End of year wrap up

Things have been pretty crazy lately. Here are some recent and end-of-year reflections, semi-structured, semi-sensible.

I should begin with an apology. I have been terribly behind and under-participatory in the online realm since October. I attribute this in part to an over-focus on getting my conference presentation ready. I am a terrible procrastinator and felt that I had to restrict my access to other endeavors to ensure that it would get done. After that, getting back on the horse, over the various RSI, over the burnout and back into the swing became a mountain I couldn't climb. My google reader page is finally down to 0 unread items for the first time in months... sweet success. I have some good trips coming up- family time for Christmas and a Vegas vacation in January. My husband may be going to France in February... don't know if I can swing that one too. At any rate, it's good to have things to look forward to, it's helping me keep my mind out of the dingy early winter blahs that try to seep in.

The job change this year was a new experience that defined most of my year. I've never left a job before that wasn't already predetermined by the end of a semester. I could have handled a lot of things better, however I do feel that this was a good choice. There have been lots of good opportunities that opened up at this position. I've already gotten to work with people who had unique diagnoses, lots of people in more critical condition than I was used to, gotten to learn a lot. I've also gotten to eat LOTS of Greek and some Indian, some Egyptian food, which we do not have back home. Hummus is my new goto snack... I really don't think I've ever seen any in the grocery stores before. Also, there are franchises of many more different chains than I've had access to before. I get a little obsessed about the food sometimes.

I feel that the blog has grown well this year. I like getting feedback from readers and statcounter tells me that there have been more than 10,000 MORE page views than last year. So, THANKS!! I do occasionally look to statcounter for what people have searched for to get to the blog to get ideas, but if you have something you're curious about or want to see, dropping an email is more likely to get a response. I had hoped to do more entries and different topics, but inspiration is fickle. Room for improvement to be sure.

So life goes on and hopefully things will get a little more under control in the upcoming year, but I won't count on it. I'm working Christmas day and then off for over a week... couple weeks off until the Vegas trip. Happy new year everyone!


Additional clock drawings

Sometimes I think these clock drawings are revealing, sometimes just plain confusing.

This one is from a man with dementia. I don't remember much else about the case since it was awhile ago. I do remember leaving him tucked in bed, call bell in hand, last words out of mouth "call the nurse, don't get up on your own" and before I could wash my hands he was already up on his feet on the way to the bathroom. I don't remember what time I asked for, but I have to assume that it was 7:40 and we get the numbers instead of hands.

This was my first experience with the Montreal Cognitive Assessment, which is becoming my preferred pencil/paper tool. However, it does start off with alternating trailmaking and has a 5 words after 5 minutes recall section, both of which are rather difficult for many people. But it's free and more discriminating than the Mini-Mental. The MDs wanted a KELS on this lady to determine if she could go home or not, but our manual was missing so I went with a basic functional eval and the MOCA. (could have stopped after the functional eval... if you can't get your pants on, you can't go home) This lady got 2/3 points for the clock since she does have numbers and a full circle, but again has just drawn a location on the rim of the clock for the time.

Finally, my most recent, which was another attempt at the MOCA but the woman almost swung at me when I brought out the paper. So we administered the test by walking around the unit and intermittently asking questions. I find it interesting that the numbers here are counterclockwise, also semi-dyslexic with the 10 as a 01. She kept becoming confused at the time... first it was 11:10, then 3:00, then 5:30 and her hands are closer to that than anything. Ironically, she was wearing a dial watch at the time.


Overcoming my Sensory Battle with Lotion

Is "Sensory Battle" a phrase yet? If not, you heard it here first! As a person who lives on the spectrum for Sensory Processing Disorder, and has experience working with children in the field, I can easily admit that my life has been full of sensory battles. Here's the story of one such encounter with lotion.

I have been fortunate in my life in that I have had pretty good skin. Sometimes oily, but since I don't wear makeup, I would say that I have had only a moderate amount of breakouts (lifetime average). But in the past few years, since I have been employed and in a dry hospital environment for the duration of the winter, my skin has gotten drier. Last year I had to start using a facial moisturizer, which was difficult but made easier by the fact that I could wash my hands off to rid of any extra lotion-feeling. This year the dryness is spreading... meaning more lotion all over my hands and body. Best summed up as: EWWWWW

I am very sensitive to tactile stimulation. Velvet=good. Tags=bad. Sweatshirt=good. Lotion=AWFUL!!! The cold, slimy, gooey feeling makes my skin crawl all over. And then it sinks in and it sticks and you can't get it off... ack. My husband and I got massages last year for our anniversary and the lotion almost ruined it for me... laying flat, unable to run or scream as lotion was poured all over me was a very tense experience.

Imagine for a moment, the strain that my struggles placed on my parents. If you have a child with SPD, you are probably familiar with the scene. Your child needs to put on sunscreen but screams, pulls away, and starts crying in hysterics when the goop is applied. Maybe you give in and don't put on so much sunscreen, then the child gets burnt and has to have aloe gel applied and the whole scene is repeated again. (Of course, this is not my only tactile difficulty, and I have processing difficulties in multiple sensory arenas).

But now I am older and understand my sensory needs better. I have managed to make great strides out of necessity- I am now able to apply chapstick multiple times per day (I find that lots of lip smacking afterward makes it better), and apply the facial moisturizer every morning (winter only). I have sought out the least flavored and scented of all products. I spent 10 minutes in the drugstore yesterday sniffing multiple "unscented" lotions trying to find the most agreeable one. The texture is impossible to try out. I am trying to start small... only apply a small amount to a controlled area and then leave my arms free to wipe off all excess. It has been a struggle thus far, but getting better. By concentrating on mastering this, I think I can finally suppress the EWWW and add another item to my List of Can-Dos: lotion.


Fighting Frustration and Fatigue

This has been a hard 2 weeks.
It is my impression that the hospital staff was stressed and unpleasant last week due to the impending holiday and just wanting to leave work and go eat copious amounts of gravy laden food. However, they seemed to bring their bad moods BACK with them after Thanksgiving, which is just not fair. Get a grip people- it's holiday season for everyone, not just you. I'm working Christmas day, so that leaves 16 more working days before I can really rest. I'm already so tired... spent this a.m. in a fog since I fell asleep on the bus, and then was ok until I walked through my apt door where I have now crumpled into a semi-lifeless blob. My eyes and brain are fatigued... I can't even begin to think about learning more about Google Wave even though I have OT buddies on there now because it is literally overwhelming to me at this moment.

A vast majority of my pts on the cardiopulmonary unit this week have been people with volume overload following dietary indiscretions over the holiday. COPD and CHF exacerbations as well for related reasons. Interesting how things move in patterns. Unfortunately, since ice and snow is coming up there will be more broken hips and the like.

The next thing I write will probably be about the difficulty getting an IRF/ACIR placement for a pt... we've been discussing this a lot at work, there are new insurance rules going into effect, our documentation has extra scrutinization coming its way. It's a detailed issue that I care a lot about but I need to be a little more coherent before I try to address that. So I'm taking some time to rest, though that time does include traveling to a football game on Saturday and likely Christmas shopping (possibly even at crazy IKEA, yikes) on Sunday.

Just trying to keep afloat...