APTA Delegate 101

With my new pal Jenny Jordan

I was watching Gilmore Girls re-runs one evening in November 2021 when an email notification popped up on my screen from Dr. Jenny Jordan, Physical Therapist, Professor in the Eastern Washington University PT Program, former Chief and current Delegate for APTA (American Physical Therapy Association) Washington, and - I would soon learn - incredible human being. Jenny's email asked if I would be willing to discuss an appointment to a one-year term as an Alternate Delegate representing APTA Washington.  

With my long-time pal, Maryclaire Capetta

I've been an APTA member since starting PT School in 2011, but despite how much money I've spent on membership, at the time of Jenny's message, I really couldn't explain what the APTA did. I joined as a student when it was compulsory, and I maintained membership because it discounted board certification and allowed me networking opportunities that I occasionally took advantage of.  Also, it felt like it was the right thing to do, supporting the leaders of my profession.  I knew that Delegates existed and that they worked on making changes that impact the physical therapy profession from a nation-wide perspective, but I had never given any thought to being a representative myself.  One of my Professors in PT School, Maryclaire Capetta, now a long-time friend, has been a Delegate in Connecticut for many years. She took me to a Delegation event at CSM in Chicago in 2012, which was my first glance at the politics of PT.  Over my eigght years attending PT Pub Night events living in Seattle, I've gotten to know several of our local Delegates including some who are good friends. All of this to say - I knew Delegates existed.  I did not know how they came to be in their role, what they did, or why I would ever want to be one.

We set up a time to chat and Jenny explained the responsibilities and the time commitment and asked if I wanted to join for a one-year term. Washington had enough elected Delegates to serve two-year terms, but because our group is pretty large, if the time came to vote and someone wasn't available, we needed to have alternates to step in. Our Alternate Delegates participate in all the regular meetings along with the rest of the Delegation and contribute to the discussions and can work on developing policies, but they do not have the ability to vote unless an elected Delegate is unavailable.  The usual process to be chosen for the Alternate Delegate spots is to be the next highest vote getter on the ballot after the votes are counted. Unfortunately, there weren't enough names on the ballot for the 2022 cycle to fill the Alternate slots. I said yes, and after one year of a much deeper dive into what the APTA does, how new policies are formed, and learning about the problems the Association and the Profession faces, I'm here to share some of that with you.

First and foremost, I want to be very clear: I’m really new at this and there are many others who have been working in leadership roles for far longer who know much more about the APTA.  I was just recently elected into a two-year term as a Delegate for the 2023 and 2024 House of Delegates Cycles and have only attended one House of Delegates meeting so far. This is my understanding of things and my experience- it’s true to the best of my knowledge.  If I'm wrong, for sure someone should tell me!  

Let’s talk about Delegations first.

I've come to understand the Delegation to be a little like the US Congress, but instead of two separate chambers, ours are combined.  In US politics, there’s the Senate with two Senators from each state, and the House of Representatives, with number of representatives based on population of the state. In the APTA, all the Academies/Sections (think specialty areas of practice: acute care, pediatrics, geriatrics, orthopedics, etc) have two votes, and the Chapters (each state and Washington DC) have representatives based on the number of APTA members in that state.  Link to see full apportionment list by state, but here's a tiny snapshot of the top of the list:

Just like in American politics, states with more members have a bigger impact on the direction of the profession. States also have Alternates, which was my role, which are included in all the regular meetings, but don’t vote unless one of the elected delegates isn’t available. According to this document, there were 73,525 members in the APTA as of July 2021. This includes professional Physical Therapists and Physical Therapist Assistants, but not our student members, which push our total membership closer to 100,000. I was curious, so I looked for comparisons from other large medical associations and found that the American Medical Association has about 250,000 members, the American Dental Association has about 160,000 members, and AOTA, the American Occupational Therapy Association, lists about 65,000 members. 

Delegates meet with their Delegations throughout the year, led by their Chiefs. Regionally, Chiefs gather at regular intervals to discuss what’s happening across the country and what groups are working on at their local levels. The whole group meets annually at the House of Delegates, led by a Speaker of the House. The purposes of the House of Delegates meetings are 1) to elect new officers to the Board for the APTA, 2) to debate and vote on motions to move the profession forward, 3) for the elected leaders of the Association to have opportunities to meet, network, recognize individuals who have done impactful work, and 4) learn about different topics related to leadership.  This year, House of Delegates was embedded into an entire Leadership Conference, including many students as well as the Delegates. If you want to find out who your Delegates are, you can search the rosters here. 

I've said Delegates too many times already...  So how about some of the work they're doing? How does a motion come to be?  In January, the elected representatives from Washington met for our regularly scheduled monthly meeting to brainstorm ideas for work that we would like to see done by the Association.  We came up with several possible ideas and broke off into smaller groups to do some early research on the topics, come up with basic rationale for why we felt the concepts were important, and then expand the concepts into more detail at subsequent meetings.  The group voted on each idea, deciding which ones we wanted to dedicate our time and effort to, and which ones did not seem to be optimal for continued work.  This year, Washington presented three motion concepts to the House of Delegates and members of our group spent about six months working on them. 

An important piece of motion development is collaboration with other Academies or Chapters.  Consider that priorities around the country differ, payment models are not the same state by state, challenges to patient care practices differ depending on the Academies and variation between settings.  So early on, we identified potential groups that might be helpful as co-makers to the motions, helping to develop statements in support, who would likely want to pursue the same outcomes.  For our three motions, we collaborated with three different Chapters and one Academy as co-makers.  I primarily worked on RC 16-22, APTA as an LGBTQIA+ inclusive organization in collaboration with the Academy of Leadership and Innovation and PT Proud, which ultimately passed by over 90% vote.  

There's a whole process that the Chief facilitates to take the motions and escalate them up the chain of the APTA to be reviewed by a Reference Committee (which I think makes sure we're not going to violate any of our own previous rules and regulations or any laws, and gives input on the language being used) as well as sharing the motions with the rest of the country's delegates for feedback and discussion.  Washington's Chief, Murray Maitland, had to do a lot of work to get our three motions reviewed and heard on the floor. Over time, updated versions are developed and the content and language can change until the minute it is debated on the floor of the House and voted on.  

This year the House had 22 motions up for debate, but did not end up completing the whole list, running out of time.  The whole operation follows Roberts Rules and Parliamentary Procedure and stays on time with an agenda - which can be amended - but which this year's delegation voted not to amend to increase the time.  It was really unfortunate because there are some really important issues that were waiting to be voted upon.  I pretty much live-tweeted the House of Delegates so you can find a barrage of my tweets from August 14th and 15th from me sharing how things were progressing as we worked through debate and voting.  

I could probably write a small book about my experience at the House of Delegates, but since I will

 Bringing RC 16-22 to the floor for vote

now have two more to attend in the future, I think I'll save those for another day.  It was incredibly exciting working on an important motion that will hopefully improve Diversity, Equity, and Inclusion in our profession.  It was amazing meeting the physical therapists who have worked so hard to shape our profession for many years - and who the leaders of tomorrow might be.  I hope this is helpful to anyone who is considering APTA membership. Know that your state IS impacted by your membership and that a small group of new members could influence how many delegates your local group has to vote on issues in the future.  I also hope that it helps more people to understand what APTA Delegates do - so if you have an issue, APTA member or not, find your local Delegates and share your concerns so they can try to help.  Feel free to reach out to me if you're looking for ways to get involved!

Blood Thinners, Anyone?

Pulmonary Emboli

I couldn't let today go by without acknowledging an important one year anniversary.  Woohoo! Let's celebrate!  On this day, one year ago, I learned that I was the proud owner of "a shower of pulmonary emboli." They're gone now (at least, I think they are... once you do treatment, you don't actually test again unless you have symptoms!)  Thanks to six months of miracle drug Eliquis - a blood thinner that meant I bruised if I came even close to bumping into furniture - my lungs are back to functioning.  So now that the scare of having blood clots in my lungs is gone - and since this 2022 paper indicates that having COVID-19 can increase your risk of having a blood clot (deep vein thrombosis or pulmonary embolism), I figured I would share my story in case anyone notices anything related.  Here it is.

Before my parents got sick from COVID, my mom was pretty sick for all of 2020.  She was having regular blood transfusions and her physicians couldn't figure out why her iron levels kept dropping so low.  There were many months of hospital visits during which she had to go alone because of COVID.  She really hated that.  Anyways, feeling very helpless for my mom's medical condition, I started to donate blood.  As a non red meat eater, I had tried donating in the past, but had always been rejected from my own anemia. I knew I couldn't possibly provide as much as she needed - plus we weren't even the same blood type and lived 3,000 miles apart.  I know she appreciated it because we texted back and forth at our appointments and she shared what she was going through. Maybe someone else's mom got my blood in Seattle and their daughter was donating in Florida. 

Click to Donate Near You!

Anyways, I went to donate blood in early April 2021. As usual, first they checked my pulse and heart rate, and my pulse quality was OK, but my heart rate was 120. (Normal resting heart rate should be between 60-80 bpm so all these readings are high.  Maximum heart rate can be estimated by 220-age, so the maximum my heart rate should technically get is 184).They decided to check my iron and if that was good, they would give me 10 minutes to get rid of the "white coat syndrome" - which I guess sometimes even health care providers have, where your heart rate or blood pressure goes up because you're anxious at the doctor's office - but which I've never experienced before.  My iron was way too low to donate, so the nice lady at the donation center told me I should make an appointment to see my PCP.  I thought - no way! This hadn't happened since I started donating blood the year before, but my iron was often too low when I tried to donate in high school and college. I figured I didn't eat enough dark chocolate or spinach that week.  After all, the timing of this blood donation was in my third week back to work after being on FMLA and my grief felt like heavy fatigue for weeks.  I just went home, rode my bike for 20 minutes, and made a turkey burger for dinner. 

A few days later, I was walking up a flight of stairs with a coworker when he asked me if I was ok.  We had walked into work together many times before, always taking the stairs, so for him to notice my breathing was surprising to me.  I thought maybe I was breathing differently with the mask I was wearing that day, but I didn't feel bad otherwise. Thinking about the failed blood donation, I grabbed the clinic pulse oximeter and my heart rate was again in the 120's.  I felt fine, so I continued the day, treating my patients, not really noticing anything.  The next morning I showered, got dressed, and was tying my shoes and with the bending over motion, felt instantly short of breath.  I checked my heart rate by hand, but didn't believe my own count so of course I dug out my own pulse oximeter and my heart rate was in the 130's. Having a quick moment of panic, I recalled my dad having a heart attack when I was eight - he was 48 - and thought - maybe I should get this situation checked out.  So I hopped onto my PCP's patient portal and made an appointment for later that afternoon and went to work, figuring it was too late to cancel my morning patients and if I wasn't moving, I felt ok. 

At work I took the stairs again, but this time, when I got to the top, I had to sit down, unmask, and catch my breath. I was sweating and had a little bit of pain between my shoulder blades. Something definitely wasn't right. I told my boss right away that I needed to cancel my afternoon patients to see my doctor and explained what was happening.  It only took demonstrating one repetition of a 15 pound goblet squat to a patient for me to know it was getting worse.  I finished my patients, sat down to write my notes, rechecked my heart rate at my desk - now 154 - and felt the veins in my neck pulsing.

As previously mentioned in other blog posts, I have a BFF who is an emergency medicine physician. Everyone should have doctor pals they can call in an emergency... but this still didn't feel like an emergency.  Still, I called her as I was driving to my doctor's office and she advised me to cancel my appointment and tell them I'm going straight to the Emergency Department.  Then, instead of going directly to the hospital, I should go home, get my cell phone charger, a hoodie, maybe some pajamas,  my toothbrush, and a book, and then go to the hospital.  (If you EVER need to go to the emergency room and have enough time to make these sort of decisions, bring your cell phone charger!).  She also wouldn't hang up the phone until I got there.

The walk from the parking lot into the emergency room left me drenched in sweat.  The lady at the

waiting on CT Scan

check in desk asked me the COVID screening questions, none of which applied, but since I was sweating, she didn't believe that I might not have just had a fever breaking.  So she asked a nurse to come take my vitals right away, heart rate still in the 150's, but since my temperature was normal, I could sit and wait in the lobby.  It was a long wait.  Honestly, without moving, I could still feel my heart racing and some aching between my shoulder blades, but otherwise I didn't feel that bad.  When they took me in for my exam, the physician asked me what I thought was happening and I told her I thought I had a pulmonary embolus but that it was weird because I didn't really have any chest pain.  S

The next moment could have gone so differently, but instead of just shrugging off that I'm "just" a physical therapist, she asked me to defend my own diagnosis. I explained that my schooling educated me enough to know that if I saw a patient that described these symptoms, I'd be worried, but that one course in the cardiopulmonary system in grad school and another in college made me far from an expert.  I explained that I had flown across the country five times over a three week span just a few weeks prior without any hydration and immediately following my vaccinations and under intense stress.  (At no time did anyone, including myself, think that my vaccination caused these blood clots.  However - I did get sick from the vaccines, likely because I was not willing to unmask to drink any water or eat anything on my flights immediately following them. Plus grief.)  She asked if I took birth control, because "the chance of clots is 2 to 6 times greater among women taking the pill compared to those who don't use birth control" and when I said yes, for nearly 20 years, she felt confident that blood clots were the appropriate place to start the diagnostic hunt.  Let me tell you - some people get REALLY awkward talking about birth control.  I am not one of those people.  Three different medical providers AND a social worker came to discuss birth control with me.  I'm not sure why it was like that... but I do think we probably should be educating teenagers more about this risk if they're considering mixed hormone oral contraceptives, just so they're educated.  Maybe my doctor told me about this risk when I was 18... for sure I do not remember. 

The doctor applauded me as a healthcare worker listening to their body because I guess that's something we're really bad at doing.  I did wait several days, I guess, but it for sure could have ended much worse.  She felt that my assessment was reasonable, so after a Covid test, which was negative, we proceeded through a chest X-Ray and D-Dimer blood test.  When the blood test came back positive, there was a chest CT Scan and then a diagnosis of "a shower of blood clots" in my lungs. I was on blood thinner medication six hours after leaving my desk and held on observation in the hospital for the night.

At which time I finally called my sister in Connecticut and my brother in Washington, D.C., and told them where I was. Let me tell you - being alone in the hospital because of COVID restrictions limiting guests is horrible.  I didn't want to tell too many people where I was or make a big deal out of it because we had identified the problem and medication had been started.  The doctor told me I would feel better fairly soon, and I was back at work five days later with a 20 pound lifting restriction.  I spent my down time searching for research papers about exercising with pulmonary emboli because my doctor told me that I was OK to be active as long as my heart rate stayed under 150... but it was still 150 at rest, so it started with walking for 10-20 minutes or biking without resistance.  I used the elevator at work for a few weeks.  I didn't lift weights. And slowly, the pain between my shoulder blades started to improve and I was able to go up the stairs without stopping.

This week, I returned to the scene of the crime and I was able to donate blood again!  I have to take iron supplements and they make my tummy hurt, but I've found ways to manage that.  My resting heart rate was 84 when I went - still a little bit high, but considerably improved.  My cardiovascular endurance is still limited, but I can ride the bike for 45 minutes.  More difficult for me is the time it takes to recover.  I can't do cardio on back to back days and my legs sometimes feel like bricks after I ride.  I think it's more deconditioning... but it's slowly improving.  And my personal favorite - I can lift over 150 pounds when I'm deadlifting, working my way up to 200.  I feel like that's going to happen before the end of the WNBA season that's about to start.  Last season started about 2 weeks after I was in the hospital and I remember that I couldn't yell/cheer because forceful exhalation made me light headed to the point I thought I might pass out. I can't wait to test that out again!  Other than wearing compression socks and taking aspirin to fly on airplanes, I feel like I've recovered pretty well.  I don't recommend it for others, though.  It isn't fun. 

Please donate blood if you can.  It's basically a free health screening for you and a life-saving gift for another person.  It takes less than a half hour to do and you can repeat every 2 months.