Our new blog!

Our new blog will be at our website at PursuitTherapy.com.  Click here to view and thanks for following!

Do you have pain when running? Q and A at Fleet Feet with Dr. Ron Miller of Pursuit Physical Therapy

Do you experience pain with running?

This is not the time to have a running injury in the middle of training season.  If you are having pain with your training, stop into Fleet Feet Orlando this Saturday November 2nd 11am-1pm and next Saturday November 9th for 11am-1pm for a FREE question and answer period.  Dr. Ron Miller will be there to answer all of your questions regarding your injury.  Don't miss this free opportunity!

For more information about Pursuit Physical Therapy, our running injury program, and what others are saying about us visit PursuitTherapy.com.

What is a health savings account and a flexible spending account? What does it entail?

Do you know what a Health Saving account is and what it entails?

Do you know what flexible spending accounts are and how to use them?

I asked a colleague and friend of mine, Robert Washick, MBA, to help and write a guest blog so the public and patients can have a clear understanding of what Health Savings Account and Flexible Spending Accounts  are and what they entail.   Many companies now are setting their employees up with these accounts to use for health care services.

We all want more money and many of us miss out on two of the best tax advantage plans available, HSA (Health Savings Account) and FSA (Flexible Spending Account)or do not use them to their full potential.

Both of them allow funds to be put into an account and not taxed going in or coming out, as long as it is for valid IRS approved services, such as medical, dental, vision and prescriptions costs.

To simplify what they are I have the following guidelines:

HSA- Health Savings Account

1.                   Must be enrolled in a qualifying high deductible plan (off exchange)

2.                   Employer and/or individual funded and is entirely owned by the individual, even if terminated

3.                   Funds deposited are not taxable when deposited nor when spent on approved services

4.                   Funds roll over and in some cases can be put into investments within account for higher potential gain in value

5.                   Funds are available once deposited

6.                   Since you have access to the funds for you and your dependents and there is no concern of forfeiture, put as much as possible into this account that meets your household’s needs

FSA- Flexible Spending Account

1.                   No mandatory plan requirements

2.                   Minimum and Maximum guidelines are provided by IRS and Plan decides within those limits

3.                   Typically Employee funded through payroll deduction, but Employer can fund as well. When terminated only funds and claims up to that date can be utilized, unless COBRA is taken or employer allows extension

4.                   Funds are not taxable when deposited nor when paying for valid services

5.                   Currently, there is no rollover and any funds remaining are forfeited to the plan – Be careful to watch your balance

6.                   Plan year specific, must incur within plan year and spend all funds by end of runout period or available funds will be lost

7.                   All funds are usually available from first day of plan year

8.                   Make sure to determine how much you will spend and deposit as close to that or more as meets your household’s needs

 By Robert A. Washick, MBA

Robert Washick

VP/CEO

Professional Benefit Administrators, Inc.

407-671-7331

800-762-4130

fax: 407-671-1580

Thanks Robert!  Hopefully this blog post clears up any misunderstanding of what these accounts are.  Our next post will review what you can use these accounts on and how to use it.  Can you use these accounts at Pursuit Physical Therapy???  Yes and an example of this will be in the next post.

Who has the BEST One-on-One patient care in Orlando, FL? Pursuit Physical Therapy and you can save money!

If you are looking for better patient outcomes, faster results, in fewer visits thus saving you money...Pursuit Physical Therapy is the place for you!

At Pursuit Physical Therapy "We don't meet your expectations of patient care, we exceed them for our patients!"

I have no doubt that my "self pay" and "cash based" model is far better than standard medicine and other standard insurance clinics including:



1.  A better One-on-One care experience for my patients
2.  Better quality of care:  Better results in fewer visits!
3.  No waiting period at the office
4.  Personalized care that is tailored to your needs
5.  Personal relationship with your doctor of physical therapy
6.  No waiting periods to be seen! Scheduled within days of call
7.  Save the patient and the healthcare system money?????

But how do I, as the patient, save money?

If you have a high deductible, high co-pay, flexible spending account, health savings account, or just need to get pain free in fewer visits, this is the post for you.  Not only will your savings be in less money spent, but less time spent receiving care, and better outcomes for a better quality of life.  These are examples of how you can save money in a "self pay" or a "cash based" system.

PATIENT 1: SELF PAY PATIENT WITH ACUTE KNEE PAIN FROM RUNNING

Patient began having knee pain when running and consulted me regarding her pain.  No significant past medical history or no red flags that warranted a referral to a physician.  No need for diagnostic imaging at the time of evaluation and treatment started on the evaluation day.  Patient left evaluation with a decrease in pain already.  I followed up with patient 2 more session within a week with home exercise program being updated each time, and patient was able to return to running pain free in 2 weeks.

Cost:  primary physician appointment, copay plus x-ray, plus orthopedic physician eval plus copay, plus standard physical therapy eval plus co-pays plus treatments 2-3x a week for 4 weeks =  a lot of money out of pocket and with insurance 

Cost: 3 visits at Pursuit Physical Therapy and back to running pain free in 2 weeks $450

PATIENT 2: CHRONIC FOOT PAIN WITH FLEXIBILE SPENDING ACCOUNT

The patient has been complaining of chronic foot pain for years and has already been seen by physician, foot specialist, chiropractor, and physical therapy.  Who knows how much money he has spent with deductibles and co-pays already.  He has already had x-rays and MRI and physician wanted to do surgery but patient does not want surgery.  Patient states heel pain and Achilles pain is not allowing him to perform job task, unable to run, and train.  Again no immediate red flags are present so no need for referral.  Patient has already had diagnostic imaging.  Due to chronic nature, the resulted outcome will take longer but patient should still receive great outcome.  Patient signed up for Running Injury and Heel pain Program for $1500.  After 9 visits, patient has returned to running pain free and continues to respond well.  

Cost of previous healthcare:  > thousands of dollars, deductibles, co-pays, etc

Cost of Pursuit Physical Therapy Running Injury Program = $1500 and pain free return to running in 9 visits.  Who knows how much money and time could have been saved if he came to Pursuit Physical Therapy first???

Not only is Pursuit Physical Therapy a cash based clinic, but many physicians are going cash based also.  The below examples were taken from a physician self pay-conceriege medicine blog.  Just to show you how your physician can help you save money also with self pay services!  

PATIENT 3: SELF-PAY (HAVE HIGH-DEDUCTIBLE AND HEALTH SAVINGS ACCOUNT).  AGE 10

Pt fell and injured arm.  Mom sent message to me over weekend wondering about ER visit.  I told them to come in on Monday and I’d evaluate.  Evaluation was not conclusive, so I sent for x-ray, which showed small fracture.  I suggested ortho, but mother messaged me back saying she talked to a friend who was an ortho and they said to just splint this.  I checked on the recommendation and agreed.  Child was in splinted, had repeat x-ray which was better, and given permission to do sports again.

In my old office, without messaging mom would likely have chosen to go to the ER.  If not, would have seen me and would not have communicated with me about her friend’s advice (and I wouldn’t have had time to listen), so cost would have been quite a bit higher.

Cost: 2 x-rays of the forearm – cash price of x-rays $80 each, so total cost of $160

Cost savings: Avoided ER visit and specialist visits.

PATIENT 3: SELF-PAY.  AGE: 40′S

History of migraines, better with Topamax as a prophylactic drug.  Can’t take it due to monthly cost.  I found a cheaper cost, but then the price went up dramatically.  Pt came to me saying they had to stop the medication, as it was costing more than $120 per month.  I personally called pharmacy, who said that the cost for them was high, but then noted another local pharmacy had it on their $4 drug list and that they would match anyone’s price.  I passed this on to the patient.

In my old office would have required payment for an office visit to talk to me about this, and would not likely have had time to research the cheaper price.

Cost: $4 per month.

Cost Savings: $116 per month and significantly improving quality of life.

PATIENT 4: COMMERCIAL INSURANCE.  AGE: 40′S

Significant head injury with out loss of consciousness.  Pt had some change in mental status (dazed), some nausea, dizziness.  Came to my office directly.  I evaluated, determined low risk for subdural bleed, more likely concussion injury.  Ordered noncontrasted CT of head and stayed in office for 2 hours before test could be done.  We re-evaluated over time and progressively got better.  CT scan was negative.  I called and did phone follow-up over the next few days and pt recovered completely.

Cost:  CT of head: $300

Savings:  ER visit and workup for head injury with altered mental status.   Cost: ?

The examples above show the cost benefit in time, money, and outcomes that a cash based system can provide.  At Pursuit Physical Therapy we pride ourselves in showing better outcomes, in fewer visits for our patients.  In the long term:  saving them money, saving them time, and returning to the activities they love and enjoy.  Visit PursuitTherapy.com for more information or call us at 407-494-8835 and schedule a consultation today.

Are you tired of running in pain? Let me tell you how I went from not running, having knee pain at week 1, to running 9 miles pain free in week 2!

So, I have been wanting to get back into running lately and hopefully to run in my first half marathon in 2 months.  I used to be a very active runner but have not ran seriously in the past 4 months, with an occasional 2 miles run.  I decided to get active and more involved in local running groups and have joined USA FIT Orlando as a member and a sponsor.  2 weeks ago I committed to running a 9 mile run with a patient of mine and with the group.  What was I thinking?  At 1 week, I attempted to run 6 miles after a few small pain free runs, and experienced an acute flare up of left knee pain.  3 days later, I was able to run 9 miles pain free!

This case shows the importance of addressing your running pain early and to solve the problem of your pain, not to treat the pain.  So what caused the left knee pain?  Eventhough, I had knee pain, I did not have a knee problem.  My problem, or the true cause of my pain, was left hip muscle weakness.  My whole left leg is weaker when compared to my right leg.  My left hip muscle weakness was causing altered knee biomechanics at my knee, thus resulting in patellar tendon pain, during, after, and for 2 days after my run.  Below is a picture that shows an example of what occurs with hip muscle weakness and its result at the knee.

I also had trigger points in my left quad and lateral leg.  The cause of trigger points is a topic for another blog posts, but when overloading a weak muscle, trigger points occur, and can have an affect on my knee pain.  Many people attempt stretching, but stretch of my IT band was not my problem.  My bigger problem was that I was scheduled to run 9 miles in 2 days but I was having left knee pain still, even 2 days after my run.  So what did I do to get pain free in 2 days and be able to run 9 miles pain free?

1)  2 days of rest

I did not continue to run in pain and just hope that the pain would go away.  Another thing is, DO NOT TAKE A PAIN RELIEVER OR ADVIL AND RUN.  This is a definite DO NOT DO for all of my runners.   There are numerous side effects of taking anti-inflammatories when running.  If I would have ran in pain I would have just exacerbated my pain and then I probably would have not been able to run my 9 miles in 2 days.

2)  Avoid over training

Simply stated.  No need to train in pain.

3)  Addressed the cause of my pain

I immediately started foam rolling to my lateral left leg and left quad to resolve the trigger points.  I started to address my left hip muscle weakness with exercises at home and in the clinic.  I also added some eccentric training to my left quad in a pain free range of motion.  This was correcting the cause of my pain.

http://www.youtube.com/watch?v=nsZiCStiJqg&list=PLwLS88Fgo0BkQ0Yre4XbsnOymp9NDC0yx&index=2

On Saturday morning, 3 days after my injury, I was pain free but I did not want to re-aggravate my injury.  My goal was just to complete the 9 mile run pain free since I have just started running and was not trained.  I was not concerned with my time but just wanted to complete the distance and workload.  I ran a 4 minute run, 1 minute walk for 9 miles.  I completed the run pain free and had no complaints!

At Pursuit Physical Therapy we specialize in the treatment of running injuries and we understand what it takes and the importance of training for a race.  There is no need to run in pain, and if addressed early, you can solve the problem that is causing your pain and get back to pain free running in just a few days.  We have also designed a proven Running Injury Program specifically for runners!  Feel free to call us at 407-494-8835 to schedule a consultation or visit us at PursuitTherapy.com today!  Get back to pain free running now!

Why does my arm hurt after breast cancer surgery? Can physical therapy help?

Since October is Breast Cancer Awareness Month and Pursuit Physical Therapy is sponsoring 2 breast cancer awareness events this weekend, today's post will be about....breast cancer.

Breast cancer and surgery

Breast cancer is now the most frequently diagnosed cancer and the leading global cause of cancer death in women, accounting for 23% of cancer diagnoses and 14% of cancer deaths.  Metastatic disease, or the spread of tumor cells throughout the body, is responsible for the vast majority of cancer patient deaths. The decrease in breast cancer-related deaths is mainly attributed in part to improved screening, and the early detection of breast cancer.  Unfortunately, many women diagnosed with breast cancer will opt to have some type of  surgery. There are different types of breast surgery that are performed and this is fully discussed with the individual and their surgeon.

Following breast surgery, either a mastectomy or involving the armpit, patients will be encouraged to start moving your arm in a controlled range of motion to help prevent the arm from becoming stiff and sometimes painful. There can also be swelling and pain as a result of the procedure. There are many barriers to post-op rehabilitation but a successful outcome is expected and many patients can return to activities 2-4 weeks after surgery.  Many of these complaints and post symptoms are common after any surgery but the sometimes arm is affected due to the removal of tissue that involves the chest and the arm. 

After your surgery

In general, women having a mastectomy and/or axillary (arm pit) lymph node dissection stay in the hospital for 1 or 2 nights and then go home. However, some women may be placed in a 23-hour, short-stay observation unit before going home.

Less involved operations such as breast-conserving surgery and sentinel lymph node biopsy are usually done in an outpatient surgery center, and an overnight stay in the hospital is usually not needed.

You may have a dressing (bandage) over the surgery site that may wrap snugly around your chest. You may have one or more drains (plastic or rubber tubes) coming out from the breast or underarm area to remove blood and lymph fluid that collects during the healing process. You will be taught how to care for the drains, which may include emptying and measuring the fluid and identifying problems the doctor or nurse needs to know about. Most drains stay in place for 1 or 2 weeks. When drainage has decreased to about 30 cc (1 fluid ounce) each day, the drain will usually be removed.

Most doctors will want you to start moving your arm soon after surgery so that it won't get stiff.  Understandably there is some pain after the surgery.

Recovery and Rehabilitation

How long it takes to recover from breast cancer surgery depends on what procedures were done. Most women can return to their regular activities within 2 -4 weeks. It can take up to 4 weeks after a mastectomy. Recovery time is longer if reconstruction was done as well, and it can take months to return to full activity after some procedures. Still, these times can vary from person to person, so you should talk to your doctor about what you can expect.

Even after the doctor clears you to return to your regular level of activity, though, you could still feel some effects of surgery. You might feel stiff or sore for some time. The skin of your chest or underarm area may feel tight. These feelings tend to improve over time. Some women have problems with pain, numbness, or tingling in the chest and arm that continues for a long time after surgery.  Many women who have breast-conserving surgery or mastectomy are often surprised by how little pain they have in the breast area. But they are less happy with the strange sensations (numbness, pinching/pulling feeling) they may feel in the underarm area.

Some women have problems with nerve (neuropathic) pain in the chest wall, armpit, and/or arm after surgery that doesn’t go away over time. This is called post-mastectomy pain syndrome (PMPS) because it was first described in women who had mastectomies, but it occurs after breast-conserving therapy, as well. Studies have shown that between 20% and 30% of women develop symptoms of PMPS after surgery. The classic symptoms of PMPS are pain and tingling in the chest wall, armpit, and/or arm. Pain may also be felt in the shoulder or surgical scar. Other common complaints include numbness, shooting or pricking pain, or unbearable itching. Most women with PMPS say their symptoms are not severe.

PMPS is thought to be linked to damage done to the nerves in the armpit and chest during surgery. But the causes are not known. Women who are younger, had a full ALND (not just SLNB), or who were treated with radiation after surgery are more likely to have problems with PMPS. Because ALNDs are done less often now, PMPS is less common than it once was.

It is important to talk to your doctor about any pain you are having. PMPS can cause you to not use your arm the way you should and over time you could lose the ability to use it normally.  Post operative physical therapy and rehabilitation can help with any chronic pain, decreased range of motion, fear-avoidance, and strength impairments that may persist after surgery.

Early detection is essential to getting a great outcome, so spread breast cancer awareness.  If you happen to receive surgery for your breast cancer, we can help get you.  If you have any persistent complaints of pain difficulty using your arm after breast cancer surgery, call Pursuit Physical Therapy at 407-494-8835 or visit us at at PursuitTherapy.com for more information.  We can help regain your motion and decrease your pain, and get back to the activities you love!

Come see us on October 20th at the JCC in Maitland from 9am - 1 pm to help support breast cancer awareness with this great fundraiser.

How does wearing heels affect your feet and the rest of your body?

Are you having difficulty wearing your favorite heels because of foot and knee pain?  Having low back pain when wearing heels?  Well, below is a picture of how wearing heels affects the feet and the rest of the body maybe predisposing you to getting your pain.  

We can help address some of the problems that can present with wearing high heels.  We can correct the problems, address any impairments, to help get you back to wearing the shoes you love.  Call us at 407-494-8835 or visit us at PursuitTherapy.com to schedule an appointment today!  Get back to being pain free in your favorite heels!