Wednesday, September 30, 2009

Outpatient

Finished third day outpatient, definitely learning a lot every day. Frustrated today because due to miscommunication - no one's fault - I ended up doing multiple forms for single evaluation when only one was needed - based on insurance. IE you do a Medicare 700 form (get used to that term) or you do a private insurance form. I was like ALL THIS DUPLICITY KILL ME NOW so I was relieved to discover it was accidental I did that and not something I'd have to keep doing!

I am enjoying all the learning....trying to get down the phrases about low load long duration stretch, increasing normalization of tone, increasing facilitation to X, inhibiting Y, and all the little things you have to write/do/say to make it very clear the services provided are SKILLED and not just like "He did some theraband, yo, it was awesome'. So I'm learned to be skilled. Can't wait for physical agent modalities course.

By the way, my friend Cookie Gimp wrote me to say he was confused as I said I wasn't certified, but according to him (meaning I didn't go google it or anything since I trust him) I said on my blog I was certified in 2007. If I said that I was confused - I took a several day COURSE in thermal modalities for certification, but never took the hours to receive actual certification (it was a required part of my school program and very generous and good - but I never got the hours in because I was never spending time in phys dys locations that did a lot of modalities). I know I was confused about how that worked originally.

Outpatient and inpatient really are two very different beasts....I like them both but I have a lot lot lot to learn for outpatient - like learning the names and how to do provocation tests for example. And it's not necessarily important I ALWAYS remember, so long as for example if I have a patient with bicipital tendonitis, I look up how to deal with it, how to treat it, the tests for it, etc so that I can treat better and diagnose better.

And - all my professors will roll over in their live graves - I did some minor evidence-based research yesterday, looking at articles in AJOT about sensorimotor versus therapeutic practice for best handwriting treatment as well as what type of underlying problems that slow handwriters tended to have. 

I need to sign up for PAMCA which involves a ton of paperwork since I work for the state department of labor, I need to put in request for a day off to make up for the Labor Holiday I worked, I need to fill out a housing request application (I want to try and get pet-friendly housing), I need to continue doing lots and lots of studying for outpatient....like reviewing the ulnar nerve distribution as to how it starts in the C8/T1 portion of brachial plexus....goes down the arm and into pinkie/ring finger etc....and being reminded of how pain versus paresthesias are in different spinal tracts so need to not lump them together as I tend to think of paresthesias (ie numbness, tingling) as pain. 

Learned some median and ulnar nerve gliding exercises today....learned about bicipital tendonitis and rotator cuff pathologies, about "milking" massage to remove edema from hand, learned ways to prevent people from compensating while doing external rotation exercises (force them to hold a rolled up towel under arm so have to keep elbow by side), etc. 

Today was kind of an "off" day in sense I had that frustrating day of repetitive paperwork and then I came home and vegged out/napped instead of working out/being productive....and I made conscious choice when leaving work today to not take any stuff home to study tonight.....my roommate Christy, a PT, made delicious veggie quesadillas and corn/black bean salsa for me and Jamie SLP and her friend Derrick so that was a nice dinner but also "off" since we don't normally eat dinner together....basically everything about today was abnormal.

Tomorrow will be semi- abnormal as well as after work we are going to a "Taste of Newnan" which is some kind of barbecue or chili cook off, I keep hearing conflicting reports, but sounds fun. Newnan is town about 40 minutes away closer to Atlanta. By "we" I mean like half of Warm Springs population, hahaha. It will be the first time in over a month that I've gone two days in a row without working out :O Maybe if I get off early (I have some overtime so if I can leave early I will to avoid that), I'll work out first.....Ive discovered daily exercise is by FAR the most important way I can handle days with less stress, more energy. 

Tomorrow I get in at 730 to finish writing up an eval, hopefully I learned all my important lessons today (ICD-9 CODES ARE EVIL) so that it won't be such a frustrating exercise. We have patients most of morning and afternoon....

I do love being an occupational therapist...getting to say I am a therapist....getting a paycheck!....wearing a name badge and being part of an awesome institution....writing OTR/L.....getting to help people feel better in diverse ways....being surrounded by fun healthcare workers.....oooh the outpatient techs CRACK ME UP. Love them. 

Blah blah blah. If you read this all you must be really bored. I'm waiting to jump in shower after someone's laundry done. Good night!! 



Monday, September 28, 2009

First day shadowing outpatient...

I am totally applying, I'm excited at the possible opportunity. :) 

Today was shadowing outpatient - one to two weeks there and then start with my own case load across town. Reviewed and saw modalities (need to sign up for a PAMCA course asap in Atlanta so I can be certified in thermal modalities myself), scar massage, PNF patterns, leuko-tape, median gliding exercises, an eval, goniometry....lots to review! 

---------------

AOTA Announces Leadership Development Program for New Practitioners

The announcement calling for New Practitioner Applicants:

http://www.aota.org/News/AOTANews/New-Practitioners.aspx

Sunday, September 27, 2009

OT Advocacy

Was very impressed to see a great article called "Blogging for Advocacy" by Alece Kaplan in the July 27th, 2009 issue of OT Practice, www.otadvocacy.com. Alece wrote about how she used her blog to advocate for OT (getting redundant here I guess lol) and some of the experiences she had and the people she reached! It was very informative and I was impressed with her descriptions of blogging for a cause. Great job Alece :)

Saturday, September 26, 2009

OT student life....lo

Hahaha it's funny because it's true...good post Kimberly (who is doing great in OT school!) Congrats. (And congrats to Wendy, Liberty, Carina, Kacey, and several others I'm blanking on, as they continue on their OT student journey...)

Thursday, September 24, 2009

Life as an OTR/L is fun here in Warm Springs...

Well I continue to learn new things every day about evaluations, discharges, treatment ideas...tons of treatment ideas I've been writing down. Need to share, perhaps this weekend. Learning more about manual muscle testing, PROM, AROM, adaptive equipment, durable medical equipment, and so forth. Tomorrow is my last day inpatient - next week I start outpatient training, then week after that different (final placement) outpatient, but I'm guessing I'll still be around in various areas as needed for a while, I dunno. I love being an occupational therapist but I still feel very much like a student. I hang out with the students too.

Tonight I went over two cottages to the student cottage where several OT students, PT students, rec students, and me the sole employee, lol, watched Grays Anatomy season premiere. We were all either texting or on laptops throughout - I've historically spent so much time hanging out with older people than I am always amused to spend time with my own age group and see how similar we are in some ways. There was some sugar-free fudgesicle eating + some light adult beverages...interesting combo right? Then Tana, PT student/pseudo mother, made chocolate chip banana bread which she let us all try....it was meant for work but the stupid student cottage oven doesn't do so well so maybe some (more) of it will end up in my tummy. my tummy cries for sweets and can you blame it?

I've been semi stressed out on and off - sometimes REALLY - and had one really bad day where I cried a lot after work - but overall it's usually pretty fun and interesting. I love spending time with my patients and I really enjoy it when I get to spend one on one time with them. I love seeing little miracles, love seeing progressions of people coming in max assist and leaving a few FIM scores higher....lol...I learn a lot from my patients. I think OT schools should include some BASIC courses on motivation and listening, hope, grief, etc - like when patients are having a hard day and feel bitter or depressed, how to best handle that...

It's neat signing OTR/L....neat getting to refer to myself as a therapist...and I'm definitely loving living on this rehab campus with a 2 minute walk to work and 2 minute walk to gym and a 1 second walk to many friends/coworkers in healthcare who live here as well. 

I do miss Memphis though, I still don't feel like I live here....that will take time. I moved here August 23rd so my one month anniversary was yesterday.
Welcome to Georgia Karen....
PS: I'm sure you guys have noticed erratic blogging blizzards....basically my computer is super slow on campus so I rarely post much as I can't get on much or easily here compared to my previous Memphis internet levels.....but when I go to coffee shop that I started visiting this week, its normal-fast so I can try to whip out everything I'm behind on. Still a long way to go but did manage to deal with about 70 e-mails this week...only 100+ more to go....

This weekend will hopefully be nice. In prep for starting outpatient OT I am going to be reading up on orthopedic upper extremity injuries such as Colles fractures...things like transverse myelitis, medicare guidelines, etc etc...

Oh....and I've gotten some very neat treatment suggestions from a friend regarding "manly" treatments like stuff involving cars instead of, fluffy kittens. Hoping for more from people on treatment ideas in general...




Tuesday, September 22, 2009

OT schools similar, regardless of price?

Wrote a post on this recently, too lazy to relink, but here is another comment on it that came from a cross-post I did on OT Connections

A Comment has been posted to Transitioning from student to practitioner...: Opinion: Are all OT schools pretty similar? Cheap or expensive?:

I currently go to a fairly large university that is "moderately expensive". What I mean by that is I have heard stories from former students whose total tuition topped out at like $80,000 and others who said they paid $22,000. I am not finished with school yet but have came to the conclusion after all my calculations that my tuition total after I graduate is about $37,000. I believe that most schools, expensive or not are the same. I mean, they all teach you the basic entry-level skills needed to pass the NBCOT and gain employment out in the field. So why bother with the $80,000 school when you can gain a similiar education at another school for $40,000 less? Just some food for thought. :o)

I'm not the only imposter syndrome poster child, haha

Jo says: 
Hi
I still get that imposter feeling from time to time and I've been qualified 5 years. So does one of my nurse friends. We are waiting to be found out by our superiors that we don't know what we are doing. We do really know what we are doing but I think it's perfectly natural to doubt every now and then. It just means that you're developing and questioning how you do things.
Good luck with your new life in Warm Springs as an OT. I'm enjoying hearing all about it.

Jo (Community mental health OT, Northumberland, UK) 

Monday, September 21, 2009

OT blog blizzard temporarily complete

I posted a bunch of posts today...the easiest ones I could....went to coffee shop with fast internet for first time since move....of course its 7 miles away and only open until 8pm..lol.better than nothing....went from 163 emails to deal with to about 115....hope to go back within next week and cross out another 30-40....didnt necessarily deal with them chronologically so much as how quickly i could deal with it/how much thinking was involved....so blog readers/commenters....have hope, I still have a bunch more to go. Most recent, a few much older ones :x

Still have quite a few posts brewing ....am wishing I could post more about work but staying safe. I do start shadowing in long-term acute care tomorrow....I have enjoyed inpatient rehab but I think I'm more of an acute person when given the choice! Better than obtuse, right? Haha...

Anyway. yeah. More soon. Yay for all you recently-starting OT students....let me know how things are going...I'm guessing overwhelming...but I promise you can get through it! If you need a pep talk/morale booster really bad, e-mail me or comment...I can be a good cheerleader. IT WILL BE OKAY!!!!!!!!!!!!!!! 

Alright I'm up way past bedtime. Gotta be up in six hours. Good night. 

i like this advice from a friend

"Here's my best advice in regard to dealing with loose ends - tie a knot and hang on!"

malaysian OTs too

wow. trombly and pendretti in malaysia. lol. international.


 blog comment:
pendretti u guys use this book too wow, where do you study OT.i like pendretti too ,but i like trombly as well,what year are you in now.oh im an ot student tooo, but im from malaysia.nice meeting you. 

Claudia Allen...lol

An old blog comment that will only make sense to OTs with knowledge of Claudia Allen and her leather lacing test.

(blog blizzard time - at a coffee shop, fastest internt ive had in a month)

"Don't worry- you're not expected to reach a true 6.0 level until your mid-late 20's. Looking back, I must've looked like an idiot trying to do the Cordovan stitch in OT school at 22 years old. It's a very useful tool (and Claudia is HILARIOUS in person) as it gives you some concrete feedback for the patients' families on how to provide the care they need. Good luck- I LOVE practicing OT! Hope you will too. "

some manly OT ideas?

When dealing with manly patients who like hunting, shooting - and a gym filled with things NOT like that - need ideas on manly man stuff. The rec therapist printed out some trivia questions on manly stuff like motorcycles of a guy who like that stuff, then we worked on standing endurance and quizzed him on manly trivia....the idea below is copy/pasted from a friend of mine. Other ideas?


 Would, for example, he enjoy outdoor magazines?  I am wracking my brain for outdoorsy stuff.  There is a deer hunting video game.  I'll keep thinking.  Is there a range nearby and does he have relatives or friends who could check him out and take him?  One idea - get a three pound hand weight, rubberband a sharpened pencil to it with the point pointing straight up.  Put a six inch circle on the wall and have him hold it in one hand (or both hands) and raise it extended to eye level.  See if he can hold it for 15 seconds, put down and then repeat.  Mocks getting a sight picture and shooting a revolver."

Home Programs for OT

http://medicalcenter.osu.edu/Pages/index.aspx

  " The above is a great site for home ex. programs etc. " - former supervisor :)

OT Blog Comments

I just published 11 comments - they had been building up since my internet on campus is so slow - so I am going to stop moderating comments and just hope nobody goes crazy. I'll get a msg when I do get one though so I can try and keep an eye on them. 

So...keep commenting and now it will show up immediately.
Thanks guys for your patience! 
Or shall I say all y'all.
Karen

Any Portuguese (sp) speaking OTs out there?

If so I have a blog for you...

Hi Karen!
Hi there
>I'm an OT student in south Brazil and i'm the president of our Academic Centert and we are making one questionary to met the OT in other countries.
>This questionary will be published in our Blog(http://catoverbalize.blogspot.com/)and it will be put in the pin board of our university.
>Help us to met the OT!
=

Tuesday, September 15, 2009

hmm

Loving Warm Springs and this area! Work is definitely a challenge for me with my giant inferiority complex, but in general, things are going well. I get stressed out with it but luckily the gym is next door so that helps me a lot with stress relief! I miss my cat Lester a lot and of course miss my Memphis friends even more, but I do like this area. 

I'm working on learning more about spinal cord injuries, quadriplegia, debility, etc. It's hard to be occupation based and client centered at all times..but I did utilize the Wii bowling and air hockey table today! 

Sorry I do not write more. Still paranoid about saying things on here about work, plus my internet connection is really bad in this area. Plus I'm always really exhausted...about to go to bed once I shower even though it won't even be 10pm. :x 


hmm

Loving Warm Springs and this area! Work is definitely a challenge for me with my giant inferiority complex, but in general, things are going well. I get stressed out with it but luckily the gym is next door so that helps me a lot with stress relief! I miss my cat Lester a lot and of course miss my Memphis friends even more, but I do like this area. 

I'm working on learning more about spinal cord injuries, quadriplegia, debility, etc. It's hard to be occupation based and client centered at all times..but I did utilize the Wii bowling and air hockey table today! 

Sorry I do not write more. Still paranoid about saying things on here about work, plus my internet connection is really bad in this area. Plus I'm always really exhausted...about to go to bed once I shower even though it won't even be 10pm. :x 


Wednesday, September 9, 2009

a typical day as OT now...I need ideas.

First, to OTs/PTs/SLPs out there: I'm doing inpatient rehab - typical stuff like TBI, SCI, CVA, etc - if you have any cool treatment ideas please share!:)


Sorry for the quiet. I am so limited in what I write right now since I haven't checked in with employees yet to see what all is kosher.

I can say some things though!

I'm half-way through my first full week as an OTR/L. (Only had Thursday/Friday of last week). It's been a little chaotic because of some unusual circumstances, so I've definitely had to step up and do things earlier than expected. But all the staff - OTs, PTs, SLPs, techs, etc, are all sooo helpful and smart and awesome and supportive, so it's worked out well. I had two patients on Monday, 3 patients Tuesday, two patients today...mostly different patients each day! If you have 3 patients that means you see them in the morning for 45 minutes and in the afternoon for 45 minutes - so each person gets their hour and a half of OT a day required. So you see people 45 minutes x 6 if you have 3 patients. So that's a lot of treatment, not to mention all the documentation. Maybe that's actually nothing - but as a new grad with limited experience in this setting, it seems like a lot. The most common things seen in this inpatient rehab hospital - are pretty typical - traumatic brain injuries, spinal cord injuries, debilitation, hip/bilateral knee replacement, strokes of varying severity...a lot of them have comorbidities or low vision so that all adds to it!

I've gotten experience with bathroom transfers requiring 3 people and lots of adaptive equipment (bedside commode with drop arm, sliding board, gait belt, etc)...picking up tricks from the experienced therapists on how to fasten adult diapers on a person while sitting on the toilet (attaching it like underwear) rather than waiting until they stand up, if they are pretty dependent....how to set up wheelchair to toilet or mat or bed most effectively and how to hold the person best...how to use an airsplint...etc etc. 

I have heard people talk about imposter syndrome and it's true...every day I'm like AUGH I'm such an imposter! I have my license, did everything I'm supposed to, but I still don't know much!! But maybe I know more than I think...nobody has any complaints at least and I'm told I'm doing well! 

I got to see a therapy dog in action....pets really can make amazing differences! 

The best part of all this is living on campus...walking out my door for 3 minutes to work....and then after work going 3 minutes the other way to the recreation center....the gym, the track, nature trails, ping pong, pool, weight room, etc....been going every night with few exceptions....I think I've gone about 6x a week the last few weeks! I go with another PT student, Tana, who lives down the road in a student cottage (her sister was an OT student here 10 years ago who now works with my former classmate Becca in Chattanooga - small world) or the SLP roommate, Jamie, or by myself! 

Today at the gym after work a lady came in to do elliptical and she hadn't done it before (we were chatting) and I totally instinctively like guarded her as she got on, I was like sorry it's the therapist in me coming out! LOL.

Um...this is long but I'm trying to write a lot to give all the info and make up for lost time! I'm about to shower/eat dinner then go study for about an hour....brainstorm tomorrow treatment ideas etc.

Okay so a typical day...
Get up 640am fully prepared for day so can be out of house by 720....walk in by 730....check schedule...
start ADLs with someone up anytime until 9am...
9am to 945, 945 to 1030, 1030 to 1115 is treatment times...
then documentation time....
lunch 12 to 1230....if time lol.
1230 to 1- documentation
1 to 145, 230, 315, treatment time...
315 to 400pm, documentation....ideally leave by 4pm to not have overtime.

430ish or 5ish to 6ish or 7ish...go to gym...or walk on trails or whatever...
8pmish to 9pmish...study...
Chill in between those times...
Go to bed by 10 30pmish....soooo tired!

It's hard being a new OT and everything being new!! I'm on high alert all day and it exhausts me! I just want to try to sleep away the afternoon/evenings but I know that's the worst thing I could do so I do so much time at gym! It's been good for me. I'm typically high-strung with new situations like this but I think all that time at the gym has really helped me handle things.

I kind of get nervous/scared when I head into work in the sense that, well, duh, I'm freaked out about not knowing everything or even close...but I need to remember how much I've learned just in 5 days there...so...hopefully can continue! 

ANYWAY....wow this is long. 

It's cool living with a PT and SLP too...and having a PT student friend...etc...
Um....

Okay I'd better get hopping. I might share some of my treatment ideas here soon!!



Saturday, September 5, 2009

first week down

Monday I just observed a few hours. Tues/Weds general orientation all day. Thurs/Fri my first two full days as OT! So much to share yet can't lol. Everyone is awesome though and so is the facility and patients. 

Fun though. Love living on the campus with the recreation center next door. Got to play air hockey and ping pong and go on walking trails near forest/lake and on outdoor track dodging deer and indoor track and weight room etc etc! With my fellow PTs/SLPs! Fun stuff!! Plus last night watched Warm Springs the movie with a PT student. 

TODAY, we are participating in the special Labor Day weekend celebration where once a year they refill the pool with the waters and allow the community admission! Me, SLP & her husband, and PT student, are going for the 10 to 1130 slot ....these are the bouyant waters that made such a difference to many people with polio way back when. 

Rest of plans for weekend include going to the gym, doing lots of OT study/review, especially of anatomy and the more technical stuff, brainstorming ideas on what to do - we do have air hockey, skee ball, a gardening area, etc for the patients so that is awesome - and then just chilling with various people or whatever.

My new motto when tagging along for just about anything is "It's Warm Springs - what else am I going to do?" lol. 

I love the quiet campus...just the chirps of bugs and frogs at night...love its beauty...the sunset over looking Lake Dream....love all the recreation opportunities next door to me, love walking to work just a few buildings down, etc!! 3 minute walk from my door to therapy doors.

I need to talk to HR or someone soon about blogging - so sorry I can't give details! I can say this week I've done some transfers, goniometry, hemi dressing techniques, maneuvering for dressing techniques for paraplegia, deltoid aid, and toileting etc lol....love being an OT :)


Tuesday, September 1, 2009

Day 1 of being a paid employee!

Day 1 of General Orientation was nice. Day 2/Final day of general orientation is tomorrow. There's lots of confidentiality rules etc so I will not be saying anything specific at all until I've probably talked to HIPAA people here and/or HR...I don't want to risk losing this job because of blogging things that seem to be safe but aren't! So whatever gets posted in next few days will be very vague if referring to work, and I'll try to stick to posting the things I said I would post and haven't yet. And now am too tired to do so, so perhaps tomorrow? :)

My goal for tomorrow is to not freak out big time tomorrow night in advance of my first REAL day, Thursday. So I'm going to go to the gym if it kills me to try and work off the stress. And do some review  of phys dys stuff like manual muscle testing, major anatomy, range of motion, etc etc.

I should do some tonight but I'm toooo tired!

Good night!!!