No Straws?

Maybe you've seen a sign like this somewhere along the way? No matter where you saw it, I can almost guarantee that a speech therapist made it. How would I know that? Because I know that speech therapists hate straws!

But not me!  I love straws and, apparently, I'm not alone.  According to Eco-Cycle International, 500 MILLION straws are used every day in the United States! Wow, that's a lot of straws!

So, as an SLP, I'm going to ask you to consider giving straws a second chance.

Of course, I know straws aren't right for every single person in every single circumstance. (Good clinical judgement must always be used when recommending the use of straw.) However, there are many good reasons for using straws and week after week I encourage my patients to do so! Let's take a look...

Dentists and orthodontists regularly recommend straw drinking to:

• reduce enamel erosion
• provide stain protection
• reduce cavities
• reduce exposure to temperatures for sensitive teeth

Some people like straws because:

• they're convenient
• they're clean
• they're fun

Sipping from a straw is said to increase the overall amount of liquids you consume. Healthcare professionals routinely promote the benefits of drinking more liquids each day. That's because adequate hydration can:

• improve kidney function
• maintain normal bowel function
• boost immunity
• prevent dehydration
• improve skin
• aid digestion
• regulate body temperature
• lubricate joints
• eliminate wastes and toxins

Straw drinking helps to increase tongue and lip control and coordinated breathing, all of which support our ability to speak with good articulation. Additionally, researchers tell us that as we suck, many of our cranial nerves are stimulated. That's a good thing. To take it even further, scientist have proven that straw drinking enhances inter-hemispheric brain integration. Wow- straws do that?


I'm making a case for straws today because just last week, I sat across from a patient sipping water from a tall glass. He tilted his head back to drink and a tidal wave of liquid entered his mouth.  Guess what?  He began coughing! If only he had a straw, he could have avoided neck hyperextension, he could have better controlled the amount of water he was getting and his lungs would not have been at risk for aspiration or penetration. Because of his good cognition and oral motor function, I say give this man a straw!


Now, having said all of that, there is such thing as a bad straw. Maybe you know the ones I'm talking about? Bad straws are typically extra wide and usually hang out at places like convenience stores and fast food restaurants...stay away from them!

Bad -vs- Good

Good straws, on the other hand, are all over the place...believe me, I'm looking for them everywhere I go. He are a few straws I found this weekend at Target:

A Manon Jar style- how trendy! Bonus points for the no-spill top and wide grip handle.

A straw with stripes, what's not to love? Easy to grip and no-spill too!

             

             

These cups are my awesome because the straws are held steady by the cup itself. These may be too juvenile for some, so take that into consideration. 

My daughter loves silly straws...another good option.

This week, take notice of the straws you see and try to categorize them as good or bad- it's a pretty fun game. More than anything though, think of the people you know and ask...

Hope it's a great week for you. Cheers!

Through the lips and over the gums, look out stomach, here it comes!

Windshield Time

Yesterday, I spent nearly 10 hours on the road with my two sons, Coby and Mike. We  traveled from the top to the bottom of the state of Texas, eventually making our way home from a great Spring Break trip. While they were enjoying uninterrupted screen time with their iPod and Nook, I was faced with a windshield and an empty passenger seat.

Ahh, windshield time...I couldn't have been happier!

I've heard some people hate driving, especially where there is no one to talk to, but if you ask me, windshield time is some of the best time in the world! I can get a lot accomplished while I'm driving. I can solve problems, make a plan, revise my strategies, map out my goals, learn all of the words to my favorite songs, go to church, secure my financial future, learn something new, finish a book, complete continuing education credits and even practice my Spanish . The long and short of it is, if I'm driving, I'm becoming a better person!

What to hear more? Here are some of my personal all-time favorites:

Audible: I'm contemplating a subscription, but in the mean time, there are...


Books on CD:  check them out from your local public library (they give you two weeks to finish your book)

• Suzi Orman- The Laws of Money, Women and Money
• Jack Canfield- The Success Principles
• Robert Kiyosaki- Rich Dad, Poor Dad, Conspiracy of the Rich
• Dr. Phil- Life Strategies

Podcasts: so many wonderful (and free) options, depending on your mood or area of interest

• Get Busy Living- Benny Hsu
• Tim Ferriss Show- Tim Ferriss
• Entrepreneur on Fire- John Lee Dumas
• Lakewood Church- Joel Osteen
• Church Unlimited- Bil Cornelius

Downloads: have fun and listen to MP3 downloads you've stored on your iPod or get serious and listen to a continuing education course from speechpathology.com,


Pandora: stream it from your phone (if you have an unlimited data plan)

• Jack Johnson
• John Mayer
• Jimmy Buffett

My car  is exactly 2 years old and just turned over 47,000 miles. Not only do I enjoy long road trips with my family  but I drive an average of 75 miles each day for work. If you ask me, I spend a lot of time behind the wheel, staring at the windshield.  There are some who do more... like my dad, who averages 1,200  miles each week, and some who do far less...maybe you?  If you ask me, you don't have to be a professional driver or road warrior to benefit from windshield time. This week, put down your cell phone and consider making the most of your time in the car by trying something new.


The road goes on forever and the party never ends. 
Robert Earl Keen

Spring Break Recharge!

Ahhh! Spring Break- that glorious time of year when life gives you one week to slow down, refocus and recharge.  There are so many options available, how do you decide what to do with yourself? I'm going to recommend you consider your options and make a list- this will help you stay focused and make the most of your time off. For the sake of diversity, I am presenting a variety of lists for your consideration.


Hit the beach:

• Get a pedicure- then wiggle those beautiful toes in the sand
• Work on your tan- make them wonder if it's real or fake
• Feed the seagulls an entire loaf of bread, maybe two- have someone take pictures, you will be smiling 
• Practice people watching- you will see things at the beach you can see nowhere else
• Perfect your picnic packing skills- variety is the spice of life
• Build a bonfire- watch and enjoy until the last embers fade to black
• Roast a hot dog on a coat hanger- but why eat a weinner when you can...
• Eat s'mores- use a peanut butter cup instead of a plain old chocolate bar
• Create new techniques for removing sand from wet bodies- let me know if you discover one
• Pretend you're a lifeguard- don't forget your whistle!
• Learn the words to Jack Johnson's song "Bubbly Toes"
• Wash, rinse, repeat!

Spring Cleaning:

I thought I should consult the professionals on this one so have a look at this terrific checklist I found on Pinterest.  She promises there will be no dust bunnies left behind!

Spring Cleaning Checklist


Refresh:

• Restock your files- make copies of often used handouts, test forms, calendars, etc. and have them ready to go
• Tidy up your car- your family, especially your kids, will thank you for clearing your therapy materials from the backseat
• Straighten up your desk, office, workspace- add a new photo or inspirational quote to your bulletin board
• Go through that stack of magazines and professional journals you've been collecting- file articles of interest of scan them to your computer for future reference
• Clean out and/or organize your toy closet- then select a fresh batch of toys to tote around with you
• Catch up on your CEUs- my favorite way to do this speechpathology.com
• Get caught up on your paperwork- ugh!
• Collect receipts from the previous year for any relevant, work related tax deductions- you've got until April 15th (tick tock)

So, pick your favorite list and get to work!  What will you do during this Spring Break?


Out of clutter, find simplicity. From discord, find harmony. In the middle of difficulty lies opportunity.      Albert Einstein

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