Category: Uncategorized

Working Inter-professionally

Posted on by Stephanie Schwartz
 

In our clinic, we work collaboratively on multiple cases with other healthcare providers to help our patients get better as quickly and safely as possible. Working with doctors of different specialties (i.e. Neurology, sports medicine, orthopedics, etc.), physical therapists, and athletic trainers is essential in returning our patients to normal ADLs and sport participation. The tricky part is getting all involved parties on the same page and keeping them on the same page, that way no one is stepping on the others toes and hindering the advancement of the patient’s recovery process. This can be difficult when days get busy or when one person out of the care team does not communicate care with the other. 

Example: an athlete is being seen for concussion recovery and is attempting to complete a return to play protocol (which is a minimum of 5 days, 24 hours asymptomatic between each day). The athlete also has another injury, unrelated to the concussion, that they are seeing another care provider for. Even though these injuries are unrelated, they do affect the body’s physiological response! To return this athlete to play, we had to put a hold on her other therapy so that it did not affect her ability to finish this 5 day protocol.

Continuing to strengthen communication skills, both written and verbal, is a big factor in keeping everyone working towards that patient’s goal. And then documenting what the patient’s goals are, keeping inter-professional communications in the patient’s electronic or paper chart, and taking the time to look at those charts to remind ourselves of where the patient is at in reaching those established goals.

Happy Friday from Dr. Fitzgerald!

Posted on by Stephanie Schwartz

 

Good morning everyone! Hope your Friday is happy and healthy. I spoke about the z-vibe as a tool to help get patients in a better position to be able to do more therapy. Vibration as a whole, and utilizing the z-vibe, allows us to  contribute to improved outcomes. This is a very powerful tool in helping patients with balance issues. We will be starting the monthly webinars with emphasis on therapy protocols. Stay tuned for those protocols and how to implement them in your practice. With nearly 7.8 million people a year reporting concussion, there is absolutely plenty of folks that need our help. And with the literature supporting that vision is affected in 90% + of folks, we are in big demand. And anyone helping in concussion management, I do not know how we can do treatment without a thorough eye exam. Keep posted. Happy Friday!!

Cerebral Spinal Fluid Leak Case Study

Posted on by Stephanie Schwartz
 

Now 70 year old male tells his story of an injection gone wrong…7 and a 1/2 years ago he went in for a lumbar spine epidural and he ended up with a cerebral spinal fluid leak. This has caused constant, 24/7, headaches that are reported to be all over the head and very severe. 

After being evaluated by Dr. Fitzgerald, OD at Dr. Fitzgerald & Associates, he was referred to complete a Multi-Sensory Reset Therapy (the Vision In Motion Pinnacle Program for those of you that know of it). Throughout the 12 day program, he was dry needled by an Athletic Trainer 2-3 x per week to relieve head pressure and allow the cerebral spinal fluid to flow. The patient states that he felt the largest impact from dry needling than he ever has with any other treatment. 

He continues to receive treatment 1-2x per week during the 1 month period between the end of the MSRT program and his re-assessment with Dr. Fitzgerald, OD. These sessions consist of eye hand coordination exercises, specifically noted benefits from tossing a ball with a partner, and dry needling. 

This patient continues to report improvements in his chronic headaches; that they now occur only at the end of the day. AND that some times he goes days without one at all! Can you imagine going through the trauma that this man has, understanding that he will always be in pain due to the injection gone wrong, and then wake up without headaches multiple days in a row?! That is the power of combining treatments appropriately, utilizing your medicine team, and incorporating a 360 degree health program. 

Sleep: Chronotypes

Posted on by Stephanie Schwartz

Raise of hands for those that get the “norm” 8-10 hours of sleep. When does your body cue you to fall asleep and wake up? Try not to confuse this as when you think you should go to sleep and when your alarm wakes you up. If you could stay up until midnight and sleep until 8, would your lifestyle allow you to do so? What about sleeping for 7 hours at night and 1 hour during the afternoon?

A podcast that I found by Peter Attia, The Drive, episode 221 Understanding sleep and how to improve it, describes chronotypes: the time of day when you feel the most awake, when you are hungry, etc. People that report having insomnia may not truly be an insomniac…what if their chronotype simply does not match their current lifestyle? After a brain injury, as many of us manage on a day to day in our professional careers, someone may have been able to compensate their mismatched chronotype/lifestyle before an injury. Now, they are telling you all of their symptoms and that they are sleeping all the time. Well, think about it. Has their chronotype changed? Is it the same as pre-injury and they are unable to tolerate the mismatch now? We are excited to have an open discussion below on this topic, so make sure you put your comments in the box below!

Follow this link for a more in depth definition of chronotypes: https://www.sleepfoundation.org/how-sleep-works/chronotypes

Nutrition & Concussion: Part 1

Posted on by Stephanie Schwartz

You know the phrase, “you are what you eat”? Well after a severe injury or illness I have found this to be truer and truer for every athlete I work with. After sustaining a concussion, the blood brain barrier becomes compromised and causes a lack of filtration of toxins. This leads to symptoms such as fatigue, brain fog, lack of concentration, poor memory, etc. The brain literally has no moat to protect it! As clinicians we have to educate our athletes on how to restore the blood brain barrier, protect the brain, and give it an optimal environment to heal on its own. Side note: a great professor once said, “The body will heal itself, we just have to give it the tools to do so.” What kind of tools should we have in our toolbox? At Dr. Fitzgerald & Associates, we look at what foods cause inflammation due to the body’s increased inflammatory response after injury. As with orthopedics, concussion injuries also go through the same inflammatory process and some people get stuck in this phase of healing. This is when they need the tools in our tool box to get through the “stuck”. What do these tools look like? For starters, research what foods may cause inflammation. Many of these include gluten, dairy, nightshades, and caffeine. It takes a special kind of artist to guide someone through dietary changes, especially to make sure they are getting enough protein and fats which is what the brain and blood brain barrier are made of. Really challenging someone to focus on what they can eat vs. what they cannot, keeping their focus positive vs. negative, is key to improving nutritional habits and concussion symptoms associated with them. Secondly, how do you know they are getting enough protein? See below for recommendations from Houston Methodist Orthopedics & Sports Medicine; it’s a great resource! Craving more on nutrition and concussion? Stay tuned for part 2 of this series: a case study on how cutting out gluten abolished an athlete’s symptoms completely.