Today I had a patient come in who consistently has too high of blood pressure. When she came in last time I referred her back up to the clinic because she explained to me that her doctors told her to take her BP meds every night before bed which is strange. Normally they are taken in the morning. The med students ended up increasing her dosage for her medication and explained that she is not compliant with medication so her taking it at night was the only option to make her remember to do it. This time when she came in as I interviewed her she explained that she took her BP meds last night with some Tylenol because she had a headache. She then went on to tell me that she woke up and still had a headache. So to fix this issue she decided to take her BP meds again. This is one of those cases where it is hard not to laugh to yourself for not recognizing that the patient actually has no idea what her meds are for. I quickly explained that BP meds are not used to decrease pain but instead to help maintain your heart at a healthy level. This information appeared to be brand new to the patient. This was great practice for me as well because explaining medications is hard for me since it is not exactly my job to administer and dose meds. But physical therapists are the only medical personnel that most patients spend the most time with. So we often have to explain to them what they are taking and what is going on with their body and diagnosis. Needless to say this patient needed some serious medication counseling because she was unaware of what she was putting into her body and what it was for.
Today I also had a patient who came to clinic with low back pain and abdominal pain. This was an initial evaluation so I was doing a full exam on her. As I started my exam I was suspecting some SI joint pain and problems. She appeared to be in pain everywhere. She then began to explain to me that the pain was mainly in her stomach and back. I decided to do a visceral screen to make sure there was nothing else going on. Well it turns out that she was positive for a lot of my visceral tests. I started to think that the issue could be both SI Joint and kidney related. In this case the pain of her SI joint was too acute for us to do anything anyways because her pain levels were too high and everything was appearing positive. At this point in my evaluation I discussed with my preceptor that I was not sure how comfortable I was continuing to treat this patient when she has positive signs for kidney problems. He agreed with me and we referred her back up to the medical clinic. This was interesting for me because I have never really had to refer a patient back to the medical clinic besides for simple medicine issues. I was excited that I caught something in my evaluation and exam that could be problematic for this particular patient.