Saturday, February 21, 2015

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

Monday, February 16, 2015

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