MEDICINE HUMOR!

How I Did It: Physical Therapy

Dr. Bridges Darko is a Doctor of Physical Therapy based in New York City

1) How and why did you choose physical therapy?

Growing up, I did not know anything about physical therapy or dream of becoming one until the late years of my undergraduate studies. My initial dream was to become an electrical/mechanical engineer, accountant or work in the military.  To me this was typical of a kid from South Bronx. As I began my college journey in the fall of 2001, I had no inclination of what major to pursue, so I spent my first two years without declaring a major.

In 2003, I took a year off from school and visited Ghana. Prior to going to Ghana, I cared for my late aunt for two months who was hospitalized at Mount Sinai Hospital in NYC. The experience changed my whole perspective and scope about life and provided me with an opportunity to shift my focus towards the health field. Once I decided to go into the health field, my father who is one of my biggest aspirations advised me to pursue nursing or become a doctor based on the job security, financial stability, and other advantages within these professions. In the process, I reconnected with an old friend whose father was a surgeon and worked for the NFL franchise, The New England Patriots. He encouraged me and offered me a job as a Sports trainer after completion of my studies. I was very driven and inspired to seek an interest in exercise science. 

While in my third year at Morrisville State College, I transferred to the University of Buffalo with the intention of becoming an exercise science major. Upon graduating from Buffalo University, I worked for a non-profit organization in NYC for a year, was unhappy with my job and did not feel connected to my goal and the path that I was determined to pursue, so I applied to graduate school. I was accepted to Russell Sage College School of Physical Therapy in the fall of 2008. These events along with the challenges and obstacles I encountered during my undergraduate studies has contributed to the passion I posses towards helping and serving patients in the field I work in. I strive to provide the best and adequate care, as well support to my patients.

2) What is a typical work day like?

I work an 8hr shift which starts from 8:30am-4:30pm with the elderly population. My schedule usually varies from time to time however, within the last three to four years, I have been working a rotational schedule throughout the hospital and in other departments. The rotation takes place every six to eight months and allows me to gain more exposure and experience. I have had the opportunity to work in the following areas (spinal cord, traumatic brain Injury, pulmonary rehabilitation, orthopedic/amputations, outpatient, skills nursing home and sub-acute/acute setting).  Each department differs in schedule and workday. At the present time, I am working at a skilled nursing home and by far, the experience has been great along with a flexible schedule. I also have private patients that I see after work at their homes about once or twice a week.

3) What is the most and least rewarding aspect of your job?

Being a physical therapist is very rewarding in itself. You get the privilege of working with patients one-on-one and see the progress through treatment as well as getting to know them and see the difference that you make in their lives. Over the years, what has been the most rewarding for me is helping patients to recover and live their daily lives to the best of their ability. The least rewarding part of my job is seeing patients health and mobility decompensate as well as lack of motivation towards getting better.

4) What educational requirements are necessary prior to applying to Physical therapy school?

As with most health professions, anyone applying to physical therapy (PT) school must have an understanding of the sciences, particularly anatomy, biology, physics, physiology and other health sciences. It is important to lay a foundation as early as possible, even starting with advanced science courses in high school. Physical therapy education includes both classroom instruction and clinical experience.  There are a number of schools that offer physical therapy degrees in the NYC tri-state area and other places across the country.

 When considering physical therapy, it is very critical to make sure to take the time to research the schools available to you and determine the ones with the best fit. The key is to ensure that the schools you apply for are accredited. Then complete prerequisite courses for your designated programs. Also, look for opportunities to gain physical therapy experiences and have all of your hours verified by a physical therapist, if required by your designated program. Take the Graduate Record Examination (GRE) at least 6 weeks before the application deadline. (Freshmen-entry students may be required to submit SAT or ACT scores). Request references from appropriate individuals, if required by your designated programs. Arrange for official transcripts from every college/university attended, to be sent to PTCAS or the institution, as required by the programs. Submit the completed application early and before the program's deadline date. Some programs use a rolling admissions process. PTCAS applicants should also review the PTCAS checklist. In order to practice, all physical therapists must receive a graduate degree from an accredited program prior to taking the national licensing exam.  With few exceptions, most programs are on the doctorate degree level.

5) Would you choose this career if you could make this decision again?

 

Yes, I can honestly say that being a physical therapist has tremendously changed my life and given me a purpose. Each day, I meet new patients from diverse cultural and socio-economic backgrounds. I truly enjoy what I do and I can only hope for the best in my future as a physical therapist.  You can also open up your own private practice if you have the means/finances.

6) What do you wish you knew when you were contemplating this career that you know now?

Prior to undergrad, I wished I had more exposure in the field of physical therapy and obtained more course work and understanding of the sciences. Having the foundation in the sciences and biomechanics earlier in high school would have prepared me much better. In addition attending some state schools may have proven to be a less expensive option that private ones, without necessarily compromising on quality.

7) Are there any trends in your career that concern you? What is the future of this field?

Currently there are no trends that concern me. As a matter of fact, physical therapy was among the 10 fastest-growing jobs in November 2012, according to CNNMoney.com and USNEWs 100 best jobs of 2014. Employment for physical therapists is forecast to grow 39 percent from 2012 to 2022, according to the U.S. Bureau of Labor Statistics.  Therefore the future is very promising. However, inspite of its positive outlook, it remains one of the most challenging careers to enter.

8)Career and life balance, is it possible?

It all depends on the department/facility/settings.  Each varies from acute care, rehab/sub-acute rehab, skilled nursing facility, outpatient clinic, school/preschool, wellness/prevention/sports/fitness, home health, hospice, industrial/occupational environments, local/state/federal government and research center. Aside from a full time position at your work place, you can work as much as you want or as little as you want. There are a lot of opportunities to work for extra pay or get paid by the day. It is all up to you and what you hope to accomplish financially.  Overall, many professionals join physical therapy for the great work/life balance and financial stability.

9) Average salaries?

The median annual wage for entry-level physical therapists was $79,860 in 2012, according to the BLS. The best-paid 10 percent of workers in the category made $112,020, while the bottom 10 percent made $55,620. The highest wages are for home health care, consulting positions and per diems, making anywhere from $100,000-125,000. The best-paid physical therapists live in Las Vegas, Nevada, Fairbanks, Alaska, and Jacksonville, Florida. For salary range, 75th percentile makes $92,860, median, about $79,860 and for the 25th percentile, something in the neighborhood of $66,950.

10) Any websites you recommend for more information on physical therapy?

The APTA’s websites and APTA’s centralized application system allows students interested in physical therapy to view school admission requirements. For more information, visit www.ptcas.org.

A.L.S: Amyotrophic Lateral Sclerosis

So you wake up and start doing your #socialmediacrawl while lying in bed. Then you notice a Facebook or Instagram notification about a post you have been tagged in and you realize your time has finally come. You've been nominated for the ALS Ice Bucket Challenge.

    

The ALS Ice Bucket Challenge is a viral charitable act that hit social media in August 2014. Participants are expected to dump a bucket of ice water on themselves and/or donate money towards ALS research. The acute shock of cold as the water hits your body is in theory supposed to mimic some neurological symptoms people with ALS may feel.The challenge has quickly taken social media by storm with several celebrities and politicians taking part.

What exactly is ALS and why is awareness needed? Here's the scoop: 
Amyotrophic (without muscle nourishment/growth) Lateral (nerves and muscles affecting the peripheral body parts- i.e arms, legs) Sclerosis (hardening ), commonly known as Lou Gehrig disease is a neurodegenerative disease which causes muscle degradation and paralysis. It is the most common motor neuron disease and usually presents between the ages of 40-60 years.There is a predominance with the Caucasian race however all races and ethnicities are affected, with more cases occurring in men than women.

Disease occurs when upper and lower motor neurons in the brain and spinal cord begin to dysfunction and are no longer able to send signals to muscles. Muscles are unable to move appropriately, creating atrophy (muscle wasting).

Patients often times initially present with a complaint of muscle weakness. There are three classifications of onset:

• Limb Onset- Symptoms include dropping things out of hands, increased clumsiness,tripping and awkward walking. Signs may be focused to one limb or several limbs.
•  Bulbar Onset- Changes in speech (slurring or quieter voice) and/or difficulty swallowing.
• Respiratory Onset- The muscles which assist with breathing become weak and patients present with difficulty breathing.

These varying symptoms are generalized into the Three D's

Dysarthria- difficult speaking
Dysphagia- difficulty swallowing
Dyspnea- difficulty breathing

Other common symptoms include hyperreflexia, spasticity and fasciculations (involuntary movements of muscles), and muscle cramps.  Some individuals will develop bulbar weakness (weakness of the cranial nerves affecting facial, eye, and mouth movement). 50% of people with ALS will also develop cognitive impairment (memory loss, behavioral changes). Voluntary eye movements are usually the last function to be lost and may often times be used as a way for communication.

 Most patients become wheelchair bound due to loss of function of lower extremities. They also need breathing support including respirators and other breathing mechanisms (non-invasive ventilation) due to loss of function of muscles. Esophageal movement is usually also lost and patients eventually must be fed percutaneously (directly through the stomach). 

 Death usually occurs 3-5 years after symptom onset but there are cases of people living for over 10 years. The majority of  individuals will ultimately succumb to respiratory failure or infection.
 
Management for ALS is largely supportive and includes using medications to relieve symptoms and improve quality of life. Aggressive physical, occupational, and speech therapy is also necessary. Riluzole is the only FDA approved medication that offers possible delay in progression, if only for a few months. However it does not provide physical improvement.

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Currently there is not a specific test that can diagnose ALS. Various laboratory testing and imaging must be done to exclude other causes of ALS symptoms first. Other possible causes include brain tumor, muscular injury, HIV, syphilis, and demyelinating disorders.

The process of developing ALS may be multi factorial (genetic and environmental). Many speculations regarding environmental causes include head trauma, diet, and neurotransmitter dysfunction.Several hereditary gene mutations have been identified in families with ALS in multiple members. The most frequent of these mutations has been identified as SOD1 (superoxide dismuatse) on chromosome 21. More information on this gene can be found at The National Institutes for Health Website.


Active research is still being done to find new treatments and a viable cure for ALS. This is where the Ice Bucket Challenge comes in. Monetary funds help with research, public policy and advocacy, and care resources.


More information on local resources and how you can help can be found at  ALS Association
Check out Star Wars' beloved R2D2 risking his life in the Ice Bucket Challenge

                    

Psoriasis

Psoriasis is the most common autoimmune disease in the US, affecting approximately 7.5 million Americans.   It is caused by rapid growth of the cells which make up the top layer of skin, the epidermis. This leads to a constant turnover of cells which creates thick, flaky skin. This chronic genetic condition tends to go away then reoccur (relapse/remit).
The classic look of psoriasis is a red, raised and inflamed patch of skin with silvery linings within. These patches will sometimes bleed upon scratching. Psoriasis is not contagious and is not caused by an infection.

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 Common areas of involvement include the scalp, elbows, behind the ears, gluteul cleft, and around the umbilicus (belly button). Nails can also be affected, growing abnormally and become dysfigured.

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There are numerous speculations as to what causes skin cells to grow and overturn so quickly in psoriasis, however a precise cause has yet to be found. For the most part, psoriasis can be controlled with various treatments, but certain "triggers" may cause a flare. Triggers include personal stress, changes in environment/weather, medication,obesity, and smoking.

Psoriasis can also involve the joints, called psoriatic arthritis. This usually involves multiple joint most often in the fingers and toes. There may also be finger swelling (dactylitis) and inflammation of tendons (tenosynovitis). Psoriatic skin changes usually occur prior to joint involvement, and approximately 30% of people with psoriasis will develop some type on joint involvement.



Psoriasis affects all races and men and women are equally affected. Though not completely understood,it increases an individuals risk of stroke, diabetes, heart disease, and depression.

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Many people often get confused between psoriasis and eczema.Eczema is usually concentrated in areas like behind the knees and in front of elbows. It is often times associated with allergies and asthma.  Eczema skin patches are not as raised as psoriasis plaques and do and not easily bleed when scratched. 

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Though there is no cure for psoriasis, there are treatments which can lessen its severity. These include but are not limited to

•  Biologic Agents- medicines that are given through intravenous infusion
• Topical Steroids- placed on the plaques, these will decrease the inflammation and severity of plaques
• Systemic Treatment- taken either by mouth or via injection, these are used to suppress the immune system
• Phototherapy- involves exposing the affected skin to UV light in the hopes that it will slow the rapid growth of the skin cells.

Your doctor may help you decide which treatment is most appropriate based on the severity of your condition, how many/how large your plaques are, and if you have any other medical conditions that may be affected by treatment. Skin may become resistant to treatment over time so combination therapies (multiple types at once) may have to be used.

There have been a number of alternative/homeopathic remedies that several people with psoriasis claim have helped aleve their discomfort. This includes aloe vera, fish oils, and hydrotherapy. Though there is no scientific research identifying these as plausible therapies, if they help reduce signs and symptoms they can be used with caution. Prior to starting these regimens, consult a physician to go over their pros and cons.

If you are still unsure as to whether or not you have psoriasis or another skin condition, its best to seek medical advice.

For more information on psoriasis visit The National Psoriasis Foundation

Right Shoe, Left Shoe, Which Shoe

Working in a hospital entails walking, running, and standing for long periods of time. If not equipped with the right shoes your feet will suffer, and so will your attitude.  We are always asked by medical students what are the best shoes to wear while on the floors so here's a compilation of the most popular shoes worn by medical personnel.


DANSKOS

Known as the mother of all hospital shoes, Danskos clogs are anatomically created to mold to your foot over several wears. The heel is open and enlarged allowing feet to move comfortably within the shoe. From personal experience, they are a bit uncomfortable to wear at the beginning due to the high arch but it gets better over time.

I have had my pair since medical school and absolutely love them! They are durable, sturdy, and don't have my feet aching at the end of the day.They also come in various designs allowing for individuality when wearing scrubs.



CROCS

 

Yes their not the nicest looking shoes,  yes they can squeak sometimes, but yes they are amazing! The loose fit of the shoes allows for a natural bend while walking. The odor resistant material keeps your feet from smelling after keeping them on for a long time. (I would suggest socks, those help to!) The closed heel and toe meets workplace standards, making it safe against biohazards and needle injury.

I have had my Crocs for at least two years. I love the ease of slipping them on and off throughout the day when I just want my feet to breath.


BIRKIE

 Flexible, man-made clogs created by the shoe company Birckenstock, Birkie's boast a removable footbed allowing you to change them when they become worn and thus increasing the longevity of the shoe. Their deep heel cup allows for better posture and decreased back pain. The longitudinal arch support distributes weight evenly also decreasing fatigue from wearing the same shoe for several hours. 

CALZURO

Initially created for surgeons, these Italian made shoes have quickly become popular due to their  massage bump infused soles which promote constant blood circulation within the feet. The comfort insoles provide cushion support with an arch that conforms to your foot. The one and half inch heel also provides all day support so your feet don't hurt when you take them off at the the day. One great aspect of Calzuros are that they can be cleaned via autoclave, withstanding up to 300 degrees of heat and ensuring all  nasty hospital germs are killed.



ALEGRIA

 Alegria shoes boast leather-based vibrant prints and colors, with patented, countour-forming footbeds. The rocker bottom outsole allows for your foot to roll naturally .The arch support is made up of memory foam, cork, and latex allowing for a customized fit.

Many of these shoes have been approved by the American Podiatric Medical Association meaning they promote good foot health and allow for normal foot function.  Almost all of these shoes have anti-slip protection which are essential if you have to run to a code or other emergency situation. Most also offer either side or top vents allowing your feet to breath. The synthetic shoes (Crocs, Birki's, Calzuro's) can all be easily washed with soap and water or sterilized with bleach.


The price of these shoes range from $40-$150 but discount stores like TJ Maxx and Marshalls sometimes carry them for half the price. Shoe stores like the Walking Company often times will give discounts to local hospitals workers with a hospital ID.


 Hopefully all these options will provide some relief from tired, aching feet.
Are there any shoes you would suggest for long hours on your feet?

Sun Safety

Though summer is in full swing, it's never to late to discuss sun safety.
Skin cancer is the most common cancer in the United States and also the most preventable.

The sun produces different types of sunrays each with varying levels of strength. Ultraviolet (UV) rays are the ones which can cause skin changes including wrinkles, blotchiness, sun spots and cancer.

Here are some quick tips to reduce your chance of sunburn

• Avoid being in the sun during it's peak burning hours (between 10am and 4pm)

• Use sunscreen which protects against UVA and UVB ultraviolet rays, is waterproof, and has an SPF (sun protection factor) of at least 15

• Reapply sunscreen every 2 hours, and after swimming or sweating excessively

• Wear a wide brim hat to protect the scalp and ears from sunburn

• Check your skin regularly for any changes such as new or discolored moles and ulcerations

• If you are a fan of tanning beds and sunlamps which also produce UV rays, try to limit outdoor sun exposure and vice versa

• Don't forget the eyes! Wear sunglasses with 100% UVA and UVB protection

The US Environmental Protection Agency has created a daily UV index to help predict risk of exposure to UV radiation based on area code. A higher UV index calls for increased protection (think more sunscreen!).

You can calculate your own area's UV risk at UV Index

                 

And no, Kanye was not spittin the truth when he said "I'm way too black to burn from sunrays". Black people and individuals with darker skin tones DO get sunburned and DO get skin cancer. (Bob Marley died from complications of skin cancer which developed in his toe).
                 

The melanin in darker skin allows for less wrinkles and fine lines and acts as a natural protectant against UV rays. However darker skin is also more proned to uneven skin tone and discoloration with increased sun exposure. So despite what your grandmother told you about "black don't crack" it is still important to protect your skin.


So as you get ready to go the pool, beach, or rooftop day party do remember to take care of the largest organ on your body, your skin.

Between finishing up our second year of residency (where did the time go?!), preparing for USMLE Step 3 (glad that's over!), and getting ready to embark on new journeys (more on that later), we had to take a step back from blogging. One of the characteristics of being a good physician is prioritizing and knowing when to spend more time on one thing compared to the other. Luckily life has slowed down a bit so we can get back to OhemaasMD .Thanks to all the supportive readers!