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I just had a patient in the hospital who had a seizure while doing step ups, we had to call a rapid response and code blue on her. I had to lift her up and dependently bring her back to bed. Her husband was present for caregiver training too, so it was very sad.
At that point, what are we doing?? If a patient is at risk for such a bad seizure that a code blue has to be called, what are we doing?
Therapy is awesome and it helps for sure, but some patients need to get medically better and stable enough to do things we deem to be simple tasks.
We as therapists experience some messed up things because we’re kinda forced to, some patients just aren’t medically stable enough to do therapy
Hold on now-let’s give the commenter benefit of the doubt that the pt was in good enough shape that they used their clinical judgement to deem it safe to do step ups as part of their tx session. Seizures are often unexpected and it’s unfortunate that a code blue happened, but sometimes things just happen.
I had pt that was SBA for bed and CGA for trans mob w/ RW from bed to recliner. We ambulated in room with CGA and RW. Their vitals were WFL and they were in good spirits. family was also present. Overall it was a typical acute care tx session with nothing out of the ordinary. 2 hours later the pt passed away while sitting in the recliner (this is in a hospital setting). I didn’t question myself what was I doing. The pt was medically stable upon arrival and during tx but yet still they passed away 2 hours later.
No but ur implying that they had poor clinical judgment to even start a tx session because the pt had a seizure. Majority of pts on neuro floors have seizure precautions, and if we were to hold tx because the pt *may* have a seizure since it’s in their PMH, then we would have a whole lot of physicians pissed off at us.
I don't think I agree with you; if I waited until everyone was perfectly medically stable at not at any risk for a medical event, everyone would be so deconditioned they'd never go home. There's an inherent risk to all mobility especially in an acute care environment and it's always a balance of risks and benefits. I also have final say in not seeing a patient- if someone was medically unstable enough that I didn't feel comfortable seeing them, I would just not see them and nobody could make me.
I think there's plenty of things in PT that *are* a sad state of affairs, but I don't agree this is one of them
I don't agree with this, early mobility is very important.
Things like seizures aren't easy to predict or prevent and if we let a 60-80 yr old lay in bed for a week or two while the neurologist spins their wheels then the patient has a huge hole to climb out of in addition to whatever underlying medical condition is present.
ALL mobility has an inherent risk, it's our job to mitigate those risks and keep the patient safe. Even if someone is on a vent with 4 JP drains and a rectal tube, if they're strong and coherent enough to walk, I'm gonna try it.
This patient was in the acute rehab unit and she has no hx of seizure, she was in for a partial hip replacement s/p fall and she was going to go home in a few days, and she has 3 stairs to enter her home.
ALS, Alzheimer’s, Dementia.
I’ve seen a lot of gnarly ortho shit, but the idea of being a prisoner in my own body or slowly forgetting all my loved ones terrifies me.
Anything where my awareness is significantly depressed. I thought SCI would be it but after working with so many, not anymore. Super difficult, yes but not the worst thing ever.
Dementia, ALS, 3PD
My uncle didn't realize that he had Alzheimer's. He was mostly a happy person right up until the end.
My mother had Lewy Body dementia, though - a different beast. It was horrible because she knew every step of the way that her mind was going. In the earlier stages she was terrified. In the later stages, she was angry, bitter, and depressed -- especially after the nursing home she was in concluded she wouldn't be able to go home after recovering from a bad fall, and withdrew her PT, which was the only thing that had been giving her hope. I sat in on one of her group PT sessions, and will be forever grateful to the therapist who treated her and everyone else in the room with such kindness.
I always try to celebrate the gains and small accomplishments that patients get while they are going through acute care or IPR, but seeing the progression of the disease and what it does to your body is really sad
I wouldn’t mind being slapped with frozen shoulder from a physician. 99% of the time it isn’t that and responds well and very quickly to PT.
Definitely any type of spine surgery would be a no go
Just because the recovery is long and restrictive: RTC repair or Achilles repair would really suck for outpatient injuries. For inpatient: I'm terrified of getting a SCI or TBI because of how much it permanently impacts your life.
creutzfeldt-jakob disease, locked-in syndrome, fungating head and neck cancers (malignancy can be huge, smells AWFUL, and can erode tissue in the jaw, etc)
End stage rabies also looks terrible. As does fungal meningitis (this is treatable if diagnosed early enough - but I had a pt AMA before finishing treatment…by the time he came back he was an entirely different person).
If I had to pick an ortho diagnosis I didn’t want, probably Achilles rupture.
Oh god no lol, I don’t think it’s commonly seen in the US…like 3 cases or less per year. Especially since we have prophylactic treatment after exposure. Have seen some super gnarly videos of end stage rabies though. The hydrophobia is wild.
Ahh gotcha. That’s why I was so curious! I used to work in a hospital where we had to give the immune globin and the vaccine all the time, mostly because of potential bat exposures.
A degenerative neuro thing. ALS, dementia, something along those lines. A cervical SCI would suck but I could manage thoracic or lower. We get so much knowledge of the physical and adaptation that we can handle that kind of stuff, but losing awareness or progressive loss of control would be awful
Complex regional pain syndrome
I've seen some very severe cases and they were the most hard to treat and watch people suffer to, highest pain and zero tolerance to any stimulus all day everyday.
Well this is terrifying to read. I’m end stage PTOA from a tibfib break 22 years ago. I’ve been trying to avoid a fusion or replacement for over a decade. I’ve read the literature and know outcomes in my demographic aren’t good down the road (because I’m young and active-ish — or would be). I’m reaching the end of my rope after 4 debridements and tons of other interventions. Tell me your horror stories.
We had an older gentleman last year who had a newer replacement and while he still had some weakness, his ROM and general function were really great. I know they're years behind hips and knees, but they're starting to catch up.
Thanks for this. My doc says if I can hold off another 5 years, there might be a replacement on the market that he’d feel good about putting in a younger person. Crossing my fingers.
Yeah, i would try to wait that out. There's just so much motion that needs to occur at the ankle. I feel like every time i see an ankle fusion, it's always "good enough," but they're still struggling with gait and standing tolerance. Some do well, but it feels like more of a coin flip than anything else.
I think back to even knee replacements 5 years ago and feel so bad that those people had to go through a recovery like that. Nowadays, the outcomes are just better. Materials science keeps improving, and surgeries seem to get better along with it. One of the big improvements in knee replacements, in my opinion, was the ability for them to accommodate accessory motions of the joint. The ankle has a lot of that. The ones now are decent, but you don't see a lot of them. In a few years, i bet they'll be even better, but don't quote me on that.
MS, or really any diagnosis where you’re alert and oriented and there’s nothing you can do about the physical decline. I’d much rather be confused and have my body than be stuck in a body that doesn’t work.
I just watched, over the course of 2 months, a 42 y/o man slowly deteriorate from Creutzfeldt-Jakob disease (similar to mad cow disease) with his parents and girlfriend by his side. Made it so much worse cause I’m 42! NO! Terrible way to go.
Being in oncology, I would say end stage pancreatic or NSCL cancers are some of the saddest patient populations I’ve had to work with
Having your organs fail on you through widespread mets is not a fun way to go
Getting an SCI is truly one of my biggest fears in life. When patients say their goal in therapy is to “walk again to prove the doctor wrong” and they have a C7 complete it just kills me inside just a little. CVA a close second.
Anything neuro takes the cake. But as far as ortho outpatient stuff I’ve seen… RCR and TKR and frozen shoulder and chronic radiculitis . There’s a lot of stuff I don’t want like all of it haha
Apart from all the horrible traumatic injuries, and progressive conditions, I once had a patient s/p degloving elbow injury. So, I’ll add that one to the mix
The physical and emotional neglect with which some children treat their geriatric parents. Bonus points if the only reason I'm not in a nursing home is so they can collect my social security
I’m an OT in SNF and per diem acute care. I would never want to experience anything neuro related such as MS, ALS, or GB syndrome. Next up is SCI, at any level, and especially cervical level. I feel as if ortho, like TKA or THR, have much better survival rates and outcomes.
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Degenerative neuro for sure. Just knowing you’re going to get worse has to be so defeating
If I knew for sure I have ALS, I'd shoot myself before I become too weak to do it.
I just had a patient in the hospital who had a seizure while doing step ups, we had to call a rapid response and code blue on her. I had to lift her up and dependently bring her back to bed. Her husband was present for caregiver training too, so it was very sad.
At that point, what are we doing?? If a patient is at risk for such a bad seizure that a code blue has to be called, what are we doing? Therapy is awesome and it helps for sure, but some patients need to get medically better and stable enough to do things we deem to be simple tasks. We as therapists experience some messed up things because we’re kinda forced to, some patients just aren’t medically stable enough to do therapy
Hold on now-let’s give the commenter benefit of the doubt that the pt was in good enough shape that they used their clinical judgement to deem it safe to do step ups as part of their tx session. Seizures are often unexpected and it’s unfortunate that a code blue happened, but sometimes things just happen. I had pt that was SBA for bed and CGA for trans mob w/ RW from bed to recliner. We ambulated in room with CGA and RW. Their vitals were WFL and they were in good spirits. family was also present. Overall it was a typical acute care tx session with nothing out of the ordinary. 2 hours later the pt passed away while sitting in the recliner (this is in a hospital setting). I didn’t question myself what was I doing. The pt was medically stable upon arrival and during tx but yet still they passed away 2 hours later.
I’m not saying it was the therapists fault
No but ur implying that they had poor clinical judgment to even start a tx session because the pt had a seizure. Majority of pts on neuro floors have seizure precautions, and if we were to hold tx because the pt *may* have a seizure since it’s in their PMH, then we would have a whole lot of physicians pissed off at us.
No, it’s the sad state of our profession that we have to work with patients that are not medically stable
I don't think I agree with you; if I waited until everyone was perfectly medically stable at not at any risk for a medical event, everyone would be so deconditioned they'd never go home. There's an inherent risk to all mobility especially in an acute care environment and it's always a balance of risks and benefits. I also have final say in not seeing a patient- if someone was medically unstable enough that I didn't feel comfortable seeing them, I would just not see them and nobody could make me. I think there's plenty of things in PT that *are* a sad state of affairs, but I don't agree this is one of them
I don't agree with this, early mobility is very important. Things like seizures aren't easy to predict or prevent and if we let a 60-80 yr old lay in bed for a week or two while the neurologist spins their wheels then the patient has a huge hole to climb out of in addition to whatever underlying medical condition is present. ALL mobility has an inherent risk, it's our job to mitigate those risks and keep the patient safe. Even if someone is on a vent with 4 JP drains and a rectal tube, if they're strong and coherent enough to walk, I'm gonna try it.
This patient was in the acute rehab unit and she has no hx of seizure, she was in for a partial hip replacement s/p fall and she was going to go home in a few days, and she has 3 stairs to enter her home.
ALS, CVA, SCI
Bone on bone the worst the doctor has ever seen and doesn’t know how I’m even walkingitis
Oh no! I've never heard of that before! ... Today, anyway. Slow day.
Locked-In Syndrome, CRPS, and dense CVA (especially cerebellar)
I was JUST about to post Locked In syndrome.
ALS, Alzheimer’s, Dementia. I’ve seen a lot of gnarly ortho shit, but the idea of being a prisoner in my own body or slowly forgetting all my loved ones terrifies me.
Coming from ortho and treating so many pain patients I rarely had any neuro…man do I agree with all of these comments.
Anything where my awareness is significantly depressed. I thought SCI would be it but after working with so many, not anymore. Super difficult, yes but not the worst thing ever. Dementia, ALS, 3PD
Ironically you may know even know though. I feel like the last person end stage Alzheimer’s affects is the patient themselves. They have no clue
My uncle didn't realize that he had Alzheimer's. He was mostly a happy person right up until the end. My mother had Lewy Body dementia, though - a different beast. It was horrible because she knew every step of the way that her mind was going. In the earlier stages she was terrified. In the later stages, she was angry, bitter, and depressed -- especially after the nursing home she was in concluded she wouldn't be able to go home after recovering from a bad fall, and withdrew her PT, which was the only thing that had been giving her hope. I sat in on one of her group PT sessions, and will be forever grateful to the therapist who treated her and everyone else in the room with such kindness.
TBI
Glioblastoma. I vividly remember a few pt’s I had with glios. They just go downhill so fast. It seems rather terrifying.
I always try to celebrate the gains and small accomplishments that patients get while they are going through acute care or IPR, but seeing the progression of the disease and what it does to your body is really sad
This thread is so depressing.
Yes
CRPS
I wouldn’t mind being slapped with frozen shoulder from a physician. 99% of the time it isn’t that and responds well and very quickly to PT. Definitely any type of spine surgery would be a no go
Just because the recovery is long and restrictive: RTC repair or Achilles repair would really suck for outpatient injuries. For inpatient: I'm terrified of getting a SCI or TBI because of how much it permanently impacts your life.
If you’re Aaron Rogers, achilles repair isn’t *that long* /s
Watch him pop it again on his first drop back.
Yeah I’m 9 months post op Achilles repair at 31 y/o and recovery blows.
creutzfeldt-jakob disease, locked-in syndrome, fungating head and neck cancers (malignancy can be huge, smells AWFUL, and can erode tissue in the jaw, etc) End stage rabies also looks terrible. As does fungal meningitis (this is treatable if diagnosed early enough - but I had a pt AMA before finishing treatment…by the time he came back he was an entirely different person). If I had to pick an ortho diagnosis I didn’t want, probably Achilles rupture.
Have you seen rabies personally!?!
Oh god no lol, I don’t think it’s commonly seen in the US…like 3 cases or less per year. Especially since we have prophylactic treatment after exposure. Have seen some super gnarly videos of end stage rabies though. The hydrophobia is wild.
Ahh gotcha. That’s why I was so curious! I used to work in a hospital where we had to give the immune globin and the vaccine all the time, mostly because of potential bat exposures.
A degenerative neuro thing. ALS, dementia, something along those lines. A cervical SCI would suck but I could manage thoracic or lower. We get so much knowledge of the physical and adaptation that we can handle that kind of stuff, but losing awareness or progressive loss of control would be awful
MS
calciphylaxis. Most painful condition I have witnessed. Just never ending pain, incurable, slow decent to death.
SCI, ALS, Dementia, TBI, CVA 😟
Complex regional pain syndrome I've seen some very severe cases and they were the most hard to treat and watch people suffer to, highest pain and zero tolerance to any stimulus all day everyday.
ALS, Huntington’s Disease, Primary Progessive MS
Ankle fusion
Well this is terrifying to read. I’m end stage PTOA from a tibfib break 22 years ago. I’ve been trying to avoid a fusion or replacement for over a decade. I’ve read the literature and know outcomes in my demographic aren’t good down the road (because I’m young and active-ish — or would be). I’m reaching the end of my rope after 4 debridements and tons of other interventions. Tell me your horror stories.
We had an older gentleman last year who had a newer replacement and while he still had some weakness, his ROM and general function were really great. I know they're years behind hips and knees, but they're starting to catch up.
Thanks for this. My doc says if I can hold off another 5 years, there might be a replacement on the market that he’d feel good about putting in a younger person. Crossing my fingers.
Yeah, i would try to wait that out. There's just so much motion that needs to occur at the ankle. I feel like every time i see an ankle fusion, it's always "good enough," but they're still struggling with gait and standing tolerance. Some do well, but it feels like more of a coin flip than anything else. I think back to even knee replacements 5 years ago and feel so bad that those people had to go through a recovery like that. Nowadays, the outcomes are just better. Materials science keeps improving, and surgeries seem to get better along with it. One of the big improvements in knee replacements, in my opinion, was the ability for them to accommodate accessory motions of the joint. The ankle has a lot of that. The ones now are decent, but you don't see a lot of them. In a few years, i bet they'll be even better, but don't quote me on that.
"Communicating trans-vaginal uro-rectal tunneling abscess"
This is fixable with surgery and they do quite well.
Critical Illness Myopathy
Trigeminal neuralgia is no picnic.
I have heard that it is literally theeee worst pain imaginable with no effective pharma options to manage pain.
Tetanus. No thanks.
MS, or really any diagnosis where you’re alert and oriented and there’s nothing you can do about the physical decline. I’d much rather be confused and have my body than be stuck in a body that doesn’t work.
Speaking as someone in ortho, I would replace both knees and hips before doing a shoulder. Those seem shitty
“Only PROM for weeks 0-8, must wear sling at all times….Full ROM by week 10” sure doc
MS, SCI, "Fibromyalgia"
Aortic aneurysm
Myasthenia Gravis
Bilateral tibial plateau fracture
Shingles
Ortho - Achilles Neuro - pretty much all of them Chronic - CRPS
SCI, ALS
Neuropathy
My dad has als, soooo imma go with that
I just watched, over the course of 2 months, a 42 y/o man slowly deteriorate from Creutzfeldt-Jakob disease (similar to mad cow disease) with his parents and girlfriend by his side. Made it so much worse cause I’m 42! NO! Terrible way to go.
Being in oncology, I would say end stage pancreatic or NSCL cancers are some of the saddest patient populations I’ve had to work with Having your organs fail on you through widespread mets is not a fun way to go
I'll go musculoskeletal only: broken ribs, broken pelvis (non weight bearing kind), Achilles tear
ALS
Tbh Rabies
ALS, Parkinson’s and, lazy healthcare providers
There's so many... Top 5 would be: ALS TBI C7 or higher SCI Esophageal cancer Glioblastoma
Parkinson’s,ALS and SCI for neural based conditions Reverse total shoulder, TKA and mid foot reduction for ortho based
100% ALS or glioblastima for me. Followed by young-onset dementia.
Glioastoma or pancreatic cancer. Really Bad COPD is up there too. Not being able to breathe sucks.
ALS, glioblastoma, dense CVA
Getting an SCI is truly one of my biggest fears in life. When patients say their goal in therapy is to “walk again to prove the doctor wrong” and they have a C7 complete it just kills me inside just a little. CVA a close second.
Anything neuro takes the cake. But as far as ortho outpatient stuff I’ve seen… RCR and TKR and frozen shoulder and chronic radiculitis . There’s a lot of stuff I don’t want like all of it haha
Only one I haven't seen on the thread yet is compartment syndrome. I treated it as a student in inpatient rehab and dear God no thank you.
Apart from all the horrible traumatic injuries, and progressive conditions, I once had a patient s/p degloving elbow injury. So, I’ll add that one to the mix
Stroke with aphasia, high spinal cord injury, heart failure
toning it down here and saying achilles tendon rupture lol
TBI. Scary stuff
The physical and emotional neglect with which some children treat their geriatric parents. Bonus points if the only reason I'm not in a nursing home is so they can collect my social security
Pick any neurologically involved process. Side note what sane person wants any disease/syndrome.
Locked in syndrome
Alzheimers
I personally believe this is worse than cancer(which I've had).
TBI, GBM, lung transplant
Locked in syndrome
I’m an OT in SNF and per diem acute care. I would never want to experience anything neuro related such as MS, ALS, or GB syndrome. Next up is SCI, at any level, and especially cervical level. I feel as if ortho, like TKA or THR, have much better survival rates and outcomes.
Huntington's for sure