Author: Hobohealth

Forest Gump and a New Clinical Prediction Tool

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Firts, let me first start with 2 (two) apologies:

1. I apologize for writing so sporadically. I’m getting married next month and promise to be more consistent in August.

We passed this couple while hiking on the N Shore of Kaua’i. She was wearing the same shirt as me from Jack Quinn’s Running Club who we used to run with in Colorado Springs.

2. Sorry the comments don’t work on the blog. In addition, if you click around, you’ll find the entire blog portion of this site acts funky. If you wondering why I haven’t fixed this already, please see apology number 1 (one).

On we go:

I do like running in different places. I especially like finding a body of water on vacation (lake, ocean, river, irrigation ditch) and running along side it. While running on assignment, I learn my way around the neighborhoods I live in and see interesting things along the way. On a recent wrong turn that took me 6 miles out of my way, I realized how quickly I could get into vast farmlands and have beautiful valley views (it didn’t seem so close on the way home). I also got an up close look at a roadkilled-porcupine. The porcupine was pretty interesting, but more than I had bargained for.

The last time I went running a small happening that I think most runners can identify with inspired the creation of a new predictive rule for the field of psychology. So, the moment you have all anticipate, my first independently developed objective measurement tool:

The Spencer Societal Startle Test (SSST)

The subject should be sent out for a casual walk on a public street. The investigator should dress as a recreational jogger and begin running from a distance behind the subject. As the investigator approaches the subject from the rear, a cough and foot shuffle should be performed at a distance of 20 ft to alert the subject of an approaching person. The investigator should continue to run alongside and past the subject.

Scoring: Score 1 (one) if the subject yells out audibly in surprise. Score 0 (null) if there is no audible reaction. A score of 1 indicates the subject will likely benefit from professional psycological intervention.

Clinicians interested in studying the SSST should note that it should be expected that the test will have strong specificity, but fairly poor sensitivity. Meaning, a high percentage of subjects who test positive under the SSST will benefit from psychological counseling, however, a negative score may not truley indicate that a subject would not benefit from psychological counseling.

Enjoy the open road…. some day I’ll write about this whole barefoot/forefoot running thing, it’s really been driving me nuts.

James

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James R Spencer, PT, DPT, OCS, CSCS

Current location: Skowhegan, ME

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Disparity

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We all know about the proven links between socio-economic status and health status, but I’m not sure we REALLY get it.

I finished an assignment in Aspen in late April and was working in rural Maine 7 days later. Aspen boasts the highest realestate prices in the country, Newport, Maine boast a truck stop that sells Fourloco. Making the quick move from a population of patients injured while using $100/day ski tickets to a population consisting primarily of Medicaid recipients whose back is prematurely deteriorating under their own weight has opened my eyes.

We have a huge problem that needs to be the focus of every future health care policy decision made in America. Prevention and early treatment are the answers to these people’s health problems and everyone’s pocket book. Many states’ indigent programs (Medicare as well) greatly restrict what services are covered. Frequently this means a person needs to have developed a problem and allowed it to progress to a more serious status before treatment will be covered. If the less foturnate have their early symptoms treated, they may avoid a more serious progression of their diseases, and we ALL will pay less.

For example: Medicare will not pay for a wheelchair pressure relieving seat cushion for a patient until they have a stage II ulcer (open wound). Rather than buying extra seat cushions early, we end up paying forcushions, the wound care for the ulcers, and a whole host of sequelae that result from the patient’s prolonged immobility. We’re talking TENS of THOUSANDS of dollars per patient. Prevention, people!

The other side of this issue is the lack of health care providers in the poorest of areas. Specialists have long wait times and patients get worse and worse while they wait to be seen. Again, early detection and complete treatment at the first signs of illness have the potential to unload the specialists and allow them to provide better service. Proper inital diagnosis by primary care physicians and treatment that they are appropriately reimbursed for will decrease the financial burden on us all.

I think you get the point. I’d like to say so much more but I’ve broken my own rule of keeping this blog brief. Feel free to comment for further discussion. Below is a related piece I heard on NPR yesterday, it really gets to the point.

NPR – Mississippi Losing the War With Obesity

Healthy travels,

James

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James R Spencer, PT, DPT, OCS, CSCS

Current assignment: Newport, ME

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ROADTRIP!

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Indiana Dunes National Lakeshore

Ahhhhhh, the open road.

I’m just getting settled at my new assignment in Newport, Maine. We drove in from Aspen from Tuesday to Saturday where I had a full refresher course of the fine art of turning a 2,000+ mile drive into something enjoyable.

One thing I remembered to enjoy was those unexpected “life experiences”: As we approached our hotel outside of Chicago that we found on the AAA iPhone app, we found it several miles down a dark access road paralleling, but not accessing, the main interstate. As we got closer, we found it sandwiched between two, ahem, Gentlemen’s clubs. The following drama of finding our way safely back to the highway, finding a new hotel at 11 PM, and eventually settling in to our far more comfortable (and far less grimy) hotel was an adventure that while not enjoyable at the time is a unique experience that does not happen during most peoples’ commute.

That next morning, we were able to stop close to our hotel to check out Indiana Dunes National Lakeshore. This is the spontaneous touristing that falls in your lap. Our visit 45 minutes off the highway drive to the baseball hall of fame in Cooperstown New York the next day is the other kind of touristing. While I’m talking about it, Cooperstown is definitely a pilgrimage worth taking for any baseball fan. I wish I had a few more hours there, a really cool place (except for all the Yankees fans 🙂 Aha! Go SOX!).

Road trips. I love ’em. In an occupation where the destination is definitely what it’s all about, this was a journey worth enjoying.

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James R Spencer, PT, DPT, OCS, CSCS

Current Location: Newport, ME

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Living

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My priority in traveling is experiencing places the way they REALLY are. Some people do travel for the good pay, some do it to test out a place before moving there full time, some people just do it for a change. I think living in a place is so different than visiting or going on vacation there, and that’s why I travel.

I love going to places and joining the local running club, learning the local hikes that only the locals know, and going to the bar with the good deals. I thought of this most recently on an over-night back packing trip in Colorado’s 10th Mountain Division Hut System. It was the kind of trip that would never, ever happen on a week vacation to Aspen. In my time here, I have developed a life with my regular hangouts, favorite runs, and my own friends…. Very different from a vacation!

I guess there’s the flip-side too. There was a town I visited growing up as a kid. Awesome, rustic summer vacations, scenic vistas, and plain-old good times. After living there for 5 months, I found this place to be a trashy, sprawling demi-city, witha highly transient population that was really the kind of place surrounded by cool stuff with very little to offer itself.

Living somewhere is very different from vacationing somewhere. Not necessarily good or bad, just different. I guess places are like people, some you are really drawn to, others you can only take in doses.

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James R Spencer PT, DPT, OCS, CSCS

Currently: Aspen, CO

Moving to: Skowhegan, ME (in 3 days)

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Traveling doesn’t have to mean professional sacrifice.

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This is the first blog of many. Enough with the statement of intention, let’s get down to it. Choosing quality continuing education programs as a traveling therapist can be a challenge. Courses are often found on-the-go between assignments or among a selection of whatever is available locally.

My biggest fear when a new PT tells me they want to start traveling are the potential loss of mentorship and professional growth. I think in my 5th year of practice (4th year of traveling) I’m just finally getting my head around the things that are important in PT practice. To understand the important pieces of practice that are so necessary to progress to my current level, some mentorship and progression had to happen.

continuing-education-travel-pt-hobohealthI don’t mean to say that an immediate new grad can’t travel, it just takes the right person who is willing to self-motivate and work that extra bit to find the professional expansion they need. My first travel assignment was perfect. It was in a community hospital with a steady staff and a solid director. I had the infrastructure around me where I could ask questions and work towards answers with my co-workers’ help. Ultimately, I found the mentorship I needed to grow. Because of the mentorship and support, I extended my contract there several times, a total of 10 months on my first travel assignment (longer than the “permanent” job I worked before traveling).

Clearly, you’re not always going to be able to find that assignment with all the support you want. So here’s my short list of the other ways to stay motivated, stay on track with your professional goals, and stimulate that mind of yours:

Take a certificate program (i.e. Paris, Maitland, McKenzie, etc.)

These certifications I personally believe are narrow in scope, but they require multiple courses and extensive study in their content. The process for each makes a person a stronger and more knowledgeable therapist.

Become an ABPTS Board Certified Clinical Specialist

This is most comprehensive way to expand you knowledge base in a specific practice area. The studying and learning required to pass the exam for a specialist certification is very time consuming, but will force you to stay up on the latest research and techniques. When you receive the certification it’s a great distinction for your resume and future interviews.

Attend state and national APTA conferences

Conferences are a great way to gain exposure to the highest level of practice. You can get education on a great variety of topics and practice setting in one place. The energy and inspiration at these meetings is contagious.

Enroll in a residency program

There are residencies that allow therapists to take a series of courses on weekends and collaborate with a mentor/expert through electronic means. Finding the right residency can be tough as a traveler, but it can be done if you are determined!

Add a new skill

Take a course on something specific you want to add to your tool box. The sooner you can put new techniques to work, the better, so maybe it’s a skill that meshes well with your current practice setting. Continuing education topics that come to mind for me would be dry needling, manipulation, wilderness medicine, primary responder for sports, mobilization with movement, or muscle energy technique, but your list might be very different from mine.