Love what you do!

Love what you look like...not right now....

2011-09-03T15:08:00.000-07:00

I'm having a rough time lately...

I had a conversation with one of my patients last week that went a little like this:
Mr. G: "Emily, are you expecting?"
Me: "No, Mr. G, not yet."
Mr. G: "Oh, just getting fat?"

Not kidding. So rude. But unfortunately, it's true. I've put on some significant weight and I'm pretty depressed about it. I was recently diagnosed with hypothyroidism. Thankfully, I have a pretty proactive doctor who is open to my ideas and doesn't think my research is crap. Unfortunately, what my research has revealed to me is that I have a more difficult condition to treat. I suspect adrenal fatigue and/or thyroid resistance. When we return from vacation, I'll undergo further testing to confirm.

If you know anything about hypothyroidism, it comes with a slew of crummy side effects. Constant fatigue, temperature swings, infertility, weight gain, etc. just to name a few. I used to get something out of going to the gym - not anymore. Now, I can hardly finish a 60 minute class and don't feel energized at all.

If you have experience with hypothyroidism, adrenal fatigue, or thyroid resistance, I'd love to hear from you and how you've coped. I could sure use someone familiar with all this right now...

Oh Sh*t!

2011-08-31T18:49:00.000-07:00

So, the ALS patient that I have is a pretty tech savvy guy. He's been working on ways to amplify his voice at work, since his volume is very decreased. Today, he brought in this FM transmitter that he had rigged to work through a regular radio. It wasn't working very well, so I suggested that we try out this device that I had been given at a conference.

The device I have looks like a fanny-pack, but it is a speaker you wear around your waist. It has a corded microphone on a headset that the patient wears. The patient then speaks into the microphone and his voice is amplified at his waist level.

Now, my patient has gotten quite used to his voice being soft. As he was leaving, I reminded him that he would have to get used to his louder voice. His balance isn't so good, and now he's using a cane. As he was leaving my office, he stumbled a bit - not too much though - and through his waist speaker I hear "Oh Sh*t" really loud! Needless to say, he turned down the volume just a little!

Oh the problems you encounter as a speech therapist!

This is why...

2011-08-25T17:36:00.000-07:00

Today I discharged one of my oldest (longest in therapy) and most favorite patients. She's one of my cancer patients who has done e-v-e-r-y-t-h-i-n-g I have asked her to do. She is one of the most dedicated people I have ever met and her hard work has paid off!

I prescribe facial and swallowing exercises for most of my cancer patients. Radiation creates significant fibrosis (scar tissue), so exercises help prevent and break up that scar tissue. My patient is so faithful in doing her exercises - she does them at home, in the grocery store, while driving, in the waiting room, anywhere. I love hearing her stories about how she does her exercises and all the funny reactions she gets!

I love working with my cancer patients! I was able to fully convey this to my patient today - on the last day she'll be my patient and the first day she'll be my friend. This is one of the main reasons I love what I do!

A Plan Worth Making

2011-08-23T18:24:00.001-07:00

Hopefully my renewed desire to blog lasts longer than a week this time!

I have so many plans for my life - plans my best friend would probably say I can't make. Remember, the only one with real plans is God. I've planned so much in my short life and am only now realizing that some of my plans were not laid well.

I have a new patient. Well, not really new to me, but new to my blog.

My patient has ALS and I helped him discover his diagnosis. He is young -too young. He has a daughter my age. He is going to die - very quickly, in fact. But he is so full of life.

I don't really have too much to say about my patient. His is a complicated story that ended in a shocking diagnosis. I want to write about him here because I want to remember him. Though I don't think you could ever forget a man like my patient.

Though my patient is going to die, his one desire, and current plan, is to get his daughter some things from Disneyland Paris, where I happen to be going in a few weeks, and surprise her for Christmas. Now, it would be so much easier to just order something on-line,, but that wouldn't be authentic. He devised this intricate plan of how I could get some things for his daughter, pack them up so I don't have to drag them all over Europe, and send them back to the states. He's thought of all the details - all the way down to finding the FedEx drop box for me to take the treasures to in Paris.

Of all the things he could be planning, this is the most important. I hope I can help him with his plan - it sounds like one God would agree with. My patient doesn't know this, but he has taught me so much already about planning - how the best laid plans never work and how the most out-of-reach things are worth planning for.

Toot Toot

2011-08-22T16:44:00.000-07:00

Wow - I need to update this more. Hopefully I can do better....

Life has been a blur lately - "too busy" seems to be the norm. Hopefully time will slow down a bit.

I'm still a speech therapist and I'm still the boss - managing 5 other therapists. Sometimes the boss stuff gets too overwhelming and I would much rather go back to the days of just treating patients. I love "just" treating patients. You never do this job for the recognition, but sometimes recognition is the little push you need to keep going.

Not to "toot" my own horn, but I was named the Employee of the Quarter for the entire Health System. Not too shabby for someone who has only worked there for 4 years.

I was named Employee of the Quarter because one of my patients wrote my boss a great letter about me. Again, you don't do this job for the thanks, but it sure does feel good to know people recognize how much time, energy, and personal investment you put in to care for your patients.

I love being a speech therapist. I love figuring out what is wrong with people and I love coming up with ways to help them. Most of the time, they've been written off by every doctor you could imagine and been labeled hopeless.

What I love most of all is working with my cancer patients. I developed a comprehensive head and neck cancer program where patients are seen by a speech therapist at the beginning of their cancer journey. They are followed regularly by someone (me) who has expert knowledge about head and neck cancer and its effect on swallowing and communication. They are referred to my by a wonderful, intelligent nurse (my mom!) who identifies them as someone who needs to be seen by a speech therapist.

The doctors may balk at the fact that my mom refers patients to me, but it is the best care out there and it is what got my Employee of the Quarter. Again, don't want to toot my own horn, but it sure does feel good.

My Favorite Little Devil

2011-01-06T07:04:00.000-08:00

I think I met my most favorite patient of all time - I'll call him Juan for blogging purposes. Juan is a twin and was most likely deprived of oxygen at birth. He looks nothing like any other members of his Hispanic family; he has a huge head, the thickest hair you have ever seen, almond shaped eyes, big chunky feet, and is the size of a seven-year-old though he is only five. When I first met Juan, I knew he must be mentally retarded - the way he was so friendly, called everyone "mama", and had not a clue that what he was saying made absolutely no sense. He became one of my favorite kids instantly.

The best thing about Juan, but unfortunately the reason why he had to come to therapy, was the way he talked. He literally sounded like the Tasmanian Devil - complete with his tongue hanging out and the hand motions to match! And it wasn't like Juan just turned on his Tasmanian Devil impression for certain people - he talked that way all the time and to every person he met. Everyone in the office loved working with Juan because he was so compliant and fun - and you got to practice your Tasmanian Devil impression (complete with hand gestures!). Juan did progress in therapy and was eventually able to functionally communicate but always seemed to go back to his Tasmanian Devil voice. I wouldn't blame him either, it was the best voice ever!

"Lots" - read "more" - Time on My Hands

2011-01-05T21:13:00.000-08:00

I have definitely been MIA for quite a while, dear blog. My apologies. It's not that I don't have any good stories, it's just that I have been so swamped at work. There are no words to describe how busy we have been. But, that's not why I'm back to blogging. I'm back to blogging, at least for the short-term, because I have a little more time on my hands and no time on my feet!

On Tuesday (1/4/11) I had my bunion on my right foot corrected. YEA! Well, not YEA yet, but hopefully soon. I'm off from work at least until the 12th (and maybe later, depending on how I feel) and should have plenty of time to update.

But for now, I'm in quite a bit of pain and am itching like crazy (thank you pain pills!) so I'll be attempting to sleep soon. Tomorrow I plan on telling you about my absolute most favorite Tasmanian Devil. Stay tuned!

Wise Beyond Your Years

2010-05-26T19:17:00.000-07:00

Since I was young, people always told me that I was wise beyond my years. Either that or they told me I was a 30-year-old trapped in a teenagers body. But that's not the point.

The point is that lately I've been feeling like I must be wise beyond my years. I have a patient and he is dying. He will probably die tomorrow or the next day. He is young; he has young children and a wife; he has a terrible disease; and he is in pain.

There are things worse than death and this man is living those things. His body is failing him but his mind is intact. He knows he is dying. He has accepted it. His wife has not. She grips to every fiber holding out hope that he will survive. But he won't and he knows that and he is ready to die.

I can't imagine being his wife. I can't imagine a doctor coming to me and asking me if I was ready to let my husband go. If I had brought our children to see their father one last time. I can't imagine....

But I have to imagine that. We all have to imagine that. Because you have to know what you would do in that situation. Have you talked to your spouse or your parents about a living will? Do you know what they would want. You have to do that; you have to know. You have to do it so that you can make those decisions for your loved one when they can't make them for themselves.

I was talking to this patient's nurse today. She lost her husband to cancer when he was 40. He was a nurse as well. She told me about the day before he died - they had a party. He joked with his friends and they celebrated his life. He was pain-free and at home. Had she not known her husband's wishes, how might he have died? Alone? On a ventilator? Without saying goodbye to his family?

If you have never asked your spouse or your parents what they would want in a situation like that, you need to. Do they want a feeding tube? Do they want a tube in their neck if they stop breathing? Do they want someone crushing their chest with CPR?

When I was talking to my patient's nurse she asked me how old I was. I told her and she was shocked. "When I was younger, I thought we were all invincible." "You are wise beyond your years to know that is not the case."

Please, go visit a hospital. If your spouse has never been to the emergency room or intensive care, take them. Show them what it is like. And then tell them what you would want them to do if you were ever the patient.

In a Funk

2010-03-27T15:39:00.000-07:00

I'm in a f-u-n-k. I need a vacation - big time. I don't know if it's work or home or a combination of both, but lately I've been feeling pretty pathetic. Now, remember, this blog is for me. So, when I post this list - a list of why I'm feeling pathetic at this particular moment - don't freak out and call my husband or parents. I'm fine - just in a funk.

I feel like a crummy wife.
I'm crabby a lot of the time.
I let little things bother me.
I have an amazing husband who takes such good care of me and sometimes I treat him poorly.
I feel like some of my friends put zero effort into our friendships.
I feel selfish that I want to make a lot of money.
I want kids but am terrified that I will be a crazy parent.
I worry about saving money but don't want to make the sacrifices required to really save.
I feel like crap when people call me bossy (which I am) and I don't know how to change that.
I'm scared about my depression and how that will affect me if/when I get pregnant.
I am tired - physically and mentally.
Sometimes I don't know why my husband stays with me.
I suck at life because I gossip too much.
It scares me to think that we might live in CS all our lives.
It hurts me to know that my husband isn't always compensated/acknowledged for what he does at work.
I hate that I can't leave work at work.
I'm pissed that my husband didn't like his birthday present when I thought that he would really appreciate it.
I feel like I have to put forth extra effort to smile and I feel fake when I do it.
I feel like I can't talk about my depression with my husband because he feels that it is a reflection of my feelings for him.
I just want to feel happy.

Now remember, this is a list for me. It just feels better to write it down.

It's all just trial and error...

2010-03-27T15:32:00.000-07:00

I'm at a Head and Neck Cancer convention this weekend in Houston and I've quickly come to the realization that a whole lot of what we (SLPs) do is trial and error, especially in the head and neck cancer population. Granted, I am learning a lot, but I am also learning that I've been doing a really good job at teaching myself how to treat these patients (not to toot my own horn, mind you).

I think that, even more important than the material you are taught, if you are taught how to find information you can figure out how to treat almost any patient population. Now, what I'm saying isn't rocket science or a brand new theory, but I think that people should know that it can be done with the information you already have.

Ok, I know this doesn't have much content, but for all my SLP readers (yes, I know I only have a few), I think you should know that you've got what it takes to help your patients even if you think you don't.

I just can't seem to find the words...

2010-03-21T16:39:00.000-07:00

I just can't seem to find the words these days to Blog about my work experiences. Whenever I see my patients I'm always thinking "I need to blog about this." but then never do. I need to start back up; it's good for me, it's good for my mind, and I really do enjoy it. So, enough with the pep talk and on to business.

I have been seeing a certain patient for quite a long time now. He has been hospitalized since January and currently resides in our LTAC. This man celebrated his 84th birthday in a hospital bed, which he will probably never leave. I think the one thing that makes treating this man so hard is that his mind is still so sharp. He is up to date on current events and has the quickest, funniest, wit.

I have been treating this man's dysphagia since he entered the hospital for a ruptured appendix (I know, weird combination - appendicitis and dysphagia). But, he has not gotten even the slightest bit better. I have been using VitalStim therapy on him and just recently forced myself to stop. He is still on a feeding tube and cannot take even the smallest bit of PO intake without sounding like a gurgle fish tank. IT JUST MAKES ME SO MAD! I love this little man and I cannot help him.

The other day, I had to have "the talk" with him. It's the talk that I am so good at giving but is truly terrible to give. It's the "your swallowing will never get better so you can now choose to eat and die or never eat again and live" talk. HATE IT! Anyway, my little man made it so hard to give that talk; his mind so clear and his wit so fast. And do you know what he said to me when I finished that talk? "So, should I call you the Obama death squad?!?"

Now that I cannot keep treating this man, I can barely stand to walk past his room. I know that if I enter just to say "hi" he'll ask when we're starting therapy again. I know I should go in, but it is just so hard. What do you do when you know you can't help someone?

Lots of new updates...sorry I'm a crummy blogger

2010-02-19T15:02:00.000-08:00

So, I've been really bad about blogging, as I'm sure you can tell. I started reading all of my blogs on google reader and have become so engrossed with them that I've neglected my own blog. Sorry blog.....

So, updates. We're buying a house! It is a new home that is currently being built. We've gotten to pick out the tile, carpet, granite, and fixtures. I'm really excited about it! We close April 15th. And, to top it off, our landlord is being nice and letting us out of our lease early! I'll have to post pictures soon. This does mean, however, that we've made the big decision to stay in College Station for at least the next three years (we want that tax credit!). We just had to come to grips with the fact that right now, this (our job situations) is the best thing out there. So, we bit the bullet and are putting down roots.

Other not so big updates....Mona is really growing on us. She is such a funny dog. I'll have to get Jon to post some videos of her. Some of her not so cute habits include sucking at potty training, **screaming** when she doesn't get her way, and gnawing on your toes with her razor sharp teeth. Hopefully it's just a puppy phase and she'll grow out of it.

Work has been going well. I have a few patients I need to blog about, but again cannot find the motivation. Stay tuned to see how that works out.

MONA!!!

2010-01-19T08:29:00.000-08:00

Well, we thought we would wait until April to get a new dog, but once we got back from our trip and came home to an empty house, we just couldn't stand it. We contacted our breeder, who graciously offered to provide us with another puppy for free, and picked out a puppy that we will bring home this weekend!

Her name is Mona and we are so excited she'll be joining our family! No dog will ever replace Toby, but we are so thankful to be receiving Mona, who I know will lift our spirits!

Quick & Healthy Chicken Enchiladas

2010-01-11T07:39:00.000-08:00

My husband rarely gets excited about something I cook, so I was shocked when we both loved this recipe for quick and healthy chicken enchiladas. Enjoy!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Chicken Enchiladas

This recipe can be layered to save time or you can fill each tortilla and roll in the traditional way. Turkey, pork, or beef can be substituted for the chicken, Top each serving with extra Mozzarella cheese.

2 cups cooked and cubed/shredded chicken

1 cup chopped onion

1 cup low fat Ricotta cheese

1 cup nonfat plain yogurt

2 oz. grated, low fat cheddar cheese

2 oz. grated, part skim mozzarella cheese

12 corn tortillas

2 cans (10 oz. each) enchilada sauce

Preheat over to 375 degrees. Mix first six ingredients and set aside.

Spray a 9-inch by 13-inch baking dish with non-stick cooking spray. Pour ½ can of enchilada sauce in bottom of pan. Follow either method below for layered or rolled. Bake for 20-30 minutes or until heated thoroughly.

Rolled Method: Place about 1/3 to ½ cup of filling on each tortilla and roll to enclose (cracks in tortillas are not as noticeable after cooking). Place seams side down in baking dish. Top with remaining sauce.

Layered Method: Follow this order: 1/3 of the tortillas, ½ of the filling, 1/3 tortillas, 1 can of sauce, remainder of filling, remainder of tortillas, remainder of sauce.

Yield: 8 servings

One serving: 1/8 of recipe

Calories per serving: 275

Fat: 7 grams

Disappointment

2010-01-10T08:15:00.000-08:00

Working in healthcare, I am always faced with disappointment. My patient's test did not go well; my patient is not working hard enough at home; my patient is just not strong enough; the healthcare system is broken and my patient pays the price. The list goes on and on.

Sometimes, disappointment is easy to brush off. It is a sad fact, but all too true. This past week, I had several disappointing situations. The most disappointing of all was that my coma patient got rejected by a brain injury rehabilitation facility.

He had a heart transplant, one of the grafts failed, he suffered an anoxic brain injury, they repaired the graft, he didn't wake up, he developed a non-healing sternal wound, he went to an LTAC and got no cognitive therapy, he came to our LTAC and I did the best I could with him, he was evaluated by a brain injury rehabilitation facility, he was denied because of his poor prognosis and length of time since injury (3 months), he will go to a nursing home with no therapy, he will ROT!

This is the broken healthcare system. I know it is broken, but my coma patient makes it all the more real. I cannot tell you how disappointed I am. And the worst part of all of it.....he has a brand new donor heart.

(Sorry for the depressing post...remember, I blog for myself as a personal record. Thanks for reading!)

Whirlwind Christmas "Vacation"

2010-01-09T07:47:00.000-08:00

Jon and I got back from our whirlwind Christmas "vacation" a week ago and we are still feeling the effects of such a draining trip. Individually, each destination was great, but roll them all together in a 10 day window of time and you do NOT have a vacation.

We started out traveling from Houston to New York (Buffalo) to spend Christmas with Jon's family. This was our first married Christmas together, so all the new traditions were being made. Before we were married, we decided to alternate Christmas each year and we're trying really hard to stick to that plan. We mostly just visited with family and relaxed. I did a little shopping with Jon's mom and we took his parents to the Melting Pot as part of their Christmas gift. I, unfortunately, still didn't get to meet Jon's brother, who didn't show up for the festivities.

The day before we were supposed to leave, we learned that Delta changed our flight to California and that we would have a 5 hour layover in the Atlanta airport. We called Auntie KK and she was nice enough to feed us and entertain us for a few hours.

We arrived in California for Morgan and Adam's wedding late. We picked up our rental car and it was pretty much non-stop from there. We helped Morgan get ready for the rehearsal dinner and Jon was even given the task of taking Morgan's wedding dress to the church! Not to brag, but we know we helped a lot and I'm sure the wedding wouldn't have gone so smoothly had Jon not taken on so much responsibility! The wedding was beautiful and the reception was fun; got to spend some time with old friends from college and make some new friends too. Jon even got an invitation to visit one of our new friends in Japan and go to Tokyo Disney.

Speaking of Disney, Jon wouldn't let us leave California without visiting the Mouse first. We spent December 30th and 31st at the parks. The 30th was cold and rainy and COLD!!! It was a good thing we packed our winter clothes for NY or we wouldn't have been able to stand it. Since it was already misting outside, we decided to ride Splash Mountain on the first day. I insisted that Jon buy us ponchos, and it was a good thing, because we got SOAKED! So, soaked in fact that it wasn't even fun. We ended up leaving the park, going back to our hotel room and drying our shoes with the hair dryer, putting on our winter clothes, and then went back to the park. The rest of the evening was pretty fun and we made sure to stay dry.

On the 31st, we knew the parks would be packed, so we made sure we had all the clothes we needed when we went in and knew that we wouldn't be able to leave. By 5:00 pm, the fire capacity was met and if you left the park you wouldn't be allowed back in. It was wall-to-wall people. Everywhere!!! They even made a majority of the walkways one-way. By 11:00 pm, we'd had enough "fun" and were ready to head back to our hotel. We had an early flight home and were in bed by midnight. Happy New Year!

We finally made it back to Texas and are so thankful to be home!

Coma Stimulation

2009-12-18T19:07:00.000-08:00

I got to do something really cool today. Multisensory stimulation for disordered consciousness, also known as coma stimulation. We have a man on our unit who is in a "coma" after an organ transplant mishap. There are different levels of consciousness, which is why coma is in quotations. This man is actually not in a coma, he is in a vegetative state. Surprisingly, a vegetative state is a better level of consciousness than coma. It is not, however, the greatest state to be in.

I've never done multisensory stimulation before, but went to a presentation on it at our national convention. The presentation was very informative and had demonstration videos. The unit that I work on is not a brain injury unit by any means, so I felt sad that this man was getting no kind of arousal therapy. Hence, my eagerness to try multisensory stimulation.

Though my man didn't magically wake up, which is what all the nurses thought would happen, he did show some promising signs of arousal. Multisensory stimulation doesn't have much research behind it yet, so the techniques can seem a bit strange. Have you ever scrubbed a patient with a ScotchBrite pad or pricked their toes with a seam ripper? Yeah, me either until today. But, it was pretty cool to see the responses those techniques elicited. I'll keep you posted on his progress.

If any of you speechies would like a copy of the presentation, just let me know!

Goodbye Baby

2009-12-15T19:38:00.000-08:00

Our beloved Toby went to dogie heaven on Saturday. He was exactly 6 months old. Who knew you could fall in love with a dog so much so fast. My heart is in a million little pieces just thinking about how much I miss him.
Toby was sick ever since we got him. He got a tape worm 2 weeks after he came home with us and things just went downhill from there. He got giardia after that and was never able to shake it. Over the past 6 weeks or so, he started losing weight and not acting like his happy self. We initially thought it was just another bout of giardia, but it was much worse.He was supposed to have "little boy" surgery on Tuesday. We took him to the vet early in the morning and had a feeling that he wouldn't be able to have the surgery, since he obviously wasn't feeling well. The vet called us later that morning to tell us that he was in pretty bad shape and was septic. His white cell count was 600 (normal is 7,000 to 10,000) and he had zero infection fighting cells.We spent the next 5 days trying everything we could to nurse him back to health. He spent a few days with the vet but came home with us at night. We had to give him subcutaneous IV fluids, antibiotic shots, and try to get him to eat. He was just skin and bones. I took off work on Thursday to take care of him so Jon could get some work done and I'm so glad I did.On Friday, I knew he still wasn't feeling better. Jon took him to the vet and he stayed all day getting IV antibiotics. His white cell count had improved to a measly 900. I met Jon at the vet with my mom and we told the vet we just wanted to take him home.We spent his last night letting him eat peanut butter toast and sleep with us under the covers. It was a very sleepless night and we thought he would pass several times. In the morning, my family came over to take him to the vet with us. He rallied a bit and at a whole piece of peanut butter toast and walked around before we left. His increase in energy and eating gave us a bit of hope, so we had his blood drawn again. His white cell count was only 1,300, even after strong antibiotics. His leukocytes were also misshapen and immature.
It was then that we knew it was time to let him go. With my family surrounding us and Jon and I holding him, he went to sleep and was finally not suffering.Jon and I are taking it pretty hard. We cry a lot. It just baffles me how much we love and miss him. Though he was just a dog, he was our family member. We love him so much and miss him terribly. Please pray for us for healing, especially for Jon.

Funny Patient Quotes

2009-12-04T20:58:00.000-08:00

Patient sitting in an ancient wheelchair in my office, looking very uncomfortable.

(Me) Are you in pain?
(Pt) Yes.
(Me) Does your bottom hurt?
(Pt) Yes.
(Me) Is there anything I can to do make you more comfortable?
(Pt) You could rub it.

Patient just admitted to our unit. Another patient, down the hall, is screaming.

(Me) Mrs. H, You're in the hospital. Remember, you had surgery.
--Blank stare from the patient, who looks very scared.
(Pt) Am I on the maternity ward?

Warning...Depressing and Morbid Post Ahead

2009-11-15T14:39:00.001-08:00

Well, the last few weeks have been very rough at work. We rotated positions, which happens every six months, and I am now a floater again. My main responsibilities are to my cancer patients, the LTAC, and then to the hospital, if I have extra time. In these first two weeks, most of my time has been spent on the LTAC, where EVERYONE IS DYING!

Working with old people who have dysphagia, we know that death is a very real possibility. However, it is very rarely staring at us at the end of the hall. In the last two weeks on the LTAC, two of my patients have died, one has coded and gone back on the ventilator, and one has aspirated and gone back on the ventilator. Ick...

I was on the unit when one of my patients died. Though she was 85, her family had still not decided to make her a DNR - Do Not Resuscitate. Friends, I highly encourage you to discuss "code status" with your parents and loved ones. When an older person codes and is resuscitated, the physical trauma their body endures is horrific and they usually don't survive anyway.

So, when my patient coded, they attempted to resuscitate her; they gave her CPR and shocked her heart. She had a trach, and from my position in the nurses station, I could hear the air rushing out of it every time they compressed her chest. It was the most awful sound. They had to continue resuscitating her until her family could be reached. The case manager makes those calls..."Mrs. XXX, your mother's heart stopped and we are trying to revive her. But you need to come now because she is not going to survive."

When they finally stopped, everyone in the nurses station just sat there. My patient was the second person to die on the unit during that week. It was just too much. Though I never really had any meaningful interaction with my patient (she'd had a stroke and was quite unarousable), hearing the air rushing out and knowing the physical trauma her body went through really shook me up.

I went to the chapel in our building and prayed and cried. She wasn't my family, I didn't really know her, but she was my patient. Being a Catholic, I know she is in a better place. Unfortunately, that only makes it a little easier to deal with.

A Big Scare!

2009-10-20T18:37:00.000-07:00

Well, Monday turned out to be the strangest day ever! I called the retinal specialists office on Monday and they couldn't see me until 3:00 pm. Until then, they told me I couldn't eat because I might be having surgery. I was super pissed that they couldn't see me earlier, so I was crabby all day.

When we went it, they dilated my eyes again and we waited for the doctor. He came in, took a good look at my eyes, and plainly said "You're fine. You don't have a detached retina." Of course, I was in shock, since I had been told I was for sure having eye surgery on Monday. The retinal specialist told me that what my eye doctor had seen was something I've probably had since I was a baby. It's called old peripheral retinal neovascularization and it happens when scar tissue forms from blood vessels breaking through the eye and then retracting. Since I wasn't a preemie, he said it probably happened spontaneously.

Though I am quite appreciative of my eye doctor's thoroughness, I think next time she should take a breath before jumping to such drastic conclusions. Nevertheless, I'm just thankful that everything is fine!

Head and Neck Cancer

2009-10-20T17:45:00.000-07:00

So I know I’ve been missing in action for a bit, but it’s time for a work update. I recently had the privilege to dive into a new area of speech pathology that I never thought I’d have the chance to experience, much less enjoy. …Head and Neck Cancer.

Our hospital has its own cancer center and through a series of events, we learned that their head and neck cancer patients were not receiving routine dysphagia/speech intervention. I ended up being asked to give a presentation to three oncologists and two radiation oncologists about speech pathology services for head and neck cancer patients. And, long story short, I know see all of our head and neck cancer referrals.

At first, I thought it would be a depressing group of patients to serve, but I’ve actually come to like it…a lot! I think the most thrilling part is problem solving for these people. They’ve been told they have cancer and that they’ll need very invasive treatment to cure it. What they haven’t been told is that the side effects of that treatment may be worse than the actual treatment itself.

Could you imagine living a life where you have no saliva, where everything tastes like drywall dust, where you’re not hungry, where your food gets stuck in your throat and won’t go down, and where you neck is literally as hard as a rock?!? But, you’re alive!

My very first head and neck cancer patient (nasopharyngeal cancer) has been very challenging. At first, I had no clue what I was doing. I read some books, did a lot of research, and then just had to go for it. Surprisingly, my patient has made some pretty significant progress and I couldn’t be more thrilled. She went to being totally dependent of her feeding tube to tolerating liquids to eating soft solids and swallowing whole pills! My speech pathology friends out there will know what a big deal this is!

I can’t wait to see where this new venture takes me. If you work with head and neck cancer patients and have any good resources to share, please pass them my way!

Nervous!!

2009-10-18T19:34:00.001-07:00

So, I thought this weekend was going to be a relaxing weekend at home, but alas, that never happens. Jon’s friends came in from Austin to go to the Renisance Festival with Jon while I planned to get some things taken care of at home. One appointment I had was with the eye doctor. I know, an eye doctor who makes Saturday appointments is awesome!

At 11:00 am I went for my appointment. My new doctor was very through and quite nice. They had this fancy new machine that can take a picture of your retina instead of having your eyes dilated. Of course the fancy eye camera is not covered by insurance and is an extra $40 bucks. So, I opted to have my eyes dilated. After she dilated my eyes, I had to wait about 20 minutes and then have her re-exam my dilated retinas.

As she tested my right eye, I could tell something was wrong. She would have me look to the right several times, check another direction, and then have me look right again. When she was finished, she let me know that I had two holes in my retina and that it was detaching from my eye. SCARY! Being in healthcare, I know what retinal detachment means. My doctor wasted no time in conveying how serious my condition was (retinal detachment = blindness) and quickly explained how I would be visiting the retinal specialist on Monday.

Needless to say, I’m a little freaked out. My eye doctor told me that retinal detachment is common in people who are very nearsighted (me!) and in people with diabetes. So, in addition to visiting the retinal specialist, I also have to be tested for diabetes. UGH!!! I’m not quite sure what Monday holds, but my eye doctor said I’d probably have laser surgery tomorrow, if not very early next week.

So, please pray everything goes well. Oh, and go make an eye appointment!

Toby

2009-09-25T15:50:00.000-07:00

So, our first order of married business was getting a dog. We didn't think we would get one so soon, but Toby found his way into our life and is here to stay. Toby is a French Boston (half French Bulldog, Half Boston Terrier) and is the cutest thing you've ever seen!

Cuteness, however, does not make up for extreme sickness. We are praying that Toby will one day be healthy. We'll let you know when that day comes because we are waiting for it with baited breath. About 2 weeks after Toby came home with us, he got a case of Tape Worms. How did we know it was Tape Worms? Use your imagination. Then, he got a nasty case of Giardia, which we are still fighting. At the tail end of his Giardia sickness, we had to go to a wedding in PA and had to board him. And of course, when we picked him up from the kennel, he had a sinus infection. So now we're dealing with green doggy snot.

Who says dogs aren't good practice for kids?!?! (Not that we need practice anytime soon!!!)

So, for your viewing pleasure, I give you Toby Jarvis!

SEX....and "until death do us part."

2009-08-17T16:55:00.000-07:00

So, I haven't blogged about work in a while and it is high time I reported another funny story. This happened a few months ago, but it is definitely worth telling.

We'll call my patient Mr. Yellow. Mr. Yellow is a pretty unlucky man. He's had diabetes since age 10 and now, at age 59, his body is giving up on him. Mr. Yellow has a wonderful, wonderful wife. I have never met a woman so devoted to her husband. When I first met Mr. Yellow, he was in the hospital for aspiration pneumonia and had developed dysphagia (swallowing problems resulting in food going down into his lungs) with no known cause. I had explained to Mrs. Yellow that we had a therapy (VitalStim) that retrained the swallowing muscles. We've had great success with this therapy on people who've had strokes, but I couldn't promise her it would work on her husband.

Now, Mr. Yellow has been too sick for many years for Mrs. Yellow, who still works, to take care of him. So, he lives in a nursing home. Mrs. Yellow comes and visits him everyday. When I told her about VitalStim, I informed her that it would be quite difficult to get Mr. Yellow's nursing home to bring him to therapy. Mrs. Yellow told me she would do everything in her power to get Mr. Yellow in for VitalStim therapy.

So, a little time passed and Mr. Yellow finally came in for VitalStim swallowing therapy. Now, if you could see Mr. Yellow, you might at first think he was dead. Mr. Yellow's diabetes has blinded him, so he always keeps his eyes close. His diabetes has also caused him to loose feeling in his legs and back, so he is wheelchair bound. When you live in a nursing home, you get stuck using their crummy wheelchairs. Mr. Yellow's chair was quite old and usually jimmy-rigged in someway to make it work.

Mr. Yellow's diabetes had also decreased his auditory processing time. When ever he was asked a question, he took forever to answer and usually had to be reminded by his loving wife that someone had asked him a question. Mr. Yellow's responses were always very short, rapid, and to the point.

So, one day during therapy, Mr. Yellow was being especially quite. I asked him, "Mr. Yellow, what are you thinking about?" He didn't respond. Usually when he didn't respond, I'd move the conversation in a different direction and brush off his non-response. This time, however, Mrs. Yellow said to her husband, "Mr. Yellow, Emily asked you what you are thinking about?" Very loudly, and quite to the point, Mr. Yellow responded, "SEX."

I just had to snicker and ask Mr. Yellow if he might want another bite of pudding, which he did. Afterwards, I commented to Mrs. Yellow that her husbands response was a good thing and that at least he still had a passion for living. I'm sure my comments made her feel only slightly less awkward.

I'll never forget Mr. Yellow and his declaration. I'll also never forget Mrs. Yellow. She showed me what real love is and taught me the real meaning of "until death do us part."

Personal reminder...

2009-08-10T18:11:00.000-07:00

This is a reminder to myself to blog about sex. No, it's not what you're thinking. Stay tuned to hear the story!

I got married!

2009-08-05T18:01:00.000-07:00

Jon and I got married on Saturday, July 11th! I can't believe the day has already come and gone. I just barely held it together walking down the asile and after that, the whole day was smooth sailing. Well, except for the heat! Here are a selected few photos. Enjoy!

Two of my beautiful bridesmaids.

Dancing with my dad.

My co-worker Marie, Jon, and I.

More updates and pictures to come soon!

I'm Married!!!

2009-07-30T18:04:00.000-07:00

So, I'm married!!! Lots of changes going on, so lots of updates coming soon!
Here's a preview:
1) Got married
2) Moved into a new rent house
3) Getting a puppy
So, stay tuned!!!

Wedding Worries

2009-06-09T17:42:00.000-07:00

I have really been slacking in the Blog department lately. I guess that's what a crazy work schedule and wedding planning will do to you. As of today, we are T-minus 32 days until the wedding. And, if you ask Jon, I am a freaking basket case.

I am in no way worried about getting married. I am worried about the following (in no particular order):
a) all the people who haven't RSVPed yet,
b) contracting a sickness during our honeymoon,
c) my newly debuted icky skin,
d) moving the weekend after the wedding,
e) being cash-strapped, as Jon calls it,
f) my future mother-in-law liking her gift,
g) my mother going overboard with the centerpieces,
h) my photographer possibly not showing up on the big day,
i) renting a U-Haul the day we get back from our honeymoon and transporting Jon's non-matching washer and dryer down the stairs by our selves,
j) my stupid leg and the fact that it is still swollen like a softball,
k) screwing up our first dance over which we have almost killed ourselves learning,
l) my mom's rule that we can't open wedding gifts until after the wedding,
m) Jon's only brother actually showing up for the wedding (I doubt he will, which makes me very sad for Jon),
n) how to make my mom understand that I don't care how the centerpieces are arranged,
o) Jon's family showing up 2 hours before the actual wedding rehearsal,
p) my Dad accidentally tore a hole in my veil,
q) getting my legs waxed,
r) somehow missing something we were supposed to do for marriage preparation,
s) not getting to eat all our yummy food or cake on the big day,
t) relatives getting drunk and making racist comments,
u) my sister's bridesmaids dress not fitting,
v) my mom demanding the florist make me a new wedding bouquet because my mom doesn't like it (but I do....),
w) not being able to kneel during the ceremony (see worry about stupid leg),
x) our luggage getting lost
y) my Dad's health and work stress level,
z) having my family pack boxes while I'm in another country in an attempt to "help" the moving process.

Ok, so, maybe a full alphabetical list is a little much, but it's the truth. My biggest worry is that I can't sleep. I have so many wedding and work thoughts running through my head that I lay awake and wake up having had very strange dreams. I just pray that I don't crash and burn.

Throughout this whole process, Jon has been my level foundation. I baffles me the way he can anticipate my worries and already have a plan in place to calm me down and take some of the burden upon himself. He truly is the person God made just for me. And that is the one thing I never worry about.

How to Help Someone Fall

2009-05-18T17:51:00.000-07:00

Sorry I've been MIA lately. Wedding planning and working out has consumed my life. On the plus side, my knee is getting better every day! I even ran down the hall this week!!! Anyway...

So, you may be expecting a philosophical post, given the title of this entry, but, unfortunately, that is not the case.

Last Monday, I was unexpectedly scheduled to see a patient first thing in the morning. This was unexpected because I was supposed to be in physical therapy. But, that's a whole other story.
Anyway, I went to see my patient, who was new to me. The patient was sitting in the dining room finishing her breakfast. I asked her if she knew her therapy schedule and she just gave me a blank stare. Ok, I thought, this is going to be interesting. The patient had a gait belt on and had her rolling walker, so we got up and walked to the schedule board. My patient had quite a hard time reading the board and I had to give her lots of directions in order for her to figure out her schedule. Again, I thought, this is going to be an interesting (and long) session.

So, I'm holding on to my patient's gait belt and we walking back to her room. She isn't paying attention very well and completely walks past her room. I cue her to look up and she turns around. We enter the door way, and out of the blue, she starts sitting backwards....ON ME!

I start yelling for her to stand up, but all she does is "OOOoooowww" and keeps going down. I don't know how I did it, but I used my How to Help a Patient Fall training and braced her against the wall as she kept sinking down. Mind you....THE PATIENT WEIGHTS 300 LBS!! So, I end up on one knee (the good one, thankfully) with the patient resting against me when the patient falls asleep! And not just dozing....snoring!!!

So, here I am, with my sleeping patient resting against me on the floor, thinking "Great! This is going to be a mountain of paperwork!", when I realize that I have to get her off of me. So, I starting yelling down the hall and the nurse and doctor come running. I ensure them that my patient has not hit her head (mind you, she is still asleep on me) and that I am ok. The doctor and nurse go back and forth about why my patient is so out of it and finally decide that she received too many sedatives. Geeze, you think 4 Xanax and 2 sleeping pills in 10 hours is too much?!?! It is decided that the patient doesn't have to do therapy and that she should go back to bed and sleep it off. Definitely a good decision, considering she's still asleep ON ME!

The doctor and nurse disperse and I am left still sitting under the patient. Thankfully, a physical therapist showed up and got the patient off of me. After I filled out all the redundant paperwork, the director of nursing asked me to demonstrate the technique I used to lower the patient to the floor without injuring myself or the patient. I compliantly demonstrated to which the DON responded "Wow, I guess that junk we teach you really works!" Thanks...just the reaction I was looking for!

Called To Serve

2009-03-31T18:34:00.001-07:00

I've had the title of this blog on my to-do list for a long time. When I had a free minute, I would look at it and just not be ready to write about it. I'm ready now.

When you are able to do something you love, actually change the outcome of a person's life, and serve the Lord at the same time, you have found your calling. I know I've blogged about this before, but it must be restated. I can honestly come home from a grueling day at work, of which I have surely complained, and still feel like I have served the Lord.

Like I said, I've been wanting to write this for a while, but today I had to. Today was one of those days where I felt the Lord working inside me. We have been so busy at work lately. With the economy in the toilet, more and more people are skipping out on preventative health care and are ending up in worse shape at our hospitals. That means we've been swamped. The volume of our adult caseload has increased at least 50% in the last two months alone. But, I digress...

I work for a non-profit Catholic hospital that serves patients from the minute they roll into the emergency room until they go home or die. Unfortunately, because I deal with swallowing, a lot of my patients die. At 25 years old, I check the obituaries every day looking for my patients; sometimes I cry when I find them. And it's hard.

Part of my job is explaining to families that their mom or dad will never eat safely again. "I'm sorry Mr. H, the swallowing study did not go well and your dad isn't safe to eat anything. If your dad does eat, it will go into his lungs and he will get pneumonia and die." I hate having to say those words to a family. Not only do I have to tell a family that their loved one can't eat safely anymore, I also have to tell them that they have a decision to make: let your family member continue eating with the understanding that it will kill them, or take away their only pleasure in life and keep them alive.

I think having to make the decision on whether or not to let a family member continue eating is even harder than making the decision to pull the plug. When a family decides to pull the plug, the disease process is final, their loved one's body is gone, and the grieving process can begin. When a family has to decide whether or not to let mom or dad continue eating, the consequences can result in a slow, yet dignified death or in a prolonged state of limbo. I tell my patients and families: "There is no wrong decision in this situation and I understand the consequences of both choices you are faced with."

I hate having to say these words, but I know God is working through me when I speak them because I am able to communicate this message well. Today, such a situation happened. I had to tell my patient's only son that his father would never eat safely again. I had to tell him that he had to decide what to do when his father asked to eat. I had to tell the son in the gentlest way possible, that his dad wanted to eat and it was time to let his father go.

I don't do my job for compliments, but people tell me, after witnessing the above conversations, that I do a very good job at presenting this information in a comforting, Christian way. That's how I know the Lord is working through me.

As I type these words, I can't help but cry. I cry for my patient, knowing that he will leave this earth soon. I cry for my patient's son, knowing that he will be without his only living relative and that in the process he may have to make the hardest decisions of his life. I want to cry happy tears too, because soon my patient will suffer no longer and he will be with our Lord; but I don't think I'm there yet.

I'm sure having to say these words to patients and families will never get any easier. But that's ok. I know the Lord put me here to deliver this information with the utmost compassion and respect for life. I know I can do that; I know that's why I love what I do; and I know that's how I'm called to serve.

I'm Pathetic

2009-03-04T19:40:00.000-08:00

Ugh, I feel so pathetic....I cried in physical therapy today. And I don't just mean a sniffle and a few tears, I mean full out hyperventilating water works. And, the best part....I work with all these people. Going into this surgery, I knew the recovery would be rough, but I didn't know it would be this rough. Case in point: I now use a crutch!

So, I went back to work on Monday and didn't use any type of assistive device; I just limped around. After work I went home and ended up falling in my house. Monday night was murder and I could barely get out of bed. So, I busted out the Pimp Cane.

I used the Pimp Cane for about half the day on Tuesday until another physical therapist offered to let me use a much cooler cane. Now, if your going to have to use a cane, it might as well be a cool one! So, out came the leopard print soft cane (pardon the picture...it doesn't do it justice!).

Well, I woke up Wednesday morning and reached for the leopard print cane and immediately dropped it....my hand hurt so bad! I actually bruised the palm of my hand putting all of my weight on the wooden handle of the pimp cane. And, to top it off, because I was using mostly my left leg to walk, I strained my calf muscle as well! I am just falling apart....

So, in physical therapy this afternoon, my physical therapist basically told me I really needed to be at home. Well, that's not happening. So, as a compromise, she issued me a forearm crutch. And boy, using it takes a lot of brain power!

Unfortunately, mine is not lime green. It is yellow and teal. We'll see what the consensus is at work tomorrow. Strangely, I've been getting called House lately....

Ok, enough venting for now. Thanks for all the support!

Addicted to Blog Reading

2009-02-27T11:15:00.001-08:00

I must confess that I am officially addicted to Blog reading. Every day after work, I come home and check every Blog I read for updates. Sometimes, when there are lots of new posts to sift through, I'll spend 2+ hours reading my Blogs. I love reading about people's every day lives, funny antics, and crazy cakes (see my Blog reviews below). If I read something particularly notable, I have even been known to talk about it at work. I know, I'm ridiculous!

I felt compelled to write this post because I read an especially awesome Blog post this morning. Kristen in California wrote about the Do's and Don'ts for Sending Racially Insensitive E-Mail Forwards. I loved this post because we've all been hit with these e-mails: You check your Inbox and your jaw drops. Why do people propagate this garbage! Anyway, her post is very insightful and worth the read. Check her out at: http://thehowertons.blogspot.com/

For those of you who would like to dedicate more of your time to Blog reading (like you really need to spend more time doing this!!), here are a few of my favorites that are definitely worth checking out!

Cake Wrecks: When Professional Cakes Go Horribly, Hilariously Wrong
I LOVE reading this Blog. If you need a good laugh, bookmark this page! The author, Jen, is an active poster who augments the reader-submitted photos with hilarious captions and stories. Check out the archives for posts such as Naked Mohawk-Baby Carrot Jockeys, Sexual Harassment Cake, Inspiration vs Perspiration, and When Bride's Have No Budget. Do be warned: once you start reading, you'll never stop! Now, go check it out: http://cakewrecks.blogspot.com/

And Your Little Do Too...
This is a great Blog if your looking for some fun, new recipes. The author, Kelly, is a girl I met in college. Her Blog is a well-written snapshot of her professional adventures, upcoming wedding, and two dogs. She also posts some really great recipes....like Black Bean Brownies. Check her out at: http://kellyandherlittledogtoo.blogspot.com/

The Paro Post
This is my friend Becca's Blog. She does an amazing job of sharing the daily joys and struggles of being a new wife and mom. She just had beautiful baby boy and I couldn't be happier for her! Check her out at: http://www.theparopost.blogspot.com/

Sarahenity NOW!
My friend from graduate school, Sarah, authors a very creative Blog full of awesome photography and inquisitive posts. Check her out at: http://www.sarahtopia.blogspot.com/

Traveling With The Thompsons
This is a Blog, written by my friends from high school, that chronicles their family's missionary preparation in Costa Rica. Once they have completed their preparation, Alison, Justin, and their daughter Cailyn will serve as missionaries in Peru. I love reading about their cultural and spiritual experiences in a country far from home; it is truly inspirational. Check them out at: http://thethompsonfamily.wordpress.com/

Mama Manifesto
This is a GREAT professional Blog co-authored by Kristen (of The Howerton's reviewed above) and Ali that offers practical advice and tips for busy, eco-friendly moms. These Mamas review products, share recipes, offer sanity-saving tips, share their own mothering mishaps, and nurture an on-line community of passionate woman. A fabulous read for mothers and future moms. Check out Mama Manifesto at: http://mamamanifesto.blogspot.com/

With this post, I hope you've found a few more places to spend your Blog time. If I've featured your Blog in my review and you're not cool with that, leave me a comment and I'll remove my review. Happy Reading!!!

Bored

2009-02-26T13:19:00.000-08:00

So, this whole stuck in bed thing is getting pretty old. I am feeling a lot better, but my leg definitely still hurts. I was really looking forward to taking a shower today (yes, do the math...I feel disgusting), but I have to wait until my mom can come and supervise...lovely!

Anyway, I've been working on wedding stuff and and reading a new book (The Money Book for the Young, Fabulous, and Broke by Suze Orman - highly recommended, even if your not broke), but my attention span only lasts so long. So, for your reading pleasure (and my sanity), a distraction, compliments of Morgan.....

Welcome to the 2009 edition of getting to know your family and friends (better late than never)!

1. What is your occupation right now?
Speech-Language Pathologist.
2. What color are your socks right now?
Light blue lotion socks, compliments of Jon.
3. What are you listening to right now?
Dogs barking outside me window.
4. What was the last thing that you ate?
Potato soup from Blue Baker for lunch.
5. Can you drive a stick shift?
Yes, though Jon says I ride the clutch.
6. Last person you spoke to on the phone?
Jon; he called to check on me and give me good news!
7. Do you like the person who sent this to you?
One of my best and oldest friends :)
8. How old are you today?
25 years, 2 months, and 25 days.
9. What is your favorite sport to watch on TV?
College football.
10. What is your favorite drink?
Non-Alcoholic: Cranberry Juice; Alcoholic: Margarita!
11. Have you ever dyed your hair?
Yes; went a little overboard with the SunIn in middle school!! Never again, though!
12. Favorite food?
Queso from Matt's El Rancho...Thank You Morgan!!!
13. What is the last movie you watched?
Monty Python and the Holy Grail...in preparation for Spamalot.
14. Favorite day of the year? D
efinitely Christmas Day.
15. How do you vent anger?
Unfortunately, I stew. And sometimes cry.
16. What was your favorite toy as a child?
Baby dolls.
17. What is your favorite season?
Winter.
18. Cherries or Blueberries?
Not in love with either, really. How about Raspberries!!
19. Do you want your friends to e-mail you back?
Blog back, maybe....
20. Who is the most likely to respond?
I would say Morgan, but she already did this thing!
21. Who is least likely to respond?
Well, considering I'm not tagging anyone....who knows!
22. Living arrangements?
By myself!!! But, not for much longer. :)
23. When was the last time you cried?
On Monday, when they told me they had to do the more extensive surgery on my knee.
24. What is on the floor of your closet?
Neatly organized shoes, luggage, and storage bins.
25. Who is the friend you have had the longest that you are this sending to?
Morgan
26. What did you do last night?
Talked to Stephanie, watched TV, and stayed up until 3am playing solitaire on my iPodTouch
27. What are you most afraid of?
Roaches....ahhhhhhhhhhhhhh!!!!!!!!!!!
28. Plain, cheese, or spicy hamburgers?
Cheese....everything is better with cheese!
29. Favorite dog breed?
Boston Terriers, but French and English Bulldogs come in a close second and third.
30. Favorite day of the week?
Thursday...best TV night.
31. How many states have you lived in?
Two...Kansas and Texas.
32. Diamonds or pearls?
Definitely diamonds!!! Sorry Jon...
33. What is your favorite flower?
Gerber Daisies, Tulips, and Roses.

There, that was a nice break!

Digital Scrap Booking

2009-02-25T09:47:00.000-08:00

I'm sure like many of you out there, I love to scrapbook. I've been scrap booking since I was a senior in high school, when we were given a year-long assignment to compile a scrapbook of all the significant things we experienced during our last year in grade school. Though it was my fist scrapbook, I can honestly say it is the best one I've ever made and I still have it. In that book are 9/11 newspaper clippings, my college acceptance letters, concert ticket stubs, and a whole slew of other mementos.

Though I love scrap booking and could spend days at a time doing it, the one huge downside is that it is SO expensive. When you're in the midst of creating a book, you never realize how much every little trip to Hobby Lobby for paper, and special scissors, and adornments, and stamps, and stickers, and pens costs. And don't forget the price of printing your pictures. By the time I'm finished, I could have easily spent $150 to $200 dollars.

So, given that I was in school and money was tight, I took a hiatus from scrap booking. That was the case, until I found.....Shutterfly!

Shutterfly is an on-line photo management sight that allows you to create tons of neat things with your pictures. You can create cards, magnets, mouse pads, calendars, coffee mugs, Christmas ornaments, and best of all....Digital Scrapbooks!

The digital scrap booking feature is awesome! It allows you to choose your photos, choose your layouts, choose your backgrounds, choose your fonts, and add all sorts of embellishments. The best thing is that once you create your book on-line, you can have it printed and delivered. A typical 8x8 book (the ones I always make) will run you anywhere from $25 to $80 bucks, depending on the number of pages you have. Now, that may seem kind of expensive, but considering that includes all of your photo processing, professional printing and binding, and delivery, it's a deal you can't beat. Plus, Shutterfly sends out TONS of coupons!

I've made four books so far from trips Jon and I have taken. I'm working on my 5th book, which is a favorite family recipe book. Surprisingly, Jon likes to help design the books too, so we've resolved to create a book after every trip we take.

For anyone interested, here is the latest coupon: Simply choose 20 photos to create your photo book and enjoy 20% off. Offer ends March 10, 2009. Promo code: BOOKSANDPRINTS

Recovering!

2009-02-23T20:28:00.000-08:00

So, my surgery today went well. However, we will definitely be postponing our wedding dance lessons until May. Rats...

I've been having knee pain and intermittent swelling since the day after Thanksgiving. Though no obvious, pinpoint, injury occurred, I am hypothesizing that I hut my knee either hula hooping on the Wii or in my step aerobics class. I think for my pride's sake, I'll go with the later explanation.

Anyway, I went in today so the surgeon could perform and arthroscopic debridement of my knee. Though I had no explicit tears, my MRI did show some plica (or junk as my physical therapist likes to call it) irritating my knee cap, which my surgeon would remove. The surgeon said that I might also have a ligament pulling my knee cap off center, and if that was the case he would have to perform a lateral release. I prayed and prayed that this would not be the case, but unfortunately, it was.

The recovery from a lateral release is much longer than a basic debridement. I'll be swollen and hobbling around (possibly on crutches) for 3-4 weeks and won't be completely healed for 3 months! And, it is apparently much more painful (though I'm sure the pain pills are skewing my perception of that at the moment!).

But, the silver lining on all of this is...

a) that the problem is fixed.

b) that the problem wasn't too serious.

c) that I'll be all healed for the wedding and the honeymoon!

d) that I got to spend more time with Jon and test drive his husband skills! (And don't worry, they're good!)

I'll be stuck in bed through Wednesday and will hopefully be back to work on Thursday!

The Length of Lent...

2009-02-23T20:12:00.000-08:00

As the liturgical season of Lent is quickly approaching, I am reminded of a funny story.

But first, a little background. Growing up, I was blessed with a strong (not radical) religious education. I went to Catholic school for three years and had parents who taught our religious education classes in addition to educating us in our faith at home. Attending religious education classes all throughout primary school was never really a chore and I feel very blessed to have parents who made faith education a priority. I believe it was my strong religious education base that made keeping my faith throughout college much easier, and for this I am very grateful.

So, when my mom asked me to teach religious education with her at our church last year, I agreed. Now, last year we had a very smart and outgoing group of 4th grade girls and all of our lessons were relatively easy to teach and explain. This year, however, it's taking a lot more effort and repetition for the information to sink in, which makes for some pretty funny stories.

Case in point:

A few weeks ago, we were studying the liturgical seasons of the church. We have a very active group of girls this year, one of which loves to answer every question, even though she rarely has the answer. I'll call this little girl Holly.

Me: Alright, who knows what the next liturgical season is?
Holly (jumping out of her chair): I do I do!!!
Me: Ok, Holly, what is the next liturgical season?
Holly (obviously reading from the book): LENT!
Me: Good! Ok, now, tell me about lent.
Holly: Um, I don't know....
Me: Ok, how long is lent?
Holly: 6 days!!!
Me: No. Lent is 40 days long. Can you tell me why lent is 40 days long?
Holly: Um, I don't know....
Me: Ok, Lent is 40 days long because that's how long Jesus was in the.....
Holly: WAR!

Now, I know I shouldn't laugh when they get a question wrong, but this one was just too funny and both my mom and I busted out laughing! At least Holly's enthusiastic!

Under the Knife

2009-02-22T19:33:00.001-08:00

So, tomorrow I go under the knife for knee surgery. It's an outpatient procedure, so it shouldn't be too bad. I'll be stuck in bed for three days, so look forward to many blog updates!

Wedding Update

2009-02-04T18:48:00.000-08:00

Here's the wedding update as of today, February 4th, 2009.....156 days and counting!

Because I like making lists, and the list would be far too long of the things I have already accomplished in wedding land, here is the list of what's left to do, wedding wise....

Confirm types of cake with our cute cake lady.
Solidify music selections for the ceremony.
Book hair and make up appointments for Bridal Portraits and Wedding Day.
Pick out specific reception songs.
Confirm floral order.
Give list of desired foods to country club.
Determine transportation arrangements for wedding weekend.
Officially sign up for dancing lessons.
Have wedding dress altered.
Complete Catholic marriage preparation requirements.
Order custom color M&M's.
Find a place to live!

Ok, I think that completes the list of things I need to do in a semi-soon fashion.

In other news, our honeymoon is completely booked and I am super excited!!! Besides all the romantic junk, we are going ziplining in the rainforest!!! Very excited, if you couldn't tell.

My Version Of A Not So Great Day

2009-01-28T15:24:00.000-08:00

Let me preface this post by saying that I know I have it easy. Every day at work I am reminded that I am healthy, I have clothes on my back, I have a job that provides me with a comfortable lifestyle, I have a family that loves me and cares about me, and that I typically never go without. This is usually in stark contrast to quite a few of my patients, who are obviously sick, may be out of work, might not have a family that cares about them, and may have needed many of the basic things in life.

I'm not complaining; just venting on the disappointment of today.

Today I got the e-mail I've been dreading. The e-mail was from the Journal of School Health and it informed me that my research manuscript had not been chosen for inclusion in the journal. For those of you who don't know, I spent a huge amount of time and energy in graduate school and 17 months after graduate school completing and preparing for submission my master's thesis on What High School Student's Know About Traumatic Brain Injury and Implications for Brain Injury Awareness Education.

I am disappointed my manuscript was not accepted for several reasons: 1) I devoted a solid 6 months of my life to surveying 336 students for my research project; all of it now for nothing. 2) I spent 17 months staring at my computer trying to figure out how to convey information about my study in print; all of it now for nothing. And 3) I am now no longer as passionate about brain injury as I once was, which is by far the most disappointing fact of them all.

Like I said, I'm not complaining; I could be far worse off. Even more than the disappointment, I think I am finally coming to terms with the fact that we all become jaded at some point in our lives. I'm disappointed that I spent all of that time working on my research, not that people won't get to see the research I did or understand why brain injury education is so important. That is jaded.

But, the good news is that now I'm passionate about other things...

The Magical Nose Pot

2009-01-24T08:07:00.000-08:00

Jon has been sick lately...last weekend he had the terrible stomach bug that is going around and this weekend he has a head cold. Ever since we've been together, I have told him about the wonderfulness of the "nose pot", as he calls it. The "nose pot" is a Neti Pot.

A neti pot is used to clean out your sinuses. As you can tell from the picture above, it's not a fancy device, just a little tea pot you stick up your nose. Well, Jon has always thought it was disgusting (and in some ways I agree with him) and had refused to ever try it. But last night, he was so stopped up that he caved and tried the neti pot.

And you know what he said....."That is the best thing ever! If I would have known it did this, I would have tried it years ago!" But isn't that what I've been saying all along!!! It's a good thing I love him!

Best Seat in Town

2009-01-12T18:30:00.000-08:00

So, I was at the hospital the other day and had to do a modified barium swallow study on a cute little old lady who had dementia. Now, people with dementia do say some pretty funny things, but this story takes the cake!

The cute little old lady is sitting in the modified barium swallow study chair, which is a tall chair that slides in between the radiology tower and the table (like being in a closet so small the walls touch your arms), waiting for the radiologist to come. Usually it takes the radiologist several minutes to show up, so I'm left entertaining my patients.

So, I'm making small talk with this cute little old lady when she says "I am so excited to be at this football game! I have never had such good seats for a football game! And, you decorate so nicely for these football games! I love sports; I played volleyball in high school. Oh, I am just so excited; I have never had such good seats for a football game!!!"

So what did I say? I did what any good speech pathologist does when encountering a patient with dementia....I went along with her story. Now, her nurse, who was there supervising, attempted to re-orient the cute little old lady several times, but with no luck. The cute little old lady just kept repeating her story! "I have never had such good seats for a football game!"

I don't think I'll be forgetting that little old lady anytime soon!

News From The Wedding Front

So, as you may or may not know, I am supposedly way ahead of the wedding planning game. I have all of my vendors booked, I have my flowers picked out, I have a dress and all the things that go along with it, and many other things I don't care to think about now. But, if you know me, that hasn't stopped me from trying to finish up wedding planning now. I want to have it all done and I want to have it all done now. What's the point in procrastinating? Anyway, I don't want to get started on my rant.

This weekend was a designated wedding extravaganza weekend. We (meaning I) designate a weekend every so often to focus on wedding stuff. Since I refuse to plan this wedding alone, my wonderful fiance, Jon, graciously puts up with me during these weekends and does a very good job helping me out.

Now, wedding extravaganza weekends rarely go well, and it usually takes every ounce of strength I have to make it through tear-free (didn't make it this time). Those of you who know me know I am a self-proclaimed organizational freak. But, despite that quality, I hate wedding planning. I want a beautiful wedding and a nice party afterwards, but all I really want is to be married to Jon. And wedding planning stresses me out! So, I'll just throw it out there that this weekend was a rough one. But, again, the point of this update is not to complain; it is to show you one of the good things that came out of this weekend!

The one last thing I needed to complete my wedding ensemble was a comb to wear at the junction of my head and my veil. I had searched all over for a comb that I like, but hadn't found one. And, I just couldn't stomach the $60 to $80 dollar price tags that came along with the ones I found. So, on a whim (I know....who knew I did whims), I dragged Jon to Hobby Lobby and blindly bought supplies to make a comb myself. Now, I don't want to toot my own horn, but I am super impressed with myself. See...

Tada!! And, the best thing....it cost less than $22 bucks and 2 hours of time!

Haven't had any work stories lately, have we?

2009-01-06T17:16:00.000-08:00

As I pulled up my blog today, I realized that I haven't posted any work stories lately, which is the true purpose of this blog. Honestly, I don't have any recent funny ones, so I'll tell a sappy one today.

There are patients you treat who will always stay with you, even if they have passed on. For example, my denture man (see archived post). I was reminded of one of those patients today when I ran into his wife (CS is a small town...). Ok, here I go trying to be all sappy and this turns into a funny one, but I'll tell the sappy part first...

My patient, Mr. H, had Parkinson's Disease. Now, even if you're familiar with Parkinson's Disease, you may not realize what implications it has on your speech and swallowing (most importantly). In patients with Parkinson's Disease, the swallowing muscles, just like the other muscles of the body, become weak. Weakened swallowing muscles result in unsafe swallowing, in which food or liquid goes into the lungs, resulting in aspiration pneumonia. Aspiration pneumonia is deadly. Most people with Parkinson's Disease don't die from Parkinson's; they die of pneumonia. Anyway, Parkinson's Disease also weakens the respiratory muscles and impairs a person's perception of speech volume. Thus, a person with Parkinson's Disease speaks with very poor breath support and a very soft voice.

So, I was working with my patient, and his wife of nearly 60 years, trying to make him more aware of his very soft speech. The following conversation ensued:

Me: Mr. H, has there ever been a time where you needed to use your voice to get something and didn't get it because your voice was too soft?
Mr. H: Well, yes.
Me: Ok, can you tell me what happened?
Mr. H: Well, we were getting ready for a trip and I was in the bathroom reaching for something in the tub when I accidentally fell in.
Me: You fell into the bathtub?
Mr. H: Yes
Me: Were you hurt?
Mr. H: No, but I couldn't get out of the tub.
Me: So what did you do?
Mr. H: I tried to yell for my wife, but she couldn't hear me.
Me: So then what did you do?
(Side note: Mr. H was a brilliant aeronautical engineer for the Air Force)
Mr. H: I couldn't get out and my wife couldn't hear me, so I wedged my foot under the toilet seat (which was apparently next to the tub), lifted the toilet seat with my foot, let it go, and let the lid slam down. I did that about 10-12 times before my wife came to see what all the noise was about.
Me: (Trying so hard not to laugh) So, you slammed to toilet seat with your foot so your wife could hear you?
Mr. H: Yes
Me: Well, I'm glad that worked, but don't you think that since your voice is so soft you and your wife may need a personal alarm button you could wear and push in just a situation like that?
Mr. H: Well, I suppose that beats sticking your foot in the toilet!

Mr. H was the sweetest patient and had the most loving and caring family. He passed away a while ago, but I often see his wife working out in our gym. Whenever I run into her, I am in awe at the love she had for her husband for over sixty years and I can't help but remember that story!

Thank You Santa

2008-12-27T08:23:00.000-08:00

Christmas #0 - the Christmas before our real first Christmas together once we're married - is sadly over. I love Christmas and having Jon there really solidified how much I love him and can't wait to be married to him. Ok, enough with the gushy stuff, onto what Santa brought....

Santa Jon definitely brought me the number one item on my list: the iPodTouch!

I know I shouldn't be in love with an electronic device, but I am! I've already loaded a few applications, but I am still doing some research on the best calendar/to do list application. I think the winner will be this one...Smart Time Plus.

Mom and Dad and Tee and Kev were definitely good to us this year as well. I say "us" because the majority of our loot was wedding/future life together related. The top "when I grow up" gift
by far was a Panini Press/Griddle:

Now the part about Christmas I like the least is upon us: writing thank you notes. And yes, you should write thank you notes and send them in the mail to your family...it's just the polite thing to do.

In other news...
I had my knee MRIed on Tuesday. The good news: it didn't cost me an arm and a leg because I had it done at the end of the year. The other good news: nothing is torn. The bad news: it still hurts, but not as much. When I went to the doctor on Monday he gave me some pretty good anti-inflammatory medication, so I think they're helping. I haven't seen the doctor again since the MRI, so hopefully on Monday he'll give me a game plan. You know, I really hate exercising, but when you stop for a while and can't go back, you actually start to miss it! I wonder if all those Christmas cookies I ate have anything to do with that?!?

Alright, avid followers (haha), I am off to play with my new toys! Enjoy yours!!!

I'm Bad at Blogging

2008-12-20T18:32:00.000-08:00

I'm such a bad blogger! I don't really blog for anyone but myself, but I love reading other people's blogs and feel bad that mine is never updated. So, here's a few (or maybe more) snippets of what's going on in my life. Enjoy!!

My Stupid Leg
Ok, so I'm blogging on Saturday night. Why, you ask? Because I hurt my stupid leg. Well, my stupid knee, really. Right now I'm laying in bed with my knee in a brace, propped up, and covered in ice. Jon is here and is taking very good care of me. I consider this a good practice run for marriage. So far, no big fights, despite the fact that I am cranky. I went to the doctor last week and was told to take the conservative route first....brace, ice, steroids. Well, that route isn't working so well. So, on Monday I'll be calling him back and giving him the ok to order an MRI. Yea, all I really want for Christmas is an MRI! Anyway, I'm being a crab and that's why.

But What I Really Want for Christmas Is....
So, I've been telling Jon for a long time that I want a Palm Pilot. I am a self described organizational freak. I have four calendars I keep up with....e-mail, day planner, wall calendar, and work calendar. All of these calendars are always up to date...no matter what. So, anyway, I have been telling Jon for a long time that it would make my neurotic life much easier if I had an electronic organizer instead of all these different calendars. Though I love writing on all of them and color coding them with Sharpie, keeping up with them can get a bit time consuming. Jon resisted the idea of a Palm Pilot because the technology is a bit older and I didn't want it as a phone all-in-one thing. So, he introduced me to the idea of the iPodTouch! Now, I already have an iPod, which I use when I work out, but WOW.....that thing can do so many organizational tricks that I almost peed my pants! So, I don't know if "Santa Jon" will put it under the tree for me, but he sure has been hinting at it. I really hope he does, because I've already spent like 4 hours in the Apps Store picking out organizational applications I would put on my iPodTouch if I got one. Please Santa, I've been an awfully good girl!!! And, I made him chocolate covered pretzels to bring to work!

How About a Knuckle Sandwich
So, work has been pretty crazy lately, more so than normal. Anyway, I have this patient who I see for articulation (pronouncing things correctly) therapy. My patient, T, is 7 years old and hates speech therapy. But, he is a good sport about it because I've devised a system where if he practices he can earn points. And points = good prizes from his parents. So, the other day, he came into my office just *thrilled* about being at speech therapy, and asked me "Miss Emily, have you ever heard of a knuckle sandwich?" Of course I know what a knuckle sandwich is, but I definitely didn't know where T was going with this. So, I told him I knew what it was and he responded with "Well, aren't they cool!" And that was it; we just went on with therapy. How random!

Speaking of knuckle sandwiches, I had another patient this week, total different from T, who tried to give me a knuckle sandwich. My patient, a very old man with pretty significant dementia, was having swallowing problems. We were down in radiology getting ready for a modified barium swallow study (x-ray of swallowing while you eat conducted by an SLP). I tell my patients, with complete truth, that the longest part of these x-ray swallow studies is waiting for the doctor. So, here I am standing in front of my patient, so he won't fall out of the chair, waiting for the doctor, making small talk. Then, all of a sudden, my patient reaches out his arm, with a semi closed fist, like he is grabbing for something on my chest. Now, I wasn't scared because this man is not strong enough to hurt a fly, but nevertheless I didn't want him grabbing me, so I gently guided his hand away from me and asked him "Mr. H, what are you grabbing for?" This is a pretty typical question I ask my patients in these situation because many of them take medication that makes them hallucinate. Anyway, in response to my question, Mr. H answered "Not grabbing, just seeing how tough you are!" Haha...this man was trying to give me a knuckle sandwich.

And I'm Done....
Well, blogging just not as fun when you have someone laughing/reading over your shoulder, so I'm signing off for now.

I'm Dreaming of a White Christmas!

2008-12-11T16:11:00.000-08:00

Well, I'm pretty sure we won't have a White Christmas in College Station, but we got awefully close yesterday! And, to top it off, snow was still on the ground this morning. Thank you global warming!!!

Reading the Obits

2008-12-11T16:01:00.001-08:00

I never thought I'd be the type of person who reads the obituaries...but now I am.

We see so many people during a single day that it can only be the awesomeness of God that allows us to remember them all. It is also the awesomeness of God that causes our hearts to sink when we find that they've passed on.

I've always been an old soul, but it still baffles me that I can recall these people and even tell funny stories about them (i.e. gluing someones mouth shut). I pray that they are at peace now and am so thankful for the impact they've had on my young life.

100 Things About Me

2008-08-18T17:29:00.000-07:00

Through I really have tons of things I could/should be doing, I love making lists and this was just too tempting.....

I am super organized and love to color code things.
I'm very witty and articulate.
I'm getting married on July 11th, 2009.
Chocolate cupcakes with cream cheese icing are my favorite dessert!
I'm a cradle Catholic.
I hate working out.
I'm afraid my dad will die too young.
My voice changed after I had my tonsils out.
I love to people watch.
I have wanted to name my dog Pavarotti since I can remember.
I love fat animals.
I have two chicken pox scars on my face, which I love.
I collect greeting cards with dogs on them (and I don't send them).
The best recipe I have is for Vanilla Chip Cake.
I met my fiance online on Yahoo! Personals.
I wish I was closer to my sister.
At any given time, I am maintaining at least 3 calendars.
I wish I enjoyed running.
I graduated with a bachelor's and master's degree in 5 years.
I love Sharpie markers.
Surprisingly, I hate wedding planning.
When I was little, I called my sister Jesus.
Rarely ever do I not get my way.
I had surgery twice on the same wrist.
I make lists of lists I need to make.
My fingers turn purple when I'm cold....which is all the time.
I watch way too much television.
I wear my emotions on my sleeve....you'll know when I'm mad.
Sometimes I think I can't do anything right.
I take really long showers.
I've always known I was an old soul trapped in a young persons body.
I play the piano.
I love clean, corny jokes.
Science fiction is my preferred reading genre.
I teach 4th grade religious education.
I love jaw breakers, even though I know they're terrible for my teeth.
I have fat eye lids.
I love my job as a Speech-Language Pathologist.
I used to play the trombone.
I'm addicted to checking my e-mail.
I love cheese.
I am addicted to Sticky Notes.
I used to do ballet.
I am publishing my master's thesis.
I have high anxiety.
My childhood fear was that I would never get married.
I was never silly until I met Jon.
I have been watching ER since the very beginning.
I pop zits.
I was president of my Catholic Sorority for two years.
I get sick very easily.
I love scuba diving, though I only go to 80 feet.
I never have less than 2 gallons of cranberry juice in my house.
I have a very sarcastic sense of humor.
I can be a bitch.
My best friend and I are almost the same person, but I'm taller.
I love candy and hate to share it.
I believe in better living through chemistry.
I need music to fall asleep.
I have poor self esteem.
I can't tolerate stupid people.
I drink way more Coke than I should.
I'm afraid I'll be unable to have children.
I love snow skiing.
I have old lady feet...and terrible bunions.
I snack in bed.
Boston Terrier's are my favorite type of dog.
I'm not very patient.
I am the most generous person you'll meet.
I think it is socially irresponsible to not keep up with the news.
I love baking, but don't really like cooking.
I have no living grandparents.
I really like camping and hiking.
I enjoy scrap booking online.
I buy way too many bath products.
I believe in buying books and keeping them.
I talk to my mom at least once a day.
I recycle paper, plastic, and aluminum.
I never thought making a list could be hard.
I hate shopping.
I love shopping on-line.
I feel awkward in social situations.
I know I will be a good mom.
One day, I will probably dress my dogs up. I will probably also buy them life jackets.
I would love to own an Audi TT Roadster.
I consider myself pretty computer savvy.
If I ever quit being a speech pathologist, I would become a personal organizer or life coach.
I believe in mental health professionals.
Sometimes I forget to brush my teeth.
I don't really like candles.
I'm a Longhorn fan living in an Aggie world.
I'll take Burt's Bees Lip Balm over lipstick any day.
Even though I know it's trashy, I love reading Cosmo.
I have four pairs of Crocs.
I am the most generous person you will ever meet.
I'm not a very good blogger.
I want to go to Europe.
I love sending greeting cards to people for no reason.
Medical drama or reality shows are my favorite.
I never thought it would be hard to make a list about myself.

Well, there you have it. Try it yourself....it's not as easy as it seems!

Dentures 101

2008-07-07T16:47:00.001-07:00

Though this happened a while ago, this is by far one of my best SLP stories. As an SLP, we learn quite a bit about human anatomy, especially of the mouth and throat. However, in graduate school, they tend to leave out practical information, like how dentures work.

Now, the great majority of the public knows about dentures, or fake teeth. I would put myself in that category, even though I had never worked with dentures prior to this experience. Now, we've all seen the adds on TV for denture adhesive, whether it be the paste or the little mouth-shaped strips. And, by watching those commercials (and presumably reading the directions), one could assume that applying dentures isn't rocket science. Well, not entirely rocket science!

Working in a Rehab facility, I knew that one day I would have to help some cute little old man with his dentures. This fact didn't really bother me....I'm not squeamish, or afraid, or grossed out by much. So, when the day came, I jumped right in.

That morning, I was seeing a cute little old man, Mr. R, right after breakfast for therapy. He had Parkinson's disease, which can greatly effect the volume and clarity of speech, and was very weak. Parkinson's disease, in its later stages, can also effect cognition, and can result in Parkinsonian Dementia. During our therapy session, I was planning to work on memory, volume projection, and the use of clear speech strategies in conversation. As I greeted Mr. R and wheeled him out of the dining room, I noticed that he was pleasantly confused and didn't have his dentures in.

So, we made a side trip to his room, where I planned to get his dentures. The following exchange is best presented in dialogue form. Enjoy!

Me: "Alright Mr. R, lets put your dentures in."
Mr. R: (In a very muddled voice) "No...they hurt."
Me: "Are they too loose?"
Mr. R: "Yes."
Me: "Ok, well, lets put some adhesive on them. Would that make them fit better?"
Mr. R: "Yes."

I proceeded to take Mr. R's dentures out of the container and squirt a line of adhesive on the top plate. I then put the top plate in Mr. R's mouth and held it there for 3-5 seconds. I turned away and began to prepare the bottom plate with adhesive paste.

Me: "Ok, Mr. R, lets put the bottom ones in."
Me: (Turns toward Mr. R to see top plate sitting on Mr. R's tongue.)
Me: "Oh, Mr. R, did they not stick?!"
Mr. R: "asdf oiadf n;akjdnf ;sadsf." (Presumably, "No.")
Me: "Should we try and stick them back up?"
Mr. R: (Shakes head 'no'.) "adsf oiawnefo;nad ;adosfj."
Me: "Ok, lets just take them out."
Me: "Would you like a drink of water to rinse your mouth out?"
Mr. R: "No."
Me: "Are you sure?"
Mr. R: "No."
Me: "Ok...."

I then proceeded to wheel Mr. R back out into the dining room, where I had decided to conduct what was left of our therapy session. We park in a sunny spot next to the window.

Me: "Ok, Mr. R, can you tell me what today's date is?"
Mr. R: (TRIES TO TALK, BUT MOUTH IS GLUED SHUT!) "WA WA WA, WA WA WA WA"
Me: "OH MY GOSH, MR. R, IS YOUR MOUTH STUCK?!?"
Mr. R: (Emphatically nods his head 'yes'.)
Me: "Oh, Mr. R, I am so sorry!"

I then high-tail it out of the dining room and back into Mr. R's room. Once there, I PRY his mouth open with my gloved fingers and desperately try to scrub the denture GLUE from his gums!

Me: "Mr. R, I am so sorry, this is the first time I've ever put dentures in before!"

Then, Mr. R's wife enters the room and immediately starts laughing. wonderful.....

Mr. R's Wife: (Laughing) "You glued his mouth shut, didn't you!"
Me: (Almost crying) "Yes, I am so sorry! I guess I'm not very good at this!"
Mr. R's Wife: (Still laughing) "He wouldn't rinse his mouth out, would he?"
Me: "No, he wouldn't."
Mr. R's Wife: (Still laughing) "He always fights me on that one! You just have to get mean with him. Really, I just need to get him some dentures that fit right!"
Mr. R's Wife: "Don't worry honey, he won't remember it anyway!"

And so ended my very first experience with dentures. Thankfully Mr. R and his wife were good sports and didn't get upset. I can only imagine the explanation I'd have to give to a crabby family. Needless to say, I haven't tried my hand at dentures again!!

And now, some Zelda Wisdom...

The "Definition" of Life ~ I'll warn you now, it's LONG!

2008-07-06T07:41:00.000-07:00

For a therapist of any kind, it’s a rare experience to see a patient from start to end. Most of the time, you may see them in the beginning and then they go to another facility. Or, they may be coming to you after already being treated somewhere else. Either way, you never really get the full story and you can’t really appreciate how much progress the patient has actually made.

My place of employment, however, allows me to see a patient from start to finish. The speech-language pathologists (currently there are 4 of us) serve our entire health system. We see patients…

at the acute care hospital (think “ICU”),
we see those same patients when they come over to the Rehab hospital (think “not medically ready to go home yet” + “intensive speech, occupational, and physical therapy for three hours per day),
And we see those same patients again in our outpatient clinic.

So, we will get to see a patient at their worst (usually in the ICU) and then follow them until the end. My first patient that I've followed from beginning to end, may be the most memorable patient I've ever had. I’ll call him “P”.

I first saw P when he was in the ICU. He was 38 years old and had had a MASSIVE stroke. The stroke was so massive that the doctors had to remove part of his skull to allow his brain to swell (which is called a “bone window”). When I met P for the first time, he had a tube in his neck (tracheostomy) so he could breathe. The entire right side of his body was paralyzed and dead. He couldn't point to a picture, he couldn't shake his head yes or no, he couldn't mouth words (when you have a tracheostomy, you must have a special valve on in order to talk…P couldn't even handle that yet), and he couldn't follow basic directions (ex: stick your tongue out), and he couldn't swallow safely (he had a feeding tube in his stomach).

I can’t remember how long P was in the ICU, but I saw him every day. Eventually, he got to where he could point to pictures, nod his head yes and no, and he attempted to follow directions (ex: when I asked him to smile, he would close his eyes). Finally, we got the call he was going over to the Rehab hospital. P had a really long way to go, but at least he was getting started.

I followed P over to the Rehab hospital, where we immediately started working on his voice. He was given the special valve that allows you to talk when you have a tracheostomy (it’s called a Passy-Muir Speaking Valve), but no sound came out. First we tried for an “ahhh”, which wasn't happening. Then, we tried for any noise at all. While we were working on turning P’s voice back on, we had to find alternative ways to communicate. P tried using a communication board, which had pictures he could point to, but he didn't like using it. Then, we gave his an electrolarynx, which is a device you hold to your neck that creates sound waves you shape with your mouth into speech. P couldn't use this, as he was unable to mouth words. So, we did it P’s way…asking yes and no questions to communicate about everything.

After quite a while with no voice, an Ear Nose and Throat doctor was consulted. I feared P’s vocal cords may be paralyzed from his stroke. My fears were confirmed, and I went to P the news. I informed him that we would still try to get his voice back, but it would be very hard (there are very few ways to treat paralyzed vocal cords).

P still had the tracheostomy and the valve and was getting quite sick of them. P had had a very deadly infection in his lungs (MRSA), but that had cleared. So, there was talk about removing his tracheostomy tube and letting the hole heal (so P would breathe normally). Well, P couldn't wait. I came in early one morning and the respiratory therapist yelled to me from down the hall. I ran to him; he was outside P’s room. He held up a really disgusting looking tube and said “he pulled it out.” I was in shock! P’s tracheostomy tube had been stitched in! I bet that hurt! Well, it was a blessing in disguise…the tube did not have to be put back in and P’s hole in his throat began to heal nicely.

Now, at this point in time, P was cleared to eat soft foods with THICKENED liquids. If you've never had the opportunity to taste thickened liquids, be grateful. Just imagine having everything you drink the consistency of cream of chicken soup….yuck!

P’s hole in his neck eventually healed and his swallowing improved enough to where he could drink regular things. He was quite glad for that! All the while this was going on, P was participating in his physical therapy and occupational therapy as well. P could not sit in his wheel chair by himself, for fear he would slouch over and fall out (because of his paralyzed side). P could not stand without being held up by a machine and three people. P could only eat with his left (non-dominate) hand and had to have special bowls and utensils. AND on top of all that, P had to wear a helmet to protect his brain (remember his “bone window” is still open.

Imagine being 38 years old, married with three kids, stuck in a hospital where you can barely eat, can’t talk, can’t walk, are surrounded by old people, and you have to wear a helmet. I think I would die… But, P never gave up.

One day, we had a medical school resident come and observe our therapy (all Med students have to do this) to find out what a speech therapist does. Now, this resident had met P while he was in the ICU. When I told her she would be able to observe his session, she was eager to see how he was. She accompanied me to my session, which was held in P’s room that day, and “barely” observed. When the session was over, and we were walking back to my office, the resident asked me “WHY DIDN'T THEY JUST LET HIM DIE?” I was aghast….how could someone say something so cruel and insensitive! I brushed her comment off and rededicated myself to providing P with the best care possible.

The next piece of news, which was good, came in the form of pain. Now, P had been working with his occupational therapist on ways to reduce the swelling in his dead leg and arm. When you have a stroke, your paralyzed side can swell due to lack of circulation and excessive fluid. P’s foot was especially swollen and painful. His occupational therapist had been working to force his shoe on, and he SCREAMED IN PAIN. She immediately came and found me and brought me to P’s room. She proceeded to mess with his shoe again, and I heard his VOICE for the very first time! It wasn't much, and the method for achieving the voicing was completely unorthodox, but his voice functioned nonetheless!

So, for the next couple of weeks, all of P’s therapists found ways to “turn his voice on”. As we did this, his voice would engage more and more often. Usually, automatic words or phrases would come out (ex: things like “Ow” or “Sh*t”. Some people hounded P for cussing, but those who knew him encouraged it. When a person has a stroke and their speech and language are effected (Aphasia), the easiest words to get out are automatic things that are ingrained in your brain. For men, it’s usually curse words…

Now that we had a voice (yea!) and some automatic speech (double yea!!) coming out, it was time to address P’s verbal communication. Every day, for 1 even 2 hours at a time, we grilled P on automatic speech. We worked hard to count to ten, to say the days of the week, to say the months of the year, to say the ABCs, and to complete the missing word at the end of a sentence. P made progress, but it was VERY SLOW!

By this time, P had been at Rehab for more than two months. The normal Rehab stay for a patient is 2 weeks. P’s insurance funding had run dry and we had to find a way to keep him a little bit longer. One of the benefits of working for a nonprofit hospital is that it’s easier to find funding for patients who need our services. Now, that funding is not limitless, but it is there for the patients who show potential for improvement.

Always in the back of my mind was the comment the resident made about P: “Why didn't they just let him die?” I thought about that a lot and really pondered what the definition of life really is. Could P really call this a life? I couldn't answer that question for him, but it did make me think hard about quantity of life vs. quality of life. P had been given more years in his life, but what about the quality of those years. Catholics (the religion I am) believe that all life is precious, from conception to natural death. We are all given our cross to bear, and sometimes that cross is continued life after tragedy. I’ll never know if P would be better off dead than alive…I don’t think I’d want to know that. What I do know is that the life P has is better because of me and my efforts.

But back to P’s journey. P was making great improvements in his physical and occupational therapy. He couldn't walk and he was still paralyzed, but he was pushing himself in a one handed wheelchair and was using his good side for all his personal care needs. He was even able to transfer from the wheelchair to the toilet with just the help of his wife.

His speech, however, was road blocked. P had managed to get single words out, but those words were usually the wrong ones. Patient’s who have had a stroke and have aphasia (language problems) usually say one word when they mean another. For example, a person may be trying to say “chair” but it comes out as “table.” Or a person may be trying to say “hat” and it comes out as “cat.” P had both of these problems, and man was it frustrating.

It came to the point in time where P had to go home. Home to his small house, out in the country, which was probably too small to move around in a wheelchair in. Home to his wife and three kids he could no longer financially support. Home to a place where he could not communicate his wants or needs without major effort on his part and the part of others. But home, none the less.

We were all sad to see him go. We knew he would be coming back as an outpatient, but somehow that wasn't enough. P had not made the progress we thought he would. Our goal at Rehab is functional independence; P was still severely disabled and dependent on others for most everything.

Again, I followed P to the outpatient setting. In the beginning, he saw all three therapy disciplines (physical, occupational, and speech). And again, he made progress in all areas but speech. One day, I noticed P was about 15 minutes late coming from physical therapy. I was irritated: was the therapist keeping him too long, had P gotten a late start, had P not shown up for therapy at all? I marched over to the outpatient gym on a mission to find him and/or his physical therapist. What I found on the way was one of the most awe inspiring things I have ever witnessed. P was walking down the hall! He was going at a snails pace, using a one-sided walker, and dragging his foot along, but he was WALKING!! I thought, wow, the quality of his life has drastically increased!

P continued to make gains in the walking department. He began walking around his home and insisted on walking in between his therapy appointments (even though we had to end almost 10 minutes early so he’s have enough time to walk!). In the speech department, however, P actually got worse.

The brain is a funny thing. P needed all that brain power to move his legs, keep him steady and balanced, and concentrate on the walking process. Not much was left over for speech.

Now, P’s funding has really run out. He is not eligible for government assistance yet, because he has not been disabled “long enough” and his wife, at her minimum wage job, makes “too much” money. The hospitals assistance for him has also run out; they've been paying for him for almost 4 months. So, we now have two weeks to wrap up therapy and give P a program to work on at home.

If only it were that easy. P is a pro at his occupational and physical therapy home exercises. He is motivated and performs them well. His speech home program is different. I can’t tell if P has lost his will to speak or if he doesn't understand the importance of practicing; either way, he is not practicing at home. I've told P on numerous occasions, when it comes to speech, I can’t fix you. I can only “GIVE YOU THE TOOLS TO FIX YOURSELF.”

So, in the next few days, P will leave us for good. Who knows what will happen to him now. Hopefully, his family will continue to provide for him and he will improve. I pray that is the case. I know I have improved P’s quality of life, but to what extent? And, is that quality worth the added extension? My co-worker, who had also followed P throughout his journey, asked me the other day, “Do you remember what that resident said about P? You know “Why didn't they just let him die?”” I responded “yes, I remember.” She then said, “In some cases, life is more painful then death. In P’s case, that might be true.” I will never know, nor would I want to, if P’s life now is worse than death. What I do know now is that the definition of life is not always clear cut. I pray for P’s continued improvement daily, and I will never forget the impact he’s had on my professional and personal life.

And now, some Zelda Wisdom...

The first man I ever helped - Mr. V

2008-07-06T07:37:00.000-07:00

Doing this job (speech-language pathologist), sometimes I ask myself “Is what I’m doing really making a difference?” Sometimes the answer is “no”, but more often than not, the answer is yes. Measuring success in this field is sometimes very difficult. If a patient has cognitive (thinking) deficits, it’s hard to judge whether or not you've really helped them. If a patient has dysphagia (swallowing problems), success is more easily measured.

Patients can have swallowing problems for a lot of reasons, the most common one being stroke. The first man I ever truly, for a fact, helped, however, had swallowing problems because he had been in a car accident.

This man, Mr. V, came to us with two crushed legs and an inability to swallow. A feeding tube had been placed in his stomach so he could receive nutrition, hydration, and medication. If we tried to give him something to eat, he would choke and cough and aspirate (where food or liquids go down into your lungs – VERY dangerous). Usually, we treat swallowing problems with electrical stimulation to the throat. However, Mr. V had an internal defibrillator, so we couldn't use electrical stimulation (it would set his defibrillator off!).

So, we had to treat him the old fashioned way…he had to lie flat on his back and hold his chin to his chest for one minute. He then rested for one minute. That sequence was repeated three times. Then, he touched his chin to his chest 30 times. All of that was done at least three times per day!!! This kind of therapy is hard; it’s hard for the patient and it’s hard for the therapist. But Mr. V, he gave it his all. Mr. V was a fighter…he was a patient of my mother’s (who is a cancer nurse) who got into a car accident on his way home from his last chemotherapy treatment. Talk about bad luck.

Well, long story short, after many weeks of intense therapy, Mr. V was able to safely swallow! Getting someone off their feeding tube (PEG tube) is a big deal in and of itself. But, getting a patient off a feeding tube using this old fashioned exercise method is an even bigger deal. Needless to say, I really felt like I helped a person when Mr. V wheeled himself out of our facility.

I still see Mr. V quite frequently. He still comes to therapy for his legs…he walks with a walker now. Every time I see him, he has a smile on his face and a big hug waiting for me. That’s why…I love what I do!

And now, some Zelda Wisdom...

Hello Again!

2008-07-06T07:09:00.000-07:00

Well, I've decided to start blogging again. I've been doing it off and on for about four years on another site, but I've decided to start up again for two reasons. First, I want to remember my patients and the lessons they've taught me. I don't write about them for others; I write about them for me, so that I may have a central place to revisit those memories. I will repost some of the more recent memories.

Second, I need to keep my sanity. I write lots things before I say them. Sometimes I say those written things afterwards, and sometimes I don't. I think this habit of mine will come in handy, especially in the next year, as I plan my wedding. I have been engaged for 9 days so far, and the control freak in me is already showing. I know, for my sake and my fiance's sake, that I cannot become a bridezilla. So, hopefully blogging about this process will make it a little easier (at least on him!).

I tend to personalize much of what goes on around me: the good and the bad. About 4 months ago, while waking through the mall with my fiance, I came across one of those decorative signs in Hallmark. It read, very simply, "Love what you do." That phrase has not left my mind. I want that to be true for me all the time: when I'm at work or with Jon or doing all the other crazy things I do. So, that is the goal, which leads me to my favorite quote of all time: "Yesterday is history and tomorrow is a mystery. We only have the gift of today; that is why we call it the present!" ~ Eleanor Roosevelt

And now, some Zelda Wisdom...