Seven Things SLPs Want You to Know About Feeding Tubes

Talking About Tubes

A new order for an ST eval is always exciting because you never know what to expect. 
Caring for a new feeding tube can be overwhelming and confusing for patients and caregivers.

These thoughts came to mind today as I was taking a medical history from the son of my new patient. I was excited to be there. He was overwhelmed and confused.

His 88 year old mother was discharged from a skilled nursing facility two days prior to my visit. She had experienced a stroke "somewhere back there" and had a brand new feeding tube "because she failed the swallowing test."

Does this sound familiar?

He could not relate any specific information about the stroke or the feeding tube, but now, he is in charge of the daily care of a stroke victim and the daily operation of a feeding tube. That's scary!

To make matters worse, her discharge from SNF to home was poorly planned. She arrived home without any medical equipment. In fact, the son told me the feeding pump she was using had been "borrowed from the rehab place." Oh my!

I worked hard to contain myself from dropping my jaw as the son answered my questions and explained the situation. No matter the circumstances, it was obvious:  she needed equipment and he needed education.

Though I'm limited in what I can do to solve an equipment problem, I felt I could provide some helpful information about feeding tubes. Here are the 7 things I told him:

What Your SLP Wants You to Know 
About Feeding Tubes

1.  You can still aspirate!

Even though the nutrition being provided by a feeding tube bypasses the problem areas (mouth, larynx, esophagus), feeding tubes are not guaranteed to prevent aspiration. Families need to know that saliva, secretions and stomach contents can be aspirated.

2. Oral care is super important

Because saliva and secretions can be aspirated, it is important to keep the mouth as clean as possible. Routine oral care helps to reduce the amount of bacteria in the mouth, thereby reducing the risk of pneumonia in the event of an aspiration.

3. The head of the bed should always be elevated to 30 degrees

Digestion is improved and reflux is reduced by simply elevating the head.  Propping the head and shoulders on pillows or adjusting the head of the bed to a 30 degree angle reduces the risk of aspiration. Gravity is a wonderful thing. 


4. There are continuous feedings

Feeding pumps regulate and deliver continuous feedings. These feedings occur at a certain rate and are delivered over a predetermined amount of time. The flow rate and feeding schedule are ordered by a doctor. The feeling of continuous feeding can be compared to the sensation of fullness when continuously snacking- you're never really hungry. While a pump may be necessary during acute illness, it may be impractical as you become for active.



5.  There are bolus feedings


Bolus feedings involve administering a specific volume of formula at a specific time of the day. A doctor sets the feeding amount and schedule. Either a gravity drip or a large syringe is used to deliver formula, water and medications. Bolus feedings approximate the sensation of fullness you experience after consuming a complete meal. Since there are long intervals of time in between the feedings, a person may experience the sensation of being hungry. Because a large volume of liquid is quickly entering the body, some have trouble tolerating bolus feedings. 


6. Speech pathologist are permitted to work around your restrictions

Feeding tubes are often inserted due to dysphagia (swallowing difficulties) and come with an NPO (nothing by mouth) restriction. When a patient is placed on NPO status, it doesn't automatically mean that he will never, ever eat or drink anything ever again.  With MD authorization  and as judged clinically appropriate, speech pathologists are able to introduce small amounts of food or liquid into treatment sessions for the purpose of assessing swallow function and safety. While these therapeutic trials are carefully planned and are an important part of helping you reach your treatment goals, patients should continue to follow NPO restrictions outside of treatment sessions.


7.  If you cheat, we want to know

Sometimes, as patients progress, they are tempted to disregard their NPO status. They may take a few sips of water, one good slurp of coffee or a bite of birthday cake. No matter what it is that tempts them, patients are encouraged to tell their therapist if they are eating or drinking anything outside of a supervised therapy session. Reporting these cheats provides valuable information to the therapist about swallow function and safety. Depending on the circumstances and/or the outcome the patient experienced, unsupervised cheats may:  reinforce the need for NPO status, explain that mysterious new pneumonia diagnosis or lead to a therapeutic progression of oral intake. No matter what a patient chooses, it is important to emphasize that honesty is the best policy.




The use of feeding tubes is increasingly common, and due to the aging of America, their rate of placement continues to rise each year.  The most common primary diagnoses among patients receiving feeding tubes are dementia (25-50%), stroke (50-75%) and head and neck cancer (60-70%). As an SLP, if you work with patients in any of these populations, it is important to be prepared to provide education, answer questions and make recommendations regarding feeding tubes. 

If you are a patient, family member or caregiver that is just becoming familiar with the basic operations of a feeding tube, remember your SLP can be a great source of information and support.



Don't be afraid of the answers, be afraid of not asking the questions.
Jennifer Hudson

5 Simple Ways to Motivate Your Patients

What motivates you?

Motivating yourself to continue moving forward during tough times can be a challenge.  Believe me, I know! But motivating a patient requires a little more finesse.  I realized that this week as I was talking to a patient and his wife.

Until he had a stroke in September, Mr. H was working full time as a business consultant. He's 81 years old, and maybe you know his type? He's focused, driven, and no nonsense. He looked me right in the eye and asked me, "How long is this going to take?"

My first thought was to tell him, "Forty minutes." Then I realized he didn't want to know how long the treatment session would be, he was looking for something more. My next thought was, "You have 12 scheduled visits." No, that's not it. "There are 60 days in each home health certification period." I sensed that was not the answer he was looking for.

As my mind scrambled to formulate an answer, his wife chimed in, "He's really down in the dumps. He thinks he's not making any progress and can't understand why he's not getting better any faster."

Well, bring out the pom poms...we've got some motivating to do!

The question is, what motivates an 81 year old man?

Stickers, Goldfish and M&Ms might keep kids happily coming to speech therapy week after week, but Mr. H, like most adult patients, needs something more. Here is a short a list of my favorite ways to motivate adult patients.

5 Simple Ways to Motivate Your Patients

Show them:  

• Quickly calculate percentages of accuracy at the completion of a task and/or show the percentages of accuracy you have recorded at the end of a session

• Share daily notes or weekly progress reports- compare the numbers recorded from day to day or over the course of a week

• Review percentages of change upon reassessment and again upon discharge- it's a quick and easy way to assure the patient they are making positive progress

Record them:

• Snap picture to capture an image of:
• oral weakness
• facial droop
• poor posture

• Use audio recordings to capture:
• vocal quality
• volume
• intelligibility 
• fluency  

• Use video to record performance while speaking or eating

• A smart phone or iPad is all that you need to:
• increase awareness
• improve self monitoring
• judge progress as treatment continues

• Be sure to ask permission before making any sort of recording; most people will agree if they know the images/ recordings will only be used in their treatment sessions

• Save the recording for future comparisons- patients are often amazed when they see or hear themselves before and after 

Encourage them:

• During practice or upon completing a task, when they get it right, phrases like good, that's right and nice job, are appropriate from time to time

• When they come close but don't get it perfect, you can give simple encouragement by using phrases like better, good try and you're getting closer 

• At the end of a session, at the end of the week, or whenever you see fit, a short discussion about progress toward goals or functional improvements is appropriate to keep patients trying their hardest during therapy...See, you are getting better.

Teach them:

• Patients and family members like to be informed, so provide information regarding short and long term goals- it's good to know what you are working toward and it's even better to know that you are making positive progress

• Provide education to keep motivation high during treatment sessions:

• the purpose, meaning or rationale of a task
• the functional importance of a skill 
• the relevance of a therapeutic activity or exercise

• Discuss disease process(es): 

• a general understanding of their disease or disorder keeps them realistic about what to expect during the healing process
• tell about the typical progression toward recovery- it's going to take some time
• share information about promising new research and recent studies- Neuroplasticity!  

• Teach them the basics of therapeutic progression- look at it as a means for measuring progress

• levels of assist: min, mod, max, etc. 
• types of cues and/or prompts: verbal, tactile, visual, semantic, phonetic, etc.
• levels of acuity:  normal, within functional limits, mild, moderate, severe, etc.

• Therapists have a knack for observing progress so discuss the many different ways to measure improvement:  faster, slower, louder, smoother, safer, more often, less often, etc. 

Talk to them:

• Without getting too wacky, discuss the importance of positive self talk- encourage a change in mindset:

• I'm working on it
• I'm getting better
• I can do this

• Tell them success stories about other patients you have worked with

A short pep talk and a new perspective on measuring progress worked wonders for Mr. H and his wife. They now better understand the process of brain reorganization and the complexities of recovery following a stroke. Both are moving forward with anticipation of progress.

Proper motivation can be the key to getting the most out of your patients. While each patient will have their own unique needs, if you focus on keeping your patients motivated you will help them reach their highest potential.


Instruction does much, but encouragement does everything. 
Johann Wolfgang Von Goethe

The Basics on Mucus and Mucus Producing Foods

Let Me Clear My Throat!

This week, it seems as though everyone having difficulty with mucus. Whether they are throat clearing, coughing, hacking or spitting, mucus is suddenly a huge part of my day. Yuck! My patients, my husband and four out of four of my children are battling this thick, gooey, stringy substance on a daily basis. What can I do?

I am a self-proclaimed saliva expert but, admittedly, I haven't quite reached that same level of competency in the field of  mucus. Since it is the current enemy, I decided to do a little research.  Here's what I found:

• Mucus-producing tissues are everywhere! They line the mouth, nose, sinuses, throat, lungs, stomach, and gastrointestinal tract
• Mucus helps to filter out viruses, bacteria and other harmful or irritating pollutants and particles
• Mucus keeps body tissues from drying out 
• Your body produces about 2 liters of mucus each day
• Mucus mixes with saliva to assist with bolus (food)  preparation and digestion
• Most mucus trickles down your throat and you don't even notice it

You don't even notice it?  Yeah, right!  

When mucus production changes, it can cause continuous throat clearing, coughing, sore throat or changes in vocal quality. Most annoyingly, thick, sticky mucus can leave you with that feeling that there is something in your throat. That's what Mrs. S was complains about every morning I see her.

We discussed probable causes for increased mucus, including reflux, allergies and illness- she denies having any of these. I taught her strategies for loosening and clearing the mucus in her throat- she uses them consistently. She even increased her intake of water in hopes of keeping her secretions from turning into goo. So, why does she still complain about excessive, thick mucus? I was racking my brain, and then I remembered: mucus producing foods!

Finally, I asked her, "What did you eat for breakfast?" She reported that she drank a glass of orange juice.  Ah ha! That's it!  Acidic foods and drinks can increase the production of mucus...I finally figured it out. 

But why is that?

The link between orange juice and mucus can best be explained by considering things from a scientific perspective.

Mucus has a pH of about 7 and juice has pH of about 3.5.  Since the human body operates best at a pH of 7.3-7.45, the juice significantly changes the optimal pH levels. As a result, the body works to stabilize the pH inside the mouth by producing more mucus. 

The additional mucus can pool in the throat, causing a person like Mrs. S to experience the sensation of thick mucus hanging in her throat. She stopped drinking orange juice for breakfast and her early morning mucus has reduced significantly. She has declared, "Problem solved!"

Of course, I don't think mucus producing foods are the cause of all mucus problems, but being familiar with this list of foods and drinks certainly came in handy this week. Take a look at the most common mucus makers and consider their effect on the patients you are treating.

Mucus Producing Foods

Dairy Products:   While there is no clear evidence that dairy products actually increase mucus production, consuming dairy products like milk, cheese and yogurt may cause mucus to be thicker than normal.

Meats:  High fat red meats and processed meats can cause excessive mucus to be problematic, particularly with persons who have COPD.

Gluten:  Excessive mucus is also associated with the consumption of gluten found in wheat products, rye and barley. This is especially true for those with gluten allergy or intolerance.  

Fruits and Vegetables:  Bananas, cabbage, potatoes, coconut, mushrooms, olives, tomato and citrus fruits and juices are known to increase mucus production

Caffeinated Foods and Drinks:  Beverages containing caffeine, such as soft drinks, coffee and tea may increase the risk of dehydration, which can lead to thicker mucus. Chocolates and desserts containing coffee may also thicken mucus due to the dehydrating effects of the caffeine in the food. 

Other Offenders:  Spices, alcohol, mint, beans, tofu, sugar, candies, pastries, beans, cereals, a variety of processed foods and fast foods can contribute to mucus changes

Individual Considerations:  People may have allergies to foods which cause them to experience increased mucus production after they eat the offending foods. While each person is different, foods that commonly trigger allergic reactions include milk, eggs fish, tree nuts, peanuts, shellfish and products containing gluten or soy. 

Whether you use this information, or share it with someone else, I hope it gives you a new understanding of mucus and mucus producing foods. Being conscientious of these foods and drinks can help you avoid a sticky situation. 

Let your food be your medicine and your medicine be your food.

Hippocrates 

Put a Stop to Weight Loss, part two

Don't be Caught with Your Pants Down

Once upon a time, I sat at my desk and watched a  PT and OT as they struggled to walk their patient down the hallway. Sure, he had some physical limitations that were problematic, but it wasn't weakness or discoordination that were giving them trouble...it was the man's pants!

He was in our facility for rehab after faceplanting into the toilet. It sounds funny when I put it that way, but that's exactly what happened...he fell, face first, into a commode. His face was black and blue, he fractured several facial bones and unfortunately, experienced some brain damage as a result. But, again, this was not the biggest problem...it was the man's pants!

The man had been losing weight and his pants were now way too big. The therapists asked him, "At one time, did these pants actually fit you?"  He nodded. "Do you have a belt or suspenders?' they asked. He shook his head. "How much weight have you lost?" they wondered. "A lot!" the man replied.

The practical PT cinched the gait belt a little tighter but the pants sagged down. The OT ran some Theraband through the belt loops of his britches, but it was not enough. The pants fell down a little further. The three of them stood there, in the hallway, contemplating what they were going to do. 

Next thing you know, the man was standing in the middle of the hallway with his pants around his ankles!


Even though this might be a funny story, continuous weight loss is not. Excessive weight loss increases the physical demands on the body, resulting in:  headache, irritability, fatigue, dizziness, constipation, hair loss, muscle loss, and, as in this case, loss of pants. 
These demands may result in serious negative effects such as gallstones (I did not know that), dehydration, malnutrition and electrolyte imbalance. 

In my last blog post, I gave 15 things to do to stop weight loss. Then, I went back to work, gave it some thought and came up with 15 more things you can do to stop weight loss.

Picking up where I left off...

15 (More) Ways to Stop Losing Weight

16. Supplement your diet- use protein powders, protein shakes or vitamins as needed

17.  Talk to your doctor about appetite stimulants- prescription medications are available

18.  Learn to read nutrition labels- make sure you can find information about calories and fat in the foods and drinks you consume

19.  Weigh frequently- monitoring your weight helps increase awareness and provides motivation to continue with your efforts

20.  Add some variety to your diet- don't get stuck in an oatmeal rut...there are some really great breakfast options out there; don't be afraid to try something new

21.  Determine your calorie requirements-  your doctor can refer you to a dietitian

22. Set a weight goal- calculate ideal body weight and use that as a guide for determining how much weight gain is appropriate; that same dietitian can help you here too

23.  Eat as much as you can... then eat 3 more bites- on average, there are 25 calories in each bite of food you take; 75 calories each meal adds up quickly!

24.  Go to a buffet- there is something for everyone and it's all you can eat

25.  Eat with others- you are likely to eat more when you aren't eating by yourself

26.  Assist with food preparation- this helps to promote your appetite and intake at mealtime

27.  Address and correct dental issues- poor dentition or improperly fitting dentures can limit consumption

28.  Rule out swallowing difficulties- dysphagia can be the cause of weight loss

29.  Modify textures as needed- chopped or pureed foods may be necessary

30.  Keep a food diary- record all solids and liquids and their corresponding calories for a do it yourself calorie count...you may be quite surprised to see 

Of course, you know this blog always comes to you from a speech therapist's perspective. These suggestions are a collection of all of the pieces of advice I have given to my patients and their family members over the years. I am not a dietitian, a doctor, or a nurse...and I don't even own an alligator purse. So, as always, consider your specific circumstances and use good judgement when following these recommendations.

What ever you do, don't be caught with your pants down.

This week, please share this information with someone you know: a patient... your Aunt Nancy... or even the neighbor down the street. I believe these tips can be of benefit to a great number of people.  


PS:  

In case you missed last week's blog with tips 1-15,  just scroll down to the October 7th posting... you can find them there.

You can click here to get to a cool website that can help you calculate your daily caloric needs.

Or click here for a free, printable food journal- a great thing to have in your therapy bag of tricks

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.