Thumb Pain

So I’ve been working for nearly three weeks now, it feels like it’s flown by as I’m starting to get used to it. One of the things I experienced in my first two weeks was some first CMC pain. Just a general dull ache, and pain on palpation of the joint. I felt like such a weakling because I’d only been working for a couple of days before it started.

I bought a pair of Thumbsavers a couple of months ago, when I knew I was going to go straight into private practice. Like everyone doing manual labour, I am afraid of overuse and degenerative conditions related to massive amounts of force applied. So I bought them, they arrived, but I never really learnt how to use them properly so that my clients wouldn’t notice I was using them.

After a week of working, I decided to work on my willing sister, willing to be the guinea pig for me to test out some maneouvres for them. They were fantastic! She couldn’t tell the difference, and I was able to push much harder with significantly less effort from my intrinsic hand muscles. But the thought running through my mind was that there was now more force going through other joints – that could have unknown long term effects too.

I asked my boss for some tips regarding manual therapy, as he has been in the private practice industry for 20 years and uses predominantly manual therapy. In Cantonese, he said I have to use literally more ‘inner strength’. In the Western world, I suppose we could describe that as ‘bodyweight’.

So I thought about this an I have changed the way I work a little bit. My hands are less tired and sore but I have a feeling my wrists in general are going to take a fair bit of wear and tear in the years to come. The focal pain in my first CMC is now less noticable, but there is still a bit there when I palpate it. I hope it doesn’t turn into a dull, chronic thing that I just don’t notice because my hands have now just been ‘conditioned’.

At this, I will continue to think about what techniques I am using, and see if I can modify the way I am working to reduce this further. I am going to learn dry needling at the end of March, so hopefully that can give me more, effective passive treatment options (rather than just interferential and ultrasound). I don’t really do spinal moblisations, as I find soft tissue work addresses the cause of stiffness better than mobilisation, apart from for assessment and gentle mobes in older patients who clearly have degenerative joint disease.

The dreaded thumb pain in action.

Living for the Future

One of the things I love about my job is that I get to talk to people much older than myself, who have lived very full lives and are enjoying their retirement.

One of the things I ask them is, “Looking backward, what is something significant, that is very prominent in your mind, that you would do differently in your life?”

I ask this question because many people around my age fool themselves into thinking they are living life “without regrets”, and that everything they are doing and experiencing are lessons in shaping who they are. For some people this is possibly the best method of learning for them – through experience, trial and error. But I think it is necessary to recognise that this must be a slow way of doing things – making the same mistakes people have made in the past, and only repeating them yourself.

In recent times, probably the past three to four months, I am starting to learn more about myself, and what is natural for me to do in certain situations and circumstances. I am reflecting and looking backward and discovering the reasons for why I have made it to who I am today, and am starting to see some patterns. I have come to the realisation that for me, living life “without regrets” involves knowing myself, what action I would take that would be natural for me, executing it, and believing that because I have been true to myself, no matter what outcome I would have “no regrets”.

So an example of this. I asked this exact question to one of my patients who I have developed a relationship with, only after just two weeks of working.

If there was anything she would have done differently, it would have been the friends she chose. A rule she lives by is a quote from Eleanor Roosevelt, “If someone betrays you once it is their fault, if someone betrays you twice it is your fault.” In this, she invariably meant that she had given people too many second chances in life, and had been hurt as a result. She believes that if she had cut these people out sooner, her life would have not only been a lot happier, but she would essentially have had more time to progress further in a positive direction.

So I had to ask the question, “How do you know if someone is the right person or the wrong person? If you have been betrayed that many times in the past, surely there has to be a pattern to the people you eventually clash with?” In my considerations of late regarding personality and intentions, I thought that these two factors must play a significant role in determining who will eventually consume you in a negative manner.

I have been pondering a theory about reducing the number of friends I have in my life. I told myself that I’d allow my expanded network of friends to increase over the next few years, but once I stabilised with the working life, that I’d reduce that dramatically. I think this process has already begun though.

In the past couple of days I’ve just decided to stop talking to everyone, and allowing them to initiate conversations with me. This is very unlike me as I have always been a big believer in trying to pick someone from a distance and going after them, for any potential, be it friendship, relationship, networking, anything. I think that people have taken advantage of that, as I know I initiate a lot and trust easily, and can reveal a lot about myself in a short space of time. This works in the short term, but I have found that things don’t last beyond a few years doing things this way.

I reasoned to myself lately that this must be because I see the potential in something very quickly, and since I’m not fond of wasting time, I therefore just cut to the chase. Unfortunately, as there are many people who enjoy chasing and playing the game by a certain set of social boundaries and rules, this does not work. People lose interest quickly – probably because they only have a superficial understanding of the world around them, and as I reveal a lot of my thought rapidly, they think they know me and probably want to take what they’ve learnt and move on.

Another concept I have heard of recently is Robin Dunbar’s Five Friendships. In essence, you can only have intimate relationships with five people at any one time, fifteen good friends, fifty friends, and one hundred and fifty acquaintances. This means that you cannot have more than this number of friends at any one time. Therefore, to make a new friend, you must remove someone.

I think during our unstable, younger years, we measure how good a friend we are by the number of friends we have. As we stablise and mature, we reduce the number of friends we have as quality becomes more important than quantity. In this way, if we are to make a new intimate friend, we must drop someone who has taken up 20% of our life, and replace them with someone else. This is dramatic.

Earlier than I thought, I’m just going to dry up my life. I’m fed up with immature people who I have put time into, who end up either misunderstanding me, or taking from me to selfishly benefit themself. I need to trust my first initial intuitions, I am hardly ever wrong about people in the long term, and giving second chances to people is messing with life.

In Buddhism, I know you are told to live for the present as life is impermanent – so make the most of now as things will never twice be the same. I feel like I’m living for the future now, but in many ways, I think it will make my present better.

Pirating SOPA/PIPA

The internet in the past few days has been shaken up by websites such as Wikipedia blacking out their whole website in protest against the Stop Online Piracy Act and Protecting Intellectual Property Act.

It has been reported in media, that major opponents of these acts believe that while the intentions of these acts may appear reasonable, they deplore what the acts might actually achieve – dramatically slowing and ultimately destroying online businesses in these harsh economic times.

From my point of view, imagine the lack of entertainment we would have if online piracy did not exist. Our lives would be bereft of so much enrichment. All the songs I would never hear, all the movies I would never watch (even though I hardly watch any). What impact would this have on society? I imagine we would most likely be back in the 60′s, where people would play tiggy and have tea parties.

It is companies like Apple who try and save the entertainment industry, and sell their content as though it’s a grocery. A necessity. Yet this is not enough; Hollywood is still losing money.

While I am a great fan of intellectual property, and believe that everything should be done to protect it, this is the future – sharing entertainment to spark further innovation. Sure, people are losing money – but maybe they shouldn’t be earning more money if they are anchored in their systems and models and unwilling to progress with the ever changing nature of reality. They just have to find ways to sell it better.

I’m an Instructor!

Another addition to my journey into the World of Physiotherapy this year will be a Hydrotherapy class that I am taking twice a week. Yesterday was my first session with five willing participants, while one of them was so kind as to turn up but let me know she was not feeling well. I was thrilled to have anyone, let alone a small class of five, for my first day.

As part of my university placements, I attended a twice weekly hydrotherapy session for patients with mostly musculoskeletal problems. During this, I asked lots of questions, and by the end of the four weeks of it, I felt that I had a reasonable grasp of what to do in hydrotherapy.

I spent the night before writing out some simple exercises that I could run through. The content that I found was particularly underwhelming; but given that it was the day before, and I couldn’t put on my creative brain with something that I’d never really thought too much about, I settled with running through some basic exercises in the group part of the class.

After a busy morning, the moment came! It was my turn to lead a group of older Australians in their twice weekly session of water exercise!

I told them midway through the class that I had spent most of last year attending hardcore aerobics classes, and that I was planning on introducing some of the moves into the pool. And I was hoping that by the end of the year, we’d have a water aerobics class for the oldies!

It’s so much fun!

Lost in Conversation

It’s funny to think that I’ve only been working for a week but I feel as though I’ve been there for a long time. I guess I’m starting to feel more comfortable, but still looking forward to each day.

Today I had seven private paying clients in a row, all fantastic people who I really enjoy talking to. I was lost in conversation with my second client of the morning. We were talking about her escapades around the expanses of Victoria, and how she organises trips for her social group. Holiday planning is her life, and well, I guess your mind can drift when discussing this topic. I forgot to check m watch and before I knew it, the twenty minutes was up and I had a few more things to do to make it seem like the session ended naturally. I panicked inside momentarily, then I thought it would be okay because it would only be 5 minutes overtime.

With my next client, she was telling me about her former job as a photo developer. And some of the interesting stories she had of developing people’s films. She was so interesting that I again forgot to check the time, then realised there was only 5 minutes to go! And then I realised that I’d probably be running 10 minutes behind in a second.

I was really having a lot of fun though, so I guess that was the main thing. In the back of my mind, I was still remembering that a lot of these clients are private paying, and therefore also expect clinical results despite how interesting the conversation might be.

Small Confidence

Today was quite a big day for me, because all the patients who I’d seen for the first time were coming back for their followup visits. I am particularly worried about the private paying patients, rather than the Medicare or WorkCover patients, as these clients are paying out of their own pockets. So all I want to ensure is that these guys are getting their money’s worth, of course.

And I think they are! My first real private paying client has just started to book in long consultations with me, because she has been so impressed with the progress she’s made after turning up for her first visit in a wheelchair, that she now wants me to work on her other joints!

And my other private paying clients are happy with their progress too. It’s feeding my ego just a little as today, one said, “It was soo painful yesterday, but today, my arm is completely free and I can move it pain-free!” I couldn’t help myself to saying, “Okay that’s great, cya later now!” Yes and then I was modestly serious for the rest of the treatment.

I’m indeed very interested in the psychology of my interactions and relationships with patients. I was analysing a heavy introvert, most likely an INFJ, and she was talking to me about her hobbies and interests, as I asked what she had planned for the year. She told me she was very much a “jack of all trades, and not really very good at one particular thing”. In my past I have thought this and told some people this exact line, and it rung true very much for me. But uncanny as I felt, I had to say, “Yeah, being a jack of all trades is quite handy, but unfortunately, in society, it leaves you being the middle man in most things, as you can understand two sides to something. However, technology is reducing the need for middle men, and well, therefore… that’s why you’re in IT/systems I guess…” This drew wry laughter from my client. In later reflection I found it amusing that she was nearly double my age, yet I felt as though we’d been on the same page from the beginning.

I’m slowly becoming less daunted by treating people who are obviously older than I. I’m starting to feel the respect I command just being a healthcare professional in a one-on-one treatment room, and how a patient clings on to every word you say. It’s humbling and I suppose this makes me respect who I am more.

I’m enjoying work I think. I’m getting my head around the various bits of paperwork slowly; it is such a hassle. Today a receptionist had a go at me because she was telling me something and I didn’t know what a PMP was, and she stopped and said, “Are you serious?” To which I replied, “Well yes, they don’t teach us much about paperwork at uni, and certainly hardly at all about WorkCover.” It is small battles like these which I know I will lose for now – I already said to my clinic manager last week that paperwork was in fact the thing I was most afraid of – but I’m quietly sure that I’ll be winning many down the track. But the main thing for now is that I like what I’m doing in the room with clients.

I look forward to going to work :)