Lebanon Valley College Study Abroad

PT Clinical Week #6

Week six has come to a close, which means Kristin and I only have 2 more weeks in the clinic before we start Part 3 of our journey.

This week I did a lot more hands on with patients than the previous week. But it was a mix of observing, helping, and then working independently, so I was able to learn in different ways.

The patient I am treating independently goes to occupational therapy following her morning treatment session with us. So I am allowed to follow and observe her there. At first I was just watching, but then no one was really telling her what to do or even watching her so my instructor told me to come up with exercises for her to do to work on the deficits I found in PT! Didn’t know I would become an OT on this journey too! I have her drawing, building block towers, and using a tiny peg board (fine motor skills). I work with coordination and proprioception of the UE but also endurance. It’s different from the US because a therapist would normally be 1v1 with a patient working or at least working with a group of patients.  But sometimes I am the only person in the room, and I am supposed to be with PT!

PT’s here are able to use the hoyer lift and don’t have to get the nurse to do it for them. I’ve never actually seen one used fully before, and the one they have is so easy to use! One of my patients has tetanus and has been bedridden for quite some time due to the infection. She is on an NG tube and isn’t able to go down to the gym for treatment; so we visit her room twice a day of which she shares with 2 other roommates. I was worried that Italians did not take tetanus shots as seriously as we do, but they do.  She just happened to be someone who didn’t get one.  Definitely a new diagnosis for me.

Friday, Saturday, and Sunday here there is a course going on Bobath NDT (Neuro-Developtment Treatment). A lot of the therapists are involved and are using some of my patients as participants. Italian therapists use a lot of Bobath concepts here, even though there isn’t a lot of evidence supporting it. We touch upon it briefly at LVC, but don’t harp on it because of the lack of evidence.

DIFFERENCES:

They have a break room where there are tons of goodies from patients or that the staff brings in. For instance, my patient is being discharged today, so he ordered a huge box of pastries for everyone. Not only do they have caffé and biscotti/pastries in the break room but they also have wine! Some of the therapists drink wine during lunch.

Apparently Italians don’t use hand sanitizers too much. It is not located in the clinic (to use after treating each patient) and it is actually really expensive for a tiny bottle in stores. So instead, therapists wear rubber gloves when treating, or they just be sure to wash their hands after each patient. They also don’t utilize spray sanitizer for the plinths like the US does after every patient. Here, they have the paper that they roll over the beds like you see in the doctors offices. Only if the bed is really dirty do they use the spray (I saw it for the first time today).

 

~Jordan

A Country Within A Country-San Marino

Torture Museum

Torture Museum

Saws used for beheadings

Saws used for beheadings

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Mega pizza

Mega pizza

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Sunday, Kristin and I decided to travel abroad yet again! This time we went to the little republic of San Marino, which lies within the Italian borders. The other 5 girls opted out of this trip, so it was just the two LVC girls making the journey. And it certainly was a journey indeed. It was a 2 hour drive from Umbertide and ¾ of the trip was up and down the mountains with switchbacks after switchbacks. I have never driven on ANYTHING like it before. It was absolutely INSANE.

Once we got there, we ate lunch that consisted of two individual small pies (yes, we each ate our own pie). The best part of the restaurant was that it was right on the side of the mountain and you could see the whole countryside and mountains from the windows that lined the wall.

After lunch, we walked the city and visited some shops. Before heading home, we stopped into the torture museum (6 euros). It was one of the best museums (partly because I love that kind of stuff). It had two floors filled of ancient torture devices with pictures and descriptions underneath as to how they were used. I was not aware of the crazy torture techniques that were used in the past. Some torture mechanisms are still used today in parts of the world. They literally did anything and everything to the human body. Here are some torture examples:

  • Horses: They would tie the 4 limbs of a person to individual horses and then have the horses run in opposite directions. Because the body is so strong, the executioners would cut the tendons, genitals, breasts, beforehand.
  • A lot of the mutilation consisted of having things pushed or cut into the genitals of males or females. They would do so by hanging the person upside down so the blood would rush to their head so they would remain conscious. And only when the saw reached the mid stomach-breast bones would the person lose consciousness.
  • Not only were people hung by their necks they were also hung by their wrists from behind their backs in order for the shoulders to dislocate.

FACTS:

  • San Marino, officially the Republic of San Marino, is an enclaved microstate surrounded by Italy, situated on the Italian penisula on the north-eastern side of the Apennine Mountains. It is just over 24 square miles and has the estimated population of 32,000.
  • San Marino claims to be the oldest surviving sovereign state and constitutional republic in the world.
  • Governed by the Constitution of San Marino, a series of six books written in Latin in the late 16th century, that dictate the country’s political system, among other matters. The country is considered to have the earliest written consitution still in effect
  • The country’s economy mainly relies on finance, industry, services, and tourism. Despite having an extremely small economy for a nation state, it is one of the wealthiest countries in the world in terms of GDP (per capita), with a figure comparable to most developed European regions.
  • It has a highly stable economy, with one of the lowest unemployment rates in Europe, no national debt, and a budget surplus. It is the only country with more vehicles than people.

~Jordan

 

Lake Trasimeno

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Another weekend down! This weekend, Kristin and I had dinner and breakfast cooked by our landlord-2 times. It is always so delicious, so it was great having it twice in one weekend! His food is so amazing that we asked him if we would be able to have our own cooking lessons, and he agreed. So Saturday after breakfast, he and his chef taught us how to make homemade: bread, ravioli, and tiramisu. He showed us and even let us help with some of the steps. Then we got to eat what we made!

We originally planned to stay around and explore our town of Umbertide, but we made an unexpected trip to Lake Trasimeno instead. We walked the streets, vineyards, and docks. We walked a total of 6 miles in a short time there. On our way back to the car we caught a glimpse of the sunset over the water. It was beautiful.

~Jordan

PT Clinical Week #5

This week I started downstairs in inpatient neurology. Such a change of pace from inpatient orthopedics. My new clinical instructor is Roberta, and she speaks very little English. This week, another student who is living with me is working with Roberta as well (as she has been for the past 4 weeks), so I did a lot of observing while she did most of the hands on work.

The schedule is much different in neuro than ortho. We see 4-5 patients in the morning for 50 minutes and then see the same patients in the afternoon. We focus on ROM and mobility in the morning and then do more functional activities in the afternoon. Our caseload consists of: patient with tetanus and previous stroke (1998) // patient previous ischemic stroke & patellar fracture // patient previous TBI (2014), hip calcification, femur fx, and tibia fx // and patient previous ischemic stroke with shoulder dislocation.

On Tuesday, Kristin and I drove to Perugia to see surgery! The surgeon was the nicest guy and even waited 30 minutes to start the surgery for us, which would never happen in the US! He spoke great English and told us every thing he was doing and why in great detail. There are very little rules in the operating room, and therefore, we only wore a mask and a hair net along with scrubs and covers on our shoes. We did not have to wear gloves, long sleeves, or remove any of our jewelry. We could literally stand right over the surgeon and the patient to see unlike the US where I had to remain far away. I stood so close for one of the surgeries that I managed to get blood on me during the hammering of the bone! We talked to most of the patients pre-op. The surgeries we saw consisted of:

Hemi Knee Replacement

ACL reconstruction

Total Hip Replacement

Tumor Resection in the medial knee.

The patient with the tumor (benign) was a young girl who during the surgery woke up and started screaming in pain! It was absolutely insane. One of the doctors quickly injected more anesthetics and she went back to sleep. Two of the other patients were awake for the entire procedure, but could not feel a thing.

 

MORE DIFFERENCES:

PTs here get 5 weeks of paid vacation time throughout the year. Most split it up: 3 weeks in the summer and 2 weeks during the winter. In terms of sick days, they can go to the doctor and get a written excuse and then it can become a paid sick day. Also in the Italian PT world, as soon as a woman becomes pregnant, she can take leave until the baby is born. After the birth, she gets approximately 6 months then if needed, can add on her vacation time. Once this time is over, she can work part time until the baby is one! Here in Italy, there are a lot more holidays than in the US, and the PTs get off for almost, if not all of them.

~Jordan

Venice-Carnevale

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Italian Opera

Italian Opera

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Room in Air B&B

Room in Air B&B

View from kitchen

View from kitchen

Kristin reading an Italian newspaper

Kristin reading an Italian newspaper

Wooden castles in San Marco Square

Wooden castles in San Marco Square

Library full of books

Library full of books

Outside the library with a book staircase

Outside the library with a book staircase

Gondola x2

Gondola x2

My mask for Carnevale

My mask for Carnevale

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Millions of people in the square

Millions of people in the square

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On Friday, as soon as work was over, we traveled for a 2 night stay in Venice for Carnevale! Because this is one of the biggest events in all of Europe, we did not stay on the mainland but stayed across the canal in an Air B&B in La Palanca, Giudecca. I was skeptical to stay in a B&B, but it was absolutely amazing (see pictures below). The best part? Our view out of our kitchen windows was right over the canal. Couldn’t have asked for a better place.

We took the water taxi to and from our place to get to the mainland. Everyone (tourists & townies) was dressed up with masquerade masks and fancy cloaks and dresses. Others had their face painted and wore various wigs. And then there were some who dressed like it was Halloween with characters from movies or TV shows.

Saturday in San Marco Square they had wooden castles set up with actors putting on skits. There was a big screen broadcasting the audience and the show to the crowd. We ventured through the streets, ate pizza/gelati/tiramasu/pasta. We also walked through St. Marco’s Basilica. Before heading back to get ready for dinner, we bought tickets to see an Italian Opera for that night! The opera was not exactly what I expected since I was picturing a big theatre with high ceilings so the sound could reverarate, but instead it was in a standard big room that they put folding chairs in. The music and singing was still wonderful, and I even managed to know a few of songs! After the show, we went out to some local bars for drinks and didn’t reach our place until 3am the next morning.

Sunday was absolutely insane in Venice. There were millions and millions of people packing the streets; you couldn’t move. We went to San Marco square where people were taking videos and pictures of a lady flying from a tower down to the square on a wire dressed up throwing confetti. Picture NYC on New Year’s Eve with the millions of people. That’s exactly how it was. We tried to leave the square, but all the major exits were blocked off with policemen and barricades. It took us 30 minutes or more to exit. While crossing over the bridges, policemen would ask you to remove your masks for safety.

Leaving Venice, I would have to say this is still my favorite city thus far. I absolutely love it’s uniqueness, and can’t wait to come back in the future.

FACTS:

  • Carnival of Venice (Carnevale di Venezia) is an annual festival that ends with the Christian celebration of Lent, forty days before Easter on Shrove Tuesday (Martedi’ Grasso or Mardi Gras), the day before Ash Wednesday. World-famed for its elaborate masks.
  • It is said that Carnevale started with the victory of the Serenissima Repubblica against the Patriarch of Aquileia, Ulrico di Treven (1162). In honour of this victory, the people started to dance and make reunions in San Marco Square. In the 17th century, the baroque carnival was a way to save the prestigious image of Venice in the world.

~ Jordan

PT Clinical Week #4

Last week was my last time inpatient orthopedics, as this week I will be venturing downstairs to inpatient neuro!

Last week, many of my routine patients were discharged home- a bittersweet moment.  It was great to be able to work with them for a period of time, see them improve, and then see them leave to go back home to their families.

On Monday and Tuesday afternoons, I was able to observe and work with patients in Aqua therapy. Monday I only observed. The PT only got into the pool for about 20 minutes to work with 2 patients because all of the other patients already knew their workout routines and were doing them independently. Patients with a pool prescription are in the pool for either 3 days per week or 5 days per week. There are many patients in the pool at one time which was a nice change from the aqua therapy I experienced in my last clinical where only one person was able to fit/and use the hydrotherapy pool at a time. It’s nice to see because the other people in the pool can be motivating factors for one another. It’s a time to socialize while also getting their therapy.

I was able to observe the PT perform treatment on two patients (one stroke; the other back pain).  The following day I performed mobilizations and prescribed some exercises for a patient with hip pain.

MORE DIFFERENCES:

  • In the inpatient facilities I have been in in the US, they usually receive 3 hours of therapy per day. Here they receive 5 hours! Instead of only focusing on manual therapy for maybe 10-15 minutes back home, here they spend up to an hour on just stretching and mobs! I often get sick of repeating the same manual techniques over and over again within the hour, but then I realize that there are other stations taking care of the other modalities that I would normally cover myself (exercises, ambulation, e-stim, etc).
  • All therapists carry their cellphones with them around the clinic. The purpose is so they can reference it when needed to help patients. Also, because documentation is lacking, there is a decrease in communication between therapists who are treating patients whose normal therapists are off or home sick. But there are some times when you look around at some therapists in the gym who do not have a patient and they’re on their phones on FB or instagram. You would not see this in a US clinic because this would be seen as impolite and there is hardly any down time due to the loads of documentation!

~Jordan

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Basilica of San Francesco

Basilica of San Francesco

Basilica of San Francesco

Basilica of San Francesco

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Basilica of Santa Chiara

Basilica of Santa Chiara

My new mug!

My new mug!

Ceramic plates at Enoteca Prosperzio

Ceramic plates at Enoteca Prosperzio

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Wine tasting!

Wine tasting!

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Temple of Minerva

Temple of Minerva

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Basilica of San Francesco

Basilica of San Francesco

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One of my favorite pictures :)

One of my favorite pictures :)

After sleeping in on Sunday, three of us headed to Assisi, since the other girls were not feeling well. I decided at the last minute to go, and I am really glad that I did! I think Assisi was one of my favorite places I have visited so far.

The city is placed precariously on a mountain with Basilica of San Francesco in high regards. We just HAD to stop to get pictures in the middle of the road haha. We did a lot of climbing up and down hills, saw the Cathedral of San Rufino & Basilica of Santa Chiara. My favorite part was where we could enter the crypts and see the tomb of St. Francis. When we came out from the tombs, the sun was setting and we got so many great pictures all the way back to our car.

On our way home we stopped at Enoteca Prosperzio in Spello for a wine tasting. It was a little more than a wine tasting as we got a glass of each wine, and a full course meal! Our coordinator paid for it all. There was a wine that was celebrating it’s 25th anniversary that was produced in one of the best wineries in all of Europe. Then we had this balsamic vinegarette that came in this tiny tiny bottle that sold for 100 euros a bottle (it was very delicious). After the wine tasting, several of the girls bought bottles to take home to their families. We really liked the ceramic plates that we saw and asked the owner to see his collection. The collection was huge and he was selling everything for a discount price. Every girl bought something, and I bought the mug below. I am going to have to send lots home in order to be able to fit all the souvenirs in my suitcase to come home!

~Jordan

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Selfie with me & Amanda Knox's Flat

Selfie with Amanda Knox’s Flat

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Roca Paolina

Roca Paolina

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Palazzo dei Priori

Palazzo dei Priori

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Last Saturday morning we woke up and had another great breakfast cooked by our landlord that included: cake with chocolate, almond chocolate bars, bread with Nutella & jam, yogurt, orange juice, coffee of our choice, scrambled eggs with ham & cheese. Next we headed to Perugia for the afternoon, which is only about a 35 minute drive from our house. It was a cold and dreary day. Apparently the rumors are that Perugia is one of the biggest drug cities in Europe (I did not discover if this was true or not). For being a Saturday in the city, there weren’t many people out and about at all! We parked next to an outside market that reminded me of an auction I frequent back in the states. It had any item imaginable for very very cheap. I bought leg warmers and a winter hat.

Afterwards we headed to the mini metro and traveled through an underground stone city (Roca Paolina) where the Christmas markets were held in December. Once we entered the main city, we visited some churches and Palazzo dei Priori (town hall). We went shopping and the girls got some great buys. The highlight of my day was when we searched the address of Amanda Knox’s flat where the murder of her roommate occurred. What was really cool was that it was off the beaten path and that it wasn’t labeled at all. So the standard passerby wouldn’t know it was hers. Apparently we heard it was for sale for 500,000 euros (but our instructor said that it is sinking into the ground so it is no longer for sale). The house is so tiny, but it does have a great view! We went to the University nearby that she attended and then headed back to the car. Earlier in last week two girls were really sick. Me and two of my roommates also caught the bug, which is inevitable living with 7 girls.

FACTS:

  • Perugia is the capital of of the central region Umbria.
  • Roca Paolina: may not be the first castle to be built in the city, but is certainly one of the most important. Built in 1373 after Cardinal Aegidius Albornoz wrested control of Umbria and Tuscia from Pope Innocent VI, it was meant as a testament to the cardinal’s prowess and power. Only three years after it was built the castle was destroyed by the local populace during an uprising. The only part of the castle that remains today are the large walls, which support the Piazza Rossi Scotti.

 

~Jordan

San Gimignano

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Snow capped Apennine Mountains in the distance

Snow capped Apennine Mountains in the distance

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Last Sunday, we woke up and finished the museum tours and did the panorama view of Siena. Then we hopped in the car and headed to San Gimignano, known for the worlds best gelato! We found 2 shops side by side that claimed they had the World’s best gelato. One was closed so we went to the other. I asked how it was possible that there were two world gelato winners that were side by side. They said every year they vote on the best one and in 2014 the one we were in, were the winners. I believe them! I got Crème brulee & crème carmel latte the first time, then we liked it so much that we went back later that night for another round. and I got cheesecake and Tiramisu. I liked this city the best of all because the views on top of the mountain were breathtaking. We even saw the snow capped italian mountains in the distance* We didn’t go into any museums here, but I would have like to have gone in the torture museum. The museum houses an impressive array of medieval torture devices including the uncomfortably spiked inquisitorial chairs, and a simply murderous looking device labeled ‘the heretics fork’. San Gimignano is known for it’s 14 towers and places of torture.

 

~Jordan

PT Clinical Week#3

Another great week in the books! This week I was able to educate more patients on various new exercises in the Italian language with little to no help from my clinical instructor (my favorite part of clinic!).

Earlier in the week, it was funny, I would be working with a patient and ask my CI if I could try for example a hip stretch for a low back patient, he would say “No, continue doing the thigh stretch”. This continued to happen a few times earlier in the week, and I was getting frustrated that I wasn’t able to come up with my own suggestions for treatment and that I was only performing what he wanted me to. However, as the week went on, he was more open to change and was willing to try all my suggestions! It was nice to have a discussion about different manual techniques, and what I really liked was that he wanted me to try them on him first so he could see if my PT body mechanics were good along with the proper force.

I’ve been working with hip replacements, chronic low back pain, cervical spine pain, shoulder pain, and post polio syndrome UE & LE pain.

Next week I will be participating in Aquatic therapy Monday and Tuesday afternoons!

SOME INTERESTING FACTS:

I found out the reason why most patients receive loftstrand crutches as opposed to axillary crutches or walkers. It’s for cosmetic reasons. Patients do not like the appearance of looking sick or severely impaired. The loftstrand crutches are much more convienent and have a sportier look.

I noticed that most, if not all of my patients are patients that would be in outpatient services if they were in the US, and NOT in inpatient rehab where they spend a month or two. I was really confused to why this was the case until I was reminded of their healthcare system. Patients often have the luxury of choosing which therapy services

Still trying to post from San Gimignano.

This weekend we are headed to Perugia, Assisi, and a free wine tasting!

~Jordan