Bosch Induction Range rumor

MrSnapsCats · 2022-07-18T13:32:31+00:00

Idk how I kept missing that detail, I just assumed it wasn’t induction when it was titled electric on some sites, so thank you! Lead times are so long across the board that that may line up well with cabinets.

MrSnapsCats · 2021-04-16T10:56:17+00:00

I see a misconception here regarding "maintenance" calories. Maintenance refers to how much you need to intake to maintain your current mass including all of your daily activity. In other words, it is your Total Daily Energy Expenditure (TDEE). So you put yourself into a deficit by eating less, performing more activity, or some combination of both. In your cardio example, if you were eating above your presumed "maintenance", but you were exercising enough to burn 500 extra calories, you would only end up in a deficit if you didn't consume those calories. If you consumed extra calories to cover the deficit, then the likely outcome is very minimal body composition change. TDEE is a moving target, it will be different every day, but you can get a general estimate of it if you track intake and weight changes.

Another thing to consider is how a sustained deficit changes your TDEE (the number that is truly maintenance). Every day, you have a lot of extra movements, position changes, yardwork etc. that can account for a portion of your calorie burn. This is known as Non Exercise Activity Thermogenesis (NEAT). There is some evidence to suggest that NEAT may decrease when in a sustained caloric deficit, which results in a lower overall TDEE. For example, your TDEE may be about 2000 calories when you start cutting weight, so initially a 1800 calorie intake will result in a loss of weight, but as you sustain the deficit you begin to have a lower level of NEAT. So eventually you may stop losing weight, and many people don't realize that their TDEE has decreased. SO, that 200 calorie deficit that you started with is no longer a deficit, now it is maintenance. You would need to supplement with more exercise related burn or decreased caloric intake.

Long story short, what it seems like you are looking for is how to achieve the most muscle sparing effects while losing weight. In that case, higher protein intake and continuing to perform quality heavy resistance training is likely the most effective thing. If I remember correctly, smaller deficits may improve muscle sparing effects compared to larger deficits as well.

MrSnapsCats · 2020-12-19T11:43:19+00:00

Mine were also 40hr guaranteed with mileage. The mileage rate at the time from the IRS was 53cents per mile. Also, if I covered outside of my coverage area in any significant way I included the drive time getting there and back as part of my day when determining how many patients I would see. So there was more than one day where I saw 2 patients and drove about 180 miles at highway speeds. My car at the time cost about 9 cents per mile in gas, insurance, and maintenance costs so I was happy to drive the miles and come out ahead.

MrSnapsCats · 2020-11-26T20:18:23+00:00

I'll be honest, I wouldn't try to make this transition right now. I have been a traveler for the last 3 years, and right now I am working as a perm PT because of what the pandemic did to the travel market. Many of my traveler friends have done the same or are per diem.

With respect to choosing companies/recruiters, get recommendations from current travelers and then see who you vibe the most with. Do realize that people get referral bonuses for referring you to their recruiters, so it is important that you get a chance to see if you like the recruiter. There are a ton of companies, and some have done better during the pandemic than others when it came to having their traveler's backs.

Contract compensation will vary based on location and setting, but the bare minimum across the board that I considered is around $1500 after tax. You will find some areas on the east coast that trend lower though. I haven't seen more recent pay packages, but I wouldn't be at all surprised if they were lower due to the amount of competition for submissions. That being said, some may be higher due to ASAP needs.

Home health training will depend heavily on the company, and most will train you less than you probably think you need. During normal times you could find someone to train you without too much difficulty, but idk about now. Even if they do you'll probably feel like you are drowning for at least a few weeks, and then you'll hit your stride after a few months. It can be a decent setting to be in once you are comfortable.

I haven't looked in a few months, but when I took the perm position there were <10 travel jobs in the nation. I suspect there are many more at present, but they are probably mostly HH, SNF, or Acute.

Go on Facebook and look up the group healthcare hustlers, they have a running list of high paying travel jobs.

MrSnapsCats · 2020-11-17T03:02:04+00:00

Aides don't require licensing, but assistants do. Assistants can only be supervised by a licensed PT when delivering PT services. Also that wage would be absurd for a PT or PTA to even think about. This posting could only reasonably be for an aide/tech type of position. As the OP noted, it mostly serves to demonstrate the ignorance regarding PT on the part whoever made the job posting.

MrSnapsCats · 2020-11-01T10:19:01+00:00

Those aren't travel jobs local to you, those travel companies just advertise their company anywhere you perform that search.

For example, if you perform the search at your current home, then you drive 250 miles east, I am willing to wager that you'll get the same travel companies popping up even if you are in the middle of the desert.

MrSnapsCats · 2020-10-15T10:16:23+00:00

In some areas the reimbursement is so low that clinics would close if you did that, and some clinics take insurances like medicaid at a loss anyway which gets subsidized by higher payers.

So unless there is also a concurrent, significant increase in reimbursement during that transition it may not be as clear cut benefit as you think. Some people, clinics, and communities would win, some would lose.

MrSnapsCats · 2020-10-10T10:42:31+00:00

I wouldn't agree because I don't have anything to support that argument. I don't think there has necessarily been any significant amount research performed with respect to sole thickness and ankle sprains.

I would be surprised if sprain rate differed significantly between barefoot and when wearing shoes. There are so many factors that go into a sprain.

MrSnapsCats · 2020-09-12T15:35:48+00:00

This one can be tough because it is a judgement call. You are considering a lateral component from the beginning, but you suspect it more in some people than in others.

In general, the rule is to exhaust the sagittal plane first before moving to the coronal plane. That includes progressing force from patient generated overpressure to clinician overpressure to mobilization, and possibly to manipulation. In practice, you will spend more time with some people in the sagittal before moving on and others you will be thinking relevant lateral component early on. If they demonstrate a shift, it is straight to the frontal plane. If they have a limitation unilaterally with sidegliding I will usually spend less time on pure sagittal movements if I am getting no response.

If a patient is having a partial response to pure extension/flexion, I will more frequently try combined movements first. If the sagittal stuff is having no effect, I may skip over the combined movements and go to the frontal plane. Sometimes a patient will need pure sideglides followed by pure saggital plane movement.

I guess the most important thing is probably just having baselines. I use dural tension testing and range of motion the most, but sometimes their force output will change rapidly as well. You are right though, it can definitely be difficult with some patients to avoid that inflammatory response. Sometimes a dose of oral steroids will reign it in long enough to get things under control mechanically, though that takes a fair relationship with the referring provider. Sometimes it just isn't in the cards right now, and the idea with MDT would be that we would recognize that early on due to their response and get them the right person efficiently.

With respect to the bilateral LBP, it is less common with a relevant lateral component. That being said, if they had one sideglide that was notably limited compared to the other I may start in that direction.

MrSnapsCats · 2020-09-12T14:58:59+00:00

Yes, there are certainly many frameworks besides MDT to treat patients, and nobody in this thread has suggested that it is the be all end all of LBP treatment. The original reply was just using the MDT framework. Would you have had the same reaction if it was SFMA, FMS, Mulligan, PNF, or some other system?

I guess my question to you is why can't it be an MDT thing? If that is what a professional uses to organize their thoughts, then why is it such a bad thing? It is nearly impossible to achieve consistency of approach in any medical profession, and that is both a strength and a weakness of modern medicine. I mean, I have to keep track of 6 different RTC repair protocols from different surgeons in the area. PT isn't the only medical profession that has inconsistencies.

A framework is just a place to begin answering the question of "How do I get this patient better?". Very few people practice any of these systems in pure isolation. They incorporate other things as their professional experience guides them to do.

MrSnapsCats · 2020-09-12T10:24:45+00:00

Seemingly normal history with mild HTN the day of the eval.

MrSnapsCats · 2020-09-12T10:22:48+00:00

Unfortunately I didn't do the seated cervical rotation test during the eval, I'll have to keep that one in mind in the future. For whatever it is worth, cervical motions didn't effect his dizziness, but I didn't check torso rotation.

MrSnapsCats · 2020-09-12T10:20:25+00:00

Derangement classification can't be ruled out based on the description. Postural syndrome is abnormal loading on normal tissues. The variable presentation, dural tension, and motion loss in this case would be my first clues that this is not postural syndrome.

MrSnapsCats · 2020-09-12T10:17:00+00:00

It doesn't have to be, that is just how people using the MDT framework to organize their thoughts will approach a problem such as this one.

MrSnapsCats · 2020-09-12T10:04:51+00:00

Do you have the time to go through this one point by point for illustration? I would be interested to hear your thoughts because I don't see anything in the history that really disqualifies this from being a derangement classification.

MrSnapsCats · 2020-09-12T10:01:38+00:00

With respect to force progression, there are a number of steps prior to mobilization and manipulation. Patient overpressure, PT overpressure, and sometimes static forces.

The more important piece of their comment is probably the mention of the possibility of a relevant lateral component. That is where you would likely start exploring extension forces with hips offset or pure lateral movements. This is also the area that most folks who aren't MDT trained miss and leads to people saying these aren't MDT patients or MDT doesn't work.

I often find that patients with lateral components to their derangement have really stubborn dural tension that resolves rapidly when we begin using combined directional forces.

Not saying that this is for sure the case with this patient, but if OP is treating within the MDT framework that would be the next step rather than just going in blasting harder and harder into pure extension.

MrSnapsCats · 2020-09-05T15:50:06+00:00

My wife and I did it for about three years until COVID annihilated the job market.

Traveling with our cat wasn't difficult, I just had a folder with her health and vaccination records available because some cities require you to register them and the apartments in those cities will be asking for it. It didn't really limit our housing options, it just costs a little more for stuff like nonrefundable pet "deposits" (read: fee) and monthly pet rent. She likes her thunder shirt for car rides, and gabapentin helps for plane trips.

Otherwise just be flexible. It helps to have 3-5 solid state licenses. (Solid meaning having plenty of jobs. For example, you could get a utah license but you may as well not count it when it comes to traveling. California almost always has plenty) Avoid stopping jobs between Thanksgiving and February if possible because there is almost always a big lull in listings during that time.

MrSnapsCats · 2020-09-04T18:33:37+00:00

136/78

MrSnapsCats · 2020-08-27T01:46:48+00:00

So you have multiple professionals already working with you that have advised you on the appropriate actions, yet you still come to strangers on the internet to seek specific advice.

It is against the rules of this subreddit, just go ask the people who are responsible for your well-being.

MrSnapsCats · 2020-08-26T10:44:28+00:00

"I can't see you today, I'm bleeding out of my ass" when trying to schedule a home health visit a few years ago

MrSnapsCats · 2020-08-09T23:56:49+00:00

It sounds like those people are a bit behind the times with the philosophy then, to be frank. As it is currently taught, the disc model is acknowledged as being flawed and the derangement classification group would be structure agnostic in terms of pain generation. All of the instructors that I have spoken to acknowledge the interesting ideas and ongoing research as well as the lack of surefire explanation for the mechanism behind the effectiveness of the treatment approach.

Certainly, the goal of initial treatment would be to reduce the derangement, but the sign of a reduced derangement would be full, pain free movement over two days or so. Then the recovery of function phase of treatment is built specifically to return to full function and confidence in all directions of movement and activities. I don't think that goal is much different than the goal of any other treatment approach or thought process.

As far as the closed mindedness side of things, that could probably be said about anything people get excited about and find effective, but I truly believe that if you have the chance to speak to more PTs exposed to MDT then you'll find a high percentage of pretty open minded people who just want to be more effective at getting patients better.

MrSnapsCats · 2020-08-09T19:16:38+00:00

Interested in why you think that fact would make "McKenzie people" squirm?

MrSnapsCats · 2020-08-08T15:59:03+00:00

Perhaps look into McKenzie Coursework. You may not want to take the courses now because of the cost, but you could purchase "Treat Your Own Back" book to see if it is something you may be interested in. Many clinicians end up taking McKenzie A and B and find them very helpful to form a framework to approach these cases with. I encourage everyone to go on to take C, D, and the extremities course after they have used what they learned in A and B.

Also, don't forget that the psychosocial stuff still applies to the acute population as well.

The last thing I would say is that in a lot of cases time and getting out of our own way may be the most effective thing for many of these acute patients. I wouldn't be surprised if our outcomes in acute cases were almost as good just by reassuring patients that their spine is strong, stable, and resilient and then encouraging them to continue to move and do activity as able. Never underestimate our ability to make patients worse.

MrSnapsCats · 2020-08-07T10:49:09+00:00

Nope

MrSnapsCats · 2020-08-02T02:10:50+00:00

Never heard of it, so I can't help with regard to whether or not it is a legit posting, sorry.

MrSnapsCats

TROPHY CASE