Turned in my thesis

I have finished my thesis and turned it in for examination! Now I just have to wait 6-12 months to learn the outcome.

Case Study update: intermittent work

Between myself and my patient going on several small holidays, we've not had many workouts in the last month. Today we finally got together for the first time in 2 weeks, and his strength and total endurance for the workout were wanting, but overall he did really well. The important thing is that his mobility has continued to improve even without the gym, and he was able to play golf for the first time since his back surgery. He hit out two rounds while on holiday last week, making it through 12 holes the first time and 7 the second. Today his hip and spinal rotation where notably better than when I last saw him. No further word or decisions on what to do after his biospy--it will be another 2 months until he goes back to the urologist for a follow up PSA test.

Case Study: Results of biopsy and hard work

My patient had his results returned. 2 of the 12 biopsy samples contained cancer cells; one had 15% coverage and one had 30% coverage. The Gleason score was 3+3=6. So, overall, early stage and not too aggressive, which is good. His urologist is recommending to wait 3 months for the next PSA test before making any decisions on treatment.

In the gym, we slugged it out hard today. 20 minutes on the bike doing 30s hard 30s easy for 5 minutes, then 10 minutes of a pyramid interval set, starting at 10s and +10s each rep up to a minute and then back down, always with only 20s rest. Afterwards I really tested him on his side lying leg lifts, seeing if he could maintain a 3 count up, pause, 3 count down for all 3 sets of 10, and he did. Finished off with some weight lifting. I was glad to see him rise to the challenge after he had been so tired earlier in the week.

Case study: needing a recharge

My patient came in today complaining of pain in his feet, knees, and back. Likely contributors are the rowing we did Friday, especially for his feet, and then the gardening he did all weekend for back. Also, the facility was filled with noisy little kids at their Summer day camp, and just made for an overall de-motivated atmosphere. So we left, and went walking around the neighborhood. Because of his pain, he had brought his cane along, so every couple hundred meters we'd stop and do exercises, like bicep curls or rows, with him holding the cane and me grabbing the middle to provide resistance. Mentally, he felt much better at the end of the session, though he was still a bit anxious because Wednesday we get the result of his biopsy.

Case study: biopsy and fitness

On Wednesday my patient had his needle biospy of his prostate. We'll get the results next week. The procedure itself went without hitch.

Wednesday we had to cut the workout short so he could prep for this appointment. We focussed on core and hip, doing planks, marching, hip ABD, etc. For strength we just did calf raises, bumping it up to sets of 20, which finally made it a challenge.

Friday the normal gym was closed so we used my gym. It was his first time trying the rower, which he enjoyed. It was very challenging for his because his knee was never properly rehabbed from '06, so I think we'll start using the rower more often for active flexibility training. We did more core and hip work, focussing on doing everything slower and with more control. Then for strength I had him use a set of rings to do body weight rows, which he thought were great. So overall a bit of a disrupted week, but some definite progress, especially on theraband rotations--he was basically able to rotate his torso 180 degrees (full left to full right), when just a few weeks ago he was only able to go about 20-30 degrees to either side of middle. This is a great and encouraging result that the tightness and stiffness from his back surgery is resolving.

Case study report

Well, I was a slacker and didn't report as I go, so here's I've been doing the last 3 weeks.

Started working with a 70 year old male, obese, played football in college, served in the Marines in Vietnam--in summary, has had an active but physically wear-and-tear life. Had spinal stenosis; in 2006 had a L knee total replacement which was not properly rehabbed, and subsequently has developed major arthritis in the L hip as well as general deterioration from compensating for the knee. In March 2013 finally had a spinal fusion of L3-L5, widening of vertebral foramen, and rods fused to his spine. Was sent to a physical therapist for post surgery rehab, and I came in to the picture near the end of his tenure to help transition on to his own.

Main goals of physical therapy were regaining basic mobility of the spine and hip and strengthening the L hip, as the back surgery has led to further weakening on that side.

The patient has been doing 2 days per week of basic hydrotherapy (mostly just walking and light strengthening exercises) and 2-3 days per week of light gym work. The basic gym routine has included stretches for the back and hip, side lying hip abduction, calf raises, very light lat pull downs and rows, and 15 minutes each on the bike and elliptical.

This past week he had his final appointment with the physical therapist and follow up appointment with the surgeon, who both have given him the all clear. Now my main goals are to continue to strengthen the left hip, improve gait function and strength, and weight loss. I performed fitness testing on Monday and started implementing the progressed routine today.

Unfortunately, after a visit last week to his GP, he has been referred on to a urologist as his PSA had increased by almost 3 points since October 2012. He does have a family history of prostate cancer, so there is some legitimate cause for concern. So, it turns out my purely musculoskeletal patient may now become a normal patient of mine. Lucky for me he's got a condition that I know what I'm doing with.