The aches and pains of Fibromyalgia

Hello everyone

I am currently on my Musculoskeletal outpatients placement. I must admit it has been a challenge so far, however I am thoroughly enjoying the opportunity to develop and apply the skills we have acquired at university.

I am currently treating a patient with the debilitating condition of fibromyalgia. This condition proves extremely difficulty and demanding to all aspects of the physiotherapy assessment and treatment session. I thus thought it would be very useful to offer you some suggestions which I have found useful when dealing with not only this condition but also the anxious, depressed and stressed patient often associated with fibromyaligia.

Fibromyalgia is a complex condition where a patient will present with long-standing pain which can encompass the entire body. The patient may also experience tender points in joints, tendons and muscles. The aches and pains of my patient involved her arms and legs, but in particular through her mid-thoracic and chest regions. These aches and pains are constant, she is painful and stiff first thing when she wakes up, they progressively become intolerable as the day progresses so by the time bed comes round she is totally exhausted but because she is still in pain she can’t sleep! As you can appreciate this condition has dramatically decreased her social activities, employment and ultimately her quality of life. In addition to the aches and pains, she feels constantly fatigued, she has difficulty sleeping, irritable bowel syndrome and huge amounts of anxiety and depression.

Dealing with this type of patient can be very frustrating and overwhelming. Every part of the body I assessed was painful! What and where are the main sources of pain? Is that the same pain? Is it a different pain? These are just a couple of questions I had to continually ask throughout the long treatment session. It is not easy to comprehend the pain and suffering that these patients are going through. The level of pain they are experiencing is overwhelming and relentlessly affects their quality of life.

The first approach I found to help deal with her pain is to show compassion and empathy. To understand the disorder and to understand the symptoms that the patient is experiencing educate yourself, the internet has a huge amount of information. Once your educated you can educate your patient. There are also many organisations that specialise in Fibromyalgia and other related diseases such as the National Fibromyalgia Association. Pass these details onto your patient so they can learn more about the disorder and speak to other people who are dealing with similar problems. Suggest activities such as hydrotherapy and stretching that aren’t too tiring but provide warmth, circulationg and promote a general feeling of well-being.

The emotional side of this disorder is probably more challenging than the pain. My patient was pessimistic and depressed. Its important for you therefore to remain optimistic, provide many words of encouragement and suggest lifestyle changes that may be promoting additional stress in their already challenging life.

I hope this helps with your clinical situations. Enjoy the rest of your pracs and if anyone has any more info that may help this type of patient feel free to make a comment.

Heidi.

Ultrasound

Hi everyone,

I previously did a musculoskeletal outpatients placement where I had seen many patients post TKR. One of the main problems these patients faced was with reduced ROM due to increased swelling. In order to reduce swelling my supervisor at the prac suggested supra-patella US to reduce intra-articular swelling. My Curtin tutor then questioned the safety of this technique re the metal implant and possiblity of burning the patient. The parameters that we were using were 1 MHz, 1 W/cm2, Cont, 8 min duration. My supervisor and tutor had a good working relationship and in the end discussed and came to a conclusion that it would be safe to perform. This was just based upon our own reasoning however. I was wondering what your thoughts are or if anybody is aware of any research regarding this situation.

Cheers
Brent

Time Management (for LESLIE)

Hi guys, I hope all of your placements are going well so far! It’s hard to believe we’re already one week down of this second clinic.

I have to say this first week in Musculo outpatients has been a bit of a challenge for me. I have really been enjoying the work, but have found it difficult to manage my time effectively. The first couple of days were the worst, having to come home and continue to do work until very late into the night.

We have been given 1hr sessions for our follow-up treatments and 1.5hr sessions for the initial assessment and treatment. Although this sounds like a fair amount of time to get everything done, I still seem to spend about a half an hour extra with each patient. This then leaves no time to do documentation, stats, any other paper work, or review for the next patient. I have been having to work through lunch and then stay on for about 1.5-2hrs after work to get paper work done and then still have to review for the next days patients when I get home.

This may just sound like I’m complaining, but I have really been stressed out over the week and need to find better ways to manage my time. Towards the end of the week I began to do my treatment documentation (S and O) during the treatment rather than taking messy notes and re-writing later, which has seemed to help. I am searching for anymore tips from those who have done their musculo placement or from anyone that has some good ideas. I am really hoping that things will ease up a bit as I get to know my patients and get into the routine of this prac.

Can’t wait to hear any suggestions you have.

P.S. this is Leslie, I will be posting my blogs under Trudi’s name
until I am sent a new invitation.

Leslie

Professional Practice/Communication – how to manage caregivers?

Hi guys!

This first entry is on my Dec placement doing neuro outpatient. Patients are allocated 1.5hours each and sometimes they are accompanied by their caregivers. I had the opportunity to work with this patient who has a very supportive spouse when it comes to rehab. I would like to share on this particular session which upset me. As part of my subjective, I asked if there were any new issues/concerns. The reply was ‘no, everything has been well!’ However, later during the session I noted that the spouse had gone to look for the Senior PT who then came along and addressed my patient’s sit to stand! Accordingly, the spouse was experiencing some difficulties facilitating STS at home. I could be too sensitive but at that moment I interpreted the look on the PT’s face as ‘Haven’t we gone through STS training during tutorial this morning? You mean you still don’t know what to do?’ (!!!) Eventually, I took over the session again but noted that the spouse had his arms folded and appeared to be rather inpatient, looking at his watch a couple of times. My immediate response was to explain to him what I was doing so as to engage him. That earned me serious ‘interrogation’, which I felt the component of ‘respect’ was lacking... All my confidence was swept away and that definitely affected the session... I chose to re-direct my full attention onto the patient then, who had been cooperative all along, pretending the spouse wasn’t there… My rationale at that point was if I couldn’t engage the caregiver then it’s alright as the main focus should be on the patient. Hopefully though, the spouse’s body language and attitude would not affect the patient negatively. (Not too sure if my rationale then was right? Any comments/opinions on this will be great!)

This got me thinking what will be the best way to manage caregivers who are present during a fairly long PT session. This is worth looking into as they are important people in patients’ lives and have the potential to influence rehab. I believe as students, it will definitely take some time for trust in our competency to be built up. Appropriate explanation of rationale + education to patients & caregivers and a display of confidence are absolutely critical during every session. I believe in engaging caregivers during a session so that they are empowered and feel involved, that they know they can help their loved ones get better. At the same time, they help to motivate/encourage patients and provide an additional pair of hands during treatment. I think the problem arises when the treatment doesn’t require an extra pair of hands. Then, it might be a good idea to ask if they would like to stay during the session or perhaps wait at the waiting area with a nice cup of tea and magazines if available! I believed what happened to me was partly due to the fact that I was ‘new’ to that caregiver and was feeling nervous. But I guessed this is normal at this stage and will improve as we gain more patient/caregiver contact experiences! Do let me know if there are any other suggestions on managing caregivers! All the best for 2nd week!

Peiying ~

It's all about communication

Hi guys, I hope your all doing well having survived week one of the new placement!
I have to say the first two days of this musculoskeletal outpatients made me feel completely useless! Previous supervisors have always commented that my communication with patients has been a strong point, and up until this week I always thought that it was too.

The first two days of this clinic saw me with 5 out of 6 patients with very limited English speaking abilities. Not only did this make it hard for me to try and get a thorough subjective and objective examination and get all the relevant information that I needed to treat these patients, they didn't appear to understand what I was trying to say! As a consequence, one of my treatment sessions lasted for a little over 2 hours!!!

Frustration at yourself (and with the patient) is a very hard feeling to try and conceal and I think maybe on one occasion the patient may have picked up on this. Aside from this being completely unprofessional, it really made my doubt my abilities as a physiotherapist - if i can't communicate with my patient how on earth am I going to succeed?

As the week progressed I learnt how to direct my questions to get an appropriate response, and the use of non-verbal communication is a fantastic thing that i really under-use! Treatment sessions have decreased in time (slightly) and that useless feeling disappears when you see that they are getting some relief from their pain/improvement in their condition.

I guess that what Physio is about - being able to communicate with everyone. We can't choose our patients and have to be able to adapt ourselves and the way we are around each patient so they understand and trust us. What a learning curve...

Fan

Professional Practice

Professional Practice

Hi guys,

During my first week of Prac I had an incident that I think you guys would like to hear about. I had completed a PT session with a client; I transferred him back into his wheelchair and was putting all the parts of the wheelchair back on it. I picked up the footplate and while handling it I grabbed onto the calf pad which isn’t actually attached to the footplate and the footplate dropped out of my hand onto the pt’s hemiplegic foot, this cut his middle toe and bruised the dorsum of his foot. When this occurred I thought it was the end of the world and that I was the worst physio in the world. Luckily the staff at the hospital were very supportive and helped me work through the paper work that needed to be filled out and assured me that it was an accident and that they have all had a similar situation.

The things that I learned from this unpleasant experience is the importance of being extremely careful and knowledgeable with the equipment at all times but especially with hemiplegic pts because they can not protect themselves. The second lesson that I have learned is that accidents do happen and that there is no need to stress out. The more appropriate thing to do is to understand the situation and to know about the process and procedures that you must go through to ensure the well being of your pt and yourself.

The process at my hospital is:
1) Notify a nurse to dress the wound
2) Notify the pts doctor of the injury
3) Fill out an AIMS form
4) Write out what occurred in the integrated notes
5) Notify your supervisor

I hope this never happens to any of you guys but if it does, don’t stress, that will not help the situation in any way. Go and find out from your supervisor what the procedure is that you have to go through and take care of the situation.

Good luck with the rest of prac!!!

Happy New Year

Hey guys.. just testing the blog system out. Hope you all had a great Christmas and Happy New Year. See you all soon. Heidi