A New Acronym to Add to Your Collection

Acronyms...I love em!  When I was a little girl, my dad would write me notes that almost always included a cryptic little message at the bottom left hand side of the page:  SWAK- Sealed with a Kiss, KOS-  Keep on Smiling, DLYML-  Don't Let Your Meat Loaf .  What? I never really understood that last one, but I still use it when I write notes to my kids. (Dad, if you're reading this, give me a call- you've got some explaining to do!)

In elementary school, I learned the colors of the rainbow using the acronym:  Roy G Biv. My first band instructor, Mr. Wood, taught use to use FACE to remember the notes on the spaces on the treble clef . He also taught us that Every Good Boy Does Fine so that we could learn the notes on the lines on the treble clef.

When I got to junior high, our PE teacher, Coach Herlosky,  was just doing his job when he taught us that CPR stood for Cardiopulmonary Resuscitation. He totally blew my mind when he went on to teach us that SCUBA was an acronym for Self-Contained Underwater Breathing Apparatus. Only a real intellectual giant would know that! I felt like the smartest girl in the world.

As I got older and school got tougher, acronyms became an easy way to remember stuff. My mom was a teacher and she was a big fan of this creative memory technique. She and her kooky letter combinations helped me memorize more stuff than can be listed here.  Flash forward to graduate school. My study partner, Normie Rodriguez, taught me an acronym to top all acronyms- the one for remembering the 12 cranial nerves.  Did you learn it too?   I won't list it here because this is a family show, but maybe you recall:  Oh, Oh, Oh To Touch And Feel...  (A quick Google search will help you find the rest if you're not familiar.)

These days, acronyms are everywhere! You can't send a text message to your BFF without an LOL, JK or TTYL. When thumbing through fashion mags, it's not unusual to read about the latest trends for the LBD.  At work, you may request an order from the PCP for an MBSS, pending HMO approval. See what I mean, they're everywhere!

Earlier this week, I was thrilled when I read about CHOKES. It is an absolutely brilliant acronym that was created to standardize aspiration precautions at a community hospital. Of course, you should read the entire article so I added a link below. Until then, here's the good stuff:

Complete oral care after every meal, minimum of every shift
Have suction set up in the room
Observe swallow and monitor PO intake
Keep patient at 90 degrees while eating
Elevate head of bed to a minimum of 30 degrees at all times
Sign posted at door: Aspiration Precautions

I have committed CHOKES to memory and have started using it when teaching family members and caregivers. Maybe you want to try it out too?  Once again, here is the link: Reducing Aspiration: A Group Effort.


Before you speak, THINK: 

T- it is true?
H- is it helpful?
I- is it inspiring?
N- is it necessary?
K- is it kind?

Change a Spoon and Change Your Life

Why is it that people who need it least are the most likely to get it?

Have you ever asked yourself this question?

As a speech therapist, I do it every time I walk into a dining room and find a person with a modified diet eating with a tablespoon. Where is the logic behind this? Why should we give a person with feeding or swallowing problem the biggest spoon in the kitchen? It only complicates an already challenging situation. On the bright side, I suppose, it does provides an opportunity for professional intervention.

Often, unable to find a more suitable utensil, it is customary to attempt to modify a big bite behavior with verbal cues and prompts. These are just a few of my favorite "friendly reminders:"


Level one- general introduction
Be sure to take small bites.
Your spoon should be no more than half way full.

Level two- educational suggestions and rationale
You will be safer and have less trouble if you take smaller bites.
It's easier to chew if there is less food in your mouth.
Try to have less food on your spoon with the next bite.
Take some of that food off the fork before you take that bite.

Level three- last resort
Wow, that's a really big bite!
That's way too much food to put in your mouth at once!
I'm not sure you will be able to open your mouth wide enough to put all of that food in there.
Are you trying to set a new world record?

Before you resort to stage three remarks, I recommend you begin the hunt for a replacement utensil. That's exactly what I did today.

Upon arrival, the patient was using this built up spoon. It had been provided by a good hearted Occupational Therapist somewhere along the way. I'm sure it was very useful and appropriate at one point. These days, however, the patient was using it to take heaping spoonfuls of catfish and asparagus. His mouth was so full of food, that it was spilling out as he chewed. It was no wonder that there were reports of coughing and choking during meals!





I asked the family to try using a long handled teaspoon. It has a smaller, more shallow bowl and holds less food.   They reported back that, without the rubber gripper, the spoon would "clang" against the plate. The patient was annoyed by the clanging and had trouble manipulating the longer handle.

Well, come to find out, the grip was removable- yay!





I gave the caregiver permission to lose this weird but enormous spoon...forever. She agreed!

Hmmm. Now we have a huge gripper. What can we fill it with? I know, a long handled tea spoon!

To fill the void, I wrapped the base of the spoon with a piece of paper towel...

inserted the teaspoon...





Voila!

Wow, what a difference!

So, the next time you find yourself tempted to let a level three comment slip out during a dysphagia therapy session, consider your options for utensil modification and remember my blog: Change a Spoon and Change Your Life!

Who do you know that needs a new spoon?


Life does not get better by chance, it gets better by change.
Jim Rohn

Why Didn't I Think of That?

Can you remember the first time you handled a catheter bag that was full of warm pee?

"Is that puss floating around in there?" I remember the occasion like it was yesterday.

Have you ever been in the room when a Physical Therapist was doing a Stage 4 sacral wound debridement?

"Pee-yew! Ouch! Disgusting! No, I'm not hungry anymore." Thankfully, it's been at least 15 years since that unforgettable day.

Have you ever been sitting across from a patient, coaching them through a meal, when they suddenly  begin coughing and spewing food all over you?

That was the day I learned to sit next to (not across from) my patients during dysphagia treatment sessions. Lucky for me, scrambled eggs brushed right off my scrub top.

Have you found yourself crouched down on the floor attempting to put your head between your patient's knees so you can read the number on the scale?

That happened to me yesterday...

I have a patient that you may remember from my "Love Notes" blog post that is experiencing an unintentional, yet rapid, weight loss.  His long term goal is to maintain an ideal body weight of 140 pounds, however, cancer and it's associated difficulties are resulting in issues that are causing fluctuations in weight. To keep track of things, I weigh the man at each visit.

For weeks, I put the scale in front of the patient, he steps on and I crouch down to read the upside down number. On this particular day, I actually couldn't believe my eyes...115 pounds? No way! He weighed 120 just a few days ago at the beginning of the week. I better look again. I moved in for a closer look and noticed he was practically sitting on my head. That's when I realized, number one, this is not safe for either one of us and, number two, there has got to be a better way of doing this.  I moved back and he stepped off of the scale.

I offer a photo reenactment for your amusement. Thanks to my sons Mike and Coby for their special assistance.


He sensed my struggle and reached down, turned the scale around and declared, "It might be easier for you to read if it is facing you."  Well, what do you know...he was exactly right!  I laughed and laughed and asked him, "Why didn't I think of that?"

I immediately reached for my camera, thinking, other people must see this brilliant way of doing things!  As I snapped the picture, I had another idea:  I can take a picture of his weight with each visit. Because photos on my camera are date stamped, I am able to create a photo reference log.

Then another great idea:  with the zoom, finger spread thingy that you can do, I don't even have to get on the floor any more, I can just point and shoot then enlarge to read the numbers nice and clear!

As silly as this story might be, one thing is for sure, I will never look at a scale the same way again. So, this week, as you go about your work day, look for small changes that can make big differences in perspective. Ask yourself, what can I do to make this easier, safer or more accurate? Good luck and have fun!



"Necessity is the mother of all invention. "  Plato

Please and Thank you

As speech language pathologists, we work with the delayed, the disordered and the demented. People not only depend on us to make sense of things, they rely on us to make those things better. We have to be creative, funny, sensitive, smart, punctual, firm, empathetic, crafty, motivating and composed, all while being charming and professional. But wait, there's more...we need to focus on function.

Working primarily with adults, I have long maintained that we should be gearing our therapy to give our patients words that are functional. Let's imagine, a 72 year old man has had a stroke. Expressive aphasia and word retrieval difficulties have wiped out most of his vocabulary and the deficits are severe. His wife is in a panic and the number one goal is to "Get him to say something. Anything! I don't care!"  Where should we begin?

Theory tells us that we should start with automatic speech sequences, including numbers, letters, days of the week, months of the year, etc. Reciting these sequences typically enables patients to produce recognizable words... a relief to everyone involved. But what next?  I don't know about you, but this scenario makes be want to roll up my sleeves, grab a box of flashcards and get to work!

Because the patient is not 3 years old , I'll likely skip over the category of colors. Because his impairment is severe, I'll pass on the categories people and places. Typically, I go straight for the category of objects. This seems to be a great starting point because we can get the most bang for our buck:  successful productions during therapy yield successful interactions in daily life. As a result, I begin the process of assisting with language recovery by targeting everyday labels for things that will actually make a difference:  remote control, pillow, water, etc.  Along the way, however, I believe we should never forget to incorporate the basics:  hello,  goodbye, please, thank you and I love you.

When a brain is changed because of a stroke, a person is changed and relationships are inevitably affected. Devastation can be wide spread and frustration related to communication breakdown can be crippling. Do your part as a speech therapist to return some sense of normalcy to the lives of those you work with by incorporating functional words and phrases just as soon as possible.

This week, encourage your patients to greet you when you arrive, carefully consider your stimulus items and create opportunities for the expression of gratitude and love to spouses, family members and caregivers. It won't be long before your actions and your choices make a difference in the lives of others.


"Gratitude can change common days into thanksgivings, turn routine jobs into joy and turn ordinary opportunities into blessings."   William Arthur Ward

Love Notes

Valentine's Day is right around the corner and I am starting to feel that love is in the air. Last night, after dinner, my husband, daughter and I hung out in the living room watching music videos on YouTube. I think it was a kitchen cleaning stall tactic, but the other two say it "quality bonding time." Call it whatever you want, there we were in from of the TV, my husband with the remote in his hand. Large and in charge, he was the VJ for the evening.

Feeling nostalgic, or having had enough of the usual "kid stuff" my daughter requests, my husband treated us to an all out George Michael video marathon. With one video right after the next, the experience included "Faith",  "As" and for the big finish, "Kissing a Fool". He sang along with George, he danced like George and then finally, he swept me off my feet. He pulled me from my perch on the sofa and spun me around  to the living room dance floor.

We swayed side to side in a little circle like two awkward junior high kids at a school dance. Our chaperone, who is 9 years old, was less than happy that we were so close, but in the end, it was great evening. Soon after, we were off to bed and each of us ended the day with smiles on our faces and a little more love in our hearts.

I headed off to work this morning feeling great! With just three visits to complete, and more than enough travel time in between, I was anticipating an "easy" day. My therapy sessions went as usual and I was providing some real top notch education. The patients and family members I spoke with were nodding their heads and, as you would hope, "verbalizing understanding of the instruction provided". Nonetheless, I realized a huge about of information was being poured out and decided a written reminder was appropriate. I declared, "I'm going to write all of this down so you can refer back to it. Consider it  a love note from your speech therapist."

Love note #1 was written to the mom of a 9 month old preemie. With no signs or symptoms of dysphagia, she is eating and drinking by mouth but has a feeding tube for over night supplements. Weighing in at just a smidge under 15 pounds and falling into the first percentile on a growth chart, intake and weight gain have been the focus.   I jotted down a list  various developmentally appropriate foods that could be trialed during meals and/or snacks. This mom was thrilled!

Love note #2 was written to a 72 year old patient with squamous cell carcinoma of the salivary glands. He has completed a full round of chemotherapy and 30 sessions of radiation. Unfortunately, three months after these treatments, he is having some complications and is rapidly losing weight. He's suffering from "chemo brain" and is now taking some pretty powerful pain medications. With a not so good memory, I knew for sure he needed a love note.

Love note #3 was written to to an 85 year old patient and his crew of caregivers. These strategies are definitely client specific but are really doing the trick in helping him to maintain a clear, dry vocal quality during meals. This love note was propped right on top of the kitchen table and is an obvious reminder of what should be going on "when eating."

Maybe next week, as you go about your work day, you will consider leaving your patients, their caregivers or family members a simple little love note. It takes but just a moment but can make a big difference in terms compliance and follow through. Why don't you spread some love around your town?

"People don't care how much you know, until they know how much you care."         John C. Maxwell

Welcome!

Welcome to Spontaneous Speech! I'm really glad you are here. My name is Melissa. I'm a Speech Language Pathologist, wife and mother of 4. I live on the south coast of Texas where the weather is great, the beaches are beautiful and the speed of life is "easy breezy". 


With 20 years of experience under my belt, I've worked with all ages and in every single setting possible. I even took a five year hiatus from therapy and taught Health Science Technology to 10th, 11th and 12th grade high school students. Some people might say I've been around the block a time or two. They're probably right...I've got the grey hair to prove it!


Back in the day, when I was working in-patient for corporate America, I almost always had a grad student or CFY riding shotgun. That was so much fun! I made it my personal mission to do provide a daily "brain dump". I would tell them, "I'm going to try to teach you everything I know." These days, I spend my work week doing home visits as an independent contractor for a variety of home health agencies. 


Life is good but the Medicare Part B caseload that I carry is not appropriate for students and that leaves me without my usual sidekick.  As a result, I find myself cruising the streets of the Coastal Bend solo. I'm like Batman, fighting crime in the neighborhood, but without a Robin. My hope is that this blog can give me an outlet for teaching and showing others about the fun and excitement of being a Speech Language Pathologist. 


As an adult/ geriatric specialist and pediatric generalist, I've got a long list of topics to cover and tons of ideas to share. That said, please come back soon and come back often! In the meantime, I'll leave you with a little motivation to continue to improve the quality of your Spontaneous Speech.


"Take advantage of every opportunity to practice your communication skills so that when important occasions arise, you will have the gift, the style, the sharpness, the clarity and the emotions to affect other people."    Jim Rohn