Deep Thoughts at the Dentist

Guys I have a confession to make…

I haven’t been to the dentist in over a year. Between Covid-related closures and life, it just didn’t happen. But I went this morning, and am so glad I did. And it got me thinking about a few things.

Leading up to my appointment, I found myself having apprehensive thoughts, like dreading the visit in fear I’d be told I have seventeen cavities and need a root canal because I missed my regular visit. I considered cancelling and waiting till the Covid-risk is lower. But, fortunately, I had the insight to realize that when it comes to your health, Ignorance ISN’T bliss and I made it to my 9am at the Future of Dentistry - Wakefield (shout out for a super-clean, comfortable experience this morning!

When we avoid facing a reality out of fear, it doesn’t make that reality magically disappear. And when it comes to caring for your body and your health (and in this case, my teeth!), what may seem innocent enough, like postponing regular healthcare prevention visits, can actually make the problem worse!

So back to my teeth. Did you know that good oral hygiene is about more than pearly whites and avoiding the pain and nuisance of a filling? Oral health not only affects your mouth, but can cause other, bigger, health problems. Bacteria living in your mouth can travel, impacting other systems, like your heart and lungs. Poor oral hygiene can increase your risk of endocarditis (an infection in the lining of your heart), cardiovascular disease and pneumonia.

As a Physical Therapist, I’d 100% rather see a patient BEFORE they have a problem, than work with them to fix it after. Unfortunately, our healthcare system historically promotes rehabilitation and medical management over prevention. While there has been some within the physician treatment model to do better in this area, this hasn’t trickled down as much as I’d like to see within the practice of Physical Therapy. We, as a profession, have so much to offer in the realm of PREVENTION and it is my hope, that in 2021, payers like Medicare and other Managed Plans begin to see this, and offer better reimbursement for visits designed to address issues before they arise.

In the meantime, you have a choice. You can CHOOSE prevention. You can CHOOSE to put healthy things in your body, keep unhealthy things out, and to make exercise a regular part of your health maintenance (just like taking vitamins or seeing your primary care physician regularly). You can even CHOOSE to see a Physical Therapist before problems arise. PT’s like HAE offer Annual Physicals, just like your physician, and can help you take a clear and comprehensive look at your current health, your health behaviors and help you construct a plan that will set you on a path towards Healthy Aging.

“When you have to make a choice and don’t make it, that is in itself a choice.” -William James

So, as we turn the corner to 2021 (Good riddance, 2020…), let’s do some thinking. How could we treat our bodies better this year? 2020 has not been easy on any of us, and our collective health has suffered as a result. What problems could we choose to face, head on, instead of ignore, as we enter the new year?

If you like the idea of a Physical Therapy Annual Check-Up, and think it could help you start 2021 on the right track, call me:) I’m more than happy to help.

#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #insurance #medicare #momboss #annualcheckup #prevention #rehabilitation

FAQ #3: What DO You Actually Do ???

FAQ: What do you actually do?

(Aka when your PT doesn’t ‘look’ like a normal PT..)

I get it - Physical Therapists who don’t always look and act like ‘normal’ physical therapists can throw you for a loop. Us Geriatric Mobile PT’s don’t have a clinic. We don’t work with aides. Heck, we don’t even own an ultrasound or estim unit (usually!). So what is that we actually do?

To answer this question, I’ll start with a few things we aren’t:

We aren’t nurses - but we do take your vitals, check your meds and help you manage your chronic diseases. 

We aren’t massage therapists - but we do perform soft tissue work, manual therapy and other hands-on techniques to help reduce your pain and improve your movement. 

We aren’t occupational therapists - but we do work with you in areas where OTs usually hang out, like to work on transfers in the bathroom, teach you how to move around safely in the kitchen and how to keep your balance while you get dressed. 

We aren’t your doctor - but we have ‘direct access’ that allows us to see you first, before you see your doctor, because we have the advanced education, skills and know-how to identify when it is safe to see us - and when you need to see another clinician first. 

We aren’t social workers - but we are great resources for how to access support within your community. We have great connections to senior centers, home health agencies and other health professionals and can steer you in the right direction.

We aren’t your therapist - but we are great listeners. We understand that the key to helping you benefit from physical therapy is to find ways to motivate you and get you more confident in your abilities. This requires getting to know you, your life, your goals, the ‘what makes you tick’ stuff. We can’t be effective without understanding this first.

So, back to the original question. What the heck do you do?

Geriatric Mobile Physical Therapists are experts in healthy aging. We understand that Exercise is Medicine and we are masters at finding ways to help you move, despite your limitations, despite your medical conditions, despite the fact that you are getting older and despite the fact that you may be scared, physically limited or simply don’t know where to start. 

We are movement and mobility masters. EVERYTHING we do as humans requires movement. Taking care of yourself, your loved ones and your home (getting dressed, taking a shower, cooking, going to the grocery) all requires mobility. Doing all the things you LOVE and ENJOY requires mobility. Golfing, playing tennis, socializing with friends and family, picking up those grandkids and getting to the floor to play with them. These aren’t always easy tasks as we age - but they are the very most important ones. Physical therapists are THE people to help you find ways to keep doing these, without less pain, with less risk of injury and with less risk of falling. 

We are illness and injury rehabilitation professionals. It is nearly impossible to grow old without experiencing some bumps in the road. These bumps may be hospital stays, broken bones, strokes or progressive illnesses like Parkinson’s. We are the people to help you find your way back. Back to health, back to moving, back to living, back to being you.

None of this stuff is easy. Growing old ain’t for sissies (direct quote from more than one of my past patients!). Mobile Geriatric Physical Therapists (like me!) make it easier. We help you stay healthy as you age. We help you recover from bumps in the road. We even help you stay comfortable as you progress towards the end of life and help your family learn to care for you if they need to. So, will you get modalities and massages and be given a home exercise program and sent on your way? Nope. Not by a long shot. Will you learn to better care for yourself, care for your loved ones and age more successfully? You bet. Want to know more? Ask us:) #ChoosePTfirst

#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #insurance #medicare #momboss

FAQ #2: How ‘Old’ Do I Have to be to See You?

FAQ: How ‘Old’ Do I Have To Be to See You

(Hint: It’s a trick question)

I’ll answer this question with another question. Are you older than you were yesterday? Then you’re ‘old enough’ to see me.

As a geriatric physical therapist, I specialize in healthy aging. This means that while I’m a great person to see if you are having age-related issues like pain or limitation from arthritis, or trouble walking or difficulty with your balance, I’m also a great person to see if you want to PREVENT some of this stuff down the road.

There are so many diseases and disorders associated with aging (Congestive Heart Disease, Diabetes, Heart Disease, Osteoporosis and Cancer to name a few), but the key to prevention is making healthy choices, and developing healthy lifestyle habits BEFORE you get older. I’m 38 - and everyday I consciously make choices that will make me a healthier older person when I get there.

So, the answer to this question is you have to be exactly as old as you currently are:)

#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #insurance #medicare #momboss

Dementia 101

As a Physical Therapist, I don’t actually ‘treat’ dementia. But, I do treat a whole lot of patients with dementia. Why do people with dementia end up on my caseload? Frequently, people with dementia fall and have fall-related injuries that require physical therapy. People with dementia are also at increased risk for social isolation, malnutrition, inactivity and inevitably, functional decline. And more than anything, because I treat older adults as a specialty, dementia is simply one of the common diagnoses I find on that long list of age-associated diseases that follows my prompt for past medical history.

Now while we all learned about dementia in PT school, and as I’m sure any physical therapist can attest to, knowing the pathophysiology and clinical features of this disease does not inherently make you good at working with someone living with it. The challenge of working with someone with dementia is not knowing what they need (that’s the easy part), but in your ability to actually get a person with dementia to ‘do’ the things - to complete a motor task or physical activity - and even more so, to modify it, progress it, or make it safer for their bodies. This is the part that even the experienced physical therapist (quietly raises hand…) can actually find really challenging.

The Cold Hard Truth

I spent the first five years of my career working as an outpatient neurorehab therapist. The next seven, I spent as a homecare therapist seeing older adults with a wide variety of injuries, illness and sources of of their physical decline. I went to an excellent graduate school (shout out to MGHIHP!). This is not said to impress you, but to lay the ground work that even the most experienced and well-educated therapists may share some of the challenges, preconceived notions and perhaps even prejudices about working with people with dementia that I had. Here’s the Cold Hard Truth: working with people with dementia is HARD. PTs are BUSY. And sometimes, combining a patient whose diagnosis makes them more challenging, with busy schedules and the productivity demands commonly placed on physical therapists, leads us to draw the following common conclusions when we see that word ‘dementia’ on the laundry list of comorbid diagnoses:

“Oh, they have dementia, they won’t have any carryover.”

“This will be quick, I’ll only be in a few sessions.”

“I’ll just do the basics and get out of here.”

“Dementia means they have no potential to get better. I’ll focus on family teaching instead.”

Have you had some of these thoughts, too? Does this make us horrible therapists? Does it make us horrible people? NO! It makes us busy therapists trying to do our best for a large population of people with the resources (time, education, energy, sanity, empathy) that we have. Could we do better? Sure could. Before I dive into how, I want to give you a brief primer on this common brain disease.

Dementia 101

Dementia is not a specific diagnosis, but an umbrella term that accounts for variety of diseases that impair cognition, memory, processing and behavior. While impaired memory may be the classic sign, people with dementia experience a wide breadth of symptoms that progressively impacts their ability to care for themselves and others, to function within their communities, and to remain independent, mobile and healthy. While Alzheimer’s Dementia makes up the majority of dementia cases (60-80%), other types including Lewy Body Dementia, Frontotemporal, Vascular and Multinfarct Dementias are also commonly encountered by physical therapists. While some dementias are reversible (such as dementias due to dehydration or nutritional deficiencies, depression, medication toxicity or metabolic encephalopathy), the majority have a slow, insidious onset and progressive nature. There is, of course, some natural slowing of reaction time and processing associated with aging, and in the pathological realm, a condition known as ‘mild cognitive impairment’ that may share features with dementia, but they remain separate entities nonetheless. There are two key features that distinguish normal age-related cognitive changes and mild cognitive impairment with a true dementia:

1. The individual must demonstrate a decline from previous level of functioning.

2. The impairments must significantly interfere with work or usual social activity.

Early Signs and Symptoms of Dementia

Identified by the Alzheimer’s Association, the following ten signs are commonly seen in early Alzheimer’s disease and other dementias. Of course, many of these can also often be a symptom of other diseases and disorders, so if you find any of these signs concerning, it’s always best practice to bring your concerns to your primary care team.

1. Memory loss that disrupts daily life.

2. Challenges in planning or solving problems.

3. Difficulty completing familiar tasks at home, at work or at leisure.

4. Confusion with time or place.

5. Trouble with understanding visual images and spatial relationships.

6. New problems with words in speaking or writing.

7. Misplacing things and losing the ability to retrace steps.

8. Decreased or poor judgement.

9. Withdrawl from work or social activities.

10. Changes in mood and personality.

Other types of dementia have their own commonly associated features:

With damage found in the brain’s outer cortex, Cortical Dementia tends to cause problems with memory, language, thinking and social behavior, with memory problems generally appearing first.

With damage to deeper structures, Subcortical Dementia causes more change in emotion and movement, along with problems with memory. In these cases, gait disturbances typically appear first.

The cumulative effect of many small strokes, Multi-Infarct Dementia typically presents with a progressive, stepwise decline in mental function and is typically seen in patients with a history of hypertension, smoking and cardiovascular disease.

Similar to multi-infarct dementia, and sometimes used interchangeably, Vascular Dementia is a result of chronic oxygen deprivation throughout the brain. Vascular dementia presents gradually, often presents with changes in vision, sensation and language deficits.

Lastly, there are some types of dementia that develop alongside of other diseases. Lewy Body Dementia can be diagnosed on it’s own or along with a Parkinson’s Disease diagnosis. With a clinical prognosis generally more worse than Alzheimer’s, symptoms typically include syncope, falls, loss of consciousness, delusions and hallucinations. Parkinson’s can also be associated with mild cognitive impairment with or without an eventual progression to full dementia in around 50-80% of patients with Parkinson’s Disease. Common symptoms of Parkinson's Disease Dementia include trouble with memory and concentration, visual hallucinations, depression and frequently, sleep disturbances. Dementias can also be found in people with ALS, Huntington’s Disease and in the setting of Normal Pressure Hydrocephalus and may be a consequence of an underlying brain tumor.

Communicating BETTER With a Person with Dementia

Getting back to my story here, I had the opportunity this fall to attend a virtual Dementia Friends Massachusetts Training. Dementia Friends is a global movement developed in the UK, which has now become a worldwide effort to change the way people think, act and talk about dementia. While this training was not physical therapy-specific (it is actually designed to educate the lay person in the community about being more compassionate to people with dementia) I found I was able to apply what I learned to greatly improve the way I was able to communicate with my patients with dementia, which in turn, enhanced how effective I was able to be as their therapist. In fact, I found this talk so helpful for my practice as a geriatric physical therapist, that I decided to complete the training to become a Dementia Friends Champion, so I can, in turn, train others. I was pleased to find that when I offered this training to other therapists involved in the geriatric community, the response was overwhelming. I currently have sixty therapists signed up to take this training with me in the month of December, and hope it is as helpful for them as it was for me.

So, what was it that I learned in this session that changed the way I treat? It gave me concrete tools to make communication easier, strategies that now enable me to more effectively teach the functional mobility tasks, therapeutic exercises and balance exercises needed to help these patients get stronger, improve mobility and decrease their risk of falls. It gave me a different sense of compassion then I had previously, allowing me to be a kinder, more empathetic therapist. It impressed on me the importance of teaching these skills - to other therapists, to family members, to the community - to widen the network of understanding individuals that surround people with dementia living in our communities. What follows are my favorite take-home messages from this training that I found most influential in my physical therapy practice. If you want to learn more, I encourage you to sign up for a Dementia Friends training session - and if you want to teach it to others, the Champion training.

Dementia slows processing time, but doesn’t make it impossible.

It can take up to 20 seconds from the time you say something, for it to be processed and understood by a person with dementia. While our instinct may be to rephrase or redirect when our initial direction goes unfollowed, try waiting that 20 seconds first. Often, while we may be trying to rephrase to make it more easily understandable, this actually adds more layers to be processed and makes the process more convoluted to the brain. Wait the 20 seconds, then either repeat the same request - or try an alternative approach.

Keep directions clear and simple. Less words. More demonstration.

Visual information is processed in a different area in the brain than speech and words. People with dementia will struggle more and more with explicit direction and declarative learning as their disease progresses. However, the ability to process visual cues, mimic demonstration and learn procedurally remains in-tact longer. Using strategies to promote procedural learning (familiar tasks, repetition, use of functionally-relevant exercise programs) will be more effective than explicitly teaching the task.

Feelings, like emotion, love and happiness, remain the longest.

We’ve all been there. Sitting in a hospital room or an assisted living apartment, with a person with dementia, locked into their own confusion, unable to communicate in any meaningful way. Do we try to communicate or simply work with them in silence? Do we use our tone, words and body language to promote an atmosphere of empathy and caring - or match them with an equal lack of expression. Armed with a better understanding that people with dementia are still able to feel an intrinsic sense of emotion, love and happiness, even without the ability to provide any reciprocity in conversation, I’m far more apt to provide them with a caring smile, accepting body language and efforts to engage them beyond whatever therapeutic tasks I may have planned.

And you know who needs to know this more than anyone? Their families.

The more people that understand these concepts, the better.

How many times do we witness well-meaning family members and friends (even sometimes, coworkers) falling into the pattern of talking ‘above’ their loved one with dementia, as if they aren’t even there? Getting frustrated, even laying blame on lack of effort, or ‘behaviors’ instead of the underlying brain disease that causes it in the first place? Don’t you think if they better understood the cause of these behaviors, and had the tools to communicate with less struggle, that they would be better able to support their loved one in a more compassionate way? There are 5 million Americans living with Alzheimer’s Dementia. There are 16 million others who provide unpaid care for them. Not to mention the community members that interact knowingly or unknowingly these individuals every day. Waiters and waitresses. Medical assistants and other health care professionals. Retail store clerks, librarians and other acquaintances. The more people people we educate, the greater the chance that an individual with dementia can be met patience, empathy and respect.

Ready to become a Dementia Friend?

Check my Upcoming Events page to see if I am offering a training and feel free to join me.

Or, check the Dementia Friends website to find a session local to you.

Diabetes 101

November is National Diabetes Awareness Month. To do my part, I’ve been sharing information each week about Diabetes - symptoms, causes, impact on the body and most importantly, about prevention. To wrap up the month, I’m putting it all together here on the website, in Diabetes 101.

Diabetes 101

Diabetes is the 7th leading cause of death in the United States, and the numbers of people living with Diabetes are increasing. Since I’ve been alive (I’m under 40, but over 35 for those of you wondering..), the number of cases of diabetes have QUADRUPLED. Trends project that by 2050, 1 out of ever 3 American adults will have Diabetes. 

While there are different types of Diabetes, the vast majority, 90-95%, have Type 2. While Type 2 Diabetes does have some genetic component, this is a preventable type of Diabetes. And for the folks in the back - THIS IS A PREVENTABLE DISEASE! Not only is it preventable, but people typically are often made aware by their doctors that they are developing it, and there are concrete ways to reverse course and normalize your blood sugar regulation to prevent progression to full course diabetes. Of the 86 million adults in the United States who are prediabetic, 15-30% will go on to develop full Type 2 Diabetes within 5 years. The key to prevention? Changing your habits and lifestyle to foster healthy eating habits, weight management and regular physical activity, But before I go on, and on and on, about the benefits of physical activity (have you heard this one before?), here is a quick primer on Diabetes.

Diabetes Is:

Diabetes is: a group of metabolic diseases that cause unmitigated blood sugar (hyperglycemia). While the body relies on sugar for energy production, too much free floating, unstored sugar, can wreak havoc and cause damage and dysfunction, and eventual failure, of organs throughout the body. Diabetes most commonly affects the eyes, kidneys, nerves, heart and blood vessels. Long term effects of Diabetes can include:

• Retinopathy

• Nephropathy

• Peripheral Neuropathy (leading to skin breakdown, foot ulcers and often amputations)

• Autonomic Neuropathy (leading to gastrointestinal, genitourinary and cardiac symptoms)

• Atherosclerosis

• Cardiac Artery Disease

• Peripheral Artery Disease

• Cerebrovascular Disease

• Hypertension

• Abnormal Lipid Metabolism

There are a few different types of Diabetes. Type 1, or what used to be referred to as Juvenile Diabetes, is not preventable. This form is an autoimmune disorder where the body attacks the insulin-producing Beta cells in the pancreas, thereby preventing insulin formation. Without insulin, the body cannot break down sugar effectively leading to diabetes. People with Type 1 Diabetes rely on careful diet and exogenous insulin (injections) to manage their blood sugar, and while healthy diet and exercise is still important for someone with Type 1, it will not prevent Diabetes in this case. Type 1 Diabetes accounts for about 5% of Diabetic cases.

Type 2 on the other hand, develops over time, most frequently as a result of lifestyle choices. In the case of Type 2 Diabetes, insulin deficiency is relative, and due instead to insulin resistance. Between overexposure to sugary foods and carbohydrates, and lack of physical activity, more and more insulin must be produced to have the same effect, leading the body to become less sensitive to this hormone and leading to this state of insulin resistance. While Type 2 Diabetics may require pharmacological management (medications that improve insulin sensitivity) or exogenous insulin (injections), many can manage their disease with diet and exercise alone.

Symptom Presentation:

Whether you are experiencing Type 1 or Type 2 Diabetes, the symptoms that you experience are a result of either blood sugar that is too low (hypoglycemia) or too high (hyperglycemia). Symptoms of hypoglycemia include hunger, nervousness, shakiness, perspiration, dizziness, lightheadedness, sleepiness and confusion. Symptoms of hyperglycemia include frequent urination, increased thirst, sweet smelling breath and when progressed too far, ketoacidosis and coma. Initial signs of Diabetes can be a mix of these. Typically, the first signs of Diabetes include:

• Blurred vision

• Polyuria (Increased Urination) and Nocturia (nightime urination)

• Neuropathy (pain, tingling and numbness in hands and feet)

• High blood prssure

• Fatigue

• Confusion

• Itchy, dry skin

• Slow healing wounds and recurrent infections 

Diagnosis:

So how do you know if you are diabetic? There are two primary tests used to screen for, and diagnose Diabetes. Most commonly, if you are at risk or over a certain age, your primary care physician will order an A1C check. This provides an average of your blood sugars over the prior 2-3 month period. A normal value is under 5.7%; a prediabetic reading falls between 5.7 and 6.4%; and a test over 6.5% indicates Diabetes. If you have fasted, your doctor may take fasting blood sugar reading. This reflects your blood sugar, at the current place in time and results under 100 mg/dl indicate you fall in the normal range. Results between 100-125 mg/dl indicate you are prediabetic, and values over 126 mg/dl indicate Diabetes.

Concerned you may be at risk? There is a great resource available on the American Diabetes Association Website that helps you calculate your risk of developing this disease. You can access it here:

When in doubt, simply ask your doctor at your next visit about your risk of Diabetes, and what you can do to prevent it.

Prevention and Management:

Whether you find yourself at risk, diagnosed with Prediabetes or living with Type 2, lifestyle intervention can prevent or stop the progression of this disease. There are three keys to the prevention of Diabetes: Weight Management, Healthy Diet and Physical Activity.

While focusing on a healthy diet is important for everyone, weight management is a particularly important step for people who are overweight or obese. Eating a balanced, healthy diet, while increasing activity and energy expenditure should help to balance out your energy intake and improve your weight management. While I won’t go into too much detail here, the important thing is to identify if this is an issue for you and if so, seek support. A nutritionist, diabetic educator or the Dietary Guidelines for Americans are all great places to start. Choose My Plate.gov offers great online tools you can access here: 

I will, however, go into more detail about physical activity. If you’ve been on the HAE website before, I’m sure you’ve already heard that getting 150 minutes each week of moderately intense physical activity (plus strengthening twice a week) is incredibly beneficial and is THE most effective way to promote healthy aging. This is the same for Diabetes. Not only does regular physical activity help with weight management, but it lowers blood sugar, lowers cholesterol, improves blood pressure, and lowers stress, anxiety and improves mood. While counseling for patients found to be prediabetic includes encouraging increased physical activity, in my experience, there is a reason inactive people aren’t active in the first place. If it were that easy to simply start being active, chances are, they would have done it years ago. But pain, fear, inexperience, lack of time, lack of knowledge...these factors, unaddressed, are all barriers to exercise. 

Role of Physical Therapy in Diabetic Prevention and Management:

Physical Therapists are physical activity and exercise experts. We are experts at finding ways for everyone, in every shape, to become ACTIVE, safely and effectively. Exercise and physical activity can be life changing. It can ward off depression, manage anxiety, improve sleep, prevent disease like heart disease and some cancers. And it can reverse prediabetes and PREVENT DIABETES. 

Exercise lowers blood glucose and improves insulin sensitivity. It improves body composition and reduces adiposity (fat tissue), which when increased, is in itself a risk factor for development of Diabetes. It aids in weight management and makes you FEEL BETTER, and often, that alone, can help with making better food choices. 

So, climbing off my soapbox: this was my long-winded way of saying, good grief, if you have been told you are prediabetic, or had an impaired fasting glucose reading, now is the time to get ACTIVE! And if you need help, ask a PT:)

In summary, Diabetes is a quickly growing problem in the US. However, for the vast majority, this is a preventable disease! Learn about it, make healthy choices and get active. Great resources exist on the internet (ADA), but as always, your primary care physician is the best place to start. Ask the questions, make the changes and get stronger, fitter and healthier!