Good Bye, Travel World....

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I made a very difficult but timely decision last week.

 

I ended my travel career.

I accidentally traversed into a place that shocked and surprised me...I realized this is a place where I'd like to put down some roots, bloom a little and create a network of friends. It has the cozy "small-city-feel" of my hometown of Kansas City, but it offers the additional wonders of water, mountains and temperate weather all in one place.

The hardest part about this decision was saying goodbye to the BEST recruiter in the world, Tony Leber, and Med Travelers. The guy is - hands down - the best recruiter any traveler could ask for. He has given 100% for me, and I am really going to miss him!

My feisty recruiter, Tony

So, today, my final blog for the travel healthcare world is simply to thank Med Travelers and Tony Leber. Thank you for the great assignments, the opportunity to explore some beautiful areas of the country and the chance to meet some kindred spirits/great friends along the way.

Thank you for three great years.

Take What You Need

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So, I finished work in time to drop by a downtown shop this afternoon to pick up a gift and to purchase a small piece of art for "the Nest," the cottage my twin and I own near our parents. The art has two birds in it, which symbolize my twin and me. Elle, I hope you like it!

I try to pick up small pieces of art wherever I go to commemorate the wonderful places I experience along this winding path. I checked the label to share the info with you - it only had Beyond Borders printed on it. Research led me to this: click here  I say let's support efforts like this to make the world a better place for everyone!

Anyway...

The other unexpected gift today was this awesome posting in the corner of the store door:

LOVED IT!! Just wanted to share...

Words of Wisdom Shared

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I receive a daily email called The Morning Blessings by a gal named Reverend Angela Peregoff. Her words touch me every morning.

A couple days ago, she wrote about St. Francis. Take a look at her Morning Blessing for May 4:

During these challenging times, each of us has the opportunity to inwardly introspect on what may be our own aggressive tendencies.  Sometimes we think, "Oh, I'm a very peaceful person.  I just love everyone!"  Try this: Walk down the street and look directly into the faces of others.  Objectively observe how your mind chatters about appearances.  You will be amazed at the overt and subtle ways in which aggression manifests.

Aggression of thought has its own vibratory potency, and it begins and ends with us.  It is good to often pray the prayer of Saint Francis, "Lord, make me an instrument of Thy peace."  Mean it.  Saint Francis' lesson was to heal the struggle he had with his vision of God. After a strong and powerful illness he came to an understanding. He saw that he had tried to equate "goodness" with "love of God," and they were not the same. Early one morning as the dawn began to break, when all was very quite and still, he heard a bird outside his window -- in a totally new way. In the power of the song of that bird he understood! The way to love God and the only way was to hear God's voice in everything.  In the mist of his physical healing he realized You love God through loving God, and not from anything else. He knew, absolutely, that there was no separation between the sounds of the world and the "Voice of God."  The birds that sang, the cries of the dying, the scream of the mad, in the despair of the leper, in the moans of the abandoned child. From that moment on, Francis could never again separate out any call for help from the God Source he knew to be Real.

The only difference between you and Saint Francis is that he came to know God was absolutely real and that he could be in touch with that reality at any time. He knew it, with all the power of his being. You also have that same potential. Go out today and be touched by the life and lessons of Saint Francis -- know that every moment you are speaking, you are not speaking to others; you are speaking to God.

 
I admire St. Francis.  He left a life of luxury to found the Franciscan Order. He lived in poverty. Many people thought he was mad, and I don't mean angry.

Prayer of St. Francis of Assisi

I walked outside at lunch and sat down on a park bench. I heard the birds with new ears; I watched the squirrels with new eyes. I thought about my patients who challenge my patience or get under my skin.

How do I open my heart to see theirs as voices of God?

St. Francis gave us the roadmap:

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
and where there is sadness, joy.

Yes, I know it's tough.  No one said it was supposed to be easy.

How much change could we effect

 if we all put this into daily practice?

Inspire Creativity in your Life

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I walk down B Hall toward the nurses' station, and there is one lady that I have noticed since day one. I try to catch her eye from where she sits inside her room or at the doorway. I have learned her name, and I call out as I pass by:


"Good morning, Susan!"
"Good afternoon, Susan!"
"How are you?"


No answer. In fact, if you look in her eyes, you will notice that she is absolutely absent.


She's young for a nursing home resident. She's nonverbal, except for a very occasional word. I don't have her on my caseload, so I can't go peeking at her chart to take a look (HIPAA, remember! We have a Privacy Act we must follow!) ....


By the way, when one of my patients points across the room and asks, "What's wrong with (that patient)?" I reply,


"Well,

their information is private, just like yours.

That means if someone asks about you, I can't tell them anything. But... if you want them to know you can tell them. If you want to know about him, you'll have to ask him.... and he may or may not tell you."


So, this gal. She puzzles me. Her look is soooo vacant. I am spurred to make a connection, but she is not making it easy.

I am thinking about her tonight as I write. My message isn't really about her; it's about what happens when you go through a period that feels as if you are walking through molasses in a swimming pool, or waking up endlessly fatigued.

Yes, it's personal. I sometimes wonder if I have recently drawn the energy of the people like Susan who seem like they are just waiting to die.

I'm not sure what it is, but I'm choosing to look at it as a "rest period." After all, towering oak trees grow through spurts (my creative time in California), then they need some rest time (here).

At any rate, I feel like I am coming out of the rest period and moving into a more creative place lately. I have been searching for activities and ways of spurring my creativity. Honestly, some of it has just bumped into me. (Being "lost" isn't always a negative thing!)

So, today I want to share some methods that help me on my creative path. Maybe one or two will move you, too.

Create an inspiring space.

Since I am in temporary living space, I can't quite decorate the way I did at my home:

my favorite room to rest and regenerate at the "Tre House"

so I bring together some of the notes, momentos, photos and small pieces of art together on a bulletin board.

These things are a constant reminder that each of us can make a difference!

Take a walk or a bike ride.

I can honestly say that when I ride my bike to work (9.5 miles) and back, I feel better! I see the which flowers are blooming, smell when someone has cut their grass, look up at the clouds and feel more thankful to be alive.

Shasta Daisies from the Tre House garden

Try a new food or drink that you've never tried before.

Our prn PT Tracy brought in some foods from Trader Joe's yesterday that many of my coworkers and I had never tasted. It was such fun! Then again, everything Tracy does is fun. She is uplifting.

Yummy Mango Butter...

Visit with a friend you haven't seen for a while, especially a positive one!

I spent last evening with a very special friend, Angela. We used to teach Reiki CEU courses together, and she is one of the most amazing healers I know. When we get together, we can solve the world's problems, stimulate our appetite for creating and manifesting whatever we want in our lives. When I leave her, I feel "right on track."

Turn off the boob tube.

I know it's easy to get sucked into a series, but really...how much of our lives do we need to lay around watching senseless reality shows? There are so many amazing things we can do.

Do something else!

Make your list!

So, this is how the Universe works for me much of the time. I wrote, Make your list...then I thought, let's check out You Tube for a good video. Click on this one, and the first thing you see is

Make lists....   : )

Thanks, You Tube

This is a great video. So great, in fact, that I think it's a good place to pause and have a refreshing, positive, creative day at work...

You guys have a great day!!

Bathing Whimsy

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The patient I wrote about yesterday?

Eva looked like a different person today. Honestly, I was dumbfounded at how much she had improved since yesterday. I have to give credit where credit is due - I have to believe divine intervention played a part. It was too much of a turnaround to be chance or meds or anything other than what it was.

Anyway, this morning I introduced Eva to a leg lifter. It's used primarily following hip surgeries to help lift the leg when you're getting in and out of bed.

helps get the leg in and out of bed!

Eva sat on the edge of the bed without assistance and began a bed bath with a pan of soapy warm water. She did great! Of course, she couldn't reach her feet (gotta be careful about bending!). I assisted, and she did the rest.

As she worked her way toward the middle of her body, she started to tell me a story.

"When I was a little girl, my mom used to say,

Wash down as far as possible,

then wash possible."

I paused a second before it sunk in. Then I began to laugh.

I had never heard that before! What a kick! That was my whimsy for the day. I learn something new every day, and today that was it. A new description for that part of the body.

When I told Stacie, the COTA, she had heard it before. In fact, she could add to the story. One of her patients (this must be a Kansas thing) had told her that Loretta Lynn had sung about this....

Of course, I tried in vain to find the song to include it in the post, but no luck.

Do any of you know more of the story? Send it if you do!

Almost Halfway Through a Very Long Drive

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Well, the northern California terrain is morphing into

NEVADA

and UTAH

tomorrow, Wyoming....

Packing and Pondering

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Okay, I'm doing more than packing and pondering. I'm crying in between.

Have you ever known

that the change

you're preparing for

is a good one,

yet you're still broken up

about it?

That's how I feel tonight. I know I said this last time I moved assignments, but I've loved this place.  I've met great people. I've experienced so many new things! I am aching as I prepare to leave, especially when I round the corner of my street to face west and I find myself looking straight at the Pacific Ocean.

Tonight, I've been contacted by Monty, who is doing well after Joan's passing. I received a message from and talked with Hank (from my first blog entry!)

I came home Saturday afternoon to find this hanging on my door:

It was from Tom's daughter. Tom had gone home a couple weeks ago, but his daughter had stopped by and left me a beautiful picture book of northern California to remember my time here.

Boy, will I.

 

As I was packing this evening, I found a wonderful page I had torn from the Live Your Best Life section of the Oprah magazine in July 2008. (I'm a sucker for quotes and beautiful photographs.)

 

I know, the print is too small. If you look closer, it says:

I suddenly realize why I have picked up this message. The timing is perfect.

It says to me:

Your world in northern California the past 18 months has been glorious, yes. But there are other places for you to explore and enjoy. Embrace the experience you are leaving, say goodbye, and get ready to fully acclimate to where you are headed.

 

Give up all the other worlds

except the one to which you belong.

Don't pine for what you are leaving.

Be present to a new experience.

Our Patients Are Our Teachers

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I was finishing up the work day when Marnee walked into the rehab department. She walked up beside me and handed me a small white envelope.

"Don't open it now. Open it when you get home."

It was stuffed.

On the outside back of the envelope she had hand written a beautiful saying by Kahlil Gibran, one of my favorite poets.

"Your living is determined not so much by what life brings to you as by the attitude you bring to life; not so much what life brings to you as by the way your mind looks at what happens."

Inside, this beautiful woman had written a card to me.

Dear Tre,

You are a beautiful young lady.

A gift from God

to so many of us

who need you.

Your smile

warms everyone's heart

and your expressions of confidence

and words of encouragement

are a blessing to this world - -

Thank you, thank you -

May God bless you

with peace of heart

and mind

and love of all -

Your grateful patient,

Inside the card was a beautiful olivewood rosary made in Jerusalem.

Tonight, I think about this wise woman who has taught me so very much. She has taught me more, I think, than I have taught her. Marnee has been my teacher. She has encouraged my spiritual growth.

I work in a setting in which many therapists are embarrased to admit they work. I am not only happy to work in skilled nursing facilities; I prefer to work there because of the quality of the relationships that are nurtured during our time together as patient and therapist.

It's like Kahlil Gibran wrote, Your living is determined not so much by what life brings to you as by the attitude you bring to life...

As therapists, it's the attitude we bring to skilled nursing. If you don't want to be there, don't take the assignment. You give yourself and your potential patients the gift of allowing someone who really wishes to serve this population if you choose to go somewhere else.

Short Video from Tre/Thoughts for Today

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Recorded this short video with my droid on my morning walk...

Click here

for Tre's Message Today!

5 Exercises To Improve Your Posture

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Every patient comes into skilled nursing for a different reason. No case is identical; however, there is one aspect that all patients share. 100% of my patients have deficits in their posture.

The importance of posture increases as we age...

Good Posture/Poor Posture

WHY??

In the population with whom I work, posture affects:

• the visual field
• the ability to swallow
• the respiratory capacity
• the ability to digest food
• balance and stability when sitting without back support and standing, and
• joint stiffness, causing back and neck pain.

What contributes to a person's posture?

• genetics
• your muscle strength that holds your bones together
• your bone density
• your awareness of your posture throughout the day
• your activity level
• your nutritional intake
• the physical requirements of your job, or
• injury or illness that changes a person's muscle tone.

For example, here's what you might look like if you have a desk job

and you're not aware of how you sit (two of the factors above):

 

Poor posture!

This is what I would record in my occupational therapy documentation as acquired thoracic kyphosis with forward neck flexion, which I observe in a majority of older patients...

 When I evaluate a new patient, I am keenly aware of the person's posture.

It affects everything!

Luckily,

subtle changes in our lifestyle

can reverse poor posture

and increase our vitality!

Let's start with exercise!

Posture Exercise Regimen
I immediately begin an exercise regimen with my patients. It's a modified regimen that I have used to keep my trunk and neck strengthened and in the proper position since a back injury last year.

Here's what you need:

• A therapy ball (recommend 65cm for people under 5'9")
• A yoga mat
• A door or wall that is clear for you to stand against.
• 20 minutes of your time devoted to optimal health....

By the way, 
your body always tells you what it needs.

(Always consult your physician before starting an exercise regimen!)

These exercises are not necessarily recommended in this order. You can do one or all. I've found each of them to be helpful in promoting better posture.

Posture Exercise #1

Start off on the yoga mat on your back. Reach up and stretch your arms above your head. Lengthen your spine. Roll over onto your stomach. Get up on your elbows. Lift your head. Breathe deeply. For some, this can feel tight. If it's not difficult for you, go a step further to straighten your arms and arch your back into a great stretch. Like this:

Yoga Balance

Stretching Exercise(s) #2
Now, roll over and and progress to stretching your quadratus lumborum through a series of moves outlined by Athletes Treating Athletes. (click!) The last one in this sequence is best done on the edge of a bed or therapy mat.

Oh, this feels good!

Posture Exercise #3

Next, stand up against the wall. Put your feet, buttocks, and upper back against the wall. Tuck your chin and push your head back against the wall. Drop your shoulders.  Relax. Do this 10 times.   (9 out of 10 of my patients have difficulty reaching the wall with their head...) 

Next....

Therapy Ball

Posture Exercise #4

Sit down on the therapy ball, then roll down until you arch your back and almost touch your hands to the floor above your head. From this position, you can strengthen your abs by doing modified sit ups. I like to stretch my arms straight out to the side and stretch my pectoralis muscles (chest muscles) - this helps open the chest area and decrease rounded shoulders.

Posture Exercise(s) #5

Turn over on the therapy ball and do the following:

a) Superman stretch: feet on the floor, balance your stomach on the ball and hold your arms straight out like Superman. Work up until you can hold the position for 60 seconds.

b) Roll forward, stomach on the ball, until your feet are straight out off the floor, your arms are straight, elbows locked and your hands are on the floor.  Head lifted and looking straight ahead. Hold for up to 60 seconds.

c) Stomach stays on the ball, alternate lifting left arm and right leg together while balancing, then lift right arm and left leg together. This one is a little more challenging, but you'll find you can hold it longer as time goes on. You'll be very aware of any weaknesses on this one!

OK, go to it!

• Look in the mirror.
• Be aware of your shoulders and your head position.
• Modify your work station.
• Switch our your office chair for a therapy ball!

I'd love you hear about your exercises and advice on posture....

Creating a Memory Book for Nadine

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There are many small things therapists and family members can do to enhance the quality of life of people with dementia. One of them is to create a memory book.

I have just completed treatment with Nadine. Remember her? She was the one with severe dementia who used to yell, "What do I do? What do I do?"


I made headway with her when I realized she could read. She started reading all kinds of poetry, moved to newspapers and magazines.


The Idea
I decided when her daughters came in to see her that we needed to create a memory book that she could read. The "girls" were pleasantly surprised when they realized she still had this capability.


"If you bring me photos, I can have them scanned and we can write a simple history on each page with a picture," I told them.


The following week, they arrived with an envelope of photographs. I picked up a black and white, and found myself staring at a 14 year old Nadine. Beautiful, young lady with a confident smile!

The next was a savvy, in-love Nadine with her husband-to-be during WWII. He was a pilot, dressed in uniform. She had a snazzy 1940's updo that rocked! That gal had style!


I pulled out a photo of an elderly Nadine with her adult daughters before the twinkle in her eyes had dulled. I could see in the photograph that she was still "with it."


Lastly, a photo of her hanging her large acrylic canvases on the walls of an art gallery in northern California. She was an amazing artist! The sad thing was that she couldn't remember how awesome she had been.


One of the employees at the facility told me that it was suspected that her dementia was in part caused by lead. When she painted, she touched the brush on her tongue to wet the bristles. A lifetime of exposure to bits of lead paint had a devastating result.


The Book
I picked up a 1" binder with a pastic insert on the cover. Inside, I slid a thick paper titled "Nadine's Memory Book." Below the title was a lovely color representation of one of her paintings that I had printed from the internet.

I created a simple history for her,

something in large print that she could easily read.

Page One (photo of her youth)
 "My name is Nadine (maiden name) (married name). I was born to (names of parents) in (birthplace) on (date).  


Page Two (photo of Nadine in love)
"I married (husband's name). I called him (nickname). He was a (vocation).
We loved to (activities they had enjoyed together).


Page Three (photo with daughters)
"(Husband's nickname) and I had (# of children).
(Child) was born in (year).
(Child) was born in (year).


Page Four (hanging her paintings)
On this page, I went into simple detail about the activities that she loved. I had interviewed her daughter and found out fun details about classes she had taken, trips she had taken and lifelong friends with whom she had spent special times.


After that, I printed off her website, with a description of her life and works. I found the last article written in the local paper about her posse of artist friends who banded together and created an art presence in the town.


I slipped all these pages into plastic sleeves after having them scanned by the building receptionist.


The Presentation

I handed Nadine the book. She rubbed her hand over the cover and read the title.

"Nadine's Memory Book," she read.

She paused, then looked up.

"That's me!"

She proceeded to read page by page to the end, not realizing the story was about her except for page one, when she read her name. It was if it could have been anyone else in the world.

....and that was okay because she was fully engaged in her process!

She has continued to hold her book throughout each day, rubbing her hands over the photos and reading to staff at the nurses' station. The nurses report that her yelling behaviors have diminished substantially. This equates to an improvement in the quality of her life, and in the lives of each resident living on her side of the building!

One day, she was reading the internet article that I had printed off about her group of artist friends. She came across the name of the man who had nicknamed the group.

Just as she read his name, "Ollie," she stopped and looked up at me with big eyes and a huge smile. My heart jumped.

"Do you like Ollie?"

"Oh, yes!"

That was it! My day was made....such a simple thing can make a marked difference in the life of a person with severe cognitive impairment.

I'll write more this week on creating a memory book and tailoring once-loved activities toward a person's current cognitive functioning. For therapists, I'll review some of the cognitive assessments I find helpful in determining current cognitive levels in residents with dementia.

Check back soon!



Laughter Really is the Best Medicine

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Bing Quotes

Laughter has been a theme this week!

I stop in to talk with my one of my favorite residents, Bertie, and she is sitting in the hallway with her best friend, Nan. They share the same last name; however, they never met until they ended up living in this nursing facility.

I squat down to be at their eye level. A smile is all they need. Bertie reaches out to take my hand.

"How are you doing today?" I ask. I know she struggles daily living in this nursing facility where there are so many people with cognitive impairments. She is as bright and clear minded as can be. A real intellectual.

"I'm okay, Tre."  She points to a paper on a tray next to her wheelchair. It's a watercolor. "Nan and I worked with paints today."

She describes what she thought when she painted the picture, then she steers the conversation to Nan. "Nan's really the one with the talent. She is full of creativity. She gives me inspiration!"

Nan smiles and looks at us. "I supply the laughter, too! You know...." and then,

"if you don't laugh, you might as well go to hell!"

It is the way she says it that makes all three of us burst out laughing. They tell me I sound like Betty Rubble from the Flintstones when I get really tickled. It's not the first time! All this laughter ends the day on a positive note.

The next day, I'm working with Marge. She has major cognitive impairments to complement a strong obsessive-compulsive disorder. To top it off, she has fallen, broken a hip, and now she is just strong enough to want to stand up on her own. She's what we call a "high fall risk."

She has pulled a condensed Reader's Digest off the shelf in the sun room and wrapped it in a towel. Who knows why. When she wheels down to the gym to meet me, she hands it to me.

I open the towel, turn the book's spine to read the titles and tell her, "You know, Marge, my grandma used to have these. We'd read them during our summer vacations at her house in southern Missouri."

I open the book. Out falls a Celestial Seasonings magnet. How it got there, I have no idea.

The most wasted day

is that in which

we have not laughed.

Sebastien-Roch Chamfort

Another nice reminder! You know, life doesn't have to be easy to laugh. The best situation is to laugh with someone you love, even if you're struggling with life.

In your toughest times, though, just force yourself to laugh.  Really.

I've been there before. Have you? 

Have you ever laughed when you're alone until you can laugh no more? It frees you up, untangles something inside of you like a knot you thought could not get straightened out.

There are laughter yoga classes and videos all over the internet.

I found this short video clip on YouTube called Laughter Yoga Steps by madankataria. By the end, you cannot help but laugh. It's very joyful!

My message today is simple.

Lighten up.

Feel joy.

Laugh at small things until it bubbles over.

Let go and really feel it in your belly!

Learning Finnish

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I have the interesting experience of being in a remote location that has attracted Finnish, Italian and Portugese inhabitants. People who love fish, wine and living near water.

My spunky patient, Ginny, was on a roll today. Carl had come by, and she fluttered with excitement.

When I told her it was time to head to the gym, out of her mouth flowed a melodious word. I think it was paskiainen. Her eyes twinkled. Her smile was wide.

"What was that, Ginny?"

She whispered the translation.

Son of a bitch!

We laughed and she headed willingly to the gym....