Thursday, September 6, 2012

My day.

Thinking about the good things of my day right now:

The sunshine this morning. Fall light is so much different than other times of the year. Love it.

The rain this afternoon. It helped my mood, and smelled incredible after. Yum.

Skylights. Smiles. Patience. Maple Trees. Wendy's Jr. Cheeseburgers. A dependable vehicle. Headphones that connect to my phone. The smell of clean laundry. My husband's humor and love. My sisters' strength and personalities.

Ridiculous infomercials.

Can't wait for the weekend.

<3>

Saturday, May 5, 2012

How do you communicate with your clients?

Wow, it's been a while! Things have been a bit crazy lately, so I apologize.

Lately, and in the past, I've worked with a lot of people who have a hard time with communication. Obviously, I'm no speech therapist, but I work with some great ones and they have taught me a lot. Seriously think about it for a minute though, without communication, all other interaction or intervention isn't as effective. So, as an OT, I feel that it is important for me to try and find a way I am able to have at least some successful communication with the clients I work with.

Sometimes, it's someone with a brain injury, where they maybe had a stroke, or a TBI. You therapists know that communication difficulties depend on where your brain is damaged. Maybe they have trouble understanding, maybe it's just expression, or possibly both. Other times it could be develepemental, autism or Down Syndrome, or from other disorders such as MS, ALS, Alzheimers, etc.

More often if it's expressive language, they can get a communication device through a Speech Therapist. This could be something like Dynavox or Tobii device. They also have apps on iPads and smart phones (proloquo2go is one) that provide access to communication as well. You can even use communication boards with pictures, letters or words that you or them can point to. If you don't have a Speech Therpist or access to one, try and advocate for your clients and get them something that may work. :)

Where I work, the Speech Therapist will look for the best option from some of the above choices as well as many other parts, and the OT plays a role for finding which access method is best. Can they use their finger to point? If not, what about a switch? Which movements are accurate enough for switch activation? What type of switch? What about using your head to choose (reflective sticker/camera)? What about eye gaze? Can they see the whole screen or just part? Can they handle 20 'buttons' or only 4? What type of mount will they need? I have a lot to learn before I would feel proficient with all of those areas, but it is fun to be able to give people that success to communicate more independently.

I also see this a lot now that I've been doing more with people who have ALS. It's hard because cognitively, things are still great, but their bodies and voices give up on them. I'll have to talk more about that in a different post so I don't get too lengthy here.

Another thing that I think of often is music. I LOVE music. There are often times you might hear me humming down the hallway or sitting at my desk. I would hate to lose any of my senses, but hearing would be one of the hardest. I listened to this show on NPR a while ago about Music Therapy and how successful it can be in regainin communciation. Think Gabby Gifford, and watch this:




I love it. Stories like that are just so incredible. So I guess what I'm trying to get out of this, is that you should try to find a way to communicate. Whether it's any of the above methods, or some others.

Here is one more little pearl--a video of a man who has been 'absent' from himself for quite some time, and how music brings him back. Love this!!!!


Happy Saturday!

Sunday, March 18, 2012

Free Switch Games for the Computer!!

So this week I worked a little on exploring some free switch games online. There are a TON of free options!  Here is a blog that has great resources......follow them! < http://teachinglearnerswithmultipleneeds.blogspot.com/2011/09/free-online-switch-activities.html > The categories in this post include Cause and Effect games, Single Switch, Double Switch, and Subscription Sites.

Why switches? Switches are great for introducing cause and effect, building attention, cognition, etc. You can have them use their head, hands, feet, elbows, or whatever, so it is great for kids that have a more difficult time with range of motion or motor coordination. It's helpful to have more motivation for reaching tasks, or a good distraction if you have a child in a standing frame.

There are a ton of options: big switches, small switches, cartoon switches, pillow switches, air switches, etc.

What do you need? First, a computer. Then you'll need a switch. And finally, you'll need a Switch Interface Box. This box will communicate between the switch and the computer. When you plug in a switch, it usually replaces or mimics the function of a certain key. One game may use the mouse, so your switch would mimic the click of a mouse; another game may use the tab or space bar keys, so then your switch will use that function to interact with the activity. Because some games use different keys to operate, this box gives you the option to say what key you will be representing so it can communicate correctly with the computer. I hope that makes sense.

I want to put some more time into finding these activities online, and then make a spreadsheet of the games, their function, what the reactions consist of, and what key/function it is mimicking. It will take some time, but I feel it would be a really good resource.

Here is a cute game where you hit your switch to find hidden animals. It's more basic cause and effect, but there are others where you have to pay more attention to timing. This is one where you have to wait and press at a certain time to hit a clown with a pie. For more of a challenge, here is one that requires more advanced timing and reaction speed. There are also games that deal with specific learning topics: alphabet, colors, math, science, etc. I'm sure you could do a little web research and find a ton!!  If you have any other resources I'd love to hear of them!

Happy Sunday!


The start of my mini garden blowing in the wind. :)



Sunday, March 11, 2012

OT vs. PT

Thought this was great! I know it's not completely true, but both of my OT and PT friends can find the humor in it. :)

Hope you enjoy it!

Sunday, March 4, 2012

Mind-Body Solutions

If you've never heard of Matt Sanford, you should definitely check him out around the web. He is originally from Minnesota, and was in a terrible car accident when he was 13 years old, which killed his father and sister, and also paralyzed him from the chest down.

He has written a book called Waking, which I'd recommend any therapist to read, as it's really helpful to gain perspective from people who have actually experience traumatic injuries/illnesses in their lives. He has a very interesting story, where he was basically told in therapy to live in the remaining part of his body that worked and mainly forget about the rest, as it would never work again. After many years of living this way, he discovered yoga, and it changed his life. He was able to use his whole body to work together, and finally feel like a whole person again. It's an incredible testimony, and has led to many changed lives as a result.

Matt teaches adaptive yoga classes in the Twin Cities, and attends workshops and speaking engagements all over the place. I'm currently a part of a study that my workplace has put on each year for the past 4 years. It is all about applying some of these mind-body techniques to our own lives as well as our practice as medical professionals and applying it to our daily work. We start off with an immersion weekend where we have training for an entire day by others who have gone through the training as well as Matt. Then, we have weekly 90 minute sessions during a work day for four weeks, and it decreases to one time per month after that for six or seven months. This week will be our third week, and so far it has been great.

We work on things like relaxation techniques, grounding, and others with a partner as well as on our own. We have all of the yoga gear there for us and we all get excused for that time of our day. It's a huge commitment for the company both financially and time wise, so I feel really lucky to be a part of it. I've tried to apply it during sessions with clients as well as at home. It's been helpful so far, but I need a lot more practice to make it streamlined into daily routine for me. I'll have to write more about it as the weeks progress, but until then, here's a great video.



Monday, February 27, 2012

Let's Talk About Sex

So while I typed the title, you know I was humming the song, 'Let's talk about sex, baby; Let's talk about you and me.......' :)

I've worked at a variety of places where people are at different stages of the medical process. Right after heart or knee surgery, days, weeks or months after a stroke, etc.  I feel like we cover a lot as Occupational Therapists: strength, coordination, dressing & bathing, vision, assistive technology, cognition, range of motion, adaptive equipment, ergonomics, hand therapy, play, handwriting, social skills, and the list goes on and on! One thing that we have education on but often stay quiet about is sex/sexuality.

I never completely avoided the topic, but I didn't eagerly bring it up either. If it came up, I would at least let them know that as an OT we can cover the topic and give them education if they are seeking it ::: appropriate positions after a joint replacement or stroke. If they wanted information, I'd give them a handout and go through it with them, but that was pretty much it.

At my current job it is encouraged to be brought up at evaluations or during the treatment process if it is appropriate/applicable. Usually it's on our IADL (Instrumental Activities of Daily Living) list of questions to go through: Transportation, Money management, sexual activity, household management, medication management, etc. It's a lot easier to bring it up if it's along side other topics. Some clients are more than grateful that the question is asked and I am sometimes surprised at their response, while other times people like to keep that information to themselves and don't feel it should be addressed in therapy.

Looking for information that we can give? I'd check your textbooks from school, conferences, or check the internet (just be careful as there may be some crazy results). What can OTs assist with? Sometimes it's discussing positioning and giving handouts, 'adaptive equipment' options and resources for purchasing, pictures or other options to assist with aphasia, and education of the disease/injury process and how it can affect sexuality. I've often had people discuss problems with Erectile Dysfunction after a surgery or injury, and then I'll refer them to their physician as well, as I obviously am not prescribing any meds.

Other times I've had clients that act sexually inappropriate in public either with words or actions. This could be grabbing themselves or others inappropriately (I've seen this more often with people with developmental disabilities in pubescent kids into adulthood) or saying sexual or offensive comments to others (I've seen this more often with brain injuries or long-term drug abuse...which is also injuring your brain). In those situations it's more about finding the root of those behaviors and then finding solutions to them. Maybe they need a journal to write those thoughts down instead of saying them, maybe they needs some time each day to themselves to act on those feelings in their alone time instead of doing them in public.

There are a lot of options, and I'm no pro, but I'm working on making it more common in my practice as an OT. If you're thinking about doing this too, I'd suggest going back to your books again, digging into some research, as well as asking other therapists around you. You'd be surprised at what great suggestions you may get! One of the therapists I work with actually made a binder with a ton of information she has collected from conferences, books, and other resources, and it's so nice to have a lot of things together in one spot to use as a great resource. Sometimes it feels that it's a taboo topic in our culture, but we have to do justice to it and not forget to address it. Let me know if you have any more information that has helped you in this area!

Friday, February 24, 2012

Pediatric Assessments I Use the Most

Just thought I'd go through a list of assessments I use for different ages and diagnoses of peds clients. Obviously it's different from location to location, but this is what I use the most often. I remember my first travel assignment not really knowing what assessment to use for what types of clients. Now I work a lot more often and consistently with pediatric clients, so it's gotten a lot easier. I still have a long way to go, but here's a start at least!

:::Pediatric Outpatients:::
-With all of our pediatric clients, the PEDI (Pediatric Evaluation of Disability Inventory) is completed. It gives us (OT, PT, and some with ST) a pretty good idea of where we are at functionally at time of the evaluation, and we also use it as an outcome tool to see how they progress in these areas during treatment. It's also really nice for functional goal writing as well. It goes over things like fasteners, opening snacks, jumping on one foot, etc.
-If they're younger (birth-5) or will have difficulty completing higher level tasks, I'll usually complete the Peabody (Developmental Motor Scales). I think that the Peabody is a bit hard to follow as it jumps around a bit, but it gets easier as you get more experience. If they are older than 5 but can't do something like the BOT, I will sometimes do Peabody tasks to at least get an age equivalence for insurance companies. The Peabody includes everything from reflexes in babies to holding a marker and lacing beads.
-For school aged kids (4-21), I usually complete the BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition). I really like this assessment and it's fairly easy to administer. Everything comes in one bag and it's easy to keep it all together. Scoring isn't bad either. I also complete the Beery VMI (test of Visual Motor Integration) often with kids that are able to use a pencil. It's for ages 2-100, includes 3 parts, and is easy to administer. Hard for kids that have a hard time with sustained attention though.
-If they have sensory needs, I will go over one or two of the following with the parents: the Sensory Profile (short or caregiver), TABS (Temperament and Atypical Behavior Scale for kids 11-71 months), or the BRIEF (Behavior Rating Inventory of Executive Function, 5-18 years).

We usually do multiple assessments in an evaluation which is typically and hour. The PEDI is always completed, and we'll pair together the BOT-2 and the VMI or the Peabody and TABS. Often, if there are sensory based concerns, we also complete additional sensory based assessments that were listed as well. It's nice to get a broad view of who the client is -- both their strengths and weaknesses. Time constraints are the worst in evals, so we always encourage them to come early to get some of the admission paperwork finished before the appointment. I like to at least have some small talk with them before I drag out all of my tests, but will do things like offer them a piece of gum (much better concentration in many kids), or have some quick fun breaks between tests to jump, play on a ball, etc. Afterward, I like to give them a tour so they can be excited to hang out in the super fun gym the next time they come instead of sit in a room and do 'homework'. :)

Most insurance companies require 1-2 assessments, and usually require that children are a certain number of standard deviations (SD) from the mean in at least 2 areas to give approval for therapy. Some insurance companies require them to be 1 SD away, but many require 2 SD away from the mean. Ha, I wasn't sure I'd ever reuse my stats knowledge after I graduated, so I guess I got Punk'd!! If they're long-term kids, insurance companies require that you complete the assessments every 3-6 months to see how they are progressing.

Anyway, that's enough for now as I'm sure I'm totally boring you. :) I'll have to do another one with adult assessments. Hopefully this was helpful!

Monday, February 20, 2012

Apps for Brain Injuries



People with brain injuries make up a very large population of clients that we see daily. We work on things like cooking, dressing, cognition, balance, strength, transfers, functional use of affected extremities if that is an issue, memory, attention, path finding, money management, etc.

One thing I like to do is to provide them or their families/caregivers with dependable outside sources that they can also get information from. Sometimes as therapists who see them consistently, we may be some of the only ones that get one on one time where they are free to ask questions and have time to discuss issues they may be having in their daily lives.

Brainline.org is a great website with fantastic information for those affected by brain injuries. One of the bummers is that our facility isn't listed on theirs as a resource in MN. Anyway, they have put together a list of 24 Life-Changing iPhone and iPad Apps for People with Brain Injuries and 18 Life-Changing Android Apps for People with Brain Injuries!!!  I actually just print a copy of these and give them to clients if applicable.

I haven't had access to them all but here are some that I have used with clients or use myself:

iPad : They are becoming more and more common for some clients to have so it is so great to have so many fantastic options available.
   - Dragon Dictation : Love this one. Dragon Naturally Speaking is also one we recommend a lot to many types of clients. Great for clients that have difficulty with organization, pain, or want things to work more efficiently if they have hemiparesis that slows them down. Downside is if clients have difficulty with cognition or aphasia, as well as certain accents/dialects.
    - Proloquo2go : I haven't used this one as much but I know our speech therapists use it often. We see it more often with kids who have speech delays but it is also incredible for those with aphasia, especially expressive aphasia alone.
    - My Emergency Info : Great to have all of your medical history in one spot in case of emergencies or to bring to appointments. It's super helpful! However, I'd maybe think about putting a lock code on it to keep it safe if I ever misplaced it.
    - Pill Time : Apps like these are a lifesaver for those who have to keep track of multiple meds or times.
    - Locate Me Now : Great! Need wireless capabilities on a network with an iPad.
    - Lumosity : GREAT website. Specifically designed for those with brain injuries. You can choose what you'd like to work on specifically and they will form a plan that fits your needs. Our facility has a membership to it so I have used it in sessions and have my own account as well. Downside, you have to pay a monthly fee.
    - There are also apps to help with calenders, grocery lists, password keepers, banking, etc.

Android :
   - Smart Hearing Aid: Have not used this one, but now I totally want to. How cool is that!
   - Evernote: I use this one often. Keep to do lists, take notes, store pictures, etc.
   - Where Am I? : also good for people with dementia
   - PTSD coach and support for veterans. There are great resources out there for those who have risked their lives for our country and our freedom. The more links we can have the better!

Do you have any others that you have used or want to use that aren't on these lists??

Sunday, February 19, 2012

Assistive Technology

Because I am the system wide float for the facility I work for, I get the opportunity to be trained in many different areas. Sometimes it's difficult for me to always be switching from one focus or facility to another, but the training I am receiving is well worth it!

This week I did some training with a Dynavox rep, as I will be working with clients who have ALS and need to know a lot more about assistive technology. It's so incredible to see what technology can do to help others access their environment. I will be getting more training from a Tobii rep in a couple weeks, but know that the devices have similar features.

For those of you who know people struggling with ALS, I would recommend checking in with their state's ALS chapter as they will usually have a lot of resources available. The one here is incredible and they make it very helpful for those diagnosed to have access to things more easily with less financial restraints.

I was able to train with the EyeMax and calibrate the machine to my eyes in order to control my choices. You can access text messaging, the internet, turn your TV channels, communicate with others, etc. By using your eyes, you can either choose a blink setting or a dwell setting. It's actually pretty tiring but your eyes need some 'training time' to get used to it. You can also access it via switch or by the touch screen if you have that capability.  It's a device that's access option can be changed as the disease progresses. Start by using the touch screen, and then advance to switch or eye gaze. There are so many incredible options with these items that are so helpful for many people.

Not only does the program use devices like the one above, but there are a lot of low tech options available to make things more accessible too. Things like different remote controls, special speakerphones, speech to text software (mostly Dragon Naturally Speaking), visual aides for staff or friends to help make sure daily routines are more consistent or to explain the nature of the illness, voice banking phrases so the client will be able to use their voice to communicate rather than the device, switches to allow visitors into secure entries, etc. Total independence isn't usually an option eventually, but it's so nice to empower people with as much control of their surroundings that they can manage.

Here is a video of Augie Nieto using the device to communicate. Check it out, and enjoy the rest of your Sunday!


Sunday, February 12, 2012

Fieldwork Advice

Lately I've had a few conversations with co-workers and friends about students: OT, PT, ST, etc. There a lot of students where I work and they have always seemed very prepared and ready to take on the demands of being a student. However, I've known some people who have had a lot of problems with students. I'll give you a couple examples of the kinds of students we get nervous about as well as a GREAT link written by students and others for tips for OT fieldwork. A lot of it would also apply to other areas of work as well.

I personally have never had a student for the whole 12 or 8 weeks because of the nature of my past employment and most likely won't in my current position since I will often be floating from position to position. I have had experience supervising students however in both OT and COTA roles, mostly for shorter periods of time.

I think having a student is great but I wouldn't be able to do it all year long. It's a lot of extra work for the therapist, mostly in the beginning, because of the prep work and maintaining your caseload while helping the student become comfortable with everything. As time goes on and the student becomes more independent and confident with clients it's great! For me it's a great learning experience and keeps me on my toes sometimes making me a better therapist. There are good clinical educators and not so good. I hope you only end up with the good. :) There are also good students and not so good students. Your fieldwork will help shape you into the therapist you will become, so take it seriously and have fun!

Some problems that are more common are students that aren't professional: dress, talk, and actions.
Dress:  I've seen students and other co-workers who have worn clothes that are either way too tight or low where skin shows that is super unecessary. Be sensitive to the cultures you work with. Some may be very offended. If you wear scrubs, wear something underneath. When you're bending over to help them with socks, shoes, or whatever, the client can often see everything. If you don't wear scrubs, watch how low your shirts are. Also, make sure they cover your back is covered when you bend over from behind. Your clients do NOT need to see your back tattoos, butt, or what kind of underwear you're wearing.
Talk: Be compassionate. Try to make conversation if client's want to talk, but make sure it's appropriate. Often religion, politics and sometimes death are stay away topics. If it comes up, don't be one sided. A friend of mine just told me that they had a student tell a client that they didn't like a certain denomination of Christianity because they weren't 'real' or 'authentic'. Turned out that the client practiced that denomination. I can't imagine how angry I would be with that student. I've worked with others who talked often of their fear of death in front of client's that were trying to defeat it. Also, talk at their level. If they are kids, don't talk to them like they are infants and know some of them have real hard problems in life and reasons for their behaviors. If they are elderly, don't assume that they are hard of hearing and remember that they have led an important life worth learning about. Don't assume anything.
Action: I often bring water into my sessions, and offer it to my clients as well. However this is not appropriate in all settings. Always let client's know what you are going to do before you do it. We would never want to be treated in that way in our own personal appointments. Be kind. If someone is asking for directions and you don't have time, find someone to help them. Smile. You are representing that company for the time you are there, make your representation positive.

Here is the link with some great advice. It was last updated in 2003, but is from AOTA and was put together by ASD (Assembly of Student Delegates) Steering Commitee. I'll put a bit of their information here. It talks about finding housing, how to get by without much money, what will prepare you the most, advice from others, skills to brush up on, time and stress management, tips, sample code of ethics for students, and common fears about fieldwork. It's definitely worth checking out! Here is the sample code of eithics and common fears::::I'll add my comments in a different color.

Sample Fieldwork "Code of Ethics" for Students
• Respect and adhere to the philosophy, policies, and procedures of the fieldwork center.
• Respect the opinions and decisions of the supervisor. Disagreements with stated policies, procedures, or directions should be discussed with the student’s immediate supervisor. If there are problems, also discuss this with your Fieldwork Director at your school.
• Respect, protect, and conserve the resources available to the student for learning and therapeutic purposes; prevent misuse, abuse, or destruction of materials, equipment, and resources. If you want to take copies with you when you leave, ask how you can use them in the future::(Will they care if you make copies and give them to future clients?)
• Maintain the clinic environment in a safe, organized manner and contribute to the maintenance of adequate supplies and equipment.
• Respect the rights and assure the integrity of clients/patients, which includes assuring confidentiality of treatment information regardless of the source as well as maintaining a goal-directed relationship.
• Complete all documentation related to the fieldwork experience in a timely manner and in accordance with fieldwork facility guidelines.
• Adhere to the contractual agreement for fieldwork education between their fieldwork center and academic program.
• Retain proof or current malpractice, professional liability, and health insurance. Your school usually helps to take care of the malpractice and liability insurance.
• Respect, cooperate, and collaborate with other members of the health team.
• Serve as an advocate for clients, their families, the fieldwork center, and occupational therapy.
• Contact the fieldwork coordinator when resolution of fieldwork problems with the supervisor is not successful or when concerns about continuance of the fieldwork arise.
• Abide by the uniform requirements of the fieldwork facility and assure a professional appearance that does not hinder the treatment environment.
• Commit to continual learning throughout the fieldwork program by using unscheduled time to observe therapies, engage in educational interaction with other team members, review resource materials, or engage in other professionally relevant educational opportunities. Take advantage of this, it's well worth it!!
• Be accountable for actions at all times during the fieldwork experience by recognizing that the facility is first and foremost a treatment environment and secondly an educational environment.
-Treatment has priority over education, and it is the student’s responsibility to assure this process while also maintaining his/her educational needs.
• Self-direct their learning as much as possible, carefully assess the need for supervision during difficult situations, and seek appropriate supervision before proceeding. Go home and research things you may have questions on, then seek further advice after. Go back to your books, search journals, and do a Google/Bing/Yahoo search!
• Seek information regarding principles, standards, and policies of fieldwork setting, fieldwork education, and the profession.
• Support quality assurance and research related to the fieldwork setting practices
• Do not act with improperly or engage in illegal conduct while on the fieldwork or act in a way that would question one’s integrity as a professional.
Reference:
Crist, P. A., & Slach (1986). Fieldwork Philosophy. Contemporary Issues in Clinical Education, 7, 67-68.

Common Fears About Level IIs
• Don’t be afraid to express your thoughts and ideas. It might seem overwhelming at first, but you will feel comfortable and very competent by the end I usually did this after sessions with my supervisor, depending on the situation. They may have already attempted that with the client or maybe not at all. Sometimes it's more appropriate to bring ideas up after or prior to a session.
• Be enthusiastic—give ideas—everyone appreciates a new or different perspective - Same as above
• Relax and remain confident
• Groups and treatment sessions will fail—it’s okay, learn from it. We still sometimes feel this way at times, it's ok.
• Don’t be afraid to be wrong, try your ideas
• Keep a positive attitude, and speak up if there is a problem
• You won’t remember everything, that’s what books are for. Use them! Agree!!! :)
• Expect the worse and hope for the best - I'd say to expect anything, always be overly prepared.
• Don’t be afraid to contribute in team meetings
• Twelve (eight) weeks go by quickly, good experience or bad - Super true
• Go in with an open mind, you may see some pretty strange things - Yup!
• Your supervisor is there to help/teach, use his/her resources
• You will not be a perfect OT/OTA, not now, not even when you have 10 years experience :)
• Don’t be afraid to try new things. Don’t be afraid to ask questions. Don’t be afraid of your patients—treat them with love and respect. Learn from your patients, they have much to teach as well
• Keep a variety of resources, including your textbooks handy for reference. Use libraries and reference materials available at the site
• Clearly communicate your learning style with your supervisor in order to prevent yourself from becoming confused or overwhelmed during your fieldwork experience
• Relax and observe other professionals
• Be prepared to spend time on documentation techniques and language
• Learn to set limits with patients
• Ask for feedback if you feel you need it
• Keep a journal or patient log, writing down specific diagnoses and how you treated each patient (i.e. treatment plan, activities, what was good, what was bad, what you would have done differently, etc).
"INITIATE, INITIATE, INITIATE!!!"
References:

Alzoni, D., Link, S., & Trone, J. submitted as part of course requirement for OT 410: Administration, Management, and Supervision at Elizabethtown College, Elizabethtown, PA

So there you go! There is a ton of other advice out there, but here are at least a few good niblets of info to start with. Sorry it was so long, hopefully it was helpful!!!

Thursday, January 26, 2012

We Want Everyone in the Gym!

So last year at this time I was working for an LTACH (Long Term Acute Care Hospital) in Texas. We went from small town Idaho where some of the older client's goals were just to be able to go home and chop their wood for their heat to a megaplex of over 8 million people. Let's just say it was a bit of an adjustment. :)

An LTACH is where someone would go between a hospital stay and a rehab stay. They may need rehab and often transfer to a rehab facility after, but are too medically fragile to get that much therapy. They stay varies, but it can be up to weeks and months. More common diagnoses that I saw were bad infections, respiratory or cardiac failure, trauma, wounds that hadn't healed from surgeries or other issues, strokes, kidney failure and peripheral vascular disease. There were 2 floors, one which seemed to have a little more involved clients than others, and then a 12 bed ICU. I feel like 99% of the people I saw were attached to at least one tube if not ten.

 When it's busy, we were running like crazy. I have never ran around that much at a job, ever. The part I didn't like about that was then we didn't get to know the clients as well. But when we were slow it was a whole different story, where you can bring people down a few times for therapy in a day if they'd like. But, it was most often pretty busy. Our saving grace were the Rehab Techs (aides). They helped us with getting clients ready for therapy, getting them to the gym, coordinating our schedules, etc. I couldn't have done my job without mine! We had heard of other LTACHs that only had 1-2 therapists for a 50 place. With pretty much all of them expected to therapy. They never were able to keep up. That is totally impossible and unethical in my opinion. But anyway, I'll get off my soap box.  
 
Here's what you could expect on my caseload there.....Most everyone had IVs and catheters, a large majority had telemetry monitors. Many had wound vacs and/or oxygen, ports for dialysis or possibly chemo, some even had vent support or rectal tubes. It's a bit overwhelming at first, but you become used to it, as I'm sure they are as well. The one thing I would say that is most important is to have compassion for these patients. They have gone through so much and I feel like by this time, many people grow numb to the situation and either don't expect great care, or don't get it from staff. They've had dozens if not hundreds of medical professionals poke them, question them, cath them, check them, etc., and we need to remember to never forget that they are our number one priority and also that they are people. With stories, families, hobbies, hopes and dreams.

When in the gym we most often did exercise (97110 code to be exact) and also did things like the standing frame with PT and completed upper extremity exercises if able. One of the therapists was excellent at manual therapy, so he did a lot of that as well. When we did therapy in their rooms of people that were more stable, we did dressing or showering, toileting sometimes, transfers, bed mobility, or did exercises there. When they were more unstable, we'd do things like range of motion, sitting at the edge of the bed, and possibly simple tasks like grooming or following commands. Also here we would sometimes put them on the tilt table (if appropriate) and provide a lot of education for the client and their family. Many are very medically fragile, so we are constantly monitoring blood pressure and telemetry. Some of my patients could not even handle transferring to the edge of the bed without their blood pressure going crazy. At times co-treats were totally necessary in order for it to be safe and most effective for the patient. Our CEO/Administrator wanted everyone in the gym if they were able to which obviously isn't appropriate for all, but when they could, it was nice for the clients to see others that were going through similar situations and many formed friendships, shared stories, or had competitions.

Often our patients were put on hold due to their lab values. In the morning, the first thing I would do is check my list, then check those charts looking for that morning's labs. The most common ones I was looking for to be in normal limits were their Sodium, Potassium, INR, and Hemoglobin/Hematocrit. Depending on their diagnoses, I also looked at their White Blood Count, Ammonia, blood sugars, BUN, Creatine, Magnesium,  their ABGs (Arterial Blood Gases), and others. We had a little cheat sheet that one of the OTs made that we all wore with our name tag so we knew what to look for which was SUPER helpful. Sometimes we had clients also receiving dialysis (which was in the building, so it was super nice---many have to leave their facility) and they were sometimes too weak or tired to do therapy. Some unfortunately, passed away during their time there as well, which could be a whole different post another time.

I really enjoyed working in this environment, but I think the best part of it was my co-workers. The therapists were all a ton of fun and didn't love everything about their jobs, but their patients were important to each and every one of them and they were always 'client-centered'. They worked as a team and helped each other out whenever needed. I often think back to work there and miss the day to day craziness. But I'm thankful at the same time that I was lucky enough to be with them for 13 weeks. :)



Tuesday, January 24, 2012

Spotlight on Stella

So lately we've been looking through a lot of pictures that we've taken during the last 5-7 years and I've been having a great time thinking back to those moments and reliving the conversations, sights, smells, and feeling of that time. I thought it would be kind of fun to document some of them and sort of do a spotlight every once in a while on those people.

So the first person I chose is Stella.

I met Stella and a bunch of her peers in July 2008 on a trip to Cameroon,  Africa. Stella started off being the shyest of the entire bunch. She was 13 and below is a pic of her and some other teenagers/tweens.
Lower Left Side
Stella was a at camp that we were volunteering at. She is the only girl in her family, with 3 or 4 brothers. Because boys/men are often thought of as more important in many countries, Stella had to wait to enter school until all of her brothers were able to get through it. School is not free in many parts of Africa so often children only go if their families can afford it. Many girls complete less school than boys, and most often go on to further job/specialty training such as being a seamstress or teaching in a school.
This is her and one of her best friends. Her friend had the privilege of attending school from the time she was very young. When I was talking to her friend, she said that she was entering Class 13 soon. This, I understood, was like later American High School, and she was only 13 years old! Stella was to be starting Class 1 the next year, which is 1st grade equivalent in the US. It's just crazy to me to think of how different their lives have been and will be. Best friends, both 13, in two different worlds educationally, and hopefully both with bright futures ahead of them. 

I was drawn to Stella at the beginning of this day and she started out being super shy. At one point in the day, the girls changed from their dress clothes to play clothes, and I saw a transformation in her personality. She was laughing, being silly, and being a completely outgoing 13 year old girl. I couldn't stop taking pictures. :)
Goofs

 The last two pictures they are waiting for water balloons that were being launched. :) Totally new experiences for these unexpected campers!
I'll never know what Stella's future has in store for her. I  hope and pray that she is surrounded by positive support and love and is given the encouragement she needs. She is just one of the MANY faces I met on this trip, and one that had a large impact on me. 
I think it's crazy to think of where we are born. There are hundreds of thousands of children less fortunate than her, and I think we can play a part in their lives. I was born into a country that has freedom, a family that was supportive, an education system that was free, and had a fair opportunity to attend many colleges. I had access to food, clean water, medical care, etc. I feel that I personally have a role to play in children's lives around the world. Whether that be providing them mosquito nets or vaccines, medical care, money for education, clean water, food, safety from slavery and injustice,  love and support. For people here in the US and around the world. 
Check into some non-profits and you'll see they're doing these things! :) You can choose a program that does many of these things like World Vision or Compassion International or others out there that are more specific for providing water, or saving from slavery, etc. Start making a difference today.


Friday, January 20, 2012

Yummy Recipes!!

So, I know this isn't a cooking blog, but it's also not just strictly and OT blog. :) I often get stuck in a recipe rut and we get totally bored with the meals we make, so I've been doing some crazy collecting on Pinterest. I could keep collecting for hours and hours, but have finally gathered enough ingredients to make some of them!

So, I'll just tell you about them because they were both fantastic! First off, I made Baked Southwestern Egg Rolls. The pic was borrowed from the Annie's Eats page. Check it out, it's fabulous. I wanted a little more pizzaz to the mix, so I also added cilantro, lime juice, and chopped sun-dried tomatoes. I think diced tomatoes would be incredible, but wasn't sure if it'd be too runny and opted for sun-dried. We dipped them in corn and black bean salsa. Soooo good! Had them for some great lunch leftovers, luckily there is a stove there so I can heat it up and make sure they get a little extra crisp.


Tonight, I made Thai Chicken Thin Crust Pizza. (Picture from their site). I found this recipe along with other greats on the Flatout bread website. I've looked in three stores for the Flatout Flatbread, and didn't think the flat buns would be enough. So, I found a really random substitute at Trader Joe's ::: Naan. :) Not sure if my Indian friends would approve or laugh at me, but it actually worked well! We loaded them with extra ingredients and loved the taste of the peanut sauce/cilantro/sprouts/carrots combo. It could use one more thing, but we couldn't put our finger on it.

Anyway, that's it for tonight. They were just too good not to share! Have a great weekend!!

Monday, January 16, 2012

Great Resources for Spinal Cord Injuries

Working with therapists with a diverse experience background is super helpful in finding resources or answers to questions. Before I started this job, I didn't have much experience at all working with Spinal Cord Injuries. I've had some in more acute settings, but never in Rehab. I still have a long way to go before I feel comfortable, but I'm slowly starting go gain some ground. The next person I cover for primarily works with clients with SCIs, so I'll have a better grasp after getting some more consistent daily experience. Anyway, there are some great resources out there that I thought I'd share as I have found them really helpful.

Check out Paralyzed Veterans of America : www.pva.org  and look around a bit. They have information on their programs, sports, ADA, finances, etc. It's not only applicable to Veterans, but anyone with an injury resulting in paralysis or loss of function. Best of all check out their publications! You can find their publications on the website that offer guides for consumers (the clients) and clinicians (medical team), they are super helpful, and best of all, they're free!!! They cover everything from Autonomic Dysreflexia, to Depression, to Upper Extremity Function. They also have great Outcome guides for what to expect at certain levels of injury. These are great for therapists, and fantastic for your clients. The biggest pain is that you have to add them to your cart individually, check out, and then they will give you a page with links for each one. Then you save each one to your computer. It's a bit time consuming that way, but once you save them they are yours! They are anywhere from 20-100 pages long, so don't expect to get through them all in one sitting. So far the Outcome Guides are my favorite!

Another great thing is that they have 3 of them available in Spanish, as well as resources for Multiple Sclerosis and things like Accessibility, Housing, Advocacy, etc. I have been referring to this site often lately, hope it helps you as well!

Friday, January 13, 2012

Know Someone with Parkinson's?

So, my job offers a variety of services in all of the therapy arenas, but I want to give a snippet about this one today. It's not even really OT related, and mainly the PTs and SLPs seem to work with these programs.

It's called LSVT training, and focuses on client's living with Parkinson's. It is a 4 week very intensive program that is recommended to do as soon after diagnosis as possible (early on in the progression of the disease). They also say it is effective with people that have strokes, Multiple Sclerosis, Cerebral Palsy, and Down Syndrome.

LSVT has 2 types: LSVT LOUD and LSVT BIG. LSVT stands for Lee Silverman Voice Treatment. The LOUD program is primarily done with a speech therapist, and the BIG program is done with a PT or OT.  They focus on just that - being big with your movements and loud with your voice.

Here is a great before/after video of a client of the LSVT LOUD program.


Here is another video with more information about the LSVT BIG program.

Go to the LSVT Global website to learn more about the programs, watch more videos, find a clinician near you, or sign up for courses. :)

I have many people that I've met along the way that I think about when I read about this program, maybe you can help others with it too! I just feel being big and loud help a lot of clients with various diagnoses in general. Not all, of course, but it's so nice that there's a specialized, proven program out there. Check it out, and let me know what you think!

Have a great Friday!

Wednesday, January 11, 2012

New Job Details

So, it's about time I update a bit about my job. I work at a fantastic place that I have really enjoyed. The learning part alone has blown me away, and I have a feeling I'm on a continuous learning roller coaster!

The facility provides a ton of great services. I don't even know where to start. The main focus of therapy is outpatient pediatric and adult clients as well as inpatient rehab. However, the OTs also work with our Driving Program, Home Care, in the schools, with Assistive Technology, etc. There are 4 locations throughout the metro area, with one being the main campus and largest facility.

Most often you won't only find the more common, run of the mill diagnoses that I have been used to over the past couple years: joint replacements, diabetes, falls, carpal tunnel, illnesses, CVAs, etc. They may be part of the problem, but most client's have multiple diagnoses or are in need of many services. My job is currently to cover for people leaving on maternity leaves, medical leaves, vacations, or whatever else. Usually I stay in a person's position for 1-3 months, so it's been a great transition from traveling.

Different locations seem to have various expertise/focus. I was at a different site during the fall and they focus on pediatric and adult therapy, as well as pool therapy and various pool classes. They also provide other services as well. The location that I'm currently at is larger and divided into teams for outpatient therapy: Neuro, Spinal Cord Injury, Ortho, Brain Injury, and Peds. The inpatient program focuses mainly on clients with spinal cord or brain injuries, but it's not limited to only these diagnoses. I have had at least a little experience with them all so far and it has been great! There are a lot of programs offered: vocational rehabilitation, an adult day program, an accessible fitness center, pool programming, chronic pain program, sports and recreation programs, as well as many others. I feel lucky to be part of such a diverse and client centered organization. My co-workers have been very welcoming and helpful which makes for an even better transition!

So far so good, and I hope they'll keep me. :o) That's all for now, hope your week is going fantastic!

Watch this video to brighten up your day and put a smile on your face. I thought it was hilarious, hope you like it!

Saturday, January 7, 2012

Hand Made Gifts 2011

So this year I wanted to make some hand-made gifts for Christmas, so I gave it a whirl. I only got a few things done, and they weren't the greatest thing I've ever seen, but I thought they were fun! :)


My sisters got guitars for their birthdays, which is super close to Christmas. While we were at the hubby's family's for Christmas, I saw that his brother had made guitar pics for himself out of old gift and credit cards. They're like the perfect thickness for pics!! Here's what they looked like:

The next gift I made was one I found first on Pinterest. I don't have a sewing machine yet so these were a sew free project I could do on my own. My mom makes incredible wool mittens and has a lot of extra wool sweaters at home. I took a few the last time I was there and made these coffee cozies to go over Starbucks or Caribou cups. They aren't the best, but a good start for the creative juices. 

   
The last is a bunch of magnets that I made for family and friends. I found the idea on a list of gifts to make for others online. There were a lot more options than you see here and I have a lot of leftover materials to make more. They're fun to use for home, work, wherever. I wish I had a magnet board in my car to use them there too. :)

So, like I said.....they aren't anything extra fantastic, but it was a lot of fun. Hopefully it's just the start to my homemade gifting. We'll see! Hope you enjoyed your holidays as well.

Friday, January 6, 2012

GREAT Blogs!

Fell upon this blog via friends on Pinterest and have been stuck on it most of the night. It is applicable to all parents and therapist working with kids or any adult clients with sensory needs. LOVE it!!
 <<<<< http://playathomemom3.blogspot.com/ >>>>>
Let me know what your favorites are! Have a great weekend!

Sunday, December 25, 2011

Holiday Greetings!




Happy Holidays 2011


Our Christmas Letter for 2011 :).......

Dear friends and family,
Know that we would much rather sit down over a cup of coffee,
reminisce old times and catch up with life, but unfortunately this little letter will have to do…
A lot of you know this, but the past year has mostly been spent pursuing travel therapy with my job (Occupational Therapist). It gave us the opportunity to explore the US, learn a lot about ourselves, and meet some incredible people. It truly was an amazing adventure! Last holiday season we were en route from Sandpoint, Idaho to Dallas, Texas. We spent the winter in Texas which was a lot of fun. After 13 weeks of being there, we headed up to Moose Lake, Minnesota. We made a few trips to Duluth to take in all that city has to offer. While we were at Moose Lake, Andy started looking for a more permanent job. After many applications and interviews, he chose a job in Business Development for a Logistics in the Minneapolis area. Through a variety of services, they help companies manage their supply-chain activities. As he started his transition there, I finished my assignment and applied for jobs in the cities. I was hired as a Float OT between four facilities and cover for maternity and medical leaves. It has been fun to get a wide range of clients, but also really challenging to learn all I need to know. I work with kids and adults with genetic disorders, brain injuries from strokes and accidents, spinal cord injuries, and lots more. It’s been a great learning experience so far, so I’m really happy with that.
The cities have been good for us, but we are often homesick for Bismarck. It is finally hitting us that these jobs aren’t travel jobs, and that we’ll be here for a while. We miss all of our friends and family back home, and wish we could see everyone more often. We do have a few friends and in the area and are now closer to Andy’s sister, so that’s been great being able to spend time with them. We’re slowly starting to make this our community and have enjoyed getting more plugged in. We’ve found a church that we really enjoy, and are now looking at opportunities to plug into other organizations. Our focus each day is to live life to its fullest, realizing that we are all created for a higher purpose. Although the past 6 months have been challenging at times, we feel blessed beyond measure to have each other, an incredible family, and a support system like none other.

We hope this New Year brings you true happiness full of great purpose. May this holiday season remind you of the true meaning of Christmas.
         Blessings to you and yours,
                   Andy and Kara


Saturday, October 8, 2011

To D or not to D?

So the D I am talking about is my OTD (Doctorate in Occupational Therapy).  At the moment, if you would like to be an Occupational Therapist, you are required to at least get your Masters degree. There are also many programs out there that also offer a Doctorate program. I've always thought it would be a lot of fun to go back to school and get my OTD. What are some of the benefits you may wonder? Well, you learn more first of all!! I think that OT is such a HUGE field full of diversity and options. I always feel like I could learn more, and I enjoy learning, so it's something that would interest me. Secondly, you can teach. I really don't feel like I'm even a tiny bit close to having the qualifications to be teaching, but I think it would be a lot of fun down the road to help others see the good in OT and teach them the ropes. Some of the cons? Well, first off, it's an expense. And not a very cheap one. We are in a situation where we have a lot of student debt, so it's not a smart or viable option at the moment. Another con is that if you end up not teaching, the pay is not usually comparable to the cost it takes. I have a lot of friends who have their Doctorate in Physical Therapy (which is also a requirement), and when we've chatted, we find out that we're really making about the same as each other. Sorry if that's a bit a loaded answer.....it's not true in all cases of course, but just with some of the friends/co-workers I've had.

:::::So here are some of the options for OT regarding schooling:::::
-COTA (Certified Occupational Therapy Assistant): Requires 2 years of schooling after college at an accredited program. As a COTA, you are able to do many of the things OTs do, except things like Evaluations. There are various state rules regarding what COTAs can and cannot do in specific areas practice, so check out your state's OT Board to find out more.
-Masters in Occupational Therapy: Some schools require you to have an undergraduate degree first, others require a couple years undergrad and then you enter a program. My school was the latter. We went to college for two years, and then entered the OT program, which is about 3 1/2 years. There are also accelerated programs at certain schools and online. Make sure you research possible schools before you dive in.
-Doctorate or PhD in OT: I won't be a pro at this one so feel free to add comments if you have more insight! There are many great options to get that D you're shooting for, whether it's your OTD or PhD in OT. Make sure to get your undergrad first, and look into the programs you may apply for before deciding what your undergrad decisions will be (what and where).
-There are also hybrid programs that offer dual degrees to get your DPT (Doctorate in Physical Therapy) as well as your MOT. People who do this totally impress me, I'm not sure I could make the cut! I'm not really sure how they work, but if you know anyone or any more about them leave a comment! :) I feel like you'd have a large responsibility after you graduate and am not sure of how the pay differs if you have both your OT and PT degrees. I know you can only take on the work of one person but really you have the knowledge for two, so I'd think you'd at least get some sort of bump up on the salary tree.

Before you choose a program, try to talk with some previous graduates from that specific track/program, as well as the faculty. It's always nice to get a good read on things to see if it will fit best with your learning style and situation. For me, I'll just wait a while until I have a clearer picture of my future, and see where I head from here before I make any more big schooling decisions.

Good luck!!! :)

Wednesday, September 21, 2011

One Year Ago

Sunrise on our way down Schweitzer


My life has been a bit of a whirlwind lately, in a good way. The last couple years have gone by so quickly, and it's funny for my husband and I to think back to where we were one, two, or three years ago. And just a forewarning for everyone brave enough to read this.....it may be a long post. :)

Last week we were reminiscing about our time in North Idaho (which we do often by the way), which started about this time last year. You know sometimes when you first meet someone or go somewhere and think that they or it is the greatest thing ever and you just want to keep things like that forever? I think that was Idaho for us during traveling, sort of of like our travel honeymoon. :) It was the first travel job we did together. I had done one job by myself in MN prior to that, and one day Andy brought up doing it together. He had a great job doing sales, but was also in an ok place with them and himself to leave and pursue new adventures. I was covering a maternity leave, and didn't have a for sure promise of permanent employment after that. I was excited to break out and see what the world had in store for us. I interviewed a few places over the phone, but out of all of them knew Sandpoint was where I wanted to be. Andy and I had once taken the train to WA to visit family, and I remember waking up at one of the stops around sunrise. It was seriously breathtaking. The tracks were going over a huge lake that was surrounded by mountains all around. Huge trees, a beautiful sunrise, cute houses on the lake. Google 'Sandpoint' or 'Schweitzer Mountain' and check out the images. You'll see what I'm talking about. I had an interview there for a sub-acute facility and it sounded great. I wasn't disappointed.

Waterfalls near Sandpoint

We sold one of our cars, put most of our items in storage, and made plans to venture west. We bought a minivan, removed the seats, and packed it to the top. Said a sad goodbye to our family, friends, and church. It was hard to leave, and we had no clue what to expect. The trip there was a lot of fun. We filled it with stops at parks, visits with friends and family, and lots of great music to jam to. Andy and I always try to make road trips fun.

The place we found to rent was listed on Craigslist as well as another local site. Your travel company will find housing for you, but if you are willing to find your own, you may save a lot of extra money. We did that, and found a steal of a place. It's used by the owners only during the winter, was totally furnished, and Mapquest said it'd be a 10 minute drive to my work. When we pulled in to town, after a few days of travels, we met the owner at a local store. The first thing he said was, "Welcome to Sandpoint! Down here is where you'll be working (as he's pointing around the city), and up there is where you will be living, (as his finger continues to raise as he points toward the peak of one of the mountains), on Schweitzer Mountain." We seriously had no clue we'd be living on a mountain. I should have known by the conversations I had with them prior, but I guess it just didn't click. We got back into our van and he led us up the mountain with his truck. One winding curve after another, and more like a 35 minute drive than 10. There was a bit of unbelief for part of the drive up the mountain, but after we got to a lookout point near the top, we knew everything would be fine. There was a gorgeous view of the city below, part of the lake, and all of the surrounding mountain range. This would be our home for the next three months.

Winter on the Mountain

I started working in town soon after. We only had one vehicle there, so Andy brought me into town for work every day, and was there waiting when I got off. It was a big change, but so great to have that time with him just to prepare for the day and be together. The first week of a travel job is always interesting. There are already interesting dynamics within a company that are important to learn and observe, and when you throw a new girl in there who looks like a teenager and says she's the new OT for 3 months it mixes things up even more. You are given tours (hopefully), meeting tons of new faces, learning different policies and procedures, and of course, trying to learn their documentation system. It's a bit overwhelming, but you have to try to soak up as much as possible and continually remind yourself that it will get better as the weeks go on. The team I worked with was from all over the US, so that was a lot of fun. One of the craziest parts was that there was another traveler there, and he happened to be from ND. Ironic or what? And if you know anyone from ND, you know that there are always connections to be found with others. That's what happens when you grow up in a state with less than a million people. I had gone to elementary school with one of his cousins and had known their family pretty well when I was younger. That definitely helped me feel more 'at home'.

My boss was pretty intimidating at first. She's an Italian from Philadelphia who really doesn't take crap from anyone. :) I remember when she critiqued my first eval I did there. I didn't have everything in the right places, and wasn't as thorough as I should've been. She asked, "So this says they needed minimal assist. Minimal assist why?" as well as other questions like that. I would say it was because of balance or for initiation. She then said, "Then say that. I have no idea otherwise. I only want to say these things once. And I'm doing it because I care about you and care about you keeping your license if you're documentation gets reviewed or audited." My documentation has been much better ever since. :) She and her co-manager were probably the best managers I've had up to this point. They didn't let anything get overlooked, were caring and understanding with their team (us), put the patients first, always were seeking to better themselves and the team, and were always trying to promote the business. It was great. I met a couple friends where I work that I still stay in touch with and hope to be able to spend more time with in the future.

Andy found himself a job doing inside sales in the first couple weeks. It wasn't anything huge, but it gave him more of a purpose and he really enjoyed his co-workers and boss. I'm sure he'll maintain some of those relationships down the road from here.

Round Lake State Park

We forced ourselves to be active and get out there to explore as often as possible. Our typical day there was so out of the norm for us and we fell in love with it. There was always something to do. State parks, mountains, waterfalls, the beach, incredible Farmer's Markets, and live music everywhere we turned. We were able to be there for their summer to turn into fall, which is so incredibly beautiful. In fact, a year ago tomorrow we were hiking around Round Lake to enjoy our anniversary. We hiked a lot and were able to kayak once. Of course, being there from September to December also allowed us a glimpse of their incredible winters. Life slowed down there when winter fell. We are used to harsh winters, but this was a lot more dreamlike. There were downfalls to this as well. We lived on a mountain and owned a junker minivan. We had to buy new tires at the first snowfall because we couldn't get back up the mountain after the snow fell, as well as chains for our tires that we still don't know how to put on right. We would get a foot of snow on the mountain but only an inch or so in town. I loved sitting in the Monarch Mountain coffee shop or the Coldwater Creek wine bar in town and just watch the snow fall. It always fell slow and straight, in big sticky flakes. On the mountain we lived right next to the ski resort, and were able to enjoy it during Thanksgiving weekend with Andy's brother. We had our first experiences with fearing moose and bears and purchased our first can of Bear Spray.

We also found a great church that we really miss called Grace Sandpoint. We met a lot of great people there and really loved the messages and mission of the church. The city was hit hard by the recession, and the church was doing a great job of reaching out to help with their needs. They fed us all every week and then had a table full of food for anyone to take that would need it throughout their week. In the basement, they had a room designated for clothing, appliances, etc. that people had in their homes and weren't using or just wanted to give. It was open to anyone who needed anything, no questions asked. Check out their website to listen to messages or find out more.

City Beach in the Fall

It's funny, we talk about Sandpoint often with our family and each other. I think they're afraid we'll move there someday, but who knows. There are no plans to head that way at this time. We love going back to that place in our minds and think of all of the great times, but also remind ourselves about the fact that it really was our travel honeymoon, and not the greatest glimpse of what reality would be if we were really there. It also makes us excited to see what our future holds with our relationship, our jobs, and everything else included.

We have other 'honeymoon' experiences from the other travel locations that we've been, but I just wanted to share about this one today, hence the blog title. Maybe I'll share more about the other places another time.

We are now living in MN in the cities working and being busy. We have already been swept up in the hustle and bustle of work being our main focus and looking back has been a great reminder to us of what we need to shoot for from here on out. We are currently living in a great area full of fun and adventurous opportunities. There are trees and lakes everywhere and I am looking forward to an incredible fall. This weekend we plan to get our butts out of our apartment and explore what this area has to offer. State parks and apple orchards here we come! Hope the weather will agree with our plan. :)

Our first snowfall in ID

Monday, September 19, 2011

Changes

So, there have been a lot of changes in my life in the past few months. I kind of backed up from our blogs for a while for different reasons, but I'm getting back in the game. :)

We are now done with traveling, and have moved to a new state/location/etc. I've got my big girl pants on and I now have my first permanent full-time job! All of my previous jobs have either been full or part- time PRN, part-time, or travel. It has been an interesting transition, but a good one.

Some things have been great and easy and others plain rough. This song really helped me get through last week during one of those rough patches so I thought I'd share it. :) I've listened to it over and over and love the musicality of it. I just always wanted to feel more of the meaning and know how it could relate to me. Then boom, last week it just hit me. I always try to do things and be things that are above my capabilities and I'm not strong enough for. I want to be able to be that blossoming flower in the desert, snow on the embers, or star in the morning. But I'm broken. This song just helped me know that I can't do it on my own and that I don't have to. I have someone to stay with me. And I have grace and mercy. :)

If the link above didn't work, here's another post: http://www.youtube.com/watch?v=9b5Snkw18Lg

Thursday, June 9, 2011

Stories

I just love love LOVE hearing about the lives of the people I work with. My dad is a Nursing Home Administrator and has been ever since I was a wee babe. My mom is a nurse. I grew up going to the nursing home for the best ice cream sundaes and playing beach ball volleyball with the residents. I remember helping decorate their doors for Christmas, and making paraffin hand molds while watching Full House on the 'big screen'. I grew up in that environment, but as I got older, I wanted less and less to do with it. I guess I got too caught up like many of us do with some of the smells, the sounds, and a little bit of a fear of some of the people that were there. Super lame when I think back at it. I got into this phase where I just didn't want to have much to do with 'older people' and I have no clue why. Then, later on down the road, OT snagged me. I really didn't know what I'd be doing, was excited about some things and not so much about others. I learned a ton, and then was pushed out to the real world. :)

It was probably an awkward transition for me, but I've reverted back to the beach ball playing girl who thought of the people at the Nursing Home as a random extended family of adopted aunts/uncles/grandparents. I have such a respect for all of the patients I get to work with, and love hearing about their lives and their stories. Hearing about getting through the Great Depression, their roles during war times, their first loves, their current loves, their advice, their regrets, their jobs, etc. I wish I could just record our conversations and make a giant book so their stories aren't forgotten. I love the lost look they get while chatting about things in the past where I know that their are reliving that moment. Or the sparkle in their eye when they talk about their spouse or their children or their accomplishments. I have had great conversations with people and wish that I could stop all of the activities/exercise/ADLs I'm doing, grab a cup of joe, and shoot the breeze for a couple hours while I learn and grow from them. There is just such incredible history there.

Anyway, it's been great, and I have a complete different outlook of the people I work with. No matter their situation, their demeanor, or capabilities, they have a story. And it shouldn't be forgotten.

I found a cool link to keep peoples' stories going by creating books/blogs/etc. I can't really do that with a lot of these people, but I'd like to do that to some people that I know personally. Think about it. Ask your grandparents, neighbor, or that white haired couple in front of you at church. Here's the link. Here's another great link to a blog telling some stories! I'm sure there are others too, so post them so we can start preserving stories!! :)

Thursday, May 5, 2011

Greatness

Check out this video. While we were in Texas we were able to go to Passion, which is an incredible conference held all over the world. I've been playing this song almost daily since, I hope you check it out and enjoy it!!!

http://www.youtube.com/watch?v=J3OEGnH5x8g

Here are the lyrics:

If faith can move the mountains
Let the mountains move
We come with expectation
Waiting here for you, I’m waiting here for you

You’re the Lord of all creation
And still you know my heart
The Author of Salvation
You’ve loved us from the start

CHORUS
Waiting here for You
With our hands lifted high in praise
And it's You we adore
Singing Alleluia

You are everything You’ve promised
Your faithfulness is true
And we're desperate for Your presence
All we need is You

CHORUS

Singing Alleluia
Alleluia, singing alleluia, alleluia

CHORUS

I'm singing Alleluia
Waiting here for you
With our hands lifted high in praise
And it's You we adore
Singing Alleluia
Singing Alleluia