TeleHealth Today

I struggled this week to find anything to write about that was NOT about the Coronavirus. That’s all anyone is talking about. In healthcare, it dominates every waking thought.


Something that you’re probably hearing more and more about is Telehealth. It has been around before we had ever heard about Covid-19, but this pandemic has certainly brought it to the public consciousness.


What is Telehealth? Most simply put, it is the delivery of healthcare when the provider and the patient are in different locations, usually using a computer or a cell phone to communicate.


Before Covid-19, it was most often discussed in really remote locations. Colleagues in Montana, where lots of people live many miles from the nearest neighbor and even further from health care providers, have been doing Telehealth for years.


It has been addressed in the Tennessee legislature in the past and would likely have come up this year if the legislature hadn’t been sent home early. Fortunately, Governor Lee has relaxed restrictions on Telehealth and opened doors that needed to be opened.


The Coronavirus pandemic has brought Telehealth up to an all new level. It has become an essential part of healthcare delivery. It is allowing those most vulnerable among us to get the care that they need without having to leave the safety of their homes.   


There’s a good chance that your Primary Care Physician (PCP) is utilizing Telehealth. I know the orthopedists are. In some ways, it is the only way to deliver much needed medical care. In physical therapy, we are using it to follow up with patients who can no longer come to our offices and to work with new patients without ever being in the same physical location as them.


Please understand that this is still healthcare and there is a charge for the service. For many practitioners, it is their only source of income. The state and federal governments have changed the rules about Telehealth reimbursement and there’s a good chance that your insurance will pay for Telehealth services.


On a different note, I saw something this week that resonated with me. This writer was asking people to be less judgmental. It hit home when someone I know was being critical of a man getting mulch at the local garden store. She thought it was unnecessary and irresponsible.


But this writer had a different opinion. He said that guy getting mulch might be an alcoholic who is stuck at home and has to keep busy with yardwork to avoid a relapse. Or the lady buying flowers who suffers from depression and working in her flower garden is what keeps her safe and sane.


You see, we can’t judge others in all this. I really struggled with stopping bike riding with a group. It is one of the things that keep me sane during a time when the Coronavirus has taken away a lot of the other things that keep me sane. But my concern for others means I now ride alone. I have friends that are still doing the group rides and that’s OK. I refuse to judge them.


I caught myself yesterday judging a grandfather and his grandson. They were in a store where the employees had taken very few precautions—no masks, no social distancing. And yet they were there, walking together, without masks. I had to stop and remind myself not to judge them. Was the grandfather not concerned about exposing his grandson to Coronavirus? That was hard.


It all boils down to the fact that we just need to love each other. Respect each other. Walk in somebody’s shoes before you criticize. But please, please, please do your part to stop this thing.

It's Not About You

I’ve never been much of a worrier. Oh my mom was. If she didn’t have anything to worry about, she would worry that she didn’t have anything to worry about. I’m not that way. Almost to a fault.


I’m not afraid of much either. I’m not afraid of the dark. Not afraid of noises in the night. Not afraid to go into a strange neighborhood. I’m not really afraid of the Coronavirus either. Let me explain.


I’m in several at-risk categories. I’m 66. I’m a healthcare worker. I’m still working, out in the public every day, seeing patients and doing my job. The chances of me being a carrier are above average. Certainly above those that are quarantined, without contact with the rest of the world.


I do respect the Coronavirus—I just don’t fear it. Not for me personally. I may be a senior citizen but I’m in quite good shape, for a man my age. I’m getting more sleep than I have since I was a teenager. My blood pressure is under control. I’m eating well.


I’m not naïve and I’m not stupid, but I’m confident that my physical condition and health practices will help me if I did get Coronavirus and I’m confident that I will get the care that I need were I to be hospitalized. In the meantime, I have a job to do.


I’m doing my part to protect myself. I usually wash my hands often, before and after every patient. Now I’m adding in a squirt of hand sanitizer every time I pass a dispenser. Washing my hands whenever possible. I wear a mask when in the clinic and when I’m in a public place.


I practice social distancing. My desk has been moved so that I’m a good distance from anyone else. I’m giving more than the six feet of recommended space. I avoid other people except when absolutely necessary. It’s not impossible for me to get Coronavirus, but I am doing everything that I can to protect myself. I feel pretty good about my chances.


But that’s not what worries me (yes, I do worry a bit, sometimes). What worries me is that I will be a carrier without even knowing it and will give it to someone else. A patient. A coworker. A family member.


Because of that, I am completely isolated from my family. With a newborn in one household and two physician parents in the other, all risk needs to be minimized. And since I’m a possible carrier, despite all I’m doing, I stay away from all of them.


I’ve quit riding a bicycle in a group not for fear of being contaminated by someone else but for fear of being the reason someone else gets it. Let’s face it—being in healthcare means I am at risk, regardless of what I do. I accept that and go on. But I cannot allow myself to be the reason someone else gets it. I have a social and professional responsibility to protect others.


Now I’m going off on a rant…. Every day, I see people being very cavalier about this. People standing around talking without masks or social distancing. People sitting at a picnic table having lunch like there isn’t a raging pandemic out there. People wearing gloves and using that as an excuse not to wash their hands (folks, all you’re doing is carrying this stuff from one surface to the other and protecting no one).


If that’s you, if you aren’t washing your hands, keeping your hands out of your mouth, and practicing strict social distancing, WAKE UP! You may not be concerned about your own personal safety but what about others? Your grandmother, your infant niece, your immunosuppressed cousin that had cancer not that long ago, your friend with diabetes?


YOU have a responsibility to THEM. If you don’t think it will get you, that’s fine. I guess that’s your business. But don’t be the reason someone else gets it. We simply must put a stop to the spread of this disease. Before someone you know or love gets it.

The New Normal

The “New Normal.” If I’ve heard it once, I’ve heard it a hundred times. Yes, we’re living in a different world right now. Our world will be forever changed because of this pandemic.

It will take the economy a long, long time to recover. There will be way too many bankruptcies. The hardest hit segment may be restaurants. It’s tragic but we will all survive.


So how do we work this New Normal to our advantage? How do we emerge better than before? How do we even begin to think in those terms when there really doesn’t appear to be a light at the end of the tunnel?


We learn how to deal with each other better. A lot of families are isolated at home. Some are quarantined.


By its very nature, this will force families to grow together and get to know each other better. Or just the opposite. Our daily structure and routines are completely turned upside down. Those of us (me included) that depend on that structure will struggle but will surely adapt. Or drown.


Like you, my whole lifestyle has been changed. My routine is work, ride a bike, sleep. Do it again. Avoid people. Shop for essentials only. Carryout is part of the New Normal. I’m inside my own brain more than anytime in my life. It’s scary in there sometimes.


We learn creative and productive ways to use our time. Ways that do not depend on being entertained. We have to learn to entertain ourselves. Restaurants and movies are closed. Amusement parks are shuttered. A lot of folks are reluctant to go to the grocery store so cooking at home has become rather creative.

We have had to learn to cook what is in our cupboard or freezer. Even if we venture out to the grocery, there’s no guarantee that what we want will be in stock.


We get closer. Not physically, at least not right now. Social distancing has ended the warm hug or firm handshake. But shared difficulties bring people together.


It has been amazing to see the outpouring of love that this community has demonstrated in the past couple of weeks. Churches feeding people. Others making masks and gowns for use by our hospital. Offers of running errands for others abound.


I saw where a local insurance agency sent a stack of pizzas to the BMH Emergency Department this week. Surely those folks, at the forefront of the crisis and heroes in every sense of the word, deserve it.


We learn to appreciate what we have. I now know what’s at the bottom of my freezer. I get virtually no time with my grandkids so cherish those FaceTIme moments and messages that they send me. I appreciate my health maybe more than ever.

We understand that we should always wash our hands and keep our hands away from our mouths. We understand that we have to do everything we can to keep from passing on this virus to others.

We discover that exercise, eating better, and getting enough sleep actually does make us healthier and help us feel better.


We learn what is really important to us. Family. Friends. Time together. Those hugs and handshakes. Real conversations. Our health. Freedom. Smiles. The little things.


We appreciate that problems on the other side of the world do have an impact on us. We truly are global now. It’s a cloudy, stormy day, but by looking for the silver lining, we have hope and faith that good days and better times will soon arrive.

We NEED phys ed

One day this week, I was driving by an elementary school while the kids were out on recess. All across the schoolyard were children in varying stages of activity. Some were standing around talking. Others were tossing a ball. A group seemed to be chasing each other in some sort of game. I loved it.


I also read this week about the Running Club initiative going on in our local schools. The same article mentioned Geoff Hamm at John Sevier Elementary School. I know Geoff, mostly from soccer, and he is the perfect person to lead this kind of wellness initiative. Enthusiastic. Engaged. Inspiring.


Our kids need more activity. No…they REQUIRE more activity. Physical Education used to be a required component of all secondary education. I know that because before I went to Physical Therapy school, I was a Physical Education teacher.


Let’s look at the big problem. Tennessee is one of the most obese states in America. Current rankings put us at about 44^th in the country.  20% of our children are considered obese. And in Tennessee, that rate for adults is in the area of 60%. In America, over 300,000 people die each year from obesity related health problems.


That’s unreal. You would think that in a state with incredible natural resources like we have here (think lakes, mountains, parks), we would have one of the most active populations around. Throw in winters that aren’t too cold and summers that are generally not too hot, and we have few excuses not to get outdoors.


Maybe, like too many things, we depend on our schools to promote an active lifestyle. But the academic demands that we place on our schools are in large part why we removed a lot of physical activity from our schools. Think about “No Child Left Behind” and testing standards that our teachers must prepare kids to meet. With all they have to teach, there just isn’t time for physical education classes.


I would argue, and have the research to back it up, that physical activity during the school day is essential for not just academic excellence but for producing healthy, happy adults. Keep in mind that my background is in this arena.


I’ve said many times that active adults create active children. I still believe that is largely true but our health issues from obesity may dictate that we can’t leave it up to parents. Historically, physical education classes were not only for providing a time for physical expression but also a place to learn new ways to express ourselves physically.


My first introduction to tumbling and gymnastics-type activities was in physical education class. We learned dance (remember the Virginia Reel?) in junior high as part of our school day was dedicated to being physically active. We have to teach kids things that allow them to find fun in physical activity.
If it isn’t fun, it isn’t sustainable.


It used to be that physical education electives were a required part of the college curriculum. Not anymore. My wife actually took a tennis class in college taught by Pat Head (Summitt). Is lack of physical activity in our schools and colleges the reason our state is obese? It’s more complicated than that but yeah, that’s part of it.


Anyway, thank you teachers and school administrators. Thank you for understanding the value of physical activity. Thank you for providing avenues to our children to develop a lifelong commitment to staying healthy.

What I've Learned from my Patients

I often tell stories about patients and athletes that I have taken care of.  I’ve been doing this a very long time so I have plenty of stories to tell.


Maybe it is about their accomplishments, the things they have done and maybe the hard work that it took to get there. Sports are not easy. Rehab is not easy. It takes diligence and persistence to get the results that you want. Those just happen to be two things that I value the most. So, I like to tell their stories.


Or maybe I’ll talk about a coach or teacher and the influence that they have on their players and students. Those folks have a tough job and always, always get too little thanks for what they do.


But one category of stories seldom shared in this space, is the effect that patients have had on me. In the fabric of my life, that is woven so richly. Yet I never talk about it here. That’s about to change.


I can remember one of my first patients when I was still a student. He was a Memphis State football player that was rendered a quadriplegic from a cervical injury when he ducked his head going to make a tackle. He was a robust, charismatic young man, about my own age, and I knew that he had no idea what turn his life was about to take.


He taught me never to take my health for granted. And that this gift that I was about to be given, a career as a physical therapist, was something to be cherished and nurtured for surely I must be there to take care of those like him.


About that same time, I became responsible for the rehab of a 13 year old boy who had a spinal cord infact, rendering him a paraplegic. He was playing in the yard when he suddenly collapsed. He never walked again. We are friends to this day and he will drop in on me for a chat from time to time.


He taught me that we should always make the best of whatever situation that we are in. Here he was, just a young boy, but he was ready to tackle the world. He’s done so—on his terms, and has become an amazing adult.


From time to time, I will take care of this amazing lady who is an internationally ranked athlete even as she approaches her 80’s. Super competitive, she does all the little things constantly and plays her game like someone less than half her age.


She has taught me that age is just a number. And to not let others decide what is appropriate activity for us, whatever our age might be.


It works the other way too. I had a patient one time (well, several really) that acted 100 and had every ailment known to medicine. When I looked at her birthday, I discovered she was only a slight bit older than me. She taught me that I didn’t want to be 66 going on 96 but, better yet, I might want to be 66 going on 36.


I’ve learned from my children as well. Both of them have had their share of injuries and, of course, I was right there with them to take care of them. They taught me that I have to separate my duties as a father from my duties as the one taking care of them when they’re hurt.


That one hits home when you think about all the young athletes that I’ve taken care of through the years. I’ve been close to a bunch of them.  But when they are injured, I have to put all emotions aside and do the job that I’m trained to do.


Those many loving and gracious parents of my athletes have taught me that I have a responsibility to be the best that I can be, every moment. I can take no days off or phone it in. When someone is hurt, I have to bring my “A” game…always. Those parents expect that of me.


I wouldn’t have it any other way.

Be a Little Kinder

My birthday isn’t until May but it resembles a small bonfire. I actually quit counting a long time ago. It is what it is. But today I'm writing about old age and it has nothing to do with sports.


One day this week, I had a car that stopped in front of me on a busy road. At first, I thought it was car trouble and then I considered the possibility of a medical emergency. So when I got a chance, I pulled up alongside the vehicle to see if it was someone needing help.


When I got even with the car, I could see an older fellow that appeared quite confused. I don’t think he knew where he was going. He then started moving forward and so I dropped behind him and followed him for a bit.


He soon turned into a parking lot, parked, got out of his car and walked into a store. He seemed fine. I drove on.


How many times have you been behind someone that did something similar? How many times have you been behind a vehicle that you thought was moving too slow and then, when you passed them, saw an older person? Did you think to yourself “they’re too old to be driving” as you passed by?


Yeah. Me too. And I’m probably a lot closer to their age than I am to yours. But those thoughts have crossed my mind more than once.


Back when I was in high school, I bagged groceries at the grocery store in my home town. It was mostly Saturdays. I remember vividly these old ladies coming to the grocery store on Saturday morning, usually right after their hair appointment. I can remember great big cars and little tiny women that seemed barely able to look over the steering wheel.


For most of them, that was the only time that they got out of the house. That car and the ability to drive themselves gave them an independence that they didn’t want to let go of. They were at an age when we would consider most of them too old to drive.


I can remember when I had to discuss with my dad that he shouldn’t drive anymore. It didn’t go too bad since he still had my mom to drive around. But when it came time to end my mom’s driving…oh, my goodness. She did not take it well.


I had told her that I would agree to allow her to continue driving until she had her second fender bender. Well, she had that one day but vigorously defended her driving. She argued that they must have moved that light pole in the church parking lot, otherwise she would have never hit it.


Even in her latest days, when dementia stole much of her memory, she would insist that she was perfectly capable of driving. For your safety and mine, it wasn’t happening.


My point today? Show a little kindness. Losing the freedom that comes from being able to drive yourself to appointments, to the grocery store, to visit friends, has got to be devastating. As a son, it was hard for me to take away those privileges.


I am not arguing that someone that isn’t safe should still be driving. I’m encouraging everyone to show a little patience on the road. If they’re going slower than you want them to, be kind. If they aren’t dangerous, let them keep driving.

Back on the Bike

I promised I wouldn’t be back to talk about my knee replacement until I was back on the bicycle. Well…I’m back. On Tuesday of this week, at 6 weeks and 6 days after having had surgery, I was back on the bike.


It was a short ride and mostly flat but it was a gorgeous day and it was glorious to be back on the bike.  My knee is still stiff but it was still a “real” ride instead of the trainer that I’ve been on for the past few weeks.


I’ll get the obvious question out of the way first. How is it that I’m this far along? First, my surgery was stellar. I’ve done everything I’ve been told since surgery. I put myself in the hands of a trusted colleague, Candy Martin, for physical therapy. And I’ve worked harder than I would ever expect my patients to work. I also have the key to the clinic so my weekends have been filled with plenty of extra rehab on my own.


Let me tell you a little bit about what I’ve learned by going through this whole thing. Keep in mind that this is my work--I’ve rehabbed hundreds of people with knee replacements. I understand that creature quite well. And I’ve always been one to be empathetic. I appreciate what my patients are going through.


But I have definitely learned a lot from being on the patient side of the equation. I’ve learned that when they say to “stay ahead of the pain,” they know what they’re talking about.


I thought I was tougher than most. I considered my pain tolerance well above average. I thought that if it hurt, I could take the pain medicine and get the pain under control quickly. Huh-uh. Wrong. Twice I waited too long to take the pain medicine. Twice I was in agony for several hours.


I’m as concerned about addiction as anybody and keenly aware that opioid use in this state is out of control, but when you’re hurting that bad, you will do just about anything. My orthopedist, Dr. Justin Jones, had warned me that the pain was going to be bad. He took one look at my X-Rays and knew that.


If you are truly in pain and taking medication as prescribed, the chances of addiction are slim. You do need to get off pain medicine as soon as you can tolerate the pain without the use of opioids.


And about those X-Rays…my knee was a mess. Dr. Jones told my wife while I was in recovery that I was at least 10 years late for having this knee replaced. The surgery took about an hour longer than normal as Dr. Jones chipped away at all the junk in my knee. I learned it doesn’t pay to put it off. I’ve known for a while that this needed to be done. When I saw those X-Rays, I knew. It was past due.


I learned to take care of the swelling. A few days after surgery, I had some pitting-type edema in my ankle. It’s called lymphedema and our Total Rehab-MEND clinic was built around it. Dr. Andi Heinemann who runs that clinic took personal care of me. I learned that this is hugely important.


I knew that early movement was important. Especially extension. You want to get your knee straight. It is the #1 determinant of good outcomes. I would lay in the hospital bed and push my knee into full extension. They didn’t have to remind me not to put a pillow behind my knee.


I knew not to be afraid of it. Early weightbearing is good for the replaced knee. I did one round on the walker with my hospital physical therapist Kim Tippitt and switched immediately to crutches.


I knew that there was a light at the end of the tunnel—that better days were coming, even when the pain was at its worst. I tell my patients that all the time. But there were times when I doubted that. Like everybody, I wanted to be well immediately.


All in all, I was humbled by it all. I’m not Superman. I’m human like everyone else. Yet while this thing was quite an ordeal, it was totally worth it. Just like my patients have been telling me for years, I wish I’d had it done a long time ago.