CARLA

A description of my physical appearance and, I suppose, my behavior is important with this next story.   It would help also if you have a recollection of old TV shows.

I am a short woman, with curly black hair.  I tend to smile alot and have been described as feisty or spunky.  I have a good sense of humor and can use sarcasm in an appropriate way.   The old TV show you should draw your attention to is "Cheers".  If you are not familiar with the show,  look it up.  It was a 30 minute sitcom filmed in a bar in Boston that will make you laugh out loud.  

Carla, played by Rhea Perlman, is the feisty barmaid from the show, "Cheers".  She is very short with black curly hair.  She is feisty and shows a lot of spunkiness.  Sound familiar?

Josh, a patient I saw many times, saw a similiarity between me and Carla.  So, that's what he called me, Carla.  However, he did not just call me that in the clinic, he spread the word around the small community I was working in.  Let me explain.

A new patient arrived at the clinic one day and said she had an appointment with Carla.  I immediately knew she had talked to Josh.  I asked her how she knew him. She stated,  "All I know is that, an electrician is at my house (Josh was an electrician) and when I told him I was coming here for physical therapy, he told me to say the name, Carla."

Another time, there was a concert in town. I was going to with a girl friend and Josh happened to be going with his wife.  I made the mistake of telling Josh where my seats were.  My friend and I had just arrived at our seats and sat down, when Josh appeared about 4 rows in front of us. 

With a loud booming voice he spoke to everyone in our section saying, "hey everyone, Carla from Cheers is sitting in this section, right there."  Of course he pointed directly at me.

When I left that small town clinic for another larger clinic, Josh found me.  He walked into my new clinic and asked the receptionist if he could talk to me.  However, he asked her to call me Carla over the intercom.  I heard the page and immediately knew that Josh was in the building.

Hearing the name Carla will always put a smile on my face and a memory in my mind of a fun patient named Josh. 

"NOOOO, I DON'T SMOKE ANYTHING"

The new laws in marijuana around the country have shed a new light on this next incident.  Maybe the individual would have received the job if he was in Colorado, but in Kansas there was no way. 

After 30 years of  outpatient physical therapy I needed a change in scenery.  I transferred to an industrial rehabilitation clinic.  In this clinic the focus was on the working individual, such as workers compensation.  We also administered post offer physical ability testing for many companies.  Post offer testing* is administered after the job offer is made, but the individual must pass this testing to be employed.  So, it is part of the hiring process.
The individual, let me call him Mark, was being tested for a position in a warehouse.  He would be handling a forklift and other motorized equipment as well as lifting heavy amounts manually.  He needed to be physically strong, mentally alert and stable on his feet.

The physical therapy tech in the clinic performed the initial intake of this client, involving some paperwork and a brief history.  I noticed a peculiar expression on the tech's face when she walked over to me to discuss the client. 
"I think Mark is high.  He smells of marijuana."  she stated.

At this point, I felt it was time for me to assess the situation.
"Hi Mark, I am Becky, the physical therapist.  I have a few questions.  Do you smoke?"  I asked.

"Noooo,  I don't smoke."  He replied, shaking his head.

"Do you smoke anything?"  I asked again.

"Noooo, I don't smoke anything."  He replied again.

"Well", I stated, " you smell of marijuana".

"Oh", he replied, "the guy that drove me here was smoking."

With a tilt of my head and questioning look I replied, "He was smoking marijuana?"

And then boom, it was like a V8 tap on the head, and Mark remembered that smoking marijuana is illegal in Kansas.  He began a bit of a stutter and stated, "well uh,  not maijuana, uh, you know that stuff that smells like marijuana."

Hmmmm, not sure what the smell alike stuff is called.  But considering that I had no direct evidence of marijuana smoking, other than my intuition and my very good sense of smell , I proceeded with the testing.  At one point in the test, he was required to maintain the squatting position while performing a task with his hands.  While doing this activity,  Mark just rolled over on to the floor to his side, in a bit of a haze, unable to maintain the position, and began laughing a bit.  
Busted. I guess my sense of smell and intuition did not let me down.

Obviously, Mark was not recommended for the job at the warehouse, due to being unstable on his feet and not being mentally alert.  However the underlying reason for not being recommended was just plain stupidity.

The lesson learned from Mark is to not smoke marijuana before you do a post offer test for a job, in Kansas and I might even venture to say, in Colorado as well.

THE SKEPTICS

Oh! The nonbelievers.  Sometime in your job you will probably have to work with a nonbeliever or a skeptic. That is the individual and many times the consumer who just does not believe your job is important or that the products or services you provide are necessary.

  I love the skeptic, or maybe I should say,  I love to prove the skeptic wrong.

"Hello,  My name is Becky and I will be your Physical Therapist.  I see that you had a menisectomy surgery (knee surgery, not necessarily minor but not too complicated.)  about a week ago and the doctor is now ordering physical therapy twice a week for one month."

She replied with an attitude,  "Hi, yes I had surgery a week ago and I am doing just fine.  I do not need physical therapy.  I think you are in cahoots with the doctor and I do not think this is necessary. I think it is all a scam to get my money.  I came today, but I will probably not come again."

Ok then.  A skeptic walked in and a believer will walk out.  Just wait.

I could tell by the way she was walking that she had some weakness in the knee.  I knew just the right test to win her over.

"Okay, let me know do an evaluation,  I will do electrical stimulation to decrease the swelling and teach you some exercises.  After we are through, we will discuss the need for future appointments."

She replied,  "Ok, but I do not need physical therapy.  It is all a scam."

During the evaluation, I asked her to lift her leg with her toes pointing outward, keeping the knee straight.  She attempted the movement and was unable to lift the leg.  The muscle required to perform this activity, the vastus medialis, was completely atrophied or shrunk up and was not strong enough to lift the leg.

Her response was, "Well shit,  I can't do it.  I guess I do need physcial therapy".

Ahhhh, One skeptic down, One new believer.

This individual recovered fully.  She is able to golf and bowl with no problems and has become a good friend of mine.  An extremely good outcome.

Don't let a skeptic get you down.  Rise to the challenge and prove your importance.

Hell Calling

Physical Therapy can be a bit brutal.  The therapists work on joints that may be stiff and not wanting to move and it will hurt some, okay it might hurt a lot.  And the phrase "no pain, no gain" is correct many times. However, we are not evil and we do not receive instructions from Hell.

A male teenage patient came to me for physical therapy after a car accident.  He was severely injured in the accident and due to this he was a very angry young man and was not dealing with his problems in a productive manner.  However, he did have a good sense of humor in a rather sarcastic way.

I was seeing this young man for a frozen shoulder due to damage from the accident.  During one specific therapy session he was not in a good mood and  was tired of me  hurting him while I moved the arm.

He very cleverly stuck the hand that I was not working with into his pocket. His cellphone was in that pocket  and without me  realizing it he set off the ring tone on his phone.  He answered the phone as if someone was on the other line.

"Hello" he said, "yes she's here.  Just a minute."
He then handed me the phone and said, "It's Hell, they want to talk to you."

Without hesitation, I took the phone, put it up to my ear and listened to nothing and then said into the phone, "Okay, he will back to you shortly.  We are almost through."

You have to expect the unexpected and have a little fun. As angry as he was, I got a little bit of a smile from him and the rest of the session went smoother.

So if you get a call from hell, just stay calm.  It might be a wrong number.

WHERE IS MY MAGIC WAND?

There seems to be a misconception about physical therapy.  Many folks must believe that we have a magic wand and we wave it over you on the first visit and all is better.  I admit we are awesome, we do make people feel better and function better and we can do amazing things as well as maintain our humility.  However,  there usually is a little homework for the patient, exercises or change of some habits that will aid in the recovery. Without the homework progress will take longer and possibly will just be too slow for some.

Here is a typical conversation......
"Good morning, how are you today?"  I might say.
"Not much better" the patient might say and then add, "those exercises do no help."
"Really?" I reply and then ask "did you do them 3 times a day everyday?"
"Well..... No.......,  But I did them once and they did not help"

WHERE IS MY MAGIC WAND?

My favorite was from a young boy about 10  years old.  He was shown a few simple exercises to be done at home 3 times a day. His mother was also given the written instructions so she could help him if necessary.  His response to the question of doing his exercises regularly was....
"Yes, I did the exercises....... one time, in the car on the way over here and I don't think they helped."

WHERE IS MY MAGIC WAND?

A few of the exercises given to a patient maybe hard to do or a little uncomfortable.  Those are usually the most important exercises to do because they address the problem.  Therefore a response I have heard several times goes like this.
" Yes I did my exercises, but not all of them.  A few of them were too hard to do and made me hurt a little so I just did the easy ones."

WHERE IS MY MAGIC WAND?

Lastly, I like to catch the individual in their little white lie when they say they did the exercises and I know they did not.  Here is a fun conversation.
"Go ahead and start the exercises that you are doing at home" I say at the beginning of a session.
The patient will ask "Which exercise do you want me to start with?"
" Oh just do them like you do them at home."  I reply.
After sitting on the table for a few seconds, looking a bit lost and not knowing what to do, the patient will finally reply "Ok, I did not do my exercises at home.  I don't know what to do."
Busted and

WHERE IS MY MAGIC WAND?

BLESS THE MOTOR MORON; FOR THEY JUST SIMPLY CAN NOT DO IT

Oh, the motor moron.  All you physical therapists out there have worked with a motor moron.  This is the poor soul who can just not do it.  You instruct them to do a lunge forward, which seems to be a simple task.  However, the activity you get is undescribable. Let me explain with an example.

To strengthen the hamstring muscle post knee surgery, a fun activity to do is sitting on a stool with wheels and just walking.  High school age patients liked this activity and occasionally would race me or another patient just for fun.  On one specific day, I had 2 high school post knee surgeries patients, one male and one female, in the afternoon consecutively.

The young man had a crush on the young lady so he stayed after his treatment for a bit to talk to her. Feeling a bit cocky and wanting to show off, the young man challenged the female teenager to a stool race.   Now I had seen this young man walk on the stool and it was not pretty.  He went all over the place and just could not coordinate his legs to walk forward. I was worried.

Despite my misgivings, the race was on.  The distance was 20 feet.  "Ready, set, GO!"

The young woman stool walked directly to the finish line at an amazing speed with no problem.  The young man could not get the  stool to move forward. He was weaving all over the place.  He lost his balance and boom, he fell off the stool.

Of course, I tried not to laugh.  I asked him if he was okay. But, I could not help it and I started laughing as did the female teenager.   The young man snickered a little, stood up and said he needed to leave.

Being a motor moron can be difficult and humiliating and .............hilarious!

THE TRIFECTA

For about 3 years, I worked in an industrial medicine physical therapy clinic.  Functional Capacity Evaluations or FCE *,was a test we administered here.   Acquiring a medical disability or social security disability was one of the purposes for administering this test. . Occasionally a client will walk into the department for an FCE and will not be completely truthful about their condition.  

One day a  young man around 30 years of age, walked into the physical therapy clinic for an FCE to determine the need for medical disability. As he walked through the department to the testing equipment, he was dragging his left leg and grimacing with pain.  He was asked to rate his pain in the leg prior to beginning the test  on a scale of 0 to 10.  0 being no pain and 10 being emergency room pain and if rated at 10, 911 would be called to take him to the hospital. 

As he sat that calmly he responded with "9 1/2" and described the pain in his left leg.   Hmmmmm, magnifying the pain a bit? 

This was documented and the test began.   During the first half of the test, it was noted that the young man dragged his left leg  as he walked from activity to activity and continually complained of severe pain.  During a repetitive activity lasting for about 5 minutes he must have forgotten his leg was hurting and started showing no signs of pain.  After the task was over and he began walking to the next activity, a light bulb went off in his head and he remembered that he had said his leg was hurting.  However he must not have remembered which leg, because....

Yep that's right, he started  dragging the right leg.   The second half of the FCE he dragged his right leg around, grimacing with pain.  I  just observed and documented what I actually saw without questioning the client.   When the individual left the clinic, he probably thought he had pulled off the lie.  But he was busted big time. This young man  lied, magnified and was malingering or not wanting to get better.  I guess you could say he hit the trifecta.