Decisions...

I am at a crossroad where I have to choose between possibly returning to that stable, comfortable place that I am not very happy with or pursue something else that I could be happier or perhaps not. It is a gamble that some of us need to decide on. But whichever path I may choose, I know it will have to decide soon.

I am talking about pursuing to continue with my old job or looking for another job. The old job is stable and I have grown comfortable with it. There are some issues and some people that I would rather not deal with but that may be true in any other job out there. On the other hand, I may end up with a new job that I would regret or hate even more. Change can be daunting but fortunately for me, my profession is recession proof. And fortunately for me too I am not in a tight spot financially. I could go for months on hiatus from work and I will be fine.

Decisions, decisions...

I heart the Warblers.

I am becoming a big fan of the Warblers in Glee. Not only are they wholesomely handsome, their melodic blending is awesome. And they are not afraid to sing songs sang by girls. Here are two of their performance that showcase their talents.

Do what is best for the patient and not just what the doctor says!

I come from an extended family of doctors/physicians and I have high respect for their profession and knowledge. But we all know that doctors are only human and they are not perfect. They may not necessarily know all the time what is best for the patient. Since I work with and see the patient more often than they have seen their doctor, I may be in the position to know what is better for the patient with regards to their Physical Therapy needs. I had a recent issue with my managers insisting that we physical therapist should follow the doctor's order regardless of what the circumstances are. That is simply idiotic and cowardice. Just because they are afraid for the doctor to yell at them is not reason enough not to do what is best for the patient.

The situation was regarding a 60 yo man with severe OA of both knees with flexion contractures and a pain level of 7/10. Doctor CP wrote "aggressive PROM" on his/her order. For the first 6 sessions of treatments, I modified the order to be mostly active stretches and home low load stretch so as to not cause more pain. No improvement on extension ROM was noted after the first 6 sessions. So my supervisor told me to do tibial pressure because Doctor CP insists on it. I complied and did 3minutes of grade III tibial AP oscillatory joint mobs instead because I believe this will be better tolerated and yet achieve the same effect as the sustained tibial pressure. Joint mobs also allow us to have more time to address the strength and pain issues of the patient. After the following additional 6 sessions of treatment with Tibial AP grade III, we achieved a 5 degrees improvement in extension. That is a very good result clinically considering is diagnosis and age. I firmly believe that if I did any more aggressive physical stretch on this patient, he would have more pain and I would have done more harm to him. My belief was confirmed during that one time when I did not put a bolster under his knees during his E-stim to have that sustained extension stretch with very low load force. The patient complained of more discomfort on the knee after the E-stim. And during that other PT session, after I was chastised for not following the doctor's order to the letter, I did the aggressive stretching (as adamantly instructed) and the sustained tibial pressure and sustained prone knee hang with weights. Patient complained of increase pain post treatment from 5/10 to 8/10. He also was not able to tolerate the full 10 mins of the sustained tibial pressure and prone knee hang so it was cut short to 8 mins.
These two instances clearly confimed my belief that the "aggressive PROM" order of the doctor was the best approach for this patient since it caused him more pain. My approach not only increased ROM, it also improved strength and decreased pain.

My treatment approach was clinically sound, ethically correct and better than the doctor's order since it treated the patient as a whole and not just his knee ROM. Since management has had run in with Doctor CP in the past, they have adopted the unspoken policy of doing what Doctor CP says regardless of it being the best for the patient or not. And what is worse, they choose to chastise me instead for using my better ethical judgement to modify the doctor's order to better manage the patient. That is just wrong!

Glee: Don't you want me?

I luv Glee and I like this song. So here is Blaine and Rachel singing "Don't you want me ".

Israel Trip - Anunciation Basilica

One of the first significant Christian church that we visited in Israel was the Anunciation Basilica. This is where Mary (Jesus' Mother) received the message from the Angel that she will bear the son of God. Our guide did not narrate how modern day people figured this location as the site of Mary's Anunciation. So that made me wonder if this really happened here. And I will repeat this theme of questioning in the other Holy sites that we visited.
Inside the church compound were images from different countries of their version of the Anunciation of Mary. The church itself was not very ancient looking or spectacularly grand. Under the church compound was some dug up ancient caves. Perhaps that is where Mary lived. I was not sure.

Israel Trip - The Jesus Boat Museum

The Jesus Boat Museum was not in our itinerary but our guide was very good indeed to take us there. I have heard about this ancient boat that was discovered in the Sea of Galilee in the mid 80s. The boat was carbon dated to the time of Jesus Christ. It could have been the very boat that Jesus and his apostle took out fishing as narrated in the Bible. Or it could have been just the same kind of boat that fishermen used during the time of Jesus. There is no way to tell who owned or used this boat so it is rather audacious of them to call it "Jesus Boat". Totally name dropping to garner more popularity and fame. Whatever! Still it was neat to see a very ancient boat.


BTW, outside of the Museum the name posted is "Man in the Galilee Museum" but the official website is Jesus Boat Museum. I do not know what is going on with that.

Dr. CP strikes again

Dr. CP is a fucker! He complains to management that Physical Therapy do too much to his patients. And if you back down and do less aggressive treatment, he also complain that we did not do this and that. And yet he will not write to the letter in his prescription what he exactly wants done. It is like he wants us to read his minds. What an asshole! He epitomize that God complex that some physician have. I have zero confidence in his abilities as a doctor. I would rather die of cancer or AIDS or something than get treatment from him.

Israel Trip - Mount Zion/King David's Tomb

In one of those days we were in Jerusalem, we visited King David's tomb. I was excited to learn that we were going but upon seeing it, I was sorely disappointed. I expected to see a grand tomb interior but instead it was what looked like a sarcophagus covered with some red cloth/blanket. The space itself was small and there were a couple of people praying. Very plain undeserving of a man of King David's stature and historical significance.

Which 877 cash now is better?

I think the one in the bus is more fun but I do like both commercial... Quite amusing.

I found my own solution.

As a result to my friend Bruno who disappointed me this past holiday/birthday by making me feel so unimportant,I have searched for a solution on how to make me feel important. Yes I have a chip on my shoulder about my birthday since my family and friends have almost always failed to make me feel special that one day in a year when we all ought to feel special about ourselves. My solution would be to allow myself to do something expensive and frivolous during my birthday. I could either do the following:

1. Get a liposuction on my birthday. This is kinda hard to do since my actual birthday is January first and most surgeon will not probably do any elective surgery then. I could opt to do this on my lunar calendar birthday which will fall on December 5 this 2011.

2. Getting a botox also falls in the same predicament as liposuction. Nobody will probably do the actual procedure on New year day.

3. Hire a really hot hustler/escort on New Year day. Very tempting but if I want sex, I could just easily go to a bathhouse. Although nobody really hot will probably want to do it with me in a bathhouse.

4. And lastly, get a spa session at a 5 star hotel downtown. Spa treatment of massage, facial, manicure and pedicure. Total pampering! This is the most feasible option since I already researched and those spa in the high end hotels are open on New Year day. Woohoo! I could even add a nice dinning experience after the spa treatment at those 5 star restaurant of the hotels.

I am so happy at myself for finding a solution to my problem. Since nobody else will and can make me feel special, I will do it myself. Who says money can't buy happiness. As God is my witness, no birthday of mine will past ever again where I did not do anything nice and special to make me feel special.