Spinning my wheels

It's pretty easy for me right now to tell someone about a typical day. I go to work from 8 to 4:30, get home around 5, jump on my bike for an hour or two, shower, eat supper, and head for bed. The jump-on-my-bike part isn't something I always feel like doing but I know I'll enjoy my planned summer adventure far more if I put in the time now.

In 2007 I went on a 10-day bike trip from Roncesvalles to Santiago, Spain with three friends. (You can read about it here.) Though it wasn't always an easy trip, I've been wanting to do something like that every since with riding across the USA being the ultimate adventure. As I near the end of my studies, I figure that now is the time to do it before I get a job and before I get any older. So this summer I signed up for a cross-country ride with the Fuller Center for Housing. The Fuller Center partners with local groups to build or repair decent affordable housing. The goal of the ride is to raise awareness for the Fuller Center along with some funds to help make this possible. In addition we'll be taking four days along the way to help with a building project. Here's some more information and/or ways to help sponsor the trip.

A week after I finish my internship in St. Cloud I'll be joining this bike adventure in Chicago and riding the remaining 2600 miles to Astoria, Oregon. That sounds a little crazy actually. That's a long way to pedal and a long time to sit on a skinny bike seat. And thus the training -- whether I feel like it or not. I spent January and February just reminding my body what exercise was. Since March I've been on my bike. Last week I was able to get outside every day which meant facing the wind. There are times when I wonder how much further I can pedal into its teeth, but then I remember that headwinds will have to be beaten this summer since I won't be able to turn when I'm tired and blow back home. This week I'm back inside since it is cold and rainy. I'm grateful for my trainer (a stand that attaches to the back wheel with a roller to which resistance can be added.) It's not very enjoyable to spin away without going anywhere but it's the best I can do. Add in some intervals and a podcast or two and I feel like I've gotten a good workout after an hour. At least I think two towels soaked in sweat should mean something. I'm hoping I can be back outside next week on the country roads with the wind and hills where I can enjoy the beauty of nature during the arrival of spring. I have two more months to get my legs, seat, and shoulders in shape. 

Working in Mental Health

I am 2 weeks into my second and last rotation. (Only 10 more weeks to go!) The University of Minnesota sets up our placements and they try to give us two different types of settings. My first one was in a smaller hospital where I spent my time primarily in physical disability/rehab. This time I'm in a mental health setting at the VA in St. Cloud. While some of the Veterans I'm working with have physical disabilities, the focus of the OT treatment is helping them in their mental health recovery. The diagnoses include depression, anxiety, schizophrenia, bi-polar, and PTSD. The Veterans involved in OT are living in the community with varying levels of independence. Though each Veteran has different goals, overall they want to increase their independence.

One of the therapists I've been working with has been at the VA for a long time. 30-40 years ago, Veterans could come to OT all day every day. Treatment consisted of some type of creative work with their hands. They worked on wood-working, leather carving, ceramics, models and a host of other projects. Having something purposeful to do did help them improve but coming all day every day didn't necessarily increase their independence. Over the years, the OT program has evolved to the point where now OT continues to provide the creative outlet through "therapeutic media" but the main focus is on skills groups. These groups are designed to help the Veterans increase their skills in every area of life and the Veterans choose which group(s) they will attend each quarter based on their goals. During my first two weeks I've observed a sleep group which is especially helpful to those with PTSD. Another favorite is the relaxation and sensory group where Veterans experience many different types of relaxation and become aware of how different sensory experiences impact their emotions and mental state. The group on dealing with stigma had some animated discussion as the Veterans discussed how to deal with people who treat them unfairly because of their mental illness. This next week I'll go from mainly observing to leading some simple groups and beginning the always present documentation. Thankfully this time it's on the computer so cut and paste makes that process much quicker. I've enjoyed interacting with the Veterans. They are interesting people and have had some rich (and difficult) life experiences.

Observing Surgery

(For some reason this didn't get posted several weeks ago.)

Earlier this week I had the opportunity to observe a total knee replacement surgery. I have never been close to an operating room before so was instructed by several different staff what to do if I started to feel woozy because "once you are in there, you can't come out until it's over." Because new components are being put into the body everything in the room needs to be sterile. The four people directly involved in the surgery were covered from head to toe including closed air circuit helmets as seen below. This is part of the reason the temperature is kept cool enough that everyone else needed a jacket to keep warm.

The anesthesiologist called me over to the head of the patient where a step stool gave me a bird's eye view of everything that happened. He pointed out the chair I could sit on if I needed too. I didn't get woozy though I did take his advice to "breath." He was kind enough to explain the surgery step by step along with some of the improvements that have been made in the 30+ years he's been in the OR. A tourniquet kept the blood to a minimum. This was a scheduled surgery so all of the hardware had been custom made. That included the plates that were "nailed" to the end of the femur and tibia so the cuts made on the bone were precise. It didn't take me long to figure out why people are so sore. Bones are drilled and sawed but the worst is muscles stretched and pulled to the side throughout the entire surgery. Once the components of the new joint had been put in and the stability of the knee verified by plenty of bending and pulling, the components were taken back out and then cemented into place. The patella was sewn back over the joint and the surgeon left to start on the next surgery while his assistant sewed up the rest. The thread now has microscopic barbs that hold it in place so knots, which tend to cause problems, are no longer needed.

I'm thankful for the opportunity to have observed a surgery but am also glad that I work with people once they are all sewed up.

Spring!!

It's been a long cold winter here in Minnesota. I should be used to it. I grew up in the cold and snow but somehow it seemed worse this year. Maybe it's because I spent the coldest part of the winter in Fergus Falls where it was consistently 10-15˚ colder than in NW Iowa where I grew up. That matters when the temperature is below zero as it often was this winter. Maybe it's because I'm no longer a kid or because I actually had to go out in the cold each day and couldn't just study at my desk in sweatpants. My one consolation--I wasn't in Embarrass, MN, which was often the coldest spot in the nation, Alaska included. One advantage of living through long cold winters is that spring is that much sweeter and more appreciated.

Today I went to Minneapolis to visit my church there and spend the afternoon with some friends enjoying spring. For us the 60˚ felt like summer. There is still snow in spots and the trees are no where near budding but the kids had shorts on as we sat in the backyard and roasted bratwurst over the fire pit. Once we were done eating we just sat and soaked up the sun. I also soaked up the time with people who know me well and where I know everyone's name. It was hard to tear myself away and head back up I-94 so I can be ready for another week of learning new names and responsibilities at a new place. More on that next week.

Home Evals

Just about every patient who spends time on the rehab floor has a therapist accompany them to their house prior to discharge to see what, if any, changes need to be made and to verify that the patient knows how to safely navigate their home environment. The first home eval I went on was for a patient recovering from a hip replacement. In order for the muscles around the hip to heal properly, the patient is not to bend that hip past 90˚. As part of therapy we help patients figure out how to do everything from putting on their pants and socks to getting out of a chair without bending too far. On the home visit, we also make sure the patient can get things from the bottom of the refrigerator or cupboard and are able to feed their pets without breaking their precautions. 

Almost every home visit I've been on involves getting rid of a rug or two. They are considered a fall hazard which is a big deal since most of our patients are over 80.  We usually suggest a grab bar or two in the bathroom which provide extra security in the shower or tub. I also learned this week that part of an OT's job description is moving furniture around. In one case this week we pushed the bed over about 3 inches so there was room for a walker without scratching up the wall. The patient also was quick to agree that the glider rocker was not a good choice for her because it was far to hard to get out of at this point. Her family agreed and they will put another chair in that spot before she comes home. Besides making sure the patient is safe at home, these short visits are often eye opening for the patient as they realize how much energy it takes to be there and what they still need to work on.

After working two weekends in a row, I am taking advantage of 3 days off to head to my parents. The original plan was to switch out my winter things for spring and summer things. The current weather makes it seem a bit early but I will leave most of my sweaters behind and I have my bike tuned up for whenever I can actually get out on the roads.

No longer faking it

One of the things I've enjoyed in the past few weeks is getting to put fundamental skills into practice on patients who actually need them rather than a classmate who is trying to fake it. For example, one basic skill for an OT is doing passive range of motion on a patient who can't move their arm or hand on their own. This may be because of a stroke or because the patient is sedated in the ICU. Either way, it's a very different experience lifting the dead weight of a completely flaccid arm compared to lifting the arm of a classmate who can't fake dead weight no matter how hard she tries. For the last several weeks I've been regularly seeing a patient who's been in and out of the ICU. One of the dangers of being in bed for so long is that joints get stiff or hands begin to swell because there hasn't been any movement to help pump fluid back out. Some days this patient has been able to assist me as I've moved her arm. Other days I've been moving the dead weight. Her joints have remained supple except for her hands. This morning I was delighted to see her out of ICU and alert. She agreed that her hands were stiff and she was finding it hard to hold a cup or feed herself. One of the OTs will continue working with her twice a day to relieve that stiffness and help her build back up her strength.

Another skill one of our professors tried to drill into our heads was manual muscle testing (MMT). We had a practical exam for this with a classmate as our patient trying to fake an injury. As part of every evaluation, I test the patient's strength for their shoulders, biceps and hands. For patients on rehab it gets a little more in-depth but for the vast majority of people I can write "within functional limits" on the form. Basically that means that the person has the strength to do simple daily things such as showering, getting dressed, getting dishes from the top shelf, or carrying a bag of groceries. This past week however, I saw a patient with a brachial plexus injury. All the nerves that go to the arm leave the spinal cord and pass under the collar bone. For this particular patient, the nerves had been compressed and as a result she couldn't move her arm or hand at all. By the time I saw her (with one of the experienced OTs), she had regained a little bit of movement. When we asked her to bend her wrist, she couldn't do it, but if we turned her forearm so her thumb was up she could move her wrist in both directions. She didn't have the strength to bend her wrist against the force of gravity but she could move it once gravity was no longer a factor. Cool. I even remembered how to rate that on the MMT scale without having to look it up.    

Low census

The past two weeks have been quiet at the hospital where I'm working. That is a good thing in one sense because it means most people in the area are staying healthy. On the other hand, it isn't the best thing for my education since fewer patients mean fewer opportunities to learn. There were 10 people on the inpatient rehab unit when I arrived, each needing 2 occupational therapy sessions a day. On Thursday this past week we were down to 1 patient. Thankfully for the therapists, 3 new patients came onto the unit on Friday so there will be more things to do this week. One of these patients is still recovering from the effects of a neurological condition that began last May. He is eager to improve so he can finally return to his own home. I look forward to the challenge of helping him progress.

Last week I experienced one of the frustrations of working as an OT (and in all of health care). I arrived at work one morning and looked at the list of patients in the hospital and recognized two of the names from their stay on the rehab floor. My thought was, "They just left. What happened?!" Then a few days later, a patient who had been on the medical floor for 3 weeks was back after less than a week at home. The reasons vary but it is hard to see people who were doing well and making progress return even if it is for a short stay. I'd like to see them go home and stay healthy.