Aimless Thoughts

Took a bit of an OT break with a vacay to Las Vegas and reading some novels instead of OT stuff pretty much since Thanksgiving. Now I'm back and ready to play! Been working on a few entries off and on, but this is mostly unstructured.

My NBCOT was due to be renewed this year, which caused a minor panic attack the other day. Not that I've been slacking on licensure or anything, I've been going to conferences, but there was a wrinkle I didn't anticipate. I graduated in May '07, but didn't test until Aug '07. My original state license did not require first year graduates to submit continuing ed to be recertified. And unlike the first 2 years of my OT schooling, I didn't pick up any CEUs in my final year due to silly things like fieldwork, graduation, getting married, etc. Somewhere in the back of my head, I had this idea that I wouldn't renew NBCOT until NEXT year, or at least until Aug of this year. WRONG-O. All 36 hours needed to be complete as of 12/31/09. I was tweaking out quite a bit, until I reread the guidelines for all activities that count (can't link it since NBCOT is rather difficult to navigate, but it should be readily accessible if you're due to renew) which includes staff inservices, fieldwork student supervision, and reading journal or textbook articles. In the past 2 years, I have actually read 40 textbook chapters afresh and over 20 journal articles. I had to go back and count though, because I was stupid and hadn't been writing it down. So major props to Your Therapy Source, HeathSkills, and ABC Therapeutics, who all either cite their resources for posts or write specifically about certain articles, because at least they can keep track of what they've read. I hope to start doing that. Usually the journals just pile up beside my laptop though, they don't actually make it into posts.

Switched some days around at work, I am on 11 of the next 12. ugh. but I am starting to get into a groove on the medicine floor. I think the biggest challenge is just striking a balance between evals and priority follow ups. We don't have as many people going to acute rehab as on the other floors, so the regulation for most recent note is a little more lax. Few happy stories on the medicine floor... you don't get to watch people making dramatic recoveries like on the other floors, there are a lot of repeat admissions and people just getting generally sicker.

Had a couple of people competing for saddest story before I left for vacation. Lady A has cancer and has been having seriously miserable orthostatic hypotension. She has been existing by running to her destinations in hope to make it there before passing out, and was admitted s/p fall on one occasion where that didn't work out superbly. I believe we had a standing BP in the 60/40 range (NOT GOOD). When I was getting her history, it was very sad, because she said she knew she wasn't going to live through her current chemo regimen. However, she at least had plenty to live for. "I want to make it to July," she said. She had relatives graduating college and high school, another getting married, and a major milestone anniversary coming up with her husband. I almost cried. I am a big believer in the power of things to live for though, so I really hope she makes it.

Lady B was a sad case as well, same day. She was majorly depressed, and in some cases very rightfully so. From her description, it sounded like her husband had dementia and she had been very hurt by him commenting about how he didn't love her anymore and some of the barriers that the healthcare machine had placed between them. However she also had some episodes of paranoia and visual hallucinations, as well as frequent falls (her admitting dx). I was thoroughly confused. 80 years old is pretty late in life for a schizophrenic break. An experienced PT pointed out that sometimes Parkinson's Disease presents with psychosis, and that seemed to make things make more sense. Sometimes I wonder if I will just know stuff like that off the bat.

Ms N was bumming me out the other day as well. I saw her before for a home safety evaluation, which was very unstructured and not super fun as her normal pleasantly confused affect turned into nasty and aggressive when asked to take part. She is normally very nice, saying hello to all who pass her room and wandering the hallways with supervision. But the other day she was walking and crying her eyes out, calling for her mother, totally inconsolable for the duration of the day. I was very sad for her, and for a lot of people in general. Dementia is such a harrowing disease.

Even as an OT I often feel helpless in my own family, where a grandmother is in the mod-severe stages of Alzheimer's Disease. I have tried to make suggestions where I can, but I'm not there 24 hours a day and really can tell that everyone is getting emotionally and physically worn out just trying to do their best. We're also beyond the point of many environmental adaptations, which is where my strength is. I think that it's overall better for her quality of life and her husband's to have them in their home, but it's hard. Right now, the major issue is her walking. She didn't learn to use a walker before AD, and has never been able to really grasp it since. Right now they are walking with handheld assist but she leans backward A LOT. It is scary to watch. Scary enough that when I was there I transferred her to a wheelchair to move her 15' to the dining room. Even then she almost fell out of the dining room chair that didn't have arms. I don't really know what to suggest to help with this gait problem. We did go out and get bed risers and cut them down to fit the dining room table so the wheelchair arms will fit under the table, and make eating a little safer. I had to leave strict instructions though that wheelchair was for meals and to the porch ONLY, she was not to sit in it all day. Need to check in and see how this is going. Any suggestions welcome.

Back to a few less depressing random notes-
I was reading an article about a guy who has motivating himself to lose weight by pledge drives and donating all the money to cancer research. Great idea I think, because sometimes it is not enough to be doing something "for your health." Saying "it's good for you" does not always make you do the right thing, but if you have that extra motivator of someone counting on you, it can make it worth it. In the comments section, a poster (#47) was asking for weight loss advice and I am sure she would take your suggestions:
Weight loss experts, I NEED YOUR HELP!! I'm the elder sister of a developmentally disabled adult (36) who is at least 200+ lbs overweight. Given his relatively small stature, we're talking about a dangerous level of obesity. My question is this: does anyone have any recommendations for programs, procedures, etc. for those with cognitive disabilities? Since his impairment (a mild form of Down's) is related to both motor and impulse control the usual advise of "eat less and exercise more" doesn't work. His impairment is sufficiently mild that he would be discomforted by placement in a program with very disabled individuals. His doctors have warned us that a stroke or heart attack are not unheard of in his age group and, obviously, further impairment would prevent him from even enjoying the limited amount of independence he now has. Any help would be very very welcome.
Comments do require an extremely short registration. My initial thought was that there are exercise videos for people with Prader Willi Syndrome, but these are marketed mostly for children and teens.

That article led me to a blog I hadn't seen before discussing Fat Prejudice in Health Care. These are stories that people have emailed in, so there is a lot of raw language, you probably shouldn't read it at work. However, it would be good to talk about at work, because I know there is a lot of prejudice in the OT/PT world. (Here is a PT related story) As a professional who is expected to transfer any patient, it can be intimidating to walk into some rooms. Yet I will say that the gastric bypass patients we see are among the most mobile of all referrals, usually welcome a little adaptive equipment to restore some independence, and are often good to go after 1-2 sessions. Obviously as OTs we need to make sure that we're treating all clients with dignity and respect. It's still good to challenge your thinking about your practice and make sure that's happening.

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