Two Weeks of Shampoo

The last few weeks around this blog have been a little too serious for my taste. Time to stop taking on all the problems of the world and get back to the nonsense and fun about being a traveler.

Things are winding down on this assignment. 11 weeks are gone and only 2 remain. In a non-traveling life, I think months and years would start to blend together for me, but the constant change in job and location helps to keep my memories of events organized. If I lose track of when something happened, all I have to do is think about where I was living, and instantly I know when it was. When did the Red Sox play the Rockies in the World Series? I was living in Colorado Springs, so it must have been 2007 – Go Sox! This constant change also creates constant deadlines – projects must be completed before any big move, i.e. Christmas cards must be sent before this assignment is over, otherwise it will be mid-December before I’m situated and organized again.

The sun set a couple weekends ago. This has been a great assignment and moving on will bring more adventure but is bitter sweet.

The sun set a couple weekends ago. This has been a great assignment and moving on will bring more adventure but is bitter sweet.

As the time has gone on with being a traveling PT, I’ve become very good at estimating time in unusual situations. For instance, it takes about two weeks for me to memorize the light switch arrangement in a new apartment. Until two weeks has passed in a new place, I am likely to be found late at night, in the dark, feeling my way around the walls trying to find the right switches. I realized recently that I’m constantly thinking of all kinds of bizarre things in terms of time.  A Costco trip at the beginning of each assignment will be filled with estimations about whether each package is big enough or too big for the whole assignment – I’ve gotten good. Two large jugs of maple syrup (32 oz each) will last 3 months. We somehow ended up with too much maple syrup on this assignment, now we’re really having to eat/drink a lot of the stuff – woe is me. 🙂

Now that I think about it, this assignment has been a tricky one for managing the amount of products we have. We’re really isolated here on the island of Molokai, and there’s no major chain stores (except for Ace Hardware). The barge comes in only twice a week with supplies and most of the stores are locally owned and small. Most of the things we’ve been buying are limited in selection and you have to buy what’s available whenever you need it. I thought I was going to run out of body wash and spotted some on sale a couple weeks ago. I jumped at the opportunity to get a decent price. As the days tick down, the original bottle is still managing to hang on and I’m realizing that with a little conservation I probably could have made it through without the new bottle. Now, with all this extra body wash, the inclination is to try and burn through the bottle fast, make every shower a super-soapy-sudsy event. But, that’s not sane, I’ve really had to step back, use the normal amount of body wash, and realize that it’s alright if I leave a couple bucks worth of soap at the apartment when the assignment is over. Man, I thought my powers of soapy-estimation were better than that. Luckily, we’ve just learned that the travel PT starting the week after us will be moving into our apartment, it makes me feel better about leaving some extra supplies behind.

Time for me to run, we’re having hamburgers tonight, gotta start to eat down the beef supply in the freezer. I’ll write again next week before this assignment is done – the deadline is approaching fast.

Tips for Road Trips – Make the Miles More Fun and Sane

I find myself on long road trips at least twice a year. I work my winters in Colorado to be close to the mountains and, more importantly, to be on my skis as much as possible. In the summer, if possible, I like to find an assignment by the ocean. The trek from Colorado to open ocean is a long drive. I’m from Boston originally, so I’m frequently headed back to the Northeast. I love the adventure of long road trips, but they can really wear you down.

Here are some things you can do to make the trip more healthy, comfortable, and, most importantly, fun. There’s nothing better than enjoying the ride and pulling into port relaxed and ready to hit the ground running.

Eat Right.

This is by far the best thing you can do to make yourself feel better over the course of a long road trip. If you truly make the effort to eat healthy along the way, you’ll hit your destination feeling better all over. On my first few major road trips, I fell victim to greasy highway food, fried snacks, energy drinks, and beef jerky. OK, I still fall victim to beef jerky, but if I keep the other temptations in check, a little dried meat won’t hurt – it’s become a road trip ritual! A hallmark of my early travel career was pulling into the next assignment with an upset stomach and feeling really greasy. Eating right is by far the most important thing you can do to feel normal when you arrive at your next assignment.

Order the Salad

Most highway rest areas are going to have a place you can order a salad. If you can’t find a salad, there’s usually some sort of healthy wrap option. Granted, you’ll occasionally find awful stops without any salad, wraps, or even those woeful gas station fruit cups, but if you order a salad every time it’s available to you, you’ll feel better all over and experience less sugar-crash than eating easier and more tempting options.

Skip the Energy Drinks

It’s a road trip – you’re gonna need caffeine. But, please, please, PLEASE, skip the energy drinks. I’ve seen some strange things in highway truck stops, but few stranger than the 32 oz “BFC” by Monster Energy. Who knew such a thing needed to exist!? …that’s a lot of beverage. Energy drinks really take their wear on my stomach. An energy drink here and there may not be the worst thing, but over a several day road trip, your occasional energy drink can easily become a 1-2 a day stomach-smashing habit. Energy drinks lead to all the “no’s” of road tripping: stomach upset, sugar crash, and a tough time sleeping when you need to. Stick to tea or even coffee. I know coffee can wear down your innards as well, but not like that carbonated stuff will. There’s some great widely-available iced teas out there that are made with minimal added sugar and with an actual brewed-tea base, stock up on a few of those for the ride for when you need a little bump.

Seek out the Continental

Continental Breakfasts aren’t known for their nutrient value, but it’s free. If you have a free breakfast available to you that may have some fresh fruit, yogurt, or bagels, this is a much better option than popping into the quick mart at the gas station just before the highway. Given two hotels of similar price and quality, go for the one with breakfast included. It’s the most important meal of the day, and I’m convinced that one of these days I’ll figure out how to correctly use the make-it-yourself waffle machine.

Make Time for Meals, Real Meals

Time management will become a theme here. My first Boston to Colorado road trip was in college during the summer of 2004. Two buddies and I took turns sleeping in the backseat of my parents’ car (after mine broke down less than 20 miles into the trip) while the driver pounded Mountain Dew and Dr Pepper until he physically couldn’t drive anymore. We made the non-stop trip to Colorado Springs in under 36 hours. We were toast at the end of that trip. Of course, at the time, I thought it would be a once in a lifetime trip. It turns out he three of us would repeat the trip two summers later on the way to west coast clinical affiliations. This time, we brought 3 more friends with us and made the full trip from Boston to Huntington Beach, California – Coast-to-coast. We stretched it out and took 3 weeks to enjoy the journey (more on this later). After many, many more cross-country road trips, I have learned to build in time for things that matter.

Take time, every day, to eat one real sit-down meal. It’ll take 45 minutes to an hour extra, but you’ll feel better nourished because of it and ready for the next leg of the trip. Also, if it’s a decent option, Order the Salad.

Pack Some Snacks

Throw some carrot sticks in a zip lock, bring along a container of cashews, throw in a couple pieces of fruit you like. It took me a lot of road trips to figure out this simple thing: if you bring your food with you, you’ll rely less on service station food. Fortunately, there’s usually some food left over at the end of an assignment. I’ll pack what I can for snacks out of the stuff left in the fridge and stop by the grocery store the night before I leave for a few extra healthy foods. When you’re sitting around all day (driving), it’s natural to want to snack to occupy yourself – better a healthy snack than a bag of Fritos.

Travel PT Road trip

Our loaded car on a brief side trip to Glacier National Park. We arrived in the off season and had the park totally to ourselves. The national parks always make awesome side-trips.

Enjoy the Journey

It’s a really hard thing to do, but set a couple extra days aside so you can enjoy the ride. Afterall, “it’s about the journey, not the destination.” Fortunately in the case of travelers, the destination is also part of a larger journey, but I digress. Bottom line, take your time, build in side trips, and enjoy these road trips that can either be a hell bent charge to reach the end, or they can be some of the coolest memories of your life.

Root, root, root for the away team

One thing I love to do on long trips is to catch a road game. It’s a lot of fun to go cheer for your home team as the visitors. Check out your team’s schedule ahead of time and see if there’s somewhere you might be able to catch them while you’re both on the road. If you can’t catch your own team, just find a game that interests you, it’s cool to see different stadiums and it really breaks up the trip.

Side Trips

“If you aren’t taking side trips, you are not on a road trip. You are only driving.” -I just made that quote up, but I like it.

There’s the quirky roadside attractions: The Corn Palace, a 30ft Van Gogh, World’s Largest Ball of Yarn. There’s winery and brewery tours – better done AFTER a day of driving. And there’s the endless list of museums and halls of fame. My list of must make stops if you’re driving near them includes: Lincoln’s Tomb (Springfield, IL), Graceland (Memphis, TN), Baseball Hall of Fame (Cooperstown, NY), The Bourbon Trail (Kentucky), and add a day for any major national park you drive by. Skip the Rock and Roll Hall of Fame, not worth it, sorry Cleveland. America has thousands of roadside attractions that are worth pulling off the highway for – check ’em out!

Exercise

You may have to get up a little earlier in the morning, but some light exercise will make a great impact on the way you feel sitting all day. I personally enjoy a few mile run in the morning, but many of the campgrounds and hotels I stay in are right by the interstate. The added excitement of cars bombing by in an area not known for runners is a little too much for me. My second choice for a workout is the dinky gym in the hotel with a single cable and a stationary bike – enough to get the job done. However, frequently, my best choice is about 30 minutes of room-based exercise.

When I’m doing my in-room workout, I focus on hitting every body part to get the blood flowing, and I like to throw in a few postural exercises. When I say postural, I mean working the upper back and core and stretching out the chest – skip the push-ups, they are over-rated and will tighten your pecs, encouraging you to hunch over the steering wheel for the rest of the day. Work that upper back and scapular muscles by laying on your stomach and raising straight arms in front of you, to the side, and behind in 3 sets of 10 for each position, this will hit a few different group of muscle in your upper back and between your shoulder blades. Stretching the front and working the back helps you pull your shoulders back and over time will promote better posture and mechanics for you. I like to throw a few leg exercises in as well – lunges and wall squats are my favorites in the hotel room. Work the core with some slow bridges (laying on your back with knees bent and lifting your hips off the floor while tightening your abs), and you’ve completed a basic, but good exercise program to get the day going. Now go crush that continental breakfast without guilt, and good luck with the make-it-yourself waffles.

Travel PT Yellowstone Road Trip

The things you’ll see on a road trip…I spy a heard of buffalo out my window.

Use Your Resources

Apps (All mentioned are free apps available for iPhone and Android!)

OMG apps! There’s so many that can help you burn those miles of road with more ease.

A decent GPS app is a must. On my day to day I use Google Maps for navigation, but not on road trips! Waze (incidentally, now owned by Google), is a GPS app with some flare. Drivers live-time report road hazards as they drive. The app will alert you as you are approaching debris in the road, traffic and detours, or even the routine abandoned car in the breakdown lane. The alerts are handy and will help keep you safe. If I need to compare the time between a couple different routes or the time added by detouring to a different city, I use MapQuest. I find MapQuest to have the best options for adding and deleting stops to your trip and easily seeing the difference in trip length.

Beyond the generic GPS to get from point A to point B, there’s thousands of apps that specialize in finding particular services. I mentioned Urban Spoon already for finding food. That’s just my personal favorite, there’s other out there that will do the same job just as well. For finding hotels I use the Hotels.com app to book low prices, but the TripAdvisor app to look up hotel reviews. I also use TripAdvisor for reviews of road side attractions to see if they might be worth stopping. GasBuddy is an app that displays gas station prices including information on when a user last updated the price. GasBuddy helps prevent showing up at closed stations with an empty tank and helps find the cheapest gas every time. I’ve found a couple apps out there for RV users and even for tent camping to review and book campsites – Good Sam is a very popular service and app for RVers.

Grab a Buddy

With a little bit of planning, you can work a lot of friends into a single road trip.

If you’re lucky enough to know someone who needs to go in the same direction as you, it’s fantastic to have a co-pilot (to operate all those apps for you). The right friends will even fly-in to enjoy a segment of your road trip with you. I once had a friend fly in to enjoy a weekend in Vegas mid-road trip – what a weekend! There’s a lot you learn about yourself while alone on the open road, but having some company makes the miles fall away much easier.

Couch Surf

I stay with friends whenever I can. On a road trip last fall (of course, from Boston to Colorado), I was able to stay just one night in a hotel on a three night trip. Night number two I spent with friends in Chicago – we went out for dinner and enjoyed catching up. I then woke early the next morning and put the pedal to the metal to make a house party in Denver the next night – way too much driving for one day. But, visiting, eating, and partying with friends made the miles seem less like a chore and made the whole trip feel more like a vacation. I would gladly drive two hours out of my way to crash with a friend rather than stay in a musty hotel room. Think of your next trip and get on the horn to see who you can crash with.

Buy Local

Buying local is one thing you can do while passing through a place to do a little good while you’re there. Your money will do it’s part to help the local economy. Also, from an environmental standpoint, if you’re buying local, less goods are having to be shipped places using less gas to get them there. We’re already burning enough gas zipping back and forth across the country with overloaded cars, no need for everything we buy to do the same.

Eat and Drink Local.

To back up for just one moment to the eating well topic, some of my best road meals have been at local, small town bars and breweries.  Small breweries have tasty beers you can’t get anywhere else and usually have great food, even in the most unlikely places. By blindly following my Urban Spoon app to tasty food I’ve discovered killer small town dives and explored cities I otherwise would have zipped right past.  At local restaurants and pubs, you’re getting a meal, an experience, and doing the local economy just a little bit of good.

Travel PT Road trip camping

Camping did not make the list, but it’s definitely worth a mention. When the weather’s right, it’s a great way to save money, meet a couple characters along the drive, and enjoy some of the great outdoors on scenic back roads.

DIY Local.

Enough road tripping and you’ll need a wind shield wiper, a headlight bulb, a quart of oil, or a new axle (different story for a different time). Try to use local mom-and-pop shops. Avoid the huge box stores. Keep the good people of Anywheresville employed by their fellow neighbors who are all helping to sustain their own community.

 

Finally, ENJOY!

Road trips should not be a chore. Enjoy your time out there on the road. The highways of America have a lot to offer in unique experiences and sights. Grab a buddy and a tank of gas, and go see everything you can!

This piece was written in collaboration with Fusion Medical Staffing and originally appeared on their site at:

Getting There: Staying Healthy, Having Fun, and Enjoying the Ride

 

Jack of All Trades

On my very first travel assignment, almost 8 years ago, I quickly started appreciating parts of PT that I never thought I would be working in or ever need to recall from the most doodled-on pages of my college notes. But, there I was, 6 months into my career – that I had originally intended to be as a professional sports PT – and I was standing by a whirl pool doing debridement on a homeless guy. Alex, an experienced PTA with a crazy amount of passion for Physical Therapy, had recently taught me the ins-and-outs of the simple wound care we were performing and why we were doing what we were doing. On this first travel assignment, I was also baptized into the world of prosthetics. Alex taught me about shrinking the stump and different techniques for wrapping and making simple adjustments to the prosthesis itself. Alex was a neat guy who took a “non-traditional” path to being a PTA and was one of my best early mentors. Along with Alex, there was a handful of PTs with varying degrees of experience who were all willing to help me through my first travel assignment. Me, Non-Traditional PTA Alex, and a few other PTs were conquering all the issues of the good blue collar people of Lowell, Massachusetts – and were definitely not doing professional sports PT. The funny thing is, I enjoyed it. Prosthetics was a cool field. Wound care wasn’t anything I cared for, but it was different and new. I even got some early ER experience and found some excitement in the mayhem I would find every time I walked through those doors – cops, crooks, drunks, and broken parts of all kinds. I ended up spending 10 months in Lowell getting some quality mentoring and all kinds of experience in a wide spectrum of PT. This was the first place I experienced the kind of place where you treat “whatever walks in the door” (or rolls in the door), it certainly would not be the last. After a few contract extensions, I triumphantly left that assignment, nearing a year and a half of PT experience under my belt – I knew it all, nothing could surprise me now!

[Just something to listen to while you read – enjoy! About Kaunakakai, where we currently live.]

I’m somewhere around 20 travel assignments now – I’ve worked in about 30 clinics. It amazes me that I have learned something significant and useful on every single assignment. My new knowledge on each assignment comes from both the things my bosses and co-workers are doing well and the things that could be done better. Much of the time, I’m learning something positive directly from colleagues who have become specialists in their own unique mixture of whatever walks in their door. Often my education is purely experiential in working with a new population, a new culture, or in a new setting – home care, inpatient rehab, private practice, acute care, hospital outpatient, ER. There is just so much variety of what you can do with PT and how you can deliver it. At the end of every assignment I make a note of what I may have learned and confidently think, “Now I’ve seen it all, I can’t possibly see something at my next assignment that I haven’t seen before.” I’m being a little sarcastic here, but seriously, after a while, there can’t be too many surprises left… right!?

I knew on this current assignment I would have to be a true generalist and pull from many different parts of my skill-set. On this island, there’s no OTs, no SLPs, no nothing other than one other PT working at a community health center up the road. To really up the anti, there’s just absolutely no where else to find any specialists, there is open ocean between us and anybody else – referring out to someone more equipped for a particular job isn’t an option. We are essentially the only option for whatever ailment you can dream up. I took a phone call last week from a case manager in the large hospital system we are a part of. The main hub of this system is over in Honolulu, and there are many smaller community hospitals throughout the islands that are a part of this health system – although, I can’t imagine any one of these small community hospitals being any smaller or more isolated than Molokai General Hospital (MGH). Anyways, this case manager in Honolulu was wanting to send a Molokai resident back home but wanted to make sure we had both PT and OT for her referral. I explained to her that we do not have an OT here at the hospital and there are absolutely no OTs on the entire island, but that we are used to filling many roles and can handle the patient. The case-manager seemed unimpressed with a reply of, “OK. Thank you,” and hung up. After the call, I realized that in a way, I am fulfilling a very Molokai role. Nobody expects to have every resource available on Molokai, but many people fill multiple roles and help the community as best they can by wearing many hats. Many employees in the hospital have their main role, but then serve an adjunct role as the as infectious disease coordinator, or employee health director, or any other job title you can picture being a full-time position in most hospitals. A funny sidenote: I was talking with someone who was one of 3 employees of the local paper, a transplant to Molokai. She described how word got out that she was decent with computers, and people (mostly older people) started showing up with their computer issues at the newspaper office for her to help. People here don’t expect to have every amenity or service, but they help each other out however they can.

Kate and I have enough years experience behind us in enough different settings that we are able to confidently carry out the vast majority of our responsibilities. At MGH we cover inpatient, outpatient, ER, and SNF (14 beds in the hospital – 7 rooms). We are serving as hand therapists, neuro PTs, the Ortho Specialists that we actually are, and essentially work in the role of rehab specialist on every condition from the age of 1 to 100 with only modest resources. We have a surprisingly great clinic, gym, and staff, but are routinely having patients order equipment they need online – there is a local pharmacy, but it’s pretty limited in the DME department. Kate has taken on the wound care, and while I appreciate having learned some about wound care in the ol’ days with Alex, I’ll pass, thank you. My learning experience on this assignment was revealed to me early on when I realized all the additional roles I would be filling:

Social worker – Kate and I both worked our butts off last week to get 2 SNF patients discharged. We called family members, called outside services, and essentially fully arranged and negotiated these patients’ discharges. Kate even went to her patient’s house to help her transfer out of her car and into her home. Not what you would call billable hours, but good work that achieved great results.We are also a part of a team that is charged with delivering a decision on whether or not to admit SNF patients. The list of variables to consider is huge, since to even get here as a SNF patient, you are typically flying commercial on a puddle jumper. Also, you have to be thinking discharge ahead of admission – there’s no home therapy services, there’s no long-term nursing home, there’s no assisted living. If a person can’t ride a commercial flight with a nurse or be expected to discharge home – they shouldn’t be admitted in the first place.

There are no surgeons. When someone cannot or will not go off island for an Orthopaedic or other surgical consult, we are the next best thing. The PCPs, many of whom we have gotten to know well in a short time, are quick to refer anybody with an ache, pain, or movement dysfunction to us for more specific diagnosis and treatment. We are determining weight bearing status for acute fractures, managing follow-up appointments, and suggesting when someone might need additional imaging. It’s a unique experience to be working with a patient that you know should have surgery, but that off-island surgery is just not a realistic option in his world. I could write another entire blog about performing PT in reality – treating within people’s financial limits, having realistic/sustainable goals for patients, knowing when someone has reached their own individual ceiling of health. When a guy shows up needing a metal plate in his ankle, but that metal plate is a plane ride away that he’s not going to take, that’s when some real-world PT is needed and when we need to decide what the best conservative treatment option is for the patient.

I do feel well equipped for this assignment that requires a wide range of skills and a certain depth of knowledge. I would not recommend this assignment for anyone without a few years experience across a few settings. It’s nice to be in an environment where we get to use a full range of our skills as PTs. Most of the time PTs will work in a setting that sees only a very small slice of the full scope of practice. Sports and ortho is still my bread-and-butter, but I have gained a lot of skills and knowledge in other areas over the years. When I am back in Colorado in the winters, I work for a hospital that practices orthopaedics at a very high level. The patients with various sprains, strains, and fractures are handed down from a team of Orthopods and ER docs that absolutely nail their diagnoses. It’s a nice luxury, but to be honest, my diagnostic skills atrophy severely in the winter from disuse. As I’m bending and straightening joints all day, patients ask , “You had to go to school for 7 years for this?” I defensively explain how making their knee bend is only a very small part of what I learned in school and that PTs are trained across a large variety of diseases and dysfunctions. But, back here, I’m using every last bit of those diagnostic skills and every ounce of my education across a very broad spectrum of pathologies. The health community here may not have specialists or surgeons, but to be as comprehensive as possible, everyone else must work their role to its limits. It’s fun, challenging at times, and definitely a new learning experience.

Friends in Places

Recently, I’ve done really well at getting a blog out to you almost every other week (::sound of me patting myself on back::). The winters in Colorado are just too much damn fun to be sitting around writing on my silly website. That leaves the 7 months when ski lifts are closed to be productive and get some marginally decent writing done. The past several weeks, this blog has been quiet…. A clear sign I’ve been having too much fun outside of ski season.

Our first glimpses of Waikiki on our puddle jumper over from Molokai. In the group of tall building by the shore (Waikiki), the building we living in during 2010 is the furthest to the left.

Our first glimpses of Waikiki on our puddle jumper over from Molokai. The building we lived in during 2010 is center of the picture, but the furthest to the left and small in the group of tall buildings near the shore.

It all started when we moved to Molokai 4 weeks ago. After one weekend on Molokai, Kate and I could see the lights of Waikiki calling from across 26 miles of open ocean. 4 years ago, we had a 6 month home care assignment over there and lived in an apartment 3 blocks from Waikiki Beach. The job on that assignment was one of the worst travel assignments I have ever had. A quick review of my blogs over recent months and years will reveal several passing mentions of that job and my rehab-oblivious boss. But, the combination of my Craigslist-surfboard and the 5 minute walk to the waves of Waikiki made the assignment easily bearable. Early on in the assignment we made friends with a few other travel PTs. We spent all of our non-work hours kayaking to small offshore islands, hiking, singing karaoke, and eating at a delicious underground sushi bar. It was pretty awesome. Over a few months, we added one friend’s significant other and some new travelers joined the group. We reached peak form in month 5 and had – as the kids say, “a frickin’ blast.” Somewhere along the line, we discovered Honolulu’s best deal ever: a catamaran called the Na Hoku II – they would let you on for a local’s price of $25 and sail for 2 hours around the shores off Waikiki, with a free open bar. Our Saturday habit quickly became beach/surf, then booze cruise on the Na Hoku II, then sushi, then if still upright we would sing karaoke (and eat more sushi). Every week was a countdown to Saturday. We got to know the characters on our weekly routine – to start the afternoon, Captain Crash would drive the boat out of harbor while playing The Booty Song, to end the night at karaoke, an old local man named Uncle Ron would sing Smoke Gets in Your Eyes. During the hours between The Booty Song and Smoke Gets in Your Eyes, we would have a blast. That was the summer of 2010, We. Had. So. Much. Fun!

Diamond Head keeps a watchful eye over Waikiki. As seen from the blurry eye of the Na Hoku II.

Diamond Head keeps a watchful eye over Waikiki. As seen from the blurry eye of the Na Hoku II.

3 weeks ago, we somehow got the whole group back together in Waikiki. I can’t think of another group of friends that could all get back together in one place without somebody missing. Traveling PTs from the summer of 2010 came from the Pacific Northwest, Texas, Molokai, and Waikiki to be together for 48 hours of AWESOME. We hit all the old haunts: we had our afternoon on the Na Hoku II (minus Captain Crash) and made it to late night sushi/karaoke – complete with Uncle Ron still singing Smoke Gets In Your Eyes. We started mornings with killer brunches and finished our nights sharing memories of our old times together. Kate and I eventually made it back to our 9-seat puddle jumper headed back to Molokai for work on Monday morning.

We only had a short time back on Molokai, because just ten days later we had a trip planned to Colorado for a really great friend’s wedding. I grew up with the groom as my best bud. Eventually, when he and another close friend said they were moving to Aspen, Kate and I said, “We’re coming too!” The wedding in Breckinridge was beautiful. The weather was perfect. The foliage was at its peak for the 10,000 ft ceremony. But, that is NOT what I found myself talking about during my return to work earlier this week. Because of my friendship with the groom during our move cross country together, we shared many friends throughout different phases of life. At the wedding, I saw friends from growing up in the suburbs of Boston and also from my new, seasonal life in Colorado. Kate and I got to swing by our winter-time job to catch up with some fantastic friends, and had a bonus night out on town. We bumped into people we didn’t expect, but were happy to see them and had… a frickin’ blast. Having fun with a bunch of friends is what I remembered and was sharing with patients at work this week. What a great time with old and new friends! I apologize in advance for the abundance of ski videos the HoboHealth Facebook page will be posting this fall as a result of my one weekend in Colorado.

We got the band back together. Here's the whole 2010 group together enjoying a brunch in 2014. A great time.

We got the band back together. Here’s the whole 2010 group together enjoying a brunch in 2014. A great time.

So, what’s the point? This post is not long excuse for why I haven’t written in a few weeks. Sure, I’ve had fun this month and haven’t been able to write as often, but this post is meant as an example of the life I’ve chosen to live as a traveler. I sometimes think of the sacrifices I make to enjoy the places I get to live. It turns out that some of those sacrifices are made up in my own head and I’m getting the best of both worlds.

I sometimes get an uneasy feeling when I go back to hangout with friends from the “good-old-days.” I inevitably come to meet the NEW friend who is a neighbor of my friends, or a coworker, or a CrossFit gym-mate, or whatever. I guess the feeling I get is jealousy, but there’s also a feeling that I’m missing something by being away traveling; that me and this new guy could be really good pals if I were around more often. But, it’s really fun times like the last few weeks that I realize I’m not missing out. I’m off building relationships that are just as strong. These relationships are built on the traveling experience and only exist because of the Na Hoku II, knowing who Uncle Ron is, powder days in Colorado, and dozens of fun things between. Someday, I’ll get my chance to make a lifelong friend across the picket fence (or at least in the next RV parking spot over). For now I feel really good traveling and I’m having a really good time making great friends in unconventional places. I hope on this assignment that I’ll meet some good people who I can stay in touch with.

I’ll try to write more often. After all, it’s not going to get any easier to write with all the fun with friends coming this winter.

Travel safe!   …but not too safe… what’s the fun in that? 🙂

Red light. Green light.

Here is a Hawaiian Monk Seal. Only 1,100 of these endangered guys left on Earth. We did not almost trip over this one like we did the one mentioned in the last blog - but there he was, just laying on the beach enjoying the sun... just like us.

Here is a Hawaiian Monk Seal. Only 1,100 of these endangered guys left on Earth. We did not almost trip over this one like we did the one mentioned in the last blog – but there he was, just laying on the beach enjoying the sun… just like us.

I feel like we’ve graduated tiers of traveling on this assignment. We’ve reached a realm with only the other wild-ones. On this small, 8,000 person, 1 hospital island the two traveling nurses we’ve met are doing their work the rest of the year in places like West Sudan and St. Thomas. We have arrived. It’s just us and the other nuts who cannot fathom the inhumanity of a 9 to 5 in Pleasantville, USA. We have traveled far to the remote, quiet, pristine island of Molokai… only to continue working the 9 to 5.

In our first 2 weeks here, I have already found this island to be a place that will broaden my view on life and how life can and should be lived. Earlier this week, while out hiking, I said to Kate, “I think this assignment is going to be life changing.” She asked me why, and I quickly back peddled. OK, “life changing” may be a little dramatic, but this is a different place, and for 13 weeks I’m living a different life than I have ever known. It’s slower here, there are few people, much of the land is pristine – this is how the rest of Hawaii used to be. Last weekend, as we were walking from the local farmers’ market that takes over the center of town each Saturday, I had my arms full of local papaya, tomatoes, and avocadoes. I took a look around at the people and buildings – and the scenery – and knew that this place is very different from anywhere I’ve been before.

Up on our hike in the Forest Preserve. A beautiful jungle protected just behind the cliffs of the North shore.

Up on our hike in the Forest Preserve. A beautiful jungle protected just behind the cliffs of the North shore.

This past weekend, we headed up to large forest reserve. Between off road driving from sea level, then mountain biking, and then hiking to an overlook at 4,300 ft, we covered 16 miles one way (pretty good on an island that is 38 miles end-to-end). We saw one group of hunters while we were on the roads. On the bike and hiking trail we saw no one at all and on Labor Day weekend! The lookout at the top was socked in with clouds, but we had heard that if we waited a bit, a hole would usually clear. As Kate and I waited, we talked about Molokai. We’ve done travel assignments in a lot of places and hiked to a lot of far-off summits, but decided we have never been in a more remote place than where we stood at that moment. The clouds later parted, and we were treated to one of the best views anywhere.

Somehow, through all this quaintness, the 14-bed hospital remains a part of the 21st century. People show up on time for appointments, the days are busy, and JCAHO and their misguided standards reign supreme. I find myself rushing through the hallways to patient rooms, back to scheduled appointments, off to grab equipment. It’s a great place to work and is full of extremely friendly people (the “Friendly Isle,” after all), but it’s a busy hospital like any other. The dichotomy of the two lives I’m living in and out of work were displayed for me full force the other day as I headed out for a quick errand at lunchtime. I had the time, but needed to move quickly to be back for my 1 PM patient. I zoomed out of the hospital parking lot and briskly down into town where the speed limit is 20. As I hit the first stop sign*, a man driving 7 mph pulled out in front. SEVEN. This guy was driving 7 miles an hour. On the weekends, or after work, I behave. I’ll drive slow, walk slow, pop into little shops, and have exceedingly long conversations with strangers. But, I had to get back to work for a patient, and this guy was driving 7 miles per hour.

Our view once the clouds parted. Likely, there isn't a single person in that valley.

Our view once the clouds parted. Likely, there isn’t a single person in that valley and the ocean beyond stretches uninterupted to the Aleutian Islands of Alaska

This life here is definitely going to change some perspectives for me because of its simplicity and the slow pace. To really make things interesting, we are going without TV altogether, and because of weak cell signals Netflix is really hard to stream. (Now, no cable, that’s life changing. I’ve already decided to put the hospital-supplied cable box away when we get back to Colorado… except for football… or hockey playoffs… or…) Despite the slow pace, the roosters waking me in the morning, the empty hikes, and the empty beaches, a hospital is still a hospital and there is work to be done. In fact, here, there is work to be done 6 days per week (yeah, more on that later). We’re working hard while at work and trying everyday to slip back into lazy island life within minutes of walking out the hospital doors – It’s pretty awesome.

More soon. I have some great blog topics coming, but getting them written down takes some time. Stay tuned, and get out on the road! As travelers, we are given an awesome opportunity to see the many different sides of this country and world – Enjoy it!

*They call it a one stop sign island – However, I have counted several. There are no traffic lights at all.

Enter Island

A hike in the Haleakala National Park on Maui. Insanely beautiful bamboo forests.

A hike in the Haleakala National Park on Maui. Insanely beautiful bamboo forests.

As I write this, the sun has recently set and I’m sitting in the house Kate and I rented today. Our landlord will soon return to Seattle, but for now, he’s our quazi-roommate staying in the separate studio attached to the house. He’ll be finishing up a few house work tasks before eventually returning to Seattle. Nice guy, interesting guy. Apparently he’s a lawyer by trade, but has spent some time working in Denali National Park. At some point, he bought this house out here on the most remote of the publicly accessible Hawaiian Islands and clearly enjoys all the great nature activities here. He has two large lockers of camping and snorkeling gear in the garage collecting dust that he has encouraged us to use, so that’s a real bonus with this short-term rental. There’s also a mountain bike thrown into the deal that he spent part of yesterday afternoon fixing-up, JACKPOT! I’m sure we’ll get some more stories out of him before this is all over. Before getting on island here yesterday morning, we spent 5 days hiking, camping, and relaxing on Maui. My visits to Maui in the past have always been short, usually over a long-weekend from Honolulu, and usually packed with as much activity on as much of the island as possible. This time around, we concentrated the trip on two main areas of the island with a few days at each place, and we were really able to soak it in and relax. In coming from the Big Island, Maui was actually an increase in pace. More cars, more traffic, more busy, more tourists – my disdain for tourists is really quite impressive considering my living the vast majority of each year as a tourist in various tourist towns. I fear for my reintroduction to the mainland in 3 months – if Maui’s pace is too fast for me, I can only imagine the shock a city or metropolitan airport would bring.

Man, I hate tourists. We camped wright by the beach, it was really peaceful in the morning and evening hours.

Man, I hate tourists. We camped right by the beach, it was really peaceful in the morning and evening hours.

I’ve grown used to the small 9-seater planes we have been taking between islands. This trip to Maui was the 4th time flying by small plane in the last several months. To sweeten the deal on Mokulele Airlines, legs between islands are $50 flat rate and free from TSA searches and waiting in a line of any kind. It’s definitely flying with all the airport hassle removed. Yesterday, however, we did not fly, we took a ferry boat over to Molokai from Maui early in the morning. We rushed off to look at the house and then were able to quickly and truly settle back into relaxation-mode. Maui is slower paced than Oahu, the Big Island is slower than Maui, and Molokai is the slowest by far. The past 36 hours here have already been an experience. Afternoons have been filled with empty beaches and sleepy, small-town diners and bars. The land here is dramatic and beautiful. This afternoon, we took a walk up a small dirt path from the beach we were on. We knew the dusty red path would lead us to some secluded beaches down the shoreline that are inaccessible by car. During a short walk down the path, we saw wild turkeys and a bunch of deer. The deer here are cool to see, but are not-native and highly damaging to the vegetation. The damage to vegetation ultimately leads to a whole other chain of erosion events and has big negative affect on water quality and sea-life. Luckily, these deer are tasty, so local hunters are able to put a significant dent in their population. Our beach-stroll turned nature-walk got really interesting when it opened up to an abandoned beach formerly occupied by a resort company that used to run this part of the island. As Kate and I strolled down the beach looking at the decaying buildings set a ways back from the water, incredible views in every direction, and crystal clear water breaking over shallow jet-black lava rocks, we somehow both failed to see the 500 lbs monk seal sleeping in the sun that we were literally about to trip over (when I say “literally,” I mean it). Kate was about 3 feet from the huge monk seal and his partner when in an instant we and the seals all realized the others were there. The huge seals rolled over and Kate and I did a super-speed reflexive sprint about 10 yards up the beach. I’m not sure about the true ferociousness of a monk seal, but I know they can move faster than you’d think and can pack a wallop with their teeth or tusks or whatever it is they have. As we cautiously circled to the other side of the seals at a distance, we watched the seals, they watched us, and it seemed like everyone understood that all four parties involved were equally surprised. There’s only about 1,100 of this species left, and here we are just running into two of them on a day at the beach… crazy. We continued a short distance down the beach and saw some fish and an eel swimming in a tide pool – nearby, there was a “lahge lobstah” shell dried out on the beach. This beach, departed only a short distance from humans was just totally saturated with life. Kate and I had been in the sun long enough, and headed back to the car. As we passed the seals, the huge one let out a bark at us, I think just to see how fast we could move again.

Taken as we approached Molokai on the Molokai Princess Ferry. A dramatic island.

Taken as we approached Molokai on the Molokai Princess Ferry. A dramatic island.

I can’t believe we haven’t been here two days yet. We’ve experienced a lot in our short time here. It will be a wild 13 weeks for sure. Work starts tomorrow morning! But for now the night is pretty quiet except for the roosters I can hear clucking around the neighborhood. More updates and pictures to come soon – I can’t believe I didn’t bring a camera on that walk today. Oh well, next time.

Relax to the Max

Kate and I finished our jobs on the Big Island today. A standard 13 week contract for each of us that flew by in no time. This is typically the time that we start packing bags for a sunrise flight to visit family on the east coast or throw all the bags in the car for a couple-thousand-mile road trip. This is typically hustle-time. But it’s different this time. As I relax and enjoy my pau hana (after work) drink, the bags are already packed and traveling the brief 120 miles to our next assignment. When we get to Moloka’i in 10 days, our car will already be there with a few weeks worth of Costco supplies packed in the rear. What to do in the meantime? Vacation!

We are spoiled rotten. We get to drive all over the country every year. Usually we travel by car and see some awesome sights along the way. Last spring we drove from Colorado to Maine by way of Key West (Get a Haircut and Get a Real Job! 10/6/13), the year before, we drove from Colorado to Alaska and returned on 10 day ferry trip down the North Pacific Coast (Alaskan Ferry Trip 12/17/12). These trips are always cool and create awesome memories, but they aren’t relaxing. The road trips are many great things, but they are not a break. Logistics, highway food, cheapo hotel beds, and an occasional call to AAA are the common obstacles. In the next 10 days, we will deal with none of that. We will just RELAX. (don’t do it)

A song about relaxing by a band with a travel-themed name. Really the perfect vacation song.

I haven’t written on here much at all about our next assignment, which, by the way, is going to be fantastic. I’ve been keeping a journal on the side. I’m not sure if it will become some sort of blog entry on here in the future, but for now, I’ll offer this brief summary of what we’ve gotten ourselves into: Kate and I will be the two Physical Therapists for the island of Moloka’i when the current PT goes on maternity leave. The only hospital on the island of 8,000 people typically needs one traveler following the recent retirement of one of their two PTs, but with the pending maternity, they will need two travelers. Kate and I will run the show for three months while hopefully grabbing a chance to explore one of the lesser known of the Hawaiian Islands. Moloka’i is less than 10 miles from Maui, but much, much, MUCH more rural and quiet. Moloka’i is one of the last unspoiled areas of Hawai’i and will be quite the isolationist’s travel assignment. A huge majority of people who live in Hawai’i have never been to Moloka’i, but many of the ones who have visited have shared their stories with me over the last few weeks. From tales of hunting wild African antelopes left over from a now closed safari park, to being trapped on a remote deserted beach for days, to the incredible kindness of (most of) the locals – everyone who has been to Moloka’i has a tall tale to tell. Perhaps in the future I’ll share some of the other stuff I’ve written about preparing for our trip to Moloka’i. To be honest, I started out quite skeptical and thought Moloka’i might be TOO rural, but I’ve come around and am crazy-excited for the next 3 months.

People do love their canoes on Moloka'i. Unspoiled beauty.

People do love their canoes on Moloka’i. Unspoiled beauty.

But, work in Moloka’i is 10 days away. The work of planning, and scheduling, and packing is done. We’ll wrap up our time on the Big Island over the next two days with some serious beaching. Then, we take a TSA-free puddle hopper over to Maui for 5 days of camping, hiking, and relaxation. Saturday morning, we’ll take the <10 mile ferry ride over to Moloka’i to let the real adventure begin. My biggest worry over the week will be preparing for a fantasy football draft on Skype with a bunch of buddies from school back in Boston (oh those goons). I promise many pictures over the next week and some unique tales from the upcoming assignment.

I have to run, the sun has set on the last day of Big Island work and I have to get to cooking this steak. 🙂 Aloha!

Mother Nature

An earthquake woke me up this morning.

I was pretty sure the ground was shaking, which was unusual since all that is under the house is hard, steady lava rock that doesn’t even budge when large vehicles drive by on the road. Kate was already out running, I quickly made a mental note that I needed to ask her if she felt an earthquake, and I was back asleep within 20 seconds. Sometime later, I found I had been laying semi-awake in bed for a while listening to the voices from the TV in the next room go on-and-on about the approaching hurricane. I sprung to my feet when the TV conversation shifted to the 4.5 earthquake that had struck this morning. I was a little surprised to find out it really was an earthquake and excited that I had finally felt one. We were in Anchorage 2 summers ago, where the earthquakes seemed weekly, and I never felt a single one. The news has been so inundated with Hawaiian hurricane histories and storm prepping tips, that I’m still not sure if any damage was done by the quake – it hit a fairly remote part of the island, so I suspect everyone is OK.

At the time of this posting (9 PM Eastern, 3 PM Hawaiian) we're about 5 hours from Hurricane Iselle making landfall here on the Big Island.

At the time of this posting (9 PM Eastern, 3 PM Hawaiian) we’re about 5 hours from Hurricane Iselle making landfall here on the Big Island.

Every single patient I have seen over the last 3 days has had an opinion about hurricane Iselle and the toll she’ll take on the Big Island, but the bottom line is we’ll just have to prepare for the worst, hope for the best, and wait. This storm is approaching from the East, the Hilo Side of the island, we are over on the West side in Kona. The Kona side of the island has sustained damage from hurricanes in the past, but these were storms that wrapped around from the South. This storm coming from the East will have to plow past two 13,000 ft volcanoes and a smaller 8,000 ft peak. These mountains may stall the storm and will likely take a lot of its force before it gets to our area…. but no one really knows.

In the meantime, we continue to wait. Kate and I both work for clinics that are closed this afternoon and tomorrow, hopefully we’ll scoot by with some wind, rain, and an otherwise relaxing long weekend. We should return to work on Monday for our last five days of work before heading off to Maui for a week’s vacation and then to the island of Molokai for the next 13 weeks… but that’s a story for another time.

Don’t worry about us, we’re prepared and we’ll be fine, but do keep Hilo in your thoughts and prayers, and hope they don’t get hammered too hard by the storm. Personally, after the earthquake this morning, I’m keeping a watchful eye uphill towards the volcano rather than downhill towards the sea. That Mother Nature, she’s a powerful one.

Continuous Education

I recently gave up my Alaska license because I didn’t have enough CEUs to renew. For a long time, all the licenses I held didn’t require CEUs, so it hasn’t been on my radar. Alaska is the first license I have had that has requirements, but some of the states I’ve been licensed in for years are adopting new rules for continuing ed requirements. I am based in Colorado, the continuing education tracking will start there after the 2014 renewals. I’m somewhat personally to blame for this, I have long supported CEU requirements and have advocated for states to adopt these requirements. I’ve heard people openly criticize these requirements. They claim that all continuing ed requirements do is drive people out to order crappy CEU programs that have little substance. I think this argument itself is crappy and believe that most PTs who have to purchase continuing education to maintain their licenses are going to reach for something meaningful rather than be the bottom feeders of their profession and community. In my case, I have 3 years to meet my Alaska continuing ed requirements and can renew at any point during that time. I have already order and started a HIGH QUALITY home study course from APTA’s Ortho Section that I previously intended to get but have been procrastinating for almost a year now. So, to you naysayers of continuing ed requirements, here’s one PT that was forced into getting high quality education by the very requirements you dismiss. And to those who believe that your years of experience are a superior substitute for structured professional development, you are wrong. I may not have been practicing for 20-30 years, but I have been practicing long enough to see huge progressions in practice – the way we assess and treat low back pain, the way technology has drastically changed total joint replacements, the proliferation of dry needling and manipulation – the list goes on… Each year that goes by, I realize how much more there is to learn, if you don’t see this, you’ve already fallen behind. People have been criticizing con-ed repeatedly in public internet discussions (I’m looking at you PT Twitterverse) and finally I get to candidly respond: You don’t know what you don’t know, and by fighting continuing ed, you are making yourself sound self-righteous and crotchety. The majority of your peers will consistently choose high quality education over the path of least resistance. Stop talking down on continuing ed requirements, they are a good thing for our profession.

Whew, sorry about that. I guess that’s been building up inside for a while. I hope smoke is coming out your ears from reading that last paragraph (my hair actually burst into flames). OK! Back to the story!

On the beach? Best place in the world to read a journal or home study course for CEUs. Continuing ed has never been better.

On the beach? Best place in the world to read a journal or home study course for CEUs. Continuing ed has never been better.

It’s not that I haven’t been learning. I read JOSPT every month, I read other articles when I’m not sure of something in the clinic, I go to coworkers’ places to knowledge-mooch when they have ordered a webinar. Travel PTs are ALWAYS learning. Different clinics have different techniques, different patient populations, and all kinds of people to learn something from. As a traveler you may work at one hospital that has the latest and greatest in surgical techniques and then you’ll work in a private practice that runs a manual therapy fellowship. A traveler is surrounded by casual learning opportunities, but we are not surrounded by funding for formal instruction – that is our challenge, our weakness. Unless you travel with one company for more than a couple assignments, you are unlikely to see more than a couple hundred bucks for continuing ed courses. But, there are opportunities out there – great opportunities! Great courses! And many of them are convenient for the traveler.

I have written in the past (Traveling doesn’t have to mean professional sacrifice 4/11/2011) about the opportunities for travelers to take larger programs like residencies and certificate programs. These are a big commitment, but force you to stay on path of continued education. Many can be completed through a series of weekend courses offered all over the country, so you can access your next stage of learning where ever you go. As I eluded to earlier, dry needling is a technique that has gained popularity and has some very high-level and quality learning opportunities. It wasn’t on my list in 2011, but it should be now!

There are smaller things a traveler can do for continuing ed credits throughout the year. Many reputable journals have read-for-credit programs where you can hop online for tests to demonstrate your knowledge on their articles. Credits are small, but add up over a year or two. The Independent Study Course I recently ordered from the Ortho Section, Applications of Regenerative Medicine to Orthopaedic Physical Therapy, has me fascinated in the first portion of a 6-part home-learning program. It is very high quality and written by THE experts. I will take a test at the end and get 30 hours of continuing ed – 30 hours! I have a co-worker who is finishing up a Foot and Ankle course this way. It’s a great means for people on the go or far away from a big city to get high-quality learning.

There are ways to get continuing ed without a huge hassle and without resorting to lousy courses that blindly dole out CEU’s for entry-level knowledge. Plan ahead, learn your states’ requirements ahead of time, and you’ll be fine. I’m well on my way to being able to re-instate that Alaska license should an opportunity arise.

Out of the Inbox

Licensure issues keep coming into my life recently. Here’s a recent email I received that offers some food for thought on tricks to get around licensure hassles. Share any tricks you have used!

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Question:

Hi!

I am a recent grad (2013) and have been doing travel PT with my boyfriend for the past year in Wisconsin and Texas. We’re now looking at getting our next license. Since everyone talks about how annoying it is to get a verification sent from each state you’ve ever had your license in to the state you’re applying for, we thought of a better idea… but aren’t sure if it would work and wanted your opinion.

We were thinking that we should apply to about 5 more states at the same time so that we only need verification from Wisconsin & Texas for each of those 5 states, in the end, saving us the hassle of sending 2, and then 3, and then 4, and then 5 verifications to each state we apply for in the future. Would this work?

2nd question: We looked at Texas’ verification request form which allows us to send it to multiple states for one $50 fee. Can we send it to 5, 6, 7 states even if we haven’t applied for those states yet? Then in the next year or so, apply for those states which already have our Texas verification without having to pay another $50 fee?

Not sure if you know the answer to these questions but just thought they were 2 ways to save money with the multiple state license applications and fees that go along with it.

Thank you for your time and I look forward to hearing from you.
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Response:

I like the way you’re thinking about licensure – getting all of those done at once by verifying only the 2 current states is a good plan and will definitely save you time and frustration. Although, over time, I don’t think it will save you any money, just because of renewal fees and that sort of thing, but it may be worth it for the trade off in reduced frustration.

I like the idea of getting multiple licenses at once, but I would only do the states you are sure you want to go to at some point. That way, if another state comes up that you want to get a license for, you don’t have to verify licenses you held but never used. Also, check the renewal process on these states ahead of time – check cost, CEU requirements, and timing. By timing, I mean that in some states everybody’s license expires on the same day – i.e. If every license in a state expires on January 1st and you just got your license today, you would have to pay a renewal fee in only 4 months.

As far as the Texas question, I think it’s a great idea to send as many verifications as you can if it’s all covered under one fee. I don’t see a downside. Typically, when a state receives any licensure paperwork on you (like a verification from Texas), they start a file. Some states keep an incomplete file 6 months, some keep it a year, some might keep it longer. You likely won’t have unlimited time to start the licensure process before they discard your verification, but I see no harm in requesting the verifications just in case you do decide to go.

After requesting all your verifications, I would follow up by phone to make sure they have all been sent/received. Also, I would send yours and your boyfriend’s in separate envelopes. In my experience, when my wife and I try to share an envelope, one of our verifications usually gets forgotten and our new license is delayed. Sadly, requests getting lost is the rule rather then the exception.

Hope this helps, I like your thinking!

James