Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Hi! was our instructor at Northwestern Univ and I remember there was no real evidence that US is contraindicatory to past cancer. We were just going by what was written in her book. I would like to know what is the true evidence. Hiten Dave' PT On Tue, Nov 15, 2011 at 11:10 AM, Vicki Schiesl-Petska < vschieslpetska@...> wrote: > ** > > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Hello, When you stand behind mentality , it helps to back up mentality with " Evidence based Practice.' I reference all of our mentalities whenever possible with references.. We utilize AOTA, AHSA and APTA resources and references in our policy and procedures. More specifically, we reference the book 'Modalities for Therapeutic Intervention...by Michlovitz, Bellew and Nolan Jr. The Joint Commission and CARF like to see this evidence. Page 101 in the Ultrasound Chapter references US contraindications as follows re Cancer: " in a region of a tumor /Malignancy. " In other words if you are treating the rotator cuff, and they have a prostrate cancer history, I would say you are okay....Just my thoughts....... E. Lynn MS PT Director of Rehabilitation Marlton Rehabilitation Hospital 92 Brick Rd. Marlton, NJ 08055 ext 4204 From: PTManager [mailto:PTManager ] On Behalf Of Vicki Schiesl-Petska Sent: Tuesday, November 15, 2011 2:10 PM To: ptmanager Subject: Ultrasound and Cancer Hello! Our clinic stands behind the mentality that ultrasound should not be used with patient's that have a past medical history of cancer. Recently, we have had some physicians " demanding " that we perform the ultrasound treatment. This situation puts our therapists in an awkward position ethically as it goes against what we are taught. Our Physical Agents book, by , states Ultrasound is contraindicated with the statement being " cancer may metastasize due to the increased blood flow. " I am unable to find information supporting either standpoint of against or for. Does anyone have any information supporting either standpoint? Thanks! Vicki Vicki Schiesl-Petska,PTA,CPI Physical Therapist Assistant Documentation Specialist HFM-Rehab Plus vschieslpetska@...<mailto:vschieslpetska%40hfmhealth.org> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Hello, When you stand behind mentality , it helps to back up mentality with " Evidence based Practice.' I reference all of our mentalities whenever possible with references.. We utilize AOTA, AHSA and APTA resources and references in our policy and procedures. More specifically, we reference the book 'Modalities for Therapeutic Intervention...by Michlovitz, Bellew and Nolan Jr. The Joint Commission and CARF like to see this evidence. Page 101 in the Ultrasound Chapter references US contraindications as follows re Cancer: " in a region of a tumor /Malignancy. " In other words if you are treating the rotator cuff, and they have a prostrate cancer history, I would say you are okay....Just my thoughts....... E. Lynn MS PT Director of Rehabilitation Marlton Rehabilitation Hospital 92 Brick Rd. Marlton, NJ 08055 ext 4204 From: PTManager [mailto:PTManager ] On Behalf Of Vicki Schiesl-Petska Sent: Tuesday, November 15, 2011 2:10 PM To: ptmanager Subject: Ultrasound and Cancer Hello! Our clinic stands behind the mentality that ultrasound should not be used with patient's that have a past medical history of cancer. Recently, we have had some physicians " demanding " that we perform the ultrasound treatment. This situation puts our therapists in an awkward position ethically as it goes against what we are taught. Our Physical Agents book, by , states Ultrasound is contraindicated with the statement being " cancer may metastasize due to the increased blood flow. " I am unable to find information supporting either standpoint of against or for. Does anyone have any information supporting either standpoint? Thanks! Vicki Vicki Schiesl-Petska,PTA,CPI Physical Therapist Assistant Documentation Specialist HFM-Rehab Plus vschieslpetska@...<mailto:vschieslpetska%40hfmhealth.org> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Hello, When you stand behind mentality , it helps to back up mentality with " Evidence based Practice.' I reference all of our mentalities whenever possible with references.. We utilize AOTA, AHSA and APTA resources and references in our policy and procedures. More specifically, we reference the book 'Modalities for Therapeutic Intervention...by Michlovitz, Bellew and Nolan Jr. The Joint Commission and CARF like to see this evidence. Page 101 in the Ultrasound Chapter references US contraindications as follows re Cancer: " in a region of a tumor /Malignancy. " In other words if you are treating the rotator cuff, and they have a prostrate cancer history, I would say you are okay....Just my thoughts....... E. Lynn MS PT Director of Rehabilitation Marlton Rehabilitation Hospital 92 Brick Rd. Marlton, NJ 08055 ext 4204 From: PTManager [mailto:PTManager ] On Behalf Of Vicki Schiesl-Petska Sent: Tuesday, November 15, 2011 2:10 PM To: ptmanager Subject: Ultrasound and Cancer Hello! Our clinic stands behind the mentality that ultrasound should not be used with patient's that have a past medical history of cancer. Recently, we have had some physicians " demanding " that we perform the ultrasound treatment. This situation puts our therapists in an awkward position ethically as it goes against what we are taught. Our Physical Agents book, by , states Ultrasound is contraindicated with the statement being " cancer may metastasize due to the increased blood flow. " I am unable to find information supporting either standpoint of against or for. Does anyone have any information supporting either standpoint? Thanks! Vicki Vicki Schiesl-Petska,PTA,CPI Physical Therapist Assistant Documentation Specialist HFM-Rehab Plus vschieslpetska@...<mailto:vschieslpetska%40hfmhealth.org> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Group, To answer the question, our policy is cancer free for at least 6 months, and if more than 6 months cancer-free, a PET scan showing cancer free within the past 6 months. An oncologist, and only and oncologist, can over-ride for pain control if necessary. I am a little troubled by the language being used here. Physicians don't get to " demand " that ultrasound be performed any more than we as physical therapists get to demand what surgery is performed, or what type of imaging studies get performed. In a collaborative relationship, in the best interests of autonomous interdependent practice, clinical doctors ASK or REQUEST. Now I'm sure that some of you out there will pull the, " But we have to please the referring physician, " and that's true but in 16 years of practice, I've never had an MD upset with a patient doing well with manual/manipulative, therex, and NMR . . . and nevertheless demand US or TENS as a " Do it because I'm the doctor and I said so " power trip. Any therapist in such a situation should, in my opinion, seriously self-review the quality and efficiency of the care they provide to their patients. Sure, there are patients here and there where a little pre-therapy US is helpful, I've yet to see any study showing that ultrasound makes, breaks, or even enhances quality physical therapy care as a matter of every-patient standard of care. That, however, isn't the question you asked. The issue you raise as a PTA is a simple one. PTA stands for " physical therapIST's assistant, " not " physical therapy assistant. " As such, it's not really in the scope of practice of a physical therapIST's assistant to decide if US should be part of the plan of care, or not. This is, as a mater of law, a matter of clinical decision making (e.g. assessment) that falls under the scope of practice of the supervising PT to sort-out, not the PTA. If the PT has decided against using US, it is NOT for the PTA to add it to the POC, even if the physician demands. The PTA that disagrees with a PT who has included US in their plan of care with the patient with cancer is, I agree, in a much more awkward position. Most oncologists agree that the heating of metastatic tissue won't go much beyond that which can be internally generated with vigorous exercise. The problem, therefore, is generally more of a risk management one than a clinical one. (I'm not advocating using US over metastatic tissue, mind you, but in areas far from the metastasis, what's the true risk? On the other hand, what's the point?) I am not aware of a single case of a PT being sued for spreading metastasis with US, but it may be informative to shoot an e-mail off to HPSO. That, frankly, may be the best rationale for not doing US in a patient with cancer . . . the same reason we don't generally advise doing manipulations in pregnant women between 12-16 weeks (that's when most spontaneous rejections occur) . . . no one wants to be called into court and blamed for something for which there really isn't a cause and effect relationship. In closing, I've only had one physician in 16 years that demanded " US and nothing else 3x/week x 6 weeks " for his patients s/p spinal surgery. Eventually, my supervisor at the time and I eventually had to respectfully request that he send his business to our competitor. Five years later, about 75% of the physical therapists and clinics in our area have responded to this physician in a similar way. Respectfully, Dr. M. Ball, PT, DPT, PhD Carolinas Rehabilitation, Orthopedic Physical Therapy Resident Charlotte, NC On Tue, Nov 15, 2011 at 2:10 PM, Vicki Schiesl-Petska < vschieslpetska@...> wrote: > ** > > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Group, To answer the question, our policy is cancer free for at least 6 months, and if more than 6 months cancer-free, a PET scan showing cancer free within the past 6 months. An oncologist, and only and oncologist, can over-ride for pain control if necessary. I am a little troubled by the language being used here. Physicians don't get to " demand " that ultrasound be performed any more than we as physical therapists get to demand what surgery is performed, or what type of imaging studies get performed. In a collaborative relationship, in the best interests of autonomous interdependent practice, clinical doctors ASK or REQUEST. Now I'm sure that some of you out there will pull the, " But we have to please the referring physician, " and that's true but in 16 years of practice, I've never had an MD upset with a patient doing well with manual/manipulative, therex, and NMR . . . and nevertheless demand US or TENS as a " Do it because I'm the doctor and I said so " power trip. Any therapist in such a situation should, in my opinion, seriously self-review the quality and efficiency of the care they provide to their patients. Sure, there are patients here and there where a little pre-therapy US is helpful, I've yet to see any study showing that ultrasound makes, breaks, or even enhances quality physical therapy care as a matter of every-patient standard of care. That, however, isn't the question you asked. The issue you raise as a PTA is a simple one. PTA stands for " physical therapIST's assistant, " not " physical therapy assistant. " As such, it's not really in the scope of practice of a physical therapIST's assistant to decide if US should be part of the plan of care, or not. This is, as a mater of law, a matter of clinical decision making (e.g. assessment) that falls under the scope of practice of the supervising PT to sort-out, not the PTA. If the PT has decided against using US, it is NOT for the PTA to add it to the POC, even if the physician demands. The PTA that disagrees with a PT who has included US in their plan of care with the patient with cancer is, I agree, in a much more awkward position. Most oncologists agree that the heating of metastatic tissue won't go much beyond that which can be internally generated with vigorous exercise. The problem, therefore, is generally more of a risk management one than a clinical one. (I'm not advocating using US over metastatic tissue, mind you, but in areas far from the metastasis, what's the true risk? On the other hand, what's the point?) I am not aware of a single case of a PT being sued for spreading metastasis with US, but it may be informative to shoot an e-mail off to HPSO. That, frankly, may be the best rationale for not doing US in a patient with cancer . . . the same reason we don't generally advise doing manipulations in pregnant women between 12-16 weeks (that's when most spontaneous rejections occur) . . . no one wants to be called into court and blamed for something for which there really isn't a cause and effect relationship. In closing, I've only had one physician in 16 years that demanded " US and nothing else 3x/week x 6 weeks " for his patients s/p spinal surgery. Eventually, my supervisor at the time and I eventually had to respectfully request that he send his business to our competitor. Five years later, about 75% of the physical therapists and clinics in our area have responded to this physician in a similar way. Respectfully, Dr. M. Ball, PT, DPT, PhD Carolinas Rehabilitation, Orthopedic Physical Therapy Resident Charlotte, NC On Tue, Nov 15, 2011 at 2:10 PM, Vicki Schiesl-Petska < vschieslpetska@...> wrote: > ** > > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2011 Report Share Posted November 15, 2011 Hello, Vicki. Respectfully, I submit that the ethical dilemma is not whether to provide US treatment to a person with cancer or, more globally, whether to follow a physician's order to provide a questionable treatment. The dilemma is whether it is ethical to withhold treatment without giving the patient the option of accepting or refusing. It is not the decision of the MD *or* the PT. The patient ultimately decides the course of treatment. The APTA's Code of Ethics (Principles 2C and 2D) addresses informed consent and the patient's role as the decision-maker. As licensed professionals, don't we obtain (and document) informed consent for all interventions? This means that we have to be aware of and able to communicate the evidence-based risks and benefits to the patient or surrogate, address his/her questions/concerns, then respect the decision. Many PT interventions have physiologic effects similar to that of US, but could benefit patients with active malignancies. In these instances, I contact the patient's oncologist for guidance as to the risks to the patient in question, and include the information and oncologist's recommendations in my informed consent document. Diane , PT Augusta, GA > ** > > > Hello, > > When you stand behind mentality , it helps to back up mentality with > " Evidence based Practice.' > I reference all of our mentalities whenever possible with references.. We > utilize AOTA, AHSA and APTA resources and references in our policy and > procedures. More specifically, we reference the book 'Modalities for > Therapeutic Intervention...by Michlovitz, Bellew and > Nolan Jr. > The Joint Commission and CARF like to see this evidence. > Page 101 in the Ultrasound Chapter references US contraindications as > follows re Cancer: > " in a region of a tumor /Malignancy. " > In other words if you are treating the rotator cuff, and they have a > prostrate cancer history, I would say you are okay....Just my > thoughts....... > > E. Lynn MS PT > Director of Rehabilitation > Marlton Rehabilitation Hospital > 92 Brick Rd. > Marlton, NJ 08055 > ext 4204 > From: PTManager [mailto:PTManager ] On > Behalf Of Vicki Schiesl-Petska > Sent: Tuesday, November 15, 2011 2:10 PM > To: ptmanager > Subject: Ultrasound and Cancer > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@...<mailto:vschieslpetska%40hfmhealth.org> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Well said!!!! Both my clinics and I feel the same way!! Ruchin, PT, DPT Atlanta Rehabilitation and Performance Center, Inc. bruchin@... www.atlantarehab.com <http://www.atlantarehab.com/> ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Ball Sent: Tuesday, November 15, 2011 5:09 PM To: PTManager Subject: Re: Ultrasound and Cancer Group, To answer the question, our policy is cancer free for at least 6 months, and if more than 6 months cancer-free, a PET scan showing cancer free within the past 6 months. An oncologist, and only and oncologist, can over-ride for pain control if necessary. I am a little troubled by the language being used here. Physicians don't get to " demand " that ultrasound be performed any more than we as physical therapists get to demand what surgery is performed, or what type of imaging studies get performed. In a collaborative relationship, in the best interests of autonomous interdependent practice, clinical doctors ASK or REQUEST. Now I'm sure that some of you out there will pull the, " But we have to please the referring physician, " and that's true but in 16 years of practice, I've never had an MD upset with a patient doing well with manual/manipulative, therex, and NMR . . . and nevertheless demand US or TENS as a " Do it because I'm the doctor and I said so " power trip. Any therapist in such a situation should, in my opinion, seriously self-review the quality and efficiency of the care they provide to their patients. Sure, there are patients here and there where a little pre-therapy US is helpful, I've yet to see any study showing that ultrasound makes, breaks, or even enhances quality physical therapy care as a matter of every-patient standard of care. That, however, isn't the question you asked. The issue you raise as a PTA is a simple one. PTA stands for " physical therapIST's assistant, " not " physical therapy assistant. " As such, it's not really in the scope of practice of a physical therapIST's assistant to decide if US should be part of the plan of care, or not. This is, as a mater of law, a matter of clinical decision making (e.g. assessment) that falls under the scope of practice of the supervising PT to sort-out, not the PTA. If the PT has decided against using US, it is NOT for the PTA to add it to the POC, even if the physician demands. The PTA that disagrees with a PT who has included US in their plan of care with the patient with cancer is, I agree, in a much more awkward position. Most oncologists agree that the heating of metastatic tissue won't go much beyond that which can be internally generated with vigorous exercise. The problem, therefore, is generally more of a risk management one than a clinical one. (I'm not advocating using US over metastatic tissue, mind you, but in areas far from the metastasis, what's the true risk? On the other hand, what's the point?) I am not aware of a single case of a PT being sued for spreading metastasis with US, but it may be informative to shoot an e-mail off to HPSO. That, frankly, may be the best rationale for not doing US in a patient with cancer . . . the same reason we don't generally advise doing manipulations in pregnant women between 12-16 weeks (that's when most spontaneous rejections occur) . . . no one wants to be called into court and blamed for something for which there really isn't a cause and effect relationship. In closing, I've only had one physician in 16 years that demanded " US and nothing else 3x/week x 6 weeks " for his patients s/p spinal surgery. Eventually, my supervisor at the time and I eventually had to respectfully request that he send his business to our competitor. Five years later, about 75% of the physical therapists and clinics in our area have responded to this physician in a similar way. Respectfully, Dr. M. Ball, PT, DPT, PhD Carolinas Rehabilitation, Orthopedic Physical Therapy Resident Charlotte, NC On Tue, Nov 15, 2011 at 2:10 PM, Vicki Schiesl-Petska < vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> > wrote: > ** > > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Hi Vicki, Probably the best way to understand therapeutic ultrasound used in physical therapy and cancer is to better understand the process of how cancer metastasizes. I know from grad school and what was told to our class that I had a picture in my mind of ultrasound waves causing tumors to vibrate so hard that they'd break off and then the heat created from the ultrasound increasing the blood supply to either the tumor to help it grow or to help the busted off cells more easily travel to a different location and set up shop there creating the metastasized tumor. Reality is... the physiology of a tumor metastasizing is complicated. And then, once a cell breaks off and begins traveling... even that is complicated. http://www.mycanceradvisor.com/2009/12/15/metastasis-how-does-cancer-spread-to-o\ ther-parts-of-the-body/ In reading literature on cancer, it is highly unlikely therapeutic ultrasound is going to cause a cell to break off from a tumor. The action of a cell breaking off is dependent upon enzymes (page 3 of PDF): http://sm.nwsuaf.edu.cn/mb/admin/upload/files/gzk/MCB5e%20Textbook/c23.pdf And when we discuss blood flow and increasing blood flow via heat, tumors require blood to grow yes, but it isn't the increased blood flow that causes them to grow... tumors grow via angiogenesis. The tumors have to secrete growth factors for this to occur. (page 4 of PDF) http://sm.nwsuaf.edu.cn/mb/admin/upload/files/gzk/MCB5e%20Textbook/c23.pdf One other thought to leave you with. We worry about therapeutic ultrasound causing increased blood flow via " heat " generated as being problematic for tumors and metastasizing. Do we worry about the bodily core temperature increasing with exercise? Best example I can think of is Lance Armstrong. I can assure you, his core temperature was maintained at a much higher level than normal for hours on end as he competed. Was anyone worried about his history of cancer being problematic (for potential tumor growth)? Selena Horner, PT ton, MI > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Diane, I also respectfully submit to you, although the Physician has every right to order what they want and the patient has the ultimate decision to accept or refuse any particular treatment, every licensed provider has the right to decide what course of treatment(s) they are willing to deliver. If through their research and own experience have found a particular treatment not to be helpful and/or possibly to be detrimental they should not be forced to deliver a treatment due to the Physician's or the patient's desire. In the end the Therapist will be the one that will have to justify or defend their decisions and actions. Instead I would explain to the patient and Physician my reasoning and if is still desired I would assist them the best I could in finding other resources for their care. Joe Trpcic PT From: PTManager [mailto:PTManager ] On Behalf Of Diane Sent: Wednesday, November 16, 2011 12:30 AM To: PTManager Subject: Re: RE: Ultrasound and Cancer Hello, Vicki. Respectfully, I submit that the ethical dilemma is not whether to provide US treatment to a person with cancer or, more globally, whether to follow a physician's order to provide a questionable treatment. The dilemma is whether it is ethical to withhold treatment without giving the patient the option of accepting or refusing. It is not the decision of the MD *or* the PT. The patient ultimately decides the course of treatment. The APTA's Code of Ethics (Principles 2C and 2D) addresses informed consent and the patient's role as the decision-maker. As licensed professionals, don't we obtain (and document) informed consent for all interventions? This means that we have to be aware of and able to communicate the evidence-based risks and benefits to the patient or surrogate, address his/her questions/concerns, then respect the decision. Many PT interventions have physiologic effects similar to that of US, but could benefit patients with active malignancies. In these instances, I contact the patient's oncologist for guidance as to the risks to the patient in question, and include the information and oncologist's recommendations in my informed consent document. Diane , PT Augusta, GA On Tue, Nov 15, 2011 at 4:11 PM, Lynn <SLynn@... <mailto:SLynn%40marltonrehab.com> > wrote: > ** > > > Hello, > > When you stand behind mentality , it helps to back up mentality with > " Evidence based Practice.' > I reference all of our mentalities whenever possible with references.. We > utilize AOTA, AHSA and APTA resources and references in our policy and > procedures. More specifically, we reference the book 'Modalities for > Therapeutic Intervention...by Michlovitz, Bellew and > Nolan Jr. > The Joint Commission and CARF like to see this evidence. > Page 101 in the Ultrasound Chapter references US contraindications as > follows re Cancer: > " in a region of a tumor /Malignancy. " > In other words if you are treating the rotator cuff, and they have a > prostrate cancer history, I would say you are okay....Just my > thoughts....... > > E. Lynn MS PT > Director of Rehabilitation > Marlton Rehabilitation Hospital > 92 Brick Rd. > Marlton, NJ 08055 > ext 4204 > From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On > Behalf Of Vicki Schiesl-Petska > Sent: Tuesday, November 15, 2011 2:10 PM > To: ptmanager <mailto:ptmanager%40yahoogroups.com> > Subject: Ultrasound and Cancer > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> <mailto:vschieslpetska%40hfmhealth.org> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Diane, I also respectfully submit to you, although the Physician has every right to order what they want and the patient has the ultimate decision to accept or refuse any particular treatment, every licensed provider has the right to decide what course of treatment(s) they are willing to deliver. If through their research and own experience have found a particular treatment not to be helpful and/or possibly to be detrimental they should not be forced to deliver a treatment due to the Physician's or the patient's desire. In the end the Therapist will be the one that will have to justify or defend their decisions and actions. Instead I would explain to the patient and Physician my reasoning and if is still desired I would assist them the best I could in finding other resources for their care. Joe Trpcic PT From: PTManager [mailto:PTManager ] On Behalf Of Diane Sent: Wednesday, November 16, 2011 12:30 AM To: PTManager Subject: Re: RE: Ultrasound and Cancer Hello, Vicki. Respectfully, I submit that the ethical dilemma is not whether to provide US treatment to a person with cancer or, more globally, whether to follow a physician's order to provide a questionable treatment. The dilemma is whether it is ethical to withhold treatment without giving the patient the option of accepting or refusing. It is not the decision of the MD *or* the PT. The patient ultimately decides the course of treatment. The APTA's Code of Ethics (Principles 2C and 2D) addresses informed consent and the patient's role as the decision-maker. As licensed professionals, don't we obtain (and document) informed consent for all interventions? This means that we have to be aware of and able to communicate the evidence-based risks and benefits to the patient or surrogate, address his/her questions/concerns, then respect the decision. Many PT interventions have physiologic effects similar to that of US, but could benefit patients with active malignancies. In these instances, I contact the patient's oncologist for guidance as to the risks to the patient in question, and include the information and oncologist's recommendations in my informed consent document. Diane , PT Augusta, GA On Tue, Nov 15, 2011 at 4:11 PM, Lynn <SLynn@... <mailto:SLynn%40marltonrehab.com> > wrote: > ** > > > Hello, > > When you stand behind mentality , it helps to back up mentality with > " Evidence based Practice.' > I reference all of our mentalities whenever possible with references.. We > utilize AOTA, AHSA and APTA resources and references in our policy and > procedures. More specifically, we reference the book 'Modalities for > Therapeutic Intervention...by Michlovitz, Bellew and > Nolan Jr. > The Joint Commission and CARF like to see this evidence. > Page 101 in the Ultrasound Chapter references US contraindications as > follows re Cancer: > " in a region of a tumor /Malignancy. " > In other words if you are treating the rotator cuff, and they have a > prostrate cancer history, I would say you are okay....Just my > thoughts....... > > E. Lynn MS PT > Director of Rehabilitation > Marlton Rehabilitation Hospital > 92 Brick Rd. > Marlton, NJ 08055 > ext 4204 > From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On > Behalf Of Vicki Schiesl-Petska > Sent: Tuesday, November 15, 2011 2:10 PM > To: ptmanager <mailto:ptmanager%40yahoogroups.com> > Subject: Ultrasound and Cancer > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> <mailto:vschieslpetska%40hfmhealth.org> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Diane, I also respectfully submit to you, although the Physician has every right to order what they want and the patient has the ultimate decision to accept or refuse any particular treatment, every licensed provider has the right to decide what course of treatment(s) they are willing to deliver. If through their research and own experience have found a particular treatment not to be helpful and/or possibly to be detrimental they should not be forced to deliver a treatment due to the Physician's or the patient's desire. In the end the Therapist will be the one that will have to justify or defend their decisions and actions. Instead I would explain to the patient and Physician my reasoning and if is still desired I would assist them the best I could in finding other resources for their care. Joe Trpcic PT From: PTManager [mailto:PTManager ] On Behalf Of Diane Sent: Wednesday, November 16, 2011 12:30 AM To: PTManager Subject: Re: RE: Ultrasound and Cancer Hello, Vicki. Respectfully, I submit that the ethical dilemma is not whether to provide US treatment to a person with cancer or, more globally, whether to follow a physician's order to provide a questionable treatment. The dilemma is whether it is ethical to withhold treatment without giving the patient the option of accepting or refusing. It is not the decision of the MD *or* the PT. The patient ultimately decides the course of treatment. The APTA's Code of Ethics (Principles 2C and 2D) addresses informed consent and the patient's role as the decision-maker. As licensed professionals, don't we obtain (and document) informed consent for all interventions? This means that we have to be aware of and able to communicate the evidence-based risks and benefits to the patient or surrogate, address his/her questions/concerns, then respect the decision. Many PT interventions have physiologic effects similar to that of US, but could benefit patients with active malignancies. In these instances, I contact the patient's oncologist for guidance as to the risks to the patient in question, and include the information and oncologist's recommendations in my informed consent document. Diane , PT Augusta, GA On Tue, Nov 15, 2011 at 4:11 PM, Lynn <SLynn@... <mailto:SLynn%40marltonrehab.com> > wrote: > ** > > > Hello, > > When you stand behind mentality , it helps to back up mentality with > " Evidence based Practice.' > I reference all of our mentalities whenever possible with references.. We > utilize AOTA, AHSA and APTA resources and references in our policy and > procedures. More specifically, we reference the book 'Modalities for > Therapeutic Intervention...by Michlovitz, Bellew and > Nolan Jr. > The Joint Commission and CARF like to see this evidence. > Page 101 in the Ultrasound Chapter references US contraindications as > follows re Cancer: > " in a region of a tumor /Malignancy. " > In other words if you are treating the rotator cuff, and they have a > prostrate cancer history, I would say you are okay....Just my > thoughts....... > > E. Lynn MS PT > Director of Rehabilitation > Marlton Rehabilitation Hospital > 92 Brick Rd. > Marlton, NJ 08055 > ext 4204 > From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On > Behalf Of Vicki Schiesl-Petska > Sent: Tuesday, November 15, 2011 2:10 PM > To: ptmanager <mailto:ptmanager%40yahoogroups.com> > Subject: Ultrasound and Cancer > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> <mailto:vschieslpetska%40hfmhealth.org> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Dear Joe: The question is if there is any evidence if US is contraindicatory for past history of cancer versus current. Hiten Dave' PT > ** > > > Diane, I also respectfully submit to you, although the Physician has > every right to order what they want and the patient has the ultimate > decision to accept or refuse any particular treatment, every licensed > provider has the right to decide what course of treatment(s) they are > willing to deliver. If through their research and own experience have > found a particular treatment not to be helpful and/or possibly to be > detrimental they should not be forced to deliver a treatment due to the > Physician's or the patient's desire. In the end the Therapist will be > the one that will have to justify or defend their decisions and actions. > > Instead I would explain to the patient and Physician my reasoning and if > is still desired I would assist them the best I could in finding other > resources for their care. > > Joe Trpcic PT > > From: PTManager [mailto:PTManager ] On > Behalf Of Diane > Sent: Wednesday, November 16, 2011 12:30 AM > To: PTManager > Subject: Re: RE: Ultrasound and Cancer > > > Hello, Vicki. Respectfully, I submit that the ethical dilemma is not > whether to provide US treatment to a person with cancer or, more > globally, > whether to follow a physician's order to provide a questionable > treatment. > The dilemma is whether it is ethical to withhold treatment without > giving > the patient the option of accepting or refusing. It is not the decision > of > the MD *or* the PT. The patient ultimately decides the course of > treatment. > > The APTA's Code of Ethics (Principles 2C and 2D) addresses informed > consent > and the patient's role as the decision-maker. As licensed professionals, > don't we obtain (and document) informed consent for all interventions? > This means that we have to be aware of and able to communicate the > evidence-based risks and benefits to the patient or surrogate, address > his/her questions/concerns, then respect the decision. > > Many PT interventions have physiologic effects similar to that of US, > but > could benefit patients with active malignancies. In these instances, I > contact the patient's oncologist for guidance as to the risks to the > patient in question, and include the information and oncologist's > recommendations in my informed consent document. > > Diane , PT > Augusta, GA > > On Tue, Nov 15, 2011 at 4:11 PM, Lynn <SLynn@... > <mailto:SLynn%40marltonrehab.com> > wrote: > > > ** > > > > > > Hello, > > > > When you stand behind mentality , it helps to back up mentality with > > " Evidence based Practice.' > > I reference all of our mentalities whenever possible with references.. > We > > utilize AOTA, AHSA and APTA resources and references in our policy and > > procedures. More specifically, we reference the book 'Modalities for > > Therapeutic Intervention...by Michlovitz, Bellew and > > > Nolan Jr. > > The Joint Commission and CARF like to see this evidence. > > Page 101 in the Ultrasound Chapter references US contraindications as > > follows re Cancer: > > " in a region of a tumor /Malignancy. " > > In other words if you are treating the rotator cuff, and they have a > > prostrate cancer history, I would say you are okay....Just my > > thoughts....... > > > > E. Lynn MS PT > > Director of Rehabilitation > > Marlton Rehabilitation Hospital > > 92 Brick Rd. > > Marlton, NJ 08055 > > ext 4204 > > From: PTManager <mailto:PTManager%40yahoogroups.com> > [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] > > On > > Behalf Of Vicki Schiesl-Petska > > Sent: Tuesday, November 15, 2011 2:10 PM > > To: ptmanager <mailto:ptmanager%40yahoogroups.com> > > Subject: Ultrasound and Cancer > > > > Hello! > > Our clinic stands behind the mentality that ultrasound should not be > > used with patient's that have a past medical history of cancer. > > Recently, we have had some physicians " demanding " that we perform the > > ultrasound treatment. This situation puts our therapists in an awkward > > position ethically as it goes against what we are taught. Our Physical > > Agents book, by , states Ultrasound is contraindicated with > > the statement being " cancer may metastasize due to the increased blood > > flow. " > > I am unable to find information supporting either standpoint of > against > > or for. Does anyone have any information supporting either standpoint? > > Thanks! > > Vicki > > > > Vicki Schiesl-Petska,PTA,CPI > > Physical Therapist Assistant > > Documentation Specialist > > HFM-Rehab Plus > > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> > <mailto:vschieslpetska%40hfmhealth.org> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Dear Joe: The question is if there is any evidence if US is contraindicatory for past history of cancer versus current. Hiten Dave' PT > ** > > > Diane, I also respectfully submit to you, although the Physician has > every right to order what they want and the patient has the ultimate > decision to accept or refuse any particular treatment, every licensed > provider has the right to decide what course of treatment(s) they are > willing to deliver. If through their research and own experience have > found a particular treatment not to be helpful and/or possibly to be > detrimental they should not be forced to deliver a treatment due to the > Physician's or the patient's desire. In the end the Therapist will be > the one that will have to justify or defend their decisions and actions. > > Instead I would explain to the patient and Physician my reasoning and if > is still desired I would assist them the best I could in finding other > resources for their care. > > Joe Trpcic PT > > From: PTManager [mailto:PTManager ] On > Behalf Of Diane > Sent: Wednesday, November 16, 2011 12:30 AM > To: PTManager > Subject: Re: RE: Ultrasound and Cancer > > > Hello, Vicki. Respectfully, I submit that the ethical dilemma is not > whether to provide US treatment to a person with cancer or, more > globally, > whether to follow a physician's order to provide a questionable > treatment. > The dilemma is whether it is ethical to withhold treatment without > giving > the patient the option of accepting or refusing. It is not the decision > of > the MD *or* the PT. The patient ultimately decides the course of > treatment. > > The APTA's Code of Ethics (Principles 2C and 2D) addresses informed > consent > and the patient's role as the decision-maker. As licensed professionals, > don't we obtain (and document) informed consent for all interventions? > This means that we have to be aware of and able to communicate the > evidence-based risks and benefits to the patient or surrogate, address > his/her questions/concerns, then respect the decision. > > Many PT interventions have physiologic effects similar to that of US, > but > could benefit patients with active malignancies. In these instances, I > contact the patient's oncologist for guidance as to the risks to the > patient in question, and include the information and oncologist's > recommendations in my informed consent document. > > Diane , PT > Augusta, GA > > On Tue, Nov 15, 2011 at 4:11 PM, Lynn <SLynn@... > <mailto:SLynn%40marltonrehab.com> > wrote: > > > ** > > > > > > Hello, > > > > When you stand behind mentality , it helps to back up mentality with > > " Evidence based Practice.' > > I reference all of our mentalities whenever possible with references.. > We > > utilize AOTA, AHSA and APTA resources and references in our policy and > > procedures. More specifically, we reference the book 'Modalities for > > Therapeutic Intervention...by Michlovitz, Bellew and > > > Nolan Jr. > > The Joint Commission and CARF like to see this evidence. > > Page 101 in the Ultrasound Chapter references US contraindications as > > follows re Cancer: > > " in a region of a tumor /Malignancy. " > > In other words if you are treating the rotator cuff, and they have a > > prostrate cancer history, I would say you are okay....Just my > > thoughts....... > > > > E. Lynn MS PT > > Director of Rehabilitation > > Marlton Rehabilitation Hospital > > 92 Brick Rd. > > Marlton, NJ 08055 > > ext 4204 > > From: PTManager <mailto:PTManager%40yahoogroups.com> > [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] > > On > > Behalf Of Vicki Schiesl-Petska > > Sent: Tuesday, November 15, 2011 2:10 PM > > To: ptmanager <mailto:ptmanager%40yahoogroups.com> > > Subject: Ultrasound and Cancer > > > > Hello! > > Our clinic stands behind the mentality that ultrasound should not be > > used with patient's that have a past medical history of cancer. > > Recently, we have had some physicians " demanding " that we perform the > > ultrasound treatment. This situation puts our therapists in an awkward > > position ethically as it goes against what we are taught. Our Physical > > Agents book, by , states Ultrasound is contraindicated with > > the statement being " cancer may metastasize due to the increased blood > > flow. " > > I am unable to find information supporting either standpoint of > against > > or for. Does anyone have any information supporting either standpoint? > > Thanks! > > Vicki > > > > Vicki Schiesl-Petska,PTA,CPI > > Physical Therapist Assistant > > Documentation Specialist > > HFM-Rehab Plus > > vschieslpetska@... <mailto:vschieslpetska%40hfmhealth.org> > <mailto:vschieslpetska%40hfmhealth.org> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2011 Report Share Posted November 18, 2011 Vicki, Here's an interesting article that just came out the other day - I happened to think of you and figured I'd share it for all. This article addresses how these investigators believe tumors may grow. It sounds as though tumor growth has nothing to do with blood flow, heat or receiving energy from the blood. It appears it has more to do with autophagy. http://stm.sciencemag.org/content/3/109/109ra117 It might be easier to understand the findings at this link: http://www.sciencedaily.com/releases/2011/11/111116143045.htm I've never been able to find any " science " proving the textbook contradiction of ultrasound over tumors or even the use of ultrasound in people with cancer. I'm willing to bet no one has really ever done a single study proving therapeutic ultrasound really is contraindicated. I also don't believe those who came up with the contraindications even understood the science of oncology. It's just one of those myths no one has ever tested, but everyone blindly follows without questioning how this contraindication evolved. Selena Horner, PT ton, MI > > > Hello! > Our clinic stands behind the mentality that ultrasound should not be > used with patient's that have a past medical history of cancer. > Recently, we have had some physicians " demanding " that we perform the > ultrasound treatment. This situation puts our therapists in an awkward > position ethically as it goes against what we are taught. Our Physical > Agents book, by , states Ultrasound is contraindicated with > the statement being " cancer may metastasize due to the increased blood > flow. " > I am unable to find information supporting either standpoint of against > or for. Does anyone have any information supporting either standpoint? > Thanks! > Vicki > > Vicki Schiesl-Petska,PTA,CPI > Physical Therapist Assistant > Documentation Specialist > HFM-Rehab Plus > vschieslpetska@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 28, 2011 Report Share Posted November 28, 2011 Selena-this is a very interesting article. I take it that you a lot of reading regarding oncology. Do you treat breast cancer patients frequently? We are developing a survivorship program where I work--and am looking at possible Fucntional outcome tools or Quality of Life Measures. Do you use any of the oncology tools that you could share? We have looked at the Promis and and also the FACT-B tool, but appears limiting. > > > > > > Hello! > > Our clinic stands behind the mentality that ultrasound should not be > > used with patient's that have a past medical history of cancer. > > Recently, we have had some physicians " demanding " that we perform the > > ultrasound treatment. This situation puts our therapists in an awkward > > position ethically as it goes against what we are taught. Our Physical > > Agents book, by , states Ultrasound is contraindicated with > > the statement being " cancer may metastasize due to the increased blood > > flow. " > > I am unable to find information supporting either standpoint of against > > or for. Does anyone have any information supporting either standpoint? > > Thanks! > > Vicki > > > > Vicki Schiesl-Petska,PTA,CPI > > Physical Therapist Assistant > > Documentation Specialist > > HFM-Rehab Plus > > vschieslpetska@ > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 28, 2011 Report Share Posted November 28, 2011 Selena-this is a very interesting article. I take it that you a lot of reading regarding oncology. Do you treat breast cancer patients frequently? We are developing a survivorship program where I work--and am looking at possible Fucntional outcome tools or Quality of Life Measures. Do you use any of the oncology tools that you could share? We have looked at the Promis and and also the FACT-B tool, but appears limiting. > > > > > > Hello! > > Our clinic stands behind the mentality that ultrasound should not be > > used with patient's that have a past medical history of cancer. > > Recently, we have had some physicians " demanding " that we perform the > > ultrasound treatment. This situation puts our therapists in an awkward > > position ethically as it goes against what we are taught. Our Physical > > Agents book, by , states Ultrasound is contraindicated with > > the statement being " cancer may metastasize due to the increased blood > > flow. " > > I am unable to find information supporting either standpoint of against > > or for. Does anyone have any information supporting either standpoint? > > Thanks! > > Vicki > > > > Vicki Schiesl-Petska,PTA,CPI > > Physical Therapist Assistant > > Documentation Specialist > > HFM-Rehab Plus > > vschieslpetska@ > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 28, 2011 Report Share Posted November 28, 2011 Selena-this is a very interesting article. I take it that you a lot of reading regarding oncology. Do you treat breast cancer patients frequently? We are developing a survivorship program where I work--and am looking at possible Fucntional outcome tools or Quality of Life Measures. Do you use any of the oncology tools that you could share? We have looked at the Promis and and also the FACT-B tool, but appears limiting. > > > > > > Hello! > > Our clinic stands behind the mentality that ultrasound should not be > > used with patient's that have a past medical history of cancer. > > Recently, we have had some physicians " demanding " that we perform the > > ultrasound treatment. This situation puts our therapists in an awkward > > position ethically as it goes against what we are taught. Our Physical > > Agents book, by , states Ultrasound is contraindicated with > > the statement being " cancer may metastasize due to the increased blood > > flow. " > > I am unable to find information supporting either standpoint of against > > or for. Does anyone have any information supporting either standpoint? > > Thanks! > > Vicki > > > > Vicki Schiesl-Petska,PTA,CPI > > Physical Therapist Assistant > > Documentation Specialist > > HFM-Rehab Plus > > vschieslpetska@ > > > > > > Quote Link to comment Share on other sites More sharing options...
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