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Memories from DC

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Do you have a city that holds an emotional place in your heart? They may be positive emotions:

  • where you got married!
  • where your first child was born!
  • where you ran your first marathon!

Or they may be negative:

  • where you got your first speeding ticket
  • where you broke your leg
  • where your parent died

Sometimes, you have a city that just triggers you.  There is a memory or a time that was spent in that place that was either so positive or so negative that you constantly place that emotion on that particular city.

Every time I think of Paris I remember waking my 3 year old up at 11 pm to watch the pretty lights sparkle on the Eiffel Tower.  It is no surprise she dreams of living in Paris to this day.

I should have expected the trigger when I landed in DC after a red eye flight.  But, in my sleepless haze, I found my way to the Metro and figured out which direction I needed to go to reach my destination.  I stood on the platform and enjoyed the sunshine.  When the Metro arrived and I sat down, all the memories came flooding back.

Lorelei and I were medevac’d from Germany to Walter Reed Medical Center 12 years ago.  Since Lorelei was not a big fan of sleeping we arrived in DC pretty groggy.  I remember searching for the shuttle I had arranged to take us to the base while carrying enough suitcases to last us who knew how long.  We had a return ticket for 2 weeks later but there was no guarantee we would be going home then.

The shuttle was only able to drop us off at the gate for the base.  This was post 9-11 and there were civilians on the shuttle.  I had to carry my baby and all our stuff up the ¼ mile long driveway to the hospital.  But it was okay.  I was finding answers for my baby.  We would be fine.

You see, Lorelei was very sick as a baby.  She cried constantly whenever she wasn’t being held.  She didn’t eat very well because she couldn’t poop.  Lorelei had become a ‘failure to thrive baby’.  They had sent us to a specialist in Germany who ran all the big, scary tests.  No, she didn’t have any life threatening disease. Yes, she did have muscles to push things out from that end.  No, we don’t know what’s wrong with her.

Lorelei was so sick that they had pulled Matt out of Iraq to come home and care for Ainsley so Lorelei and I could go to DC.  Okay, let’s be honest, first they told me to leave my 3 years old with friends in Germany while my husband was in Iraq and I took Lorelei to the US.  When I explained (read: yelled) about how I wouldn’t do that, they brought Matt home from Iraq.

I finally found the place in the hospital where we were supposed to check in and get our lodging assignment for our time in DC.  When I explained that Lorelei was the patient and not my husband the lady at the office said those fate filled words “Then I cannot help you”.  This was during the height of the war and this office was focused on helping families of soldiers who had been injured in Iraq and medevac’d to Walter Reed.  My baby didn’t count.

I was alone in DC with a very sick baby and no clue where I would sleep that night.  No clue what answers we would find in this place.  No clue what the next step was.  As I got back on the elevator to go back downstairs my luggage literally exploded all over the place and I started bawling while trying to grab all my luggage and pull it into the elevator.

Luckily an intern walked by and took pity on the crazy woman crying with a baby strapped to her chest and luggage that was all over the place.  He finally got the story out of me and figured out what needed to be done.  He marched me downstairs and had the information desk get me a hotel room for the night with a shuttle to come pick me up.  I continue to offer up thanks to that intern. I was, and am, so grateful for his help.

As it turned out the trip was non-productive.  They ran the same tests they had already run in Germany which led to the same diagnosis that we had received in Germany.  Which was “we have no idea why your kid can’t poop but she needs to be on medication for the rest of her life”.  It would be 5 years before we found the naturopath and nutritionist who would finally give us the diagnosis of celiac disease.  This would allow all the pieces of the puzzle to come together and allow for the healthy teenager we now have.

Therefore, I should not have been surprised when 12 years later the Metro brings about all those fears, anxieties, and tears.  But I was surprised.  I had difficulty breathing.  I became nearly paralyzed with fear.  And I had to figure out how to put one foot in front of the other.

I started with gratitude for how much our lives have changed in 12 years.  That fussy, failure to thrive baby has turned into a beautiful dancer/8th grade President/super fun teenager.  And I was in the DC area for a conference to help me with business development.  Because I own my own business.  Which is so very awesome.

I was honest with myself and the people around me about what was going on.  I texted Matt to get some support and I also told my group what was going on.  I acknowledged that these were old memories surfacing which decreased their power.

I moved forward with what I was in DC to do in the first place.  I did let the memories have their time while I went for a walk before the conference started.  But, once the conference started, I let go of those memories and focused on what I was there to do.

Grateful, honest, and moving forward.

Maybe you find yourself in a place filled with fear, anxiety, pain, or overwhelm.  I encourage you to remain grateful for all the good you have in your life.  Be honest about where you are with people you can trust to vault that information.  And then figure out how to move forward.  You are not meant to live in this place.

Why Use a Cash Based Model?

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Why did I choose a cash based Physical Therapy model for PT4EB? One reason:

QUALITY OF CARE FOR EACH PATIENT BASED ON THEIR NEEDS

PT4EB utilizes knowledge, experience, research, and patient preference to determine specific treatment plans to return each body to optimum performance. I do realize that is a hefty mission statement that may seemed filled with “buzz words” to sound good. Let’s break it down:

Knowledge – Amy is the only Physical Therapist with a PhD in Orthopedic Manual Physical Therapy in the Maple Valley, Covington, Black Diamond, Kent, and Renton area.

Experience – 16+ years of clinical experience in outpatient physical therapy with years of emphasis on military personnel/dependents and pediatrics.
Research – Writing your own dissertation helps one to understand and interpret the current research available.

Patient Preference – It doesn’t matter how good your treatment plan is if your patient doesn’t agree it is the right strategy for their body. Therefore, we discuss your treatment plan and come to an agreement of what works best for YOUR body.

The current insurance based model of physical therapy creates an emphasis on getting patients in and out as quickly as possible for each treatment session while performing the maximum number of treatment sessions that insurance allows. Physical Therapy Assistants (trained, 2 year degree program) as well as Physical Therapy Aides/Techs (on the job training) are utilized to move patients through their program which works well if patients are progressing on schedule through their treatment. But, Assistants and Aides are not able to make changes to the treatment plan set out by the Physical Therapist causing some patients to get “stuck” on a treatment plan until their next scheduled visit with their Physical Therapist.

I have obtained optimum patient outcomes with a one-on-one based treatment plan that allows one hour for each treatment session. Each session begins with a review of how the patient responded to the last treatment session and how their body is feeling now. Manual treatment is applied to restore normal joint motion, decrease muscle tension, improve fascial mobility, and retrain muscle coordination. The treatment is often concluded with a review and modification of the home exercise program to continue until the next visit. This is a very active treatment approach that requires complete patient participation in providing honest feedback, implementing changes to daily routine, and performing their home exercise program as prescribed.

Patients are usually seen once per week or even every other week as opposed to 2-3 times a week at a more traditional Physical Therapy clinic. This is to allow time for the body to respond to the treatment and eliminate any possible soreness or fatigue from the treatment. It also allows patients to try their home exercise program and see the effects the exercise has on their symptoms. Patients tend to require fewer visits which may decrease the cost of treatment. The following table provides a comparison of a cash based PT model versus a more traditional PT model.

Cost per visit

Cash Based                                                Traditional PT
Cost per visits                            $125       Co-pay                                             $40
Number of visits                              4        Number of visits                                12
Total Cost                                  $500        Total Cost                                      $480
Time Spent with PT                    240        (15 minutes per visit)                       180
Cost per Minute                       $2.08         Cost per Minute                           $2.67

As a patient, it is important to remember that insurances do vary. Some patients have a high deductible and will be responsible for their entire PT bill – even if they go to a traditional PT clinic that bills insurance. A cash based model allows patients to fully understand their costs up front and not be surprised by a large bill three months after treatment. All patients are provided with a superbill at the end of their treatment session that has the ICD-10 and treatment codes they can submit to their insurance for reimbursement. Of course, the time taken from work or school to attend 12 treatment sessions versus 4 treatment session also must be taken into the accounting for each patient.
If you are looking for improved outcomes in a shorter amount of time, I recommend a model that focuses on the quality of care versus the quantity of patients seen.

My Valentine’s Day Present from the American College of Physicians

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American College of Physicians Issues Guideline for Treating Nonradicular Low Back Pain

Be still my heart! The America College of Physicians (ACP) decided to give Physical Therapists (and other “alternative” treatment options) a HUGE Valentine’s Day present by issuing new guidelines for the treatment of nonradicular low back pain.
Okay, did I lose you at “nonradicular”? That just means low back pain that is in your back and does NOT radiate down to your leg! Radicular low back pain is pain that begins in your back AND radiates down your leg. Radicular low back pain is caused by a pinched nerve in your lower back and there are different treatment recommendations for that!
The ACP did a comprehensive review of the literature and concluded that acute low back pain (lasting less than 4 weeks) and subacute low back pain (4-12 weeks) are best treated by heat, massage, acupuncture, or spinal manipulation. While heat can be done at home and acupuncture must be delivered by an acupuncturist, the terms “massage” and “spinal manipulation” as they are defined in this guideline are treatments delivered here at Physical Therapy for Everybody. Two out of four options found in one location! For patients with chronic low back pain (longer than 12 weeks) the ACP recommended exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction. Again, “exercise” and part of the “multidisciplinary rehabilitation” are also treatments delivered here at Physical Therapy for Everybody. You can receive the manual treatment and exercise treatment recommended by the ACP in one place by one person!
On the pharmacological side, acetaminophen was not effective versus placebo, NSAIDs are first line therapy drugs, tramadol or duloxetine are second line therapy drugs, and opioids are the last treatment option, which is only used for patients who have failed other therapies.
And surgery? Forget about it, says the ACP. There is no research to prove that surgery decreases low back pain.
So, if you have low back pain that does NOT radiate down to your leg, the ACP (which probably includes YOUR doctor) recommend that you see a Physical Therapist (or an acupuncturist if you prefer the non exercise route). Want to read more? Please visit:
https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain

What are all those letters after your name?

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Dr. Amy Konvalin, MSPT, DMT, PhD, OCS, FAAOMPT – WHAT?!? I am often asked what all those letters stand for that are listed behind my name. And, what are the letters that are listed behind other therapists’ names? To start, let me begin by explaining the entry level Physical Therapy degree.

In the early 1950’s, a Baccalaureate Degrees (BS) was the entry level degree for Physical Therapists. In 1979, the American Physical Therapy Association (APTA) House of Delegates adopted the resolution that the entry level degree for Physical Therapy would be a post-baccalaureate degree and schools starting shifting to the Master of Science (MS) as the entry level degree. In 2000, the APTA released the Vision 2020 which stated that physical therapy services would be delivered by doctors of physical therapy (DPT). So, the entry level degree that each Physical therapist holds is largely dependent on the time frame in which they graduated. The curriculum has changed significantly over the years to meet the rigors of a DPT program and due to the advancements in medical research that have occurred over the years.

Since I graduated in 2000, the same year that Vision 2020 was released, I received a Master of Science in Physical Therapy. As I grew in my practice, the demands of Vision 2020 weighed heavily on my mind. Would I do a transitional program to earn my Doctor of Physical Therapy? Would I get advanced training through a fellowship program? After moving to Washington State in 2006, my plan slowly unfolded.

The American Board of Physical Therapy Specialties offers an Orthopedic Certified Specialist (OCS). This involves passing a rigorous 8 hour exam that is written each year by Physical Therapists who are experts in outpatient orthopedic physical therapy. It is grueling and I am grateful to have passed the exam in 2011.

I earned my Doctor of Manual Therapy (DMT) in 2011 by completing a year of classes and advanced clinical instruction followed by research to support my dissertation topic. When I completed this degree, I felt comfortable that I had met the APTA’s desire of Vision 2020. But, I wasn’t done yet!

Back to school I went for another year of intense study and clinical instruction followed by a written and practical examination. When I had successfully completed these, I earned Fellow status in the American Academy of Orthopedic Manual Physical Therapist (FAAOMPT). This is akin to the fellowships doctors go through during their training. Although not required in the physical therapy profession, it is highly recommended to continue learning and advancing skills in the clinical setting.
Well, after all this it was only one more year of school and a dissertation to earn my Doctor of Philosophy in Orthopedic Manual Physical Therapy (PhD). ONLY!

I hope this helps to explain the “alphabet soup” behind my name a little better and give you some knowledge as a consumer when you see these letters behind the names of other Physical Therapists. And, if they have different letters behind their names, please feel free to ask them about it! I guarantee you, if they took the time and energy to earn those letters they are more than happy to share that information with you!