hiatus

No updates this weekend, I'm visiting with my family! Have to get my webcam working so that some other things can get done too. :)

Long term care calculator

Saw this calculator (thanks to the Alzheimer's Reading Room) to figure up long term care expenses for different regions. I can't seem to make it work since I can't select cities, but this may be a function of firefox, hopefully not of the program. Anybody who can work it, let me know if it's a reasonable estimate compared to the real world.

Adaptive Equipment- a different view

I've had a few thoughts about Adaptive Equipment (AE) lately
I saw this post on OT Advocacy and read the second reference, a diatribe on the lack of utility of a sandwich holder which the author's OT wanted her to use. This was interesting to me on 2 counts, first: this entry reflects an unfortunate client-therapist relationship, since there is no point in forcefully recommending devices that the client does not want, and this should have come up during a session; second: I consider myself well versed in various AE items, even some that are obscure, thanks to a tech-based fieldwork and my mother's old texts (1977?) on facilitating independence in homemakers, yet I do not believe that I had ever heard of the sandwich holder. My first reaction was "how pointless," and I had been thinking of devices that could be permanently put out to pasture. Other nominees would include the button hook (how often do you really have to wear a shirt with buttons on it?) and the oven stick (hello microwave).But instead of starting a chronicle of useless devices, I had a second thought. Just as it does a client injustice to insist upon their purchase and use of a device, it is also inappropriate to know of AE that could be potentially helpful and desireable and not allow the choice to be theirs. Despite my knowledge of AE, I am a minimalist and a Mcgyver-ist as well. Never a reacher and a dressing stick when the reacher will suffice. Never a sock aid if we can put socks on using a footstool. But if someone expresses an interest or a problem that I know of an AE solution for, no matter how outlandish, then I feel obliged to discuss it with the client and let them make the final choice. For example, I had been working with a lady in her 80s who had a tibial plateau fx and was either non or toe-touch weightbearing. So her main transport was going to be a wheelchair, using a walker for transfers. She really, really, really wanted wheelchair gloves. I didn't think that it was necessary for her to spend money on those, but she enjoyed being able to propel herself around the facility at her own will.

Another story that comes to mind is from my very first fieldwork, when an OT had constructed what she termed "claws" out of splinting material and strapping that compensated for decreased grip in a pt who'd had a spinal cord injury. The specific pt that it was crafted for loved being able to use the claws to pull up his pants. My supervisor tried the same idea with one of her outpatient clients (who'd also had a high level SCI) but was in his 20s and wanted nothing to do with pink claws. I guess what I am taking a long time to say is 'different strokes for different folks'- there will be devices that are appropriate and wanted by some clients that will not be appropriate or wanted by others. And that should be a choice left up to the client.

On a PS note, the picture above is from one of my mom's texts, of which I believe the copyright is long expired. I may look through the collection and see what other illustrations and instructions can be shared for homemade adaptations, just in case anyone is curious.

What I'm Reading Now

Current reading pile

• Mansfield Park, Jane Austen- trying to finish this so I can get on with everything else. The first 200 pages were not particularly exciting, but now it's picking up
• The Tipping Point, Malcolm Gladwell- borrowed this from my dad and my husband now picked up the audio book. I'm a little competitive, so I'll have to keep up while he's reading.
• Stroke Rehabilitation: A function-based approach- I bought this quite a while ago, but now need to get around to reading it since I will be on the neuro side of the floor quite soon.
  
• OT Practice 7/13- did take a break from the novel to go through that. Have to browse the OT Connections Forum to see what the conversations are about that... the main article was interesting, I just need to process it in relation to my own life.
• Rehabilitation of Traumatic Brain Injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches (Archives of Physical Medicine and Rehabilitation Vol 89, Dec 2008)- Saw this referenced in the previous OT Practice and it referred to 2 different treatment approaches that I wanted more information on. Haven't set out to tackle it yet.
• Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational "categories" (Canadian Journal of Occupational Therapy April 2009 Vol 6 Num 2)- Saw the abstract on Karen's blog and had my library buds pull it for me. Should be an interesting challenge to daily practice.
• Validation of a New Coma Scale: The FOUR Score (Annals of Neurology 2005; 58:585-593)- I saw this in our new employee handbook in the 'preparing for neuro' section. I can't remember if I learned about this before or not. I know that we did the Glasgow Coma Scale and the Rancho Los Amigos Scale for Brain Injury, but I thought I would look into this. Not sure if it is used on our floor or not, but it's worth learning about.
• 17 files from my neuro professor/coworker- piles of powerpoints, buckets of documents, all in preparation for the scary neuro floor. eeep!
  

So that's what I'm up to. I love reading, but sometimes there is too much... this doesn't even take into account my Google Reader list or daily newspaper browsing. Anyone know an electronic reader that will transport the information into my mind?

information overload

As usual, I panicked over the wrong thing, this time, it was continuing education, of all things!

Earlier this year, as I contemplated job changes and whatnot, continuing ed was far away on my back burner. But when I had to get a license in a new state, I had different, more confusing rules to learn. The main, biggest, worst difference in the 2 states is that you cannot "roll over" CE hours in Maryland. But in February, that was not my concern. The worry was how I would manage to fill in the hours well, and options seemed limited. I did get 2 hours from my jurisprudence exam (required for license) and had a coupon from AOTA for a free CE article (1 hour, but not as of yet cashed) and prospects for further ed looked bleak. I am saving my monies for the 2010 AOTA conference as a dual education/reunion opportunity with some of my classmates and know that I can pull a whole year's worth (and some) of CEUs at that event. So knowing that, and knowing that I get no roll over (Grr grr grr) that just left me with 10 hours to figure out for this year.

My main difficulty was balancing educational benefit and financial cost. I attended a seminar on stroke at the facility (couldn't beat the rates and a friend wanted to go) which was good. I will be presenting at a local state conference as well, so I will get credit to attend and to prepare, but I have to look into the rules to see how that will shake out. So everything appeared to be taken care of... however...

That's when cool offers started pouring in. First was the guilt that I should attend 1 state conference and not another. That would be an extra event in November. Then our NICU therapist introduced me to the Developmental Therapists in the NICU conference which would be in Phoenix this year. I got an offer for 13 hours to learn therapy Spanish over 2 days... I got another NICU conference pamphlet in the mail today (16 hours w/ optional pre-conferences) which also advertises an online CE library... enticing. The quality of solicitations that I am getting is improving, which is bad, since there's already too many choices!

The 2 NICU conferences are tempting... one since it comes recommended by a coworker who has NICU-know-how, the other since it is close by. But as to be expected with a conference that earns you so many hours, they are each quite expensive. It's also a bit prohibitory in my mind, since there are only so many things I can keep in my head at once and I don't know if it's worthwhile to expend a lot of effort on NICU learning when I probably won't get to practice it much.

Therapy Spanish hits me in a sore spot... I feel like languages are one of my strong suits, however, my language skills (other than English) are really underdeveloped. 2 years of concurrent Latin and Spanish in high school was fun, but didn't give me a strong basis in either language, and college Latin proved even more futile. ASL was fun, and I can still sign Journey songs, but I don't have a functional usage. While I can cheat while reading Latin/Spanish and decipher somewhat, there's no way to do that in sign. And there's no way to learn any language without a lot of practice... which I just haven't set aside the full time for.

It's hard thinking about all the things you could learn, all that you could use, all that you could grow to be... especially on days when time seems limited even for the daily mundane tasks. So much potential, and too many other things in the way. Sigh.

(by the way, I have no experience w/ any of these CE companies or the specific courses, so I can't offer any comment on their overall worth. I have no relationship with any of them, monetary or otherwise and this is not an endorsement.)

As if people needed excuses NOT to use mass transit

hearing loss? back injury? and what else?

A medline release about subway stations being loud enough to damage hearing has been heavy on my mind of late. I notice that I can often hear the music from my fellow travelers MP3 players- they are cranking it up to hear it over the other noise, which only feeds into this probability of hearing loss. It's also pretty commonly acknowledged that bus/truck drivers are at risk for chronic back pain from the vibrations of the vehicles (here, here, here for a few quickly obtained (if not most definitive) sources). A student project looked at vibrations as well as "measuring “impulsive shocks,” which occur when a bus driver hits a speed bump or a pothole." I have been starting to wonder seriously about the effects of constant vibrations from the metro and the forceful impact of "impulsive shocks" from Baltimore's potholes.

Personally, I feel like I am rolling the dice enough against sustaining an injury in some way: Recent AJOT article highlighted potential for work-related injuries in OTs; I am constantly dancing on the edge of RSI in my wrists, elbows, and shoulders; and I have yet to see the effect from my sports playing, but the possibility of hip, back, ankle or shoulder OA remain highly in the future. Lousy to be thinking about this in my 20s. It's a scary world out there.

first day back

First day back... first day on the surgery floor.

It's hard returning from vacay anyway, but trying to get a feel for a brand new floor at the same time is double hard. Added into that is a factor I had not previously considered- July 1 marked the transition from classroom medical students to residents. So not only do I not know the ropes, but the people who are writing the orders don't know the ropes either. I didn't realize when I accepted a job at a teaching hospital that part of my job would be teaching doctors. But we are all teachers, and we are all students...

I had a sad realization today when I realized that a PT student who was present before I left must have completed her rotation. Already in just three months there have been 3 different OT/PT students in the office that have come and gone, I've had minimal contact with any of them. I've never had my own fieldwork student yet since I hadn't been licensed long enough to take one at my previous job and now at my current job they have a (needed and appreciated) requirement that you have to work a year in the facility before taking a student. I have had several job-shadows before, but it's different, being that they were all just for a few hours and all high school students except for one pre-OT.

Anyway, first day was a comedy of errors and minor misfortunes. First eval of the new rotation, a (thank goodness) cotreat w/ PT was of a gentleman who was quite agitated and upset, who basically tried to run down the hallway away from us and was working very hard at pulling out his IV and chest tube. He later left AMA, though he did allow someone to remove the tube properly before running off. Second guy kept having low O2 sats and no rebound despite cranking up the oxygen. Saw a lady before lunch who was quite limited in cognitive and physical abilities. Mod assist for feeding, Max assist for grooming. Nice though, and later walking by I saw her son, which was crucial since no one has been able to get ahold of family members. So I had to go on a mad dash to find the MD and case manager so that discharge plans could be made, but that actually worked out well.

Last guy, I had tried to see multiple times throughout the day to no avail. Half started an eval twice and had to leave for different reasons. Finally came back to finish it following a wound vac replacement, at which time the new docs announce that he has to go to the OR tomorrow for surgery. I say, what are you doing? and the response is "we don't know yet." It apparently will start as a wound debridement and then based on the amount of muscle loss and damage to the fascia may have to be an ampuation of his leg. Which is, of course, majorly distressing for him and effectively renders my evaluation useless, since he will need new orders and a reassessment once he's medically stable following the procedure. Pretty impossible to make reasonable goals or discharge plan when you don't even know the impairments yet.

Hopefully it'll get a little easier tomorrow.

back in the saddle

It was so nice to have some time off from everything!!
I love the beach, and I did some real disconnecting this year, only checked email twice and facebook once in a week, and did not bring any OT materials either. Left my phone turned off for several days (no one to call me anyway since I was at the beach w/ all my top callers). My husband was not as prudent and accepted a call from my office... ack. But other than that slip, a total unplug. I so often feel out of balance in my occupations, a point brought sharply home by realizing that I opened up all my puzzle books this week for the first time since LAST year's vacation, despite the fact that I really enjoy that. I read a good novel and a crummy nonfiction book, played Rock Band with the family, just relaxed. It was good to be away from everything. This evening I got to check my mail (so satisfying to have a whole box full for a change!). I cleared through a list of 354 google reader items pretty quickly this evening (skimming many, real reading a few, and just deleting a bunch including 125 medline notes).

So Monday takes me back to the day-to-day worklife, since I did not hit the lottery and cannot as yet retire to my own beach house. This may be difficult since I am naturally nocturnal and have slipped closer to that schedule in the past week... waking up at 6 is going to be harder than usual. I really need a job on afternoon shift... too bad no one wants to do therapy at night. I have ended my medicine rotation and am moving to the neuro/surgery floor, so that will be new and interesting.

I did start a twitter account before vacation which I will be primarily using to share interesting articles right away instead of letting them languish for ages in my bookmarks until I find enough similar for a webgems post. I held out on twitter for a long time, but I need to figure it out since I will be presenting on using social media effectively and efficiently as an OT for a state conference this fall (!!yay!!). For now, these updates will be funnelled into the much too long sidebar... I am looking into getting a new layout, 3 bar or otherwise and maybe more specific to OT if possible.

First twittered link is an article from Gretchen Rubin about how to make meetings better. Different sites have vastly different numbers/types/procedures for meetings. My last job held monthly OT meetings, and sporadic as-needed meetings for the inpatient and outpatient staff, all of which were informal. My inpatient rehab fieldwork felt like there was a meeting everyday at lunch. We had inservices, all rehab, all OT, specific team meetings, strategic planning from the upper management, etc. And during my 3 months I think we tried to do rounds reports 3 different ways. My other fieldwork supervisor was a consultant, so there were LOTS of meetings we went to during that time. Currently I have daily rounds (depending on the floor), a monthly OT meeting, a monthly acute care meeting, a weekly floor meeting, and a bimonthly all rehab meeting. With the exception of the dailies, it's not too bad. It's hard to balance the good you can do by being at a meeting and representing OT and advocating for various clients vs actually being able to go see and treat and document those clients instead. It's no secret that I am not a big fan of meetings, so anything to make them a little better is appreciated.


Happy 4th!!

Aerobic Exercises in the Pool

I've had interest in aquatics since I finally conquered the water (6th grade?). My research project in OT school was on aquatic therapy for CVA pts at a local rehab, and I also spent a fair amount of time lifeguarding. But the spur for this article is more personal... my dad had a heart attack 2 years ago at a young age and has been working hard at galvanizing the men around him to be proactive about heart health. My uncle has been resistant, saying that he can't do regular cardio due to his knee replacement... so here's some low impact cardio exercises you can do in a family sized pool. As always, consult a doctor before beginning an exercise regimen of any kind, especially if you have risk factors for cardiac disease. Seriously. Also, be careful in the heat, since that could aggravate a cardiac condition. Again with the checking with doctors.

Treading Water- an easy exercise that can be done for a long time. For variation, try arms only, legs only, or holding a weight above your head.

Walk Laps- good for a shallow pool, you can add resistance through leg bands, such as these from Speedo

Jumps/Skips/ Bobs- simple enough, more demanding than just walking. Jumps or skips in the shallow end, you can do bobs up and down in the deep end trying to get high into the air and deep to the bottom of the pool. Be careful not to over exert, especially if you are holding your breath.

Underwater Laps- build lung capacity by swimming progressively farther underwater. Slow your breathing during your rest breaks.

Side push ups- plant your hands on the pool wall and practice lifting yourself out of the pool. Be careful with this, keep your head back and away from the wall or your teeth are in peril. As an alternative, if you have a diving board, you can do pull ups while in the pool, you can also do these from starting blocks if your local pool has them and allows them to be used for this purpose.

Crunches- with your back to the pool wall, stretch your arms so they support you and let your feet dangle straight down. (this is 90* shoulder abduction for those who are anatomically inclined) Then, you can do oblique (side to side) crunches.

Stepping- if you have an aerobic stepping program that you are familiar with but have a hard time tolerating the impact level, weighted steps can be used in a shallow pool.

If you have access to a lap pool in your community, swimming laps is good cardiovascular exercise and can also help you work on expanding lung capacity and strengthening. To mix up the routine, consider using a buoy to force you to swim only with your arms, or a kickboard for the opposite. Also, many local community centers offer aqua aerobics... if you're already paying for membership, you can take advantage of the class.

Some resources:
http://www.exercisegoals.com/water-aerobic-exercises.html
http://squidkid.org/2008/03/19/water-aerobics-for-very-smart-dummies-pool-workouts-101/

ps- again, go to the doctor!! use these tips at your own risk.

Gaining ground

so I'm not such a newbie anymore. I even turn in the right direction now when getting off the elevator...

In fact, we're getting near to floor rotation time, so soon I should move on from medicine for awhile and into a new frontier. The medicine floor is sometimes a drag... I hate seeing people with multiple admissions or trying to tell people that they aren't safe to go home. However, I have seen some cool things in the past months, including one lady who had a neuro disorder so rare that they were collecting her CSF for research and a guy recently with an unknown tick-borne illness (learned a new word, Rickettsia). I have definitely had some times where I wondered whether I was smart enough to work at this hospital, but everyone makes mistakes and I am learning. Definitely taking a closer look at lab values, figuring out more about those.

I have gotten to take 2 visits into the NICU in the past couple of weeks. I work with a girl who is really experienced with feeding and so I got to see the different units and today I got to see a baby intervention in the feeder/grower area. It's interesting stuff, but unfortunately I don't get to devote a lot of time to learning this (since they're kinda paying me to do other things too) and it's such a specialized area that it seems that it would 1. take a lot of time to learn and 2. be best to learn in person from an expert as opposed to on your own.

The whole peds/NICU interest causes me internal unrest, as I really don't know what areas of OT that I want to go into. Yes, I know that I am young, but I have such broad scattered interests that I have no idea where I'm going. Early this year, I had made out different possible career tracks and things connected to each... there were at least 4 and I had programs and interests on each card that I'm not willing to give up, so the range remains broad. In similar news, I just volunteered to do my first home mod evals as an OTR/L... don't know what will come of this, if anything. don't even know if it is volunteering or consulting for money, which I will definitely have to figure out :-P

I have been stressing out the past couple of weeks, it's been busy at home and work and I have been dancing on the edge of tweak out. I have a wonderful (albeit unpaid) vacation that I am leaving for this Thursday after being at work everyday for 11 days (1 was a conference). I truly need a vacation at this point. I had planned to schedule blog posts ahead of time, but I don't know how many I will get done. The other thing that I have thought of doing on vacation is reviewing info for my next rotation (neuro or ortho & ICU) but I think I am coming up on a point where I just desperately need a break. I have been pretty devoted to reading OT stuff for about 90 minutes each day (metro ride) and I just want to move to something less taxing on my brain. I have lots of ideas right now but I think that my mental health needs me to not overwork for a week. Should be a good time with family, actually try to relax for an extended period instead of running around like a vagabond. Have to learn how to balance life.

Donate Bone Marrow!

You can sign up to donate your bone marrow for free (there is usually a registry fee attached). This site also allows you to donate umbilical cord blood if you're having a baby. You could save a life!!

A few notes on Alzheimer's Disease

Been reading some more on Alzheimer's lately. I have HBO's "Alzheimer's Project" on my DVR but haven't gotten around to watching it yet... but here are some other notes of late.

I have been reading about the Home Environmental Skill Building Program during my metro trips, which has been interesting. I can't use it very well in the hospital environment, but it would be good in home health as long as you could justify the billing. It has had some good insights for me anyway, namely, the understanding of different priorities between OT and caregiver.

If this article about early-onset Alzheimer's doesn't scare the crap out of you, you don't worry like I do... yikes. I have a lot of word finding difficulties, so my paranoia is bumping up now.

Stumbled onto The Alzheimer's Reading Room while looking up something else, it will probably become one of my top blogs in the scrollbar. I found it because I had read about the Test Your Memory exam on a Medline press release and wanted to see what was included in the test. However, after looking at it, I think we need an adaptation for the US... don't tell my history teacher father, but I'm not sure that I remember when WWI started. I would pick the JFK assassination as a seminal date in many of the current elderly individuals' minds, however, I don't know if there is a reasoning behind the date that it shouldn't be something the person actually lived through.

Saw 2 clients w/ dementia today, one early-stage and one end-stage. Depressing. Early stage lady was faking it pretty well but had severely decreased short and long term memory. Independent w/ BADLs though, so I am recommending adult day care, hopefully that will work out well. My end stage lady was a social admission... 92 y.o. husband came in w/ a cardiac emergency and she can't care for herself. Sweet lady, but gets confused in the middle of her sentences. She was good at ADLs too though. Long term care for her. No one likes to see their mother's mind crumble.

Quickie Acute Care Stories

It's hard to remember the stories from my job now since I pass in and out of peoples' lives much quicker and can zombie zone-out trying to make it through a ridiculously scheduled day. Like yesterday morning, when I found myself staring at 11 potential evals with no one to share. In the zone. Anyhow, here are some memorable moments...

3 Primary Runners for "Patient of the Day!!"

- Mr. X is 1 month s/p CVA that was not treated well at his hospital and received no rehab, now presents w/ visual deficits. He talks about his eyes dilating in and out, changes in light and dark, and not being able to see well. Finally he says, "I can only see half your face." Trying to figure out if this is a hemianopsia or other field cut, I ask which side. And his reply is, "the one with the big pimple."

- Mrs. Y is s/p fall and starting to have some memory problems, but is well tended to by her family. She says, "my daughter diagnoses me very accurately. She knew I had kidney failure while my doctor was still running blood tests." The PT asks, "is your daughter a doctor?" and she replies, "no, she uses the internet."

- Mr. Z is admitted for COPD, but apparently has no functional deficits and the shortness of breath isn't kicking in very quickly during activity. Unable to evaluate him during the morning as he had eloped out of the hospital, off the campus, and down to the gas station for a coffee and a newspaper. (independent community mobility- check!)

I just don't think you can write fiction to accurately display the craziness of the real world.

I was happy about Mr. X though because I happened to be sitting in on rounds and the PA was saying what a good vision workup OT had done with him, which made me feel good as vision is not my specialty. (Thank you Gutman and Schonfeld, I never would have remembered it without you). Later in the week, I was attending a different set of rounds and they were discussing a pt. w/ eyesight that had deteriorated due to cancer and suggested a low vision consult, and it was a good opportunity to educate the case manager, social worker, and doctor, as none of them had any idea that OT could do so much in the field. So, a few vision victories there.

Touching on the original point again, it is hard to blog after work now. The acute care life can be quite stressful and there's such pt turnover that I do mind-dump a lot. That and the use of the laptop all day makes it difficult to work on it in the evening as well. Really trying to avoid repetitive strain injuries, and it is becoming quite difficult. I do have a lot of good jotted down ideas that will get typed up eventually, but I've been restricting my blog access until I get a (for now) secret project accomplished. I am also in the midst of 7 straight weeks of full weekends- either I travel or someone traveling to me- and that leaves less time for other stuff too. Like my exercise goal, which is now back somewhere in the precontemplation phase... GIANT sigh.

Until next time- enjoy the crazy things life brings you today!

Slow on the Updates

Some busy times lately...
So for the first time in 2 or 3 weeks, I finally was able to discharge a patient on the evaluation. I have been so busy lately and working over a lot because every person I have seen has needed subacute rehab or nursing home placement, which means that they all needed goals written and follow ups done... very time and thought consuming. Wednesday we only had 7 new evals (only!) for 3 OTs, so we actually got to the follow up cards... one of the other girls said, "did you pick up? You still have cards in here" and the answer was yes, I have a full load today, but I just have too many people to actually see them all in a day. Been exhausted all week really. Sleeping on the metro instead of reading.

Trying to answer a Call for Papers for my state conference... haven't decided whether to submit for AOTA as well or not. Having a hard time following through on the requirements to write it up, very pathetic as I have no trouble writing on here, but once there's a deadline my brain is locked and procrastination sets in. I am obviously not going back to school any time soon.

I am going to Orlando in 2010 for the AOTA conference, and hopefully will get reimbursed for it from our continuing ed funds. I'm actually in a strange CE situation... I was a little panicky earlier in the year, but picked up 2 hours just applying for my new license. If I present at my state conference, that's 6 hours (have to pay to register anyway) plus a few as credit for the presentation, and my hospital is offering a stroke course for 6 hours that is super cheap for employees, so I could finish the rest of my hours right there no problem. But I am interested in the AOTA course Integrating Mental Health Into OT Practice with Older Adults... it is another 6 hours and still priced very fairly for members. I think it would be very helpful for me, but from a financial or efficiency standpoint, it doesn't make sense. I can't carryover extra CE hours in my new state, and I will have more than enough from the AOTA conference for 2010. In theory I guess I could order it and then just hold off on submitting the exam until I need it (2011?) if it is active that long. I am also holding onto 2 completed CE articles from OT practice on contemporary motor control that I hadn't submitted since I can't find my coupon.

A world with many options is simply a world filled with too many decisions...

I do have 2-3 interesting case studies I will post soon. Busy set of weekends coming up- worked last 2, had a visitor last weekend, at my parents' house for a wedding this weekend... Even though we always try to cut back to have relaxing time we always get large stretches of weeks in the summer and fall that are heavy on travel. Hope everyone is enjoying summertime before we hit triple digit heat on the East coast. :)

Update on Reading Without Getting Sick

After ~2 months of efforts, I have reached my conclusions on reading on the metro train without getting carsick.

I have found that a combination of strategies allows me to read almost nonstop while on the metro.
- Choosing a front facing seat: I will take back facing seats over sideways facing... if forced into sideways seats, I turn so that I am taking up more space and oriented toward the front.
- Front Car: I try to get a seat near the front of the overall train. There isn't a big difference between car 1-2 or 2-3 but there is a major difference between front most and rear most in amount of sway.
- Don't touch anything: I avoid contact w/ the walls of the train, since they vibrate.
- Eliminate degrees of freedom: I hold the book close to me, pinning down one page w/ both hands if necessary.
- Periodic rest breaks: If I feel the train going into a turn, shaking extra, or going faster than normal, I close my eyes. I had been looking up away from the book, but closing my eyes forces me to feel when the situation has calmed down.
- Accupressure: I couldn't find my sea-bands, but when I went to the store, I remembered what i didn't like about them. The elastic does have give, and the little pressure balls can cut too tightly. However, I found psi bands, which are doubly adjustable both at the wristband and at the dial. Pretty cool, hopefully the plastic won't break.

And there you have it! I've been knocking out important articles and texts with ease.

DISCLAIMERS
1. I am not a doctor and cannot advise you on best remedies for your individual situation... go get a checkup.
2. I am not going to try these remedies while in the car. I think that cars are too bouncy, and given to too many directional shifts in both left-right and up-down (at least where I am from). It's enough for me to just not get carsick in the car, I won't be pushing it there.
3. There is one known remedy for motion sickness that I have not tried, which is eating ginger. It's not feasible for me to do that nonstop for 2 hours everyday and I hate gum of any kind more than any non-SPD person could possibly understand.

Art Contest

I read about this contest on the Your Therapy Source blog and it's pretty cool... definitely a fun thing to work into a school, EI or outpatient pediatric therapy session. Most of my kids weren't using adaptive devices for our work though, just better designed products.

I am off tomorrow and excited about it! Once I get the house cleaned up for a weekend visitor, I am going to sleep and relax and update some posts. :)

OT Quotes

This little entry was gathering dust in my drafts queue, and though it's past OT month and likely past many graduations, here are some randomly collected semi-inspirational quotes. Feel free to share additional gems in the comments.


"Great leaders are almost always great simplifiers" -Colin Powell

"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm

"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium

"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf

"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb

"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning

"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips

"Everyone has a moment in history which belongs particularly to him." -A Separate Peace

"It's what you learn after you know it all that counts the most." -Phil Jackson

"The time to hesitate is through." -The Doors

"In valor, there is hope." -Police Officers Memorial

"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy

"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf

"The journey is the reward" -Greg Norman

"Stone walls do not a prison make, nor iron bars a cage." -Lovelace

"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks

"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach

"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King

"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher

(if this collection does not deserve the adjective "random," then I don't know what would)

Interesting OT Connections threads

I've been trying to spend a little more time on OT Connections, especially in the posting department as opposed to lurking. Here's some topics that I have found interesting in the past few days.

You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!

Food for Thought- a really good student project involving nursing home residents having greater control over meal time

Documentation on PDAs- a home health group is going paperless

OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there

Oncology Research Articles- I am looking for good rehab research relating to pts w/ cancer

Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread

SI for Geriatrics- some good information about bringing sensory strategies to the older adult population

Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?

Things I am currently thinking about...

Longer updates to come soon, I've had a couple of busy weeks and have to work this Sunday. But here's some thing's I've been thinking about.

• Contemporary Motor Control theory
• Best practices for home residing people w/ dementia
• The kid on Breaking Bad
• Reading more AJOTs
• Branching into NICU?
• A couple of interesting case studies- pt. w/ ABI and another w/ multiple complex brain issues
  
• Customer service
• Energy Conservation
• Changing layout on the blog?
  

Might have some free time tomorrow, hope to get some updates on here soon.

Stories

One of the amusing things about working in a field that lets you interact with lots of different people is simply the stories that you come across. It is a well known adage that to be a writer, you must read, but I think that listening to other people's original stories is the way to go- you can't make stuff like this up.

For instance, a man with COPD and schizophrenia had a vision that if he smoked more, he would get healthier. He was later admitted to the ER with persistent cough and shortness of breath.

I've had several people who've had quick reentries to the hospital, which is always lousy. I had one lady that I evaluated in my first week of real work, and I remember her because I have an aunt with the same name. Most people, in meeting someone, would be at least mildly interested by that sort of anecdote, but this lady was thoroughly not amused. She needed to go to short term rehab since she'd had compression fractures and a pacemaker placed. 2 days after she got home from rehab, she fell at home and was even less happy to see me the second time around.

One of the downsides of working in acute care is that you see SO many people that it's hard to remember all the stories. The COTA has asked me once or twice about Mrs Soandso and I'll say 'can you refresh my memory?' Even with the response, 'yeah she's the frail little lady' I am usually struggling to remember. :)

An old story from my last job that I never got around to writing up- 102 year old man was taking a mini-mental. I stick out my arm and say, "what's this on my wrist?" trying to get the response "watch." Instead he says, "oh that's some kind of growth. A mole. I big mole."

Recently evaluated a man w/ very advanced Alzheimer's and Parkinson's diseases. Per the chart review, he was basically wheelchair bound at home, largely nonverbal. Yet he somehow managed to 'take his family hostage' (though no weapon was mentioned) and he was brought to the ER in handcuffs. He was far too combatitive on day 1 for me to work with- throwing things and slapping at people. When I saw him on Day 2 he was a little more calm and the PT and I were able to get him into a chair, he was able to state his first and last names, but other than that we couldn't get him to follow any simple commands or tell us anything else. Later that day, while working with his roommate, he had decided to remove all his clothing and sheets and was requiring one person's complete attention to keep him from crawling out of the bed.

I do not envy our case managers and some of the placements that they have had to pursue recently. It is probably just 'the way things are' but it is very difficult having people with lousy home or medical situations come in, but not have rehab needs to qualify them to go elsewhere. I am trying not to get overly bummed out about that part, since I end up with a role in the drama. It also makes me think about what choices I would make in some of these situations, which is also a downer.

Though I have tried to hide it, my coworkers have figured it out (even quicker than last time) that I am a techie. We are encouraged to do point-of-care documentation and get notes in ASAP after an eval, so we all have little tablet laptops. I had been using mine as a regular laptop, but using a touchpad all day at work and then at home was making my wrists go into agony. So I resolved to figure out how to manipulate the tablet software (despite not having regular access to preferences) so that it would suit my needs, and for the most part, I have. I attempted a few evals Friday using this strategy to document in the room, and plan to hit it hard next week and make it work. Even with just trying it out on Friday, I got comments from a lot of excited coworkers who wanted to learn how to do it too. I may need to prepare a how-to guide since I don't mind sharing but definitely didn't get out on time on Friday. My current home computer is too newly purchased to talk about such things, but a tablet wouldn't be a horrible next purchase, however, the only thing I can see it really helping with is blog entries, so it's not really worth it as yet. Suppose I could eventually look into a tablet PDA, but the smaller screen would take a longer time to make work. I may also have a problem with mine at work since one section of the screen seems to have difficulty responding to my inputs... might have a dead zone.

Some of my coworkers are very resistant to the computer documentation, I am still surprised that a lot of the departments at the hospital do not do computer documentation. Everything was computerized at my last hospital, and this one is considerably larger, so I assumed they would be more 'with the times' so to speak. I remember way-back-when, first year OT school when potential research topics were brimming in my brain and I had thought of doing a project on whether therapists with computer documentation were faster, now I am glad I didn't since it is such a hot-button issue for some. Can of worms, though it would still be interesting to see the results. Anyone else use tablet computers for point-of-care documenting?

My current metro-reading strategy of reading a paragraph as the train slows down and stops at a station is going well. Since I can't seem to time the shuttle departure right (don't know if it's possible to) I am also picking up 10-20 minutes reading time there too. I am officially CAUGHT UP on all my OT Practices that had piled up during the transition time and actually eagerly awaiting new ones since I have time to read!! I am working on responses to some articles too, hopefully will be ready to post those soon.

May is Stroke Awareness Month

Read the CDC feature on stroke

Make sure your friends and family know the signs of stroke so that they can be prepared to act in an emergency.

Check out these sites for more info:
American Stroke Association (a division of the American Heart Association)
Internet Stroke Center

OT by PT

Addressing the problem of professional crossover.

One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.

One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.

I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.

I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'

I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.

Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.

Sharing a Brain

I did not submit this card to Postsecret, but I share the sentiment...


I'm a metro girl though, not light rail.

My only complaint about the new way of commuting is that when I was driving if I left for work early in the morning and/or left work early in the afternoon, I could cut my driving time. Now the time is constant, but often longer than if I had been driving and not had traffic problems.

Other potential problems include that I have to leave by a certain time or my shuttle bus won't take me to the metro; and that it does not run on Sundays, and I work 2 of those a month. No major progress on the overcoming motion-sickness front either. Latest strategy is to read 1 paragraph at each metro stop, which is a little better.

Recession Job Market

For the third part in the little mini-series on job hunting (here's the links in case you missed searching or interviewing for an OT job) I would like to address the topic of job-hunting in the midst of a recession.

The recession is not making big headlines this week, perhaps because the doomsayers have realized that we are probably not going to end up in another great depression or a post-apocalyptic nation focused solely on survival. However, it is still a topic on people's minds, especially when discussing a job search.

Occupational therapy made the headlines by landing on Time's 150 Recession-Proof Jobs list. OTRs come in at #18, and OTAs at #72. Rehab/Healthcare jobs in general were well represented on this list- PTs, PTAs, Therapy Aides, SLPs, and also RNs, LPNs, Athletic trainers, Massage and Respiratory therapists were all in the top 120.

We now interrupt this entry with a quick little note about political advocacy here. It's likely that athletic trainers have climbed their way onto the 'recession proof' list through their efforts to redefine their scope of practice on a political level. Since any individual can now be considered an "athlete," they now have a much wider base of clients to work with and places to seek employment- like outpatient rehab clinics. Recreational therapists, on the other hand, are not on this list, perhaps because they have been cut out of some Medicare legislation affecting reimbursement and their necessity to be employed in certain environments. Right now, they're trying to become a covered, required service under Medicare for additional settings. Just a little word about how you can't live as a therapist in isolation- political action is required if you'd like to continue having a job and being relevant to the rehab world. As one of my teachers said, if you don't have the time to do it, at least kick some money to the people that are working on it at your state and national associations. We now return you to your scheduled blog entry.

One thing that surprises me about the job list is that OTAs are not higher on the list, or even higher than OTs. I would think using more OTAs could be more profitable for many organizations, as long as there are not a superfluous amount of evaluations to be done as opposed to treatments. My current job is obviously one of those places since we get about 1200-1500 orders for OT/PT/SLP evals each month, so there are only 2 OTAs and 1 PTA. OT Practice recently had an article celebrating 50 years of OTA education, and the associate's degree remains a cost-effective way to get into occupational therapy.

Despite the accolades the profession has been garnering, I think that the only people who say that OT is 'recession proof' are those not currently working in healthcare. Many sites are in the midst of a soft or full-on hiring freeze. Some hospital units are closing completely, orthopedic units are trying to step up the service due to decreased elective surgeries- My old hospital was trying to see acute orthopedic surgery pts 3x for PT and 2x for OT everyday; a friend at a hospital-based SNF was trying to see subacute ortho pts 2x for PT and 1x for OT each day, which is causing their depleted staff to work overtime everyday. (Obviously the second group is salaried, keep that in mind during your job search.) PRN (as needed) nurses and therapists are seeing a dramatic cutback in use of their services, which used to be a pretty lucrative way to earn money without a full time commitment.

Though it may be callous to gripe about cutbacks on perks, that too has become the reality. Sign-on bonuses (taxed very high anyway) are getting cut. CE money is often getting cut, which is a shame, because high intesity courses that give a lot of hours are more expensive. It stands to reason that therapists might choose to stick close to home and maybe go for something based less on the knowledge they will receive and more within their price range. I don't know that it's technically fradulent to pursue CEs outside your realm of practice, but it is professionally discouraged. It wouldn't fly in my current state, since they have to preapprove everything you go to. Money for therapy supplies is likely getting slashed in budgets, so you may have to appeal to grants to get the fancy new equipment. Another cutback is in the retirement arena- matching 401K funds are dwindling. My current company still has a pension plan, which I thought had all gone kaput long ago, but they are keeping that and tossing out the matching funds.

If you work for a hospital, then at least your healthcare benefits are fairly safe. After all, they can't just deny you admission to the hospital. However, I have heard of some places charging an extra fee if your spouse's employer also offers health insurance but you chose instead to go with the hospital's plan. The wording was that the hospital couldn't afford to subsidize the rest of the county's healthcare costs. The other issue related to healthcare is that it can be hard to job-swap since a person would face up to 3 months without any benefits, especially if you have a spouse or family depending on you for coverage. If you're single with a chronic health condition (especially including pregnancy) then the issue has to be weighing into your decision as well. Related to that, it's good to pick an area that has multiple job offerings, so that you don't have to pick up and move if you want to work somewhere new. In a related situation, it would be very difficult for my husband to find a new job, so when I accepted my new position, we had to live somewhere that would be a reasonable commute for both of us. Part of the reason that we chose to move to Baltimore instead of back where our parents live is so that he could keep his job- trying to move and find 2 new jobs is stress that we're not ready for yet.

Though this post is a bit of a downer, don't be mistaken, there are OT jobs out there. You may have to take a position that isn't your dream job, but there will likely be plenty of positions available in hospitals, SNFs, and large facilities. There will probably be fewer openings in schools (these are usually limited anyway since people tend to keep those jobs when they get them) and small private practice facilities. There are also likely to be fewer openings in OT college towns since there is always a fresh supply of therapists available. But when there is a legitimate opening at any location, the current therapists will likely be stressed by trying to deal with the workload and they will want to fill their position. And if you're just starting OT school, don't be put off by the cost of the degree. Student loan debt is better to have than other types, people have used those loans for international travel and buying cars and still come out ahead. And since there will be some type of OT job available when you graduate (not necessarily a perfect one, or one that pays $100,000/year) you will be able to pay back your loans.

The jobs are out there, good luck to everyone that's looking. I have to guess that they will be a little harder to land in May or December, so you may want to start your search pre-graduation if you're expecting to get a job right after school is out. Happy hunting, everyone!

Interviewing Tips

I am not an expert about getting jobs, but I have been through a few successful interviews recently. Here are some tips that I recently wrote out for a friend. This is not comprehensive, any of these topics could be significantly expanded.

Basic Interviewing Tips- I'm not going to really cover these since most OT students have probably gone through at least one interview in their lifetime, if only the one to get into school. Wear something nice, conservative, that you are comfortable in. Bring extra copies of your resume. Learn about the company before you go. Use positive body language. Etc.

Rule #1- You are interviewing THEM as much or more than they are interviewing you. So the questioning should be a 2 way street. You have questions, you deserve to get them answered before you make a decision. Make a list- If there's anything clinical that you really liked or didn't like at your fieldworks, you can form a question to devise whether a similar situation exists at the new place. You should get information about what they offer for 401K, health insurance, days off and other benefits from the HR department, and they should get you that information before you leave that day.

Questions they will probably ask you:
- about the experience and interest you have in their population
- about your goals for professional development/ what you want to get out of the job
- your strengths/weaknesses
- might ask you to describe a situation when you overcame an obstacle at work or resolved a conflict with a coworker
(Here are some more interview questions, I'd say the ones about coworkers and goals are most likely to appear in your future)

Be honest in your appraisal of your abilities. A recent job candidate rated herself "10/10" in dealing with all types of diagnoses, therapy techniques, and practice locations- despite only having a year of experience. Also, it can be good to pause briefly before answering a question, especially if you find yourself often making foot in mouth statements. If you're nervous about how you'll react to questions and handle things on-the-spot, many college campuses have a career center that will offer to do free mock interviews or resume workshops. Check it out, you're paying for it anyway. If that's not available, have a trusted friend or adult interview you and offer constructive criticism.

Another question that will definitely come up is what you expect to be paid. (this might even be on the job application) I'd encourage you to discuss this with your professors, but there are also other good resources. Enter your state into this page on the Career InfoNet and see the wage table for your target state and compare it to the nation as a whole. You can also look for your city or metro area on the left sidebar. This gives you a good idea of the range, although I don't know anybody getting paid in that 90th percentile area. Advance also has a salary calculator, but you have to sign up to play with that. In my experience, their sample size has been too low to be truly helpful. Don't get dazzled by the money though- you're looking for the best overall place, the money will come. Also, FYI- sign on bonuses are taxed VERY high.

You should also take time to point out anything awesome on your resume or portfolio and explain how you got the honor and why it's special. For example, "I wanted you to know that I was elected to the office of Grand Poohbah of the Water Buffalo by a group of my peers to coordinate volunteer efforts in our community." Nobody knows why you were honored or what the title means until you explain it.

In the post on searching for a job, I mentioned that you should look at several sites and try to do multiple interviews in a near time frame. You'll want to keep detailed notes of what you liked and disliked about each site, what their typical day was like, anything important that they told you. Keep the names of everyone you talk to- try to get business cards as that will make it easier. And remember that you should send a follow up thank you note after the interview- email is acceptable.

If you feel like the interview went well and the facility looks promising, you can ask to have a shadow day. I strongly recommend doing that. See what a normal day is like, what the expectations are for productivity, get a feel for the balance of the caseload. Among other things, you can ask your future coworkers what they really think about everything, see what kind of people they are.

You want to take your time to consider any and all positions that are offered you, but you should be timely and polite about it- your interviewers are trying to fill their positions quickly and will appreciate your honesty. Nobody is asking you to commit to a position on the interview day, but be timely.

After all that, if you decide to accept, you'll have to pick a start date and all that. So if you come out of the initial interview feeling positive about the place, or if you are definitely living/practicing in a certain state, you will want to start investigating the licensure procedure there. Figure out the timing, how long it will take to get a license. Consider whether you need to start work right away with a temporary, or if you want to take the NBCOT exam first. I didn't want to try to balance studying and working, but it depends on what you want. All that plays into the potential start date.

Bottom line- be honest, be you, and try to find the best fit for your personality and for your skills to grow. Good luck everyone!