An extra-curricular event turned into a major highlight of the week. It started on Wednesday, 5:30pm, with a presentation on auroras organised by the director of the Otago Museum, Ian Griffin. Ian is an avid aurora photographer whom shared his passion for auroras and photography journey. There were other guest speakers who explained the science of auroras, the history of auroras in NZ (of which dated back many decades), and how to go about photographing them. There just so happened to be an aurora storm brewing that night, so after the presentation I raced out with my camera (already in the car, set to go...) and snapped up some more scenes around Dunedin. I spent the first 3h hiking around an unfamiliar farm walking track to only find one composition worth taking a picture of (Paradise track to Highcliff track). The storm was almost over by this stage, so I promptly made my way to Hoopers Inlet - a safe composition location, to make the most of the southern light display.
...Right, back to physio talk. Respiratory pathology was the theme of our Monday morning. The 8am pathology lecture discussed COPD, which was useful because my placement at 9am was a community COPD placement. This is my last placement block for the semester... lets break it down a bit.
On Mondays we do home visits to patients referred to us by the asthma society, these patients tend to have severe COPD, amongst other chronic health conditions. I jumped at the chance to get the ball rolling and called dibs on telephoning and taking the lead as physio for the first patient. We travelled in the asthma society vehicle then it was shoes off at the door (figurative and literally). My patient was an older female with COPD, recent respiratory failure, diabetes, sleep apnoea, osteopenia and at higher falls risk. I checked in on her diabetes management and energy levels before we went outside to complete a 6min walk test. The second part to the visit was to make sure she was confident with her home exercise programme. "Compliance to a home exercise programme is measured as the thickness of dust on top of the their exercise printout". Thankfully there was no dust collecting on this patients exercise programme. With such positive rapport gained, she happily showed us her CPAP (continuous positive airway pressure) machine to treat her sleep apnoea and oxygen tank in her bedroom.
The second home visit was to a middle aged female with bronchiectasis (COPD). She was having trouble clearing phlegm. We put our chest auscultation, percussion and vibration techniques into action. She was able to clear some sputum from her left lung - we probably could have got more if she hadn't coughed a large amount up before we arrived. This lady also has a nebuliser with saline topical inhalant which is used similarly to washing a bowl in the kitchen - the water (saline) is put into the bowl (inhaled in to the lungs), in the bowl the water loosens off the foodstuff (thick mucus), and then the patient attempts to empty the contents into the sink (coughing the phlegm into a tissue).
On Wednesday, we were based at the clinic treating patients who weren't quite ready to return to the respiratory rehabilitation programme but well enough to attend exercise sessions at the School of Physiotherapy. One patient of interest that I was treating was a middle aged male who was recovering from a recent liver failure with COPD, low back pain, oesophageal varices (think varicose veins normally found on the legs, but these veins are in the gastrointestinal tract), and has had a few joint replacements. By now I hope you can appreciate the complexity physiotherapists are trained to rehabilitate.
Friday was a new setting again. We were providing education and exercise to the Pacific Islanders (associated with the Pacific Island Trust). These Pacific Islanders are keen to make healthier lifestyle changes. What makes this placement unique is the intervention style, which better meets the needs of the ethnic group. We will attempt to be especially culturally sensitive and incorporate cultural knowledge (games/activities/other values) into our Friday sessions. Today we were assessing their individual cardiovascular risk factors. There were three stations: height/weight/waist circumference, blood pressure, and blood glucose/cholesterol. I was in charge of taking blood pressures and calculating their risk of cardiovascular disease within the next five years. You can find more info about measuring your own risk factors here (contact your GP or physio if you have any concerns): http://www.knowyournumbers.co.nz/
Our MSK lab was on lumbar spine manipulations (yes, that's our Million Dollar Roll technique!) We also refreshed our palpation skills and assessment of mobility for the cervical spine as some preparation for next week MSK lab on manipulation of the lower cervical spine. In our MSK tutorial we had a shoulder case study and we worked through a differential diagnosis and treatment strategies. I found time to practice the MSK content covered so far with a peer on Thursday... I dear say that there will be plenty more peer-practice sessions to come!
Neuro had us examining the use of physiotherapy in long term management of progressive neurological conditions. An update on my modules... I've taken a 'lets do bits of everything' approach with the last three modules: paediatrics, spinal cord injury and peripheral nervous system conditions. I'm almost finished. A group of students booked a room out to watch the neuro DVDs associated with the modules. It was useful to have an open discussion about the impairments everybody else was observing.
Physical agents lab focused on TENS (transcutaneous electrical nerve stimulation). We had these hand-held devices sending tingly sensations through electrodes placed on our skin. There were different treatments including: conventional, acupunture-like and high intensity. The tingly TENS, from conventional treatment parameters, can be left on muscle tissue for almost 24/7. By the end of the lab I found myself playing with the machine, increasing the stimulus to contract my muscles... as it turns out, the 2x AA batteries can produce more stimulation than I can tolerate. Later in the week we had a lecture on interferential current - this will be next weeks toy... I mean treatment modality. Interferential current is slightly different to TENS (although appears to be similar). The main point of difference between TENS and interferential current is in its applicability. Interferential current uses two different pulse frequencies to treat a common (often deeper) tissue without stimulating pain receptors. The treatment pulse is the difference between the two frequencies. This is used to preserve muscle mass... it is especially useful if you had a spinal cord injury... or if you plan to sleep all day. TENS is mostly used to treat pain.
We have an assignment for the physical agent component of PHTY354. It's a vague case study with a few questions to answer in a 1500 word essay (basically, what is the likely diagnosis and how would we treat it with electrotherapeutic agents). This is due at the end of the semester (i.e. two weeks from now). The word limit isn't too much of a problem, rather it is fitting in time between the other demands and preparation for exams... and the rare time-out for yourself.
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| Hoopers Inlet |
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