cardiac rehabilitation II

Phase II: education by physiotherapist/ dietician/ cardiac nurse...

Patient will stay home during phase II and their activity level will keep as 4 METs.

They are also encouraged to walk around the corridors 3 times a day with their heart rate not more than 20beats of their resting heart rate.

Phase III: Outpatient cardiac rehabilitation program

we will exercise the patient with the intensity at 60-75% HR reserve (or Borg scale 12-15) of aerobic exercise + low moderate resistance training.

what about ECG? exercise stress test? cardiac surgery? diagnostic test????

To be cont'd.... :)

大拇指外翻 hallus valgus

大家如果有留意新聞
應該知道前個排Victoria Beckham
都因為Hallus Valgus要做手術
唔可以著佢既至愛 --> high heels
maybe we should talk about hallus valgus today

(information mainly from Current Rheumatology Diagnosis & Treatment by William Jenkin)

History:

Most likely results from the combination of a biomechanical fault, constrictive footgear, and walking on hard surfaces

Physical Examination:

standing position: observe the degree of deformity 畸形狀態 of the great toe and lesser toes. the overall posture of the foot is noted. look for lateral deviation 偏向
of the great toe / medial bunion

gait: looking for evidence of abnormal ground contact or early heel rise, which would indicate possible tightness of the Achilles tendon 腳跟.

seated position: the ROM of the ankle, subtalar, transverse tarsal, and metatarsophalangeal joints is noted. The plantar aspect of the foot is examined for abnormal callus formation, particularly beneath the metatarsal head and along the medial aspect of the great toe.


The neurovascular status of the foot is carefully assessed, noting venous stasis changes. Doppler studies are obtained if there is any question regarding the circulatory status of the foot.

x-ray findings


Treatment:

Non-operative

The patient should be encouraged to wear shoes of adequate size and shape. This simple form of management may relieve most symptoms.

Pads may be placed in the first web space or over the median eminence to help take pressure off a painful median eminence. Pads are also available that can be placed underneath the metatarsal heads to take pressure off painful calluses or sesamoids.

If after adequate conservative management the patient continues to have discomfort, surgical intervention may be considered. Surgery is not performed for cosmetic reasons or to allow patients to wear fashionable shoes, but rather to correct a symptomatic structural deformity.

Juvenile hallux valgus deformity presents a significant problem in management, but as a general rule, conservative management should be continued until growth is completed, after which surgery may be considered. Extra care must be taken into consideration in the juvenile population where cosmetic appearance may play a greater role in the patient's or parents' desire for surgery.

Hallux valgus surgery is generally contraindicated in high-performance athletes or dancers until they are no longer able to perform at the level necessary to continue in their vocation or avocation. Premature surgery in these individuals may diminish their special abilities.

Surgery (only mentioned the most common one)

Distal Soft-Tissue Procedure



The procedure requires releasing the soft-tissue contracture on the lateral side of the metatarsophalangeal joint, including the lateral joint capsule, the adductor hallucis tendon, and the transverse metatarsal ligament.

On the medial side of the metatarsophalangeal joint, the medial eminence is removed 2–3 mm medial to the sagittal sulcus and in line with the medial aspect of the metatarsal shaft. The capsule on the medial side of the joint is plicated to hold the toe in correct alignment.

Postoperatively, the patient is maintained in a firm compression dressing, which is changed on a weekly basis for 8 weeks. During this period, the patient is permitted to ambulate in a postoperative shoe.

stomach infection

stomach infection for a few days
no energy to update blog :<
it is horrible to vomit everything you eat
i am just like all the other girls like to stay skinny
but i don't want to be skinny because i am sick
i want to be "fit" (actually, skinny is not the term i like) because i exercise regularly and eat healthy
now this stomach problem makes my skin look so bad.....
sigh...................................................
i was suppose to go to Sugar but now have to postpone!
Have you been to there?
i heard it is very nice!

http://www.openrice.com/restaurant/sr2.htm?shopid=42060

avocado

like it so much
good for skin :)
oh....but dun eat too much coz it contains fat


dun worry
they are "good fat"
just want to remind you guys :)

tired

去完macau返黎很累呀........................

ate some nice food there though
gambling?
no i did not :)
parents did :)

ice cream

when you are tired from work/ study
it is nice a have a cup of ice cream :)
what's better?
the ice cream is brought by a guy that truly loves you

Enjoy :)

啪骨 - manipulation

有好多人問我"啪骨"係咪好痛???

啪骨 (其實都唔知係咪咁譯) 即係 manipulation
it is a passive moblization of your joint that exceed your normal physiological movement of your joint...

anyway....

啪骨 係唔應該會痛架!
不過你一定要放鬆囉!
唔係好易會整親
同麻唔好求其係阿水話識啪你都俾佢啪先得架!

physiotherapist working with cardiac patients (1)

yes, physiotherapists do work with cardiac patients
what do they do? exercise....of coz (大家應該估到:)

cardiac rehabilitation contain 4 phases

1. inpatient phase (if patient got a CABG. they will most probably admitted to the ICU)

we basically educate them how to measure their heart rate, what the hell is "borg scale", what is METs (yup, 亞洲人好似無咩興趣呀!) Patients at this stage are actually confined to mobilise until 4 METs.... 咁咩係 4 METs 呢? see below





to be cont'd

the first blog

as i was reading the blogs from various friends/ professions/ beauty blogs
why don't i also write a blog about a life of a physiotherapist
and to share some knowledge in here
and also share a bit of my life
to express my emotion

let's have fun :)