Cosi Belloso, a physical therapist who fell into the world of orthotics and prosthetics by chance, shares her insights, it's clear that the journey of amputation recovery is a tapestry woven of many threads. She stresses the significance of early physical therapy, debunking myths about mobility predictions and shining a light on the comprehensive care that goes beyond the limb itself. Cosi's accidental path led to profound realizations about patient empowerment and education, which she now advocates through her show "Cosi Talks."
The road to rehabilitation may be paved with challenges, but it's the human spirit that lays the bricks. We uncover how motivation, paired with an orchestra of interdisciplinary communication, can lead to remarkable recoveries that defy expectations. Through anecdotes and experiences, we learn that every amputee's journey starts with a challenge, but it's the tailored coping strategies and unwavering support from healthcare professionals that can lead to extraordinary achievements. Cosi reveals the profound impact of empathy, patient education, and the art of choosing the right prosthetist on an amputee's path to reclaiming life.
Cosi Belloso, a physical therapist who fell into the world of orthotics and prosthetics by chance, shares her insights, it's clear that the journey of amputation recovery is a tapestry woven of many threads. She stresses the significance of early physical therapy, debunking myths about mobility predictions and shining a light on the comprehensive care that goes beyond the limb itself. Cosi's accidental path led to profound realizations about patient empowerment and education, which she now advocates through her show "Cosi Talks."
The road to rehabilitation may be paved with challenges, but it's the human spirit that lays the bricks. We uncover how motivation, paired with an orchestra of interdisciplinary communication, can lead to remarkable recoveries that defy expectations. Through anecdotes and experiences, we learn that every amputee's journey starts with a challenge, but it's the tailored coping strategies and unwavering support from healthcare professionals that can lead to extraordinary achievements. Cosi reveals the profound impact of empathy, patient education, and the art of choosing the right prosthetist on an amputee's path to reclaiming life.
Hello everyone, my name is your heels and this is another episode of the prosthetics and orthotics podcast with Brent Wright. How you doing, Brent?
Speaker 2:I'm doing well yours. I know that you're bundled up, man. What the? I'm wearing an actual scarf.
Speaker 1:Yes, I'm not to the point where I need to wear jackets outside, but I'm getting to the scarf, the scarf point of scarves. It's really cold. It's. I think it may even be below 20 degrees Celsius.
Speaker 2:Yeah, oh well, I can't do that. That sounds cold.
Speaker 3:I know that zero is freezing right so.
Speaker 1:Oh good, how are you doing?
Speaker 2:I'm doing well, man. I'm uh, I'm actually really excited about this episode Today. But before we get into that, I mean One of the things that's been interesting and I know we've plugged on it a few times, but I've been really pushing into this idea of flexible sockets sockets that move with patients and I've been having really crazy success, and I don't Quite understand it. I wish that there was an explanation. But, for instance, um, you know, one of the guests that came on that was, uh, faisal. I've put him in almost a nearly full TPU socket, so very flexible, and he's saying that he feels more secure in that than he did in his solid pa12 socket. Wow, so can can you explain?
Speaker 1:that to me? I've not, but it could be. It could be that the vibration propagates in a more natural way, right that the the forces that come through that feel more natural. I think that that may be the only thing I can see. Or it's just the localized kind of, you know, it feels less plasticky in some kind of way because it feels more kind of like an item of clothing, or it's just the absorption is better, so then it feels just more comfortable. But that's really cool, dude.
Speaker 2:Yeah, it's, it's very interesting, and so I'm actually getting ready to send my first one to katia and Latvia, who is going to be putting it on her technician who travels to the Ukraine and so he puts a lot of miles on his socket, so I'm really excited About getting that out and getting some miles not in the us and not even made in the us. So this idea of Um centralized design, decentralized production Is really working.
Speaker 1:Yeah, I think, and but it's one of these things that in additive, like a lot of people talk about this all the time but doesn't actually end up happening all the time, more does it often make sense. But I think with these kind of like crisis area kind of things and you know that kind of sharing of experience and expertise, it really does make sense and uh, yeah, I'm excited, you know, for that and I think it makes a lot of sense when we're looking to create access, literally worldwide.
Speaker 2:I think additive manufacturing is the only way to go At this kind of decentralized Production.
Speaker 1:Yeah, it's cool. And then, is this an fdm socket, or is it like a material extrusion socket, or is it mjaffer? What is it? It's going to be a multi jet fusion tpu.
Speaker 2:It's going to be a multi jet fusion tpu and a very short pa 12 socket just to kind of be the attachment point and uh yeah and. But it's going to be lattice as well. So there's some a little bit of um kind of foam cushiony feel to it, but vertically it the patient will be able to load the socket almost like in a little bit of a shock absorption way. So I'm really excited about that's good dude.
Speaker 1:I'll keep his post on there. I'm really interested in that as well, so that'd be really really cool. And so who's on the show today? Mom?
Speaker 2:So, uh, yours man, I'm. I'm really excited to have cosy beyoso on the show today. She is a physical therapist with a lot of experience and has really Drove into how to take great care of patients of the limb difference community, and one of the neat things that I think that she does is not only getting people active but also provides education. So not only about Exercise and what you can do to help yourself, but she will also bring in prosthetics, sometimes some vendors, to share some of the new technology to really empower patients To know what is available when they go out there. She hosts a show, I believe, and she'll share on a weekly basis, called cosy talks, and I've actually listened in a couple times on that and the information is great, a lot of interaction as well, and so I'm really excited to see, see and hear her perspective on the role physical therapy plays and then also the experience that she brings of like what role does the prosthetist play? And Uh, we'll just kind of dive into those weeds. So I'm really looking forward to that conversation.
Speaker 1:It's awesome, amazing, so cosy. Welcome to the show.
Speaker 3:Thank you very much. I'm excited to be here.
Speaker 1:So, cosy like, tell us how did you get involved with omp?
Speaker 3:Uh, by dumb accident, um. So I've been a physical therapist now for 23 years and I've been working in healthcare for almost 30 Uh, and when I first started working out, I was at Jackson Memorial Hospital in Miami, florida and working in the level one trauma centers and Jackson Memorial it's a pretty, it's a tough hospital to work in and they basically would rotate the therapist every six months to a new specialty. So I was basically starting a new profession every six months, um. So as ramjet the rookie, I always got the rotations that nobody wanted and, for whatever reason, um, the amputee rotation was not a popular rotation, um. So probably about a year and a half to two years into Practice I was assigned the amputee rotation and at the time, you know, in our school we only had a three day lecture on amputee, so I knew nothing, nothing about working with amputees. And I walk in that day thinking they're finally going to realize I don't know what the heck I'm doing and they're going to fire me.
Speaker 3:Um, my senior therapist, uh, his name is Curtis Clark and he literally wrote the book on how to treat amputees. There are some books dating back to the 70s and 80s where you're going to see his name written in there and he goes to me that day and he says look, I know you don't remember anything from school. I'm going to sit down with you, we're going to do a full-on orientation and I'm going to sit with you with every single patient until you feel comfortable. And he did Um. It was probably one of the best learning moments, um, I had ever had up until that point. Um, and I fell in love. I fell in love with working with amputees. At that point, okay that's super cool.
Speaker 1:I think that's really nice. And and are you now like super specialized in this or just something? You, you, you kind of do a lot of other stuff besides, but your main focus is here.
Speaker 3:Yes. So I am now specialized. I'm kind of one of the old school. I'm a college myself, one of the old fart PTs. So back when I was in school, you know the physical therapists they really focused on training us on all the different specialties and I think there's over 20 different specialties and physical therapy alone. So, like I said, one of the reasons why I loved working at Jackson was I was rotated through all the specialties. So that included trauma, icu, cardiac transplant, pediatrics, infectious disease, spinal cord injury, traumatic brain injury, burn, trauma, wound care, I mean you name it. I've done it and I think working in all those different specialties just really strengthened my clinical skills and in turn helped me provide better quality care for my amputee patients. So I spent pretty much the first two thirds of my career rotating around different specialties and always having amputees on my senses, and about six years ago I decided to just focus exclusively on amputee care.
Speaker 1:And, coming from physical therapy, what are the special challenges with this amputee care area? Let's say this is a Reno inside.
Speaker 3:Well, every specialty definitely presents with its own unique challenges. So general challenges that I find with working with amputees is that mainly, they're not just amputees right, a lot of my amputees are also cardiac patients, they're also autoimmune patients, they're also trauma patients, in some cases pediatric, in some cases transplant patients, in some cases burn trauma patients. So for me, this is this is the part that I love from a clinical standpoint, because I get to use and pull from all of my different skills and treating the amputee as a whole patient. Another one of the challenges that I find is lack of specialized care. So some of the viewers on my show will call me a unicorn, because there's just not that many physical therapists out there who've decided to hang a shingle and call themselves amputee specialists. Those of us that are out there were very passionate about what we do in serving this population, but there's just not that much specialized care out there from a rehabilitation standpoint and I find that to be a huge challenge.
Speaker 1:Okay, that's kind of interesting. I think it seems like it could be a really valuable niche, I think also for the community, and also for this, this community, I think maybe, like physical care usually well you know is there more of a lifelong care component. Do you really see people for many, many years in this, this aspect of physical therapy? It seems like it could be really rewarding as well.
Speaker 3:Right, oh, absolutely. And I tell my patients guys, you're stuck with me. So as our bodies age, you know we're living longer and longer. You know in the caveman days we were lucky if we lived until we're 20, that we're living well into our ninth or 10th decade sometimes. So in living longer, we need more specialized care, regardless of whether you're an amputee or not. And the more I just learn about things, the more I realize that not only do you need your primary care doctor, you need some of your specialized care. Your physical therapist is part of that clinical team that will take care of you as you age, and even more so for the amputee, because there are a lot more issues that will arise as the amputee gets older.
Speaker 1:And what do you see like? Just because we have like I think our audience is pretty much from all over the place, but we also have a lot of people outside the states and stuff. So physical therapy for you, what is physical therapy, what's non physical therapy? Because there's a lot of different specialties around the world. I mean, for you is anything and anything, or what does it specifically mean?
Speaker 3:So as a physical therapist I assess the disorders of the musculoskeletal system and how it affects gross motor function. So that's like the really wordy definition for the dictionary and this is pretty much a global definition. So you'll find that a physical therapist in the United States will have the same practice, acts, very similar practice. Ask as a physiotherapist in London or a physiotherapist in Australia or anywhere else in the world.
Speaker 3:So you know I work with gross motor function. So what does that mean? The big one is walking right, how to get from one place to another, and gross functional mobility. And how is your musculoskeletal system affecting your ability to do these things Right? So in the case of an amputee, there is a missing limb preventing them from being able to do gross motor function activities, such as walking, running, getting up and down from places, transferring from one place to another.
Speaker 1:Okay, that's cool. And when are you typically like in your context? When are you brought into the process? When do you meet a new patient? How does that happen?
Speaker 3:Well, when am I brought in or when yeah?
Speaker 1:those are my next questions. You can do both at the same time if you want, right.
Speaker 3:Right, okay, so ideally, ideally I am brought in on day one or day negative one.
Speaker 3:So when I worked at Jackson Memorial Hospital we had a wonderful amputee clinic. It was actually run by Dr Walker and he's a surgeon who again wrote the book on a lot of these surgeries and amputations. But if we knew of someone ahead of time who was going to be receiving the amputation, they would bring us in to meet the patient prior. If we were lucky and again this was dependent upon insurance and funding if we were lucky I would get to start working with the patient prior to their amputation and getting them strong and to start doing muscle strengthening and range of motion exercises and basic mobility skills. And if the pre-surgery physical therapy wasn't available, certainly from day one. So as my patient is opening their eyes in the recovery, they see my face in there and we start to do some very gentle work with them there and following them through, basically for the rest of their lives. Okay, so that's when the physical therapy should be there from day negative one, but that doesn't really happen a lot right.
Speaker 3:No, no, it doesn't. It does not In reality. For example, in my own clinic here, many of my patients are seeing me years after their amputation and they had never worked with a physical therapist. One of my in my I have an exercise program that I developed and one of my amputee models an amazing below the knee amputee young man. He never received physical therapy and still he started working with me to do this fitness program. So it's a little shocking sometimes to see this.
Speaker 1:And the other thing is like one thing I want to ask you. I'm not trying to be facetious here, right, but I know a bunch of people where the it's always like the doctor says like you'll never walk again, and then they always end up walking again, is it? The doctors are really bad at predicting this. Are they going to kind of quietly try to motivate these people in a kind of negative way, or what's going on there with this Like you'll never walk again, and then the guy ends up walking again anyway?
Speaker 3:Yeah, I don't think the reverse psychology is going on. I think it's just a lack of information. And again, it's not a knock against doctors. I know I'm infamous for kind of throwing my colleagues under the bus, sometimes just to kind of poke at them. But no, I don't. I think it's just a lack of information. Doctors right now they're just so busy trying to keep up with medication and standards of protocol for treatment that when it comes to the nuts and bolts pun intended of patient care with amputees they don't have time to have that, to have that education. And that's our job. It's our job as physical therapists and prosthetists to support the doctors and letting them know hey, this is the services we provide. In my case, I am the gate specialist. I am the one who is the expert on analyzing and treating and teaching gate again to these amputees. So if you want to know what a person's reasonable outcome will be, refer them to me and I can talk to them about that.
Speaker 2:So I had a question about. So I think it really hit home or resonated with me. I mean, I've been in the field for a little while, since really since I was a teenager, and so it just comes naturally to me that you said a lot of these patients have comorbidities or something else going on. It's just, it's not just, hey, we have lost a leg, and so we have a lot of people that are residents or even people looking at the field of prosthetics and orthotics, and I think they get a little bit surprised about the complexity. It's really not about replacing a limb or the prosthesis, it is about treating the whole body. Can you share a little bit to that? You know, section of our audience of this is this is different than just playing a mechanical engineer where you're putting some stuff together and on it goes to a patient. It's much bigger than that.
Speaker 3:Gosh, absolutely, and in a lot of ways, you know, as physical therapists, we receive a lot of medical training in our curriculum. We take a lot of coursework on differential diagnosis, on pharmacology, a lot of things that people would think, oh, that's more of a doctor's side of knowing things, but we need to know about these things. We'll never know it as well as a doctor does, but we need to know about these things in order to treat our patient as a whole. So the most, probably the most common example I can give is the diabetic patient, right? So your diabetic and vascular amputees account for depending on the literature, you look at 80% of amputations, right? So if you don't understand the basics of diabetes, if you don't understand the basics of vascular disorders, you are already setting your patient up for failure. The reason is because you're not going to be aware of some of the things to look for when you're treating the patient as it pertains to their diabetes and their vascular disorders. So another further example into that you know limb volume management, right? We all know that in that first year and a half to two years after amputation, it's very challenging for the amputee to manage their limb volume fluctuations, right? And what is it that you need to educate your patient on what are the things that you need to be looking at in this patient to help them with this particular obstacle? So, if you know that they're diabetic, if you know that they have high blood pressure, if you know that they came off of vascular disease, those disease processes are still very much active within the amputee.
Speaker 3:I tell my patients your disease did not go away just because we amputated your leg. So, asking them questions and digging a little deeper how's your glucose doing today? Right, how's your diet doing? How's the edema? Measuring edema on the leg and distinguishing between okay, this is limb volume fluctuation from post-op, surgical, post-op fluctuations versus you know what this is coming from? Something deeper, this is coming from possibly one of those comorbidities. What can we do to determine if we can help them with this? Having a basic knowledge of pharmacology and how the medications your patients are going to be on will possibly be affecting them and then eventually affecting their prosthetic fit and use. So it's all tied in together.
Speaker 1:But then ideally, of course, you'd have a meeting with all the doctors and all the different people and all discuss this kind of stuff. But does that actually happen? Or is that still like some kind of dream? To like that everybody would, you know, get on the same page, or you get an update directly from the surgeon or the endocrinologist or whatever, to really get ahead of the curve?
Speaker 3:Yes, in a perfect world, we need to have a team approach, and we are seeing certain centers of excellence that are popping up right now. So the first one that comes to mind is atrium health. They're located in the Carolinas and they are doing a phenomenal job of providing the team approach where the amputee gets the surgeon, the psychologist, a dietitian, social worker, pt, ot I mean all across the board, but that's not the common thing yet. So, for example, in my case, I'm out on my own. I'm an outpatient, private outpatient clinic.
Speaker 3:Probably the majority of the doctors here in Tampa have no idea what my name is right, but it doesn't mean that I'm not accountable. So my responsibility to my patient when they come in is I'm assuming that there's nobody talking to them about these issues. So it is my part of my job is to educate them on these issues and to remind them hey, when was the last time you had your visit with a vascular surgeon? When was the last time that your endocrinologist took a look at your? You know your diabetes and your glucose, and how are things being managed there? So while I am not the head doctor, it doesn't mean that it is not my responsibility to encourage this communication, to give this education information to my patients. And then, yes, if me too, of course, I'm trying to reach out to these clinicians and do the best that I can to communicate and provide that communication in between.
Speaker 1:And how about specifically between, like the communication between the OMP people involved? I can say there might be different ones, right, and the physical therapist? Do you think that could be streamlined as well?
Speaker 3:Oh, absolutely. For me it's, like you know, the prosthetist and physical therapists go together like peanut butter and jelly. So if I have a brand new patient coming in and again, I'm a direct access clinician in the state of Florida, so what that means is a patient can just come into my clinic and come see me without a physician referral, and that's typically how it works for my particular clinic my patients will come and see me. So I do have to take the initiative to contact the doctor and introduce myself, to contact the prosthetist and also introduce myself and say hey, your patient came in to see me. I am now treating them for this and that and the other.
Speaker 3:How can we communicate with one another to make sure that we're all on the same page and providing the best care possible? And to me it's also just valuable because we provide different lenses to what's going on. So what I see as a physical therapist is going to be different what the prosthetist sees, and it may be different from what the surgeon is seeing. So for me to have that information from all the different clinicians as much as I can is going to provide me the best picture of what's going on with this patient.
Speaker 1:And how would you like? Well, you know, the physical therapy is like okay, part of it is you do an exercise with me, right, but also part of it I have to do it myself. And then how does that work? Because there's there's like homework, right.
Speaker 3:Absolutely so. I tell my patients they'll come and see me on average twice a week for an hour and that's one on one care and that's actually a lot compared to what unfortunately is is is out there right now. And what I tell my patients is this one hour that we're spending in the clinic. This is not enough. This one hour is enough time for me to give you all the education and information I possibly can to make sure that you're doing things properly.
Speaker 3:And what I've learned over the years is the more I educate my patients and the more I see their the light bulbs going off and their understanding of why their body is doing what it's doing, why I'm giving these particular exercises, how they work, I find that I have much, much better compliance and outcomes with my patients. And then the other side of it is I don't overwhelm my patients. You know a lot of my colleagues. You know they'll give their patients a stack of papers, of all these little printouts with exercises, with like 15 exercises on them, and the patients won't do any of them. So I've learned over the years to focus again on education and information and keep it simple Two exercises, three at most, that they will be doing consistently and with good form, and then we build upon that.
Speaker 1:I think that's really good. But you really see, like you know, Bob comes in, Bob's not really motivated and he just has, like you know, an 80% worth outcome. Then Jane, who comes in and is really motivated? Is it that stark with your specialty?
Speaker 3:Oh, absolutely, I mean, I have it's. What was that urban legend of? The bumblebee is really not supposed to be able to fly because the ratio of the size of its wings to the ratio of the size of its body it makes it physically impossible to fly. I don't know if that's true enough, but that was an urban legend growing up. But nobody told the bumblebee it couldn't fly and it figured it out. So I do see that a lot with my patients.
Speaker 3:Yes, the number one thing that will determine whether or not a patient will walk is motivation Back into that. Yes, there are physical obstacles and physical issues that can predict the outcome of whether a person will walk or not. But I have folks who have come into my clinic and on the inside I'm thinking to myself this person has no business walking, there's not going to be able to do it. I'm going to do the best I can and I'm going to give them everything I've got as a clinician. But statistics are stacked up against them. But because that person was so motivated and didn't give up, they walked. And this is over 23 years. I've had several examples such as that and then many other examples of people that should have been doing cartwheels out of my clinic that because they were grappling with issues like depression and not being able to accept what was happening with them, that they weren't motivated and then they couldn't overcome that.
Speaker 1:We've had a couple of examples of patients on here and a lot of the people and of course we're self selecting, because the type of patient would want to go on a podcast talking about their experience with OMP is a course of kind of person that's really motivated. I mean, you're going to not get the people that hate this whole experience and it's the worst thing that ever happened to them and it overshadows their life. They're probably not going to go on a podcast and talk about it. So we end up having these super motivated like these nothing can stop me kind of people that have, like this, radical acceptance of their current circumstances and radical understanding of the future and just they work towards it. Is that kind of the attitude that works best, or one of the attitudes that works best.
Speaker 3:No, yes and no. So it's interesting that you bring that up because I've had viewers in the past when I started doing the show and I would have. I've had Paralympians on the show. I've had CNN top 10 hero on the show. I've had a two-time world champion drag motorcycle racer. I've had several military veterans, very high functioning from a mobility standpoint individuals, and some of the comments I would get from my viewers is that they would feel actually discouraged. They would see these people and they're thinking I can't do this. They're so positive and so optimistic. This is not me and it's kind of a two-pronged approach to that Number one.
Speaker 3:All these people that came on the show and have all this motivation, that's not where they started. That is not where they started. They started waking up one day and not having a limb attached to their body. They had to go through all of those same emotions, all of those same trauma in losing their limb. So what many people see on the show is the end product, right, that they've been through this long journey of healing and obstacles.
Speaker 3:And the folks on my show, they're pretty raw. They're pretty raw and gritty about talking about what some of those obstacles were. Some of them talk about depression. Some of them talk about being suicidal. Some of them talk about the issues that they had with their marriages and with their children as a result of amputation. So it's not just roses and rainbows and unicorns. They need to see, they need to show and express that, and they do. And then to the person who's going through it and I have my own personal cancer journey so I can speak in terms of what it's like to have that physical trauma the journey to healing is a lifelong journey. It's a lifelong journey and it's not one that can be done on your own. You need that village behind you for the support. So this is something I really encourage on the show as well.
Speaker 1:Okay, that makes a lot of sense. And what were you? Because I was really interested. My follow question was going to be like I'm so, not like that. I feel as if you want to. I guess sometimes I don't feel like getting out of bed in the morning and you know what, my life is pretty darn awesome compared to nearly all many on the planet.
Speaker 3:And I still.
Speaker 1:I'm a little bit maudlin sometimes, you know, and I see all these guys like a marathon, like you know. No, no, I don't want to wear a marathon. Is that what I have to do, you know?
Speaker 3:No, no, and the thing is like on. So, on my personal side, I'm a runner, I love to run, okay, but I've had four children, I've been through cancer, I've been through chemo, I'm still on oral chemo. I have physical limitations. Okay, I will not be doing ultra marathons, I will not be even doing a marathon, but does it mean that I don't like that?
Speaker 3:I love looking at the marathon runners, that I love looking at Olympians and just kind of getting inspiration from there. Yeah, and that's all that is. That's all that is, you know, and a part of it is it's not, it's not them, it's you. You have to adjust your own interpretation of what you're seeing. So if you're not someone who likes to run, that's fine, you know. It doesn't mean that you can't enjoy watching other people with their success as well and being inspired by that. So for me, I don't see somebody who's outperforming me on a physical standpoint and go, man, I wish I could do that. Or man, you know, why can I do that? I'll never get there, that's okay. I admire what they're doing and it motivates me in the morning to just do a little bit more for whatever it is I'm doing that day, whether it's because I'm doing a run or I'm just trying to get through my laundry for my four kids.
Speaker 1:And is there any kind of like you know, if you do get somebody who comes in and is not you know he's really struggling with this thing, are there anything you could do psychologically to help these people kind of cope with the situation and get better?
Speaker 3:Yes, so I'm not a trained psychologist and I do say that a lot on the show and with my patients, but I've had to learn a lot of psychology to treat my patient. So the interesting thing about physical therapy is we have to get our patients to participate in order to do our treatments. You know, as opposed to a nurse or a doctor, the nurse is giving you the medication, the doctor is doing the surgery on you, right? The person doesn't necessarily have to actively do anything if that makes sense In physical therapy. You're having to ask a person who just underwent trauma to do some very painful movements Okay. So they're in physical pain, they're in emotional pain, they're in spiritual pain, and then you're sitting there over their bed saying, okay, time to do exercise, right. So we have to learn a lot of psychology and to be respectful of what that person is going through. And that's something that I'm still learning, because everybody is different. Everybody is different in the approach that works for them. Everybody's different in what stage that they are in in terms of their emotional recovery. So I do talk to my patients a lot about what's going on inside their heads. I do, and I realize that, if I can somehow address that and a lot of it is anxiety. A lot of it is fear of the unknown, okay, not knowing what's going on with their body, not knowing what their future holds. So if I can empower them with information and education, then I can start to help address the psychological and the spiritual needs of my patients.
Speaker 3:When I worked in home health care, one of the first things I would ask my patients is where do you like to go to church on Sunday? Where I live, in the area where I live, it's very, very a lot of a Southern Baptist community here in Catholic community. So I'll ask my patients is this something you would like to be able to do? And most of them would say yes, I want to be able to go back to church on Sunday and be a part of my community again and get that spiritual growth again. So there are those ways. And then, obviously, making referrals. So I'm always encouraging people if they need to get counseling right, whether it's from a psychologist, whether it's from a psychiatrist, whether it's from an amputee, certified peer visitor from the amputee coalition, whether it's from a support group. So, looking out for the psychological and emotional well-being of my patient, yes, that is definitely something within the scope of my practice.
Speaker 1:Okay cool, because I think that is the issue. That is the toughest. It's painful. You're already not feeling great about yourself. You're sitting home alone, you have to do these 20 reps of some like painfully, other things that you know. You're saying everybody's different, but are there really like strategies that work for many people or for certain groups of people? Just go and do it, start small. You know what are the kind of things that kind of would tend to work outside.
Speaker 3:Or from, and this is probably a coping strategy I learned when I was working in spinal cord injury and probably my third year of practice at Jackson Memorial. So spinal cord injury I mean that's probably one of the more brutal injuries, along with amputation and cancer and burn trauma, that can happen to the human body, you know. So we would get in Miami a lot of young men who would have motorcycle accidents, and they're walking one day and then the next day they're being told they will never walk again, right? So we would only have a few days to get these patients ready to go to inpatient rehab and if they were not ready on time they would get sent to a nursing home, right? That was just the that's healthcare system, like it or not. So as therapists, we were always under the gun. We've got to get these patients up and ready, we've got to get them moving. And these poor guys and men, women, you know, they'd just been scraped off the road a couple of days prior, learning that they never were going to walk again, right? So how do you get to the patient and get them to understand that we need to start working while they're coping with this?
Speaker 3:So one of my senior therapists. There was one guy who was just refusing treatment, refusing treatment, refusing treatment. And we went in to talk to him and the senior therapist just said to him look, man, your situation stinks right now. It really stinks, but this is what we have to get done. So this is what we're going to do for you. That first hour of the morning we're going to let you be in here on your own, because that was one of the complaints of the patient is I'm never alone. Everybody's always in here, poking and prodding at me, poking and prodding at me. He goes you're going to have an hour to yourself where no one's going to be in here to bother you, and you can cry and scream and shout and throw things if you want, but that hour is just for you. And at the end of that hour we're going to come in and we're going to do your work and get you going.
Speaker 3:And it worked. It was a very simple coping strategy but it worked because it kind of gave him a time to focus on his grief, to focus on his fears, to focus on his depression and to do just to be human right. And it gave him that focused time. And then it also gave him a time to say, okay, now I have to get to work. And I've used that particular strategy with several of my patients and teaching them that strategy and saying, look, you need to have that release, you need to have that outlet for your grief and your mourning and your anger and your fear. But you also have to get through the rest of your day. Especially if you're a mom, especially if you are working, you know all of these things that you have to handle in your day. So that that's. I know it's very wordy, but it was one particular coping strategy that I have found to be very effective for many of my patients.
Speaker 1:I can imagine. I think it's also just like it's this realization that is actually happening. It is actually happening to you, and also like you can imagine yourself being like oh God, I guess I have to do this now. You know, acceptance is radical, it's just it's it's accepting it's.
Speaker 3:In the military they have the saying of embrace the sock, so it's like, yes, this is an absolutely lousy situation, this is not a normal situation for you to be in and you are reacting in a very normal manner. So let yourself have those reactions and again, I am not a psychologist. This is just. You know certain coping strategies that I've learned over the years from colleagues and from what I've seen that works.
Speaker 1:And how do you like I guess you could be very strict, but you need to do this, or you can be kind of compassionate or sweet and kind of conjole people into them. You know, how do you know which? Because I guess you were different with different people at a different time, right? So how do you kind of decide when to be strict with someone and when to be like you know, when to let it slide that he's not doing the exercises and when to be like you need to do this and be more of like coach.
Speaker 3:let's say Well, that's 20, that's 30, no 20, 30 years experience in the healthcare field and studying humans. That's just something that comes with experience and that's something that I look back on my first years as a therapist and I smack my hand against my forehead going, oh my gosh, what was I thinking, trying to make this patient do this at this time? And that is just a life skill that has to be learned with experience and observation. So, with my, if I have a student or if I have a newer physical therapist, I tell them the same thing that was told to me many years ago Look at every patient and learn everything you can about that patient, you know. Look at their demographics, their gender, their belief system, and not in a judgmental way, meaning you're just learning everything you can about the patient. And then you look to see how are they reacting to this, how are they reacting to that, what was successful, what was not successful?
Speaker 3:You do this for every single patient and pretty soon you're going to start to see certain similarities between certain patients. Right, you'll start to see some of the more basic observations, like if this person is comes from this country of origin and they have this set of belief systems, chances are they might want to react a little bit more to this kind of approach. Okay, or somebody who was born in this decade versus somebody who was born in that decade, right, there's different approaches there and you just learn to just observe human behavior, and to me it's one of the more fascinating things about what I do is just getting to know patients and getting to see, okay, what's going to work for you. How is it that I can help you and how can I adjust my approach to help you the best?
Speaker 1:This is really interesting. I was with you first. The first part of your thing completely logical, totally understood it, expected it, even everyone's different right. We know that right Right. But the whole thing about you kind of segmenting your patient group and saying you know, this guy is this religion or this person is this kind of ethnic background.
Speaker 3:Well, and it's not. You know, and I know people are going to be like oh my gosh, she's, she's typecasting. No, no, guys, it's just a matter of saying so. For example, I'm Cuban, I come from a, my parents are Cuban, Cuban immigrants right. And when I work with someone, for example, who was my grandmother's age, right, If I walked into the Miami hospital room and I would see a woman who was in her 80s with a total hip replacement and she tells me she is an immigrant from Cuba, right, Chances are she's a very hardworking woman and I know that she is someone who is used to being independent because she had to come over from Cuba and start her life all over again as an immigrant.
Speaker 3:Why? Because I'm Cuban. So I understand, I understand that background, I've seen it in my own family, I saw it in many of my families. So this is a woman that is going to be very fiercely independent and will want to get up and get moving and get going right, Versus some other folks that perhaps did not come from that kind of a background where they had to start all over again, start their lives all over again, and they may not be necessarily that aggressive with their independence. And I have to perhaps take it a little slower with them. Okay now, these are all things going on in my head. It's not something that I'm telling the person and these are things that I'm going. You know what? I think this might be what this they approach, this person needs. But let me just see, I may be right, I may be wrong, and I adjust from there.
Speaker 1:I think it's wonderful. I just never thought of it this way, like and I understand you know you're not trying to like typecast or whatever people or something in particular way. It's just a stepping off point really. But I think it's really really interesting looking at it this way and saying, okay, where's this person from? Maybe I needed a completely different approach. I think it's a really really wonderful way to be so sensitive to their background and where they come from.
Speaker 3:And it could be that I'm completely wrong and I've been wrong many occasions and again, this is not something that I charge in there and saying, well, you're from this background, therefore I'm going to treat you this way. No, it's just saying, okay, I think this is what I'm walking into. Let me just approach with caution and approach with certain things that I think might work for this particular patient. If not change my game, move on. So you know, in other households for example, when I worked home health for many years, you know I'm going into someone's home, I'm going into someone's personal environment. Right, there were certain cultures that I know of that they don't want people wearing shoes inside their home.
Speaker 3:So I would know that if I had a particular patient and then in their patient record it show that they were from this particular culture, that I would just remove my shoes before I came, or I would ask them would you like for me to remove my shoes before I come into your home? Do you prefer that I see you in your living room versus your bedroom? So it's being sensitive to some of these differences and a lot accordingly. And then the other side of it is if you don't have an awareness for some of these differences in your patients. You're going to piss off a lot of people If you walk into every room with the polyana hi, I'm your physical therapist. Oh my gosh, let's get started. If you treat everyone the same way like that, it's just going to blow up in your face.
Speaker 2:I would like to talk a little bit about the professional side of things. We've talked a lot about the patients and some of the mental stuff that goes on with that, with how deep you're going with patients, you're invested with patients, you have a lifelong relationship with a patient and it is emotionally taxing, even if that's your thing. How do you as a professional physical therapist so tell either young physical therapists or even some of the young professionals say, the prosthetist and orthodist coming in? How do you separate that, or can you separate it from your personal life?
Speaker 3:There are two types of clinicians and again just general umbrella observations in my career that I've observed. There are clinicians who bring their work home emotionally, that they are thinking about that patient that is dying and they're thinking about that patient all night long and they're really concerned about their patient. Then there are certain clinicians that when they leave work, they leave work at work and they come home so that they can be with their families. I don't think there's a right or wrong to either one. I think it's acknowledging which one are.
Speaker 3:You Are you?
Speaker 3:Because I'm the clinician that I do bring a lot of us home with me and I'm thinking about my patients and I'm thinking about oh gosh, I hope that they need that phone call, I hope that they made peace with their children.
Speaker 3:I've had to learn over the years how to compartmentalize some of that, how to keep my humanity and have that compassion for my patients At the same time when I come home, not to put that into my home life where it can affect my time with my children, where it can affect my time with my husband and things like that. Again, I think that's a lifelong learning process. You learn when to become a little bit more involved in a patient's care, you learn when you need to step back. You also need to learn sometimes when to protect yourself and completely remove yourself from the situation. This is something, again, that comes with the experience, but I think when I see a new therapist and I see someone who's perhaps struggling with these issues, it's a matter of talking to them about it and saying, hey, yeah, this is a very real thing as a clinician that you need to learn to deal with. But it's going to take you time and air trial and error to learn how much to be invested and when to pull back just a little bit.
Speaker 1:Now, how about dealing with these other professional groups? Because we talked a couple of times about this Everybody's got their own way, everybody's got their own vocabulary, everyone's incentivized differently. How do you communicate with each other? We talked before about ideally, we talk more and we do a more team approach, but how do you deal with each other? Different professional, different backgrounds, how do you suggest doing that?
Speaker 3:Just honest and open-minded, open-handed. I've seen a lot of interesting drama in my own local OMP community and it's just something that I observed and I saw that there was a lot of drama there between clinicians because there was a lot of insecurity, a lot of sometimes even territorial type drama, and then I got thrown into the middle of all that when I opened up my practice. So when I did open up my practice, I just kind of operated with an open hand. I would introduce myself to all the different clinicians that I would potentially be working with and just letting them know this is what I'm doing. This is what I'm here to do.
Speaker 3:Yes, I am working with several other people in the community, which some of them may be your direct competitors, but right now I'm here to treat your patient. And how can we communicate best to treat your patient? So I've always been very open. I don't have any secrets about who I work with, who I don't work with, none of that, and I think everything else. You just kind of focus on the quality of care you're giving your patient, practicing in an honest and ethical manner, and everything else will just come into place.
Speaker 1:And what do you wish that your standard OMP practitioner? What do you wish they would know more about physical therapy? What kind of things should they ask more about physical therapy? Ask two physical therapists.
Speaker 3:Just to come into their office. You know, unfortunately I do run into a lot of prosthetists that don't understand why a physical therapist needs to be involved in patient care. And I see a lot of physical therapists. I'll call out my own colleagues. There's a lot of physical therapists out there that they think that treating an amputee patient means putting a hot pack on them and putting them on a bicycle and they won't use their gait training skills. But from a prosthetic standpoint, you know, I think if they could just accept the fact that we are just as important as their care is to the amputee patient and their lifelong success and to let us do our job, you know, let us come in and do our job so that we can help your patient do the best that they can. We're not here to take over the job of the prosthetist. That's not what I'm interested in doing. I'm interested in making sure that this patient has lifelong success with their prosthetic device and mobility.
Speaker 2:When you're talking with your patients, or they're probably already involved with the clinician. But let's say it's the day one or day negative one and they ask what, kosi? What do you look for in a prosthetist's orthotist? How do you go about choosing one? What do you tell them?
Speaker 3:I tell them to start interviewing people, to not be afraid to choose their own prosthetist. A lot of times I hear from patients and viewers that they were just assigned a prosthetist either by their doctor or by their insurance company and they had no idea that they had choices. So that's usually the first thing I tell people is you have choices. You have a choice whether or not you want to work with me as your physical therapist or whether you want to work with John Smith as your prosthetist. So first of all is understanding that you have a choice. Second thing is is start utilizing all your resources. You know, look at the reviews on Google. Talk to fellow amputees. Who is it that they're using for their prosthetists? Those are the best kind, I think, is when you get a person-to-person referral, interview your prosthetist, okay. And I tell people this I was like guys, if you're thinking about a particular prosthetist, show up at their office or give them a call and just say hey, I have a couple of questions. Would you be able to have a few minutes, whether it's now or whether you'll give me a call tomorrow, or do you have a few minutes to answer my questions? I'm looking for a new prosthetist If you don't get a phone call back from that prosthetist, chances are that's not going to be the prosthetist who's going to be there to help you when you're having to troubleshoot your prosthesis right?
Speaker 3:Same goes for physical therapist. Ask your physical therapist. Do you have experience treating amputees? If not, are you willing to communicate with my prosthetist to learn more about the prosthetic device and help me get going with this prosthesis? Okay, so ask questions to your prosthetist.
Speaker 3:Ask them what is going to be the process? Am I going to have a choice in what prosthetic foot or knee I end up with? Okay, that's another red flag right there. If the prosthetist is just going to assign you a prosthetic foot, that's a red flag to me. Are they going to take the time to let you trial more than one out and get your opinion? Are they asking you in their interview of you? Are they asking you what are your goals in your life? What are the activities that you need to be able to do to function in your life? That's how we approach. What kind of prosthesis will be best for you? At the end of the day, you're not married to your prosthetist. You might start working with a particular prosthetist and things are simply not working out, and that's okay. It's okay to get a second opinion, it's okay sometimes to even switch clinicians. Same goes for PT's.
Speaker 1:Okay, Kosi, thank you so much. I think it's a really open hearted discussion. I think it's really wonderful to see a very, very different perspective and really wonderful to talk so openly about it. So thank you so much for your time today.
Speaker 3:My pleasure.
Speaker 1:And Brent, thank you for being here as well today, Of course.
Speaker 2:Yeah, this was great and yes, thank you, kosi, for being an advocate for your patients, our patients, and really providing them a great springboard to get good outcomes and providing them kind of a sounding board as well. So thank you for that.
Speaker 3:My pleasure.
Speaker 1:Thank you for having me on the show and thank you guys for listening to the prosthetics and orthotics podcast. This was a great episode. We really liked it and hope you do too and tell everyone you know about it. Have a great day.