OOOH! SEX QUESTION!

Did I get your attention?

What do you do when a very old man with dementia is inappropriate towards women, expecting sexual favors (confusing them with his passed wife, at times)? Honestly my instinct is to recommend paying someone to cuddle with him since that's probably the only thing he can really handle anyway, but I know that's not exactly kosher and I'm not sure how you'd do it…”Excuse me, Escort Services? Yes, I'd like to use y'all, but not for any home runs, ya know what I'm saying?”

I wonder how many escorts specialize in geriatric services…ie cuddling and minor intimacy. Hmm. Yo Escort Services who have Google Alerts: Think about it!!! Geriatric Specialties!! You're welcome.

I was asked by the man's daughter how to handle this situation, and I told her I'd look into it and get back to her. Anybody have good ideas?!! I might post this on the OT mental health listserv, but first I should probably check some literature and the archives too, as I know this is a relatively common issue….the whole retrogenesis thing I guess.

Okay I'm jumping in the shower and heading to bed! Those of you who just started a new fieldwork (apparently January 5th was a big start day), I/we would LOVE to hear from y'all if you have anything to share, whether good, bad, stories, facts, thoughts, whatev.

Health promotion for OTs

A recent e-mail that made me happy…I changed her name/location. I gave her some tips but if anybody wants to chime in, please feel free.

AOTA! Check it out!!

My name is “Jane Doe” and I regularly read your blog! I wanted to say that I love the blog as it opened up my eyes to OT and I learned a lot about the profession. Your blog is one of the reasons I am applying to OT school because it gave me a perspective of OT from a student's view! I am actually in the process of applying to a master of OT program in “Doeland”(I am from “Dooda”) and I was wondering if you can give me some tips.

I have to submit an essay discussing OT as part of my application and it's due this Friday! and I am freaking out…one of the question is to describe a trend in health care and how OT is positioned to play a leadership role. I was thinking of maybe discussing the switch in healthcare to health promotion and disease prevention but I am a little unclear on how OTs can play a role in this.

If you can give me any tips I would really appreciate it!

Thanks and keep up the great work on the BLOG!

Check out otadvocacy.com! I c/ped her comment

Haha, good luck, you'll do great! That dang ACLS has always tripped me up (according to my score, I shouldn't be allowed to operate home appliances).

Anyway, I should introduce myself- my name's Alece and I'm 2nd year MOT student at the University of Washington (in Seattle). I've been reading your blog for a long time now (since April 2008) and admire your dedication.

I am very interested in political advocacy at the state level, and for my Master's Project I've just launched a blog about OT advocacy in WA State- you might enjoy checking it out: www.otadvocacy.com

Day 4 of Geriatric OT Mental Health Level II Fieldwork

Today I did the chart review and subsequent evaluation, MMSE, and ACLS! ON a man with severe dementia.I also wrote it all up. All by myself!  I also wrote up the 8 group notes (four people, 2 groups)…although my OT ran the groups. Tomorrow, I run the groups! Augh!!

I watched a cooking task this morning – a lady who had to make scrambled eggs – and it's a miracle she didn't burn herself, she was sooo unsafe. It was my OT's neuro patient, but she wanted me to watch because I could potentially bring patients down to the kitchen for cooking tasks.

I am very proud of myself because today I went and hung out with our four patients (about to be six) + some other random patients, in a big room, for a little while, before group…instead of cowering in the nurse's area.

The first group was on discharge planning/importance of support systems. The second group was on identifying leisure activities/why they are important.

I really like watching Margaret run groups because I learn a lot about dealing with problem behaviors. I tend to be too nice – doh.

I don't necessary feel like I've been thrown to the sharks, but at least the dolphins. It's only the end of week 1 and I've done two LACLS, like 5 MMSE, lots of chart reviews, and 1.25 evals, as well as written up at least 2 evals, several cog notes, and lots of group notes. I know it's my last rotation and I've already had 6 months, but it's a very different setting!
 I'm starting to finally grasp the paperwork and how the system runs – I have to understand the big picture and the step-by-step process, in order to be able to problem-solve.

My favorite quote of the day was when I asked the man with severe dementia why he was here, and he said “You tell me and then we'll both know!”

3 days down

Who knew Baby Jesus had hypotonia!

Day 3 over!

So…I struggled last night and this morning with dread over going to work. I'm a creature of habit, I don't like unpredictability, I don't like not feeling competent, blah blah. But I swallowed it!! My OT had a packed schedule with her neuro day program, so she sent me to the gero inpatient ward to do a chart review, and then I came back. I practiced the LACLS and made myself a cheat sheet of what to say and did some other reading, while she saw her patients.

She had this one patient in a wheelchair attempt to take his jacket off one-armed (since his other arm had no function from a stroke), by using a pulling/shaking method, and WOW, it was hard to watch. He was struggling and getting frustrated and she was skilfully helping him, but after about a minute I was (internally) like OH PLEASE FOR THE LOVE OF GOD LET ME HELP. And you know, my OT training teaches me that its important for him to do it by himself independently, and then my “gimp” perspective taught to me over the year from my “gimp” friend, makes me wonder, Why?? If it doesn't really bother him to get help getting his jacket off, why bother frustrating him so much doing it one-handed?  It was painful to watch him struggle!! My OT, btw, has awesome knowledge and skills. She has done a ton of continuing education and loves alternative therapies and is very smart and talented at OT-osity.

Then when it was time for the eval I did the chart review on, she had to do something really quick, so I went up to start. I wheeled the lady to her room – she had severe depression/anxiety – and she cried a lot. And when asked why she was there, her answer was “My stupid husband brought me here thinking it was an emergency room”. I feel so sorry for these people who just feel utterly betrayed and lost. She kept saying she just couldn't stand to be alone anymore, and crying. I just wanted to throw my clipboard of evaluation questions down and give her a hug!! I started asking questions and then my OT came in and finished up, then I did the MMSE with her – her short term memory was horrid, so she scored pretty badly. The doctors LOVE the MMSE and so when I went to turn it in (they do most of their stuff via paper charts!!), they had me give it directly to the doctor who had that lady's chart, and he was really nice. He apparently worked with the people who developed the MMSE so he gave me some cool information on it, and pointed out it's a great tool to use repeatedly (ie every few days), to determine whether a person has delirium versus dementia. Oh. And her sentence creation? Was “Love is God's greatest gift”.

I think of everything, the sentence people write on the MMSE, is most revealing. Breaks my heart. Think about it. You ask them, off-guard, to write you a sentence, about anything, and that which is most important to them, is what flows out of their fingers. The lonely lady craves love. The euphoric lady is, uh, euphoric (Euphoric Lady is Euphoric, Sarah), and the lady with circular logic/dementia just wants to be understood.
Lady with dementia: “Please understand”
Lady with euphoria: “I am a happy person and I love everyone”
Lady with fear of being alone: “Love is God's greatest gift”

I also got to give the LACLS for the first time, to an older hearing impaired man. I did the running stitch and whipstitch, then my OT took over for the single cordovan stitch, I'm not quite there yet (but probably will be tomorrow)!! Poor man could not untwist the lace for the life of him.

The coolest part of the day was unfortunately not directly related to my rotation. I joined the psychologist for his group in the stress disorders unit (I was with him Monday morning as well). I LOVE that unit because most of them aren't that dangerous or unpredictable, or at least less aggressive. You have a lot of sad people there, but not people ranting and raving and screaming and tearing off their clothes. It's subdued. The group was very small. One of them discussed some very painful memories, the other one was just very very sad and quiet. One lady kept picking at her clothes as if not sure what to do, I wanted to give her a Tangle toy to hold onto! I contributed a tiny bit to this session. I REALLY REALLY REALLY would like to work with this population of people debilitated by depression/anxiety. I have so many ideas for things I would do with these people. I realized that this morning that when I enter the gero inpatient psych ward, I'm scared and/or saddened, and don't feel like I have much to offer besides compassion…but when I am with these people with depression/anxiety, my soul shouts and sings with ideas of things to do.  I'm thinking that maybe, when the gero ward is quiet, if my OT is busy, that I would be allowed to do some non-billable work in the stress disorder unit….doing a lot of activities that focus on soul-searching through (mildly) creative outlets.
You know how Care Bears are like CARE BEAR POWER or whatever, and then like their stomach shines with this huge light that focuses on the person/thing, and changes it? I want to be like SEROTONIN POWER and have my necklace burst into this spotlight and infuse them with happy chemicals and thoughts.

Ok….my posts have gotten back to being really really long, but it helps me to spill it out. Tomorrow I may do an evaluation, MMSE, and LACLS with supervision…ie the whole tamale!! And maybe some ADLs…

After work I hit the Curves gym and have been hanging out with my friend I'm living with!! Lester the Lion Kitty is curled up next to me. I just talked to Brooke who is at John Hopkins and she loves it so far (although she's only been in orientation but it's obviously an awesome place). Also talked to another good friend for a catch-up chat and that was also awesome. Now I'm going to hang out some more and go to bed. YAY for being ridiculously overdetailed.

Day 2 of Gero Mental Health Fieldwork

So the first few hours of today weren't so cool, but it ended better.

Last night I took an anti anxiety pill to help rid of my jangles, and went to bed early. I woke up about an hour later because I had this really bad dream where my beloved Lester the Lion kitty was eaten by a dog. I cried!! I've had a lot of dreams lately where I'm just really uneasy and scared. I guess just reflecting all the changes I've had lately in my life! Anyway. The problem with that pill is that it helps at the time, but when I wake up in the morning, I feel rather sad and broken. So that's not cool. I woke up this morning and I was like, I'm not sure I can handle this. I'm not sure I can do this fieldwork (or any new fieldwork). Rough. I consoled myself with the knowledge that if I do break down, I'm in the perfect place. LOL.

Went to work, and it turns out there was orientation issues, and that I was supposed to have gone to the main campus Monday morning, and I need to go right that moment. I volunteer to look up directions on Google Map, but my OT wants to draw me a map to go the back roads as it is easier. It looks pretty straight-forward so I agree to try her way. Unfortunately one of the roads had an issue and I had to get directions in a Walgreens, but I did eventually get there, in the rain.

The fieldwork coordinator there (not just for OT, she has 500+ students) was quite kind as apparently the mistakes were on both sides, not just mine. She let me get my TB test there instead of finding the health department, and we're working on the CPR card thing. Of all the stuff stolen from my car that night in October, I never thought my CPR card would end up causing me more grief than all my financial cards!!

I went back to my hospital using yet another way – I had now gotten directions from 3 different people and all of them had said something that wasn't quite right, lol.

The rest of the day was a combination of interesting, a little scary, busy, and slightly confidence-increasing.

We did a group with 3 old ladies – one we had evaluated, two that would be evaluated later in the day. One lady, let's call her Jane, kept insisting “I'm not crazy!” and she was rather euphoric and motor-mouthed and restless. The other two ladies were rather quiet. Euphoric Jane cracked me up, she kept talking about how much she loves belly-dancing. One of the quiet ones, when asked about things she values, said “My kids and my clothes”. The first group was on self-awareness, by answering questions about valued things/events, and the second one was using big pictures and discussing emotions displayed in the pictures (ie happy child, sad person, etc).

The lady that was so agitated yesterday – screaming and cursing – was mild mannered today.

Later on we did several evaluations.

1) A lady who talked/processed sooooo slowly and was very Alice in Wonderland, using circular answers “That is the answer to which the answer is asked”, kinda stuff. She could not remember the state she was in at all, or county, or town. She scored in moderate dementia range using the mental status MMSE questions. She did poorly on the leather lacing assessment. She also didn't handle imitating a placemat very well. This is one of the confidence boosters today – realizing the ADM craft placemat wasn't so hard and I wouldn't have to struggle to learn it.
I was the one who gave the MMSE with my supervisor sitting next to me. Pretty cool. Her “sentence” that she had to write (without any suggestions on what to write) was “Please understand”. It kinda gave me chills – considering the way she spoke so slowly and circular-ly.

2) The euphoric lady. She was living alone up until this hospitalization. Hard to imagine her being safe. Euphoria is hilarious. Her sentence was “I am a very happy person and I love everyone”. I did her MMSE as well.

3) This was awesome. We went back to do the evaluation on one of our earlier pleasant quiet ladies, and she was NOT in a good mood. She kept saying SHUT UP and NO. My OT was trying nicely to get her to participate – and she was having none of it. She finally said “If you don't go away I'll throw my coffee in your face!”. My OT didn't flinch, she stayed calm.

===
I did a few mini chart reviews – learned that the Axis I diagnosis is what we have to use – did my two MMSEs – and learned how to enter in the info/notes for a group therapy session, into the computer. They still mostly use paper charts and their computer system is like DINOSAUR DOSsey, with like, using the function keys and arrows to get around, a TOTAL pain in the butt. It doesn't even word wrap!! Shockingly old school.

I need to practice the ACLS some more…that single cordovan stitch is going to be the death of me. And I'm not the only one. I know lots of other students who struggle with it.

——–
It's really interesting to me to see how people can be logical and smart in some ways, and then utterly incompetent in other ways, in these settings…the brain is so complicated!!! Spoken like a true neuroscience major.

———
ANYWAY….this was a little disjointed, but whatev. I wrote it with lots of distractions. After work I went to the gym. I think physical exercise at the gym is going to be my saving grace for getting through this fieldwork with my mental health intact. That and wonderful friends. And SEROTONIN! Come on you little serotonies!! Work harder!! Be fruitful and multiply and stuff!

——–

CPT, ACLS…assessing cognition

………

These two videos were made while in OT school, when we learned them during lab. Now I’ll be doing it on real people!!!
Yes, I know there are some mistakes in both videos…we were students just trying to get SOMETHING out there.
Pointing out errors to be helpful is great. If you want to be critical though, just make your own, better, video, so we can benefit from your awesomeness, okay?
ANYWAY! I’m going to watch these videos to refresh my memory, then go to bed,and hope tomorrow is a little less overwhelming!!

First day of final fieldwork, overrrrrrrrr

Today was my first day of my geriatric mental health fieldwork.

I met up with my supervisor around 8amish, read student manual binders for about an hour and a half until I was utterly overwhelmed, then joined a psychologist while he went and did a group in the inpatient ward that deals with stress disorders. It was an initial group and it was interesting. One lady there was complaining about how she couldn't have her makeup – she had the good point that they kept saying you should do things to make yourself feel better, but makeup would make her feel better! LOL! You aren't even allowed conditioner or face soap or anything. You get a baby Johnson's shampoo and Dial soup. Wow. Anyways, all these people were pretty high-functioning overall…able to interact, crack jokes, use words like “acrimonious”,…lol.

Even though this group was basically an initial hi, don't stop making your meds after you leave, kinda group, they all clamored to tell their stories, although sometimes indirectly, like…”What do you think it does when your mother tells you, when you're still a child, that she was molested?” Etc. They all mostly had problems with depression, anxiety, a few bipolars, a few DID (dissociative identity disorder)…honestly, considering my own background with depression/anxiety/panic attacks, and their high levels of function overall, it was a little hard for me to be present. I could see how precarious the slope is, to ending up inpatient. The psychologist kept discussing serotonin, which I wear around my neck (www.madewithmolecules.com), and I could feel it practically burning into my skin!

My OT supervisor also showed me the gero inpatient ward I'd be in – although sometimes if another ward has a low census, they temporarily combine them or something, so there were lots of young people there…including one lady who looked like an Amy Winehouse, screaming and cursing and trying to get out…my OT was just showing me around cool as a cucumber as this lady ranted and raved in the halls, not more than a few feet from us. She oddly seemed to ignore us. When it was time to leave the locked ward, the supervisor had me slip through quickly, since this lady was trying to leave. “I need to leave. I need to go to a hospital that will actually help me.”

Those were my two forays into the inpatient psych areas…the rest of the day was a combination of reading through mind-numbing huge manuals, and getting to see a few outpatient treatments with my OT, specifically a few that used assessments I'd be using – I got to see the Cognitive Performance Task – CPT – done, as well as the MMSE. The man on the MMSE scored in the moderate dementia range, answering with confidence that it was 2008, that it was Fall, etc (while also knowing it was January 5th).

For the lady who she did the CPT on – she did quite well. She scored slightly lower on the “shop” task because she “bought” a belt before checking the wallet to see how much money she had. The “phone” task was interesting as she really had to call a store and ask about a gallon of paint, which is a little flustering. I was thinking they'd have to be careful on this one not to let the patient call a big hardware chain that would make you navigate a menu to get to a person. They do account for that in the test though. Pretty interesting. The lady would think out loud, and for example on the medication task, she'd be like “Hmm…this says take as needed…normally at home I don't put those in the boxes if it says that, but I guess I could put one in a day…what do you think?” Therapist, noncomitally: “Whatever you think is best.”. Luckily she always self-corrected her mistakes, but it was a little slow-going. The only sub-task she really did poorly on was the “travel” one, following a very basic map.

There was/is a little confusion over orientation – I did get my ID badge today at least. And I was shown around some. My OT seems interesting and nice and so do her PT/ST colleagues. Here's the big scary issue. THE HOSPITAL IS A GHOST TOWN!  They're closing down wings, laying off therapists and support staff, left and right. Maybe I misunderstood, but my OT was saying they had like THIRTY OTs a few years ago, and now it's down to four OTs. Today I saw one PT, one PTA, and one ST, and then just my OT. Maybe she meant, actually, that there were like 30 therapists total, and only 4 now…hence the four therapists I met today. I'll ask for clarification. Regardless, there is no receptionist, and there are all these massive rooms/wings that are filled with AWESOME rehab equpiment, that are just dead/quiet. We stopped through the Independent Village that they boast about on their website, that has like a fake little grocery store, gas station, fake ATM, etc…it is SO COOL, it is like every OT's DREAM for functional, occupation-based treatment…and it's DEAD. Dead because it's isolated now (it was attached to the rehab area which is defunct), and it would be unsafe for a single therapist to take a patient to an isolated area, far away from any help. Seriously, a little chilling, to walk into these rooms strewn with rehab equipment. And this little village BROKE MY HEART. Such a beautiful, perfect, stunning, amazing, coolest thing I've ever seen. And yet empty. What this also means is that my OT has a lot on her plate – she runs the neuro day patient program, AND she has to do support staff functions that normally a receptionist/admin person would handle, and she is the only therapist I know of so far….today I ate lunch alone because they had a meeting through lunchtime. Not a big deal, just very different from my last two rotations. I think I'm going to have to be creative about my learning since it looks like basically I'll get to watch my OT do things a few times, then I'll be on my own from then on out…of course getting in my necessary supervisory hours, etc, but I won't be working side-by-side with any therapists.

They use the Allen's Level stuff a LOT – some of the RTI, ADM crafts, and then the CPT. Also the MMSE and ACLS. So this will be a great learning experience! I feel confident I can administer the MMSE, and the CPT is relatively straight forward once you learn some of the nuances with lower functioning patients. The ADM crafts and ACLS (leather lacing) are going to be hard for me because I have such major issues with visual perception and therefore struggle mightily to do these types of tasks.

Okay…this is my longest post in a long time. Basically, I'm feeling somewhat scared and overwhelmed, but I think that's normal for the first day/week of a fieldwork, and I think I can handle it, I just need to keep a lid on my panic!! Hey, if I do go postal, I'll be in the right place, lol.

I've gotten some sweet blog comments lately – thank you.

Last fieldwork starts tomorrow…

Tomorrow is my first day of my final fieldwork. Geriatric mental health. I'm scared. Of course. But I think it will all be okay. I need to refresh my memory on ACLS, CPT, and MMSE, and start planning Life skills groups. Of course by the end of this week I'll have a much better idea of what exactly to prepare. I've prepped my clothes, my lunch, etc for tomorrow, plus organized paperwork, so hopefully everything will go smoothly tomorrow. The CPR card may be a big deal, we shall see.

Okay, I'm going to try and go to bed soon. Wish me luck on my first day. And I seriously seriously seriously seriously am getting my act together so I think I'll FINALLY catch up on emails, Facebook, blog entries, questions, etc, SOON!!!!!

ACLS video with Spanish captions!

So I have to do the ACLS at my upcoming rotation and I was looking at the google video and I stumbled across this thread, and thus discovered my ACLS youtube video (starring classmates Kerri and Allison), has been captioned in Spanish! Ha ha! Cool!

http://www.youtube.com/watch?v=9IzjK6WJiKo

http://www.ot-advantage.com/ota/blogs.aspx?id=988&blogid=96