Wednesday, October 31, 2012

Pediatrics, peds, kids, children, kiddos, and other four limed sassy, young creatures

My blogging is virtually (get it?) nonexistent these days.  I think my last update was around the beginning of this semester.  The theme of this semester is CHILDREN(!) and I feel like that is basically what I have spent all my time and energy on lately.  We are taking some other classes, but largely this is the kid semester.  Though I have no carved out my particular niche in the OT world yet, the only thing I have, in fact, weeded out is peds : )
My quietness is in part, to me keeping my head down and trying to make it to the finish line: T-minus  7 months until I am done!  And only 4 weeks until I am done with classroom work for life.  It is also in part to the fact I am not passionate about learning pediatrics and simply don’t have the bubbling enthusiasm about projects and assignments that I have had in previous semesters.  I’ve mostly kept to the “if you can’t say something nice, don’t say anything at all” motto on this blog except for the few instances where I took a lot of time to voice my complaints in a professional manner, so I feel like remaining quiet was better than either A) faking enthusiasm or B) complaining. 
It’s not just peds though.  I think largely my class is just burned out and ready to be done.  This semester has been a little crazy in general from the get go.  We had a hurricane and missed an entire week of school the first month in, we all have family things going on: births, deaths, surgeries, sickness, etc., etc. etc.  You can only put real life on hold for a certain amount of time and in OT school, I think to a certain extent you do put at least part of your life on hold because you are simply too busy to do and attend to everything.
Lastly, I think the design of my program kinda sets us up for this burnout to be honest.  It was very hard to go from practicing virtually as an independent therapist to transition back into the student role of assignments and papers.  I think this is uncommon though, as most universities I’ve heard of save all of their long fieldworks for last.  Good and bad to every program and my programs has a TON of GOOD (my favorites being our extensive anatomy program, applied kinesiology class, and AMAZING orthopedics class as well as the fact that all of our instructors really try their best to give us diverse and unique experiences)), but I don’t particularly like this one aspect of how we are set up.
BUT I (and largely as a class, we) now see the light at the end of the tunnel.  We have 4 weeks, Christmas break, then one last 3 month rotation!  And if nothing goes wrong (crossing my fingers/knocking on wood/thinking happy thoughts) my fieldwork should be amazing!  That is also helping me get through this semester : )
Instead of attempting to explain all the crazy stuff we have been doing I figured I would high light some of the fun moments (you know, stay positive) because we have done some pretty cool things this semester too. 
  
Some cool lectures/classes


This is a picture of the lovely OT student who goes by the name of STC feeding from a slow release nipple at a great feeding lecture we attended at a local hospital.  Despite the fact I’m not a peds person, I really enjoyed this lecture and found it very informative, mostly because I had major tactile defensiveness when I was a kid and will know what to do in 10 years if I have kiddos who have feeding issues.  They gave us some great resources!  This is something I love about my program, because the instructors really do try to set us up with maximum resources and experiences.





Here are some pics from a lecture we had on low vision.  I think this was one of my favorite things we have done all semester because I am interested in learning more about low vision.  It’s such as unique area in the therapy role carved out just for OTs.  Hoping to learn more about this one day.




Here is a pic of OT student A and OT student K (our only brOT) in the class participating in some sensory activities during a lecture on ADD, Autism, and Bipolar Oppositional behavior disorders .  And yes I feel cool because I learned this term at conference (something I realize I never wrote about… whomp whomp)

We also had a great lecture from an OT who works with at the VA on the OT role in Veterans health care.  I am also very interested in this topic so I really enjoyed this lecture as well. 


Some assignments/work

We have done two more activity bags that I may post.  One was for Ot in a non-traditional practice setting (mine was for a veteran returning with mental health complications) and a general neuro activity bag. 

We have done several big assignments in peds including an overview of development, a cerebral palsy case study for early childhood, and a spina bifida case study for middle childhood.  We also administered the Peabody assessment for an assignment, and had a long research assignment on a particular peds journal article. 

We also did a case study from our fieldwork 1 experiences (I was in an out-patient sensory integration clinc --- more peds) that deserves another post entirely if I have the time/energy. 

We made a dynamic splint

We did another IEP for our second level II fieldworks

We have been working all semester on writing a book as a class on prevention and wellness information throughout every decade of life (probably another 6 posts that I will never write to explain the complexity of this assignment)

We are also working on a research case study from our first level II fieldwork over the summer that is going to be a pretty big project – I am doing a flexor tendon repair case treated with early active motion protocol. 

We have done presentations on pros/cons of different aspects of healthcare in America such as Medicaid contraction plans and the Affordable Care Act.

Hmmmm there are tons of little things in between that we have done but I think that is a good enough picture for now.  I will be updating a little more soon.  I need to process/brain storm what my moves/plans are going to be over the next several months in regards to studying and taking the NBCOT getting licensed, and finding a job.  VERY scary but exciting stuff!  My enthusiasm shall return!

PS Happy Halloween!
: )

Tuesday, August 14, 2012

I’m back! Finished FW II and starting my last end class semester

I’m pretty confident that if I went back and read my last 10 post they would all begin with something like, “I know it’s been forever since my last post” or, “I want to post more, but never do!” So, instead of me confessing that anymore, let’s just take it for a given.  I am posting less and less as I near the end of my OT school experience.  The end?   That’s right, the end is in sight!!! I cannot believe I only have 3 more hurdles to jump through: one in class semester, one more level II FW, and then boards (which I will admit I have given absolutely no thought to yet). I have become increasingly greedy of my free non-OT time.  I still love love love OT, but I also love other aspects of my life as well and find it more and more difficult to keep up with other OT things in my free time such as blogging, blog reading, OT practice articles, etc.  In fact, the reason I didn’t blog at all over my 2 week break was because I flat out needed a break from all things OT – and I had a blast!  I got to relax, read several books, go fishing, kayaking, swimming, running, free spin classes, 9 am yoga classes (my favorite little luxury), spend time w family, friends, and, of course, my dog Ellie, and then I topped it off with the most perfect beach weekend ever!
But now I am back and ready for some OT action! I thought I would first wrap up my FW saga for those following it.  I finished about 2 weeks ago and passed with a good score and some excellent feedback.  I was skeptical during week one and maybe even a little a midterm, but I really do feel confident that I could be an entry-level therapist in an out-patient setting.  My CI defined entry level as being able to complete an evaluation gaining all of the necessary data and knowing where to look up correct information if it is a diagnosis I am unfamiliar with.   I got a chance to practice/prove that the last 2 weeks I was there as I had two patients that were very different than anyone I had seen before.  Without sharing too much, one was a patient who had a stroke and was almost completely dependent in transfers, ADLS, etc and the other was someone that, among other things, had some vision issues, which was really neat to research because I had never seen/treated visual deficits before.   
The last week of my FW was especially fun!  We had several students at my site this summer so there was a lot of celebrating and awesome treats.  I did my in-service at the beginning of the week and my topic was on mirror therapy, which I had a lot of fun researching and reading about.  I made a mirror box (wish I had taken a pic – I’m making my own, so I will take a pic of that one later) for my site to keep and use.  They were very receptive to a new type of therapy that they didn’t make a regular practice of using and all seemed interested.  As I began researching it, I shared the information with my CI and she let me use it in therapy the last 4 or 5 weeks with several of my patients we thought might benefit from it.  That’s another reason I liked my site and especially my CI: she always allowed and encouraged me to try things/activities that they didn’t use regularly in the clinic, so it pushed me to try and be creative when I could.  Speaking of creativity in the out-patient setting, I wrote the promised post about being occupation-based in an out-patient setting weeks ago and never posted it!  I need to give it a once over and add a few things, so hopefully that post will follow.   But back to my in-service… I made yummy s’mores cookies because I am obsessed with all things s’mores and the first student to do their in-service set the bar pretty high with yummy treats.  On my last day we went to lunch, and then happy hour after work. It was so nice of them to do something for the students for our send-off.  I will sincerely miss spending my days with everyone that works there; they were all such nice people and great therapists, both PT’s and OT’s alike.  I deliberated quite a bit over the CI gift and settled on a pedicure and some handcrafted earrings.  I made matching sets of earring for the other 2 OTs there since they helped me so much this summer and were so nice.  I was not excepting any sort of gift since I had already been given so much, but my CI surprised me with a bag of all my favorite snacks, gum, a therapy ball, and the most awesome gift of all, a healing hand charm necklace on, of course, black and gold ribbons (Saints colors).
Tomorrow is my first day back to my last semester of actual classes and I would be less than honest if I said was eagerly awaiting this experience.   I part of me is a tinsy bit excited, but the vast majority of me wishes I were going to another FW placement rather than back to the classroom.  It was just such a great experience to actually be able to practice what we learn about in school and do day to day things that I will be doing for the rest of my life.  But alas, the rest of my life can wait as I know there are still many things I must and need to learn in the classroom before I am truly ready.  We are taking Research II (which I have been told has been reconstructed and is with a new instructor – refer back to my honest confession of disappointment with this class last semester), Management, Applications II, Principles of Practice Early Life (we save peds for last), and Community Based/Specialized Practice.   Should be an interesting and very different semester!

Sunday, July 1, 2012

Fieldwork – Going on month 3!

Things are settling down for me here in New Orleans! I am loving my new, rat-free home and I have one month left of fieldwork – I can’t believe how fast the past 2 have gone by.  I’m learning so much and I wish I could share more but between fear of violating HIPPA and time constraints, I know I have not shared much sans for my experience of going through fieldwork – which I hope has at least been a little helpful/ entertaining/ semi-worth reading?
Going on my 3rd month I feel much more confident alone with patients.  My CI basically sits behind her desk occasionally checking on me or answering any question I may have.  Though I can’t give details on the patients I have been treating, I thought it might be a good time to give an overview of some of the diagnosis I have seen on fieldwork:
Lots of shoulders – adhesive capsulitis (frozen shoulder), humerus fractures, rotator cuff syndromes, rotator cuff repairs,  high functioning stroke patients with shoulder pain
Wrists – distal radius fractures and distal ulna fractures
Flexor tendon repairs
Mallet finger
Various fractures of the hand: phalanx, metacarpal
Ulnar neuropathy
Carpel tunnel
Radial nerve palsy
Elbow – olecranon fractures
Scapula fractures
Cervical myelopathy
Tendon transfers
Nerve repairs
Strokes – both ischemic and hemorrhagic
Hmmm I’m sure I am missing some, but this gives a general overview.  I have also seen many patients with co-morbid diagnoses that we are not specifically treating in this setting including:
Bi-polar disorder
Schizophrenia
Traumatic brain injury (TBI)
Severe anxiety
One interesting thing about my cite without giving away too much info (talked to my CI and she is also unsure if I should post my actual cite even though it is superly unique and I want to share) is that we see a lot of trauma.  So often we see multiple injuries/diagnosis at once that we have to work with.
Owww another cool thing – I got to see hand surgery last week!  I spent one morning with a very nice hand surgeon who let me watch 3 procedures.  I saw 2 ORIF (open reduction internal fixation) of metacarpal fractures (one was 4 months old and one was new so it was interesting to see the difference) and one very unique injury which of course I can’t share because it would be identifying, but I can say it was basically someone who completely destroyed their hand.  They opened it up took out a lot of damaged nerve to prevent neuromas, removed some badly damaged muscle and tried to put him back together as best as possible… hands down my favorite surgery to watch. 
Not sure if I mentioned this ever before, but prior to discovering OT school I had pretty much pinned down going to school to be a surgical PA (physician’s assistant) – just like my mom did).  I have always been fascinated by surgery – ever since the first time I saw my mom doing heart surgery when I was about 6 and banged on the glass shouting “where is all the blood?!?!” BUT as I was going through my undergraduate career I realized over and over again that my heart was really not into medicine and that I also wanted to make a different career choice for lifestyle reasons (I wanted low stress, no call, and the luxury of my career being a balanced part of my life rather than all-consuming entity.)  Luckily, during my search I found OT and fell completely in love with it, but before that I had almost reasoned myself out of medicine.  If I may have ever had any slightly little doubt about my choice of OT over surgery, all of that and more was put to rest after watching surgery for 5 hours.  It was amazing, but incredibility exhausting – just to watch! I had a small pang of “what if” when I saw the first incision, but after 5 minutes in I was completely over the feeling.  Let me say I was extremely thankful and fortunate for the experience and I would still have done it in spite of this, but I was miserable about 20 minutes in! We had to wear these vests  because the surgeries required lots of real time x-rays (which were awesome to watch), but the vest weighed like 20 lbs and combine with the odd positions so that I could actually watch what the surgeons were doing, my back was in more pain than I have ever been in since my injury.  If that wasn’t enough to confirm my career choice, I talked to 2 residents at 9AM who had worked 7PM-4AM the night before and were already back ready for surgery.  They were also talking about the weekend work schedule and call schedules, and after hearing about 10 of those conversations, and watching in pain for 5 hours, I was more than happy to go back to the therapy gym, stretch out, and finish my work-week so I could go home and enjoy my weekend.  I think the people who choose that type of work really have to love it and have a passion for it, but that was and is now more clearly, just not for me, which is very convenient since I love OT.. even though I am glad OT is not 99% of my life… because after school I want to study to be a yoga teacher… and learn Spanish… and play the piano…  and sooo much more I want to do everything!
Speaking of doing everything, I still want to post on occupation-based OT in out-patient and I want to write a really good post about mental health issues that have been on my mind for quite some time– instead when I sit down to write I find myself rambling and figuring out things about myself rather than actually sitting down to efficiently write what I want to share … oh well,  it can wait – it’s Sunday after all!  Have a great week!

Monday, June 18, 2012

Rat Drama – Fieldwork Midterm

I have been at large for even longer than usual and I have a perfectly good explanation – I’ve had RATS! Big (8-10 inch), disgusting, terrible, horrible, rats, infesting my house and causing all kinds of mayhem!  I have been dealing with this for 6 weeks (since the very start of fieldwork, of course) and I finally have it under control after a lot of sweat and a few tears.  I am writing this post from my very new, very fabulous kitchen because after 6 weeks of rat drama, I up and moved – yes during the middle (literally) of fieldwork.  Luckily, I have become particularly skilled at balancing my work/school and personal life so it has not interfered with my rotation whatsoever – except for me updating my temporary co-workers daily about my rat drama :)   
In fact, I my midterm was last week and I got some pretty great scores, which I am extremely proud of.  For mid-term I had to fill out some paperwork separate from my CI and rate myself in areas like evaluation, interventions, professional behavior, knowledge of OT etc  etc and then my CI filled out the same form and we compared our results.  I rated myself higher for knowledge of OT, and professional behavior and rated myself as still improving for evals and interventions because I don’t expect to have entry level skills at 6 weeks in.  My CI actually gave me higher ratings than I gave myself for several topics.  We both agreed that the skills I am still cultivating are evals and grading of activities/ exercises for all different types of clients, but after talking with her at midterm I feel much more confident about my intervention skills.  I love this fieldwork site because I get tons of evals.  I think I wrote about this in my other post, but I basically started with my own clients and took over only a few existing clients my CI was already seeing.  I think starting from scratch with tons of evals makes it a difficult rotation, but I believe I have learned way more than I ever would have had I not had to think each and every person through on my own before comparing ideas/ treatments with my CI.  While I love that this is how it is set up, tons of evals can be mentally exhausting for a therapist in training because it takes a lot of mental energy to conceptualize what you want a person to do from start to finish in therapy.  On days when I have only 1-2 evals and the rest regular treatment sessions, I always get out of “work” at a normal time… on occasion when I have 4-5 evals in a day in addition to some regularly scheduled patients,I have literally stayed 2-2.5 hours extra to finish up.  Combine this with the fact that for the last 3 weeks I have spent 3-5 hours a night either --- A) cleaning up after rats B) searching for a rat-free place to live or C) moving to a rat-free house --- you can see why I have not been on my poor neglected, blog.
As I mentioned, I have been feeling much more confident during fieldwork.  I am almost on my own now with most of my patients and my CI often sits behind her desk watching.  She still helps me when I get someone new and have to either do wound care (which I absolutely love) or splinting (which I like a lot too).  In the past 2 weeks I have made 3 mallet finger extension splints, 2 dorsal blocks, a resting hand splint, a thumb spica splint, a hand-based thumb spica splint, a radial nerve palsy splint, and one more than I am forgetting.  I am also feeling more confident in my splint making skills after this surge of splinting. 
I want to write more.  There is so much to say, but my poor mind is swimming with exhaustion from moving all weekend,  bootcamp this AM, and a full day’s work!   I still want to read up a little on e-stim and iontophoresis (I am probably spelling this wrong) tonight in a manual my CI let me borrow.  I will try to not stay away so long this time – I desperately want to write about occupation based interventions in an out-patient setting --- hopefully by this weekend!
As always I greatly appreciate the comments, e-mails, feedback etc I receive from all my readers.  I know I am pretty far behind, but I will catch up soon!  Rest assured I have at least glanced at your e-mails and am waiting until I have time to fully respond to them – especially the few I have gotten from people applying to LSUHSC! 

Wednesday, May 30, 2012

From thinking like a student to thinking like a clinician: the awkward transition into clinical reasoning.

I am currently in week 4 of my first level II fieldwork.  One thing that has been weighing on my mind toward the end of last week and the beginning of this one is how difficult it is to go from thinking like a student to thinking like a therapist.  See I am very good at being a student – 6 years in the making and I have perfected my routine.  I know how to study, write papers, take notes, do group work etc etc etc because I have spent the last 6 years perfecting these skills in a way that they works best for me.  Knowing how to be and think like a therapist is all new to me.  I am slowly developing these skills, but they certainly do not come easy and without many mistakes.  What is awkward (and don’t get me wrong, also great) about it is that I am learning in front of people (my CI, therapists, and all of the clients) and at the risk of sounding incredibly vain, it is hard to not be good at something with people watching.  There are days where I feel like I have it all together so to speak: I ask all the right questions, plan good exercises/treatment session, finish an eval without leaving out any pertinent data. BUT there are plenty of days where I feel incompetent, constantly second guess myself, and in a nutshell, clueless.  The student in me often wants to take a problem and look it up in some book to find the answer.  This actually works great in some instances being in an out-patient ortho settings as there is almost always some type of protocol to look up; however, this protocol will only give a basic outline of the order of progression and, of course, not plan out your whole treatment session, which is where clinical reasoning comes in. 
To develop these reasoning skills, I have been making, what I like to call, “game plans” for all of my clients.  When I do an initial eval I also fill out a form my CI suggested I create that has the clients diagnosis, their personal goals for therapy, list of strengths, list of weaknesses, my STGs (short term goals), my LTGs (long term goals), and treatment/interventions.  I usually fill this out with the initial eval and use the back write out my “game plan” and then what I actually end up doing with them so I can keep track of progress.  I keep these in my personal charts for the clients because this is a big hospital system with paper charts that do not always come to OT.  I have gotten pretty good at making these “game plans,” but the problem arises when the client is unable to do the exercises or activities I put on my “game plan” or if they can do them too easily.  I will go ahead and confess I am still not completely comfortable treating clients, and really wish that I had experience as a tech prior to school – so those of you considering OT school, go out and get tech jobs asap!  But back to the plan… I am comfortable when I have my plan, but when I have to go off track of it, as I do very often, I sometimes have moments of sheer panic with no backup plan and no different activities or grading of the activity/ exercise pops in my head.  So my plan to revise my “game plan” is to write activities/ exercises that are a little easier and a little harder than whatever I originally planned.  Again all of this planning may be inhibiting me from being able to improve with clinical reasoning when I discover what the client can and can’t do on the spot, but I have to start somewhere and I am an excellent planner! Because the major problem is knowing what exercises/ activities to do I have taken a few steps to try and learn as much possible about what the therapists typically do that this site. I have looked through all of the handouts they issues to clients, explored their computer program with print out exercises, and looked up as much as I can find in my books.  And most importantly, I also try to pay attention to what other therapists do during their treatment sessions with clients that have the same diagnosis as my clients. 
I am up to 4-5 patients a day this week, and since I was at first, largely doing new evals so I could establish my own set of clients all summer, and just really beginning to delve into more progressive treatment session which is why this is all on my mind.  There are some clinical skills that I have seen drastic improvement on over the last month though, which show me just how far I have come.  For one thing, I can write almost all my treatment notes without having to have more than one little thing here or there added in or changed.  I used to write them on scratch paper and then rewrite them after my supervisor looked them over (which I would highly suggest at first) but now I am doing pretty well the first time around and no longer need that.  I am still doing my initial evals mostly on copied/scratch paper so my CI can add her input on goals etc (which I also highly recommend) but they are not nearly as covered with red ink as they were in the beginning (so I think I am improving the questions I ask the clients as well as my goal setting skills… well sometimes my goal setting skills) My CI has also taught me to become a pro and manual muscle testing and goniometry.  As a hand therapist she is very precise and after learning under her for the past month I feel pretty confident in these skills.  For those of you who may currently be in OT school and may be thinking you learned this in school practicing on your friends… I assure you did not!  It truly is so different testing people with actual injuries and more importantly it is so very different having to be quick, efficient, and reliable.   I am also becoming pretty good at treating shoulder injuries (despite my earlier post with the pic from my notes stating “never treat a shoulder”) because I have a lot of clients with shoulder injuries at all different stages.  I’ve got a few distal radius fractures, so I am feeling more comfortable with that diagnosis as well.  I do have a lot of trauma clients who have multiple injuries where all bets are off for looking up things in a book, but I am learning to adapt! 
Thinking this is a good update for now.  I am appreciating all the nice comments and e-mails I have been receiving and I assure you if I have not had a chance to get back with you I will at some point! Also like to remind my tons of new readers that this is a blog for me to spill awareness and experiences about OT school, not a formal blog, so learn to love my typos, incorrect grammar, and multiple random parenthesis that sometimes make sense and sometimes do not : )



Sunday, May 20, 2012

First 2 weeks of FW II

Wrote this Thursday and I was so tired I forgot to post it – ha!
I mustered up some mental strength to blog today!  I know I still need to write about conference, but what I really feel like writing about is fieldwork, so I am :  )
As I mentioned in a previous post, I am at the same FW cite I was at for my level I in March.  It is an out-patient, mostly ortho (but some neuro and lymphedema) setting and there are 3 OTs who are all CHTs and absolutely wonderful!   Though they all pitch in and help me/ let me watch them, I have one main CI who is probably the most organized person I have met in my life.  The first day, the very first hour, I was there, she handed me copies of a printed out weekly calendar so that I could schedule my clients.  At the top of each week was a progression of how I would go from observation to a full caseload of 8-10 clients a day.  Week 1 – observe/ help, week 2 – 1-2 clients per day, week 3, 3-4 per day etc etc.  Now in week 2, I am currently taking a lot of new evals so that I can keep these clients as my own all summer while also taking on a few of her clients. 
I have been keeping a notebook, which I find to be very helpful, divided into sections where I can jot down information about different diagnoses I see, goals, notes on how to do evaluations, tips for documentation, goals,  info on modalities, treatments, etc etc.  I found it was especially helpful these first 2 weeks as I was trying to get a handle on how they do things. 
I have one big in-service project to do during my rotation which is 12 weeks long.  I also have to do a case study/ research poster on one client during my rotation that I will use for research class next fall.  Other than that I have no formal homework, which is nice.  I give myself homework, of course, by going home and looking up diagnoses and treatment/interventions for future clients so I can prepare for the following day/days.  What is hard right now is that I can look up a protocol for a diagnosis and get a game plan of what needs to be done, but I am severely lacking knowledge on how to do it – what exercises, activities, treatment/interventions need to be done to accomplish the goals I have set and the progression of treatment I have found.  I recognize that this is the point of fieldwork, and it is only week 2, and I am not supposed to have all the answers, but that is currently my biggest struggle so I wanted to note it.  Luckily, I have a great CI, who I think has a perfect system of progressing students.  For the first few weeks (up until about midterm), she sees all my clients (evals and treatment sessions) with me and said that she will set aside time to discuss my interventions for the day once I start getting more repeat clients and not evals. 
I am far too tired to think creatively enough to share information about specific diagnoses I have seen or experiences I have had with various people without violating HIPPA and being disrespectful to individual privacy.  I will have to think on this at length some other time and decide if it is worth it to try and share in some random, partially made-up way, or if my time would be better spent describing other aspects of this fieldwork experience. 



Tuesday, May 15, 2012

SO much to write about... yet oh so tired!

I need to write a long post about conference!

I also need to write multiple posts about my first week and now second week of fieldwork II!

I can find zero energy to do either : (

Been experimenting with early morning workouts/ bootcamp classes on top of my 8-9 hours a day of fieldwork - I am sooooo tired in the evenings, but I am absolutely loving my life right  now.  Blogging marathon soon to come? Fingers crossed!