Monday, June 30, 2008

totally bummed about work

Ok, today was the last day before the new Medicare provisions go into effect. In their infinite wisdom, our elected officials have, through their inaction, been unable to pass a bill extending continued physical therapy benefits beyind 18 visits annaully, to Medicare patients,.. oh as well as giving us a 10.6 % pay cut.. with another 5.6 % cut to come in January. Jolly. So tomorrow, my patients will either cancel, decide not to go food shopping, or just cross their fingers and pull out the credit card. I am totally bummed looking through the schedule, seeing a full half of todays list of patients are Medicare recipents, the majority of whom are juggling with the cost of driving to PT, never mind having to pay out of pocket for it..
As the 4th of July comes up, and there is a faint hope that the bill will be reeviewed upon the return of the Senate and House after the holiday, I wrote a happy holidays letter to our local rag: and just in case thy don't publish it, I am printing it here, in cyberspace, with maybe a few passers-by to glance through it. If you are the child of a loved parent, or if you are afraid of growing old in this country, pass it on. I moved to this country 12+ years ago, invested my heart and soul in it, and here I am, a few days before we all go out to wave flags, go sailing, eat macaroni from a paper plate, fill our eyes with tears thinking patriotic thoughts, while our older, injured parents and neighbors are worrying about the cost of their next physical therapy visit and how much medication / gas / food / heating oil (insert your own ________ ) can cut out in order to make it. I am totally bummed, not only because these people have welcomed me as their own child in this community, this country, but because this is a sure sign of the things to come, an ecology in peculiar imbalance where our elders are as we speak, being nudged out onto the creaking icefloes. A strange time, as I plan to take the stage in our local church, as an invited member of our broad tribe in Sag Harbor, as a still dripping wet citizen of this country, to read the Declaration of Independence and the Bill of Rights (how ironic) with a flag in one sweaty hand and a desperate sinking feeling in my belly.

(to the editor @ the easthampton star)

Dear David,
I am writing to your paper, and to address my adopted community for assistance, both for my profession, but primarily for themselves. As many of your readers have passed through the doors of my business, and literally through my hands, I have had the pleasure of being able to assist many in this town to resume their physical capabilities and return to a full, functional life.

Despite the increasing stresses of annually diminishing reimbursements from the insurance industry, combined with the rising cost of doing business for everyone, my partners and I at Manual + Sports Physical Therapy (MSPT) have been able to continue to provide quality care to many locals and visitors alike. However, with this weeks decision in congress to cut payments to doctors by 10.6% beginning July 1st, and for a future cut in January 2009 of a further 5.6%, our business, and our ability to provide continuing care for our Medicare patients, is in jeopardy.
Our schedule of payments (as PT’s in out-patient non-hospital based clinics) from Medicare is directly liked to the physician pay scale, and thus our physical therapy reimbursements will also be severely cut, beginning this week. Patients receiving Medicare-covered physical therapy will be limited to a maximum of $1810 per annum, which works out to about 18 to 20 visits, per annum. Worse still, linked with this bill HR6331, is the cut to an exemptions process for the more impaired patients, who prior to this bill passing, had been able to qualify for an exemption; for example, someone who might have a knee replacement, and also suffers from a rotator cuff tear, or someone who has had balance difficulties and co-existing knee and back arthritis, an elder who has chronic back pain and also has hand arthritis... To anyone who has had ever seen their parents age, none of these conditions are surprising, but anyone can figure out that few of these complex conditions are manageable with a 6 week coverage of physical therapy. All patients will now be subject to the cap of $1810, regardless of the complexity of their condition. Following this 18 visit maximum, which many of my Medicare patients have already met, these elderly will have to self-pay, or be discharged. Some will be able to manage in a home setting or a local gym with an exercise program, most will not. The majority of our Medicare patients continue to need the skilled delivery of physical therapy care beyond the arbitrary cap, and would continue to benefit from that continued care.
I therefore urge your readers, this week, to call their members of congress and senators, and urge their support for the passage of HR6331. They will resume work following the July 4th recess, on July 7th. There is a chance that pressure from the public, in an election year, will force the reinstatement of the exemptions process, and continue to facilitate the care that I and my staff have been able to offer across the east end, from our Southampton, Sag Harbor, East Hampton (East End Physical Therapy) and Montauk offices.
As an aside, I will be participating in the reading of the Declaration of Independence at the Whaler’s Church in Sag Harbor on July 4th.. This follows an invitation from the Deacon’s committee, who each year, gather a group of citizens to represent the diversity of the area in celebration of the past with an eye on the future. As a twelve year resident and a six year-citizen, I am honored and delighted to participate in this special event. As someone who cares deeply for this community’s older, injured physical therapy patients, as well as its weekend warriors and athletes, I will be privileged to take to the stage in this event. I hope your readers will attend, and be moved to look, not just back at the dappled, colorful past, but ahead towards a country that values the health and well being of its older citizens. Please make a call to your political representatives right after the glorious fourth.
Yours Sincerely,
Sinéad A. FitzGibbon, P.T., M.S.P.T.

Wednesday, June 25, 2008

more china news

oh this is a lazy one: I recently did an interview with Cailin Brophy from the Southampton press about the China Trip: here is the online version of the interview, the paper version will be in the stands next week!

Sunday, June 15, 2008

turkey trot

Saturday afternoon, 80+ degrees and sticky, I was fed up of planting the 100 ostrich ferns that I had had delivered, and decided to go for a run in the woods. Following the recent disappearance of the inch-worms, I felt I had only to contend with my wobbly legs and 5 million ticks, so I sprayed up (tick guard, made in Southampton, NY, all natural, no DEET), grabbed a bottle, strapped on a heart rate monitor, scribbled a note for Dennis, and left.

Running from our house onto the newly cut section of the Blue trail, I marvelled at the sudden blossoming of the laurel, house height overnight it seemed, and my pace was stable but slow. I ran 8-or so minute miles enjoying the dramatic changes of the landscape from last week..Where the inch worms had eaten a hole in the canopy, the laurel thrived, exploding into lacy doily-like flowers for a spell. Heading 'round into Dry Gulch, the fescue grasses were deep green, tall and thick, the trail headed downhill and I gathered speed. Picking my way along the sandy singletrack, dodging the baby-head rocks, I was relaxing into the longer strides, not paying too much heed until I heard a squawk and a flap as I almost landed heel-strike on a baby wild-turkey, Mammy flapping off into the brush to my right, while baby, unharmed, ran to my left, under the ferns and disappeared. It took all of about 20 feet for Ma to regain her wherewithal, before turning a 180 degree U-ie, and heading straight for me..

Then it was my turn to squawk, dropping to 5:30 or so for the next 200 metres as I barrelled down the trail. The first thought in my head was of an NPR show from last winter, when some journalist was reporting about how these previously non-aggressive (waist-high) birds were now attacking humans.. My second thought referred to the previous week's mountain bike ride, when I deliberately chased one of these beasts down a trail, just for giggles, to see how fast they could run.. Well, with my fancy schmancy Gary Fisher Rig and its 38 x 19 single speed gear, this turkey outran me.. and those muscley legs were foremost in my mind as I pegged it up a hill, dodging laurel branches, hopping over fallen logs..

I listened for flapping, expecting blood and guts any second, then slowed to a jog when nothing came. Panting, I checked my watch. HR 175.. Jen (my coach, my buddy) would be delighted. I wondered how long I could have kept that up for.

Shelter Island 10k race next weekend. I think it is a road race. I hope so. I don't think my poor heart could stand the excitement of a repeat.

Maybe I should start trail running with more equipment..

(Pistol practice at Maidstone Gun club range this winter..)

Thursday, June 12, 2008

back from the ranch

(a clump of joshua trees, prickly, painful)

Back from the ranch a.k.a "Xantusia" under the hospitable care of Mssrs. Dan Empfield and Mark Montgomery, I am now endowed with the title of certified F.I.S.T. (Fit Institute of Slow Twitch), have a thorn from a joshua tree embedded in my scalp and am jonesing for a dog with a rinkly face on the other side of the country..and it transpired thus..

Susan Roman, one of my trusty PTA's in our Sag Harbor office, had in March brought the course to my attention. Both of us being triathletes, one of us being a total gear head (hint.. not me), and both of us dealing professionally in physical therapy on a daily basis with our injured triathlete and cycling friends, we figured that this course would be a good match for our triathlete -therapist - 3rd decade athlete brains.

Long haul flight to Ontario CA, pleasant drive uphill to the deserts of the San Gabriel mountains and up a bumpy sandy driveway to Xantusia, the coupound of the Empfield and Montgomery duo. Greeted by several of the 8 (rescue /vagrant) dogs that live there, we quickly settled in, aided by a bike ride up the canyon (8% grade), a beer and an early night.

(dan on day one, before he was fed up of our questions)
Day one of the course began after a gruelling uphill ride into a neighboring canyon, stopping only to view the valley or snap a quick photo of the desert views. The first morning, after breakfast #2, was mostly an introduction into the FIST method and philosophy, observation of a triathlete fit process, and much discussion. Four of the course attendees were professional bike fitters from TREK, one of whom was, no joke, a rocket scientist, now in R+D for the Wisconsin company. Another, a yoga therapist from Portland who is a much lauded fitter, specializing in riders with injuries (low back pain, hip arthritis, chronic injuries, neck pain etc.) An olympic medalist from cycling track in the LA games rounded out the group, so needless to say, there was a lot of Q+A time. Comments about fitting, concerns about the details, the equipment, the technical specifications of all and sundry, the aerodynamics of helmets, the pressure testing of nether regions on saddles: all fair game during the couse, lunch and dinner. Rounding out the night was a visit by each of the dogs, in turn, for a scratch, a rub, a paw or a dribble. I fell in love with Punkin', a squishy faces boxer mix with chopped off ears and the most wonderful demeanor, whispering quietly to her, vowing to sneak her into my carry-on for the return to Sag Harbor. Monty must have read my mind, pouring another beer, warning me about how everyone loves Punkin' (and likely growelling in his head.. "don't even try it girlie")

(ooh the downhill makes the climbs worth it..)
Day 2, another early morning ride in yet another canyon , with another gruelling climb, this time with the yoga fitter, who also happens to be a billy goat. Between gasps and splutters, I gave mono-syllabic answers to Michael the billy-goat about questions we had in reference to the fit progess, and how, as health care professionals, we could modify.. and dare I say (!) improve the process. Near the mountain top, I paused to chceck out a coyote (who looks JUST like the cartoon version, all skinny and ribs with pointy ears etc), take a photo.. actually glad for a rest, then continue on to the summit. We came back to the ranch, flying downhill, snarfed breakfast #2, and took up class again, complete with 4 or 5 of the dogs. This day wsa all hands on, or rather, fingers and thumbs.. as we fine tuned our measurement methods, becoming more skilled and confident with each practice. The methodology is interesting, if imprecise, but the outcome is great, smart and helpful. The client goes through the fitting process and on completion, has a set of measurements in a "universal bike language" that can be then applied to EVERY available frame on the market, to get the optimal fit.

(click on play to see me fit at a most aggressive 81 degrees.. and COMFY I might add!)

We did more networking, more comparison measurements, more philosophising about the application of the fit to mere humans (as opposed to the Ironman professional athletes that Dan is used to working with) and then had more beer at the end of the evening, watching the sunset spectacularly from the elevated viewing deck. (valley view from Monty's house)
Rising early but not so bright the next morning, I skipped the group trail run and gathered my thoughts.
How could I apply this in my PT practice? Quite easily actually, having 60 patients a day in the office increases the liklihood that we can get more people happier on their bikes.
Would I have a target market group for this application? Absolutely. Eastern Long island is chock full with weekend warriors, tri-heads and injured patients looking to return to cycling, or take it up as an alternative to pounding the pavement.
Could we improve on the product/ process? Completely. With our evaluation, assessment and analytical skills of PT and yoga combined, we can address the positional and functional issues that prevent optimization of position, and improve tolerance of non-inured athletes to aggressive positioning. This by a system of prescriptive exercises, not unlike what we apply in our PT office lives, coaching bodies to increase the liklihood of sustaining these positions, and activities, for the long haul.

Next blog: problems with the process, how S+S can improve it, and plans to take over the world.. well, not really, just plans to set up a comprehensive medical bike fitting service. Oh yea, and the thorn..dingbat walked straight into a joshua tree while discussing saddle design and women's saddle sores with the rocket scientist from TREK.
(sinead fitting stephanie after dinner)