Put a Stop to Weight Loss, part one

Life is Funny

When you were in preschool, an afternoon nap was mandatory. 
As an adult, you dream about taking a nap in the middle of the day.

Way back when, your bedtime was 8:00 pm.
As grown ups, most of us only wish could turn out the lights and crawl under the covers at 8:00 pm. 

When you were in elementary school, you were required to read 30 minutes each day.
As an adult, there's not much time for pleasure reading, and if there is, it's certainly not happening on a daily basis. 

When  you were a kid, your parents pressured you to go outside and play with your friends.
As an adult, you wish you could go outside to enjoy sunlight and fresh air while visiting with your neighbors... but if you did, you know there would be no one to make dinner.

When you were a teenager, you wanted to get out of the house and move as far away as possible from your parents.
As an adult, you would pull out your two front teeth to have your mom or dad live nearby. 

When you are a younger adult, you count every calorie and exercise like a crazy person to maintain your ideal body weight. Desert is reserved  for special occasions.
As an older adult, weight loss is slow and steady...it happens without even trying.  People encourage you to eat as much as possible.  Deserts and snacks become mandatory. 

Does this sound familiar to you?

As a medical speech pathologist, I advise patients and family members on ways to prevent weight loss each and every week. Over the years, drawing upon both research and clinical experience, I've come up with a list of things that can be done to put a stop to weight loss. 

Considering this, I present...

15 Ways to Put a Stop to Weight Loss

1.  Keep favorite foods on hand and serve them often- avoid foods that are likely to be refused...like Brussels sprouts and lima beans

2.  Choose high calorie foods-  eat a creamy baked potato soup rather than vegetable and broth soup (that's diet food)

3.  Choose high protein foods-  meat, fish, chicken, cheese, beans, yogurt, eggs and peanut butter

4.  Add butter...to anything and everything- each pat of butter adds an additional 36 calories

5.  Use high fat dairy products- whole milk, cream, sour cream, cheese and cream cheese

6.  Add high calorie condiments- use dressings and mayonnaise generously on salads and sandwiches

7.  Add sugar or honey- ditch the pink or blue packets when sweetening your drinks, and get an extra 16 calories per teaspoon by adding the real thing

8.  Skip foods and drinks that are fat free, sugar free or diet- always go for the full fat, full sugar, full calorie options

8.  Add sauce or gravy to meats and veggies- it puts extra calories in every bite

9.  Provide sufficient serving sizes- larger portions may be necessary in some cases

10.  Eat 3 meals and 2 snacks every day- no skipping!

11.  Give high calorie drinks- juices, milk, soda and sugar sweetened tea are best... there is no nutritional value in water, I repeat, there is no nutritional value in water!

12.  Offer bedtime snacks- because it will be a long time until breakfast tomorrow morning

13.  Eat desert every chance you get- pies, cakes, cookies, brownies,  pastries and ice cream

14.  Use extra seasonings- food tastes better when the flavor is enhanced with salt, pepper, red pepper, cinnamon or vanilla

15.   Exercise- increasing your level of activity increases your natural appetite

Pass these tips along to someone you know who may benefit or put them into practice when you head off to work with your patients today. Several small changes in food and drink choices can lead to big increases in daily calorie consumption. Give them a try. What have you got to lose?




Growing up is mandatory. Growing old is optional.
Unknown

10 Things to Do Today to Avoid a Missed Visit Tomorrow

It's All About The Schedule

Yesterday, I was on a roll working on a business project, when I realized, "I'm going to be late for work!"  I dropped what I was doing, raced out the door and started that car just as fast as I could. "I've got 27 minutes to get to a home that's 30 minutes away...but I think I'll make it."

At precisely 12:30, the scheduled appointment time, I knocked on the door, ready for swallowing therapy. As I walked in, there was a strange but familiar face- it was the nurse from the agency. She was there to do her re certification visit. Oh no!

We run into each other every now and then, and when we do, it's always the same:  one of us has to wait a really long time, or one of us has to leave.  When it comes to home health, we work on a first come, first serve basis. In other words, even if you had an appointment and were there right on the dot, if someone else is there with the patient, they have first rights for completing their visit. 

We quickly agreed that she would complete her visit and I would re schedule mine. No big deal, except now, I have a 30 minute drive back home. One hour of my day went right down the drain. I hate it when that happens.

Scheduling appointments of any kind can be tricky. Over the years, I have created a list of things to do to make sure my day moves like clockwork and situations like I just described are avoided.  I realize I just told you a story where my scheduling efforts went wrong, but ordinarily, I've got this scheduling thing down. Do you?

10 Things You Can Do Today To Avoid A Missed Visit Tomorrow

1. Have a planner that works for you

I've been using the same style of calendar for the last 5 years.  I picked it up at Barnes and Noble. The cover design changes from year to year, but the insides are 
always the same. 


 I can see the entire week at once and there are large blocks of space for scheduling a full day's work. I just pencil in the hours of the day and then start scheduling.

You may prefer something larger or with more pre filled information, I just happen to like this.  It's small, durable and cute, and for me, it's perfect! Find what works for you, and don't leave home without it.

2.  Help others establish a scheduling system

Chances are, if your patient is forgetting about your therapy visits, they are missing other important appointments, too. Take a few minutes to find a calendar in the patient's home and write the appointment down for them. If there isn't any sort of calendar, give them one. You can pick them up at the dollar store or print them from your computer, either way, help them establish the good habit of recording appointments. 

3.  Schedule your visits around all the other stuff

Ask your patients about any other appointments they have scheduled for the week, and plan your visits around them. This may include appointments for PT, OT and/or nursing, doctor visits and even trips to the beauty shop. Asking about possible conflicts in advance can save you a lot of time in the long run, and ultimately, help you avoid missed visits. 

4. Schedule in advance

Before you complete one visit, try to schedule the next. Doing this keeps you one step ahead, plus it increases your chances of getting the day and time that is perfect for your schedule. If you're not able to schedule in advance, make sure you call the morning of the visit. If worse comes to worse, call at least an hour in advance. Whatever you do, do not show up unexpectedly, because it's never good when that happens. 

5. Set a predictable day and time you will be there

As much as possible, try to quickly establish a predictable day and time that you will see your patient. When multiple visits need to be made in a week, a predictable Monday-Wednesday and Tuesday-Thursday pattern seems to do the trick. While standing appointments are not possible for all patients and every circumstance, consistent scheduling almost always guarantees a completed visit. Not only do the patients appreciate knowing what to expect, it will help other therapists and providers gain consistency as well. 

6. Make a reminder call the night before

Every evening, usually between the hours of 5 and 6 pm, I make a quick phone call to remind my patients of our scheduled visit. If there is going to be a conflict that requires a change of plans, there is more time for rearranging visits the night before. These quick calls take less than two minutes and significantly reduce the chances of a missed visit.


7.  Give them the choice of how to communicate

Everyone loves choices, so offer your patient the option:  Do you want me to call you, or does texting work better? This way, you are sure your message will be received, and received messages lead to less frustration and fewer missed visits. Also, double check:  Is this the best number to reach you? 

8. Use texting 

When appropriate, text messaging is an easy and effective way to communicate with your patients and their family members. While you should always schedule your initial appointment by phone, you can use texting to send reminder messages, to change appointment times and to let your patient know you're running late. Text messages can easily be exchanged any time of the day (or night) and allow people to respond at a time that is convenient for them. Texting is clearly a win-win...just don't do it while you're driving. 

9.  Remind them: communication is a two way street

As my dad would put it, "The phone works both ways!" So, be sure to encourage your patients to call you if they foresee a conflict or need to adjust the appointment day or time. If my dad's approach doesn't suit you, then try the Carly Rae Jepsen approach:  "Hey, I just met you, and this is crazy, but here's my number. Call me maybe."

10.  Tell them about the consequences of a missed visit

Without being overly dramatic or threatening, remind the patient that missed visits have consequences:  the visit may not be rescheduled, the make up visit may be made by an unfamiliar person, the visit may have to be re scheduled to Saturday, the missed visit is reported to the agency and, in most cases, it's also reported to the doctor. (That usually gets their attention!) There are also various possible financial consequences of excessive missed visits, but discuss those only as a last resort.



No matter what you are scheduling, and to matter where you're doing it, these tips will help you better manage your time and your appointments. Get started today and have fewer missed visits tomorrow!

Respect the people who find time for you in their busy schedule. But love those who never look at their schedules when you need them.
Unknown

Therapy and Your Purse

A purse is more than just a fashion accessory when you are a speech pathologist... it's a chew toy, a hiding spot and even a germ magnet.  

Let me tell you about the adventures I have had with my purse. In doing so, I want to share 3 important lessons I've learned about therapy and purses. I'll start at the top...

#1:  Don't take your eyes off your purse

One afternoon, I was working with a preschooler at a nearby daycare. As we were playing, I  glanced up to see that she was wearing my sunglasses. She saw them in my purse and helped herself. "Awww, how cute!" 

She laughed and smiled, and so did I, until...snap! She broke the left arm off my sunglasses when she tried to put them on top of her enormous head. Oh, brother!

On another visit with the very same little girl, she spotted my car keys. They hang on the outside of the purse so they're easy for me to find. She took them off then latched them back, took them off and latched them back. 

"What a fun game! You're very good at that! Now, let's get back to work."

When our time was up, I gathered my things, dropped her off at her classroom and made my way to the parking lot. I quickly realized...I've lost my keys.  It took nearly 20 minutes to find those darn car keys...the little girl had put them in her pocket. Ugh!  

A few months later, I was doing a home health visit with an adult patient. She had a  cute, fluffy little dog that was prancing around, in and out of the room, carrying along a variety of dog toys. "What an adorable dog. She really loves to play!"

Well, this precious little fluff ball turned vicious when it came time for me to leave. She was jumping on me and barking like crazy. Come to find out, she dropped her tennis ball in my purse when no one was looking, and she was in attack mode because I was about to leave with it.

Lesson finally learned: don't take your eyes off your purse. 


#2:  Don't put your purse on the floor

Nothing good happens when you put your purse on the floor... believe me, I know!

Once, an eager little puppy chewed the strap off my leather purse while it was sitting on the floor. That's right, as I was busy guiding practice through oral motor exercises, that puppy was chomping on my purse. 

The purse sat in my closet, out of order, for nearly three years before I decided to have it repaired. 

On another occasion,  I went to see a patient for a dysphagia therapy session. His hospital bed was in the living room of the tiny home and two big dogs sat alongside. With very little space, I put my purse on the floor where I stood and got busy. The wife commented, "The dogs are very protective of my husband. They never leave his side."

When it was time to go, I reached down to gather my things.  My purse was sitting right in the middle of a yellow puddle. Yup, that's right, the dog had peed all over my new purse. That was so disgusting, the purse has never been used again.

My occupational therapy friend, Teri, once told me a story about putting her purse on the floor. While she was working, roaches crawled into her purse. Gross! But that wasn't the biggest problem. The real fiasco began when the roaches crawled out of her purse into the front seat of her car as she was driving. Wow! 

I was glad to know that I am not the only one with a purse story, and again, I finally learned:  don't put your purse on the floor.

#3:  Purses are dirty

A recent study by Initial Hygiene has revealed that women's handbags are contaminated with more bacteria than the average toilet. Yuck!  

In fact, tests showed that one in five handbag handles contains enough bacteria to actually make you sick. 

Because purses come into regular contact with our hands and a variety of surfaces, the risk of transferring different germs onto them is very high, especially since bags are rarely cleaned. 

Tests conducted by the research group revealed that leather handbags are the most bacteria-riddled of all purses as the spongy texture provides the perfect surface for bacteria to grow and spread. The research also revealed that the dirtiest items in the average purse are bottles of hand cream,  tubes of lipstick and mascara. 

Experts suggest that women regularly clean their hands and their handbags with antibacterial wipes or gel to prevent cross-contamination. I suggest you never again use a purse that a dog has peed on.

Do you have a funny purse story? I would love to hear it. In the meantime, keep your eyes on that dirty purse of yours and, by all means, keep it off the floor.

Combat stress with this quick fix

The de-frazzler you have in your purse:  gum!

That pack of gum you carry around in a case of a garlic emergency can freshen your mood as well as your breath.  According to Huffpost Healthy Living, researchers from Australia and England found that when agitated people chewed gum, they felt less anxious, more alert and had 18% less cortisol (the stress hormone) in their saliva. The study authors hypothesize that chewing increases blood flow to the brain, which helps with alertness and may also distract us from stressors.

So, before you have a  Monday afternoon melt down, find some gum and get smacking!

How Do You Measure Up?

As I was moving about my work day today, I realized I was using the same app over and over again. North side, south side, young and old, if you were getting therapy from me today, you were looking at my sound level meter.

Have you heard about this wonderful thing, the sound level meter? Well, let me tell you all about it!

A scientist would tell you that a sound level meter is an instrument that measures sound pressure levels, but that sounds kind of spooky to most people.  So, the way I explain it, "It's what  I use to measure the loudness of something."

It's an app I downloaded from the App Store a few years ago. It's made by Sky Paw Co. Ltd. and is currently in it's 10th edition. Did I mention... it's free? You can get rid of pesky pop ups and banner ads for a mere 99 cents, but I never did that. And good news for you guys with Android devices, the free app is also available from Google Play.

The app developer says that it "precisely measures the sound pressure levels all around you" but  goes on to say, "We've tried our best to make the app as accurate as possible, but this app is intended for entertainment purposes only." Since I'm not conducting scientific research,  "as accurate as possible" sounds great to me!

The Sound Level Meter:

A Handy, Dandy Tool for SLPs

Provide education:  

Using the sound level meter as a visual reference, it is a snap to provide education to patients and family members regarding volume.

• Teach the basics about environmental noise 
• Explain normal parameters for conversational loudness
• Make recommendations on how to decrease environmental noise
• Give information about compensatory voicing techniques
• Use as a reference when teaching about good vocal hygiene
• Explain vocal misuse and/or hyperfunction
• Teach the correlation between breathing and voicing as it relates to intensity and duration
• Discuss the consequences of inadequate intensity 
• Explain auditory comprehension compensatory strategies

Provide feedback:

Prompts and cues are great, but visual feedback is a highly effective way for your patients and family members to understand their performance levels.

• Help your patient see how they measure up
• Show your patient what is normal, too soft or too loud
• Demonstrate appropriate and effective performance levels
• Show your patient target volume levels
• Provide measurable data to show changes over time
• Use the plotted history to quickly see the effect of adjustments being made

Daily use in therapy:

As I mentioned earlier, I have found numerous ways to incorproate a sound level meter into my daily treatment sessions. Besides voice therapy, I have also used this device when working with persons with Parkinson's Disease, Dysarthria and Dysphagia. Here are just a few examples:

• Practice using increased volume to enhance intelligibility
• Practice using decreased volume to diminish vocal misuse
• Enable patients to see pauses between words when practicing slow rate
• Practice producing a strong, effective cough
• Practice producing a strong, effective throat clear
• Teach the patient to monitor and/or assess their own performance

Other neat benefits:

There are a variety of sound level meters out there, this one just happens to be my favorite because of some of the cool features.

• shows average, peak and max values
• gives real life examples of loudness equivalencies
• creates a plotted history of average values
• easy to use
• quick on and off using play and pause
• record and export data for future analysis
• large digital numbers are easy to see
• allows for calibration 
• sensitive up to 110 decibels 
• able to be used on iPads and iPhones
• compatable with Android devices 
• cool new overlay feature

While it may be true that quiet people have the loudest minds,  a quiet voice is generally ineffective. So, as you go about your work this week, consider who you know that may benefit from the feedback a sound level meter provides. Download the app and give it a try...what have you got to lose?



The volume of your voice does not increase the validity of your argument.
Steve Maraboli

Look Left: Compensating for Hemispatial Neglect (Part 2 of 2)

Hemispatial neglect, also known as left neglect, results most commonly from brain injury to the right cerebral hemisphere and causes visual neglect of the left hand side of space. When half of your visual field is lost, half of the world is gone.  The consequences of neglect can range from humorous to devastating, but one thing is certain, compensation will be necessary during the recovery process. Here are a few tips from the pros.

Compensating for Neglect

Left Sided Neglect and Mobility

Persons with neglect are at a higher risk for accident, injury and fall. Take precautions to increase safety and awareness.

Use a wheelchair tray or trough when seated;  use a sling or other positioning device when walking

• prevents subluxation of the shoulder
• prevents injury to the arm, hand, elbow
• keeps the limb visible 
• increases body awareness

Outline doorways with bright tape 

• increases environmental awareness
• provides a point of reference when seeking the left visual field
• prevents collision and injury with door frames
• increases safety
• reduces risk for fall

Clear the way

• eliminate necessary obstacles on the left side
• provide clear, clutter free paths
• offer verbal and visual cues as needed

Stand or walk next to the person on their affected side

• encourages them to look and scan to the left
•  enables you to steer them away from obstacles
• increases safety- reduces risk of colliding, tripping or falling

Left Sided Neglect and Meal Time


Not only will persons with visual neglect eat only half of the food on their plate, they will not be aware of things on the left side of the table. It is important to consider the entire dining environment.  Small changes can make a big difference.

• Place napkin, utensils, beverages and yummy deserts on the left side of the table
• Rotate the plate during the meal to ensure all food is consumed
• Sit on the person's left side to draw their attention that way
• Use hand over hand techniques to facilitate use of left hand, when appropriate
• Give verbal and tactile cues as needed
• Tape a line down the center of the table or tray where the meal is being served
• Avoid distractions and eliminate clutter

Left Sided Neglect and Activities of Daily Living



Neglecting half of the body can be problematic when considering hygiene and dressing. Compensatory strategies to the rescue!

• Dress, shave or wash the left side of the body first and then the right
• Encourage the use of the left hand as much as possible
• Label drawers to indicate contents within
• Place all necessary items to complete the task to the left
• Use a mirror to provide feedback
• Provide verbal and tactile cues as needed
• Eliminate distractions
• Reduce clutter
• Limit choices

Additionally, there is a tremendous variety of adaptive equipment to make life easier for the person with hemiplegia and associated visual neglect. Occupational therapists are the experts here and can assist with selecting appropriate devices or pieces of equipment

Try to let the person do as much as they can for themselves. It may be easier and save time for you to do the task, but the person will become less independent unless they try to do tasks on their own. 

Left Sided Neglect and the Environment

Retraining an individual to attend to the left side of their world takes time and persistence. Consistent attention to the left, even during leisure activities or when visiting with a friend, can speed the recovery process.

Place frequently used items or objects on the left

• remote control
• glasses
• water
• phone

Position bed to encourage looking toward  windows and doorways

Position TV or radio on the left 

Sit on the left side of the person

To avoid startle, approach from the right

Left Sided Neglect and Reading or Writing

Reading and writing abilities can be significantly limited by changes in the visual field. External cues and simple modifications are helpful.

• Draw a brightly colored line down the left side of the page- cue to use as a reference point for finding the left margin

• Use a ruler, index card or blank piece of paper to follow the lines of text

• Number the lines in order to follow proper sequence and avoid skipping

• Follow along using a finger

• Use enlarged print or double spacing 

• Cue and prompt as needed

Neglect affects all aspects of a person's life. Encourage families and caregivers to learn more about ways they can assist in recovery. Incorporating compensatory strategies during the rehabilitation process can increase awareness, safety and ultimately, independence. 

Helping a person will not necessarily change the world, but it will change the world for that person. 

Unknown

Look Left: The Basics of Hemispatial Neglect (Part 1 of 2)

Hemispatial neglect, also known as left neglect, results most commonly from brain injury to the right cerebral hemisphere and causes visual neglect of the left hand side of space. Although it most often affects visual perception, neglect in other forms of perception can can also be found, either alone or in combination, with visual neglect. 

No matter the reason or the result, witnessing neglect in a stroke survivor is a mind blowing experience. They teach us about it in school, but when you experience it first hand, you're almost guaranteed to be amazed.

I clearly remember a woman I was working with at a rehab hospital in Houston. She had visual and perceptual neglect of the left side of her body.  Not only did we have trouble getting her to see the things on the left of midline, she literally did not recognize the left side of her body. 

I was working with her during a therapeutic lunch meal, trying to get her to eat the food on both sides of her plate, when the neglect became apparent.

Ms. P: What is that?

Me:  That's your arm. 

Ms. P:  No it's not.

Me:  Yes, ma'am, it is. It is your left arm.

Ms. P:  That's not my arm. That arm is fat and ugly.

Me:  It's a little puffy, but it is your arm.

Ms. P: Get that thing out of here. It's disgusting. 

Me:  But it's your arm, we can't get rid of it.

Ms. P:  Well, you're a smart girl, I'm sure you can think of something. 

I thought she was joking, but it was no laughing matter for her...she wanted that arm gone or she was not going to eat.

Just this week, I had another run in with left neglect. I was so busy coaching the patient through his safe swallow strategies, I didn't notice, until the end of the meal, he had only eaten half of the food on his plate. It's almost a perfectly straight line down the middle of the plate...unbelievable! 

Quick, snap a picture!  This is good material for a blog!

So, if you've read this far, you've learned two of the signs of left neglect, but there are more...

Signs and Symptoms of Left Neglect

• Frequently bumps into objects, furniture, door frames or people on the left

• Unsure of footing while walking, with stumbling or tripping

• Often startled by moving objects or people appearing suddenly on the left

• May have bruises on left arm, shoulder, elbow or hand

• Frequently loses place when reading and becomes frustrated when reading

• Struggles to find or misjudges the start or end of a line of print in reading

• Only writes or draws on the right half of the page

• Problems in finding things on desks, counter tops, cabinets or closets

• Fear or anxiety in walking through unfamiliar areas

• Eats the food only on the right side of the plate

• Little or no awareness a hemisphere deficit exists

• Difficulty acknowledging the left side of the body

• Comb only half of their hair
• Put on only one sleeve of their shirt, or one leg of their pants
• Wash only the right half of the body
• A woman may apply makeup to only the right half of the face
• A man may only shave the right half of his face

Model on the left. Patient's drawing on the right.

The stylish half beard

Okay, so now that we can identify hemispatial neglect, what are we going to do about it? Please check back for part 2 of this blog. I'll give you tips and tricks you can use to compensate for neglect or increase safety with mobility, during ADLs, at mealtime, when reading and writing.

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


What we see depends mainly on what we look for.
Unknown

Images courtesy of cognitiveneuro.wordpress.com, Stroke4Carers.org and gainesonbrains.com