Just a reminder about living life:
from one of my favorite blogs, Things We Forget.
So, so true!
Monday, February 27, 2012
From One of my Favorite Blogs
Back to my blog home page: http://travelingotr.blogspot.com
Just a reminder about living life:
from one of my favorite blogs, Things We Forget.
Just a reminder about living life:
from one of my favorite blogs, Things We Forget.
What Can Come Out of Your Mouth
Back to my blog home page: http://travelingotr.blogspot.com
WARNING:
IF ANY OF YOU HAVE SENSITIVE STOMACHS, DO NOT LOOK AT THE PHOTO IN THIS BLOG ENTRY...
We received a new, quite debilitated patient who was transported four hours from the nearest "big" city. Whitey had been in a top rated nursing facility, the kind that looks like a five-star hotel.
The rehab staff had given up on making progress with him, as evidenced by their therapy notes.
I completed Whitey's chart review and asked myself what I could do to start the process with this guy. What could I do to help him progress steadily so that he could go home with his family?
I went to Whitey's room and immediately heard the sound of a feeding tube at work. The bag of enteral nutrition hung on a pole at his bedside, and I could hear the hum of the machine delivering it to his stomach.
I introduced myself. Whitey opened his eyes. He was "there," but I couldn't understand a word he was trying to tell me. His voice was muffled. His lips were dry.
I immediately realized I needed to check out his mouth. After all,
"Let's start with your mouth. I need to moisten your mouth and while we're at it, it would be good brush your teeth. I'll help."
I got the supplies together and put them on his tray.
"Whitey, please open your mouth."
Crooked, brown teeth. Many were missing on the sides, but there were teeth intact in the front and back. I handed him the brush mixed with water and mouthwash. He had been cleared during a swallow study to drink water in the presence of the nurse or the therapist.
He was able only to do a little. My focus shifted from attempting to have him do the whole task to having him hold up his head in neutral. He was so weak that he had difficulty holding his head in neutral and brushing his teeth at the same time. His head kept lilting to the left.
This was an opportunity to strengthen the neck and trunk.
I began flicking at those teeth with the brush. I really should have worn a pair of goggles.
What I had thought were brown teeth were really shiny white teeth covered with a slime of (don't gag) tube feeding and yellow/brown/green phlegm.
I methodically flicked the brush into the crevices of Whitey's teeth until the front teeth were pretty clean. Not bad!
Then...
I started on the sides. By this time, I was pulling out solid yellow green clumps. (I know, this is really gross.)
When I got to the inside of the roof of the mouth, I found brownish buildup all around the base of the teeth...
I kept flecking the buildup with the brush, alternating with brushing until a small section peeled away from the tooth. "Oh, my gosh, I thought! I am going to have to reach in and pull it."
That is what I did.
I nearly gagged.
I kept pulling.
He began to gag.
I just kept pulling.
And finally...off the roof of Whitey's mouth came a thick, hard, brownish yellow shell of old snot and feeding tube that had not only covered the whole roof of his mouth, but that had been growing down into his throat.
I almost came undone.
No wonder no one could understand him!
The moment that whatever-it-was (a plug??) was pulled out, Whitey's speech could be clearly understood.
In 16 years I have seen nothing like it. I can do blood, wounds and most bodily fluids, but I cannot do phlegm. I felt weak. I can only imagine how he felt!
What do I think about this?
Even the "best" nursing facilities don't always give the best care. Every person on a G tube needs oral care throughout the day, not just twice a day.
You never know what can come out of the mouth...
WARNING:
IF ANY OF YOU HAVE SENSITIVE STOMACHS, DO NOT LOOK AT THE PHOTO IN THIS BLOG ENTRY...
We received a new, quite debilitated patient who was transported four hours from the nearest "big" city. Whitey had been in a top rated nursing facility, the kind that looks like a five-star hotel.
The rehab staff had given up on making progress with him, as evidenced by their therapy notes.
I completed Whitey's chart review and asked myself what I could do to start the process with this guy. What could I do to help him progress steadily so that he could go home with his family?
I went to Whitey's room and immediately heard the sound of a feeding tube at work. The bag of enteral nutrition hung on a pole at his bedside, and I could hear the hum of the machine delivering it to his stomach.
I introduced myself. Whitey opened his eyes. He was "there," but I couldn't understand a word he was trying to tell me. His voice was muffled. His lips were dry.
I immediately realized I needed to check out his mouth. After all,
O.T.s = ADLs
(Occupational therapists = Activities of Daily Living = brushing teeth)
"Let's start with your mouth. I need to moisten your mouth and while we're at it, it would be good brush your teeth. I'll help."
I got the supplies together and put them on his tray.
"Whitey, please open your mouth."
Crooked, brown teeth. Many were missing on the sides, but there were teeth intact in the front and back. I handed him the brush mixed with water and mouthwash. He had been cleared during a swallow study to drink water in the presence of the nurse or the therapist.
He was able only to do a little. My focus shifted from attempting to have him do the whole task to having him hold up his head in neutral. He was so weak that he had difficulty holding his head in neutral and brushing his teeth at the same time. His head kept lilting to the left.
This was an opportunity to strengthen the neck and trunk.
I began flicking at those teeth with the brush. I really should have worn a pair of goggles.
What I had thought were brown teeth were really shiny white teeth covered with a slime of (don't gag) tube feeding and yellow/brown/green phlegm.
I methodically flicked the brush into the crevices of Whitey's teeth until the front teeth were pretty clean. Not bad!
Then...
I started on the sides. By this time, I was pulling out solid yellow green clumps. (I know, this is really gross.)
When I got to the inside of the roof of the mouth, I found brownish buildup all around the base of the teeth...
What the heck??
I kept flecking the buildup with the brush, alternating with brushing until a small section peeled away from the tooth. "Oh, my gosh, I thought! I am going to have to reach in and pull it."
That is what I did.
I nearly gagged.
I kept pulling.
He began to gag.
I just kept pulling.
And finally...off the roof of Whitey's mouth came a thick, hard, brownish yellow shell of old snot and feeding tube that had not only covered the whole roof of his mouth, but that had been growing down into his throat.
No wonder no one could understand him!
The moment that whatever-it-was (a plug??) was pulled out, Whitey's speech could be clearly understood.
In 16 years I have seen nothing like it. I can do blood, wounds and most bodily fluids, but I cannot do phlegm. I felt weak. I can only imagine how he felt!
What do I think about this?
Even the "best" nursing facilities don't always give the best care. Every person on a G tube needs oral care throughout the day, not just twice a day.
If you have a family member on a tube, check your loved one's mouth.
If you are a caregiver, check your patient's mouth.
You never know what can come out of the mouth...
Thursday, February 23, 2012
Photographical Whimsy From This Assignment
Back to my blog home page: http://travelingotr.blogspot.com
I love to look for the unusual. Here's a bit of unusual from my time along the northern coast.
I have really loved this crazy place!! There is no better experience than to meet new people and explore places you would never otherwise see...life is short. Get out there!
I love to look for the unusual. Here's a bit of unusual from my time along the northern coast.
Most Unusual Mailbox
(it's a mermaid!)
Most Unusual Car Front Adornment
Most Unusual Item in the Pharmacy
Most Wonderful Lesson To Share
Most Unusual House Number
I have really loved this crazy place!! There is no better experience than to meet new people and explore places you would never otherwise see...life is short. Get out there!
Wednesday, February 22, 2012
Tips for Caring For Ill or Bedbound Loved Ones
Back to my blog home page: http://travelingotr.blogspot.com
Tonight, for those of you who are taking care of a loved one or who know someone who is a caregiver, this blog is for you.
Taking care of a loved one at home is one of the biggest sacrifices you can make. It can wear you out.
I want to share some recommendations for caregiving, simple things that can make a real difference for you if you are giving care to someone who is ill.
Jennifer B. Buckley wrote an online article called Home Care Tips for Elderly Loved Ones in which she made four good recommendations.
All good recommendations....
From therapist's eyes, I see some additional things that I believe are really helpful.
Positioning
The best thing you can do for your loved one is to keep them from getting pressure sores if they can no longer move their limbs in bed. You can do that by:
Bathing
If your loved one is unable to be bathed in a tub or shower, you can still bathe and shampoo your loved one's hair.
The following technique is taken from Bathing Without a Battle, which describes a technique called The Towel Bath which has been used in skilled nursing facilities and by home health agencies. I had the pleasure of trying this technique with a great OT at one of my assignments. This technique is especially calming and effective with dementia patients who may become combative if you attempt to shower them.
For shampooing, this is a great product:
It's a one-step, rinse-free cap that fits over the head after you warm it for 30 seconds in the microwave. It feels great. It fully washes and conditions the hair. After massaging the cap, you pull it off, blow dry the hair and comb.
No more greasy, "I-can't-wash-my-hair" locks.
Medical Equipment
Your loved one may qualify through insurance or Medicare for a hospital bed, wheelchair, walker or 3 in 1 commode.
This equipment allows optimal movement and positioning of your loved one in the home. The commode increases safety by allowing your loved one to use the commode at the bedside at night to reduce the risk of falls.
Meals on Wheels
Having one meal provided for each day may decrease the burden on you to cook meals. Don't be afraid to receive assistance from community or church groups.
Preventing Caregiver Burnout: Be Aware!
The best thing you can do for yourself as a caregiver is to connect with services and people who can help you. Check out The Family Caregiver Alliance Website for info on how to find these resources.
This is just the beginning of the list. If any of you have specific ideas to share, I would welcome your input!
Tonight, for those of you who are taking care of a loved one or who know someone who is a caregiver, this blog is for you.
Taking care of a loved one at home is one of the biggest sacrifices you can make. It can wear you out.
I did a google search to see what others had written.
Jennifer B. Buckley wrote an online article called Home Care Tips for Elderly Loved Ones in which she made four good recommendations.
- Keep a small pitcher at the bedside for accessing fluids.
- Avoid placing mirrors by the loved one. It can confuse them.
- Buy your loved one's clothing in basic colors for increased ease in allowing them to choose what they want to wear.
- Use large numbers and dials on remotes and phones.
All good recommendations....
From therapist's eyes, I see some additional things that I believe are really helpful.
Positioning
The best thing you can do for your loved one is to keep them from getting pressure sores if they can no longer move their limbs in bed. You can do that by:
- Making sure the head of the bed is kept below 45 degrees if they are in a hospital bed at home. Above this angle, and they are at high risk to get a pressure sore at the sacrum (to put it bluntly, the top of the butt crack).
- Floating the heels by placing a thick pillow (or a thin one doubled up) just under the ankles so that the heels do not touch the surface of the mattress.
- Positioning your loved one on the flank of their buttock, which is the fleshy part, when you turn them into sidelying,
- Putting a pillow between the knees.
Bathing
If your loved one is unable to be bathed in a tub or shower, you can still bathe and shampoo your loved one's hair.
The following technique is taken from Bathing Without a Battle, which describes a technique called The Towel Bath which has been used in skilled nursing facilities and by home health agencies. I had the pleasure of trying this technique with a great OT at one of my assignments. This technique is especially calming and effective with dementia patients who may become combative if you attempt to shower them.
Click on the colored link above to print out the full instructions!
For shampooing, this is a great product:
It's a one-step, rinse-free cap that fits over the head after you warm it for 30 seconds in the microwave. It feels great. It fully washes and conditions the hair. After massaging the cap, you pull it off, blow dry the hair and comb.
No more greasy, "I-can't-wash-my-hair" locks.
Medical Equipment
Your loved one may qualify through insurance or Medicare for a hospital bed, wheelchair, walker or 3 in 1 commode.
This equipment allows optimal movement and positioning of your loved one in the home. The commode increases safety by allowing your loved one to use the commode at the bedside at night to reduce the risk of falls.
Meals on Wheels
Having one meal provided for each day may decrease the burden on you to cook meals. Don't be afraid to receive assistance from community or church groups.
Preventing Caregiver Burnout: Be Aware!
Common warning signs of caregiver burnout:
- You have much less energy than you used to
- It seems like you catch every cold or flu that’s going around
- You’re constantly exhausted, even after sleeping or taking a break
- You neglect your own needs, either because you’re too busy or you don’t care anymore
- Your life revolves around caregiving, but it gives you little satisfaction
- You have trouble relaxing, even when help is available
- You’re increasingly impatient and irritable with the person you’re caring for
- You feel overwhelmed, helpless, and hopeless
The best thing you can do for yourself as a caregiver is to connect with services and people who can help you. Check out The Family Caregiver Alliance Website for info on how to find these resources.
This is just the beginning of the list. If any of you have specific ideas to share, I would welcome your input!
Tuesday, February 21, 2012
10 Ways to Shift the Direction of Your Life, Part Two
Back to my blog home page: http://travelingotr.blogspot.com
Stretch.
Fill your lungs with breath. Get in touch with how you feel. Be aware of where you hold stress in your muscles, and then learn to stretch those muscle groups so that you care for your body. It has to carry you through life!
I have a tough one with this one. I literally have to schedule it in, and many times, I punt it for another activity. I find, though, if I stretch in the morning, I feel much better during my day!
Be open to the Divine in everyday life.
Being open to the Divine is far deeper than listening to a sermon in church every Sunday. There are miraculous moments every day taking place if we turn our gaze to them. An ocean wave, the sounds and flight patterns of a flock of birds,
periennials sticking up through the ground after the last snow, unexpected generosity of a stranger, the miracle of love, an emotional or physical healing. The list goes on.
What if we open our eyes to all that is?
Listen for what you would normally not hear.
We only really hear part of what others say. What if we hear with sharper ears? What if we read body language with sharper eyes? What if we tune into our own intuition? It's about more than words.
Let go of the need for material success.
Let me give you an example taken from a news article by CNN on 2010 Heroes. Narayanan Krishnan was a bright, young, award-winning chef with a five-star hotel group, short-listed for an elite job in Switzerland. But a quick family visit home before heading to Europe changed everything.
"I saw a very old man eating his own human waste for food," Krishnan said. "It really hurt me so much. I was literally shocked for a second. After that, I started feeding that man and decided this is what I should do the rest of my lifetime." (direct quote from CNN)...
Since then, he has served more than 1.2 million meals to homeless and destitute people in India. He let go of a need for financial wealth and followed a passion to help save his people. He is now recognized all over the world. Amazing man.
When I say he is a wealthy man, it's not at all about material success.
Choose joy.
I went through a period in life in which I thought I could certainly not get through it. I would certainly never want to re-live it. Everyone goes through at least one or two of these distressing times in their lives.The only thing that got me through was a conscious decision to choose joy.
Every morning, I looked in the mirror. At that defining moment, I decided on my day. I could choose joy or not....
I don't know about you, but I'd rather be around a positive person than a pisser!
My hope is that at least one of these ten "direction shifters" speak to you. Let me know...
Stretch.
Fill your lungs with breath. Get in touch with how you feel. Be aware of where you hold stress in your muscles, and then learn to stretch those muscle groups so that you care for your body. It has to carry you through life!
I have a tough one with this one. I literally have to schedule it in, and many times, I punt it for another activity. I find, though, if I stretch in the morning, I feel much better during my day!
Be open to the Divine in everyday life.
Being open to the Divine is far deeper than listening to a sermon in church every Sunday. There are miraculous moments every day taking place if we turn our gaze to them. An ocean wave, the sounds and flight patterns of a flock of birds,
What if we open our eyes to all that is?
Listen for what you would normally not hear.
We only really hear part of what others say. What if we hear with sharper ears? What if we read body language with sharper eyes? What if we tune into our own intuition? It's about more than words.
Let go of the need for material success.
Let me give you an example taken from a news article by CNN on 2010 Heroes. Narayanan Krishnan was a bright, young, award-winning chef with a five-star hotel group, short-listed for an elite job in Switzerland. But a quick family visit home before heading to Europe changed everything.
"I saw a very old man eating his own human waste for food," Krishnan said. "It really hurt me so much. I was literally shocked for a second. After that, I started feeding that man and decided this is what I should do the rest of my lifetime." (direct quote from CNN)...
When I say he is a wealthy man, it's not at all about material success.
Choose joy.
I went through a period in life in which I thought I could certainly not get through it. I would certainly never want to re-live it. Everyone goes through at least one or two of these distressing times in their lives.The only thing that got me through was a conscious decision to choose joy.
Every morning, I looked in the mirror. At that defining moment, I decided on my day. I could choose joy or not....
I don't know about you, but I'd rather be around a positive person than a pisser!
My hope is that at least one of these ten "direction shifters" speak to you. Let me know...
Sunday, February 19, 2012
10 Ways to Shift the Direction of Your Life, Part One
Back to my blog home page: http://travelingotr.blogspot.com
If you know me personally or have read all my posts, you'll know that I am a "seeker." A seeker of my own personal truth.
seek·er (s
k
r)
Expand your mind and spirit.
Learn something new every day. Explore one new thing about the area in which you live every week. Open your mind to the simple and sometimes unintended teachings of others. See everyone as inter-connected.
Simplify.
Identify what is "holding you down." Many times, it's "stuff." Get rid of all the extra stuff you're holding onto....closets full of old clothes and shoes you don't wear, a garage full of crap you haven't used, weight that slows down your body or negative thoughts that prevent you from living a better life.
Focus on Positivity.
I run into people alot who have only negative things to say. They complain about their work, their spouses or children, where they live, their weight, anything you can image.
WOW.
That wears me out.
When I start to complain, it wears me out! Did you realize if you focus on positive things, you don't feel so TIRED. I really need to work on this one this week!
See the best in everyone.
The princess didn't know there was a prince underneath....
when I am working with patients who stretch my patience (and lately there have been a few new challenges!), I have to remind myself to find one special thing about them that humanizes them, makes them likeable and creates a connection.
Often, it creates a shift in my own vision and enables me to connect and understand. Not always easy, I know!
Forgive.
I wrote a blog last fall on forgiveness. Click here to read it. We can agree that it's one of the most difficult challenges of our lives. What I have found, though, is that there is a great weight that is lifted when we forgive the other. We are able to move on, whether or not we keep that person in our lives, and have a clear slate. If we fail to forgive, we continue to be bound to another through a negative event.
I choose to forgive every day. Until I genuinely feel it in my heart.
If you know me personally or have read all my posts, you'll know that I am a "seeker." A seeker of my own personal truth.
seek·er (s
kr) n.
1. One that seeks: a seeker of the truth.
The past 18 months have been a grand search and experience of stretching beyond the life I knew, physically, emotionally, spiritually. It's exciting to get out of a comfort zone and push into the unknown.
Here is some of what I have learned and continue to learn...(part one)
Expand your mind and spirit.
Learn something new every day. Explore one new thing about the area in which you live every week. Open your mind to the simple and sometimes unintended teachings of others. See everyone as inter-connected.
Identify what is "holding you down." Many times, it's "stuff." Get rid of all the extra stuff you're holding onto....closets full of old clothes and shoes you don't wear, a garage full of crap you haven't used, weight that slows down your body or negative thoughts that prevent you from living a better life.
Focus on Positivity.
I run into people alot who have only negative things to say. They complain about their work, their spouses or children, where they live, their weight, anything you can image.
WOW.
That wears me out.
When I start to complain, it wears me out! Did you realize if you focus on positive things, you don't feel so TIRED. I really need to work on this one this week!
The princess didn't know there was a prince underneath....
when I am working with patients who stretch my patience (and lately there have been a few new challenges!), I have to remind myself to find one special thing about them that humanizes them, makes them likeable and creates a connection.
Often, it creates a shift in my own vision and enables me to connect and understand. Not always easy, I know!
Forgive.
I wrote a blog last fall on forgiveness. Click here to read it. We can agree that it's one of the most difficult challenges of our lives. What I have found, though, is that there is a great weight that is lifted when we forgive the other. We are able to move on, whether or not we keep that person in our lives, and have a clear slate. If we fail to forgive, we continue to be bound to another through a negative event.
I choose to forgive every day. Until I genuinely feel it in my heart.
Part Two to follow....
Friday, February 17, 2012
Steps + Gin = ?
Back to my blog home page: http://travelingotr.blogspot.com
I was interviewing a new patient about her home....and this is what I found.
I was interviewing a new patient about her home....and this is what I found.
30 steps to enter cliffside home
PLUS DAILY DOSES OF
EQUALS
Femur Fracture
Lesson:
Be Careful
Where You Have
Your Cocktails
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