They Call Me Galvez

The return to Michigan for the holidays was different this year.  Not only was I staying for two weeks, but I was also returning as a student.  Whenever I come home, I always get nostalgic, but at the same time I get this urge to clean things out.  I found a bunch of old pictures and miscellaneous items in my room that brought back some memories. Sadly, I think I’m the only one that wants to throw things out.  My brother and Mom are packrats and have managed to build quite a collection of things since I’ve moved out over 20 yeats ago!   Lots of things pile up and there are plenty of arguments about what to keep!  I’m not sure this is a battle I can win.  We finally got rid of: an old 200 pound trinitron TV, my old scooter, and some junk moved out of our house.  I did find some old CDs and DVDs I can still use in Houston.

I always go to the movies with my dad whenever I come to Ann Arbor.  My bro, my dad, and I saw The Last Jedi the day after I arrived.  Only fitting because we saw Return of The Jedi together in 1983.  That movie solidified my geekiness and also turned me into a fan of seeing films movie theater.  Anyways, we also saw Jumanji: Welcome to the Jungle but my curiosity was piqued after the movie.  We saw the movie in “D-box” seats.  They basically are seats that are synced up with the movie and move/shake with the action.  I did notice something interesting… I usually have trouble using my crutches walking out of the theater after being seated/stationary for hours.  After experiencing the movie in the d-box, I was able to use my crutches to walk out of the theater.  This got the physical therapist in me thinking… Was I less tired today?  Was the outcome a result of specific environmental conditions?  Was the increased sensory input affecting my balance?  Was it simply the result of being stimulated for 2 hours instead of sitting like a bump on a log for 2 hours?  Will the same effects happen again if I watch another d-box movie?  Will have to continue this experiment in Houston… HAPPY NEW YEAR!

This was the first article I published in Advance Magazine for Physical Therapists… it led to the crazy idea of writing a book and publishing other articles!  It has been quite an adventure…

Reversal: When Therapists Become Patients

We see patients every day. It’s real easy to forget they are people too, not just another “total knee” or “laminectomy”. Ever patient has a story. When taking a history how well do you really get to know your patients? I always used to wonder what they were going through, what things were like for them. I came to the seemingly obvious realization that a diagnosis affects people more than we know outside of the controlled therapy sessions. There are so many other factors involved in Rehab other than just mobility. I had to live through my “discovery”.

I graduated from Physical Therapy school at the University of Michigan- Flint in December 2003. I moved to San Diego, California a month after graduation in the hopes of finding a great job, an active lifestyle, and a nice girl. I found almost everything I was looking for in San Diego, but then I got some stunning news last September. I was diagnosed with a golf ball sized brain meningioma on my Tentoral membrane. The tumor was applying pressure to my brain stem (specifically the Pons) and my cerebellum. I was having severe symptoms of dizziness and nausea before I got things checked out. I had just started doing more swimming and surfing.   At first I thought I had an ear infection or maybe a Vestibular Problem, nothing too serious. Then I started getting headaches and nausea. That’s when I knew something wasn’t right.

According to the American Cancer Society 2% of all cancer related deaths were attributed to brain cancer. Males have a 0.66% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.50% chance of dying from a brain tumor. (1)   But men are at risk none the less, I never thought it could happen to me. It did. Meningiomas are the most common type of primary brain tumors at 27.4%.  (2) Meningiomas affect mainly elderly African-American women.(3) The Glioma family of tumors account for 44.4% of all tumors, with Glioblastoma being the most common type of Glioma at 51.9% and Astrocytoma representing 21.6% of all Gliomas.(2)

I’ve never been sick before. I always thought my first surgery was going to be orthopedic, not neuro and not so soon. I figured I’d have surgery at the hospital where I used to work because I knew the staff pretty well and I was familiar with how things were run there.  After much deliberation, I also chose to do my rehab where I used to work because I didn’t want to be alone and I knew I would be in good hands. When I first moved to San Diego I was torn between working in a hospital vs. working in a private clinic. I chose the hospital. I’m glad I made that decision because not only did I meet a lot of new people but it also opened the door for many other work related opportunities.

Knowing the staff where you have surgery has its perks and draw backs. (See side bar) I got the best treatment, but I also had a lot of visitors. I liked the friendly atmosphere, but it left me with very little privacy. The only awkward moments I had were taking showers with the assistance of the CNAs. It took me a few weeks to get used to that. I’m a pretty shy guy, and then I figured they see naked people all the time. At least none of my friends / old co-workers would see me naked!

Pros and Cons of going through rehab where you work (could be a side bar)

Pros

• You’ll get the best care.
• Your co-workers will be great advocates for you
• Lots of support.
• You’ll be familiar with protocols/policies and procedures.

Cons

• So many visitors, very little privacy.
• Your co-workers will see you at your worst.
• It’s like you’re still going to work.
• Different perceived roles with your co-workers.

The hardest thing for me to deal with in rehab was knowing what needed to be done to progress, but not being able to do it. I was discharged in a wheelchair to my apartment with my dad in early December. My dad had just recently retired so I would have someone with me at all times. He spent over 6 months away from home in Michigan to stay with me in San Diego. This in itself was a huge adjustment. I’m used to being on my own and doing things by myself.

I really think it was harder on my family than it was on me because I knew what to look for in terms of progress. I had to explain to my dad every day that things were going well, specifically with weight shifting and balance. He would only look at the big functional goals like walking distance and speed. It was tough trying to tell both my parents to stay patient because I shared their impatience.   They were so used to cheering me on as an athlete that I think it was a difficult adjustment for them to make.

I turned to my old co-workers for support once I started outpatient therapy. Actually they were the ones that took me out to happy hours and would help me escape my overprotective parents. We usually kept things professional during my therapy sessions. Sure, we would joke around, but there was mutual respect on both sides. What I really appreciated was my therapist asking me what I wanted to work on at the beginning of each session, while still setting certain objectives each session. I also appreciated the feedback on the identification of my impairments so I could attempt to correct them. Sometimes we get so used to telling patients what to do, we forget to tell them why we are doing certain activities. Setting my own goals really kept me going. The goals I set for myself helped me to focus on what I needed to do.

Things to remember when working with patients 

1. Check-in periodically – Always ask their opinion on how they feel things are going
2. Involve them in the treatment planning
3. Help them set attainable functional goals
4. Explain why they are doing certain activities
5. Listen to their concerns. Don’t forget they spend more time with you than with their docs.
6. Remind them that maximum progress is made outside of the therapy sessions through their HEP.

People ask me how I dealt with everything. My response to them is every day was different with new challenges. I know this is a cliché, but I had to take it one day at a time. I would wake up every morning and certain things would be a little easier. Each day brought a different challenge. Treating and beating each new challenge individually made the days go by faster. I never let go of the belief that I’m still a regular guy. It just takes me a little longer to do common everyday activities. I literally grew to hate the wheelchair and the walker so I would force myself to progress. I’m also still a pretty immature guy so I took the time to laugh at myself and all the difficult situations I put myself in.

I can’t even imagine going through rehab as an elderly adult. I have so much respect for them. The physical and psychological demands were enormous on me, an active young man. Their stage in life would obviously bring about different challenges/goals.  The biggest realization I made was that when patients go home, their impairments go with them. Unlike us, they get no vacation or breaks from the impairments. We get to go home at the end of the day and leave things at work. Putting on my shoes as a patient has definitely opened my eyes as a therapist.

Sources

1. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK (eds.) Seer Cancer Statistics Review, 1973-1999: National Cancer Institute, Bethesda, MD, 2002.
2. Report, Primary Brain Tumors in the United States, 1992-1997.
3. http://www.emedicine.com/NEURO/topic209.htm

I’m finding less time to blog, so my entries are getting less frequent.  I’m gearing up for a trip home to Michigan at the end of the month on top of that, I’m trying to setup the next international speaking engagement.   I’ve been invited to speak at the Michigan Physical Therapy Association Student Conclave and the Michigan Physical Therapy Association Spring Conference in Bay City Michigan at the end of the month.  I always look forward to coming back and reconnecting with old friends and family!  Growing up, I always felt different from everyone because I was ALWAYS the smallest and most shy kid in the room.  Sports brought me out of my shell.  I finally met more people similar to me in college.  I got involved in the Asian American and Filipino American student groups because I felt like I had to get involved and spread my new-found pride about my heritage.  I’ll admit that I probably had too much fun in college, but it really helped to form who I am today.  I learned so much outside of the classroom at the University of Michigan!

I then moved to LA to go to school full time and improve my GPA before applying to grad schools. After a year in California, I moved back to Michigan to start physical therapy school at U of M-Flint. Before I left for LA, I applied to the U of M-Flint Physical Therapy Program since I still had my Michigan residency. I graduated from Physical Therapy school with a Doctor of Physical Therapy (DPT) degree in December 2003. I woke up one morning and decided I should move to San Diego. So I did. I’ve done the Michigan-California drive five times, three times with a companion and twice by myself. I knew 2 people in San Diego when I moved. I made some good friends in San Diego, but in the back of my mind I still missed everything and everyone I left behind in Michigan.  This is when things got interesting! 

Surprisingly, I’m finding that I don’t mind public speaking.  I’m very comfortable talking about my experience as a healthcare professional turned neuro rehab patient/brain tumor survivor. In the beginning, I couldn’t get through the presentation with out getting emotional.  Over time, I’ve learned how to get through the “tough part” of the presentation.  Making people laugh has made it easier for me to talk about my experiences.  I have now spoken all over the country and am starting to speak more internationally.  Coming back to Michigan is always special because it toughens me up every time.  My family and friends have no problem reminding me who I am so they keep me grounded.  They have no problem calling me out on my “laziness” and refocusing me on what I should be doing!  My family and close friends in Michigan ALWAYS “keep it real” with me, which I find refreshing.  I know that they can dish it out and won’t be easily offended when I “return fire.”  This should be a very interesting return trip to Michigan.

I got some more cool stuff in the works… stay tuned…

One of the 1st videos…

I found this…  Was weird because I treated many of his patients and I think one recognized me in the waiting room!  Every patient should have a list like this whenever visiting their doctor!  Make sure your concerns are addressed!  Doctors are very busy so there may not be time for small talk!  PRINT OUT 2 COPIES:  A COPY FOR YOURSELF AND A COPY FOR THE DOCTOR TO KEEP IN YOUR FILE.  MAKE SURE THE DOCTOR KNOWS YOUR CONCERNS!

I.  Current Symptoms (it’s in your chart but make sure they know!) 

WHEN:

All the time:  left sided facial numbness, left sided tongue numbness, loss of appetite, malaise, clumsiness can’t walk a straight line

Occasional:  Nausea and vomiting, lightheadedness (when working out), headaches (with increasing intra-abdominal pressure)

ACTIVITIES THAT BRING ON SYMPTOMS: 

With quick movements: headaches (also when changing positions/levels), dizziness

II.  Questions

1. What is the prognosis? I’m very concerned about the cranial nerves, with the basic body functions and the blood supply to the cerebrum, cerebellum, and brain stem.
2. What specific procedures can be done to take this thing out?  Will the entire thing be able to be removed?  How much damage will be done to the cranial nerves/vascular tissue during the procedure?
3. How common is this tumor?  How did it grow so big?  What was the blood supply for the tumor/what “fed it”?  How long do you think it’s been there?
4. I’ve been having dizziness with exertion, Should I worry about the carotids or any other arteries that supply the brainstem or cerebrum.  The last 2 really bad dizzy spells I had came with running ~5-6 miles.  Are there any vascular tissues affected with the tumor location?   I also notice dizziness/lightheadedness when working out.
5. Was the cerebellum (or vestibular nuclei in the pons) also affected? My coordination has been off for a few months.
6. How long is the rehab?  What kind of lingering effects should I expect? Timelines?
7. Once it is out, is there a chance for relapse?  Is there anything I can do to prevent it from happening again? What caused the tumor/where did it come from?
8. Am I now at risk for new tumors to pop up?
9. When can a procedure be scheduled?  I really need my parents from Michigan to be here for me.
10. When can I return to surfing, triathlons, work?  Is there anything I should avoid post-op?

Earlier this week I had the opportunity to speak at San Diego State University’s Doctor of Physical Therapy program.  I’ve spoken at different Physical Therapy programs all over the United States over the past few years, but this one felt different.  The program at SDSU is only 4 trolley stops away so I have a feeling that I will be visiting there more often.  I lectured at a neurology class for 2nd year students.  Last semester I helped out there at a neurology evaluation lab.  Last month I went up to Loma Linda University to help out with a lab.  I really enjoyed helping out at the lab because I felt like I was giving back to the profession that has served as the foundation for the MKF concept of post treatment “thrivership.”  I wanted to show the students that we don’t just “have a tumor/cancer”, we are “LIVING with a tumor/cancer.”  I think that message can resonate with many groups.  You educate the students that tumors/cancer are not always a death sentence, and that they can educate their patients that people can live productive lives after being diagnosed with these diseases.

Earlier this month I was in Las Vegas for the American Physical Therapy Association’s Combined Sections Meeting. This is is a big conference where PTs/PTAs/students have the opportunity to learn the latest news and clinical techniques in the profession.  I always enjoyed meeting other therapists and vendors at these conferences.  The past few years, I have been attending the Oncology Section programming.  I was formally introduced to the benefits of a post treatment physical rehab program for tumor/cancer patients.  After I did my radiation treatments, I tried to keep physically active because I needed to stay active to keep my sanity.  I now have “Peer-reviewed” evidence that confirms the benefits of a physically active lifestyle for general health benefits after treatment.  In my humble opinion, when done safely, under the supervision of a qualified healthcare professional, the benefits of physical activity (PA) after treatment are too great to ignore!  I have seen many survivors fall into “self-defeating ruts” after treatment.  There are so many benefits to physical activity!

I truly believe that post-treatment exercise programs need to be formed to harness the benefits of physical activity.  Dr. Steven W. Morris at St. Jude’s Pediatric Research Hospital in Memphis, Tennessee has presented numerous in-services/seminars addressing the benefits of physical activity for post-treatment cancer patients.  I was lucky enough to present his findings at a young adult survivor event in San Francisco a couple years ago!  I think young adult survivors turned “post treatment thrivers” are in a prime position to become the leaders in the promotion of a physically active lifestyle after treatment!  We are the ones with all the potential and the loudest voices.  Throughout history, revolutions are propagated by young people who realized there needed to be some sort of change.  This is a prime opportunity for Generation X and Generation Y to create our legacy!  The change in society starts on an individual level before it can catch fire.  If we truly commit to a healthier lifestyle, we should see changes in the prevalence of these diseases!  The trick is getting the under represented populations to follow suit.

Thoughts from the train…

Well, the train broke down AGAIN!  I’m stuck between San Diego and Oceanside probably until 1AM.  Other than this hiccup, I’ve had a great start of the week!  On Monday, went up to Loma Linda in San Bernadino county.  I had never been up there before, so I was excited to explore a new area! San Bernadino is east of LA, located close to “the valley.”  I was going to give a talk at the Loma Linda Physical Therapy school and help out with 2 neurology lab sessions (basically, I was going to be a “Guinea Pig” for a bunch of 2^nd year Doctor of Physical Therapy students to practice on.) My main duties in lab were to give them feedback on their technique and teach them some tips on dealing with patients.

* YIKES!  OK, THE LIGHTS JUST WENT OUT ON THE TRAIN…. I’M SITTING ALL BY MYSELF IN COMPLETE DARKNESS IN THE CABOOSE OF A STRANDED TRAIN IN THE MIDDLE OF NOWHERE!  THIS IS THE PREMIS FOR A HORROR MOVIE! At least I have a window seat… actually a bunch of window seats!  I’m not claustrophobic cause I can see the sky!

Was kinda funny because I remember the whole student mindset.  In grad school, we had to learn how to do “critical thinking.”  Sometimes there is not clearcut right/wrong answer. We had to choose “the most correct” answer.  Determining the “more correct answer” drove me nuts!  Each question had something “correct” in it, but there was always one little detail that made it incorrect!  I had friends in school argue every little point of each question they answered incorrectly to squeeze every point on their quest for the perfect score.  That was definitely not me. I figured that ultimately, I’m not going to waste my energy arguing minute details if ultimately I understood the value of the question. Anyways, I got to tell my personal story as a young physical therapist who got the rug pulled out from underneath him and had to recreate himself. I usually talk about helping patients find their own path.  In the lab session, I got to meet the students and challenge them face-to-face. It was kinda cool seeing the “light click on” when I’d give them feedback on their techniques.  The fact that I actually taught someone something that they can use to help someone else was a pretty cool feeling!   It was similar to the feeling I first got when I taught a patient with a spinal cord injury how to successfully transfer from his wheel chair to the mat table independently!  I remember thinking “Someone will actually be applying what I taught them! COOL!” This is what drew me to the Physical Therapy profession in the first place!

*Lights Back on now!  The last trip I scheduled to LA got canceled because someone decided to literally lay down on the track!  Yikes!  Anyways, I’m doing a lot more speaking at PT programs.  I think I’ll be helping out at labs more often now.  I find them more fun because there is more interaction.  Seeing the light “click on” was such a cool feeling!  Plus I enjoy messing with students… hee hee hee!  There are no “nervous testing hands” because I’m not grading them.  I’m really looking forward to doing another lecture and lab at San Diego State University this semester!