Adjusting

The last two weeks have been a bit of a blur.  I've been rather busy adjusting to the new schedule at my second site.  Instead of working 8:20am - 5:30pm, I'm working 7:30am - 3:30pm.  Instead of going to bed between 10 & 11 and waking up at 6:30, I am going to bed between 8 & 9 and waking up at 4:45.  Instead of driving 5 minutes to get to work, I am driving 50 minutes to get to work.  Instead of working with children mostly under the age of 16, I am working with adults all over the age of 50.  It's a whole different world and I'm still getting used to it!

I finished up my time at my first site on the day before Thanksgiving.  We were opened the day after Thanksgiving, but all of our patient's cancelled appointments that day.  I obviously "passed the course," so to say.  I fulfilled all the requirements and felt very proud of the growth I made during my time at the clinic.  The staff gave me a nice little card and gift when I left.  It was really encouraging to hear from my CI that I had grown in skill and most importantly in confidence.  I stopped back in to visit the clinic just this week to get another signature from my CI.  We chatted for a bit while she worked with one of the girls that had been on my caseload.  She offered some advice about where to begin my job search if I was interested in staying in this area after I graduate.  She also said that she has been tossing around the idea of bringing me in for just a few hours at the end of the day as the caseload always picks up during the after school hours.  I cannot say how excited that made me!!!  I absolutely loved every part of my experience at my first site and would be honored to work there after I graduate!

Things are going well at my second site.  I get along great with my CI which helps ease my overall hesitance in working at a long term care facility.  I feel like I have already learned a TON about how to work with that population but I know I will continue to learn more and more.  My CI started having me work with my first patient a week ago today.  He is a great guy; easy going and very motivated to get better so he can return home.  She started me with my second patient on Friday.  This lady is kind and polite most of the time, but also lacks motivation and often complains about having to come to the therapy room.  She told me on Friday that she enjoys doing "detail work" so we have been doing a lot of fine motor activities to increase her endurance and task tolerance.  We also worked on some ADL's yesterday but the CNA's are required to do most of that work at this facility.  I've learned how to use E-stim and diathermy--which is pretty easy despite the complexity of what both modalities actually do.

It's hard to believe that I'm in the last leg of my educational journey to becoming a COTA.  I know I will continue learning a lot during the next 6 weeks at the nursing home.  Then it will be time to study my butt off and take my national board test so I can get a real job and start making money to pay off all my schooling! Most importantly I will be in a job that I love and look forward to every day--it will be fulfilling and with that I will not be able to complain!

The End of the Beginning and the Beginning of the End.

Well, it's hard to believe it but today marks the start of my last week at my first fieldwork site!  (If you're confused, start again--at the title.)

Things became very busy for me the past few weeks.  I have not updated recently and I apologize to any of you who are just dying to hear about my experiences!  I'll share a couple "highlights" and then I'm off to prepare the house for family later this week.

I have experienced so many different things over the last 7 weeks.  One of the biggest learning experiences for me has probably been learning about seizures.  This is definitely not something we talked much about in my schooling, but is a VERY common issue with a number of my patients.  I've witnessed a few different seizures in the last couple weeks.  One happened at the end of a treatment session I was doing with a young 4 year old.  It was a relatively mild seizure but it was somewhat frightening to observe as I was holding her in my lap.  Her eyes darted to one side, she went into the asymmetrical tonic neck reflex (ATNR) and then became unresponsive for around 15 seconds.  It is pretty typical for the patient to become exhausted after experiencing a seizure and that is exactly what happened.  She curled up in a ball next to me on the ground and was totally out of it.

I witnessed another seizure just last week.  This was during a session that I was just observing with an 11 year old.  We were working on ADL's in the bathroom when she said she felt dizzy.  The next thing I know her mom (who was also with us during the session) steps in behind her just in time to catch her before she hit the floor.  She began shaking and all of the color went out of her face.  The girls mom and my CI coached the patient to take deep breaths so that she wouldn't hyperventilate.  She remained light headed for quite a while and then ended up vomiting a couple times.  The mom requested that we call 911 because she had never seen her daughter do this before.  I went to the office manager and quickly explained the situation and asked her to make the call.  My CI and I met the EMT's outside and they took her to the hospital to get checked out.  It was a very frightening situation for me.  I thought to myself "what would I have done if her mom and my CI had not been in the room?!"  I hope that gut instinct would have taken over, but honestly I don't know if I would have known what to do.  We weren't taught how to handle patients during a seizure!  At least now I have SOME clue what to do during a more instense situation though.

The last exciting story before I bring this to a close.  I had 11 patients on my caseload today!  One of them cancelled but regardless, it was a very busy day.  Of the 11, 2 were patients that I had never worked with one on one before.  All in all the day went really well.  I have no serious complaints.  I've had super busy days before but I was definitely more "on my own" today than I have been other days.  My CI gave me good feedback at the end of the day saying that she thought I did a nice job with all the kiddos that I saw as she was keeping one eye on me and one eye on her patients.  I worked nearly 10 hours today and with that--I'm tired so I'm going to get some work done around the house and call it a night!

Next Monday I will begin the end of this journey.  I start at my second site and I am pretty excited.

I've been thrown to the sharks...but I still have a life jacket!

I think I should cut to the chase and let you all know that I got high markings for midterm.  Both of the OTR's at my site agreed that I am doing really well but would like to see a little more confidence from me.  If you know me at all this should not come as a big shock.  My shyness typically comes across as low self-confidence.  I'm just not one to really put myself out there.  Last week, I mentioned my struggles with doing transfers.  This is something I have discussed with the OTR's at this site and they are pushing me to really work on it.  I am happy to say that my confidence is building and along with that, my ability to transfer the patients has improved as well.

I've been doing a lot more "independent" treatments.  The OTR's have in a sense thrown me to the sharks and allowed me to work one and one with a lot of patients.  As they see that I'm comfortable, instead of hanging over my shoulder, they retreat to the office and check on me periodically.  When they know a certain patient may be more difficult for me to handle, they hang out nearby just in case I start to get in over my head.  They won't let me fail and drown...they are there for me and I couldn't be more thankful for such great clinical instructors!

I've had an eventful week.  I was kind of working with a patient that has pervasive developmental disorder.  I mentioned this patient in my post on October 3rd.

"Seeing an older teen pulling the therapist's hair, slapping her and trying to bite her was hard to deal with! I feel like I need to be trained in some kind of self defense. I guess working in that situation is the only way I'll ever be able to figure out how to handle it"

After the situation that happened on my first day of fieldwork, everyone has said that the rule of thumb with this patient is to stay at arm's length away to avoid putting yourself in harms way.  I have done my best to always maintain that distance and have avoided rough situations.  Yesterday, this all changed.  While working with her, the OTR said that she was going to go grab a list of activities for the patient to pick out what she wanted to do.  Upon getting up and leaving, the patient proceeded to try and follow her.  I knew she needed to stay in the private treatment room so I moved into action.  The instructor from my mental health class told us to always keep ourselves between the patient and the exit to the room.  Just as this patient reached the door, my foot blocked her from opening it.  I did what I could to keep my distance but I was too close.  I got slapped a couple of times.  She then retreated momentarily and threw the toy that we had been using before the OTR walked out.  I asked her to pick it up and she headed for the doorway...which I was standing in front of.  She grabbed me and dug her nails into my arm.  Ironically...I stayed calm.  I pryed her hand off my arm and she did it again.  Then she threw a bottle of hand sanitizer and a box of kleenex.  She proceeded to throw a book and a small piece of plastic at me (though she failed to hit her desired target).  I was still calm but on the verge of losing my cool.  With patient's like this, we are told to have no reaction to the behaviors they display.  The patient is "looking" for the reaction and by responding, it will only get worse.  I'll have you know that I walked away from the treatment session, slightly shook up, but rather proud as well.  I still have claw marks on my arm, but the experience definitely taught me a lot!

Outside of that adventure, things have been very busy.  I'm treating around 6 patients a day as well as doing daily notes and progress notes.  I'm still loving every minute and look forward to each new day.  Nearly 5 weeks down with only 3 more to go.  Time's flying!

Busy, busy, busy!

What a week it has been!  I can hardly believe it's Friday tomorrow!  What I really can't believe is that tomorrow marks the end of week four...I will be half way done with my first site!!!

I've been treating a lot of patients this past week; especially the last two days.  Up until this week I've never felt overly stressed about getting my daily notes done.  Today hit and I walked into the office with a stack of charts waiting for me on my desk (yes...I have my "own" desk).  It's not like someone else put them there for me to do, I left them there on Wednesday night because I did not have time to finish them before I left.  Each time I sat down to work on notes, one of the OTR's would ask me to go work with another patient.  I did a total of 6.5 sessions today.  That's the most patient's I've personally treated in one day.  I wrote notes for 5 of these sessions, plus I had 3 notes to finish from yesterday.  I wasn't able to sit and catch up on notes until after my second to last patient around 3pm.

Despite being slightly overwhelmed, I've walked away from work each day this week feeling better and better about what I'm doing.  I feel like I am getting a pretty good grip on what I'll be doing for the rest of my life.  It's kind of funny to me that the one thing that I hated in school is what I'm the most comfortable doing at the clinic.  Passive range of motion (PROM) is the most basic way to make a huge difference in a patient's overall ability to function (at least that's how I am viewing it).  I've been hesitant to do PROM with a couple different patient's because of the complexity of the condition, but my OTR has been pushing me to do more and it's helping me build skills and confidence.

The other thing that I struggled with for a bit at school was doing transfers (to and from wheelchairs).  I thought I had mastered the technique at school so I wasn't too worried about it--until I had to do it in real life!  Transferring someone who is fully capable of walking and has normal muscle tone (even if they try to act differently) is not even close to transferring someone with high (or low) muscle tone with limited walking ability.  I'm struggling quite a bit with it and I'm really having to work on it so that I don't drop a patient!  My height continues to be a bit of a battle, but I'm learning to adjust how I do the transfers to make it work for my height.  I am sure my program director would be happy to know that while I may not always have proper body mechanics, I am at least thinking about what I should do before I start the transfer!

Tomorrow I will be going over my midterm evaluation with my supervisor.  I'm rather nervous/anxious to find out from the professional(s) how I'm really doing in the field! :)

Loving This!

I'm not sure I've said this or not...but I am LOVING this fieldwork experience!
I've been doing more treatment sessions this week.  Along with continuing treatment with the patients from last week, I've conducted sessions for a few other kiddos, mostly with Autism. Some of the sessions have been better than others, though "challenging" is probably the best word to describe how I feel about these sessions.  You make all these wonderful plans for the treatment session, and then the patient is having an off day so your plans go awry.  I guess if I've learned anything in the last few days, it's that my teachers were right when they said we will have to think on the fly!

As stated last week, I've been working on my catching/throwing and balloon hitting skills. It's turned into a bit of a joke with the staff at my clinic that I'm being graded on these skills so I really do need to work on them! This morning was an opportune time to do this very thing.  I saw a patient with Ehler's Danlos Syndrome (EDS) (super interesting diagnosis that I already know a ton about thanks to my old roommate who also has this somewhat rare condition).  He was full of energy so we played bowling, then basketball, followed by baseball.  He wore me out, but I had so much fun!

An update on my shoulder in regards to treating the 22 year old that has CP--I've done much better this week with finding better ways to help support him so that I am not injuring myself.  So, thankfully my shoulder is no longer in so much pain.  So that's the good news of the week! I think I'll end on that positive note!

Nearing the End of Week Two

Let's see if I can recap the past few days...

On Tuesday I was able to work with a couple more patients.  A young boy with cerebral palsy (CP) was my first patient in the morning.  He is a super funny kid to be around.  He always has something to tell you, he loves to tickle you, and 90% of the time he has some kind of super power.  My first time working with him on my own involved a lot of energy on his behalf!  He was so wound up and I was not able to get all my treatment goals completed.  It made writing the daily note rather difficult!  Which...speaking of note writing, he was the first patient I had to write a note about.  My supervisor didn't have me write notes for my patients on Monday.  It proved to be more challenging than I expected.
My second patient was a girl around 20 years old that also has CP.  She is non-verbal and doesn't seem to like therapy a whole lot.  She puts forth little effort and lacks motivation in a big way.  Regardless, I've still seen some improvements over the last two weeks.  She was kind of another tricky patient for me to see because her range of motion on the right side is so limited and she is non-verbal.

On Wednesday I got to see my very first patient from Monday again.  We worked on lot on seated activities which required a lot of physical support from me.  I feel like I've thrown my shoulder out from trying to help him maintain his balance on the edge of the mat.  At the end of the session, he requested that I transfer him back to his chair.  I was really nervous about doing the transfer because of his high muscle tone, but since he requested that I do the transfer, I went for it!  My supervisor showed me what to do and it was an overall smooth transfer!
After lunch, I went with my supervisor to do a session at a patient's home.  This little girl has a very rare diagnosis of D-bifunctional protein deficiency disorder.  She has very low muscle tone so the two main things that OT works on is doing some passive range of motion (PROM) as well as minor weight bearing through the upper extremities.  I watched my supervisor (who has worked with this 4 year old since she was 2 months old).  I was scared to even touch the precious little thing for fear of hurting her.  My supervisor let me finish up the shoulder PROM and just sit with her for a little while.  It was a very neat experience and I hope I get to go back and work with her again a few times before my 8 weeks is up.

Today involved another adventure with the two boys that have CP.  The younger one that I started with on Tuesday and was full of energy was significantly more mellow today.  I accomplished nearly all of the treatment goals during the session (which made note writing MUCH easier)!  I also worked with the older one who nearly knocked me to the ground on Monday and Wednesday.  I did better with him today and learned a better way to keep him stabilized but my shoulder still feels like it's going to fall apart.  We had another smooth transfer back to his chair at the end of the session and I felt pretty good about the session as a whole.
Later in the afternoon I worked with the cute little guy from Monday.  We got more accomplished than we did on Monday which made me feel good.  He's so easily distracted that he is hard to work with but he's adorable and I love working with him!

While I've only done a few treatment sessions on my own, I've been assisting with many more throughout the course of each day.  I have been working on my throwing/catching skills, my balloon hitting skills, and even my soccer skills!  I have learned how to play new games and I got to play on the swing a couple times too.  I'm absolutely loving this time of learning!!!

Treatments are Underway

I did my first two treatments today!  How did it go?  Well...it wasn't terrible, it wasn't great...it was a good learning experience, that's for sure and I'm happy with how it went overall.

My first patient that I saw is around 22 and has athetoid type cerebral palsy.  I've spent plenty of type watching the staff at my clinic work with him but he typically has high extensor tone and it made me nervous about how I'd be able to handle him.  Luckily when I started with him, physical therapy had already been working with him and they had just started a new activity to work on sitting balance.  I then worked on some reaching and core strengthening.  I assisted him with sit-ups.  Watching my supervisor and the other OT do this--they made it look so easy!  I nearly fell over when I tried assisting him!!!  I told him I was going to have to start working out at the gym just so I could continue doing his treatment.  He's such a good sport about dealing with me as a student.  I know that I'm going to learn a lot from working with him!

My second patient was the cutest little boy I've ever met.  He is around 6 years old and was diagnosed with agenesis of the corpus callosum (a rare birth defect in which there is a complete or partial absence of the corpus callosum).  My supervisor sat back and let me run the session.  It went pretty smoothly, all things considered.  He loves books and of course that is the first thing he wanted to do. After that we played on the swing for a little bit.  Next I had him copy some letters on the chalk board.  I realized I need to have a more structured activity if I am going to work on fine motor stuff.  The last thing I worked on with him was a three-step obstacle course.  Physical therapy had joined me at this point so we had him walk on a balance beam, jump over "stones" and hit a balloon while kneeling.  I hit the half way point of the session and that's when I kind of freaked out.  I felt like I had NO idea what I was doing and/or that my supervisor probably thought I was dumb for doing the things that I did.  I felt a lot like I did when I was doing practicals at school...unprepared and nervous as all get out.  I pulled myself back together and finished strong.

I have no idea who I will be seeing tomorrow.  I don't think either of the patients I saw today will be there again tomorrow.  I'll walk in the door, check the schedule and hopefully not freak out about who my supervisor puts on my case load for the day.  I think she's giving me 3 or 4 patients though.    Should be an adventure!