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Higher-Land Oc​cupational Therapy, PLLC

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Secondary Gains

Posted on April 15, 2019 at 1:36 PM Comments comments ()
"Secondary gains" is the term applied to the gains a person obtains through being ill or injured: through defining themselves by their diagnosis. These gains could be monetary, social, or personal. 

On the surface it seems illogical to think that a person could obtain any gain from any diagnosis, and no professional medical provider would automatically assume that any patient would have any gain from a diagnosis. How could someone possibly benefit from never being able to get out of pain after an auto accident, or never be able to heal completely from a surgical procedure? It is rare for the mind to take this direction, and it is almost always on a subconscious level, at least at first, but it happens. Munchausen, and Munchausen by proxy are extreme examples of having secondary gain from a diagnosis. 

What this looks like in the treatment room can be very subtle with most people. as a pain management therapist, I have seen patients use an illness to say "no" for her when she cannot say "no" herself to bosses, family, friends. Her diagnosis now gives her an out from all the business and service; an excuse to care for herself for once. I have seen patients use the diagnosis to punish and manipulate family for not serving her/him. The patient always gets more ill, or more in pain after doing a thing and then complains bitterly that "nobody else" would do it.. "and now just look at me". Patients who get out of work as a result of diagnosis find that others will pay their way, and they no longer really have to work, and the diagnosis is a very good "reason" to not work. 

The most interesting secondary gain I have seen is when a patient actually begins to define him/herself by the diagnosis. Every aspect of this person's life will revolve around the diagnosis. It is the single most intense focus on any social media page, they usurp conversations to divert toward the diagnosis and how any subject involves the diagnosis. Often you will hear them say variations of, "well at least you don't have.... (fill in the blank, I have heard them all.) 

This person will spend their time with me complaining about all the other medical professionals who have not helped them, who would not listen to them, who have fired them, etc. This person will reject any and all suggestions I make with a reason or two why that suggestion cannot work. this patient also makes it his/her mission to educate everyone, including doctors, nurses, therapists, the check out person at the sore... regarding the diagnosis and how much suffering it entails.

When a person has come to define himself/herself by a diagnosis, this entrenched mentality is very difficult to overcome, because none of us wants to lose our identity as such a loss creates quite a bit of internal chaos. The patient actually has the diagnosis, and it really is painful and often debilitating, so identifying and understanding the line between treating the diagnosis and enabling the mental illness becomes very difficult. 


 

How Integrative health clinics work

Posted on January 11, 2017 at 10:18 AM Comments comments ()
   When you hear a clinic calling itself "integrative health" , you know this clinic has some combination of  traditional western medicine, holistic/naturopathic care, chiropractic, and/or therapy (PT, OT, ST, nutrition). The idea is to allow the consumer to integrate her/his health care choices in one location, with all the providers being aware of what all is going on in this patient's health-related life. There are many benefits to this, including the patient not being given conflicting information, not being over-treated, medicated, etc., and not having to re-tell the story multiple times.
     Here at Lubbock Advanced Physical Medicine, we offer JohnFBarnes-Myofascial release, provided by myself (occupational therapist), Chiropractic care, and medical management which includes joint injections for pain, trigger point injections, and headache protocol, as well as pain related prescriptions if the consumer is not already receiving this care somewhere else. This is a great convenience for the pain patient to be able to address his/her pain management all in one location. However, it is very important for the consumer to be aware of his/her rights and responsibilities regarding such a convenience.
     To begin with, a consumer is not obligated to accept ALL care provided in an integrative health clinic simply because it is provided or even recommended. So, for instance, if the chiropractor recommends the patient receive OT for JFB-MFR, but the patient neither has the time nor the inclination , the patient may reject this recommendation and still receive the best chiropractic care in Lubbock without any fear of penalty, rejection or lesser treatment while accepting other treatments provided. Furthermore, if a patient begins with a treatment plan with multiple providers here, and decides one isn't contributing to his overall wellbeing and medical improvement, that patient can discontinue the plan with any one provider at any time and continue to receive stellar service from the providers he/she chooses to continue with. There is no penalty for this.
     In addition, if a consumer were to receive a referral from his primary care physician for Chiropractic care or JFB-MFR, this consumer is not obligated to receive treatment from all the providers in an integrative health clinic. He/she may only participate in treatment from the one provider to whom she was sent. This is not a problem at all.
     Each person is ultimately in charge of her/his own body, as each of us has to live in our own body and we are usually experts in the history and pain issues of our bodies. Part of our goal as integrative health providers is to return to each person who comes to us full autonomy and authority over his/her own body.
     As far as consumer responsibility goes, there is one large issue that each person must take personal authority for. If you are already being followed medically for pain, and receiving any prescription medications or injections for pain from an outside source, our medical practitioners MUST be made aware of this. this is critical to your health, so as to not over medicate you causing further damage to your already injured system. In such a case, our medical provider may not follow you at all, or only enough to keep the rest of us informed regarding your level of medical intervention.
     It is also the patient responsibility to be assertive regarding his/her wishes regarding care accepted, but to also keep an open mind. Many people have tried so many things to obtain relief from pain by the time they get here that they find it hard to trust that anything else could help. Yet, they come, because any small hope is better than none. We are very excited about the integrative health plans we offer, and we are very optimistic about our own service as well as the service of the other providers we work with! You will become quickly aware of how excited we are about this and how confident we are that we can help. We all believe that the increased benefit of our combined services is exponential, and that you will improve much faster if you combine services. Because of our excitement and our belief systems, we may come over as being "pushy"... for lack of a better term. Please don't silently feel coerced! Just be as assertive as we are, speak up! For instance, maybe you have tried a decompression table before and it caused you pain and spasm that you were unwilling to tolerate. Then one of our providers here recommends it. Just be honest about your experience and your unwillingness to try that again. It is really ok! It is YOUR body, after all, and only you have to sleep with the pain at night!
     If you have any other questions regarding an integrative health clinic, just ask! You can post your questions here, or you can ask at the clinic you are choosing to trust with your body; but ask. It is YOUR body, ALWAYS be informed. You are in charge!

Referrals for occupational therapy

Posted on January 3, 2017 at 11:50 AM Comments comments ()
I have not written on this blog for a long time, and one of my resolutions is to make this more of a priority. One question I often get asked is why a patient has to have a referral from a doctor to receive therapy from OT/me.
 The first and easiest answer is that both your insurance and my governing rules require a referral/prescription for OT if I am going to touch your body or use exercise as therapy. Small differences between your insurance and my governing body (TBOTE) are as follows:
     Insurance requires that the referring provider be a medical doctor, PA, FNP, psychiatrist.
     TBOTE allows me to accept referrals from all of the above, plus chiropractors, psychologists, and LPC's as well. If you are a cash patient, you can obtain your referral from any of the above mentioned providers. If you desire to use your insurance, your PCP, pain management doctor, surgeon, or psychiatrist may provide referrals that your insurance will accept.
  Now, you might think it is unnecessary and even limiting/invasive for this requirement to be in place. certainly it makes things more ...complicated... for me! However, it is a rule set in place for YOUR protection. Your doctor, who knows your medical history and your body is the best one to determine whether therapy is safe for you, or whether the potential risks outweigh the potential benefits. Also, your doctor should know all the things you are trying to alleviate pain as this gives her/him a more clear picture of your mindset and desire to get better.
   While JFB-MFR is extremely gentle, and I have successfully used it with patients as early as the day after surgery or the week after an auto accident , NOT ALL THERAPIES ARE THE SAME! Insurance companies and TBOTE cannot take so much time to categorize each therapy individually, and their greatest desire is to protect you, the patient. Your doctor is the best person to determine whether your body is ready for therapy.
   That being said, many doctors do not know much about JFB-myofascial release, and may be hesitant to refer a chronic pain patient to traditional therapy due to fear of increased symptoms. You may have to educate your doctor about it. Add to that the fact that as an OT in Lubbock, TX, I am a little off the traditional path of therapy practice. I do love to talk about what I do, however, and I have actually visited with doctors whose patients asked them to look into this therapy more before saying "no". Once a doctor is confident that this therapy will not harm her/his patient, the doctor is typically happy to refer, and both the doctor and patient can learn a new thing, and I gain new friends while myself learning new things!
   So the referral, while somewhat complicating the initial process, is a win-win-win in the long run.

Money, Money, Money!

Posted on November 13, 2013 at 10:59 AM Comments comments ()
      There was a post on my blog page recently regarding the cost of myofascial release therapy. The person was not rude, but only stated that therapy is an "unnecessary expense". I considered ignoring this post, as it may be the truth for this person at this time. I decided, however, that it is a post that bears responding to, given the state of medicine and the economy currently. Myofascial Release is a therapy that works to relieve all manner of pain, and its effects are long lasting. I have patients whose goal is to be able to walk around their home without pain, to be able to reach up and wash their own hair without pain. They want to be able to stand at the kitchen stove and prepare a meal. It is not a lot to ask, and the expense of the extreme pain medications they are on is greater than my treatments cost. Also, their meds render them unable to operate cars, to cook, to walk around the block and in some cases, even to stay awake. Those are my most severe, home-bound and disabled patients. This therapy relieves their pain, reducing patient dependence on medications, and increasing independence and participation in family activities. These folks would say that this therapy is, for them, a necessary expense.
      Lets talk about the folks who are not yet disabled by their pain, the fireman who has carried one too many patients to safety, the paramedic, the farmer who has thrown one to many tarps, the nurse who has lifted patients until she herself has become a patient. These people CANNOT work doing what they do if they become addicted to pain medications. When their pain becomes crippling, they have to quit. What if there is a form of therapy that can relieve their pain, return their bodies to symmetry, and keep them serving us. What if this therapy can keep these people gainfully employed and not dependent upon government for their bare survival? WHAT IF?
     I see patients who are considering surgery, considering early retirement, considering giving up doing that thing they love. Myofascial release is successful in relieving their pain and keeping them earning money. Of course, my job is to work myself out of a job with your body, so I teach each patient to self treat using MFR techniques, I teach family members to treat each other, and I teach strengthening exercises specific to each person's work needs to maintain the pain free status.
     If you tell me that you are hurting, and that this therapy is an unnecessary expense for you, then you are saying that you are not worth it. There may also be a twinge of hopelessness to such a statement. I know what the therapy is worth. 2 years ago, my arms were going numb to the point that I could no longer work. I got treated with MFR, learned to self treat, and changed my specialty in Occupational Therapy to myofascial release, because it worked. My hands are worth the price of this therapy. no surgery, no 3-6 months down. And I got rid of most of the migraines in the bargain!
     I cannot guarantee that myofascial release works for everybody. Nobody can guarantee that, not even surgeons and medications can guarantee a pain free existence. I can guarantee that we will work as a team to identify the antecedents to your pain, that I will give you as many tools as I know to make you independent in the treatment of your pain, and that I will do no harm.

healing crisis

Posted on August 15, 2013 at 12:50 PM Comments comments ()
 I just wrote regarding "healing crisis" on the FAQ page. I think that it is a good idea to describe what a healing crisis might look like by describing my own.  My healing crisis seems to always come in two forms: migraine headache and re-visiting memories hard. Right now there are no other practicing MFR therapists in Lubbock that I can find. I am looking for one, though so....anyway, all my healing crises are attached to the seminars I attend, where I spend about 2 hours a day on another student's table. Headaches are the big pain for me. I know that they are connected to the shifting and healing in my body and associated healing crisis, therefore I try to not medicate and ride it out. Honestly, I usually can only make it to the third day, when I must choose between the seminar and the ER, and then I take medication to keep myself at the seminar. With these migraines always come some memory that I have to "work through". I put quotes around this because I want to highlight the fact that "working through" will look completely different for each person for each crisis. It cannot be described, and I cannot warn you what to expect, only to expect something. Every time I go through this, I experience exponential spiritual growth (or what seems to me to be exponential..it could be snail's pace to anyone else..) and understanding with it. I experience forgiveness of self and others, clarity of thought, direction and intention, and renewed hope. This is my experience, I cannot speak for others. I will say that among the community of MFR therapists, I hear stories of similar periods of spiritual growth associated with their healing.
     Along with the headaches and memories, I will often have some soreness that feels like achy flu muscles or like I ran too far. I get very tired, and also very restless. sometimes I cannot sleep, but most often I sleep very deeply and have odd dreams. The first time, it was a bit dis-combobulating, even though I was told to expect such. However, no one can tell anyone else what to expect, and such was the case with me. Every time I work my way through, I am better for it. Now, I actually invite the crisis, knowing it is but one more valley, just a road trip to my Oceanside destination. Two things John Barnes always says, "healing is a journey, not an event", and "healing is messy ". I am worth it. Healing is worth it. So onward I go!!

My first experience with JFB Myofascial Release

Posted on July 24, 2013 at 9:32 PM Comments comments ()
     By the time I obtained my MOT, I was 40. All the lifting and moving patients, driving for home health and bending over to treat and such was taking its toll on my body, especially my lower back and both arms, which kept going numb, especially when I was driving. One of the first techniques we learned in the first class I took is a release at the tailbone, or the sacrum, called a lumbo-sacral release. I had driven 6 hours to get to this class, so that region of my body hurt. Sitting in the chairs hurt. Well, we have to perform these techniques on each other as we learn them. When I treated the other therapist, I felt things move, soften, and her body shifted to a more neutral position (her hips had been lying crooked on the table). So I was amazed. I was absolutely sold when it was my turn and in 5 minutes on that table my lower back pain was reduced to almost nothing. After three days of such treatments and a leg pull (if you want to know what that is, come see me) on each leg, my pain was gone!
     Now my first experience being treated by the MAN, John F Barnes, PT, seemed nothing short of miraculous. It was my third class, and a year later. I had been treating with MFR for a year with results I was still being thrilled by, but my arms, especially my left arm, were going numb and staying that way for long periods. I was losing strength and feeling. At the seminar, my left arm was numb and cold. I need to feel my hands to do this work, so when Mr. Barnes asked if we had any questions, I asked what I might be doing wrong for my arm to be behaving like this. He asked me to be his first demonstration, so up on the stage I went. He took my arm and did an arm pull (see leg pulls above...) and it began to do some movement of its own accord. Mr. Barnes calls this "unwinding". after about 7 minutes with my arm behaving like a snake, I sat up. I was very light headed, but made my way back to my chair. My arm began to ache like a headache in it. After an hour or so, it got hot, really HOT!! For the rest of the day, it had all manner of sensations that kept my attention fully on that arm; and true to the nature of fascia, my right arm experienced many of the same sensations. The next day, I did not notice my arms. That is important. I did not think of them because they did not bother me. They have not bothered me since. It has been a year and a half. My hands are my livelihood, so THANKS, JOHN F BARNES!! My arms and hands are strong, no numbness, cold, achiness. Oh, my patients thank Mr. Barnes too.

my MFR beginning

Posted on July 15, 2013 at 11:06 PM Comments comments ()
Though I am good at what I do (OT and myofascial release), I am not at all good at computer stuff. Consequently, this is my first blog. I would like to begin by just saying that "blog" is an annoying sounding word to me, sounding much like a bodily function. Still,  I like the idea. I have decided that my first blog will be about how I came across JFB-MFR.
  I was working an internship in hand therapy during my final semester of MOT school. I had a patient with regional sympathetic dystrophy. If you don't know what that is, be thankful. It is painful for these patients for the therapist (or anyone or anything) to even touch the affected parts. I was trying to treat her, but everything I did textbook made her worse. Being the nerd I am, I went on a search. I typed in RSD, and up popped the face of a man who happens to look like my uncle, and his eyes absolutely captured me, so I studied more. I asked questions of my clinical instructors, but they had no idea. I dropped the idea for a time, until 2009, when I had the opportunity to go to one of John Barnes' classes. I was hooked within the first hour. after 3 days, I came home and used it with success with every patient I had, even babies with spina bifida! The anecdotal success stories still amaze me. JFB-MFR therapists believe in the innate ability of the human body to heal itself. We facilitate this self healing. I love this idea, because it plays right into my philosophy as an occupational therapist that my best job is complete when I give back to each patient his/her own power, autonomy, and volition.
  To this day, I am thrilled and amazed by each story of healing my patients have to tell me. I learn from each one, I laugh and cry with each one. It never gets old, never EVER gets boring! I am continually amazed by the success of this work. I guess I shouldn't be surprised anymore, but I do so love surprises!

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