My cortical systems are failing me

Today we learned about cortico-striatial-pallido-nigral-thalamo-cortical systems. Or something similar to that… And we learned about hand skill interventions. And we worked on peripheral nerve injury worksheets ,and learned about falls in the elderly. Sometimes I think (in fact, I'm sure), people look at OTs and go, why in the world are we paying so much to have her swing our child or make him play with play-doh?” Well after days like this I have a lot of scientific sounding answers! And I plan to share these answers (on the generic “why do you have a master's/why should we pay you so much for common sense stuff) soon!

And my research group spent two hours with our professor mentor figuring stuff out.

And then I went to dinner with nine OT girls and two of their husbands/boyfriends, to celebrate my birthday! And I got some wonderful presents!

We went to a great little Mexican restaurant called La Espiga. It was fun and I really appreciated it!! That's the best part about OT school – the wonderful friends you'll make! Oh yeah, and learning how to help people…AHAHAHA just kidding – it is ALL wonderful. Although I'll admit I'm tired and feeling overwhelmed. And that my left eyeball feels like someone is pushing it into my skull. That doesn't really motivate me to study. I may work a little on research and then call it a night! Pathetic I know! Oh, and I officially submitted my Assembly of Student Delegates application! We can't campaign until November though! So I won't go off on a tangent telling y'all how wonderful I am and why I should hold a certain position! Just kidding. 🙂

It's good to be back in school and to see everyone! Perhaps tomorrow when my left eyeball is behaving and not messing up my cerebral cortex, I will have more to say.

Oh, and today is PATTI's birthday, everyone! She is a new MOT student and her blog is linked on my sidebar!
Oh and my OT “little sib” (incoming class) e-mailed me and she also seems very devoted! This upcoming generation of OTs are going to kick some occupational BOOTIE!

By the way, this might totally get me in trouble, and if I get outraged responses I'll end up deleting it, but I decided the slogan of outpatient occupational therapy should be “More paperwork, less poo.” …because it seems a lot of OTs and/or OT students base their decisions on where they want to work, based on how they handle body fluids!

Happy Birthday to Me! And my twin! Happy Birthday Dear Future Occupational Therapist…

A photo documentary of a budding occupational therapist….haha I’ll do anything to pretend I’m staying on-topic!

Age Four

Kristina and I were eating chocolate spaghetti. And we were angels at one point too.

Our first day of school at age 4, and being siamese twins…
My sister and I in DC a few years back, she dressed me up!

Me and Haley after getting TOTA scholarships in Nashville!

I am 25 today! Insane! A QUARTER OF A CENTURY! And obviously my twin is too, she lives in San Francisco!

I am allowed to be 100% off-topic today, seeing as how it is my BIRTHDAY! Woot woot! But I did say occupational therapist like twice!, so that counts for something.

I’ve gotten a bunch of Facebook messages, a few e-mail cards (including a video of my friend’s adorable two year old singing happy birthday karen, happy birthday snail breath…), a few little adorable glass snails, a cool laptop tray, cookies, thank you cards, pencils, Costco cash, and money to buy a graphics tablet, a mini camcorder, and a few American apparel dresses…etc. Yay!

I’m about to go work out and do some cleaning/homework, but other than that, I plan to spend a lot of the day talking to peeps abroad (my Norwegian host family, my friend Doug in England) as well as my family and hopefully some friends!

I start back with OT classes again tomorrow, the fieldwork is over, so I better try and enjoy today as the craziness is ABOUT TO BEGIN! Or rather, CONTINUE!

Someone. Is. Going. To. Die. Miss. OTPF. Is. Going. To Go. Postal.

I've been working on my occupational profile, and I've been doing the cultural, physical, social, personal, spiritual, temporal, and/or virtual contexts that either support or inhibit my patient's desired outcomes. I had gone through three of them and had easily a page done, when my Microsoft Office Word document got an hourglass and stopped responding, which has never happened before. I had to close out and I LOST MY WORK! I LOST MY WORK! I LOST MY WORK! I LOST MY WORK! I am SO mad! SO SO SO SO SO SO SO SO SO SO MAD! AND NOW PARANOID ABOUT LOSING MORE WORK! AUGH! AUGH! AUGH!

Okay. I'm done with my emo rant now. But seriously now. That sucks. A lot. Ok, let's go see if I can remember what I wrote about those first three contexts. Good thing I'm Miss OTPF 2007 or I'd be hurting even more right now…deep breath….

BTW: I held a baby today while volunteering, and the baby was in such an angry state when I walked in (he was in isolation so it took me a while to gown up) that his heart rate was showing as over 300!!!! BPM!!!!!!!!!!!!!!!!! I think my heart rate is 500 BPM right about now! Augh! Augh! Augh!

How to pack for a stay in a rehabilitation hospital

In the last two weeks I’ve learned a lot about what should be packed for patients who will be staying a while in a rehab facility! The information I give here may vary slightly in different rehab hospitals but not by much!

Short version of How to Pack for a Rehab Hospital Stay:
Pack simple and comfortable outfits, like a slightly baggy sweatsuit (for wheelchair comfort, ease of pulling it up, and/or room for a diaper and/or catheter)
If possible, put an outfit together for the patient and leave it sitting out each night! It makes it easier for the person helping the patient dress
Bring any special toiletries like toothpaste brands, deodorants, etc – make sure the patient won’t run out.
Bring fitted diapers if needed – the elastic underwear ones
Bring some pictures, flowers, balloons, cards…anything that gives the room a personal touch and reminds the staff (and patient) this person is LOVED and REMEMBERED!

UPDATE: My friend Burt pointed out that stenciling your name into ALL items brought into the hospital is a really good idea! Things DO get lost!

Long version of How to Pack for a Rehab Hospital Stay:
WHAT TO PACK FOR A STAY IN A REHAB HOSPITAL/WHAT TO CONSIDER:
The patient will be given a basin for basic washing (and should have access to a shower at some point in the day), as well as some basic toiletries as needed, like a comb and toothbrush. The patient will have on a basic gown and may have the possibility of being double-gowned or given paper scrubs, but it is by far best to have the patient’s own clothes. I recommend you have basic clothes that can be mixed/matched, and that are very comfortable to have on while in a wheelchair all day. If possible, sweat pants are good – the patient may end up with a diaper and/or catheter and could use the extra room in the pants. Plus, sweatpants are easy to put on, even with one hand. If you are visiting daily, consider putting an outfit out for the next day. Otherwise the patient and therapist or nurse have to spend time figuring out what to wear, which often involves the patient pondering a while or having to direct the therapist/nurse in finding exactly what he/she is talking about. I can’t tell you how many times I had to unzip suitcases or root through dirty clothes trying to find what the patient was talking about. The patient will probably be given socks that have traction stickies on them, but will probably also be wearing compression stockings for a while. Consider bringing a pair of sneakers and some socks, just in case or for when the patient doesn’t have to wear the stockings anymore (it’s usually based on their diagnosis or how far they walk – it is to help prevent DVT). Also have a basic toiletry bag with any special toothpaste, special brushes, special makeup, special deodorant, special anything, since the stuff provided by the hospitals will be cheap and generic. AND – it seems most patients in rehab hospitals are in diapers. The diapers provided by hospitals are usually generic wrap-arounds like the ones used on babies. Consider buying the type of diapers that have elastic in them and can be pulled up like underwear. Patients seem to really prefer those. Buy a lot!

Consider bringing in basic candies/snacks if the patient can tolerate them/is not diabetic. Also, I cannot stress this enough – pictures of your family or the patient – as well as signs of outside presence like balloons or flowers or cards or even just writing on the bulletin boards- is really, really helpful, in an indirect way. I think it may sometimes be easy for rehab staff to forget that this patient is a loved person who was not always as low-level as he/she may currently be. While I never saw any instance of a nurse or staff member being mean or unhelpful to a patient, I think that those patients who had that extra touch, helped remind us of their “real” life. At least, that was the case with me! When I would see a patient who seemed barely able to function and was hard to understand, it was only those pictures that helped me realize this was a loved being with a family and a history that far exceeded that of which I was currently seeing.

Moving on. The patient will probably be woken up in the morning by either a therapist or nurse to do some basic washing and grooming, before being taken to breakfast. The patient will then have a combination of OT, PT, and possibly speech, along with breaks, until around 3pmish. Books or other ways to pass the time – playing cards, magazines, etc, would be appreciated. Don’t forget to write a thank-you card for all the staff when the patient leaves, if you think they did a good job. Even just a simple “Thanks for all your hard work!” on a sheet of printer paper can boost morale. Overall, I felt like all the rehab staff at my hospital did a great job of being compassionate and caring!

I wrote up this list because it seemed to me that a lot of families would pack slightly differently if they knew what I mentioned above. Keep the toiletries and clothes simple, keep the clothing comfortable, keep whole outfits easily at hand, and provide personal touches like flowers, cards, balloons, messages, or taped-up pictures.

Final day of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

I had fun today. I got to treat my patient alone and wrote his note without a single correction needed. I made him make slugs and porcupines with theraputty and pegs, among other things. I assisted others as needed w/o problems. I helped out my therapist with a really low-level TBI patient with lots of wounds/fractures. I said goodbye to patients and they were all very sweet about my departure. My supervisor gave great feedback to me on my required forms and said the biggest thing was to work on assertiveness, but she also felt that would come with time as I gained more confidence in what I was doing. I had a good time with her. The afternoon went by equally quickly and nicely, with no problems at all. I feel like I've gotten proficient in basic wheelchair maneuvering/leg-attachments, how to replace oxygen from the room to the tank, where to find all your basic comfort things, how to assist a patient in ADLs in the morning, basic transfers, basic insurance knowledge, basic chart reviews, basic evaluations, etc. A lot of knowledge in just two weeks!

The Ultimate Irony – with an update

A patient with a TBI (traumatic brain injury) trying to flirt with me and telling me that I was a beautiful woman. And then me helping change his poopy diaper.
=========================

Update: I got two e-mails on this post. One was written by a person with spina bifida, and the other person was a TBI survivor. Both weren’t thrilled with the tone of this post.

You know, I keep making this mistake…I write something that my friends/family might find either amusing or at least not think twice about, but then I hear from people who have the diagnosis/similar problem, who are offended by what I said. You would think I’d have learned my lesson by now, but apparently I haven’t. I’ll keep trying, I promise. It’s not so much that I lack compassion so much as I’m still learning to remember to try and see things from the client’s point of view.

Another Clarification: – “irony” is probably the wrong word to use in regards to the above situation, because it makes it sound like I’m saying it’s ludicrous for an incontinent person to flirt. That is not the case at all, and it wasn’t what I meant to imply. I guess I found it ironic that even a man who was extremely confused and incoherent, covered in tubes and barely able to move, functioning at a very primitive level, would still even have the presence of mind to say flirtatious things! It shows you how little it takes for testosterone to kick in!

Also, both men pointed out how humiliating it can be to have your diaper changed, which I would completely agree with. I can’t imagine how it would feel if I had to experience that. So I can see why, as a TBI survivor or someone who has had to deal with this, it would be hurtful to discover that people wrote about how much they disliked it.

One of them pointed out that it can be taken as offensive that I showed strong distaste regarding dealing with body fluids. I apologized, because I could see the situation from his point of view. However, I am also a student, new to fieldwork and only just delving into the world of adult diapers or other body-fluid related things. The average adult walking around, has little to no experience dealing with such things. I think it is natural that I would find it difficult to deal with for a while. In the two weeks I was on fieldwork, it got easier and easier to handle seeing and/or changing diapers, and I know eventually it will become commonplace, and I won’t think twice about it. But for right now, it IS something that affects me, and while I don’t plan for it to affect me forever, I do think it’s okay to bring the topic up. I just need to do so in a less offensive manner!

I appreciate that the men were willing to share their viewpoint with me. It was yet another good lesson on awareness and understanding. I originally told them I’d just delete the post, but I realize it’s better to just add on this update, explaining what happened and why – as perhaps others can learn from my (repeated) mistakes.

Medicare Therapists

I got a comment on a recent post where I talked about struggling about working with a geriatric population in a rehab hospital . Aine left a comment saying “But during my years in management, I supervised many therapists who struggled with the role of therapy in that setting. We used to divide ourselves into “medicare part A” therapists and “medicare part B” therapists. In other words, some didn’t feel comfortable or competent with the long-term population (med. B patients) and only felt effective with the med A patients (those in for short-term rehab before going home).”

I thought this was an interesting way of looking at it!

I’m watching Grey’s Anatomy and making sure a tornado doesn’t hit Memphis (it never does) while also working on my patient’s occupational profile, playing online, and eating pudding. Talk about multi-tasking?

Day 9/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Day 9/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Today started out a little rocky but ended smoothly. We got several new patients to eval, and they were all low-level, so there was going to be triple-booking and times when I would ideally treat a patient alone, which isn't technically allowed. I was nervous because I do not feel confident in my ability to handle transfers or anything alone. It ended up working out. I helped one of our “regular” patients with ADLs,  and assisted with evals as needed. One of the patients was in a motorcycle crash and VERY low level, so it was exhausting for the OT, PT, and PT student to deal with that patient. During that hour I was treating my patient, with another OT in the gym keeping an eye on me. We stuck mostly to arm exercises and didn't do a lot of standing so that the potential for problems was minimized. I used an idea that Merrolee gave me, about trying to be more occupation-based, to work with my patient. He is working on standing balance and endurance, and I've been having him do tabletop fine motor activities to distract him while he stands. I knew he liked to travel, and Merrolee suggested pulling out maps and letting him trace where he has been, or something along those lines. I searched around my house but apparently didn't have a US map. I did have a US state-puzzle from the dollar store, though. I brought it with me and had him stand up, then pick up the state puzzle pieces and make a pile of states he had been to, states he wanted to go to, and states he had no interest in. It got him thinking about his past and his adventures, and he stood up longer than he ever has before. It pretty much rocked. I didn't make him do anything crazy with theraputty today, although tomorrow I plan for him to make slugs and porcupines. Slugs meaning he will make long skinny rolls of putty, then stick pegs in for eyes. Porcupines – round balls with tons of pegs. Good for hand strength and endurance and also slightly more amusing than just rolling it back and forth forever.

I also got this great idea for getting mini armadillos and stuff and throwing them around the hall, then letting him run over them with his roller, to make roadkill, just like he would in a RV. Am I amusing or what? I'm totally kidding. But the thought did cross my mind.

I ALSO had this great idea that perhaps tons of other people already know, but I thought about putting some bubble wrap (on some dysem so he won't slip) underneath his non-weight-bearing foot, for sit-to-stand transitions. The point is to NOT pop any bubbles while standing up, with that foot. Many people have a tendency to put weight on the affected foot when standing up, so this would provide some feedback. Maybe it won't work, or maybe it's been done. Whatever, I'm proud of my idea.

I've been trying really hard to make sure the patients know I respect them, I will be gentle with them, and I won't treat them like a piece of meat. I will also be respectful of their feelings and not just randomly start wheeling them backwards or something without giving them some feedback on what I'm doing/why. I also look them in the eyes and smile. I think it is paying off. Today I took an older woman back to her room, who has a ton of problems. She speaks very slowly and haltingly, with exaggerated yet imprecise mouth movements. She can be hard to understand. I put her back in her room and made sure she was ok, and she said “I…like….you.” I was like awww! I like you too! That REALLY made my day.

Overall, I'm enjoying this rotation now. I don't know if I'd want a job in such a place, and in fact I'm pretty sure I wouldn't, but I am getting to appreciate my patients a lot more now.

One patient today, who we were evaluating, had no teeth and tardive dyskinesia, and she was VERY hard to understand. My OT asked her to repeat herself and she said “You…have…hearing…problems.” AHAHAHHAAH

I also got to see pitting edema today! The patient had nicked herself somehow and edematous fluid was steadily dripping out, TONS of it. It was gross but cool to see!

Hmm…that's about it for today. Tomorrow is my final day of fieldwork! And Sunday is my birthday! I'll be 25! Wow! That is crrrrazzzzzzzzzzzzyyyyyyy.

Day 8/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Day 8/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

I've been hearing some hilarious stuff lately! I had one patient (CVA) tell me she was brought to the hospital just because she was extremely constipated! I had another one tell me that me and my OT supervisor were “twins”. I've also been hearing stuff broadcast over the nurse station speaker from the call button – things like “I need to go Number Two Extremely Urgently!” – or “I need help! I need EVERYTHING!” –  okay, that's not funny from a patient perspective, but it's funny to overhear it! Another patient asked my OT supervisor to “unimpact her”. And it seems that, almost universally, patients call us “Nurse” or refer to themselves as being in “physical” therapy.

I would actually say I had fun today! I'm officially retracting my soul-sucking statement from last week! I was able to help with transfers, assist with multiple patients, treat my own patient with some different things, etc. I left a note on one patient's bed who was being discharged today that said “Hi Mrs. ___, we'll miss you! – The Twins, Karen and Supervisor” with a really bad picture of us playing balloon volley and the kitty puzzle with a missing piece. She appreciated it! LOL.

Today I got there a little bit early (around 6:50am) to do some brainstorming. I flipped through my ENTIRE textbook of “Occupational Therapy for Physical Dysfunction” by Trombly this morning, to try and see if I could find anything that would be helpful..nothing screamed out to me though as a treatment activity for a patient who has a hip replacement, touch down weight bearing status, bilateral shoulder arthritis causing limited range of motion, and hand arthritis.  I'm tired of therabands and arm bike and arm pulleys! It seems like such a cop-out! I know it is necessary but still! So today we did the arm rickshaw which works triceps, shoulder flexion stretches using a bolster on an inclined table, standing up four different times and doing a nut-bolt activity and a wooden colorful puzzle activity, and then doing some theraputty exercises. I made him pick little objects out of the theraputty, which is pretty typical, but then I forced him to make little balls and stick pegs in it, ie cupcakes with candles…he thought I was crazy but he was a good sport and went along with it! I just am trying hard to think outside the box! I definitely don't know what I'll do tomorrow! Guess I'll get there early and brainstorm again by staring at the shelves of random stuff!

My favorite thing in the world right now is smiling at a patient and having them smile back! Sometimes it is a sympathetic smile, sometimes it is an ironic smile, sometimes it's a genuinely happy smile…whatever the reason, I LOVE having that smiley connection! I think a lot of these patients don't get smiled at enough!

Another huge thing to me right now is learning that phys dys is NOT magic! It all is starting to make sense! Even things like changing out catheter bags doesn't seem so crazy anymore. I'm figuring out how to charge insurance, do chart reviews, do evaluations, write progress notes, etc! I'm not as scared about my Level II three-month rotation at a rehab hospital anymore! Also….here is a tip to all you current/incoming students….it might seem a little bit overwhelming when you are learning little nitpicky details about how to do manual muscle testing or goniometry on tiny areas, while in school…but it is very likely you will never do any of that in a normal rehab hospital or job! Insurance typically just wants to know, grossly, how that patient is functioning. You can typically eyeball range of motion, and just do huge muscles for manual muscle testing. It's easy! So learn it just in case you get a job in hand therapy or orthopedics, but probably you won't have to memorize nearly as much as you think! Don't be scared!

I will be glad to get back into my “normal” school routine, crazy as it is…but I plan to enjoy my last two days of fieldwork!

Days 6 and 7 of Adult Phys Dys Level I Fieldwork in Occupational Therapy

10/15- Monday

Today went smoothly. I was tired after the weekend conference though! And my patient that I was following, was suddenly discharged this weekend because his family decided to take him home! So I wrote up a week-long treatment plan for nothing! Oh well! You have to roll with the punches! So I got a new patient of my own, who had a total hip revision! I need help thinking of occupation-based, minimal resources needed, ways to work on improving his standing balance, standing endurance, general weakness, etc. It's hard! I forgot to journal this Monday so I'm writing this Tuesday, and it's honestly hard to think of things that happened yesterday! The days run into each other when you see the same patients and do roughly the same things every day.
–
10/16 – Day 7/10 of Adult Phys Dys Level I Fieldwork in Occupational Therapy

Today went pretty smoothly. It started out normally. We did ADLs (activities of daily life) with patients from 7am to 9am. Most of our patients were already dressed and ready by the time we got there. That is actually somewhat of a pain, because each patient needs 1.5 hours of OT a day (6,  15 minute, units), and typically two of those units are used for ADLs. If patients don't require assistance, we have to figure out if there is a way to sneak them in later, to get in all their required therapy! However, for me personally, I like it when they are already dressed, because there is less likelihood to see nakedness and potty parts! If you know what I mean! Today I saw a woman empty her colostomy bag and it was REALLY gross looking. She was very casual about it though, and so was the OT, so I was impressed with both of them. I am good at keeping a poker face but it still grosses me out!

At 9am I got to treat the patient I am following. Denise was nearby and would help if needed, but I was in charge. I'm going to admit to y'all, I was NOT occupation-based. I know we are in school right now learning that the whole point of OT is to be occupation-centered and to not be “upper extremity physical therapists”. But guess what – in an inpatient rehab gym with limited resources and limited time, and/or low functioning clients – it's all about the therapeutic exercise, which I guess counts as preporatory methods. We did stuff like the arm pulleys, pulling items out of theraputty, hip precautions education (no internal rotation, no adduction, no bending past 90 degrees, etc), and then some standing, while doing tabletop fine motor activities. It's really nerve-wracking to me, dealing with the patient and the wheelchair maneuvering, and especially taking on and off the leg rests as the patient moans in pain! I think I'm doing okay though! The patient is very patient with me! Haha I kill me. Ok, anyway.

We saw all our normal patients – I did a lot of transporting and a lot of stand-by treating. I wrote the note on my patient and I was so proud. Unfortunately a lot of the medical shorthand isn't transferable to computer, but it's basically stuff like “Patient seen in am for adls. Patient seen in am for approximately 1 hr of therapeutic exercise, standing balance tasks, and education. Patient performed approximately six minutes on the arm bike, with three to four rest breaks. Patient has fair+ endurance. Patient did this. Patient did that. Patient c/o p! 2 B shldr arthritis. (Patient complained of pain secondary to bilateral shoulder arthritis)  It's pretty cool writing notes! And seeing patients! I had slept well last night, but had a lot of bad dreams, including one where I cried constantly, so I was feeling a little bit jittery/nervous today. Luckily everything went okay. One of the patients cracks me up constantly. She literally makes me laugh out loud with the things she says. She and I were working on a 100-count kitty puzzle while working on her standing endurance/balance, and at one point she said “I hate you kitty!” while trying to figure out a certain piece. Also, we finished the puzzle and one piece was missing, and she said, “This kitty is missing a body part. It should come to therapy, that's where they get help”.

Overall it was a normal day. I don't feel like my soul is being sucked out of me anymore, but I do feel regularly nervous. I'm an anxious person and it FREAKS ME OUT to not be in control or know what's happening or not know how to help someone! So I still wait eagerly for the day to end – which I didn't do in my pediatric rotation – but everyone is really nice and helpful!

===========================