Monday 19 October 2015

Y3S2W14-16: We made it.

I'm pleased to announce that we all survived the examination period... some of us more worse for wear. Here's a look at how these last couple of weeks went for me.


On day one, the very first day of  the examination period (Monday) I had my practical exam for PHTY354. This was split between cardiopulmonary (CVP) and integrated studies (IS). Stress and anxiety has some weird and not-so-wonderful effects. I spent the afternoon of Sunday and Monday morning avoiding all study related material and trying to quieten my inner voice. Deep breathing, relaxation exercises and distractions were only somewhat useful. The stress upset my stomach a bit too, and although I felt like vomiting on Monday morning, I couldn't... probably because I skipped lunch on Sunday and could only bring myself to eat soup on Sunday evening (and even a bowl of that took over an hour to eat). It's fair to say, I was stressed. Why are these exams so stressful? It's because we've got a whole lot of knowledge to regurgitate, adapt and apply to practical settings with examiners whom we highly respect observing us. Furthermore we're expected to have the competence and knowledge because it's exactly what could arise in our physiotherapy careers. It's important to get it right. After a quick prayer to whomever was listening to my thoughts, I rocked up a little bit early to the practical exam. 

The exam was set out between two rooms, the first room for CVP and then we progress to the second room for IS. We've got 15min in each room to read, prepare and complete the tasks. CVP had both a written question component and the practical component whereas IS only had a practical component. I think the physio gods were listening because my questions were straightforward. The examiners also ask additional questions regarding the case to find the extent of our knowledge - I won't list these questions though...

Here were my questions:
Written: late stage pregnancy, restricted or obstructed lungs?
CVP: Person with diabetes is referred to you for PVD programme. Perform tolerance test and prescribe exercises.
IS: Person with an unknown chronic condition needs exercise pacing to help them achieve their goals (e.g. walking to supermarket, making bed, mowing the lawns). Then give positive feedback to this patient.

My peers had written questions where they were given values and they had to determine whether the profile given was type 1 or type 2 respiratory failure; read PEFR graphs and decide what condition it is consistent with; Or state the respiratory capacity for the selected respiratory volumes. On the practical side of CVP they had a good variation which included suctioning procedures, treating shortness of breath whether it be atelectasis or children with asthma, and mobilising people after various surgeries. Integrated was even more varied! My peers had to assess hand and do a differential diagnosis (thank goodness we studied that last week in our prep... see last week's blog post), interpret questionnaires we may use e.g. the McGill Pain Questionnaire, assess and treat injured nerves, oh and there were some return to work programmes, pelvic floor training and pregnancy related questions too.

Later that week (Thursday) we had our PHTY355 written exam. Okay, so I had plenty of prep time for this exam - except my stomach/absent appetite hadn't changed at all and I ended up sleeping through most of Tuesday and the morning of Wednesday. Thursday morning came around fairly quickly. That morning I resorted to a liquid breakfast from the supermarket along the way as I walked to the examination. I was in Castle 1 lecture theatre... comfortable seats, plenty of leg room, good ergonomic set-up, a recipe for comfort (and success)! The exam was two hours. It covered content on business, legislation, discharge assessment, Health & Disability Commission processes, evidence based practice... a real mixed bag. After this exam I took off to Waitati to relax until the sun went down... so not a lot of study has happened this week yet.


To our disgust (although we're over it now), we had a Saturday afternoon exam to finish the week. This was PHTY354 Part A written exam covering IS and CVP. I arrived early (as I usually do) to the exam, it was a sunny day and I was prepared having stopped via Subway for lunch... my eating habits seemed to have resolved themselves. For a three hour exam, the time went very fast! I didn't even notice my hands getting tired... maybe I didn't write as much as I thought I had, ha! Just joking - the exam consisted of 16 pages of short answer questions (no essays! Yay!!). I won't give away any of the questions details away, other than to say if you studied well or if you engaged in the content throughout the year then you would do alright. It's a day off tomorrow, starting with the Rugby World Cup All Black versus France quarter final (wait... have I had a day of study since my practical exam at the start of the week... ummmm).

Our last exam was the following Tuesday afternoon. It was PHTY354 (everything examinable). Apparently that was the last external exam of our BPHTY degree. Woohoo!! So this exam was based on two case studies and covered major components of MSK, Cardio and Neuro. I found this exam was a real squeeze to fit in two hours - I rushed it a little. It was the only exam where everybody stayed in the exam until the last minute! So now, I'm done for the year! Woohoo!! A couple of mates and I went for a burger after the exam. The exec organised an end of year piss-up too - nothing has changed there.

Lab group C got together for a group photo as evidence that we survived our third year of undergraduate physiotherapy.



On a different note... last year I made up my own neuro test. This year (during my cardiorespiratory placement) I dreamed up a product that doesn't yet exist (to the best of my knowledge) for people with COPD. It's a chest compression device that is synergistic / coordinated with the patients breathing mechanics. The device would take neurophysiological input (EMG) and be perhaps offer different levels of assistance through a micro-computer. Sounds pretty good right! Well, how about if it could read blood saturation and adjust breathing mechanics too? How has this not been invented already? So, if you see something like this in the clinical field in the future, then you'll know that it wasn't me who did the hard job of putting it together and the research determining its effectiveness!

If you read my blog from the beginning of the year, you'd know that I grew a mango tree from a pit (having eaten the mango flesh in January). The final update on it's growth is, that it is no longer growing. Around August I changed its position to a sunnier spot in the kitchen and I think the sun burnt its leaves (suspected cause of death)... so the message for summer is to be sun smart. Slip, slop, slap & wrap... and if you've got a seedling, find out what optimal conditions are for its growth.

Provided I pass the exams, I'm set to complete my final year of physiotherapy in Nelson in 2016. Nelson is known for its warm climate, stunning beaches and photogenic surrounds.  It isn't a main centre, so it's unlikely that I'll get any specialisation experience (spinal care units etc) rather I'll get a good grounding in the basics.


I'd like to thank my place of work, the team at Knox Rehabilitation Clinic, for their support over the year. I've learned a lot working as a massage therapist. Furthermore it was good to have access to a MSK clinic for weekend group preparation for our individual practical exam.

http://www.knoxrehab.co.nz/


Surviving physiotherapy has largely been about the social support of your peers and teaching staff (as much as it is your own study and self-directed learning). Thus, a big thank you to them - I'll miss you all next year. I'll even miss Graeme and the sport injury clinic... between Graeme and Helen, the sport injury clinic is an amazing place to volunteer. Anyway, I don't doubt that I'll see everyone around graduation in a years time (after we pass our placement and research year).


Physiotherapy Undergraduate Year Three Done!!
Year four begins early February 2016
Catch you all next year!

Friday 9 October 2015

Y3S2W13: Y3 Summed & Summarised

 Final Week of Y3 Lectures & Labs.
University 2015 is coming to an end...
Graduation 2016, we're almost there. One year to go, bring it on!

I've attended some self-directed group learning sessions... one session was especially productive. We focused on conditions of the posterior upper limb. First off, we used the whiteboard to compare/contrast each of the conditions, then we split into smaller groups to be patient and practitioner... not having the condition required us to know how the condition presented... and we needed to know how to diagnose the condition. So both of us needed to know everything - good way to study! 

When I say I've attended "some" self-directed practical group sessions... I really mean, "I've attended a group practical session nearly every day this week." Compared to second year, the scales, in terms of self-study/notes and practical study/verbalising, have taken a large swing toward practical revision. The timetabled labs this week were also revision. I found these especially helpful because we had access to equipment. The more I think about clinical situations that could arise, the less prepared I feel - however, when we break the situation down and apply some logical thinking (physiotherapy clinical reasoning), then we can't go too far wrong. And, because there are situations where we can actually do a lot of harm, it's good to know when to do nothing at all. Knowing when treatment is indicated and contraindicated is the key to surviving third year of undergraduate physiotherapy. Not having extensive clinical experience is probably the biggest barrier to being a productive physio student in fourth year... but this is why we have fourth year before being unleashed unsupervised on the public. Having said this, it doesn't make us any more confident for our practical exam next week!

"We have to fill our brains up [with knowledge]... even the spaces that we know will only hold info for a few weeks" - third year student.

"When you're not sure what to do with a patient, refer them on. Got some cultural barriers, refer them on. Can't fix the problem with a single manip, refer them on..." - third year physio with a sense of humour.

"Knowing there are things that you don't know is a problem. Knowing there are other things that you don't know to know, things that you need to know, is a bigger problem" - another third year student.

By the end of third year we know useful rehabilitation science, anatomy, physiology, pharmacology, pathology... the foundations of healthcare practice. Furthermore, we know how do assess and treat many musculoskeletal, cardiopulmonary and neurological conditions in various settings (hospital, private practice, community)... the foundations of physiotherapy practice. Moreover, we have a good grounding in many speciality areas in physiotherapy practice (paediatrics, sports physio, mental health, occupational health etc). Having said this, physiotherapists treat the person and not just the condition. Thus it's important to know that there is other knowledge from other areas of physiotherapy to draw upon... imagine a person a plethora of different medical, social and psychological conditions, then put them in a social, political and physical context... and know physiotherapy can help them live better lives.

If you're a current second year student wondering when you're going to learn physiotherapy... there's a good chance that you need to pay more attention in class. However, you'll need to wait until the second semester of third year, and in particular attend 'integrated studies' labs/lectures as this is when all the missing pieces of the puzzle 'what is physiotherapy, and how do we do it' are brought together.

Our final week ended with class photos in front of the University Registry building / clock tower on Friday around noon. This was a good way to finish the academic year!


I would like to thank all who have taken the time to read my blog this year. I look forward to continuing my journey through undergraduate physio and sharing my experiences of the final year of the BPhty programme with you in 2016. I wish to extend my thanks to the students and staff who have contributed to the excitement had thus far - it's a frightening thought knowing that we're almost ready for the big wide world.
I'm only going to write one more post this year to cover my experience through the exam period.
It's time to put knowledge to practice!
Wish us luck!

Tuesday 29 September 2015

Y3S2W12: Paediatrics

Paediatrics was the theme for both CVP and integrated studies. In the integrated studies lab we critiqued a research paper written by the guest lecturer in terms of a family centred approach and the ICF framework. It was then on to another text, a 'children-style' book focused at debunking cultural beliefs that disability is caused as a result of you or your family doing something bad. These books took a surprisingly long time to ready, but had clear messages without being too confrontational or disrespecting the cultural beliefs. The simplicity of the books was also great! The author was a graduate of UoO physio school, and is working in the Philippines as a physio. The second lab was a lot of fun and involved real infants... the running joke was that for the females' in the class, their 'ovaries were working overtime'... fair to say they especially enjoyed that lab. We had three infants in our lab (with their parents), the age range was between three months to 12 months. We got to observe them play and interact with them. Also, we were able to complete the Alberta Infant Motor Scale (for diagnosing developmental delay in infants)... this was much better than completing the outcome measure by watching infants on a video clip like we had in semester one.

CVP paediatric tasks included teaching parents how to mobilise their child's secretions (percussion etc), modifying PEEP (positive end expiratory pressures) by blowing into a glass of water through a straw (with dish washing detergent), manual handling skills for infants with appropriate chest physio interventions (including games for children!). We practised glossopharyngeal breathing "frog breathing"... because this is legitimately how frogs breathe and it legitimately works for humans. We practised a lot of patient education for the caregiver / parent of our patient too!


Business planning was the topic our PHTY355 lecture... it basically took us through the pros, cons and process of creating your own practice (or venture that may require business planning). Here's an insight... we're probably not going to become millionaires from private practice (or from physio in general)... after all, 'health care shouldn't be there to make profits, right?' Ha! Apparently New Zealand has one of the highest rates Kick Start (new) businesses in the world... and one which has one of the most new business failures.

Third year dinner is one of the biggest, if not the biggest, physio event. This year the third year dinner was held on Sunday at LoneStar. It's a night of reflection on our journey through undergraduate physio. Time to share our highs, laugh through our lows, and thank the student exec committee for their long hours. There are some social awards, performances, good food and even better company. This is quite possibly the last time we will all be in one place (other than exams) before we graduate... because next year we're pretty much on our own. Below is a pic taken, prior to our entrées being served, of my good physio class mates (and Gill - a wonderful lecturer who took us in first year for some MSK, and most of integrated studies this year). Professional looking bunch.


Integrated studies individual community assignment was handed in on Monday... I last mentioned this around mid-semester break, but I wasn't sure where the assignment instructions were... we got those a week or so after the mid-semester break... I linked osteoarthritis of the knee, quality of life and physiotherapy from data collected from our community visit.


Clinical studies requires SWATs, clinical diaries and reflective statements from all four placements be submitted as a final 3rd year portfolio. These portfolios were due on Friday. I'm all up to date - no more assignments or portfolios to submit this year... Time to focus on external exams!
One week of lectures to go!

Wednesday 23 September 2015

Y3S2W11: Old Dog, New Tricks

Fear not of old age, for physiotherapy is here to help. Older adults... or 'elders' if they're especially wise, are trainable - like old dogs, their bodies can learn new tricks. When you are struggling to open the jar of jam or need to leave 15min earlier to get to the bus stop because you're now walking slower - call a physio. We'll set you up with an exercise programme to make you buff, strong and fit. 

The 'older adult' was the theme of integrated studies this week. The first lab was self-directed and consisted of eight stations. After the lab, we were able to get a case study from the reception to present about in lab two. The older adult is likely to have multi-morbidities (many diseases / health conditions) and we're expected to help them manage these whilst improving their physical function.

Phty355 series from ACC continued... it is reasonable to assume that deciding whether a client can claim under ACC is not always a black and white process. We had another 'prep for 4th year lecture' and the key messages came from current 4th years. Most of these messages are encompassed by the phrase "fake it until you make it". 

I see you Intensive Care Unit (ICU) Syndrome is a psychological syndrome some inpatients acquire in an ICU. We were going through a different psychological syndrome (but one that's familiar to us... study stress) in our CVP lab on the role of the physio in an intensive care unit. This was an intense lab, but us per usual we had some fun. Key stations in the lab had us practising suctioning... this involved putting a catheter with a vacuum into the part of the lung where it branches into two i.e. left and right lung, to suck up secretions in an unconscious patient. For added amusement, the unconscious patient was hooked up to an ECG monitor that would 'randomly' flat-line (i.e. the patient's heart supposedly stopped), so we appropriately managed the patient's airways (put them back on the ventilator) and perform chest compressions. Good fun. We also taught self-suctioning to our patient with a tracheostomy whom had a 'Swedish nose'. 'Dressing up' in personal protective equipment (PPE) during the lab whilst suctioning was important and quite amusing too. To top off the lab, most of us had a ride on the tilt-table! Good fun! This lab also had us working on a patient with burns and another patient after a heart transplant, both in an inpatient setting.


CVP lecturer on Thursday had extensive experience as a ICU physician in New Zealand. This presenter had an immense passion and enthusiasm for intensive care. He shed light on the importance of the physio in ICU. He was excited to have worked with Margot Skinner (current lecturer at the School of Physiotherapy and current executive board member of WCPT) and J. Pryor (a graduate of Otago, world renowned CVP physio and co-author of our CVP textbook) during his time in the intensive care profession. He described the shift in medical philosophy and use of technology over his time in practice, in particular a shift to non-invasive ventilation. He joked that his colleague had described non-invasive ventilation as "ventilator foreplay... preparation for the big event" at a time when using non-invasive ventilation first became available. However, today with modern non-invasive systems we can support patient at an appropriate level without robbing them of the dignity of being able to speak etc when previously patients were given a tracheostomy tube or endotracheal tubes for ventilation straight away.

Some inspirational quotes from this lecturer:
  • 'Fall in love with all areas of physiotherapy that you encounter'. 
  • 'I see a lot of physiotherapists wearing a stethoscope, but the most important tool you bring into the ICU is your hands... stethoscopes only give you a fraction of the information... physiotherapists feel the physiology happening with their hands'.

Thursday 17 September 2015

Y3S2W10: Death & Taxes

PHTY354 was split between occupational  health (integrated studies) and palliative care (CVP).
  • Our CVP lecture/lab concentrated on the physio role in palliative care. We had a guest lecturer from Dunedin's hospice describe the philosophy of assisting people to live a quality life right up to their death... not prolonging death or prolonging life. The hospice works with the patient and their family to plan how the patient wants to die. The physio role is to keep the person as well functioning and with the least amount of symptoms as possible (if the patient wishes for this service). During the lab we watched a local Dunedin person's documented life leading up to his death and the involvement of the hospice and hospital. This tugged at a few heart strings. Our second lecture of the week saw an oncology physician talk to us about cancer. Thus, in our lab we also covered lymphatic drainage for lymphoedema, post mastectomy management, and care for people with other end stage disease and cancer.
  • Integrated studies lectures had two guest lecturers, the first was a clinical educator from the School of Physio clinic in Dunedin, the other a clinical educator from the School of Physio clinic in Christchurch. These two lecturers were experts in the area of occupational health. In New Zealand, physiotherapists can specialise in Occupational Health... this has a large overlap with the work done by Occupational Therapists... (so that's neuro rehab, hand therapy and occupational health that physios and OTs share similar roles in patient rehab!) The first lab was case based and looked at different factors that affect occupational health (such as workplace layout, biomechanical analysis, environmental/individual factors, organisational/policy, and psychosocial factors) and putting together a rehabilitation plan (return to work plan) for a patient. The second lab was more hands on, this involved setting up work stations (chairs, tables, correcting postures etc) and recapping strategies for lifting/transfers (then problem solving for different occupational demands).
We had the first lecture in a series from ACC (accident compensation corporation) representatives for PHTY355. ACC is New Zealand's 'insurance' system whereby everyone (including visitors to NZ) are covered by the government if they are injured as a result of an accident. It's a 'no fault' system, removing the right to sue (therefore, less psychosocial factors and generally people recover quicker). We looked at how a client is entitled to compensation under different categories of the 'Accident Compensation Act, 2001' such as 'Personal injury caused by accident' (PICBA) and 'Work related gradual process, disease or infection' (WRGPDI). The lecture took the form of case studies; we split into small groups and were given case studies to debate whether it was reasonable for the patient  to be entitled to compensation, and if so under which cover policy (if any... there are some legal requirements and medical 'grey areas' to interpret).

So I've now finished my last clinical placement for the year. I must admit that it was probably my favourite placement of my undergraduate degree so far. Without saying that one area of physio is more important or better than another (each area is equally awesome), here's why you might enjoy this placement.
  • If you like responsibility, making semi-critical decisions, complex health conditions, medical jargon and monitoring vital signs then cardiorespiratory physio is for you.
  • If you enjoy seeing a transformation of the patient from their most vulnerable health status to a threshold where the patient can usually resume or cope with their life demands, and know you've played a large role in their recovery, then cardiorespiratory physio is for you.
  • If you enjoy taking patients for walks around the ward in their PJs (or hospital gown), giving out red socks with grippy bits on them, or drag-racing people in wheel chairs (in slow motion) then cardiorespiratory is for you.
  • If you don't mind rogue mucus missiles, practitioners stealing your patient, decrypting handwriting, holding your patient's pants up as they walk, frequently washing your hands, teaching people to breathe or having the same patients' most days of the week, then cardiorespiratory might be a well suited option for you.
During my placement I got to treat people with pulmonary fibrosis, pneumonia, COPD as well as those having undergone CABG and lung lobectomy. Most of my clients were discharged upon finishing my placement - everything appeared to be running smoothly. Interesting points of this placement included CT imaging of a patient with subcutaneous emphysema caused by a CPAP/drainage accident following a pneumothorax, an xray of the pneumothorax itself, the effectiveness of physiotherapy techniques are easing work of breathing, and normalising SpO2 with principles of physiology (such as ventilation-perfusion matching, minute ventilation etc). For example, one person I saw had a blood saturation (of oxygen, SpO2) of 90% in sitting. The person had pneumonia in the right lower lobe and a non-productive cough. The combination of left side lying and diaphragmatic breathing increased the SpO2 to 96%. Magic (science)!

Right now (as I think ahead and start dreaming about future employment) I feel that an ideal job would be to work as a physiotherapist in a hospital during the work week 8:30am-5pm (cardiorespiratory ward would be great thanks!), then run musculoskeletal clinics in the evening 6-8pm and work as a sports physio on the weekend... oh and then start a petition to have the 7 day week extended to a 10 day week so I can have some time to go tramping (... is there an outdoor recreational activity that involves both physio and tramping? Adaptive outdoor neuro-rehab and/or chronic disease adventures through exercise perhaps?).

Thursday 10 September 2015

Y3S2W9: Celebrate Physio

World Physiotherapy Day occurs every year on the 8th of September. It is a day to celebrate and raise awareness of physiotherapy in the community and what better way to do this is than to offer neck/shoulder or calf muscle massages  to the public. All funds raised were donated toward maintaining Dunedin's Physiotherapy Pool.


The world confederation for physical therapy (WCPT) is a large promoter of physical therapy world-wide. They produce posters and banners for clinics  to display - below are two pictures from posters - very cool!


The regional physiotherapy body celebrated world physiotherapy day with a treasure hunt around Dunedin!! What better way to be physically active!


Integrated studies looked the role of physiotherapy in the mental health area. Dementia, depression, anxieties, psychosis etc. The first lab for IS was great! When we got through the patient assessments (questionnaires etc) we were invited to join in a mindfulness activity and a yoga-like relaxation activity. For whatever reason I was not settled and displayed some poor mindfulness and self-control (might have been the stress of resitting my presentation the next day). Anyway, here's what happened. The mindfulness activity involved taking two raisins. We had to see it as a unique shape, as possibly having a smell (yes we smelt it), we noticed how salivation had begun, after putting it in our mouth we felt its texture, taste, etc. The second raisin was to be eaten as we usually would... automatically. My problem begun right from the get go... after not having any lunch my automated response was to put it straight into my mouth, chew, swallow... bugger! So I had to get another two raisins. Anyway, this made a bit of a scene (we were sitting in a circle). Having demonstrated my inability to be mindful I should have known better than to complete the next activity next to somebody who snores. This second activity had us lying relaxed on yoga mats, we were to follow the instructions of the lab demonstrator (who was a specialist in the area of physio and mental health). Instructions guided out attention around the classroom and inward on our body sensations. The guy I was lying near begun to snore, he snored right in my ear and I struggled to suppress my laughter. After the class I apologised to the lab demonstrator for my lack of mindfulness (and self-control). What a lab!! The second lab was nice and short. It concentrated on the physio role in a dementia patient ward.

So I mentioned that I had to resit my clinical presentation. I was happy with this opportunity given that my 'winging it' before the semester break had not paid off... probably because I rambled about my patient and had little/no literature to back up anything. Cool, so round two was on Wednesday and I wasn't alone. It turned out another student had focused too much on the client case too (and rumoured to have put his slides together after waking at 5am the day of the presentation)... he's a smart guy and can usually ramble his way through anything. Anyway, I was prepared with a script and had re-jigged my powerpoint presentation. I kept to the same topic, answering the question "what is the best manual therapy for mechanical neck pain, given that the literature suggests they are equally effective?" So, how did it go Round Two? Well I got it all out in the end, even if I was over time (again) and wishing I had a bit more drool in my mouth to keep things running smoothly.

Our two hour CVP lecture on Monday was nicely split between our usual lecturer (topic: non-invasive ventilation) and a guest lecturer (another surgeon from Dunedin Hospital) on vascular surgeries and peripheral vascular disease. It was very interactive (very!) - the presenter didn't have a powerpoint, rather he just systematically go around class asking each of us questions and filling the gaps when needed. The third CVP lecture of the week (on Thursday) was on general surgery, presented by a general surgeon (actually, he was a breast surgeon specialist). He recognised that ERAS (enhanced recovery after surgery) lead to better patient outcomes, and physiotherapy plays an important role in this strategy.

In the labs we were able to experience some of the non-invasive respiratory devices (CPAP and IBBP). In addition, we discussed respiratory management for patient's with spinal cord injury and some last resort techniques for unconscious patients based on primitive reflexes. I enjoyed the CPAP and IBBP aspects of the lab the most. The CPAP (image below) is similar to sticking your head out the window of a moving car (not recommended...) or walking outside on a windy Wellington day... essentially it is a machine that blows air (or gas, possibly humidified - depending on the model) into your mouth or nose. The high pressure splints open the airways and is normally used on patients with sleep apnoea. I had a go talking with a nasal CPAP and found that it was most odd because the air rushes from the nose and back out of the mouth as you talk. This was entertaining. The other machine was a IBBP... like a CPAP this machine can be set to blow air into the mouth or nose, however it switches off when the flow rate stops (e.g. when the lungs are full) so the patient can breathe out easier. Put simply, this machine is interesting in that the machine does most of the breathing in for the patient!


Due to the success of the first cultural dinner (good job student exec!) we had Cultural Dinner 2.0. This was again at the Hunter Centre at 7pm on Wednesday. Again, there was a plethora of cultural dishes both mains and pudding! The personally think one of the key highlights is having the staff mingle with us, even with their busy schedules! Some staff are actually pretty dedicated to the cultural dinner cause, one staff had his cultural dish slow cooking on his office bookshelf from midday!

I've discovered elevator humour (sort of). On Wednesday we took the elevator down from 7th floor. When we got on, one of the overhead lights must have blown and we remarked that "the mood lighting was fairly effective" given that we were all standing closely in silence. The elevator then proceeded to stop on most floors on the way down as more people squeezed on. We decided the 23 person capacity was very optimistic given that 11 people was a stretch! One of the medical staff mentioned that they'd hate to be the 23th person, but I claimed that they would be lucky to be the first one off. The hospital staff are (mostly) very friendly, the pain team dropped in on a patient we were having a consultation with and reminded the patient to "be sure to press your PCA (patient controlled analgesia) button, especially when you know the physio is coming". Not only is this a good thing for the patient to do, as it allows them to perform respiratory and mobilisation exercises in less pain, but it is a funny inside joke that seeing the physio is an overall painful experience... great humour! The patients are allowed a sense of humour too, one patient I saw retorted to the question "how are you feeling today?" with "Well, I don't feel well enough to take you out dancing". We'll take that as a compliment. For some people, there are things on the respiratory ward that are not pleasant to do. Respiratory physio involves encouraging phlegm expulsion, and then looking at its quality/quantity. My physio peer (we were working in pairs) looked moderately disturbed when listening to the very wet sounding phlegm coupled with the sound of hard-work of bringing it up... then quickly turned away quickly when we were assessing the phlegm in the specimen container.

Thursday 3 September 2015

Y3S2W8: Chest physio & womens health.

This week was the start of my final placement for the year - 7th floor at Dunedin Public Hospital (cardiorespiratory). The weather was a little bit drizzly, so there was a clear trail of wet footprints on the carpet to follow as I walked through the front entrance to the hospital at 8:45am. A potent aroma of coffee greeted me, and I wasn't surprised to see a number of staff and patient's family cuing for this elixir. On the elevator, waiting areas and on the wards themselves, the hospital is generally a quiet place... until you listen more carefully then you hear the murmur of healthcare, patients and families - it's like the walls of the hospital breathing, but we shouldn't listen too hard. On the 7th floor we have a very small cupboard to store our personal items, then we're drawn to the nurses station - the morning begins. We receive a patient case file, decrypt the previous notes (not only are some people's handwriting illegible, but there are new abbreviations) and decide what our role is with this patient today. The pace in the hospital is not very fast, thus it's not at all like a MSK placement (which resembles speed dating in comparison). CVP requires you to give the patient time, and of course many of the other staff will be in line to visit your patient too. Then there's the unpredictability of the patient - their condition is usually less stable and if the physio is scheduled to see them but they have a hypoglycaemic episode, their family arrives, etc, then it becomes a juggling act towards the end of the day. We need not worry though, because provided they don't check themselves out then we'll see them the next day (or monitor them as needed). Another difference between MSK and CVP is the day/date awareness. MSK people are very aware of what day of the week it is, but often are unaware what the date is (you discover this when the patient fills in forms or when rebooking) - however, in hospital the date no longer matters and patient's start getting the day of the week mixed up! This is fair enough too because everyday must be the same for patients' in the hospital.

On day one (Monday) of placement three other peers and our educator introduced the placement with a discussion about our online case study and the wiki that we completed. Afterwards, we worked in pairs to treat our patients with a modest amount of supervision from our clinical educator. The main case I worked with on Monday was a man ready for discharge. We assessed his walking ability on the flat and with stairs and deemed him fit to return to his home. There are commodes at the hospital which can be used for transporting patients - I got to drive this to the orthopaedic gym on 4th floor with the patient in it... it turns out that it's a rear wheel turning chair, which means that we have to drift the chair around corners. Drifting chairs around the hospital sounds like fun, but we had to remember that crashing wasn't an option (they're not easy to steer) and my patient was >80years of age (I'm sure he wouldn't have enjoyed this).

On day two (Wednesday) I got to see a patient with idiopathic pulmonary fibrosis. The poor patient had an acute infection affecting the right lung, more than the left... as a part of our subjective/objective/treatment we needed to auscultate. We heard fine crackling in basal area of his left lobe with end inspiration, and throughout the breathing cycle and evenly distributed through the right lung - interesting! We were invited to have a look at an xray of another patient who had had a complete right lung pneumothorax... apparently the person had put up with what they thought was an exacerbation of asthma - ha!

On day three (Friday), I got to see a patient two days post CABG - he was still in phase one of the road to recovery plan. In this phase, the physio will assess his respiratory health (our patient had pneumonia a few weeks before his surgery), after treating his lungs (with breathing techniques) we mobilised him from one chair to another chair about two metres away. Our patient was a little bit unstead on his feet, so we decided that was enough exercise at the time. The physio will visit him over the weekend to help him continue clearing secretions effectively and mobilising him a bit further. The second patient I saw required a pre-op consultation with a physio (heart valve replacement) - so we got to do this without our supervisors attendance. We discussed his living situation, physical capacity and goals following treatment, then taught him the breathing techniques and educated him about the post-op plan (from a physio perspective) i.e. lung health, gradual mobilisation/walking, advise about wound care (bracing the chest when huffing), and lifting precautions.

CVP focused on physiotherapy for managing a patient pre- and post-operatively from surgery on their chest or abdomen. Key points to note were the management of patients presenting with restrictive versus obstructive chest conditions and the effect of incision location on our rehabilitation plan. The lab put this knowledge into action and we completed case studies, practised physio-patient interaction with some techniques. The School of Physio has a few full body manikins, and the manikin working with us today was Heartly. He wasn't looking to good (or feeling too good either... lightheaded due to low BP etc), with a chest drain in his pleural cavity following a lobectomy and nasal prongs to improve his oxygen saturation. It was our job to safely get Heartly out of bed and into a chair. During the lab we got to have a play with incentive spirometry, mainly because it is useful for people with a restrictive lung presentation, such as many people after chest surgery. Incentive spirometry requires the patient to breath in with enough suction to lift a ball off the bottom of a container - the ease of this can be changed via a dial on the device.

Incentive Spirometry 10s challenge.

The Integrated Studies theme of the week was Womens Health. We covered the role of physiotherapy through pregnancy (antenatal and post-natal care) including appropriate exercises for abdominals and pelvic floor, as well as strategies to assess and reduce posterior pelvic pain. We discussed postural strategies for minimising low back pain during pregnancy too. On the note of pelvic floor training, we investigated the high level evidence for reducing stress and urge incontinence and prolapse too. We were lucky to have a physiotherapist who is a specialist in Women's Health during labs and lectures. In the lab we got to lay around on mats (or plinths) and practice abdominal and pelvic floor training - good fun! And, hear about pregnancy education (using a pregnancy atlas) - not so much fun, especially for the pregnant ladies out there! Oh, and we got to see our classmate's bladder and abdominals with an ultrasound imaging device!


PHTY355 lecture was about running our own private practice. After listening to the business talk I left the lecture thinking that I'd like to focus my future of physio on health rather than earning big money through owning my own business.

Saturday 29 August 2015

Y3S2: Mid-Semester Break-ing Bad.



"The burden of research" pertains to the participants in the research. Occasionally minority groups are subject to research participation more than other groups, and this can be seen as a burden on these groups... but over the break, I  felt there was a burden on us to transcribe the interview because it takes a very long time to transcribe an hour and a half of interview! Luckily we could split transcribing the interview up within our group.

From the interview transcript (see last weeks blog post for info on what I'm talking about) there are two assignments.
  • The first is a group assignment where we discuss the meaning of 'quality of life' and 'empowerment' for the volunteer that we interviewed, then to discuss the role of the physio in maintaining functionality and wellness (based on volunteers experience). In addition, we hand in the questionnaires and interview transcript with it.
  • The second assignment... well... I can't remember where the instructions for it are...

I was up Signal Hill, which looks over Dunedin and the harbour, for sunrise on Sunday.
Sunday was then spent at the Sport Injury Clinic for there was a year 9/10 netball tournament which had athletes from Christchurch to Invercargill competing. It was quiet on the injury front, leaving only three knees and two ankles to strap between 9am and 3:30pm... again, it was a quiet day in the clinic.


I'm on placement next week at Dunedin Hospital. I'll be up on the 7th floor (ward 7A: respiratory, and ward 7B: coronary care). The placement description suggests we will be seeing inpatients whom have had elective or emergency cardiothoracic surgery, and respiratory conditions (COPD, pneumonia, cystic fibrosis etc). In preparation for this placement we have to complete a small online wiki and group case study... so I done that over the break. We were also asked to do some reading around anaesthesia, cardiac and respiratory conditions to refresh our memories and to help us with our line of subjective assessment (questioning) for these patients.



The University of Otago, and School of Physiotherapy have scholarships available for third year undergraduate physio students. One of the scholarships currently open for applications is the 'Sheila Consuela MacDiarmid Scholarship' valued at $1500 to be awarded to a student with an interest in further studies in the MSK area (with a strong academic and a developing professional standing). Sheila was a graduate of the Dunedin School of Massage in 1928 (now School of Physiotherapy) whom had a particular interest in orthopaedic work. I decided to have a quick search about Sheila, and discovered that she was a registered physio in the same year that she graduated (nb. the first physiotherapist to registrar in NZ was in 1921). I couldn't find any more info than that with a quick Google search. Anyway, I will add my application to the mix and hope to get an interview (the second part of the application process).

By now you'll realise that I enjoy the challenge of finding new spots to capture the Southern Lights (Aurora Australis) around Dunedin. Over the break there was a big display that was unfortunately washed out by a full moon. I still joined the chase and captured a small glow (which would have looked magnificent if it weren't for the moon). 

Aurora Australis, Waldronville (South of Dunedin)


Tuesday 18 August 2015

Y3S2W7: Public Speaking

It was my birthday on Monday, and again my kind hearted peers wished me a wonderful day and signed a card. They're too good!

Even at work, the team put on a morning tea, a happy birthday sign behind the reception desk and a card! Spoilt!



So what else happened on Monday? Well, we had two public speakers. Both of whom work at the Dunedin public hospital. The first was an anaesthetist. He described his how the anaesthetist developed from its historical roots, as well as his role at the hospital, making it clear that they do more than the stereotypical lounging around drinking coffee, listening to music, doing cross-words whilst the surgeons are at work. We got a brief insight as to the role of physiotherapy before or after surgery too. The second speaker was a sports physician who discussed conditions of the athletes heart, such as cardiomegalopathy and Spontaneous death syndrome / Sudden arrhythmic cardiac death syndrome. He also touched upon drugs in sport. Both speakers were exceptionally entertaining!

This is the week of our CVP community visits - interviewing people with chronic conditions about empowerment & quality of life in their own home. This meant that, in groups of three or four, we were off on very short road trips (some longer than others) around Dunedin to learn about a client's life, living with a condition(s). My group had organised Tuesday afternoon to visit our client. Each person in the group had a task, whether it be the leader, driver/navigator, QoL questionnaire researcher. I was fortunate enough to be the driver and lead the interview process for an hour an a half... as this interview is a key component of our next two assignments, somebody will need to transcribe the conversation word for word!


On Tuesday evening I was asked to medic Dunedin Technical Football premier lad's game against University. Having not been their sport medic this year (three second year physio students / sport medics have been looking after them) I arrived at the changing room to an almighty cheer - they must have missed me. By the end of the match they were joking that I was their lucky charm. Dunedin Tech won 16 - nil... what a slaughtering. My understanding is that this score margin is the record for the season so far. Well done lads! Dunedin Tech are currently second on the table, behind Caversham (same as in 2014).

Dunedin Tech (while/maroon) vs University (yellow/blue)

This was also the week of our clinical presentations. These presentations were about a case we were involved with or a condition/treatment/assessment procedure(s). For my presentation I attempted to emphasise the role of clinical reasoning and evidence based practice (literature, client preference, clinician expertise) by making use of a case I treated whilst on Unipol (MSK) placement. The case was a stiff neck with end of range pain (left rotation and side flexion) and I described how I went about choosing the best manual therapy technique (this happened to be Mulligan's SNAGs). Then, to finish I was going to elaborate on the technique and demonstrate it. However, following on from last weeks foolish 'no prep for the presentation' approach I rambled (probably quite poorly) through the allocated time and had to wrap up halfway through my powerpoint presentation... I didn't use any cue cards, didn't have a speech memorised, it was all purely off the cuff... not recommended. Others who had prepared well gave superb presentations!

There is a growing group of physio students who are keen to improve their photography skills, so on Wednesday night some of us made a trip to capture the night sky - I was on a mission to take a star-trail picture... here's what I came up with. The orange glow is from Dunedin city lights.

Papanui Inlet, looking toward Dunedin

Thursday was fairly eventful too. Our 8am lecturer was a physician at Dunedin Hospital who was involved with emergency ischaemic heart attacks. We got the overview from the paramedic to hospital interventions and soon came to realise that living in a remote place at the time of bad weather was not advantageous to minimising heart damage (or mortality) - many hours waiting for the rescue helicopter, then a return waiting time as you're flown back to hospital.

The 8am lecture was followed by a sitting in on more PHTY355 clinical presentations. From the presentations I've had a good reminder about MSK management for sore backs, necks, shoulders... some neuro balance stuff and today I heard about the student experience on the orthopaedic ward - especially the physio role in perioperative abdominal surgery. The following lecture was on patient rights in research - this all made good sense. Finally, our Integrated Studies lab in the afternoon was an eye-opener! The theme for Integrated Studies was phantom sensations, phantom pain and amputation. We were practising our amputee stump bandaging skills on models then had the opportunity to hear from an amputee - yes that's right, another guest speaker! This person had lost their hand in a workplace accident. They brought in their prostheses which included the classic 'Hook' (think Peter Pan) and a $100,000 bionic hand... yes, we got to play with the bionic hand!!

Current assignments on the go:
- Group and individual qualitative-based assignments from the info we collected during the home visit. I'll tell you more about these next week.

... Half the semester gone!! Off on a one week (mid-semester) break next week!

Tuesday 11 August 2015

Y3S2W6: Hokey Pokey


"You do the Hokey Pokey and you turn yourself around, that's what it's all about"
...and you thought I was going to talk about Hokey Pokey ice cream, right?!

On Wednesday we gave our group presentations. My group presented a community exercise and education programme for peripheral vascular disease to the class. This was a topic I knew a lot about (having covered it in a presentation in my BPhEd degree) so I was able to cover exercise prescription and management without much preparation or any cue cards. The exercise component included a choreographed 'Hokey Pokey' in which the audience (and assessor) joined in ... good fun! 

Other groups, with other topics, pulled out equally interactive and informative presentations... and put the hard work in as not to rely on cue cards!! The asthma group presentation had us breathing through straws then playing games like 'tag' - mainly because there is a high incidence of asthma in school aged persons... check out 'Jump Jam' on youtube to see how primary children can integrate dance and exercise. The COPD presentation was targeted to the elderly, so naturally we sat in a giant circle and done a chair aerobic warm-up, then kick many small Swiss-balls around the group circle. This was followed by exercising our upper limbs in the same way with balloons. The diabetes outreach team invited to the local Marae looked to incorporate Maori culture, and had choreographed a couple of upbeat songs for an aerobic exercise session; "Shake it off - Taylor Swift", and "Jump - Van Halen". I heard that another lab group on diabetes introduced themselves with a Mihi. The cardiac rehabilitation group had a focus on transitioning patients from a phase II to phase III programme. Many groups gave out 'home-made' information brochures. All the groups had a slightly different interaction between presenters which made it very entertaining - some gave a patient interview demo whilst others treated the audience as the targeted audience that we were suppose to be.

Integrated Studies focused on connective tissue conditions like fibromyalgia, rheumatoid arthritis, ankylosing spondylosis and gout. In the first lab, we were given the diagnostic criteria, practised evaluating xrays, and physical assessments of these conditions (n.b. xrays won't pick up on fibromyalgia... obviously). It also required us to think how we would adapt our MSK consultation for a patient with osteoarthritis and/or rheumatoid arthritis going in for a full hip replacement in two days time! For the second lab, we had a middle aged person come in so our year group could interview them and find out about how ankylosing spondylosis was diagnosed and what it is like living with it (they have ankylosing spondylosis). It was mentioned that their first port of call was a physio, and that physio didn't pick up on the condition (and neither did the chiropractor whom they saw after a year of non-improving symptoms)... rather it was an osteopath that referred the patient for an xray. I'm not sure whether Osteos refer most people for xrays, but I'm pleased the condition was diagnosed so it could be appropriately treated! Ankylosing spondylosis is a disabling condition, and when medically treated can put the patient back to near 100% functional, pain-free living!

Required readings are usually articles or book chapters that we are REQUIRED to read (they are usually associated with a lecture or lab)... it is expected that we know the content in these texts. Anyway, reading these is usually a mundane task. Occasionally we will be required to read an article that strikes us as interesting or enjoyable to read. One article (that may have been last weeks required reading... don't stress, we'll have a one week break soon for catching up) that was strikingly good to read was: 
'Pryor, J. A. (1999). Physiotherapy for airway clearance in adults. European Respiratory Journal, 14, 1418-1424'
Confession: I don't usually read articles from beginning (intro) to end (conclusion) - usually it's the abstract followed by the discussion that I read first... followed by whatever section in a jumbled order has the info I'm looking for. This probably isn't good practice - but it's proven to be time efficient. However, this text gave a historical background on physiotherapy / respiratory therapy in the introduction, something that struck my attention before I had a chance to skim-scroll-down (a.k.a "eyeing up") the document. So this is one of the few articles I have read from start to finish (from intro to conclusion). Here is a brief bullet-pointed outline of the origins / development of documented respiratory therapy adapted from Pryor (1999).
  • An Assyrian text instructed that a condition characterised by 'fits of hissing coughs, murmuring wind-pipes, and phlegm' be treated by 'braying together roses and mustard in purified oil, then drop some on patients tongue and blow some into his nose'... then "he shall drink several times beer of the finest quality; thus he will recover".
  • 1898: The 'intermittent' then (1901) 'continuous' postural [drainage] method was described for bronchiectasis.
  • 1915: Soldiers with lung injuries were given 'exercise' and taught forced expiratory techniques.
  • 1953: Vibration and percussion techniques were added to postural methods.
  • Post-1960s new technologies emerged from around the world, and have been adapted by others since.
    • Belgium's 'Autogenic Drainage'
    • New Zealand's 'Active Cycle of Breathing Techniques'
    • Denmark's 'Positive Expiratory Pressure'
    • Switzerland's 'Flutter'
    • USA's 'Incentive Spirometry' & "frog breathing / Glossopharyngeal Breathing"
"We've got to die of something, eventually". On Thursday morning we had a lecture from a cardiothoracic surgeon working at Dunedin Hospital. Although there was very little relevance to physiotherapy, we got a good history about the development of surgeons, the problem solving and chaos they were faced with. Apparently Henry VIII empowered barbers 'barber-surgeons' (yes, the people that shave man's face and cut hair) to perform surgeries... mainly because they had sharp knives/blades. Historically, problem solving was related to sterilisation, keeping the lungs inflated, anaesthetic, and there was a belief for some time that if you touched the heart it would go in to fibrillation (it would have been very hard to operate on the heart without touching it!!). The surgeon described their role (general procedures for various conditions and materials i.e. heart valves) when repairing the plumbing or heart components. 

On Saturday we had the Physio Ball. There were a couple of pre-ball gatherings, with good food and great company. It was raining, but that didn't put a damper on the evening!


The ball itself was set at Dunedin's iconic railway station. There was a lot of work put into setting up the ball room to make it look Grecian (big thank you to the ball committee). The ball had everything: food & drink, live artists, DJ, lights, cameras, dancing. Photo-wise there was a photography guy who stayed around the dance floor, and a dedicated Grecian scene group photo area - with props n' all!  



Wednesday 5 August 2015

Y3S2W5: Hands Up

Last Friday we were given our preliminary fourth year placement locations. I'll keep you all in suspense as to where I'll be placed. I created a quick graphic showing where AUT send their fourth year students versus where UoO send their fourth year students. (My artistry is at a 'stick-man' level, so bear with it!). Pleased note that I've likened the students of both schools to superheroes (and not making one a villain)... However, I'm pretty sure Yoda would beat Superman if they were to clash over a turf (clinic) war... 


Hand therapy was the theme of Integrated Studies this week. We had a guest lecturer Hand Therapist take two lectures. The first lecture was pretty gruesome (awesome)! We saw hands that had been chopped, crushed, burned, broken, congenitally deformed, post surgery, missing skin... we were impressed to learn about the intricate work that a hand therapist can do to facilitate healing of the hand. We were reminded of the complex anatomy of the hand and forearm then given skills to differentially diagnose the involvement of different structures. The lab associated with this theme had us measuring pinch strength, sensation testing with filaments (it reminded me of fishing line of different diameters), STI testing (Shape, Texture, Identification test... nb. physios don't do sexual health screening), palpating structures (bones, ligaments etc), differentiating between extrinsic and intrinsic muscle stiffness (i.e. lumbricals), muscle testing (very specific!!), reducing a finger dislocation, and differential diagnosing (tennis elbow, radial tunnel syndrome, posterior interosseous nerve syndrome) and treating conditions of the upper limb such as Mullet Finger & swan necking.

Hand Therapy is NOT Palmistry
One of our lab demonstrators for a hand therapy lab suggested the following book was a 'bible'... so I've added it to my growing physio library of books (and ebooks).

The CVP lecture and lab looked at physio interventions for respiratory disorders: breathing control techniques, relaxation positions, postural and autogenic drainage, flutter/acapella and PEP (positive expiratory pressure), percussion/vibration. We also looked at inhalers, spacers, nebulisers and oxygen therapy devices.



Cultural competence lab had us reflecting on our prejudices, culture and building rapport by talking about our ancestry/family history and ties to regions of the world/NZ as is the cultural norm with Maori greetings (rather than introducing ourselves and getting straight to the point of what brings them in to the clinic).

In social events this week, we had an inter-faculty quiz night on Thursday and a piss-up on Friday!



Coming up next week is the annual physio ball!

***

 I spent some time browsing around the internet for more physio memes!  
I'm definitely blurring the line between good humour and poor taste with a few of these.












Hopefully you got a chuckle from a few of those!