Opportunity Lost

[I heard the sounds of Scuttle Buttin’ coming from my pocket – it was my phone ringing. The caller was using a restricted number; it was most likely a representative from agency calling, so I stepped away from my eval to answer the phone]

Hello, this is Keith.

Hi, Keith, it’s Gina. I need to ask you something… Can I do ultrasound on the neck of patient with a pacemaker?

I’m sorry, why?

I wasn’t sure if there is a contraindication to doing ultrasound on the upper trap of a patient if they had a pacemaker.

Well, I cannot think of a reason why I would apply ultrasound to the neck of a patient who has a pacemaker. But, do mind me asking why you are considering ultrasound for this particular patient?

Well, she is 95 years old and is having neck pain. The doctor’s office just dumped her on me for physical therapy and wants me to fix her. I told her that I can try some massage and some exercises, but I was hoping that I could use the ultrasound too.

Are her symptoms persistent all the time? Are they provoked with particular movements?

Nothing with a compression test – it does not make her feel any worse. Her neck does hurt more with rotation, though. But, it doesn’t affect the symptoms down her arm.

What symptoms down her arm?

She says she has burning down into her arm and fingers. Actually, that is her primary concern right now.

And are the symptoms in her arm or hand provoked with any particular neural tension tests? I’m thinking of tension tests that would bias the ulnar nerve, the median nerve or radial nerve…

I don’t know. I was just hoping that I could use the ultrasound to help with her neck pain, but I don’t want anything to happen with her pacemaker.

Well, as I said, i wouldn’t try it. Anyway, the fact of the matter remains that ultrasound has not (over the years) proven to be effective in the treatment of painful complaints and – personally – I would be more concerned with the patient’s distal symptoms.

Well, maybe I will call the doctor’s office and ask them if they think I can do ultrasound. If nothing else, when I go back into the home, I can explain to the patient and her daughter why I am limited with what I can offer.

Sorry I wasn’t more help…

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2 thoughts on “Opportunity Lost

  1. So perfectly true Keith. Virtually none of her colleagues will challenge this “reasoning,” and all the rest of us can do is wait for actual, well, you know. I see this kind of questioning by therapists in their twenties as well, so my vision of the future remains pessimistic.

  2. Sad, but true. Logic seldom trumps habit.

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