Learning Something New Everyday | Global Medical Innovation

Malas Hierbas No Mueren!

This week Laurel and I started our new rotation in the Rehabilitation department. Compared to the past specialties we shadowed, there was a different environment in Rehab. While mornings were less busy than afternoon and evening hours, there seemed to be an environment with a lot of energy and hope (thanks to Dr. Paula Mora and her team 🙂 )! We met and interacted with patients of all ages from a young teen to senior citizens.

Me and my Scrubs Finally!!

Laurel and I in Rehab! Dra. Nathani and Dra. Chen??

One patient that I fondly remember was ‘Jaques’ who came with his wife for his regular therapy. Jaque was a previous veteran who had fought in WWII in Japan during the bombing of Hiroshima and Nagasaki and was also a former soccer player in the All American team at UC Davis. Having observed his difficulty in breathing during a walk to a beach one day, his wife brought him for his annual checkup upon which the doctor noticed a blood clot that had blocked most of the oxygen from going into his brain. Immediately Jaques became admitted into the hospital and underwent an angioplasty. After his surgery, he required therapy to help him regain his mobility and balance causing him to return to Hospital Clinica Biblica 2-3 times every week for the 1st two months and then every 15 days for the past month. When Jaques and his wife first came into the rehab department, they went through an initial screening where Dr. Mora asked him about his daily activities and how he was doing/feeling. Subsequently, he started his rehab therapy with the cycle ergometer which is a stationary bike exercise that requires the patient to continuously pedal for a set amount of time. This exercise measures maximal aerobic power (the ability of the muscles to translate oxygen from the heart and lungs into energy). Next, the patient did a set of exercises that consisted of running sessions and then weight lifting. While Jacques completed his therapy, I noticed how invigorating Dr. Mora and her colleagues were. So many patients come to rehab after enduring all sorts of health problems that cause normal activities as simple as walking or turning quite difficult. Being able to get patients back on track and giving them the energy to do so requires a great amount of optimism and strength. Seeing Dr. Mora applauding patients on their achievements, no matter how small, or simply talking to patients about their life and day-to-day activities to provide ease made me realize how important empathy is in medicine. Towards the end of the session, Jacques stated an interesting phrase in Spanish, “malas hierbas no mueren” or “bad weeds do not die.” After spending just 30 minutes of my time with Jacques and his wife, I realized that his quote best reflected his approach to life and explained how he was able to recover so fast after such a life-threatening and debilitating illness: in the face of whatever obstacles, a weed stays strong and manages to survive just like Jaques did.

Clinical Needs Finding

An interesting clinical needs finding that I discovered after interacting with Jaques was how difficult it can get for patients to continue their therapy at home. I remember Jaques’ wife explaining to the doctor 1.5 hours of exercise at home appears demotivating for Jaques that it even discourages him to begin his therapy. To this, Dr. Mora responded by prescribing multiple shorter exercises to help him continue his session. Talking to multiple other patients throughout this week, I realized that therapy often becomes difficult as other activities at home may get in the way. Reflecting on these observations, I believe improvements or simple app-based technologies can be established to help patients find motivation to continue on with their therapies even after being discharged from the hospital.

Another interesting case I observed this week an older female patient who had come to rehab to get electrotherapy for her back pain. This patient had a previous history of scoliosis and a recent fracture in the T9 and T10 vertebrae led to a surgery in which screws were placed to provide spinal support. Typically, a surgeon would replace the fractured vertebrae; however, her advanced age resulted in the doctor taking less risk. Here is a diagram that provides a better understanding of the patient’s surgical treatment.

T9 and T10 Vertebrae Fracture Surgical Instrumentation [Annals of Rehabilitation Medicine Journal]

Post-operative, the patient complained of a neuropathic pain that extended from her vertebrae all the way to her ribs. To treat this pain, Dr. Mora advised her to make frequent visits to the rehab to undergo electrotherapy and heat therapy followed by some stretches/exercises.

Example of what Electrotherapy looks like (not the real patient) [Absolute Health]

Talking to Dr. Mora as we waited for the patient to complete her electrotherapy on her right, lateral side of her body, I realized how sensitive and fragile our body is. The doctor explained to me that a nerve may have been getting aggravated at the tip of the screws sending pain to spread through her lower back. Doing personal research on this, I recognized that many patients experience this issue and I believe that there needs to be a better solution to address surgical treatments to heal lumbar fractures. Dr. Mora then discussed that many doctors in Costa Rica disregard physical therapy as a medical treatment option and therefore prolong sending their patients to rehab. Explaining the significance of the electrotherapy session for the patient’s pain, she shared that her role allows her to bridge medicine with recovery of the patient. While the perception towards physical therapy is evolving, there still needs to be awareness and education to doctors in developing countries with regards to the role of rehabilitation to patients.

Another interesting case I shadowed was a male patient that had come for cardiac and spinal therapy. This patient had a previous history of cardiac problems that required him to undergo angioplasty. In addition, he also had a spinal tumor that caused his spine to deform. Here is an image that best illustrates the impact of the tumor on the patient.

Example of a Spinal Tumor [Spandidos Publications]

Spinal Cord Tumors and their Impacts (you can observe the spinal curvature that develops) [ResearchGate]

After the surgical removal of his tumor, the patient endured severe mobility issues that resulted in him shifting his entire weight to one side of his leg. After using the cycle ergometer, Dr. Mora asked the patient to walk in front of the mirror upon which the patient realized his incorrect posture when walking. After several sessions of walking back and forth in front of the mirror, the patient’s posture improved. To me, it was really interesting to see something as simple as a mirror provide patients with physiological and cognitive self-awareness about themselves. Being able to observe themselves and quickly re-situate themselves to match their desired state gives them confidence to continue working on themselves.

On The Other Side Of Things:

In my free time, I enjoy cooking food and I am enjoying it even more here in Costa Rica! I am not able to find many ingredients and spices that I typically use at home so being able to cook and prepare a variety of dishes with minimal ingredients is quite exciting and thrilling. It’s kind of like those episodes on MasterChef (or any baking/cooking competitions) where the contestants are required to prepare a dish using the ingredients given to them. This week I prepared chutney with rice and then another dish with dry broccoli curry with rice and potatoes. To me, being able to cook home-made meals allows me to feel closer to home and also allows me to share a part of my culture with others. Next week, Laurel and I will start ER rotations (hopefully!!) so stay tuned to hear interesting case stories and my experiences there!

Dry Broccoli curry, potatoes, and Rice 🙂