The Breakdown...

Alright guys...I'm a crier. Can't deny it. But, generally, I don't cry about clinic.  I made it through our part times and the first full time without any breakdowns. Even if I was way stressed or upset, no crying.  Do not want to cry in front of people.  I finally broke. Darn it. Two very stubborn children, and an exhausted Thursday morning just pushed me over.

Child number one is an 8 year old adorable red-head who is as stubborn as the red-headed stigma would indicate.  She comes in at 8am which is just too early for her because she's never quite awake. We call her "baby jaguar".  I am not sure when, but at some point she decided she was baby jaguar and her mother is mama jaguar. Sometimes my CI also becomes mama jaguar and I have since been deemed auntie jaguar. She is a riot. She cracks me up, but can be so hard to treat.  Honestly the session with her didn't go badly, it was just exhausting. Trying to figure out how I am going to accomplish my goals for the session, get her to wake up, then cooperate, manage the time...bleh. And Thursdays are hard days cause they are our Fridays. To add to this scenario, her mom is one of the local pediatricians.  She's a really nice woman, but my relationships with the parents is really weird because...I don't really have one because my CI always goes out and talks to the them and kind of takes over the conversation, so I really don't know what this MD mom thinks of me and I don't have the opportunity to...get comfortable with her, so I want things to go well with her daughter.

Child number two is also adorable and is one of my favorites.  She is baby doll perfectly cute.  Shes got blond hair that goes to just above her shoulders and is Shirley Temple curly.  It's always perfectly styled with a bow, she is the perfect size of chubbiness- not to big, not too little- and her mother puts her in the most darling clothes.  She about 2 and an only child and she acts like it! :)  She is sweet and a good girl, not mischievous, but she knows exactly what she wants and wants to do everything her way.  Between being stubborn and being 2, she's got determined down pat. My treatment session with her was....a disaster. So frustrating. I got therapeutic stuff done and I made it through the session, but it was so disorganized, all over the place, and totally in her control and not mine.  I was so frustrated. On top of that, I have been sick for most of the time that I have been here and during that hour I was feeling especially drugged up and disconnected, you know those sudafed commercials where the person gets a cold and has the sinus pressure and their head becomes a balloon? That was me- I finished with her and had an hour break so I told my CI I was going to get out for a minute and went to the local Rite Aid to just get away for a few minutes.  Then I came back and it turns out that my CI had been taking notes on these treatment sessions and gave me feedback. She was totally nice and it was helpful, but I was already so discouraged that the last thing I wanted was feedback.  It was all constructive and there was positive feedback in there too, but I just broke down and bawled. It was so ridiculous.  She said she has only ever had one student that hasn't broken down crying while in their peds rotation (and the one that didn't cry she didn't like).  I was hoping and planning that I would be student number 2, but apparently not. And apparently pretty much everyone in peds has days that they just break down and cry.  One of the OT's the other day was talking about a treatment session with a boy and it wasn't going well and he was in timeout so she put him in the ball pit to sit for time out (sensory processing difficulties) and she said she crawled in the ball pit with him and put herself in timeout cause she was mad and it was not good.  So, there ya go.  If you want to work in peds be ready for tears, and out of control emotion.  It's intense.  Still love it- most days- but it's intense.

Funnies...

Nicole referring to a child earlier in the day who is 12 months old and is expected to have some kind of UMN/brain damage (which can't be seen on the MRI) that is causing her problems...

"Oh yeah, the baby we saw earlier, the one with the brain."

The other day I was in the hallway right next to the "gym" and I hear one of the OT's say to the child she is treating:

"You got an 'H'; h for fabulous."

Hmmm...

Today we were talking about PT and OT and how we don't like the idea that PT in lower body, OT is upper. It doesn't really make sense.  We were talking about how BOS impacts ability to perform ADL's and such and my CI says

"Right, if you just knock out my knees, I wouldn't be able to hold on to these folders."

Blushing...

Definitely my most awkward moment in clinic thus far....

Pt profile: 27 yr old male, neck pain. MD dx: myofascial pain syndrome. Onset of injury: 1 yr.

Pt is a 27 year old very hot and attractive male presenting with neck pain. Patient presents in waiting area with profoundly slumped posture and apathetic look on his face. With introduction pt responds appropriately, smiles, is friendly, accepts treatment from SPT initiating session. Upon further examination, SPT determines that beyond being extremely attractive, the patient has a gorgeous body. hmmm....SPT does not recall a chapter in Magee or Dutton referring to patients who appear extremely sexy. Never mind. on with the exam.

Pt history taken, no other significant comorbidities. Pt is in excellent health other than persistent neck pain, insidious onset, complaints of muscle tightness, decreased ROM.

SPT must perform posture and spinal exam.  "Danger Will Robinson"...SPT is professional. She can do this.

"Can you please...take off..your shirt...so I can take a look at you shoulders and neck?"

SPT starts blushing and suddenly forgets how to speech English which means medical language and the practicing of phrasology in lab is definitely gone! Ah- don't look he's your patient, but dang he's built. No transference, no transference...but...dang, it's not everyday a young, healthy, built, male comes in for PT. Yikes. Professionalism.

Initial Eval. Complete. Clean room.  Breath. It's your job. Weird. He's hot. Weird. It's your job. Weird. I just asked a 27 year old sexy man to take off his shirt. Weird. Dang. English, English. I couldn't speak. Flustered. Haha. Thank goodness it's the END of the rotation and not the beginning. CI observing the flustered blushing SPT=not goodness.  Whew. Wow. Glad that one's over.

Two days later. SPT walks into clinic. Approached by coworker, PTA, young female (slightly younger than SPT).
PTA: " Nicole D_____ ________" (name withheld for legal purposes).
SPT: "Oh, yes. I remember him."
PTA: "He was on my schedule this morning at 7 am. Oh-My-Gosh"
SPT: "Yeah, he's kind of attractive huh?"
PTA: "Uh....yeah. Like, really hot."
sigh of relief. phew. I'm not the only one who gets like this.
PTA: "I had no idea. He was my 7am. I walked in first thing this morning, walked out into the waiting room and had to walk to the back to pull myself together. He's so hot. WHY DID YOU PUT HIM ON MY SCHEDULE??? SO EMBARRASSING!"
Hahahaha....oh so glad we could commiserate. The joys of PT.

Update

All right guys. It's been a long time since I blogged and I must admit, a lot has happened. It's kind of lonely out here and I don't get to share my stories, so I'm going to write a lot, but I'll break it down so you don't have to read it all at once...especially those of you who can't read for very long (any guesses at who that is? :) ).  So, here the run down on the last few weeks of clinic. It has been good overall, but definitely challenging.

 

Curve Ball Number 1

 

So this clinic runs with a lot of PTAs and a few therapists (more on that later...or maybe another post). There is one PTA (who is awesome, young funny, I totally love him!) whose mother has been ill for a while. She rather abruptly went downhill and actually passed away within two days.  So sad guys. It was so so sad. That's a whole other story though- how this relates to clinic? He had a full schedule which was promptly distributed among therapists. No one minded picking up the extra work, but let me tell you...it's been a bit stressful. I was carrying almost a full load last week.  This week has been a bit more manageable, but this week (which is now last week) the hospital announced that it will not in the future be as big as it once was, or have as many employees. English translation, were laying people off.  105 to be precise.  Turns out that they are laying off people in management type positions and those who have been there the longest (they get paid the most). They laid off our main office person, we have two and that afternoon they laid one of them off. We were shocked. Unsure of how we were going to keep things running.  Even more weird is that the director of the department didn't know about it. The lady who got laid off called the other office lady, who called our boss and informed him.  The next morning, they laid our second office person off. Brilliant. With no indication of who was supposed to do their duties, it has been an interesting ride. I'm less than impressed with the company and would never work for them.  They have shown some very unfortunate qualities in the weeks since then. Clinic is still good, but I would not choose to work for them.

Midterm evaluation, curve ball #2

Midterms were a never ending nightmare for me. Mostly because they came in the middle of all that I just described. Between our coworker being out (and actually, two other coworkers had family members pass away the same week) and all the layoffs, things were crazy and stressful.  Then there is CPI web. My CI emailed DeLeo a long time ago with all of his information, but he never got a response from her. I thought our "assisting your CI" form was a form we could give them so they could send in the information. I sent it to him and was reminding him of it daily, but it just wasn't getting done. I didn't think it was a big deal. DeLeo called for my site visit and first was irritated because she couldn't reach me directly. I didn't think about it until that morning, but they have the number for the CCCE not my CI, but I never got an email or anything asking for more information, so I assumed it wasn't that big of a deal. When she got through she started the conversation by asking "first, were you aware before today that your CI wasn't going to be there today? Why didn't you tell us this, that your CI wouldn't be there the day of your site visit." Ummm.....my CI is here. He is standing at the desk right behind me right now....  ... "Oh. I was told that your CI isn't there today."  "uh. He is. he's standing right here." Let me just tell you, that is not the way to start the site visit. Scared me to death.  Then we talked about CPI web and DeLeo made it clear that I was supposed to give her all my Ci's info, that was now my responsibility. I think that's weird since I had to ask him for all the information before I could send her the email...whatever. I didn't get access to my eval until that Monday, didn't get to start it until Tuesday and then everyone got laid off. Both my CI and I had the vast majority of it complete Tuesday and finished it Wednesday, but hadn't signed off on each others. I was getting emails everyday from the program that were stressing me out like crazy about getting it done.  I was seriously starting to get afraid that they wouldn't let me pass this clinical or something. I finally sent an email to Dr. B telling her that the week was crazy due to unexpected curve balls (read previous section) and also asked if in the future, if they were sending emails like this if they could please include the CI because it was a lot of pressure on me to go in every morning for two weeks now and bug him about getting this done. She called me that evening and we talked it through a bit and all was fine (so glad it wasn't DeLeo I was dealing with at that point cause I don't know if it would have been smoothed) but let me tell you. It was more stress than it was worth.

And now: The patients...

Biceps rupture

"hello Mr. smith, I see you are in here for shoulder problems. Can you tell me what happened."

"Are you sure you wanna know?"

"Yep. Lay it on me, I need to know."

 Ahh yes, you can always be a bit surprised.  Turns out the man was having sex last year and he torn/ruptured a tendon. He couldn't remember which one, but I am pretty sure it was his biceps. So he says, I was having sex and it just started to hurt, but I just kept going anyway. He starts to demonstrate the movement for me. Wow. Didn't really care to have that part. It wasn't graphic or anything, but this 70 something year old man, big tall, burly, black, is showing me how he's having sex. And he keeps saying "I just couldn't stop. I just kept going anyway."  hahaha.  My CI still cracks up about it every time. It was so funny guys. How you rupture your biceps having sex...I just don't know. And why the man  couldn't control himself...well...yeah. It was quite the eval.

A Tattoo to remember

Shoulder eval. The incident gives you a good idea of what this guy is like. Mind you, he's gotta be in his 40s. I can't remember exactly his age. He tells me that he was drunk this night and his friends convince him (while he's drunk of course) to drive his motorcycle up this flight of stairs without a board under it. He manages (I don't know how) to get all the way up the stairs, but biffs it on the way down. He falls off the bike face down, the bike falls on his back, fractures his ribs in 9 places and fractures his scapula. Brilliant.

Its now 4 or 5 weeks out and he's cleared for therapy. Honestly, he's not that interesting of a patient, but this is the part that is worth talking about. I tell him to take his shirt off during the eval so I can look at his shoulder and scapula etc. He stands up to do it and kind of slows down and says...uh...I hope you aren't offended by my tattoo.  Right. Chances are I'm not going to be too impressed if he starts off like that, but whatever. Not my body, not my husbands back I have to look at (he is married), I have to see his shoulder so whatev. turns out on his back he has this huge tattoo. Covers both shoulders. There's a castle in the background. A wizard on his left and a naked woman on his right.  Why he thinks it's cool enough to get a tattoo like that I don't know, but I'm focused on the eval so I don't pay much attention.  He comes in for his second visit and I start doing scapular mobility and soft tissue work. I'm not doing a lot of active stuff with him since his fractures aren't fully healed so I have a lot of passive stuff I'm doing. I didn't really realize at the eval, but the naked women in right on his R scapula so I'm staring at it while I'm doing this work. And then I see the whole thing together and realize what it is. Left side, wizard with wand sending smokey magicness out of it that flows over to the woman on the right and bursts into flames, right under the naked woman who is tied to a stake. The guy has a tattoo of a naked woman burning at the stake. wow. And that's what I get to look at every treatment. fabulous. I don't know.  Maybe it's just me, but really? Weird. Ugghh.  Nope turns out I don't really appreciate it.  My CI cracks me up sometimes. First time he said "You should have said to him, why do you have a tattoo of a naked man on your back?" because he can't see it. Maybe you could freak him out and he'd think its wrong. yeah....not. But it would be awesome if it worked out that way. The other thing he teases me about every time I treat this patient is making the woman dance. He's like, you can just play with his tattoo.  Make the wizard move and talk and she can move back.  So I get to imagine a dancing woman burning at the stake. Wow.  I just don't understand some people.

Is this patient appropriate for physical therapy? (Halvaksz would be so proud!)

This is by far my favorite story so far. I wish I could have taken a picture because it was wild. So this patient comes in 1 week following a fall...actually multiple falls.  First of all, we're working with a new person at the desk who transferred over from the outpatient rehab unit that's in the hospital itself, they do all the neuro stuff (got to be honest. Wish I was there. For some reason, the program told the hospital I had to do OP ortho, which is weird to me since I'll be doing OP in SC and I did OP ortho in VA and I don't even want to do OP...but so it goes). So anyway, she's over on our side now. I went out to the front 2 or 3 times to see if my pt was there, but they kept telling me no. She wasn't there. Finally, about 30 minutes late, I get a page that my pt is ready. What? 30 minutes late and i still don't have the chart. I go out to get it and see who my patient is. This woman and her daughter have been sitting there since I arrived, which is 45 minutes ago. Guys. I felt so bad for this woman. They just sat there for 45 minutes and I was in the back the whole time, just doing random stuff because it was my first patient of the day so I didn't have any new paperwork to be doing.  Anyway...

This poor woman is in all kinds of pain post fall(s), but I was supposed to treat her neck. She's a bit older, in her 70s and she has a lot going on. She lives alone, but her daughter lives near by and does a lot to take care of her. The woman fell a week before at home and her daughter was out of town until...a day or two before she came in to therapy. The lady was taken to the ED by a friend that night and then fell again (I think) that weekend so she was back to the hospital.  They sent her home both times. They looked at her neck and nothing was fx'd.  She had had multiple spine surgeries if I remember correctly, so her spine was their primary concern. That and a head injury. The CT was clear, but I'm pretty sure based on what they told her that she had a minor concussion. This is all manageable.  she really had a loooong history of stuff, but I was still feeling good about everything.  I finish all that and have her change in to a gown.

I go back in and start doing a posture assessment.  First thing I'm drawn to, her R shoulder is sloping down. Now, pretty much everyone who comes in for this kind of thing has a sloping shoulder, that's not surprising. That's the side of her neck that hurts, but man alive. Her shoulder is more like a ski slope type sloping. It's way down. So I note that and keep going. I have her raise her arms to watch her move. Remarkably, she's able to get the right one over her shoulder, but not her left (hx of RTC injury). So then I just have her stand and I start looking at her clavicle.  There's a big bump sticking out so I start to look at it. The daughter sees and says, oh yes. We forgot, she had a clavicle fracture years ago. She never did anything about it.  Later she was told that she should have had surgery and it just didn't heal right so there been this big bump there ever since. But I keep looking at it and the daughter says...huh. That looks different than the last time I saw it. That doesn't look right. Even compared to what it was before.  At this point I am quite concerned. My next question reflects why. I ask "so when she broke it, did they remove a part of the clavicle then or later when she had shoulder surgery. Did they take a piece out?" The answer is even more concerning. "No, she never had any kind of surgery on it."  As I look a little further I realize what has happened. Her clavicle is broken in half.  I assume that is where the fracture was. But now, post fall...the clavicle is in two totally seperate pieces. I can see the fractured medical part of the clavicle. It's still in the skin, but it is sticking out in a wicked way.  The medial portion is completely displaced, which then explains the ski slope of a shoulder. Her shoulder is no longer connected to the sternum by the clavicle.  That piece of the clavicle is now hanging out somewhere in her brachium.  You can sort of make it out, but not exactly. At this point my brain is screaming "not appropriate for PT, not appropriate for PT."  I have a very clear picture in my head of what's happened, the woman isn't having any signs of nerve damage, she's maybe got a bit of vascular problem, but nothing really significant. I'm pretty sure I don't want to evaluate her neck, but I have the woman look in the mirror at her shoulder to tell me if it is different than the last time she looked at it (she hasn't really looked in the mirror since she fell.)  When she does she sort of freaks out. It's not like it was before at all.  There used to be an indentation between the two pieces of bone, as in, she used to be able to hook her bra strap on the lateral piece of the clavicle to keep it up, but she said she had noticed her bra strap kept slipping this week.  ( note: a. I think it's awesome that she could hook her bra strap on her clavicle b. yeah, no wonder her bra strap is slipping, her shoulder is depressed a good 4 inches, it's like she doesn't have a shoulder connecting to her arm. straight slope down.) So I explain to them that I think that she needs to have her shoulder x-rayed and looked at by the physician. I'm concerned about moving her neck around because if that bone moves, it could damage some vessels and cause serious problems. However, before we proceed like that, I want to go get my instructor (I am a student, I could be wrong) and make sure that what I think is correct. He's seen a lot more than I have.  I go and try to find him and of course I can't. I'm in a hurry- not that worried about the patient. I am really pretty sure of myself, but this woman has been here well over an hour and now she's not even going to get treated, she's getting sent somewhere else. I honestly feel bad for her. I finally find him. He looks and her and agrees. We call the doctor (who is in the same building, but of course all they can do for her is leave a message for the doctor. They have to go all the way home and come all the way back). Really, I need to find out if there's a way to actually send urgent cases more directly to the doctor. I should have been more assertive. We let the daughter call and then I talked to them, but I should have called to see if I could directly get a hold of a nurse cause frankly. if that bone did move and hit those vessels we are talking serious emergency. Anyway. We asked the patient to call us and let us know what happened, but we haven't heard anything. Wow. I realized the importance of yes, no, yes with referral. 2 ER visits and a visit to the PCP and I was the first one to even look at this. You couldn't miss it if you looked.

The end.  i have more stories, but don't feel like writing anymore. Plus I know that Rach isn't reading. :)

Caton Manor Week 5

During this week, it was pretty simple. The first new patient is a 64 y.o. male with long-term COPD who is O2 dependent and a recovering heroin addict who fell down 15 steps. He is a very nice man and ready to work :-). The other patient is not so much fun...I call him "Mr. Cranky-pants" to my friends, haha. He is a 52 y.o. male s/p L transtibial amputation with a R big toe amputation and a diabetic foot ulcer under the 1st ray. He is also on methadone like the other patient for recovering drug addiction. He is obese and has diabetes. Overall, he has a terrible attitude, difficult, complains continuously and is rude. First, he is sleeping in his room because he stays up all night watching tv because thats when the movies are on....and in the time that I tried to say "well, would you mind if we talk about changing your sleep schedule so you are awake during the daytime and asleep during the nightime", he had already fallen back asleep. And then, when I asked him "are you okay? are you tired?", he yelled at me saying "yeah, I'm fine, I'm not sleeping". Ridiculous! Basically, I have to push back when he pushes me and let him try to do things on his own and then offer help eventually. The problem is that he ends up getting like an hour and a half of my time, when he is only supposed to be treated for 45 minutes. And most of the time is spent with me trying to explain things to him because he is just being difficult.
My CI is still letting me be pretty independent and she is still very busy and disorganized, but things are getting done. I helped with wound rounds this week...not as scary as the first time.
Dr. Birkmeier came on Tuesday for my midterm eval...it went well. My CI said that I am exceeding her expectations and do really well with the patients. Yay!

Caton Manor Week 4

One of the main things that I learned this week is that I'm not a big fan of getting 5 patients to treat at the same time. I think that its kinda rude to the patients because they end up sitting around for so long waiting for instruction or one-on-one care. Basically, the main problem is that nursing does not follow the schedule that is given to them from rehab and the tech does not pay attention to the list he has for which patients are treated by which therapists. Sooo...I am working a lot on my concurrent treatment skills...haha. I've talked to the other therapists about this craziness and we all work together to tag team patients which is nice. Its just amazing to me that certain people have difficulty following a simple plan. I understand if kinks happen and you need to be flexible...but actually using a foundation system would be a good idea for all...maybe I'll work on this more my "improvement project"...haha.
I also learned that venous stasis ulcers on LEs can bleed a lot...even pass blood clots. On Wednesday, I was able to work with the OT to get the patient with sarcoidosis with paraplegia and changing levels of consciousness (hallucinations/delirium) to sit up at the edge of the bed. He was a Max Ax2 but his tolerance increased to 20 minutes which was great. And then, I looked down...there was a pool of blood at my feet. Due to his long hx of steroid tx for the sarcoidosis, he has thinning skin at 56 y.o. resulting in numerous wounds on his LEs and sacrum. He was in a state of limited consciousness and didn't even notice his leg which does have sensation. Basically, the blood flowed because of the dependent position of the limb. Nursing was notified and we are not planning to sit him up for a couple of days now.
I have three new patients! First, 49 y.o. male s/p acute stroke of the MCA resulting in R sided weakness. Initially, I was told that he only spoke/understood French...and he has expressive aphasia. I was like "oh man, how am I supposed to do this eval". Basically, I went in, started do like the chicken dance to demonstrate what I wanted him to do. And then, nursing informed me and the PT that he does understand English...I was like...what? Haha. Oh well, I got the initial eval done, he still didn't understand why I wanted to look at this R side which "didn't work" based on our language we developed. The second patient is a 40 y.o. male at end-stage HIV/AIDS. I wish that Dr. Harris-Love could be there to help! He is incredibly weak, very thin (skeletonish), moves slowly, but attentive and alert. He likes to roll his eyes at instruction, haha...but I think he likes me because he has expressed appreciation when I take the time to explain why we are doing things. Also, there is a 78 y.o. male s/p L TKA...he is completely different from the last patient with the TKA. He has so much less pain! However, today...I was worried he had a DVT....so guess what I used. Thats right, the Wells Clinical Decision Rule. From my tally, he was positive....but according to the PT who looked at this further, she ruled him to not bee positive because he rated his tenderness pain only 3-5/10 and it was not significantly warmer from his other limb. I was still a little nervous about it...but you would be too I think when he calf is tender, size difference of 3 cm, s/p major surgery...etc. But, his swelling did fluctuate during the activities and he tolerated treatment well.
I have the new patients because two of my patients went home last week (mainly due to insurance reasons...sadness). The 59 y.o. with severe arthritis, gout and the L TKA and the 30 y.o. with jaundice and generalized weakness, etc. both went home. Their stories are still so interesting to me.
And then, today, I learned that I'm terrible at duck-pin bowling. I went on the rehab outing to a bowling alley in Glen Burnie. And well...I'm just no good...haha. But it was fun. Its kinda made me nostalgic though. Bowling is something to do with friends or family, and I have not been in forever. So I kept daydreaming about the other times I have been bowling. I can say that all of the people in the rehab dept at Caton Manor are quite enjoyable. :-)
How are all of you doing? P.S. the count down has begun....crazy! We are half way done!!

Caton Manor Week 3

Yay...now I'm in real time. The week started out with learning that the patient with the lung mass unfortunately was discharged to the hospital. It is believed that the mass progressed to being cancerous and her illness is from this progression. Also, I learned that she has stated that she is okay with this situation and that she has lived a good life being 93 and all. This is very sad because she is a very sweet lady. But unfortunately, this is the nature of this type of facility. The patients here have very intense conditions. Some of the other patients I have met have hx of being a pedestrian who was hit by a car (2 patients in fact! one s/p TBI, the other is recovering from drug abuse, B tibial fxs, L humeral fx, CV2 fx, L hand edema), individual who recovered from a 3 yr coma from assault & has resulting all extremity contractures since he had no coma tx, female with dyskinesia from long hx of anti-psychotics, male who shot himself in the face 4 yrs ago and recovering from an infected facial reconstructive surgery...and so on. I'm sorry if these stories are too much; let me know please. These are just some of the crazy things that come to Caton Manor.
On the other hand, the other patients that I have are doing well and I'm seeing a positive progression in their abilities. For instance, the 99 y.o. woman...who is adorable...she can sit EOB unsupported for 15 min and can follow verbal cues to lean forward to relieve her back pain and not push backwards. And she remembers my "beautiful voice"...haha that made my day on Tuesday. Also, I had the best Max A transfer from W/C to bedside with her ever! The 59 y.o. woman with severe arthritis and L TKA and climb stairs safely. On Tuesday, I also got a new patient who my CI eval'd. She is an 82 y.o. woman hospitalized for severe asthma attack, who was D/C back to her apartment which had been flooded by a water heater explosion from upstairs, air dried by fans and then had to go to Caton Manor because of difficulty breathing. Rehab's vote is there is mold causing her problems. She is a sweet lady who I'm working with on increasing her endurance, etc.
I have another new patient who I eval'd today (Thursday). The patient is a 56 y.o. female with spinal stenosis s/p decompression and fusion for L2-L5, end-stage renal disease, kidney transplant x2, DM Type 2, OA, RA, HTN. She is very high functioning and going home on Saturday.
Alright, so back to Wednesday...wound rounds at 5:30 AM...oh man. I really don't like wounds too much. There were three patients who I remember in particular. The first patient of the morning was 50 y.o. woman who is obese, LE edema, decreased strength, severe keratinosis, and the largest sacral wound which was just scary. You could see things that you really wish you couldnt. And it just looked so painful. And it wasn't her only wound! She had another deep under her belly skin folds. Okay, the next memorable patient is my patient who is 53 y.o. man with neurosarcoidosis and resulting paraplegia. His skin is thinned because of his longstanding steroid txs resulting in many wounds. He had 4 wounds on his L LE, 2 on R LE and 3 on his sacrum. There were just so many that it because difficult for the wound MD to describe all of the locations. And finally, there was a 50 y.o. man who has heart & lung problems, hx of severely painful LE compartment syndrome, s/p B fasciotomy which the incision sites did not heal...there was even a skin graft that failed. The skin graft donor site has also remained open. Sooo painful. Anyways, it was interesting to see what % were granulation, slough or necrosis according to the MD.
On a fun note...I danced with a patient!! My 72 y.o. woman s/p multi-infarctions. I have danced/side-stepped to music with her yesterday and today :-) It was fun. She continuously would chuckle to herself about the fact that we were dancing. But she enjoyed it. She has the best smile about it too, haha. She is hard of hearing so she cannot really figure out the beat to the music...but no worries, its helping with her coordination. I still have to email Klima about this :-)
Hope you have been having a great week! Have a nice 4th of July weekend!! :-) I'll be heading back to CT again.