased risk of ACL injury. AAOS Now. 2012(Nov).

2. SHULTZ S, KIRK S, JOHNSON M, SANDER T, PERRIN D. Relationship between sex hormones and anterior knee laxity across the menstrual cycle. Med Sci Sports Exerc. 2004;July 36(7).

3. Wood R, Stanton S. Testosterone and sport: Current perspectives. Horm Behav. 2012;January 61(1):147-155.

4. Hayhurst C. Managing patients who are transgender. PT in Motion. 2016;July.

5. Health consequences of chest binding. Transgender Cosmetic Surgical Procedures Web site. http://www.ftmtopsurgery.ca/blog/ftm-faq/health-consequences-chest-binding/. Published 18 December 2014. Updated 2014. Accessed Aug 13, 2016.

6. Herman J. Gendered restrooms and minority stress: The public regulation of gender and its impact on transgender People’s lives. The Williams Institute: UCLA School of Law.

7. Toibaro J, Ebensrtejin J, Parlante A, et al. Sexually transmitted infections among transgender individuals and other sexual identities. Medicina (B Aires). 2009;69(3):327-330.

8. Lgbtq. NAMI: National Alliance on Mental Illness Web site. http://www.nami.org/Find-Support/LGBTQ. Accessed Aug 16, 2016.

9. Gender dysphoria. In: Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2013. http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf. Accessed Aug 17, 2016.

10. Transgender FAQ. Human Rights Campaign Web site. http://www.hrc.org/resources/transgender-faq. Accessed Aug 17, 2016.

11. Transgender health care. Healthcare.gov Web site. https://www.healthcare.gov/transgender-health-care/. Accessed Aug 18, 2016.

12. Carone D. How political correctness interferes with healthcare. KevinMD Web site. http://www.kevinmd.com/blog/2011/12/political-correctness-interferes-healthcare.html. Updated 2011. Accessed Aug 18, 2016.

13. Ladau E. Why person-first language Doesn’t always put the person first. Think Inclusive Web site. http://www.thinkinclusive.us/why-person-first-language-doesnt-always-put-the-person-first/. Updated 2015. Accessed Aug 18, 2016. 

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About the Author: Brianna Durand is a 2nd year Doctor of Physical Therapy student at Texas Woman's University in Houston. As a military brat, she has a love of travel, but her heart is nestled in Seattle. She enjoys weight lifting, yoga, cycling, and heartfelt discussions about changing the world.