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. :)

 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 :  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!!
 <<<<< >>>>>
Let me know what your favorites are! Have a great weekend!