POV_ New Grad OT Usage and Ultrasound
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[00:00:00] So yeah, let's uh, let's dive into how was your, how was your fieldwork placement? I loved the, the place itself. I love the, um, the experience that I had. Loved hands. I, I think I remember this conversation. I came up to you in AOTA and I was like, I don't know about hands. And Now kind of look where I'm at now.
So I'm very fortunate. I love the experience and I think I love one because I hate, oh my God, hands so scary. Like, no, I don't want it. And then you hate someone. You're like, I need more . I call a certified head therapist and oh, my own clinic. Like you go for honestly like zero to nothing. Like nothing to to a hundred.
You know, miles an hour. Exactly. So, so no, I, I love the orthopedic aspect and I love, um, I think my brain has kind of transitioned into orthopedic aspect. Um, and I love just the hand aspect. I love the elbow. We treated, [00:01:00] um, pretty much majority. Elbow to wrist hand, but we did have occasional shoulders. We had a neck tendinopathy.
Um, kind of those are the two main tendinopathy something along those lines. Okay, I'm gonna I'm gonna let that one slide.
Very cool. Very cool. All right. So let's, um, dive into some of your questions. Go ahead. Ask me some of your questions. So the first question is, how do you define success within your clients? So how do I find success within my clients? I find success in my clients based off of what they tell me that they want.
Right? So sometimes people don't know what they want. Um, they just want to quote unquote, feel better. So You know, sometimes we have to put it into perspective for [00:02:00] them and help them see what is actually possible. It's realistic. And, um, you know what they can keep achieving even, you know, after working with us because sometimes like I usually describe there's like a There are, um, temporary types of issues, and then there are permanent types of issues, right?
And so, um, our temporary types of issues, we can fix them, they can move along, they live their life. And then sometimes we work with people who have what I call forever injuries, and, um, we have to manage their expectations, and we have to help them manage what they you know, what is possible and what they can keep doing throughout the rest of their like lifespan in order to keep making small incremental, um, improvements.
So the way I, you know, see success with them is [00:03:00] if I can help them achieve a certain percentage of that, a certain amount of that, you know, obviously I'm, I'm really, I'm very results driven. So if someone comes into me and they're like, very functional, right? For example, I've worked with people who, like, currently right now have a couple of baseball players.
Um, they're high schoolers moving into college. They're. they're like in such an early stage of their career, and they just want to be able to play without pain, without injury, right? So that's their goal. They sometimes patients don't know how to say that to us. It's my job to figure out what they're trying to say and then deliver the results.
And that's what's successful. Um, those are just little temporary types of injuries. little hiccups. But then there are people who work with us who have forever injuries, stroke injuries, spinal cord injuries, um, crush injuries that can be life changing. [00:04:00] And part of it's like managing expectations of, and to me it's successful if I can help them, uh, manage some of that, keep some of that hope, keep working on it and getting results.
Okay, so with ultrasound, what are your experiences using ultrasound within the clinic? Well, I used to use ultrasound just like everyone coming out of school, doing the PAM course. You have to do the PAM course and you learn all about like, you know, heat pack, cold pack, all that good stuff. Ultrasound, eSTEM, how to use it.
And I would use ultrasound specifically because other therapists showed me how to use ultrasound, or they just said, well, that's a billable amount of time to use, um, in my experience, after using it for a certain many, many years, I'm decided that, uh, I would rather use. other things, other treatment [00:05:00] methods versus ultrasound, because that's eight minutes, um, of complete boredom in my life.
And I don't really see the results, um, as fast as I see other treatment methods. Um, you know, so I, now in my practice, I, I, um, rarely ever, ever use ultrasound. What are those other modalities that you use that you find are more effective than therapeutic ultrasound? Um, in general or in terms of PAM? Um, let's do in general, and then we can do in terms of PAM.
So, um, in general, you have to understand why you're, why you would consider using ultrasound, right? So if ultrasound is to decrease inflammation, to reduce scarring, um, to reduce pain, then the other treatment methods that [00:06:00] I like to use to reduce inflammation, to reduce pain, um, and to reduce scarring is to simply use, um, effective manual therapy.
So effective manual therapy techniques can help all of those, and the results can be immediate. Again, if it's effective, right? Um, if it's not effective, then you won't see it. But, um, but yeah, so what are some common things that people use for, um, for ultrasound. If it's used for shoulder tendinitis is you in order to use ultrasound effectively, you have to expose that tendon.
Majority of the time people are just rubbing the fricking ultrasound on without exposure of that tendon. So for example, if you're trying to do. a rotator cuff and you're trying to expose it, then you have to put the shoulder into internal rotation to be able to expose that tendon. If you are trying [00:07:00] to do biceps, a tendon, then you have to put that shoulder into external rotation, right?
If I want to be effective with it, I'll just use other techniques that will then help to realign the scapula to the humerus, how to move the. Um, and then I'd help to make sure we're moving the muscles in a way, strengthening in a way that's going to help to reduce that inflammation, to reduce that pain, uh, to reduce that muscle imbalance, and I can get better results, faster results, more motion, less pain, um, and then to reduce their inflammation long term.
using proper manual techniques and then picking the best exercise in the order in which makes the most sense for that patient's injury. So, uh, I'd rather use my [00:08:00] 10 15 minutes towards that than towards ultrasound. And now what about in comparison with other PAMS modalities? The ones that are paid by, like, you wouldn't use, you wouldn't use E STEM for it because E STEM is really a way to interrupt the way the brain interprets pain, right?
So, E STEM doesn't, it's not the same. You could use heat, but heat is a very passive method and it can be great for doing with someone before to kind of get them to relax and warm up so that when you go to town on them, the pain isn't as sharp. You can use cold. Cold can help soothe the pain. Um, tendon issues, pain issues, especially chronic ones.
[00:09:00] They're really great for, for like, if the muscles are overworked or sore, it can be really soothing for the patient. It's not a paid service. You can do it. You can show them how it's done. You can use it as part of your treatment, but it's an unpaid service. And then you just. teach a patient how they could do it on their own.
I still use that methodology in my clinic because let's face it, patients don't always do it at home. So if you have them there, just spend a couple of five minutes showing them how to do it, you know, doing it with them, holding them accountable to doing it so that when they leave, they can feel a little bit better.
But, um, But yeah, so those are some of the different modalities. Currently in my clinic, I use something called the radio shock wave. It is FDA approved, but not Uh, not reimbursable by insurance. And so as a therapy clinic that, um, is, is out of network with insurances, majority of insurances, it's a paid service that [00:10:00] someone's got to be willing to, to pay for out of pocket and it's effective.
It's, it's effective immediately. So patients will feel it and you'll see it in their results, right? Again, we're results driven. Um, and so It's so much more effective because if you look online and you look at what people say ultrasound does, it says, I mean, everything says the same, but who at the end of the day shows the results, most people are not supposed to feel ultrasound.
And so if you can't feel it, and then at the end, when you test against and you don't see any results, it's hard to say like, Oh, ultrasound works right with shockwave. You can, you know, applied correctly. You can see the results immediately. For majority. And that kind of goes back to, I was looking at, I did some preliminary research and review, and I found that when I was doing this whole project, that majority of the ultrasound evidence and [00:11:00] conclusive evidence was all over the board, there's some that is effective, some that's not effective, but the one conclusion that I had found was that it's effective with other modalities when it comes to like, you were talking about manual therapy.
And so I wanted to see. Based upon your experience, if you had done ultrasound and manual therapy together to see those results faster or not as much. Yeah. Yes, you have to. So ultrasound works best when you put the tissue on stretch. If you put the tissue on stretch, that is a form of manual, right? So by it's lonesome, it's not as effective always paired with something else.
It's more effective. So for example, if you are, if you're doing it for a trigger finger, Right. So a lot of the research might show like, Oh, for trigger finger, it's the best. So once they do a research and it says, Oh my God, it worked on this. Tinocinvitis, which is a form of tendonitis to reduce inflammation and to soften the [00:12:00] scar.
Let's apply that shit to everything and then say that it works, but it doesn't necessarily work the same because we're assuming that every single tendon works exactly the same. By nature of a tendon, it is, uh, but by nature of injury, the forces that shear upon it is a little bit different. But when you're doing a trigger finger, technically speaking, you should be in order to expose that tendon, you've got to put that tendon on stretch, right?
And so you're pairing up stretch with With the ultrasound. And so, yes, technically speaking, it can be more effective that way. But the research across the board doesn't say, Oh, it is so effective that then I'm going to Huang is going to say that modality is so effective. I want to use it in my practice.
I have just chosen, I have just, I have just chosen over a period of time, [00:13:00] either based on research, but also for my own research, for my own experience, that it's not as effective. So I have made it my, you know, clinical decision not to use it. Do I use it? Do I own one? I do. Right? Do I know when it's appropriate to use?
I do, right? But that doesn't necessarily mean that I'm going to choose it in my clinical practice, Huang's clinical practice, because I find that other things work more. So if I found other things to work more, that's a decision that I can make and say, okay, I've chosen not to use that. That's within your, you know, but if someone asked me about it and my patients asked me about it, sure, this is what ultrasound does.
This is what it can do. And this is why I have chosen not to use it. If you want to have it and you want, you insist upon it. One, you can say here, and I guess I'll get another therapist. Fucking hate it. Um, [00:14:00] or you can go find another clinic that fucking does it. Like, it's that simple. So. I know you, the, now the variable, I call them variables on the ultrasound machine, the different types of mode, continuous, pulsed, intensity, frequencies.
Prior to you making the clinical decision to use it with certain clients versus not certain clients, what were, what typical. settings variables would you have used on some clients? It's been so long I have no idea. Um, I remember Specifically, continuous is great for if you are softening scar, right? It's like, like constantly, right?
Um, and then the variable, uh, is good for like inflammation. Other than that, I can't remember. Now I only ask because a lot of things now are so, um, how do you call it? Like automatic, [00:15:00] like the setting on the machines are so automatic. That, um, you only need to learn the settings, you know, yeah, the settings when you're first starting out like Shit was manual when I started.
So yeah, you're like darling, but now most machines make us stupid. Like, honestly, they make us dumb because we're like, Oh, turn it on. Yep. Turn it on. Here we go. Kind of thing. Ply the jelly. Here you go. Yeah. So yeah. But okay. I can't remember what it's why but um, you know why You might have already asked this but what are the pros and cons?
Mostly cons I want to see as the reason why is you still don't choose to use ultrasound within your practice All right. So the pros are is covered by insurance The pro is if you don't know what else to do, you can do it, right? [00:16:00] Um, the pro is that it's an easy method of treatment that majority of people are familiar with, right?
The cons are, um, it's boring. The con are is, um, it is, you know, patients can't feel it and don't feel the results right away. You have to do a minimum of eight sessions. And even then, um, that was probably just whatever base based off what insurance paid versus like, Oh, the research says eight visits. Um, so what did I say?
Um, it was boring. Um, minute, like slow results. Yeah. And, um, what's another con? Um, yeah, those are the two. Those are the two main ones. Mostly it's boring. Yeah, because in our, [00:17:00] um, based upon my experience, we usually put, depending upon whoever the patient was, each person, we saw a lot of distal radius fractures.
We saw a lot of scaphoid fractures. We saw a lot of, um, elbow dislocations. We had an ulnar humeral dislocation of the, of the elbow. We saw fractures of the, of the metacarpal distal phalange, all those things. And so each person to me was very cookie cutter, very, Very the same, very systematical. We put them on heat for 10 minutes.
We then did ultrasound. We did pass the range, active range, depending upon if there's any protocols. And then we did therapeutic services with them. And I found that's your therapist, uh, cookie cutter approach, correct? Yeah. Because of the patients or cookie cutter. Let me say that clearly. Yeah, no. And I found each person was different.
And so I, I find myself. Wondering why was it effective? If it even is effective and getting [00:18:00] did you test what they were like, did the treatment and test them again to see if it helped during that one during that 10 minute span of time that you performed ultrasound? No. Then how would you know? Exactly.
There you go. So what happens in therapy, right? And it's not, it's not anyone's fault, right? This is what you will see, which is I'm going to treat everyone the same. Now you as a clinician can sit there and say, I'm going to treat everyone the same because the protocol says I'm going to put them on this, this, and the, the people around me are going to do ultrasound because everyone else does ultrasound.
Now you can practice that way. There's absolutely nothing wrong with that. Until you don't get results for your patients, period. And when you don't get results for your patients, they're going to be like, what kind of a therapist are you? I [00:19:00] don't feel better. They're not saying that to your face. They're just not going to show up for therapy,
right? They're not going to show up for therapy and they're going to talk, tell the doctor what therapy doesn't help.
So what was it? Right. Yeah, it kind of goes back to the question of, is it the therapy work in the therapeutic exercises that we're doing that's tailored to you specifically? Or is it goes back to did ultrasound even be effective? And I find that within research alone was there was one who specifically looked at Ultrasound in conjunction with exercise that was tailored specifically to, um, that person who had non specific chronic low back pain and each exercise was different, but they had conjunction of affair of ultrasound.
And then they also had another, they had a placebo, uh, placebo group, kind of same concept. And then they had one that had nothing and they found [00:20:00] that the, they couldn't differentiate or couldn't make a decision on is ultrasound effective. With exercise because the placebo they had the same results whether the ultrasound was on versus whether the ultrasound was off and they couldn't make that correlation because in therapy, you can't withhold treatment is unethical.
Mm hmm. Like, right. So I did research I did a, you know, way back in the day like when I first started and I was like, I want to be a researcher. You know, um, then I realized how much reading there was. No, um, there's a lot of red tape around. There's a lot of red tape around it, right? Because you can't lie.
Yep, it's unethical, right? So, and you can't really withhold certain treatments, right? And you have to have one stable thing and one movable thing. But when you have in therapy, you have so many movable, um, factors, it's really hard to [00:21:00] say whether it's ultrasound alone or not. So that's why when you look into the research and people are like, well, I want to be evidence based.
Yeah, I mean, there's only so much evidence. You have to create your own evidence. Like, what has worked in your, in your practice? Like, so you're going to come out and you're going to get that practice as you go through your career as a therapist. And then, you know, remember that whatever you do now and whatever you decide, you know, five years, 10 years, 20 years now, it can change.
And once you learn more, change your mind. If you learn something new, it's okay to change your mind. I am okay with the fact that when I first started, I did ultrasound. I am perfectly happy and content with myself that I did ultrasound back then, but now I don't because I have learned in my 20 plus years, uh, it's not as effective as [00:22:00] other things.
Once I devolved skills. Right. Once I developed better skills, more effective skills, I just, I changed my mind, right. And that's okay. That's, you know, most people come are willing to pay out of pocket, um, for services where they can feel and see results. Exactly. Yeah. Yeah. I know. If you're at an inpatient clinic and you're high volume, right.
What people get there is completely different. So if you're working in a high volume clinic, there's only so much you can do and their therapy tends to drag on a little bit longer just because you're limited in your time and resources. right? But as a therapist, right? So speaking from therapist to therapist, you get to decide [00:23:00] what kind of therapist you want to become.
Ultimately, when you graduate, you can make that decision. What kind of therapist am I going to, to, you know, to become and your everything around your way of treating your style and all of that will help you decide, you know, what kind What you want to do, you know, so yeah, so kind of your to answer this question, but what, um, the other two questions we're talking about the effectiveness of using ultrasound with their clients and why are we not kind of thing and other modalities you using in conjunction with it.
But what was your route as a, as a licensed clinician, and then to a business owner.
What was my, my route? How did you, how [00:24:00] did you become like, what was your, what was the course and the path that you had mentioned, how you took steps to get from when she graduated, and then you wanted to say, for instance, own a hand clinic one day, and you took the sacrifices and pay or whatever you need to get there.
So I just knew that I wanted to become a certified hand therapist. So I didn't take any fucking job. Right? Like you, you get desperate and you're like, uh, I'll take any job, right? That comes along. No, like I didn't take any job. I worked in a skilled nursing facility. I worked in acute care. I was very specific about, I don't want to work with kids because I want to become a certified hand therapist.
If I happen to treat kids, that's fine, but I'm not going to take jobs where I'm treating kids with disabilities, because that's not going to get me to my goal. Exactly. I'm going to, you know, and I [00:25:00] I share a lot of resources on my, my website and I love them for media of like, don't just take any fricking job, you know, take the jobs that are going to move you closer to your goal.
I took a job in acute care where I got trained. I got trained in, in, uh, wound care. I worked with a lot of upper extremity types, all types of injuries, uh, but they had an outpatient center. And they had a hand therapy center. And I said, if I can work here long enough, maybe I'll get there. And even though they were not the best hospital, even though they were not the best paying, even though I had to work on the fucking weekends, like I ate shit for a while.
And I took that job. And that job taught me a lot about wound care that then helped me get to my next job. Right? I took the skilled nursing facility position because, um, it was gonna pay me, it didn't matter [00:26:00] that I had to drive far. People are like, I just want a job that's down the street. If I have to drive 10 minutes, like screw that job.
No, that was a sacrifice that I was willing to make because I would rather work with adults than work in peds. What happens is You come out, you're desperate for a job. You're going to take any fricking job, right? And then you're stuck in that job because you get comfortable. You get fucking lazy as shit and don't fix up your resume and apply for more jobs.
Even though I had my job, I kept applying for other jobs. What happens to most people is they get rejected and then they're like, oh, you know, I got rejected There's never a job for me Right. I keep applying. It's somewhere I Applied and some jobs. Well, i'm in [00:27:00] miami. That shit was shady as shit and it still is And they would be like, oh we need you to do this and this and I was like That sounds really shady.
I trusted my gut. I said no. Thank you You Because you can't be that desperate because you're going to make the wrong decisions, right? Um, I was a little bit more tied down than most people I think, even when I was younger, right? Um, so it wasn't like I could just easily fly and move to another state. I was already committed.
You know, my now husband, we were together. And so, I mean, you know, so I was a little bit limited in where I was willing to go, but within the South Florida, I was willing to drive. I was willing to, I lived in Miami, drove to Fort Lauderdale for a job, you know, and did that for a short period of time. I took different positions.
I had three per diem positions. Even when I had a full time position, I had a [00:28:00] per diem position. You just have to be willing to work. Right and I built my skills and I said from one job I said I got the skills and I took it to another job and I said hey, you know in this other job I was still able to work with hands and arms and this and this and and you just raise your hand And then I built my skills.
I got that full time job Uh, I was patient. I raised my hand I kept trying even though I was being rejected and even though I had a really great job I kept applying to other positions because I could choose You Every position I've been in is because I chose to be there. Um, and then from that, I gained my experience.
I became a certified hand therapist, and then I left my very comfortable position to then take another position. Granted, it was for money, but it was also for experience. Every single job I've ever taken has always [00:29:00] been hands down more important to experience than the money, except for that last job. I was like, I got my experience.
Now I want money, right? Now I want money because I wanted the money, but the experience was to work in a small private clinic versus staying in the hospital because it was very comfortable in the hospital. You once you get comfortable in a role, sometimes you'll lose your willing like your fight your your You know like your willingness to like do the hard thing and so I have to leave a very comfortable position to then move into um A private clinic to see how that worked and that that set me off to then make so every single decision There's a saying that that no decision is wasted No decision was wasted.
You might look back and you're like, Oh, I wasted my time. No decision is [00:30:00] wasted. Made that decision, suck it up, take it for what it is. What are you going to learn from that? Move on to the next thing. What's the next thing? Move on to the next thing. That's how I set up. And then I was like, okay, I'm going to start my own business.
And then I started my own business. And do you find, and do you find those skillsets that you learned from each, each place Is what propelled you to keep going forward? Or did you be like, hey, I've already learned how to make splints in school, and this is how I'm going to do them. Did you ever find any mentors along the way that changed the way of you thinking or the way you do things?
Um, you know, there wasn't a lot of mentorship the way it is now, right? Um, Back then your mentors were the ones that were right next to you. Now you can purchase into programs and find mentors in different ways than that ever was before. Before [00:31:00] your only mentor was a book before your only mentor was a class that you would take, and then that was it.
There was no way of really keeping in touch with them, but there, but you could take classes and then you could see and be inspired by people. You can still do that to, to this day, take those courses. Um, but I think there's just more opportunities. Um, for mentorship now than there was before like you could watch YouTube videos and say, hey, that person is mentoring me I'm, just watching those free videos, right?
And if you like someone enough, you can join their program and be mentored by them You can take a job And be mentored by someone because you took a very particular type of job um, I didn't necessarily have really big mentors. Um, but I had some therapists that were around me that I could go to ask certain questions.
here and there. Um, I, [00:32:00] I also think that the people who, um, made an impact on me were the ones that were maybe not so good. Cause I was like, I do not want to be like that person. I've learned that I've learned that this, this semester. Yeah. Yeah. I was like that I don't want to be. Right? And along the way, I was like, I don't want to be like that.
I don't want to be like that. I don't want to be like that. I want to be like this. I want to be like this. And then I gathered on and said, okay, so then it's up to you personally, because nobody's going to tell you what to do. You're a fucking adult. You're out of college. Nobody's going to tell you to do anything.
You have to make the decision. Everything comes down to your own decisions. You want to be a better therapist? Take some classes. Go look them up. There's so many people who want to be better therapists and don't do anything about it because they're waiting. It's like sitting under a tree and waiting for the apple to fall right into your mouth.
Instead of [00:33:00] going around and picking up the apple and then putting it into your basket, cutting it up and eating it. Yeah, right. So how hungry are you to Do the things that you say you want to do to achieve the goals that you say you want to achieve Because you're gonna come out of school You're hungry right now, but talk to me in three years and tell me how hungry you are Actually, don't tell me how hungry you are.
Show me how hungry you are. Yeah, because I'm all if i'm about seeing results for my patients. I'm all about seeing action And people who say that they want certain things Tons of people come and tell me they want to become a CHT and they want to be a business owner. But a lot of people don't do that.
Show me you want that because, you know, a lot of people tell me that and don't do shit. So the thing is, is you have the benefit as a young person to, to have that bias, to think that [00:34:00] everything you think and everything you want is correct. You're gonna find out really soon how incorrect you are. Don't let one to shoot you down.
Right. I know. Don't, um, you know, don't let me be the one to shoot. But what happens is you have to rise above that. Yeah. Right. So you, you know, as it should be. You, as it should be that, um, your ideas. are shot down because you have to have the the um, how do you call it? The um,
you have to have the discernment to know when something is good, when something is not good. And when you're, you're young, you're new and you're fresh, um, you have the fire, but you don't have the discernment, right? You have the fire. The key thing [00:35:00] here for someone in your stage of career is to not let that fire go out.
Yeah. My first three years were my hardest three years as an occupational therapist, because you're, you are surrounded in places, right? You are surrounded in places where you will feel like you're stuck in a rut and everyone is shooting down your ideas. And that you have no autonomy. As a student, as a new grad, you have no autonomy and you have no autonomy because you don't have discernment.
The only thing that you have is fire. And as long as you can keep that fire, you're golden. The minute that fire goes out, you're going to be just like them in five years. You'll be just like them. The ones that you talk shit about right now. Think shit about right now. You'll be one of [00:36:00] them.
