I can't believe how fast time has flown by these past three years. Reality is starting to set in...for the first time in 18 years I will no longer be a student--well that is if I don't pursue my PhD. I still can't believe it.

I have started trying to narrow down the geographic region that I intend to stay in. I realized that the type of job, job market and climate are not the only factors that I must take into consideration, but I must also take into consideration the cost of living, available resources, housing, etc.

It's hard for me to believe that I will soon be completely on my own. Honestly, I think my largest concern is, ironically, health care coverage. I will be covered on my mother's insurance until I either graduate or turn 24, but after that I have no clue of what I will do! I have a few chronic pre-existing health conditions and dread that thought of paying outrageous premiums just to be healthy. I don't know if I'm ready for this yet. Boy I'd give anything to be 5 years old again!

I have been extremely fortunate to have two great CIs thus far. Though very different in their approaches, they have both contributed greatly to my nurturing development. I would just like to take the time out to thank the both of them... Diana Correa and Amy Patel.

They were both very supportive, offered constant constructive feedback, and were just excellent to work with. I felt the need to write this even more after hearing CI horror stories. Sometimes it is difficult when two people have conflicting personalities or the expectations that one has for the experience are too high or low--both which I was fortunate to not have to experience.

My only advice is to put it all out on the table in the beginning with finesse. That way you decrease any tension before the pot boils over.

My internship is coming to an end and I am really going to miss it. I am finding it harder and harder to have to tell my patients that I will not be seeing anymore. Some of my patients I have seen since the very first week of my clinical!

As with all things though I must prepare for it to come to an end. The good thing about it coming to its closing is that I will now get to examine some new and interesting things with other therapists. So far, I will be following a PT who works on wound care this Friday. I am super excited for this since I am doing my advanced elective in wound care.

I am also hoping to examine a women's health specialist before I leave because I don't exactly know what they actually do as therapeutic treatment-- I just know what they treat. Hopefully everything will be as awesome as my clinical has been thus far. I must say I feel as though I was lucky and very fortunate to work with so many varying diagnosis'. I even got to see a total shoulder arthroplasty this week! This clinical has made me even more excited to get out and work in the field!

The past week has been quite exciting. I now have patients with polymyositis, post reactive streptococcal arthritis that lead to a total shoulder arthroplasty, MS status post ORIF, and a post polio syndrome/post cervical fusion patient who is now fused C3-5 and T2-L2. Needless to say this has been a very exciting week.

I must admit with each of these patients I felt like a deer caught in headlights because I had never seen anything like these before. On top of that, I got two of them in one day. Part of me wanted to freak out and have my CI do the evaluations, but I figured that these were some pretty rare patients especially for the setting that I am in, so I should take advantage of it.

Luckily, I was able to calm myself down so that I could successfully complete the evaluations. Granted, I took about 10 to 15minutes longer with these evaluations because there were times that I almost became lost with myself--some of the patients had so much going on that I found it incredibly difficult to focus on just one or two things. Though they were extremely challenging, I MADE IT! I was able to complete all of them independently for the most part, and I have treated two of the patients with much success within one to two visits.

I realized its important to have confidence in yourself, especially with these patients, because they can feed off of your energy. So even if you are freaking out on the inside, if the patient sees you as confident, then they are more confident and easier to treat in the end.

Whoa, glad that I got those out of the way!!!

For some reason I don't think I realized just how much paperwork is involved. There's evaluations, daily notes, progress notes, discharge summaries, billing. I'm officially convinced that you have to work overtime just to do documentation unless you have blocked off times in your schedule for it. It can be so easy to fall behind especially if all of your patients' documentation is due at the same time.

I'm curious to know how other therapists avoid the crunch time. Are there any tricks that people use in order to avoid falling behind?

I see it as common sense: You should do what the therapist tells you. I mean, when doctors give them medicine to take, there is no hesitation most times. But, if I give them three exercise to do at home twice a day, they come back complaining that they feel the same or worse-which makes me feel like I did something wrong. With further investigation, I find that they didn't do them, or that they are doing something totally different than the pictures show because "it was more comfortable at first."

I know some will discharge patients who aren't adhering to the therapist instructions, but what's the time limit on that? And how do people avoid getting discouraged?

So far most of my patient's diagnoses have been pretty basic but I have had a few complex/interesting diagnoses also. I realized that though it feels good to practice on my own, the most important thing is to know when you need help. Granted you don't want to seem like you don't know what you are doing in front of the patient, but it is better than doing or saying something incorrect. Heck, the therapists at my site frequently ask one another for assistance when they are stumped, so why should I be afraid to ask for help when I need it?

Even though half of me hates asking for help, I learned young that if you never ask, you'll never know. I assumed that it would more or less only apply to school-related activities, but this has quickly made me notice that it applies throughout life, especially in a field that is constantly evolving.

On the flip side, today I had a patient "stand me up." The last time I saw the patient he said that he was feeling better than before and wanted to stop therapy even though he still had some pain. Now this was someone who after 2 weeks had maybe done 1 day of his home exercise program that consisted of about 3 exercises... Needless to say I didn't feel that this patient was appropriate to discharge and continue therapy on his own. After expressing this, I assumed that the patient would choose to continue therapy as most others do when you make a recommendation...but of course he didn't show up.

Part of me wants to be stubborn and say FINE if you don't want to help yourself then how can I help you, but the other part of me just wants what is BEST for his physical needs and somehow spend all of my time trying to get him to comply. I tried a stern, but caring approach...obviously it did not work with him. It's like a rollercoaster ride! :D

In the one day that I was gone, the majority of the patients who came realized that I was not there and asked where I had been. This included patients that were not my CI's or mine.  I was so surprised that they had even noticed that I was gone! It was so cute because some were concerned that I was not coming back. I felt so loved!!!

This really made me realize that even when you are working somewhere where the patients are not totally dependent on you, you still significantly impact their lives even when you feel as though you are not doing much. Life lesson: Always make sure you are making a good impact on a person's life because even the slightest negativity can affect a patient just like the slightest positivity can.

One of the major things that came up was treating patients with mental and emotional challenges. For some reason, we foolishly assumed that we would not see patients with these challenges just because we were in a different setting. I say "foolishly" because we clearly know that a large amount of the population face these challenges at some point in their lives (depression being perhaps the most common), yet we still assumed we wouldn't see it.

So often we hear that outpatient facilities have more cookie-cutter type practices. However, during the short two weeks that I have been at my site, I realized that you can't be "cookie cutter" no matter the setting because each patient has different needs. Even if you have two middle-aged construction workers with L knee pain, there are so many other components that must be accounted for when you are treating them, especially their mental state and how they perceive pain.

What works for one patient might not work for others and how WE think patients should react to pain is honestly of little importance, because pain is perceived by everyone differently. I think it is so critical for everyone to remember that. Even if a patient has anxiety, is depressed, etc., how they perceive pain is how they perceive it, and though it may be frustrating, we have to find ways to do what is best for them.

I have found that these patients in particular have an extreme amount of lower extremity weakness. Most can barely perform a single leg stance for more than 3s or a single leg demi-squat-no matter the age, activity level, or physical build! It is amazing how something so simple as a single leg stance, which is needed every day to walk and perform many functional activities, can be so easily overlooked (especially when you have the big strong men who squat hundreds of pounds, but can't balance on one leg to save their life).

I think everyone should take time out of their day to practice the single leg stances and squats, and see if they notice a difference in their bodies. I know I have!

Everything about this clinical has, for the most part, been different. A lot more individual exercise plans are done versus group exercise, the patients are all relatively independent with their exercise plans, and best of all I get to work with more biophysical technologies!!!

The only down side is the LONG hours. Since the clinic is open 7 a.m. - 7 p.m., there are some days that my CI (and thus me) is scheduled for 11 hours. This will definitely be something that I will have to get used to, but I know that it will all work out.  

Time to break out the old ortho and test and measures notes to brush up!

Nonetheless, I will be so happy when finals are done. No more late nights, all nighters, and need for vitamin overload for three whole months! Luckily I get to start my clinical ASAP while everything is fresh in my head.

This has been a pretty difficult year; however, I must say I will kind of miss it. No more adventures and jokes about red hair and Canada, jokes about the limbic system, random songs about the professors, baby stories, movie nights, gross pictures or stories about THE neighbors for an entire summer. L

I just want to thank all of my professors for at least attempting to make this an enjoyable semester even when the material wasn't! THANK YOU!!!

As soon as finals are over I will be starting my second internship. I am expecting this one to be very different from my previous experience considering this one will be an outpatient orthopedic setting. None the less I am still very excited for it. Hopefully my CI will be as great as my previous one!!!

In our program we have an entire 16-week course dedicated to wound care that is very detailed and even includes the opportunity to see patients in the hospital and have some patients come to labs. We learn multiple ways to change dressings along with multiple treatments for a wide array of wounds.

On the contrary, according to a nurse in our class, the only thing they learn is the wet-to-dry technique. So why do facilities choose to allow them to handle the wound care if they are less trained and receive less reimbursement?