Bread + Butter + Cheese = Happiness!

August is National Sandwich Month!

That's right...there's an entire month of every year dedicated to the celebration of the sandwich.


How cool is that?






Love them or hate them, Americans eat 300 million sandwiches each day. That means we consume as many sandwiches each day as we have people to eat them. Wow!

Here are a few more sandwich fun facts:

• The sandwich as we know it today was popularized in England in 1762 by John Montagu, the 4th Earl of Sandwich. Legend has it that Montagu had a substantial gambling problem that led him to spend hours on end at the card table. During a particularly long binge, he asked the cook to bring him something he could eat without getting up from his seat...the sandwich was born. Montagu enjoyed his meat and bread so much that he ate it constantly, and as it grew popular in London society, it took on the Earl's name.

• The first recipe for a sandwich appeared in an American cookbook in 1815. Upon arrival, the most popular version of the sandwich wasn't ham or turkey, it was tongue.

• Peanut butter and jelly sandwiches first appeared in the 1920s. Up until then, peanut butter was viewed as a luxury product. You were likely to find peanut butter and pimiento sandwiches, or even peanut butter and watercress tea sandwiches. Once the price of peanut butter decreased, it stopped being seen as an indulgence and started to be used by moms as a filling way to feed children at school.

• The iconic New Orleans sandwich, the po boy, came about in the Great Depression during a streetcar worker strike. Two brothers, once streetcar operators themselves, owned a sandwich shop nearby, and promised to feed any down-on-his-luck striking worker for free.  When a hungry striker walked into the shop, the clerks would yell, "Here comes another po' boy."

• The Sloppy Joe also came about during the Depression. It was the invention of a short order cook named, you guessed it, Joe.

• The Reuben, a wonderful combination of corned beef, Swiss cheese and sauerkraut, appeared not in  New York deli as you might imagine, but in Omaha, Nebraska. The sandwich was named after one of the participants in a weekly poker game that took place in an area hotel.

Of course, most Americans today wouldn't dream of eating a tongue sandwich, but that's okay because we've come up with some pretty excellent sandwich ideas since then... including the grilled cheese sandwich.

The precise origin of the grilled cheese sandwich is not clear, but food scholars speculate that it was in the 1920s that some enterprising mind came up with the idea to combine bread and cheese and grill it.

The grilled cheese became a mainstay meal during the 1930s as citizens could usually afford this relatively inexpensive sandwich. During World War II, the grilled cheese was a favorite of the armed forces, with official Navy cookbooks containing recipes for making these hearty meals. Before long, school cafeterias and moms across the US were making grilled cheese sandwiches a part of their meal planning. 

Today, I want you to consider the clinical importance of the incredible, edible grilled cheese sandwich. 

15 Reasons SLPs Love Grilled Cheese Sandwiches

1.  Cheese is a good source of protein- so many of our patients don't get enough of it; it's better to eat gooey cheese than take a shot of Pro Mod any day (if you ask me)

2.  It's easy to chew and swallow- you don't even need teeth to enjoy this grilled goodness; your patients won't wear themselves out with bolus preparation like they might with other types of sandwiches

3.  They're high in calories- which is a great selling point for most of our older adult patients who are experiencing gradual weight loss; it sure beats drinking an Ensure for lunch!

4.  A perfect finger food- whether you cut them in half, in quarters or into bite size pieces, these delicious sandwiches require no utensils and minimal fine motor skills

5.  Easy to prepare- you can have a warm, crispy sandwich in a matter of minutes; they're on the table before you know it...great for busy caregivers

6.  Available on most kid's menus- even if your patients are eating out, they can enjoy these easy to chew, easy to swallow sammys

6.  Available on most alternate menus- in nearly every facility I have worked, the glorious grilled cheese is available as an alternate for an otherwise dreadful or difficult meal

8. Yummy in your tummy- they're considered by many to be the ultimate comfort food

9.  Endless options for upgrading- add extra protein by topping your cheese with bacon or ham, add veggies with slices of tomato, fresh spinach,  sauteed mushrooms or onions

10.  Requires only 3 simple ingredients- use any kind of bread and any kind of cheese; chances are, all of the ingredients are on hand...no special shopping trips required

11.  Enjoy at breakfast, lunch or dinner- everyone agrees, you can eat grilled cheese any time of the day or night

12.  A terrific transition food- it's a perfect bridge between a mechanical soft and regular diet, and, depending on the patient, between purees and mech soft foods; use this sandwich during therapeutic trials in consideration of diet advancement or upgrade

13.  Even the pickiest of eaters love them- that's true for both adults and children; there's no need to poke or prod your patients to "keep eating"

14.  Happy plates!- your patients are likely to eat the entire sandwich and earn a 100 under the % of meal consumed column of the patient flow sheet

15.  They are familiar and recognizable- you can't always say that when your diet is restricted to pureed, finely chopped or ground meats



So, does that make you want to jump on the grilled cheese bandwagon?  I sure hope so!

As you go about your work this week, remember the functional and clinical importance of this simple sandwich, and imagine how grilled cheese can benefit the patients on your caseload. 

Now...LET'S EAT!

Thanks for reading. Hope it's a great week!


Life is like a sandwich, you have to fill it with the best ingredients.
Unknown



PS:  Are you doing it all wrong when it comes to making grilled cheese sandwiches? Check out this video on how to make a grilled cheese sandwich the right way...it's pretty entertaining and demonstrates an excellent technique. 

Preparing for Chart Audit- Documenting Skills of a Therapist

My mom came down for a short visit a few weeks ago. Because it's always a big deal when Grammy comes to visit, we spent the afternoon preparing:  the boys  swept the floors and cleaned the bathrooms, my daughter changed the sheets on the bed and I had straightened up things in the playroom, office and living room. Coby, Jay and Mike put on fresh t-shirts, Meredith  brushed their hair, I dabbed on some lip gloss and my husband was wearing his best baseball cap.  We were looking good...or so I thought.

All of the sudden, I looked at things from my mom's perspective- it was a completely different picture!

Because we were preparing for our trip to Arizona, there was significant disarray:  the kitchen table, bar, living room, dining room, foyer and hallways were stacked high with boxes, bags and totes. There was even a wagon parked in my office! Upstairs in the playroom, the kids sat like zombies, glued to the tv, there were laundry baskets full of clean clothes and someone "accidentally" pulled the curtains down.

Mom didn't have to say a word, but I knew she was thinking, "Oh em gee!"

All I could  say is "Please don't judge me. It's not always like this."

She gave me a very polite smile and a sympathetic pat on the back, "I know."

Maybe this has happened to you... you think you're doing a good job, but when you look at things from someone else's perspective, you realize maybe you're falling short.

Well, that same thing can be true when it comes to the documentation of therapy services.

Let me explain.

One of the agencies I work for requires all therapists to assist with chart auditing. It's just a few hours each year, but it's a great opportunity to look at documentation from a different perspective. Until I participated in this auditing process, I never really knew how evals, recerts and visit notes were being  judged. 

Well, come to find out, there is only one  thing that really matters:  the documentation of the skills of a therapist. 

To be more specific, Medicare guidelines state that "all therapy services must be medically necessary and be provided at a level of complexity and sophistication that requires a speech-language pathologist to perform the tasks."

So, if you're not writing about the things you do that no one else can do other than you, the therapy professional, you are falling short. An auditor could deny payment on a claim if these things aren't abundantly clear.

Keeping that in mind, I thought I would review some of the components of skilled services...those complex and sophisticated things you do every day that make your job so great.

Here we go! 

15 Activities That Require the Skills of a Therapist

1.  analyze medical and behavioral data

• complete a thorough chart review
• obtain past medical history
• consider physical, social, emotional, cultural influences

2.  evaluate and assess using appropriate tools or protocols

• select assessment tool
• administer test
• score and interpret results

3. determine diagnosis and prognosis

• assign diagnosis
• record severity of impairment
• make a prognostic statement

4.  use terminology that reflects technical knowledge

• showcase any professional, discipline specific terms
• incorporate appropriate medical terminology

5.  design plan of care 

• establish functional short term goals
• create functional long term goals
• define criteria for discharge

6.  develop and deliver treatment based on progression of complexity

• select appropriate materials, activities, strategies, etc.
• incorporate hierarchical methods for delivery of tasks, cues, etc. 

7. facilitate success

• modify tasks or activities, as needed
• provide encouragement or praise, as appropriate
• share documented progress with patient, family

8. guide practice during selected therapeutic tasks

• provide demonstration
• use prompts and cues as needed

9. provide discussion of rationale

• give information about how the intervention:
• relates to a functional goal
• improves safety
• increases independence

10. use objective data that supports progress toward a goal

• accuracy of response
• speed/ latency of response
• frequency of occurrence
• number of cues
• type of cues
• level of independence
• physiological changes

11. use feedback

• verbal
• visual

12. explain decision making

• modification of treatment plan
• change of treatment activities
• addition of goals or activities

13. provide patient/ caregiver/ family training or education regarding:

• diagnosis
• plan of care
• goals
• progress
• barriers to progress
• strategies, techniques
• precautions
• facilitation of carryover and generalization of skills

14. make professional recommendations

• compensatory techniques
• safety strategies
• diet texture
• liquid viscosity
• communication alternatives
• carryover activities

15.evaluate and assess education provided

• patient, caregivers, family members verbalize understanding
• patient, caregivers, family are able to return demonstration

Often times, I begin visit notes using the easily identifiable phrase,  Skilled intervention this session included...

Here's an example from a note I wrote last week. In just two sentences, I detailed quite a few activities from the list above that only a therapist could perform:

Skilled intervention this session included: demonstration, instruction and guided practice through various AROM and PROM exercises for increasing oral strength, movement and agility- min visual, verbal and tactile cues; demonstration then guided practice though laryngeal elevation, glottic closure, voicing and deep breathing exercises- min verbal prompts; guided practice through speech production tasks, naming activities and picture description tasks- mod phonemic cues and binary choices;  guided practice with swallow strategies and safety techniques- SLP provided demonstration and min verbal cues. Education was provided to patient and caregiver regarding rationale and functional importance of each speech, language and swallow task- understanding verbalized. 

Granted, these were two pretty long sentences, but I'm sure you'll agree, there was no question about what I was doing as the SLP to provide skilled intervention during this session. This is not the entire note, and this is not the absolute only way to document your skilled interventions, but...upon review, I'm fairly certain this claim will be paid!

So, this week, as you go about your work, think of exactly what you are doing to offer complex, sophisticated therapeutic skills to your patients, their caregivers and families. Then,  be sure to write it down, because if you don't write it down, it never happened! 

Thanks for reading...have a great week!

We should be rigorous in judging ourselves and gracious in judging others.

John Wesley

It's Go Time!

Today was a huge day!

After four months of intense focus and massive action, I'm in Phoenix, Arizona for the American Speech Language Hearing Association's Healthcare Business Institute conference...ready to introduce Spontaneous Speech Therapy Tools to the world.

Watch out, here I come!

The morning was frantic and started with a game of  slip and slide in the shower. Then, it was last minute preparations with device charging, app loading, bag packing, spur of the moment problem solving and painstaking decision making. It was so stressful, at one point, my mom, who is also my travel partner and marketing constituent, commented, "You're killing me!"

I just laughed at her, and I'm pretty sure she rolled her eyes at me. There's no time for drama or dying, I thought. We've got to get over to the convention hall...quick, fast and in a hurry!

We got things situated at our booth just seconds before the doors opened- whew! People began pouring in. There were SLPs everywhere you looked- marvellous!

We slapped on a smile, grabbed flashcards, business cards, pencils and magnetic bookmarks and got to work.  We met people from Iowa, Oregon, California, Florida, Texas, Michigan, Massachusetts, Maryland and even Canada!

We met:

• 2 university professors- one from Dallas, the other from Arizona
• a university dean- I think she was from Michigan?
• Joni, the director of speech and language product development from Attainment Company
• Justin Goldstein- the ASHA sponsorship manager
• The Speech Guy- I think his name was Jared
• Sandra, THE expert in Orofacial Myology- OrofacialMyology.com
• numerous rehab directors
• SLPs working in hospitals, nursing homes, assisted living facilities, rehabs, outpatient clinics and schools
• Eric- app developer
• 5 of the SLP Bloggers:  Lauren at Busy Bee Speech, Jenn from Crazy Speech World, Danielle with Sublime Speech, Allison from Speech Peeps  and Jenna from Speech Room NewsSpeech Room News
• several researchers
• a couple of graduate students
• a girl that presented a poster session on Evidence Based Practice using Constant Therapyapps
• 2 women starting private practices
• a couple that offers online speech therapy services- Reach Therapy (I want to try that!)
• an awesome lady from Dripping Springs, Texas that let me use the hotspot on her cell phone to sell her an flashcards

And that was just day one...we get to do it all over again tomorrow! Yay!

I'll update you on the neat people we meet on day two. In the meantime, meet my colleagues by visiting the links above. Great people!

Thanks for reading...have a great week

We don't meet people by accident. They cross our paths for a reason.
Unknown

Easy Breezy for the 4th of July

As  a toddler, my son Jay loved the 4th of July. He appreciated the red, white and blue decorations around the house. With great pride, he helped hang a crisp new American flag on the front porch. He clapped with each and every flash, bang and  pop of the fireworks. It was marvelous!

He called it "America Time."

Whether you call it America Time, Independence Day or the Fourth of July, it is a great time of year to have a little fun: 

10 Easy Breezy Things to do This 4th of July

1. Watch a movie...like The Patriot
2. Go to a baseball game...or watch one on TV, and while you're there-
3. Eat some Cracker Jacks...play with the fun toy at the bottom of the box
4. Light up the grill...cook up some hot dogs and hamburgers
5. Line your sidewalk with American flags...do your neighbor's sidewalk too
6. Make some ice cream...use it to create the perfect banana split
7. See a really great fireworks show...or hit a roadside stand and make your own magic
8. Have a water balloon fight...a water balloon launcher will take the fun to a new level
9. Slice open a watermelon and get juicy...seedless varieties, of course
10. Wear red, white and blue...a classic, all-American choice AND it looks great in pictures

But don't save all of your fun for the weekend...you can have a little fun at work too!

Whether you are leading a group or looking for an activity to use during a one-on-one session, check out these links below.  I've pulled together a few puzzles and games that are sure to provide some holiday fun for you and your patients.  Because I've done the searching, you don't have to. You're welcome.

Easy patriotic crossword puzzle

4th of July trivia quiz

Word searches, mazes, word scrambles and more

4th of July bingo game

All puzzles and games are free and printable, so enjoy! With all of the time you have saved, you can stir up a glass of fresh squeezed lemonade and enjoy and easy breezy America Time weekend.

Thanks for reading...have a great week!

I believe in America because we have great dreams, and because we have the opportunity to make those dreams come true. 
Wendell Wilkie

My Life in Boxes

Have you ever been excited about a box?

I have!

My parents brought me home from the hospital in a box. That's right, a cardboard box. Can you believe that? I can't say that I actually remember that day, but I bet my parents were excited about their box.

They also kept that oh so special box and, until I was 3 or 4,  I loved to watch TV inside of it. That's right, I would get a pillow,  my cold blankie, my favorite Raggedy Ann beach towel and my box and I would watch Planet of the Apes. I got to stay up late on those nights- exciting times!

Life was great in the box!

As I got older, boxes were exciting because they usually meant moving. 

We moved from Texas to Louisiana when I was 8, and once in Luling, we packed all of our stuff into boxes and moved four more times. 

As far as I know, all of the boxes made all of the moves, but I try not to remind my mom what happened to the TV armoir during that last move. 

Hint:  It flew out of the back of the truck and broke into splinters!

Growing up, grandparents, aunts and uncles sent boxes full of Valentine's treats, Halloween goodies, birthday and Christmas presents. No doubt, there was maximum excitement when those packages arrived!

When I was in college, my grandmother was totally in to the Home Shopping Network. She called, late one night, and told me that she was sending me  Dr. Allen's Wonder Baker. 

What in the world?

She assured me it would change my life. The anticipation was almost too much- I thought the box containing the Wonder Baker would never arrive. Can you relate?

As I got older, I excitedly packed my own boxes and moved: from Baton Rouge to Fort Worth to Houston and finally to Corpus Christi.  Each move meant more and more boxes. 

What can I say, I love stuff!

In 2002, I was expecting my first baby and, no matter how hard I tried, I was not able to find all that I needed for a cowboy themed nursery at the local Babies R Us. So, I took my first shot at Internet shopping. 

I ordered cowboy bedding, cowboy curtains and coordinating bandanna fabric to make a diaper stacker and matching pillows. I ordered a hat/coat rack in the shape of a big green cactus and a little table and chairs with...you guessed....cowboys!

Needless to say, the nursery was going nowhere without these things and I could hardly wait for my big purchase to arrive so I could get to work pulling things together.

With absolutely nothing else to do, I kept careful watch for that big, brown truck. Finally...

The day arrived. 
The truck pulled up. 
The boxes were delivered.

Maybe it was those crazy pregnancy hormones, or perhaps it was sheer excitement, but when that UPS man knock on my door, I went nuts.

I gave him a giant hug. 
I invited him in. 
I even took his picture.

 I bet he still talks about me to his UPS buddies- that wacky lady on Sutherland Drive,  waiting for her boxes.

Once that precious child arrived, there were even more boxes in my life, and as the children continued to arrive, so did the boxes. Joy!

Months and years go by but some things never change- there will be boxes.

In fact, I am focused on boxes now more than ever!

Since Spring Break:

• searched the world over for the perfect box size and box shape
• created a mock up box out of scrapbook paper
• worked with designer to create professional box design
• searched the world over to find someone to make my box
• decided Hong Kong has the best box making capabilities in the world
• converted measurements and colors for desired box specifications
• arranged payment for boxes via international wire transfer (scary stuff, I assure)
• received color proof of box from Hong Kong
• returned color proof of box to Hong Kong
• arranged for a split shipment of boxes to meet deadlines
• 100 boxes now via UPS Express
• 400 boxes later on a slow boat from China
• hired a customs broker to clear my boxes through the Port of Houston
• hassled above customs broker to complete shipping forms for boxes by deadline
• waited for boxes

Whew, I'm exhausted!

Well, last Monday, June 15, I received an email from UPS: 

Your package has been sent and will arrive by the end of business, Tuesday, June 16. 

Those nice UPS folks even gave me a tracking number so I could obsessively watch my boxes move around the world-  from Hong Kong to Anchorage, Alaska, then on to Memphis, Tennessee, over to San Antonio, Texas, to down to CORPUS CHRISTI! 

Everyone in the house and neighbors up and down the block were on watch for the big, brown truck...waiting for the boxes. 

Now, unlike the previous UPS experience, this delivery was uneventful, and actually pretty sweaty and gross.

It was 5:52 pm when the dolly was flung out of the back of the truck. The UPS man removed 5 boxes, stacked them up, and, with great effort, pushed them straight through the middle of my front yard. (I still can't figure out why he didn't use the sidewalk.)

Anyway...

I greeted him at the door.

He plopped the boxes right in the middle of the foyer.

He left.

He did not smile. I did not want to hear about the exciting journey my boxes had taken. He did not care about my new business. He did not even let me sign my name on his little brown computer thing.

 He left a few drops of sweat on the front porch and he was a gone pecan. 

Nonetheless, the boxes have arrived, and nearly one week later, I am still excited about it!

Take a look at my beautiful boxes...

For most people, boxes come and go without event, but not me- my life, past, present and future, are in these boxes !

I want to show you and tell you more about my boxes, but that will have to wait, so stay tuned!

Thanks for reading...have a great week!

Most people think in the box. Some people think outside the box. I want to create the box. 
Solly Tomari

June is Aphasia Awareness Month!

In 2008, Congress declared June as National Aphasia Awareness Month in an effort to increase public awareness and advocacy for the understanding of a communication disorder that affects approximately two million Americans. While this is a significant step in the right direction, awareness and understanding of aphasia by the general population remains low. 

What do you know about aphasia? Check out this informative video I created.

Still not sure what aphasia is or what it would it be like to have aphasia?

Take a few minutes to experience listening, reading, writing and speaking with aphasia using these neat aphasia simulators.  

I asked my husband to try these simulators before publishing this post, and quite honestly, he did not understand my fascination with this experience. 

him:  This is confusing.
me:   Exactly!
him:  I don't understand this.
me:   I bet you don't!
him:  Does this make sense to you?
me:   Yes. I got all of the answers right.
him:  Are you trying to make me feel dumb?
me:   No, just trying to make you understand what it's like to have aphasia.
him:  Do you work with people like this?
me:   Every day.
him:  I feel sorry for you speech therapy people. I don't know how you do it.
me:  It's the people with aphasia we should be worried about. I don't know how they do it.

No matter what you think of the simulator experience, there is a lot of information provided at this site, and along with it, hopefully, a new perspective  toward those living with aphasia. 

Give it a try and let me know what you think.

In the meantime...

As professionals, SLPs have had experience with aphasia through specialty coursework, research, continuing education and clinical practice. With that experience comes the responsibility to serve our patients,  to educate their family members and to increase public awareness. 

So, as you go about your work this week, please take the time share these resources with others: tell a friend or family member about this blog, promote aphasia awareness by sharing this link on Facebook, or help someone through the aphasia simulators. You will be glad you did.

Thanks for reading... have a great week!

When something bad happens you have three choices.  You can either let it define you, let is destroy you, or let it strengthen you. 

Summertime, and the Living Is Easy Breezy!

I'm not a big Alice Cooper fan, but he and I do agree- when school is out, it's worth singing about!  

Bring on the good times! 

Friday was the first official day of summer vacation and the guys were ready for some fun.  The conversation went something like this:

What are we going to do this summer, Mom? 
I don't know. What do you want to do?
We don't know.
Well, why don't you two go make a list of all of the things we can do this summer. Come back later and let me see what you came up with.

Off they went.

When they came back, they presented this list:

• baseball camp
• movies 
• beach
• sleep overs
• travel/ visit grandparents
• Schlitterbahn
• stay up late

Doesn't look like it's going to be too difficult to keep them entertained this summer, does it?

Since we all know that summer vacation doesn't really exist for most grown ups, I decided I had some planning to do too- I needed to map out my plan for the weekend. It could be the last chance I have to get things in order around the house for a while. Knowing that, I grabbed my legal pad and started writing.  This is the actual list of what I planned to do:

• check mail
• pay bills
• check bank accounts
• file papers
• purchase graduation gifts (x5) 
• write blog for 06/08/15
• return pajamas to Dillard's
• exercise (x2)

With my list complete, I moved on, feeling confident:  I am going to accomplish 8 things this weekend. I can do this!

Well, remember the old saying about the best laid plans for mice and men? Yup, that was me...my plans went awry.

John Steinbeck should have written about the best laid plans for mice, men and women who make lists of things to do.

Anyway... 

Here is a list of what I actually did:

• went to a pool party at the neighbor's house- a great way to kick off the summer!

• went to Coby's baseball game- they lost, but I can't remember the last time I laughed so hard (PS:  next time you see me, but sure to ask to hear the story and/or see the picture of  Dirty Mike- it's sure to give you a good laugh too)

• packed the family up for a trip to the beach-  we took every beach related item we owned and had so much fun we decided to stay till almost 1 in the morning; my crafty husband even built us a bonfire as the sun was going down; we watched a beautiful moon rise as we sat under the stars and marveled at the universe- glorious!

• attended online church (by myself) while I folded 5 baskets of clean laundry (by myself)- it was the low point of the weekend 

• baked a big batch chocolate chip cookies- delicious!

• went to a baseball team party for Mike and Jay- I actually had a great time!

• watched 8 innings of an LSU baseball game- we won!

• took the dog for a walk- enjoyed the cotton candy colored sky as the sun set

• thought about writing an outline for the 06/08/15 blog- but ate a mango popsicle instead

In the end, I did not do a single thing on my list, and  believe me, under ordinary circumstances, this would be major source of frustration, aggravation and disappointment. But, not this weekend, it's summertime and I'm going to do like Jack Johnson- I'm going to move like a jellyfish and go with the flow.

This week, as you go about your work, try to be just a little more relaxed in your approach to life, and take some time to enjoy all that the summer has to offer.

Remember: the tan may fade, but the memories of an easy breezy summer will last forever.

In the meantime, I'm headed to Padre Island...I'll save you a seat!

Thanks for reading...have a great week!

Live in the sunshine. Swim in the sea. Drink in the wild air.  
Ralph Waldo Emerson