The following is not really OT-related, but it’s rainy and yucky and cold and I am feeling lazy and procrastinationish and have only done one good thing today, which is the following story, plus I think I’m allowed an occasional random post, but I promise I’m going to start doing more OT work in a minute or two. Plus the posts below this one are PURE *OT* baby, check it out.
Today I braved the cold rain to go pick up a 13-year-old in 8th grade, let’s call him Bob, from school. I took him to get Starbucks because I’m a bad person and was okay with pumping up with sugar, caffeine, and about ten thousand unneeded calories. And because he enjoys the experience and I try to take him there every few months. I think it’s important to give kids one-on-time quality time with an older person, and while he wouldn’t admit it, he really likes me because I’m more or less insane. I lived with his family during a semester of college, years ago. Long story. Moving on.
This kid is hilarious. We had our Starbucks, then went home and upstairs to his room to play with his Legos. He has a really nice Lego table his grandfather built. The last time he wanted me to play Legos with him (he has this whole village set up on the table and storyline behind it), I pissed him off because I tried to give a monkey a gun, and he wouldn’t let me play anymore. (He is very mature and smart and understands a lot, although he is immature when it comes to play) Anyway, I thought I was hilarious, but he didn’t.
Today he knew better and didn’t directly ask me to actually play Legos and follow his storyline, but he showed them to me and talked about them (there was a recent explosion), and I offered crazy suggestions, all of which he didn’t like. I tried to add in random things and he said “New policy: No non-Legos in the city”. For example, he didn’t like my idea of a giant dragon egg in the middle of the village, and putting all his villagers staring in awe at it. He also didn’t like the idea of eating the Queen’s pet lego shark for dinner. He also didn’t like it when I put Lego flames in the Lego goblet in the King/Queen’s bedroom, and started screaming “Fire! Fire!”. He also didn’t like it when I threw a weird Lego bug into their room and started shrieking in terror. He had to exclaim in frustration, “Do you want me to kick you out again?” as I tried out all these antics. I tried to convince him the bad guys should show up on the village island via his mini Fedex Planes and not just magically show up. He didn’t like that idea either. He wanted to know a good occupation for a skeleton Lego. I suggested putting him in the cafeteria to detour anorexics. He didn’t like that idea either. Apparently, I was not made to play Legos.
I made some joke at some point, the kind of joke that amuses me and used to go over his head, and he said, “You know, you used to make jokes that would go over my head. Now I’m in public school. I get them now.” Guess I better watch it…
Then I asked him if he would rather have a monkey or a robot to help him do things, if he needed help (going back to an earlier OT post about this), and he said something about wanting a robot, because monkeys are messy. Then I asked him if he’d want the monkey if the monkey could clean up its mess, and he said no, he’d still want the robot, because robots can talk. Plus, he said, the robot can help him enslave the world. Later on I forgot what he had decided and asked him again and he said “depends on which one is more efficient”. I laughed and said I needed to bring a tape recorder with me. He said, “you can get those at Ike’s (drug store).” I said, “monkeys?” “NO! Tape recorders!” Oh.
Finally, I asked him for paper so I could write things down, and he handed me a sheet of reinforced binder paper, since apparently you can buy this, and I was impressed. He said he hates having to waste a sheet of paper for something small, and I said they should make paper like they do paper towels, where you can choose the length. He looked at me with an incredulous look on his face and I pre-emptively said “Shut up” before he could say anything. He said “You’re starting to get the picture.”
I love this kid. And believe it or not, he loves me back. 😛
We had a wonderful R.N. named Ruth come in and talk to us about bladder, bowel, and sexuality in the aging. She gave me permission to put up whatever I wanted from her handout, because she said it was all common sense things you could find on the Internet. But still listen to your doctor or OT or other licensed healthcare professional instead of me, the lowly student.
- Loss of bladder capacity to almost half of previous capacity
- Reflex telling us to urinate comes later so older people have to rush to a bathroom
- There are multiple types of incontinence, including transient (like temporarily) or stress (muscle weakness)
- Neurogenic bladder is when the brain and bladder muscles don’t communicate properly anymore. This is frequently seen in MS, Parkinson’s….
- Overflow incontinence: Seen in men with prostate problems – the prostate gland enlarges and blocks passageway so man dribbles urine all day.
Treatments for bladder issues:
Seeing a urologist, stress tests, urinalysis, Kegel Exercises, Biofeedback, Dietary changes, Medication examinations, and more!
- Intermittent catheterization: having to insert a tube inside of yourself at regular intervals to make sure your bladder is emptied.
- Guys are lucky to have condom catheters, while girls aren’t quite so lucky!
- Some condom catheters are held with a band, others with GLUE!!! ::cringe:: apparently it isn’t that strong.
- OTs working in a rehab hospital will frequently encounter Foley catheters…the patient may have a bed bag at night, and then when the OT goes into the patient room in the morning to help with ADLs (activities of daily life), the OT can help the patient switch their bag to a portable leg bag
- Some people spend close to a thousand dollars a month on incontinence pads. In those cases a more permanent catheter may be a better solution.
- Constipation is a big problem for the elderly, with many reasons, including slower digestive system, poor fluid intake, lack of exercise, certain medications, certain diseases…lots of reasons!
- Elderly people often are concerned with having the right amount of bowel movements a day, when in reality there is no “normal” – it can vary substantially
- Laxative abuse is rampant. Laxatives should not be used more than 4x a month or so, roughly.
Treatment can include dietary changes, drinking more, exercising (We saw part of a Richard Simmons wheelchair video!!), stool softeners, suppositories…by the way, she mentioned “Power Pudding” – you can google the recipe – to help with constipation.
- Complications of constipation can include hemorrhoids, anal fissures, and other not fun stuff. If you are helping a patient with ADLs and notice something very wrong with their stool, pass on the information!
OCCUPATIONAL THERAPY WAYS TO HELP PEOPLE WITH BLADDER/BOWEL PROBLEMS:
- Assess hand function and range of motion to make sure they can follow good hygiene
- Make sure the person is educated on possible assistive devices to help in the bathroom.
- Help them learn to wear easy-to-doff clothing so they don’t have to fumble with their clothes when desperate
- Consider a bidet, popular in Europe
- Suggest clearing path to toilet, getting nightlights, grab bars
- Suggest Bedside commode, raised toilet seat, etc…
- Try to help the person get back as much dignity as possible
Wow. Did I mention wow? Wow.
- Women have fewer sexual hormones and lubrication
- Men have slower, quicker erections, less sperm, longer refractory period
- Surgeries, attitudes, alcohol, drugs, disease, depression, and more, can affect sexuality in elders
- Females might try education, counseling, hormone therapy, artifical vaginal lubricants, Kegel exercises
- Males can try education, counseling, penile blood flow studies, suction devices, penile injections, surgical implants, medications..
Side note: We were discussing vaginal lubrication and the nurse got off on a tangent and ended up saying “Wow. How did I get on that topic from vaginal lubrication?” And one of the girls in the class said “That’s ok, I do it all the time!” AHAHAHAHA
- Sexual activity is still possible at older ages, but may require more effort, time, and positive attitudes. (“A woman is like a crock-pot…she needs to simmer…”)
- Sexual activity can be good for the health
- Sex doesn’t have to be just intercourse. Be creative.
- Follow the PLISSIT model: Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Maybe PLISSIT stems from a play on the word Explicit? I don’t know. Basically, don’t shy away from the subject as an OT. Sex is on the forefront for many elderly people and it might be helpful if you bring it up.
- Sex is possible even with catheters and hip surgeries and more.
- If you are uncomfortable with this topic, or feel you have reached your knowledge limit, you can certainly refer the person to a psychologist or psychiatrist or the doctor or whoever needs to know.
Now for the extra amazing part, in my humble opinion.
They were from a medical clinic, but still! We have a 7-foot screen. I don’t care who you are, a seven-foot penis is scary.
The videos were about various ways males can achieve erection, including injections, suction, and implants. They had graphic descriptions of each one, clearly focusing solely on the penis as it became erect, filling up a 7-foot screen. We have Baptists and virgins and your average uncomfortable people in the class, shielding their eyes. I watched it like a train wreck, trying not to laugh. I know it’s a serious topic, but it was a very cheesy movie and I don’t think many people are used to watching these things on gigantic screens. They had cheesy couples who would say things like “I take it. It works.” – “I even help with the injection. It’s part of our lovemaking.” My favorite part was when the cheesy announcer guy talked about how Viagra was invented in the 1980s as a heart drug, but…”It didn’t do much for men’s hearts, but talk about a happy accident.” AHOSEEOHAHAHAHAHAHAH!!!!!!!! I love it!!!! It does kind of kill me though, that Medicare will not pay for shower benches but it will pay for Viagra.
So anyway…there are lots of ways to make sex possible and comfortable for elders (or those with disabilities in general and according to “Cookie Gimp” there is a better medical clinic video I need to see, showing couples with disabilities having intercourse.) It’s important as an OT to be aware of the sexual needs of elderly people and not be afraid to discuss it. It’s an activity of daily life and there are a lot of options.
Finally, I want to know if senior erotica exists. If it doesn’t, I’m totally getting a part-time job, writing it!! Seniors are our fastest growing population and they need some good reading!
Update: There is an unmet need for senior erotica, based on my google searching…
We had a lawyer named Sandy come in, who served as an ombudsman for long-term care in this region (I guess she specializes in geriatrics?). An ombudsman is a Swedish term for a person who serves as a citizen advocate. People can complain to her about long-term care via almost any media.
She pointed out that a lot of time, when investigating the claim, the problems were that very nice & good healthcare providers had gotten burnt out and overwhelmed over time, and ended up making big errors, at the expense of the client, obviously. I thought this was interesting but also scary. Right now we students are so “fresh” and enthusiastic and sure we are going to be so evidence-based, occupation-focused, client-centered, holistic, etc…but I know the healthcare system ends up jading a lot of us. I don’t think anyone goes into an occupation saying “hey I think I’ll get a master’s degree so I can be a big giant be-ouch to everyone I meet and treat my patients like meat and make them angry!” This leads to her next point, which is that we need to be aware of our own boundaries and limitations – if we are not self-aware, we end up hurting not only ourselves, but others. And we put our occupation -as occupational therapists ha ha – in jeapordy. I can never spell that right. jeapardy. Jeopardy. There.
I asked if an ombudsman for long-term care had to have a certain type of degree, and she said that they are usually a social worker, nurse, or attorney. I thought that was interesting and wondered why an OT couldn’t do that job.
She reminded us that while a lot of people have dementia and may say crazy things, we still need to pay attention – while it is not common, sometimes there ARE predators masquerading as healthcare providers. A little scary to think about – your interpretation of a person’s rantings may make a big difference. Augh.
I’m kind of skipping around and just hitting on the things I found most interesting…my disclaimer as always is that it was y own understanding of the lecture and not iron-clad fact.
The final thing I want to talk about is she discussed a recent fad in moving out of large institutions and trying to get people back in their homes (Again via home modification, assistive devices, aging in place measures, etc)…or if not homes, maybe cottages or green homes where the place is MUCH smaller and made to be more like a house.
I enjoyed hearing about her job and it made me aware of all the people out there doing jobs I don’t even think about. I am glad people like her are there to help protect our elderly. I think the main message I got out of her lecture was to be self-aware and try to treat our elderly people with the respect and dignity they all deserve. Because if we don’t, people like her will come after us!!
So I've decided I should drop out of OT school and go into advertising because today I thought of “Grannycam” (already invented, bummer), and then also “Crays of Our Lives” if you maybe, I dunno, happened to be a crayfish researcher who wanted to do a soap opera on Animal Planet? LOL
I've spent the evening working on my to do list and have been productive. I'm working on reading management chapters for the midterm, finished half another midterm, searched for a geriatric article, finished a proposal for our geriatric media project (having older people write advice on paper from their childhood, and wrap it up in easily-done felt fortune cookies, for a young class to open). And then SIGNED UP FOR AOTA CONFERENCE!!!!!!!!!!!!!!!!!!!!!!!!!! Got my plane tickets and hotel now too!!!!!!!!!!!!! And finished my Christmas thank you cards….cough. And more. Productivity, baby. Now I am lazy after working so hard and kind of want to give up for the night, but I am going to do my two lectures so I'm caught up. Again. I'm like the most prolific OT writer ever, but I have so much to share, it's bursting out of me yo!
Oh btw, I had a dream a few nights ago I was watching a girl pushing her mother's wheelchair and doing such a bad job that her mom's head kept on hitting the ground from it tipping over (not painful, just ludicrous, in the dream), and I was, as an OT student, all horrified and wanting to run over there and teach her what to do!!!!!!!!!!!!!!!!!!!!!!!!!!!!
My OTS friend Virginia brought over a neat game the other day. She got it through Campus Crusade, and it is available through mysoularium.com. It’s technically a “spiritual” game where you use pictures (50 of them spread all over as above) to answer questions like “What three pictures most symbolize what you want for your future?” etc. It seemed like it could potentially be modified to be a great OT tool.
Some possible uses (maybe taking your own photos instead of using theirs):
1. Elderly people -asking them questions about what symbolizes different parts of their past (reminiscing is a powerful tool)
2. Mental health – asking people questions that they can link to cards reflecting their emotions
3. Cognition – asking people to link cards using some sort of category such as “red”, or asking them to describe the photos, etc.
4. Spirituality – its original purpose – depending on the situation and what the person needs – asking them about their spiritual hopes or issues. This is actually kind of touchy – I kind of wanted to cry when I was doing this with Virginia!
5. Tons of other things…be creative.
Anyway…it was neat.
OTS Karen (me) and non-OTS but still cool, Christa, stuck in traffic for 40 minutes and surrounded by trucks…it was Saturday morning when there was ice and we saw tons of bad accidents.
Too many trucks, augh. .
OTS Meg and OTS Karen are totally twins. By accident. Because dressing like each other on purpose is SO third grade.
Last random picture, I swear.
The past year was pretty intense, work-wise…we had many a study marathon…now we've had quite a break from the insanity, but it's starting back up. February will be a very hectic month! This picture is from last semester…Brooke and Allison were at my house studying…probably for neurobiology, I don't know. It was painful.
One of the girls in the OT class below us has hurt her wrist, and needs a nocturnal resting hand splint. Guess what! My OT class knows how to make those! When I was looking through my pictures trying to find a picture of Neal, since my search function in Windows Explorer KEEPS HAVING AN ERROR AUGH, I found this picture of us trying to draw out splint patterns….(you draw them on paper towels based on a person's individual anatomy, then you trace them bigger onto this material, then you dip it into warm water baths so you can cut it and mold it…)
Neal is our Distance Education SuperHero, and we love him, and he loves us OT students back! This is what he had to say about our MOT class, after reading the recent NY Times Article on OT (this is where, if I were a good blogger, I'd link my previous post on it, but I'm not a good blogger, so well, sorry). PS: We do have two guys in the program, so when he says “girly girls”, I'm sure he meant to include + boyie boys as well.
If there was ever a “sisterhood” at our UT campus, it is undeniably the girly girls of OT. Our class of '09 is top of the crop and downright entertaining. A year and a half ago this class came into a new environment of teaching thru video conferencing. With technical difficulties, walking blocks between classes, and bearing the weight of a masters level program, my “sisters” have survived and grown up before my eyes.
Neal “tech dude” Smith
Do I need this t-shirt? I want it!! Some days my stats make me think I do need it….other days I feel really popular. 🙂 I’m almost at 25,000 page views for this OT student blog! Woot woot!
Regardless, I feel like if I wore it, I’d get some pity!
So Neal, our “tech dude”, wrote the sweetest thing about OT today for the blog but I’m going to wait to post it because um, I have to go shower now before I go enter in research data. Our online management meeting was quite successful – we’re moving onto budgeting for a department as well as starting a project on “little people” aka LPs aka dwarves (old offensive term being midgets)…we had to pick a population that does not traditionally receive OT. I think it will be cool and potentially can really help some people!