Courtney Gavin Madsen's Blog http://www.360oandp.com/courtney-gavin-madsens-blog.aspx Copyright 2010 360oandp.com 120 info@nospam360oandp.com mojoPortal Blog Module V 1.0 A recent prosthetic challenge in my rural setting http://www.360oandp.com/CourtneyGavinMadsensBlog-1965-a-recent-prosthetic-challenge-in-my-rural-setting.aspx Thu, 15 Apr 2010 23:26:42 GMT http://www.360oandp.com/CourtneyGavinMadsensBlog-1965-a-recent-prosthetic-challenge-in-my-rural-setting.aspx http://www.360oandp.com/CourtneyGavinMadsensBlog-1965-a-recent-prosthetic-challenge-in-my-rural-setting.aspx As I suggest in my blog introduction, I practice in a more rural setting than most. Vermont only has approximately 600K people and most live in just a few larger cities. The rest are spread out into the surrounding, rural towns. Our practice encounters challenges everyday in serving our patients well and yet running an efficient business. For example, we do house calls if needed and the drive can be to a town 30-40 minutes away. Prosthetic patients can be very challenging in this situation. You have to be prepared for a prosthetic fitting or adjustment if going all the way to someone’s house, and yet you know you have limits on how much you can without a lab and certain tools.

A recent frustration occurred with just such a patient: A female bilateral below the knee amputee who lives in a rural town. She cannot drive and has no support system by way of friends or family. She needs to be able to come to the office for specific modifications I cannot do at her house and yet she continues to cancel appointments as her rides fall through. Many other options have been exhausted for her and sometimes I want to drive myself to get her for an appointment with me. Is this efficient, though? Do I have the time to spend an entire day on only one patient? Does this equal excellent customer service and helping those in need or does this represent poor business practice? I don’t have the answers to these questions…yet. For now I am waiting on her to reschedule and contemplating our ride together if it comes to that.



Courtney Gavin Madsen  ...]]> Offloading the arch??? http://www.360oandp.com/offloading-the-arch.aspx Thu, 01 Apr 2010 00:27:39 GMT http://www.360oandp.com/offloading-the-arch.aspx http://www.360oandp.com/offloading-the-arch.aspx As the title states, this is my current challenge. I had a patient today with a hx of pes planus and plantar fascitis. She is a young, healthy female who has had bilateral plantar fasciotomies approximately 10 years ago. She developed scar tissue and had a second surgery to remove it in 2003. She has been in pain since. She has had every modality you can think of to treat inflammation and scar tissue with no resolution. She is currently back in PT and was referred to me for new foot orthotics.


Her biggest complaint is pain in the medial arch, where the majority of the scar tissue has developed. Consequently, she walks on the outside of her feet most of the time. I am going to attempt to make foot orthotics that will allow for relief medially but give support and alignment to the foot/ankle. I took an impression in foam with her seated and am still thinking about how to proceed. I welcome feedback but also stay tuned for the results!

 



Courtney Gavin Madsen  ...]]> My first blog post: Lets talk about degenerative scoliosis http://www.360oandp.com/my-first-blog-post-lets-talk-about-degenerative-scoliosis.aspx Thu, 25 Mar 2010 19:34:16 GMT http://www.360oandp.com/my-first-blog-post-lets-talk-about-degenerative-scoliosis.aspx http://www.360oandp.com/my-first-blog-post-lets-talk-about-degenerative-scoliosis.aspx Hi All!

This is Courtney Madsen with my first post! Until my own blog is set up, I am using my boss'. I am really excited to use this format to share information with other O and P practitioners and other professionals involved in our field. I have had many times that I would like to share a particularly good solution I found to a clinical problem, a great patient outcome, or ask questions for issues I might be facing in my daily practice.

That brings me to the subject of my first post.  Does anyone have experience or suggestions for a back orthosis to help with pain in older patients with degenerative scoliosis?

For example, I have one doctor (a spinal surgeon) who sends me many patients with the dx of degenerative scoliosis, usually secondary to arthritis.  They are usually 70 years or older and not a surgical candidate. Therefore weight, donning independently, and comfort of an orthosis are major concerns. He is a fan of the DDS back brace system but I have not had much luck with it. I tend to prefer something like an Ossur Miami Lumbar or a CAMP TLSO corset. I understand how the DDS is supposed to work, but I'm not sure it is accomplishing all it says it can do or easy for people to put on themselves. My patients just seem to want pain relief and understand changing alignment is difficult when you are older.

I welcome any success stories or devices people like to use. Thank you!!



Courtney Gavin Madsen  ...]]>