A Cold Wind Will Blow Through Your Door

Yesterday set a new record for me. I went for a run and it was 18 degrees outside. It was COLD! I think the coldest I've ever run in was about 30ish. This was a new experience for me. One good thing that came from it was that I was able to test out the right amount of clothes to wear in cold weather. You don't want to be underdressed in the cold, but you certainly don't want to be over dressed. I hate being hot when I run! Yesterday though, I think I was just right. I had on my gloves, tights, a long sleeve shirt, and a jacket. The only thing that I might have wanted was something to cover my ears. It was a little windy and my ears were cold. But, once I got going, it felt great! I love running in cold weather! Well, maybe that was a little extreme, but it sure beats 90 degree weather at 5:30 in the morning in the summer in Texas! I loath that with every fiber in my body!

Tomorrow begins my fifth week of the fellowship. I can't believe how fast it is going. I only have 5 more months here. And let me tell you, they are jam packed with things to do. I think every weekend from the middle of February until the end of April is booked with something. Jason (my brother, not any other Jason! :) ) is coming in a couple of weeks, I am going back to Texas the last weekend in February, the HUGE conference here is the first weekend in March, mom and dad are coming the week after conference, I fly back to Texas for a tournament, and my last planned trip right now is to Cincinnati for another conference. Somewhere in there I want to plan a trip to Baltimore and New York City. Before I know it, it will be June and I'll be packing up to head back to Texas. There is so much to do before I leave. I better get started on that list of mine!

The fellowship is going well though. I continue to learn something new everyday. We are slowly learning the quirks of all of the staff scattered among the different clinics and the ins and out of the clinic. All places have their issues, that's for sure. I really enjoy it here though. We are slowly building a case load which is nice. It gets old day after day observing. I learn by doing, so let me do! This past Friday we taught the OT students the first splint, the wrist cock-up splint. It went so much better than I expected. I approached the entire situation very relaxed which I hope put the students at ease. We were told they are very uptight and want everything perfect. Let me just tell you that my splints aren't always perfect so I wouldn't expect someone's first splint to be perfect. I really enjoyed helping them learn this splint. This Friday we teach the hand based thumb spica. I wouldn't say I hate this splint anymore, but it's certainly not my favorite. I am getting more and more comfortable with it. Hopefully I can convey to these students the correct way to make it!

So, here's to week 5. Only 18 left!

All The Right Moves

Today was a great day at work! Much better than last Tuesday. We only had one observer and Jennifer was observing office hours with one of the doctors. So, it was was just me and Lauren doing splints. Tuesday is always "learn a new splint" day. Today it was the gutter splint, both ulnar and radial. I started the morning by practicing a radial gutter on Jason, as there were no patients there. It's a pretty easy splint, in that they patter is basically a rectangle and you drape it over the ulnar side of the hand. It actually turned out pretty well too. I then saw a couple of patients and was able to make their splints for them. I made a couple of hand based thumb spicas and a forearm based as well. Lauren and I were able to man the splint station and I didn't have to have her help too much. I am continuously getting more comfortable with my splints, although there is always room for improvement. I then practiced a radial gutter. It's a little more difficult in that you have to make a hole for the thumb and make sure you roll that out. It didn't turn out so bad either.

Good thing I practiced the ulnar gutter this morning, because we had a patient come and I was able to make her splint for her. I didn't have to be too perfect with it, as she is having surgery Thursday and then we will re-adjust the splint after surgery to make it fit better. Lauren was pretty impressed with the splint as was I. The afternoon slowed down a lot and Jennifer came back, so we practiced the splint that we have to teach the OT students on Friday. We practiced making a pattern and then the splint because we won't have the pre-cuts that we use in clinic. This splint is the easiest of the three so it wasn't so bad. It will be a fun one to teach. All in all, a pretty good day at work. Busy, but good. We actually got off a little early too. I left work around 5:15 as opposed to 6:15 or 6:30. So, I went and got a pedicure and my eyebrows waxed. It wasn't as great as the place I go to in Dallas, so I'll have to keep looking. But, my toenails look so much better!

Tuesday is also when I meet with my personal trainer, Lance. I decided that I would go for a quick run to warm up before heading to the gym. It was about 38 degrees out tonight, so I of course put on shorts and a jacket and set out. You always dress for about 20 degrees warmer. You don't want to be comfortable when you start, and I definitely wasn't. As I was headed out, some guy yelled across the street "where are your pants!". My legs were definitely chilly for the first mile or so, but then they get warmed up. In fact, my upper body was getting a little too warm. I probably could have gone with only my reflective jacket. I got in a good 2.5-3 mile run before heading to the gym. It's so hard to run in the city though. One because my Garmin doesn't work because of the tall buildings. The satellite can't pick up. And there are too many stop lights. I get going just to have to stop again for another light. It's a good thing I can head for the museum on the weekend. Not too many lights out there.

Lance put me through another great workout! We started again with step ups, only this time I was on the largest plyometrics step. It was tough but I did it. Tonight we really focused on back and shoulders. I did some rows, reverse fly, and sumo squats, all with scapular retraction. I also did lat pull down and then cable triceps extension. I told him my triceps are weak, and he definitely took that to heart. I did quite a bit for my triceps tonight. I then ended with the ab machine again which is a great workout. My abs are still sore from Saturday. I am still enjoying working out with him. I always come away sore but a good sore. Tomorrow is my day off from working out because I'm at work from 6:30am until around 9:00 or so. Except tomorrow night we have a Philadelphia Hand Society meeting at a swanky Greek restaurant. Should be a lot of fun and a great lecture. It makes for a long Wednesday though.

Early Mornin' Rain

This was the scene from this morning. I knew that it was raining outside, but I didn't imagine what I was about to walk out in. I put on my coat, tied my hair back, grabbed my umbrella and headed downstairs. When I got outside, I just about blew away. It was pouring and the wind was blowing 40+ mph. It was crazy! On the 6 block walk to the Hand Center, my umbrella flipped inside out about 5 times. My pants were wet, my hair was getting wet and I was miserable. I just wanted to hop in my car and drive to work. It doesn't work that way here in Philly. So I sucked it up and proceeded to work. When I got to work, my hair was a mess, so I tied it back and hit the ground running. I knew I had a couple of patients on my schedule so I had to get ready for that.

My day today consisted of two patients and then helping out on splints. Jennifer was in surgery today so I was the only fellow and had more opportunities to practice. I made two hand based thumb spicas and they actually looked good. I also made a hand based thumb spica and it also turned out well. Maybe my hate is turning into just dislike. It was a good day on splints!

Everyone today at work kept talking about how warm it was outside. They said it was in the 60's. Coming from Texas, 60 isn't that warm. But when I walked outside it felt so good! I decided I would go for a run. I have been afraid to run at night here in Philadelphia but I figure that if I stay in areas where there are a lot of people, I'd be okay. So, I headed toward Rittenhouse Square. Once there, I headed north toward the Ben Franklin Parkway. That leads to the Philadelphia Art Museum where I ran Saturday but I thought, why not. Once I was at the museum I decided I would run the stairs, Rocky style. I actually ended up running the stairs about 6 times. It felt great too. Although my calves were burning! I was then ready to head back home. It was a gorgeous night, and I had a fabulous run. Although, I did get a few expletives yelled at my by the homeless man on the corner. He kept yelling for help and I just ignored him. He used a few naughty words to express his anger at me. Oh well. I'll get over it!

Feels Like Home

This morning was trial three for Jennifer and myself trying to find a church to attend. We met at 12th and Chestnut to then walk to Arch to catch the bus. We were going to try Trinity Baptist Church, a Southern Baptist church that we found on the internet. It was quite an adventure. We got on the bus, barely had the $2 fare and headed to somewhere we had never been. I had to ask the driver where we should get off, and thankfully he was nice enough to tell me. When we got off, I saw the sign for the church. We were only 30 minutes early! So, we go into the church and Jennifer headed up the stairs to the sanctuary where we figured we could just sit till church started. Well, there was "Sunday School" going on. I couldn't seen in, but Jennifer said there was a small group meeting at the front. I was picturing a group of about 15 or 20. I could see down the stairs to their fellowship hall and saw a few people walking around and just talking. So I figured we could go and introduce ourselves and get a little more information. The first person we met was the pastor, and he introduced us to a few other people that were probably in their 30's. So far it was looking promising. The last church we were at, the youngest person was probably 50 or 60. Here they were a little closer in age. We spoke with the pastor for quite a while and he gave us information on their weekly activities. One question we asked was how many members they had. His answer: 50. I just about fell over. So not what I'm used to at First Baptist Dallas. Numbers aren't everything though. It was time to start worship, so we headed to the sanctuary. Very similar to a small Baptist church in Texas. The service was nice, very laid back. But, I just didn't feel right about being there. I just didn't feel like I would enjoy going to this church. After the service, we jetted out of there!

One thing I forgot to do was figure out how we would be home. I had looked up the bus route to get us to church, but didn't look up the return trip. Thank goodness for the iPhone. It came through again! Or so I thought. We went and stood at the corner to catch the 32 bus. Well, we stood there for about 20+ minutes and I decided to look up the route again. This time SEPTA told us to catch the 48 which was on a different street. We had about 7 minutes to get there before the bus, so we hustled down the street. As we are at the corner, a bus passes by and we thought, Oh no! So, we cross the street hoping another one will come soon, and at the bottom of the hill, we could see a bus. As it got closer, we could see the 48. Hallelujah! We hopped on and headed back to Center City. It was fun to try another type of public transportation. I don't think Jennifer was too excited about it though!

I think I've finally got my apartment all together. It only took me a month. So, I have 5 more to enjoy it. I know it is small, but it's cozy. I don't need much space as I'm hardly here and when I am, I'm either studying or sleeping. Here are a few pictures. Enjoy!

Looking in the front door

Bedroom/Living Room/Study

The front door

Behind door #1: The closet. Behind door #2:

The Bathroom

The Kitchenette

Hurt So Good

This morning I finally decided to stop being lazy and go for a run outside. It's so hard to run outside in Philly during the week so I have to save it for Saturday. It was a little chilly for shorts this morning, but it was a gorgeous day. The sun was shining and it wasn't miserable outside. I headed for the Art Museum and to run by the river. I was on a time crunch though as I was meeting with my personal trainer again. The run was really good though. I actually felt great to be out on the streets again. I have about a month to go until the Cowtown 1/2 Marathon, so I hope I can get some mileage in before then.

After my run, I hustled over to the gym to meet up with Lance. I gave him my food log and we reviewed it while I was working out. He had me start with bridging and knee flexion with a Swiss ball. It was a tough workout for my hamstrings and hip muscles. I did a set of those and then went on to an ab workout with the ball. After a set of those, it was back to the legs and I repeated that cycle a couple of times. When it was time to get up, I definitely felt my abs saying "figure it out how you are going to get off the ground cause we're not helping!" I then did step ups on one leg, then switched legs for a 20 reps, then 15, then 10 all in a row. It was a great cardio workout as well as leg and balance. Then it was right into walking lunges. Then I had a "working rest". I had to do rows while placing one hand on the Swiss ball and with my knees in a slight lunge position. My legs felt that more than my arms. Then it was back to squats, then rows, then squats, then rows, then squats again. Constantly moving! He then had me to triceps, biceps curls and overhead press, all with 8 pounds, all in a sequence. Then right after my overhead press, it was right back into triceps. It was tough. The weight wasn't so bad for the biceps or overhead press, but my triceps were dying. Then it was back to abs. He had me do this crazy machine where you sit and pull these handles which makes you fire your ab muscles. He had me do it both with no weight and also 10 pounds. I did about 3 sets of each and then we called it a day. It was a great workout. We seem to target the same groups but do different ways each time. He also focuses on proper form and stabilization, which me being a physical therapist, I think that is super important.

I was pooped after all of that. I went straight home, grabbed some lunch, and took a much needed nap. I ended up sleeping for about 3 hours and wanted to sleep some more. Everytime I have to use my triceps, I definitely feel them burning, as well as my abs. They are wanting a break! But, I'm excited to be working with Lance. It's a good pain and I know I'm going to see results!

Weird Science

Today was my first day as a "teacher". Scary thought. As a a fellow at the Philadelphia Hand Center, I am responsible for teaching first year OT students at Thomas Jefferson the basics of splinting. Seeing as how I have never been formally taught how to splint, this should be interesting. This morning, we had to sit in the computer lab and help them with evidenced based practice. Pretty boring, but it is relevant to our (their) field. Everything in medicine is based on EBP. Then the afternoon is when I had to regurgitate what little I know about certain "tests" they will perform. We had to go over volumetric measuring for edema, grip and pinch strength testing, Semmes-Weinstein sensory testing, static and moving 2 point discrimination, and pain. For the most part I knew what I was talking about. They aren't even tested on this so it will be fine.

Next week starts the scary part. I have to show them how to make a wrist immobilization splint and then they have the entire class time to make one. The week after that they do a thumb spica (I HATE this splint) and then a resting hand splint. Apparently these students are quite anal and this could be a beating. The best part is, I have to grade them. Seeing as how in the last couple of week I myself have thrown away splints I have made, I will probably be a push-over and pass them all. They really are a good group and we will have some fun.

Tonight, I had another Philadelphia "first". I went to my first 76ers game! The best part is they were playing the Mavs. Although, the Mavs lost so that was a bummer. I went with Jennifer (the other fellow) and Jason, an OT we work with. We had a blast. We rode the train down there and had awesome seats. We were behind the basket about 10 rows up from the court. Jason says that the 76ers suck right now so tickets are cheap. On our way home, we were entertained on the train. After the doors closed, the music began and these three guys started dancing and flipping through the aisles. It was so fun! When the doors would open they had to stop because it's illegal to have music and to put on a show (especially since they were asking for money afterward). They were quite talented and had the entire train car entranced. Fun way to end the night!

The Last Thing I Needed First Thing This Morning

Today was just an awkward, tough, tiring day. Let me just give you the run down.

I was being proactive and got up early to try and get some reading done. My apartment since Monday has had a little smell of gas, but hey, I guess it was okay since I woke up Tuesday. So, I head out to Starbucks and got a few pages done in my chapter. I didn't have anything at home to make a lunch so I figured I would stop by Subway since they open early for breakfast and you can get sandwiches too. Well, this certain Subway on my route into work doesn't open until 9:30. A no go on the Subway.

I get to work and check my email and there was one from my mom. She proceeds to inform me that while she was driving in front of our house on her way to work, she noticed glass in the street by my car. My driver side window had been smashed in. Luckily I had cleaned out my car before I moved, so there was nothing in there to steal. But, my parents still have to get it fixed.





After work, Jason (yes girls, that's his real name!), one of my co-workers, told me he would check on my "gas leak". He figured it was just a pilot light on my stove that got blown out. So we walked to where his bike was left and found that all that remained was his chain and the front bike tire. The frame and back tire had been stolen. I felt horrible, but he said it was a cheap bike, he has another, and it happens all the time in the city. No wonder I see people walk into stores with their front tire and when they lock up their bike, they weave the lock through basically the entire bike. So when we got to my apartment, Jason was a little overwhelmed by how bad the gas smell was. Luckily is was only that the pilot light had blown out. Easy thing to fix.

My next task was to go to the gym and run, then meet with a personal trainer. I have never met with a personal trainer before so I was super excited. I knocked out a 2 mile run. Crunched for time! I then met up with Lance. We talked about nutrition, my current workout routine, what my goals are and how we can proceed. He really is going to touch on a lot of things and I'm looking forward to it. After we talked for a little while, he took me downstairs and we started on legs. He had me doing leg curls and we really didn't count reps. He had me start with 20, then do another 10 but he never stopped me after that number. He just had me keep going until he figured was good. After I rested, he added more weight and I went again. Next came the leg press and he did this the same way. Except with this exercise, he had my legs quivering. I like that feeling though. After one set of about I don't know, he added weight and I went for another unknown number of reps. Needless to say after that exercise, my legs were jello. We then went to arms and back and did some rows. Next came abs and then came triceps. Let me just tell you. My triceps are WEAK! I could barely last! The nice thing though and I appreciate this, Lance has me keep a very good form. He has me doing scapular stabilization during my upper body work and I have to maintain that throughout. So after we were finished, I signed up to meet with him Saturdays and Tuesdays. I'm excited to make this part of my routine and can't wait to see results.

On my way home from the gym, the one block I have to walk, I stopped at the corner deli/market to pick up a few things. Lance wants me to keep a food diary and to incorporate more protein into my diet. So, I bought a few things and headed home. I bought a new salad dressing and when I went to shake it up, the top flew up and dressing went everywhere. On the walls, on the stove, on the floor, on the cabinet and on my favorite sweatshirt. I cleaned it all up and then took off my sweatshirt. I wanted to make sure it wouldn't stain so I reached for the Shout. But, instead of Shout, I grabbed the Clorox Clean Up with Bleach and started spraying away. By the time I realized it, I had already covered about half the stain. So, I grabbed the Shout and went over the whole thing. I had to do an impromptu load of laundry so even though it's 12:15, I have to be at work at 6:30 in the morning, won't leave until after 9 pm, I'm up doing laundry. I just want to go to bed and put this day in the books. The sad thing is, this wasn't even that bad of a day. I've had worse and I know I will have even worse.

At The End Of The Day

Mondays are going to be the death of me. Well, possibly Tuesday, and Wednesday, and Thursday, and Friday too. I am worn out! And it's only week 3. This morning stated with a lecture-ish time with one of the therapists and it was on ROM, edema, sensory, etc. Things we learned in grad school. She even made us demonstrate everything to her. After about an hour and a half of that, we were able to go back to the clinic. I was actually able to do the majority of a new eval by myself which was exciting. But then I ended up helping out with splints. I mainly took the intake information from each patient. It seemed like every time I checked a patient in, another one was coming over for a splint. I thought it would never end. It's even harder when I'm not doing the splints and mainly observing. The quick and easy ROM checks I was able to do on my own, so that was nice. Hopefully tomorrow will be a little more exciting and I can practice my splinting skills. I'm not super confident and just need more practice.

Tonight I had planned on going for a little run (on the treadmill). I seem to have planned that just about everyday I've been in Philadelphia, it just hasn't happened. Walking home tonight I started talking myself out of it. So, I came home, cooked dinner, and have been sitting on my couch/futon/whatever watching a movie. I have been so unproductive it's not even funny. We have another lecture on Wednesday, but luckily there aren't 500 chapters to read like today's lecture. Only 2 this time. Thank goodness!

So, something's gotta give. I've got to figure out my running schedule and find some motivation. I do have a half marathon to run in about a month. I hate working out in the morning, but it just might have to come down to that. I also have to figure out when I'm going to get all my reading in. I am planning on going to Starbucks for about an hour before work in the morning. While it is nice that we typically don't start until 8:30, I end up staying until around 6 or later. It's wearing me out and I can't seem to get in a groove. So, task for week 4: figure all of this out!

5 Things I Learned on Day #11:
1. The lumbricals pass volar to the MP axis of motion and dorsal to the PIP and DIP axis of motion.
2. I learned how to perform 2 point and moving 2 point discrimination.
3. Static 2 point discrimination comes back after moving 2 point discrimination in terms of sensory recovery.
4. Always keep the splint on your left side when you are cutting if you are right handed.
5. I hate Preferred splint material just as much as I hate making a thumb spica splint.

These Boots Were Made For Walking

I survived my first super long Wednesday. I was only at work for 14.5 hours today, but surprisingly wasn't dying at the end of it. Wednesday is the clinic day of the Department Chair. He is a very well respected surgeon, and very thorough with his patients. He will not leave the exam room until every question the patient asks has been answered. There are a couple of issues though. 1. He schedules patients from 8 in the morning until roughly 7:30 at night. 2. He will usually run 3-4 hours behind all day. You do the math and determine how long he will be there. Wednesday is also the day of morning conference, which starts at 6:30. So, that makes for quire a long Wednesday. Today was alright though because we didn't have any patients sent over past 5:00, so the other fellow and myself were able to practice our splinting skills. We are slowly being able to do more, but what is super scary is that we are going to be teaching first year OT students how to make 3 splints. I will be in charge of one lab and Jennifer is in charge of the other. I'm an actual instructor, like, on their syllabus. Scary!!! It wouldn't be so bad if I was teaching something I was well versed in. Of the three splints, I'm so-so comfortable with one, I HATE the second, and the third one I've only made, oh, maybe twice in my life. Class starts next week so I've got some work to do.

Today I had to write a 911 email to my mom for her to send me my comfy shoes. I love that I get to dress up for work and can wear heels everyday. But man! My feet hurt!!! Yesterday I wore a new pair of high heel boots and was standing all day. By the time I finally got to sit down around 3, my feet were ready to fall off. I think my low back is suffering too. It was killing me this morning. So, mom is sending my Danskos (my awesome clogs! I'll look so cool with my dress pants and clunky clogs) and my Birkenstocks. I love those and luckily have a few pairs of pants that I can wear with these. Too bad I can't wear my Uggs or flip flops. I'd been in much better shape. Hopefully she rushed that package to me!

5 Things I Learned on Day # 8:
1. With wrist extension exercises, if you give the patient a dowel/pen to hold in their hand, it will keep the EDC from influencing wrist extension.
2. With radial nerve injury at the wrist, you lose 40-60% of your grip strength.
3. Dimethyl Sulfoxide is not FDA approved but some use it for pain relief. Apparently it is used readily in equine medicine. Yep, horses.
4. Martinis were created by the wealthy. It used to be that if you drank straight liquor you were seen as a drunk. The wealthy did not want to be perceived as drunks. so they invented the martini which has vodka and a splash of vermouth. That makes it a "mixed drink" instead of straight liquor. Therefore, they weren't perceived as drunks when they had martinis.
5. The students I'll be teaching "don't know anything". So, it won't matter how bad my splint is because theirs will be worse.

Call Me Irresponsible

This morning I woke up early to ride the Subway to Methodist Hospital. Luckily the subway stop isn't too far from my apartment so I only had to brave the cold weather for a little while. Man! It was COLD. It didn't help that I was wearing pants with flats and no socks. I love watching people on the streets look at my feet. I'm sure they are thinking "stupid girl with no socks!". Socks would just ruin the outfit and I never wear socks.

Methodist is not in the cleanest of neighborhoods in south Philly. But, I made it there safely. I was there to observe one of the surgeons. She had 5 cases that she was doing this morning. One was a trigger thumb, a couple of ganglion cyst removals, and 2 CMC arthroplasties. I was able to stand right behind the surgeon and see pretty much everything. It's nice being in a teaching hospital. The surgeons are always talking about what they are doing, directing the fellow or resident, and for the most part will show other visitors what's going on. The doctor was constantly explaining things to me and showing exactly what she was finding.

The best part of it all is that she was done at noon, so I had the rest of the afternoon off. And I didn't use it too wisely. I first went to the GAP and bought a couple of sweaters. Then onto Bandolino to buy a pair of boots and heels (total of only $78!). I guess I wore myself out from shopping that I came home and crashed for a couple of hours. I should have been studying, but I was pooped. I have to admit that I haven't been sleeping too well in Philadelphia. I'm sleeping on a futon from IKEA which is not quite like my Sleep Number bed at home. I'm also having a hard time regulating the radiator. On/Off. On/Off. Can't quite seem to get it right.

I have been able to get some reading done this afternoon. I still have a lot more to do, which I think will always be the case. I don't foresee myself ever getting caught up. I also cooked my first meal at my apartment tonight, in my miniature kitchen. Spaghetti and meat sauce. I don't think I have ever cooked that in my semi-miniature kitchen in Dallas. Now I have leftovers too for the rest of the week. Even better!

So, now it's back to the books. Tomorrow I will be observing the surgeon during her office hours. So, another pretty laid back day. Wednesdays going to be hard when I actually have to work!

A Whole New World

My eyes were definitely opened this morning. I knew I wanted to find a church here in Philadelphia, and was hoping to find something similar to FBC Dallas. Before I moved here, I researched Baptist churches in Philly. Let's just say that at most of these churches I would stick out like a sore thumb. The closest thing to a Baptist church is a Presbyterian church so I researched those too. I found FBC Philadelphia and it's pretty close to my apartment. Can't tell too much about the church from their website but I'll give it a try. This morning though, I decided to try out Tenth Baptist Church. It's in the Rittenhouse Square neighborhood, which is a pretty nice area. The sanctuary was pretty small with very drab colors. Quite a contrast to the red carpet at FBCD. The extent of their choir/musical instruments is an organ and what I assume was a small choir. They were in the back balcony so I never saw them. I'm so used to an orchestra and a huge choir. We also used those books (hymnals) to sing from as opposed to screens. I haven't used a hymnal since high school I think. Not only were there environmental differences, there were also differences in the services. They have some doctrinal "things" they do such as readings and songs, etc. The service was very nice, but I'm not sure if it's the place I want to go. Especially if this dude will say a 5+ minute prayer each week. Whoa! That dude covered it all! I think I'm going to try out FBC Philly next week. Keep your fingers crossed.

This afternoon I hit up the gym that I joined yesterday. It's one block east of me, so it's super close. It's a funny layout too. It's not large on one level, but has several small levels. It's easy to get lost in there though with all the different rooms. I decided to jump on a treadmill and when I walked into the room, it smelled like bad breath. Good thing my nose acclimated to it. I now remember why I always run outside. Even with a TV attached to my treadmill, I just can't do it. I made it 2 miles on the treadmill before I'd had enough. So, I decided to do some weight training. I need to get over my dislike of the treadmill if I'm going to run the Cowtown Half Marathon in less than 2 months.

After the gym, I decided to do some laundry. I felt like I was back in the dorm all over again. I HATE laundry facilities. I am so spoiled that my apartment in Dallas has a washer and dryer in it. I had to drag my clothes down to the basement, put my clothes in the washer, pay my money, go back upstairs and wait for the clothes to wash, go back downstairs to put the clothes in the dryer, pay my money, go back upstairs and wait for the clothes to dry, go back downstairs to pull the clothes out to find that some weren't dry. But I said forget it and pulled them out anyway. The main thing that wasn't dry was my towel and it can dry in the bathroom. Such a pain in the rear. At home, if things weren't dry, you just turn the dial and let them dry again. Without having to pay more money.

So today was a day of trying new things here in Philly. The rest of my weekend has been spent studying. I feel like I'm back in grad school, except I have more reading to do. It helps that it's stuff I enjoy, but it's still reading and I still hate reading. Tomorrow morning I go to Methodist Hospital to observe surgery all day. Then Tuesday I'll be in the same doctor's office observing clinic. This week should fly by.

Into the Fire

One Week Down...25 More to Go. It's crazy to think that is all the time I have left here. It's going to go so fast!

I am happy to report that my first week as a hand therapy fellow as been great. I enjoy the people I am working for/with, Jennifer, the other fellow, is so great to work with, and I'm learning so much. The therapist that we work with the most has quite a bit of confidence in us and is letting us take on more and more responsibilities each day. And apparently, if you show proficiency in a skill, he's going to make you in charge of that skill. Scary! Such is the case with a certain wrist splint. It seems to be the most common splint they make and I'm been deemed the "wrist splint expert" (yeah, right!). So, if anyone comes over and needs a wrist splint, I get to make it. Very first patient this morning just happened to need one, so I was immediately put to work. Good thing he was young, a med student, not rushed for time, not a jerk, etc. that when I royally screwed up, he didn't mind that I had to re-do his splint. I got a little carried away with the scissors and made his splint waaaaaay too small. Oh well. I made another one and it was just fine.

I have to admit that I have truly missed working with adults. I love the patients I treat at Scottish Rite, but it's nice to be able to sit down to treat an adult and carry on a conversation with them. I have more fun talking to the patients that actually treating them. Being in a new city, I'm getting all sorts of recommendations from my patients of where to go and what to see and do. I'm also learning many Philadelphia (Philthadelphia) terms/phrases. One patient today who is Jewish was teaching me Yiddish phrases. I now know what chotchkas (sp) are and what it means to schlep.

5 Things I Learned on Day #5:
1. Don't cut too much off of a wrist splint. Make sure it comes about half-way around the forearm and cups the hypothenar eminence.
2. "DJD/CMC Arthritis" and "Osteoarthritis, hand" have the same exact ICD-9 code.
3. Paradoxical Extension: When you attempt to contract FDP but instead the lumbrical is pulled proximally, thus resulting in PIP and DIP joint extension rather than flexion (involved finger assumes an intrinsic plus position).
4. Many patients can be a pain in the ***. You try to please them (within reason) and get them out the door ASAP!
5. Less is more when it comes to hand therapy. (Dave's favorite phrase)

All By Myself

My mom left Philadelphia this morning to head back to Dallas. I'm so thankful that she came with me to help me move in. I could not have done this without her. She helped shop for and put together furniture, set everything up in my apartment, and was a trooper in all of this cold weather. Us Texans aren't used to these conditions. Although I don't think she was going home to anything better. I heard Dallas was having pretty cold weather too. Thanks so much mom!!!

So, now I'm adjusting to being here by myself. It's a good thing I had to go to work so I didn't have time to be sad. I'm miss everyone so much, but I'm here to learn and then I can head right back to Texas. That is, unless I fall in love (with the city, or a boy!) and take a permanent job up here (just kidding Amy!)

Today was another adventure. The Center City office had a different set of therapist working today, other than one who makes his home there. Tuesdays, Lauren is at the CC office and she is our main splint instructor. So, Tuesdays Jennifer and I will be learning how to make all sorts of splints. Today was the basic wrist cock-up splint. It's probably the most common splint they make. What's real nice is that they have pre-cuts so all you have to do is slap one on a patient, trip it up, and you are good to go. Well, almost. Lauren is a great teacher too! She is so laid back and patient and let's us learn by doing. We jumped right in and practiced making splints on each other. When we get a little braver (an better!) we will be able to make them on patients.

5 Things I Learned on Day #2

1. The optimal position to splint in is supination, but not all of your patients can get into that position with gravity assisting you. So, you just have figure out a way to get them into supination.
2. When cutting down splint material, move the splint, not the scissors.
3. Use Goo Gone to clean velcro glue off of scissors. (I know, not rocket science, but I always just use hot water. Goo Gone is so much easier)
4. Methodist Hospital is not in the best of neighborhoods, so make sure not to stay too late when observing surgery.
5. The Broad Street Line is the subway line to take to get to Methodist.

Another day down. It really is going to go by fast! Tomorrow is going to be an early and late one. I'm mentally preparing myself to be at work for about 15 hours tomorrow.

I Gotta Feeling

I think this fellowship thing just might work out. Today was my first day and it went really well. This week we (myself and Jennifer, the other fellow) are going to be mainly observing. It was comforting to hear one of the therapist tell us that this needs to be stress free and to enjoy ourselves. This is our fellowship and we need to make it what we want. Then she showed us all that we had to read and study. Yikes! It's a lot, but it's what I'm wanting to make my profession. I love this subject and look forward to learning all that I can.

I've been challenged to list 5 things I learn each day. So here's day number 1:

1. Mallet fingers take at least 6 weeks to heal. That is if you don't let it "dangle" at all.
2. When strengthening shoulder external rotation, you should keep the shoulder in slight abduction, such as placing a towel roll in between the body. This allows for more blood to the subacromial place. Full adduction is an ischemic position.
3. February is the coldest month in Philadelphia.
4. Dr. Ostermann will quiz the therapy fellows just like he does the surgery fellows. Be ready!
5. The best places for wine tasting: One on 2nd and one on 13th and Sansom (around the corner from me)


So, not all therapy related, but useful information no the less. Let's see what Day 2 brings!

Bring On The Day

I've been in Philadelphia for about 5 days now, and I'm ready to get in a routine. It's been fun moving into my new apartment, going shopping (several times), and just walking around the city. But, it's time to do what I came here to do. Tomorrow morning at 8:30 I will begin another leg of my journey toward becoming a CHT. I'm enjoying this ride headed toward my final destination but all of these small trips are necessary. I have a lot of emotions running through my mind about the fellowship. I'm so excited about what all I will learn, but also scared about the unknown. But, I'll never know unless I try. So here goes nothing!

Just what have I been doing in Philadelphia the last week?


1. Moving/Furnishing my new apartment. The walls are still bare, but I've got ideas in mind.



Yes, it's all one room. A small (less than 300 sq.ft) studio, but everything I'll need for 6 months.



2. Celebrating like the locals. New Years Day, the street that leads to City Hall is closed and there is a 6 hour parade. It's the Mummer's Parade. Like nothing I've ever seen. Anyone and everyone dresses up, to some theme, and parades up Broad Street toward City Hall. The smaller groups have simple costumes and come dancing through the streets. The large groups and string bands are very elaborate. They use all sorts of feathers and glitter. The common theme though seemed to be gold spray painted shoes. The party goes on all night long too. Apparently there is an after party in South Philly.





This group did a take on Slumdog Millionaire. They filled the streets dancing!


This is part of one of the bands. They can't have any brass instruments. They can have saxophones, but most of the instruments are string instruments. Quite talented!

The Bare Necessities

It certainly has been a whirlwind the past few days. This last weekend I packed up my life, or as much would fit, into 4 suitcases and headed to Philadelphia. We flew up here Tuesday morning which would give me about a week to get settled in before starting the fellowship. Thank goodness my mom came with me. I certainly couldn't have done this without her.

Tuesday was mainly a travel day. Because of the Wright Amendment, Southwest can't fly direct from Dallas to Philadelphia. We had a layover in St. Louis but we didn't have to change planes thankfully. Our flight left Dallas at 8:55 CST and we arrived in Philadelphia at 2:15 EST. Once we got all of our luggage which was ridiculously heavy, we boarded the ever trusty Lady Liberty shuttle. Door to door service. Very clean. Highly recommend it! They took us straight to the hotel, which conveniently is only around the corner from my apartment building. You can actually see my apartment from the hotel window. After getting checked in at the hotel, we headed to the apartment to sign the lease. It's sort of weird to have two apartments. I had just talked to my Dallas landlord and was now signing with a new one. The manager didn't have everything ready so I couldn't get the keys that day, but she did let us go up there and see the apartment since we were planning on shopping the next day. My first reaction when we walked in (but I kept it to myself) was "I don't remember it being this small". It is only about 300 square feet. But, for 6 months, it will work.

Wednesday morning we got the keys for the apartment, measured to see what furniture would fit in there and headed off to get the ZipCar. ZipCar is a car rental group that isn't your average car rental. There is no office you go to. They have cars parked at different parking lots all over the city and you have a card that is linked to your account. When you reserve a car, you go find the car, place your card on the widow, and the car unlocks. The keys are already inside, so you are good to go. They also have all sorts of cars. Mazda coupes, Honda CRVs, Mini Coopers, even BMWs. We reserved a Honda Element because we knew we could fit all of the furniture in it. In South Philly by the river, there is a strip of shops. They have a Walmart, Lowes, Home Depot, Staples, Target, and Ikea. We hit them all. First stop was Ikea to get a futon and a TV stand. I bought a desk from Ikea and then we hit up the other stores for odds and ends. The hard part was getting it all back to the apartment. Thankfully there is a freight elevator that we could use. Everything made it into the apartment just fine. Shopping took a lot out of us, so we called it a night. Everything would get put together another time.

This morning, we headed over to the apartment to start putting everything together. The TV stand didn't take too long to put together. A few minor mistakes, but it is holding up just fine. The desk was a nightmare. It came in about 30 different pieces and I made quite a few mistakes. I put pieces together wrong and I used different screws in wrong places. Again, it's holding up nicely. There is supposed to be a drawer but after messing with it one too many times, I said forget it and put the drawer in the closet. The desk only took me about 3 hours to put together. Next was the futon. I'm not too sure about sleeping on a futon, especially after owning a Sleep Number bed. But, it will work for 6 months. Once everything was put together, the apartment surprisingly looked larger. It's still very small, but at least I can put some furniture in it and make it feel a little like home. We still have quite a bit of work to do, but it's coming along. Tomorrow we plan on doing a little more shopping and try to finish everything out.

The Living Area




The Kitchen




I can also wish everyone a very Happy New Year! I don't think I've ever not celebrated in Dallas, so this is a new thing for me. 2010 is going to be a very exciting year. Well, at least the first 6 months are. I've been given an amazing opportunity to come to Philly and learn under amazing surgeons and therapists. That in and of itself will make 2010 one to remember. I'm excited about what is ahead. Happy New Year, 2010!