My top tips for new Physiotherapists

There's a busy conversation on the Twitter machine at the moment #toptipsfornewphysios - quite timely as now is the time of year that new grads are starting out in the big bad world of work.  So, I decided that 18 years after I was in that very same exciting but daunting situation, here are some of the pearls of wisdom I have collected over the years:

1. It is important to make a personal connection with the patient/client.  Always introduce yourself #hellomynameis and never assume that the name you see on the referral letter or medical chart is the name the person likes to be called.  Always ask the person how they would like to be addressed - 'Is it OK for me to call you......?' or 'what would you like me to call you?'  
2. Make the most of non-verbal communication - 3/4 of the stuff we communicate is done through non-verbal communication - how we appear to the patient.  Be very aware of this! How you stand, hold your arms, even how you are dressed will send out very powerful messages - you want to make sure you are sending out the right ones.  Be wholly attentive to the patient, get yourself at eye level, use open arm gestures and relaxed postures to encourage an environment that is conducive to the sharing of information (so important in your history taking!)
3. Always remember that we treat PEOPLE not tissues or conditions or injuries.  OK, so we do do a fair bit with tissues and injuries - that's physio, but behind every injury is a person - you'll be a better physio if you never lose sight of this. 
4. Use your own internal quality gauge when going about your work - some simple questions to ask yourself - 'Would I be happy if roles were reversed here and I was the patient and 'they' where the physio?', 'Would I be happy if my Dad/Mam/Sister/Brother/Grandma/Grandad received physio treatment like that?', 'What would I want?'........If you're happy with the service you are providing then great, if not then do something about it! 
5. If you're going to work in the NHS/HSE you will undoubtedly encounter the political stresses and strains of the system that will impact on your work.  Get yourself some advanced communication/conflict management/industrial relations training - the type of thing that comes with training as a Union Rep - when I trained as a CSP Rep years ago, my eyes were opened to exactly how the healthcare system works, and more importantly it enabled me to appreciate the complexities of the healthcare hierarchy and the personnel relationships within it - Hopefully you will have a long career in the health service, and having this knowledge will make it easier for you to contribute to strategic planning and the improvement of services and it might just prevent yourself from banging your head against a wall!!
6. If you can, get some experience working in a specialist oncology setting  with specialist oncology physios.  #cancerrehab is such an exciting area to be working in right now (it had me hooked 16 years ago!).  There is a massive amount of research coming out about the effects and impact of exercise and physical activity for preventing cancer, reducing recurrence, making treatments more effective and improving patient outcomes.........We are definitely on the crest of a very big wave and once it hits, then patients, doctors etc are going to be looking more to the exercise specialists to intervene in cancer treatment.....and that's us!!!!!
7. Do some Manual Lymphatic Drainage training.  I'm not sure if physio course itineraries have changed much since the early 90's, but I remember very little, almost non-existent teaching on the lymphatic system (apart from it being something to do with the immune system - killer T-cells, remember them!).  BUT, the lymphatic system is one of the most important systems in the body and and appreciation of how it interacts with all of the other systems and how it is involved with injury, healing, repair and nourishment of tissues will add vital information to your clinical evaluation, reasoning and treatments.  I wish I had done my MLD training years earlier than I did, I use it all the time, not just with lymphoedema and swelling. 
8. If you make a mistake or do something wrong then apologise  and learn from it - simple! 
9. The day that you think you don't need to learn anymore, or even worse, the day when you think you don't care anymore - GIVE IT UP AND GO ON GARDENING LEAVE!!!!!!!!!!
10. ENJOY every second, learn from every experience, keep an open mind, smile and laugh, be creative and have fun, reflect often, mind yourself, grow personally and professionally.  Always appreciate that you are in a great profession - you have the skills to massively impact on other peoples health and wellbeing, you meet amazing people daily, and no 2 days are the same .......... and before you know it you will be an 'old' physio (but in your mind you're still a fresh faced new grad with the whole world to learn) and you'll wonder to yourself 'How the hell did that happen?!?!?!?'  

Don't miss YOUR chance to shape the future of cancer services in Ireland!!

I posted on Facebook recently about how the Department of Health here in Ireland have appointed a steering group to work on a National Cancer Strategy for 2016-2025.  The work hasn't yet started - there is a period of public consultation whereby the public (we and us) are able to make comments to the Department of Health and steering group (them) regarding our own views/opinions/experiences of cancer care in the country and how we think things should proceed. Now, this is a really important opportunity for 'us' to impact on what goes into that strategy document, we shouldn't waste this chance.  Having worked on a similar level of national document in the NHS (NICE Improving Outcomes for Brain and Spinal Tumours) in the past, I can tell you that each and every comment that comes in through the public consultation period is read, recorded and acknowledged. So lets imagine that we wanted an improvement in access to specialist cancer rehabilitation services - you know to help people get their life back on track once medical treatment has done its stuff. If only one member of the public mentions this in their feedback form, you could see how it would be easy for 'them' to assume that access to rehab services isn't really an issue, as only one person has brought it up......but if a hundred people mention that they are very concerned about lack of access to specialist cancer rehab, then it would be a little harder for the Steering Group to ignore this!!  I'm not trying to tell you what to include when you give your comments - there are many areas of cancer care that could be improved upon, but naturally as a physio working in this area this is one of my major concerns, along with the nearly non-existent provision for lymphoedema services. And just to put this into a bit of context - The National Cancer Strategy Document that was published in 2006 contains the words 'lymphoedema', 'lymphedema' (American spelling), 'physiotherapy' and 'rehabilitation' a grand total of ZERO times........can you imagine that - a strategy for cancer care that doesn't even contain those words which are so vital to the complete package of care offered to anyone having cancer treatment.
This is now 2015.  We have shed loads of research which support physiotherapy and rehabilitation as a key aspect of cancer care not to mention the countless models of comprehensive care around the globe where these things are already part and parcel of what is on offer.  Lymphoedema occurs in upto half of all patients who have some form of treatment to their lymph nodes - it is a BIG part of cancer care and it does need to be mentioned.   If 'they' get lots of comments via the public consultation process asking what they are planning to do to make sure that everyone who needs lymphoedema services is able to access them, or everyone that needs physio is able to access it as part of their total cancer management then they will have to address this and come up with a really good reason if these things are not contained in the document.    So please when you see the link is taking you to the DoH website, don't groan and think to yourself 'what's the point'......CLICK the link. It's here again for you (and you do have to click on the blue word 'here' on that page to access the document) and fill out the form.  Collectively our voice can be very LOUD!

Treating breast cancer related pain

An article appeared in the New York Times this week entitled 'When pain persists after breast cancer surgery' It mentioned that upto 50% of women post mastectomy might be affected with ongoing pain for a long time after their surgery and for many this pain might never go away. Further down the article it mentions that a study had been done looking at giving women a pain killing injection to combat this pain and that in the majority of women this was looking like it worked.....although the long term effects are unknown at the moment. The doctor who has pioneered this work was quoted as saying “Even if you had to do the injection every six months, that’s so much better than having that pain.” And here's where I have the problem with the article. Yes, anything has to be better than living in constant pain, but there are alternatives to injections (and those injections look horrendous, if you're a bit sqeamish don't watch the video). It is amazing what a bit of hands on therapy can do!! This 'hands on stuff' is what I do day in day out, and I have to say that the vast majority of clients respond well to it, After breast cancer surgery there are many reasons for ongoing persistent pain, many of them directly related to the surgery - scarring, myofascial tightness and nerve damage. However, there are lots of other factors which impact on the woman's experience of pain and among these we have to look outside the area of the breast and chest wall. We need to be looking at the whole integrated mind - body system and consider carefully the emotional and physical impact that the breast cancer treatment rollercoaster has had on the woman. In my experience, breast cancer treatment related pain seldom occurs in isolation, it is often associated with other symptoms such as movement restriction, swelling, altered/ineffective movement patterns, cancer related fatigue, Axillary Web Syndrome (cording), lymphoedema. Add into that mix sleep disturbance, low mood, body image issues, and a whole load of other psychosocial problems.......would a six monthly injection help all of these??? The evidence for the effectiveness of the injections is looking good, but I would just hope that women who might be considering this line of treatment would see a physio who is skilled and knowledgeable in breast cancer recovery BEFORE they get the needle!! We've a lot to offer, we can fully analyse movements and tissues and have the skills to do something about the problems we detect and physio works! Physio V needle.....I know what I'd go for!

Pinterest positivity!

I love Pinterest! I could spend hours looking at the huge range of stuff that's on there and I find myself going off on tangents then forgetting what I was looking for in the first place.  (I also love Pinterest Fails, but that's my evil alter ego talking!) I've been adding to my own boards and yesterday started up a board called 'The Bucket List' and then proceeded to search the interweb for pictures of things/places that I could add to my board - stuff that I want to achieve before I get too old or am taken by the man above to a higher place. I realised that once I'd added my trip to NYC and a few other places I want to visit, then I was trawling the web for trawlings sake - so my bucket list board wouldn't look empty!

I'm not saying I don't have any dreams or aspirations, cos I do, but how do you capture 'I want a long happy healthy life enjoyed with my loved ones' in a picture?  I am actually very content with my lot! (and lets face it, I'd need a good lottery win to enable me to have the time and the dosh to do a lot of bucket list things).  So I decided I needed another board - 'the stuff that I can tick off on my bucket list' - that's going to be so much easier to fill I think and I wont get depressed on this dreary, cold June Bank Holiday Monday finding pins for it! Now, off I go on a self directed tangent!
Here are my boards!

Activity Tracking.......

How technology has moved on!!! I recently got one of those new fangled activity trackers and have to say I love it!! I got the Withings Activite Pop watch - you wear it as normal like a watch and download the app to your phone, then go about your business and like magic it tracks how many steps you do, converts that to how many miles you've walked and how many calories you've burned and it also tells you how much sleep you get and the quality of that sleep. I spend lots of time in the swimming pool and eventually there will be a software update that will enable the Activite Pop to know I am in the pool and then track how much swimming I do! It's a great little motivational tool, you'll see in the picture the smaller disc on the clock face - that tells me what percentage of my daily activity I've completed today, or it tells me how much more I need to do to get to my 100% (which I have set at 10,000 steps per day).  So today I've done roughly 80% (8000 steps) and if I go out and do a brisk walk, it's a light dry evening so I've no excuse not to go out and get those extra 2000 steps I'll be done for the day!!  How it works I do not know, it blows my mind even beginning to try and work it out. (Maybe there's a leprechaun inside it who pops his head out every now and again and reports back), but whatever the mechanism is, I've tested it against my phone GPS tracker and it seems to be fairly spot on in its accuracy.  

I think this new technology can have a role to play in the fight against cancer and other diseases.  We know that a half of all cancers can be prevented by diet and lifestyle choices.  Being physically active is proven to bring health benefits that can reduce the risk of developing cancer.  The international recommendations regarding the level of activity we need to do to get those health benefits is 30 minutes of moderate intensity exercise on most days of the week.  As a physio working in cancer care I feel it is my responsibility to spread this message and inform my clients that they can reduce their risk of cancer recurrence by increasing their activity levels and to help them to achieve this as it is not always the easiest thing to do though for people who have been through treatment and might be suffering with Cancer Related Fatigue (CRF).  CRF is a common side effect of cancer treatment, affecting almost everyone who has had treatment at some stage in their journey to recovery.  It is complex and multi-factorial and the management of it is far from simply 'getting yourself more active'.  I've done lots of work with clients who have CRF and I'd always advocate that folk use whatever works for them to pace themselves, monitor their activity levels and ultimately try and ensure they get their recommended level of daily exercise.  So, over the years the tools I use have changed with the times, starting off in the early days with a simple paper diary sheet, we then progressed on to pedometers and then the GPS phone apps, but I really think that the new wave of activity trackers could be a game changer in the management of cancer related fatigue which to put it in its most simplified form is very much about finding a balance between rest and activity and working out an individual programme to increase activity levels without causing fatigue levels to rise. My tracker is so simple to use and it must be foolproof! It gives me great feedback and motivation. Plus they don't have to break the bank, with lots of different models being available on the market for all budgets.  Here's my analysis for my activity for Monday -  a day when I spent all day working with clients, who would have thought that I'd clock up so many miles just moving around the treatment room!

and the second picture gives me my sleep breakdown for last night - with a 4month old baby it is certainly encouraging to see that I am actually managing to get into a good deep sleep.  I didn't need the tracker though to tell me it only took me 4 minutes to get to sleep cos I know as soon as my head hits the pillow I'm out like a light! And now, I've spent a little longer writing this than I thought I would so it's now dark outside, I'm not going to get to my target steps for the day and it's time for me to start clocking up the zzzzzzzzzzzzzzz's!! Night, night!

Lymphoedema Information and Resources

I'm presenting at a Lymphoedema Awareness Information Day in Enniscorthy on 25th April organised by the Hope Cancer Support Centre.

 I will be talking about what lymphoedema is, who is at risk and why and what a person can do to reduce their risk of developing it.  I will also be talking about what we do to manage lymphoedema.  In order to make it easier for folk who attend the talk to find the information resources I will be referring to, I have them all here:

The international consensus document

Best Practice for the Management of Lymphoedema

The Lymphoedema Support Network (LSN)

Lymphoedema Ireland

MLD Ireland

The British Lymphology Society

Macmillan online community

Lymphoedema Network Northern Ireland (LNNI)

Joachim Zuther’s Blog

Activa Healthcare E-Learning zone

BMJ online learning module

Hope this helps! ;-)

When is a physio not a physio?

I am often asked what the difference is between a 'Physiotherapist' and a 'Physical Therapist' and it annoys me so much that here in Ireland it takes me a while to answer, whereas in the UK, where our professional title is protected I can simply say 'they mean the same thing!' And what that is is that over there anyone using the title 'physiotherapist' and hence 'physio' or 'physical therapist' has gained an internationally recognised degree level qualification in physiotherapy (physical therapy), which covers anatomy and physiology, disease processes and the effect on the body, pharmacology, psychology, sociology and the application of clinical skills and a whole lot more.  Student placements are undertaken in all areas of healthcare including musculoskeletal, neuro, cardi-respiratory, paediatrics, womens heath, rheumatology, oncology etc and they are expected to be committed to their ongoing continual professional development as part of their 'licence to practice'. In Ireland 'yer man' off the street can come at you with a wet sponge, crack your back and dish out some well meant advice and call himself a physio! I find this both frustrating and concerning! I'm not going to enter into an arrogant dialogue about 'them and us'......there's plenty of that out there, just google (second thoughts I wouldn't bother), but the message I'd rather convey is just make sure that the therapist you are seeing is legitimately what they say they are, and the safest way by far of being guaranteed that they have received a standard level of training is to always make sure your physiotherapist is 'Chartered'.  All Chartered Physiotherapists are registered with the Irish Society of Chartered Physiotherapists we have to submit details of our ongoing professional development to register and we have to be fully insured - it's for your own protection! Now, where's me wet sponge!!