under the belt

This week I got a few new experiences under the belt.

First, I and another clinician have been providing Lee Silverman Voice Treatment (LSVT) therapy to a 60-something client with Parkinson's disease. LSVT is THE speech therapy for individuals with PD and one of the only therapies in our field with such high levels of evidence supporting it. It truly is amazing. Not only were we delivering this therapy, but we were being supervised by the creator of it (who is also one of my current professors). It seems she doesn't usually do clinical supervision in our clinic, so this was a unique opportunity -- and one you can bet I was pretty nervous about. I was also nervous because I don't think of myself as having an "LSVT personality," in which you are a super excited cheerleader and also a boss of the session and client. However, it went very well. BUT, the specific experience this week that was a first for me was that we had to dismiss our client. LSVT is very regimented and requires treatment fidelity to be effective. Part of the therapy is homework -- daily on the days you receive treatment (four days per week) and twice daily on the days you don't (the other three days of the week). Our client was not doing homework. It was a tough thing to dismiss: Sure, it was too bad I didn't get the full experience of the therapy and seeing the results and getting those therapy hours, but more than that, I felt bad for the client. It kind of feels like sending the message, "You failed" (which I know is not true). Plus, I had built up a relationship with this client and all of a sudden I was saying, "Sorry, I'm not going to help you anymore." Sad. I don't disagree that it was the right thing to do. I hope the client will find a time in life when he can commit to the therapy and comes back and does it!

Second, I performed my first real bedside swallow evaluation on a real life hospital patient yesterday! The patient came in with suspected stroke due to right-side weakness and some decreased ability to talk, which was then exacerbated by a fall onto a hard surface (so likely post-concussive as well). Imaging did not confirm stroke, but a swallow study is always in order for suspected stroke because cranial nerves can be damaged, impacting your motor and/or sensory functions -- both of which are very important for swallowing. As you might imagine, the subfield of swallowing in speech-language pathology is a very important one -- it's probably the only one in which your decisions could result in the death of the patient. Yikes. The goal is to determine whether the patient is safe for swallowing, and what types of textures or strategies might facilitate safety. Safety is does not just mean eating without choking; what you really want to be concerned about is aspiration (food or liquid going down the trachea into the lungs) because this can cause aspiration pneumonia and subsequently death. AND aspiration can be silent! That is, the patient does not react to food/liquid slipping down past the vocal folds with coughing -- it just goes down. Aspiration can not be confirmed with a bedside swallow evaluation; a video fluoroscopy swallow study is used for that, in which you actually watch by way of X-ray video barium boluses being swallowed and can see it going down the wrong way. But anyway, I did the bedside eval, which looks at swallow structure structure and function (including strength and range of movement) and sensation. We then provide different consistencies to the patient and observe swallowing, while also feeling on the neck for proper movement of the larynx. Yes, I was nervous. Yes, I forgot some things or did not fully do some things (no worries -- my SLP supervisor was right there helping me out). I got lucky that my patient has no dysphagia / no risk of aspiration. Yay, patient!

amazing discovery of the week:

Tomato bisque is easy to make. This is an amazing discovery for me because I love tomato bisque...no idea why I never looked into this before. Probably because I only have it at those fancy soup and sandwich places (and Noodles & Co, haha). [[True confession: I HATE tomato soup (like the canned stuff) and always have. I wonder why I ever even tried eating tomato bisque...]] Yes, I went an easier route (read: canned tomatoes) than some recipes that are out there, but it is still quite tasty. All we did:

--finely dice a medium yellow onion
--sautee until translucent in 1 T butter and 1 T olive oil (or whatever combination of oils/fats you prefer)
--stir in 1 T of flour (or corn starch) and 1 T sugar and cook for at least 1 min while stirring continuously to prevent burning
--add a little bit of water (I added probably 1/4-1/2 c)
--stir in 1 T Better Than Bouillon (or you can use a can of chicken broth instead of this and water)
--add two 28 oz cans of crushed tomatoes
--add salt, pepper, sugar, chicken broth stuff to taste
--bring to a boil
--reduce heat and simmer for 15-20 min; add more liquid if you need it
--allow to cool some and add 1.5-2 c half-and-half (or heavy whipping cream) or don't add it to the pot and simply add desired amount to each bowl

So easy. We didn't even bother with pureeing it (I generally hate pureeing soup in a blender...at least my blender...because it takes so long). Using crushed tomatoes and finely dicing the onions makes for a pretty fine-textured soup.

This plus a colby jack on poppyseed/sesame seed/hazelnut bread sandwich Foremanned made for the perfect lunch for today. Yay for a perfect lunch to suit the weather; boo for it only being like 51* today. And rainy. Ick.

hospital

This is not my for-keeps internship (real internships are in the spring; I have my school placement but am still interviewing for my other placement), but I have an offsite placement at this hospital for a few months this semester. I spend one morning per week here going around with the SLPs.

I just finished my second week, so I am still doing a lot of observing. So far, it has been a really great experience. I am with the SLPs who work on the acute floors (as opposed to rehab), so the patients we see have just had their injuries/damage/surgery or have just had a new development in their speech/language or swallowing. Yes, swallowing. This offsite is actually specifically for swallowing, though I have seen about half-and-half swallowing and language/speech evals. My first week I saw a heartbreaking stroke case but obviously can't share the details. This last week was all about swallowing. I even saw someone in the ICU, got to gown and glove up, and help move the patient...I felt so Grey's Anatomy, haha. We also had two video fluoroscopic swallow studies (VFSS), and I was pleased with how much I actually do remember from my dysphagia class.

If anyone is curious what a VFSS is, it is a video x-ray of swallowing. We present the patient with different textures of liquids and solids that have barium in or on them so that they can be visualized by x-ray. Our job is to observe how the patient handles the different textures in her mouth, pharynx, and larynx and to determine what is safe for the patient. Typical textures are thin, honey-thick, nectar-thick, puree, and cracker/cookie, and then we will often do a barium tablet as well to determine the safest way for a patient to take meds. The most important thing to look for is if anything is going down the trachea instead of the esophagus, but there is A LOT more to look for than that, and it all happens crazy fast.

kansas in signs

Another trip to KS under the belt. It was a really fun trip and one I was very much looking forward to, especially for two reasons: 1. I would get to see my husband again after a month of being in different states; and 2. I would finally get to meet my new niece!

kansas signs...

I always find it exciting to cross state lines. Does anyone else honk when you do? I asked a few of my friends here about that, and they looked at me like I was crazy. Well, I do.

Near Colby. No offense to the man, but this creepy Jesus head popping up out of the wheat billboard always weirds me out.

Delicious Mexican food found here. I always love when I get to Goodland at some meal time (or not meal time...as I specifically waited until 2:30 for lunch so I could eat here) and have time to stop for longer to get this food. Hands down they have the best tortillas I've ever eaten. We always get plain tortillas as dessert. It's called El Reynaldo's. It's funny because the signs and menu pictures at this restaurant totally make it look like a chain, but it's just a local place. Although, there is an El Reynaldo's in Burlington, CO, too, but I haven't stopped yet to find out if it is the same/related.

Probably one of the prettier state border signs and setting. I love how they have a huge pull-off area for photo ops. I still remember the first time I went to Colorado (as a kid)...I expected to see mountains immediately upon crossing the border.

I still have to get a picture of my favorite billboard along the drive for my collection. It will probably be easier / safer to get when I am not the only person in the car. Plus, this trip I had forgotten what town it was near so it was all of a sudden just upon me. Next time, I'll be prepared.

last first day

As one of my classmates so wonderfully pointed out, this is my last first day of school!! (At least as a student...and as far as I have planned.) Class starts in 15 min. I think I kicked off this monumental milestone in the right spirit...with free beer from the graduate student organization.

"beach" camping

This weekend I went camping with some friends at a lake outside of the west entrance to Rocky Mountain National Park. For some reason, it took us four hours to get there. But the drive on Trail Ridge Road through the park was beautiful! We saw a large elk herd and a mama moose with baby moose:


And, also, it was raining a good portion of the day, so being in the car for so long didn't really ruin any plans.

Since we were, after all, camping at a lake, I took my suit. But, even in July, a lake at 8300 feet is quite a bit different from, say, East Lake. I chose to stay dry, but some people did brave the chilly water.

After a while, we went into Grand Lake to look around. Half of the group went off to do a hike, and the rest of us vegged with live music, beer, and chile verde at a patio restaurant.


When we all met back up at the campsite, there were some kids -- one in particular -- very insistent on hanging around, "telling jokes," and reprimanding us for "breaking laws" ... and not to mention, being quite unsafe with pokey sticks.


Sunset Point Campground lived up to its name and gave us a beautiful sunset over the lake.


We roasted hot dogs, marshmallows (S'mores!!!), and banana boats, and did some singing around the fire. We turned in pretty early, and five (out of the six pictured below) of us in one tent made for some decidedly cozy quarters, but I was warm and comfortable the whole night through, which, in my book, are two key ingredients for camping.

more kansas

Turns out, if you check your camera, you just might have more pictures than you thought. Here are a few more tidbits from our trip to KS in May.

As I mentioned, we went to Missouri for the 13-year periodical cicada emergence. In SE KS and SW MO, we saw a lot of box turtles crossing the road (so cute). On one of our trips through the area we were at, I casually noticed what I thought was a turtle crossing the road. But, that "turtle" actually caused some excitement among certain members of the crew in our van (did I mention that both sets of our parents went with us?). Brian and his dad were pretty excited about the huge tarantula that was on the road. Naturally, we turned around so it could be collected.

This beast of a spider is now living out its days in an aquarium in Brian's parents' basement. I think Brian's mom was pretty excited about that since she is the one who ended up taking care of Brian's (long-living!) last tarantula after he moved out for college. Understandably, taking care of a tarantula is especially difficult in the winter months when it is no easy task to find crickets for it to eat.

On our way back to Colorado, we drove through the craziest dust storm in western Kansas. I had never experienced anything like it.

If you can make out the elevator in this picture, it is about a mile from where we were stopped in our car. The whole town disappeared in this dust storm!