One year

One year

March 13, 2020 is the day I remember to be “the first day of the pandemic”. For the past week or so, I’ve been thinking about how the world started to change on March 10th, 11th, 12th, 2020 and how the world has since changed since those early days in the pandemic. A few memories have popped up on my social media platforms of beginning of pandemic cancelations which has made me feel a mix of nostalgic, sad, and humored by our ignorance to COVID-19.

I’ve met quite a few people who measure the last 365+ days as “before pandemic” and “during pandemic”. We are not quite at the “after pandemic” time period and might not be for quite some time. This time last year the world was blind to how long the pandemic would last. Schools/workplaces asked students/staff to prepare for two weeks of remote learning/work. TWO WEEKS! ????? That was extended to a month, then two months… yet still today, schools/workplaces operate on fully remote or partially remote schedules.

A friend reminded a group of my friends the other day that we were 25 when the pandemic started. Soon, I will be turning 27….we’re still living in a pandemic. If that’s not a scary way to measuring pandemic time, I don’t know what is.

When this all started though, our world was convinced COVID would be a short-term occurrence. Yet, our entire world continues to be influenced by the consequences of COVID-19 in some shape or form. Every decision I make takes into consideration health risk and mitigation.

There is not a day that passes by I don’t think about measures to stay healthy. I still wear a mask every public place I go. I wash my hands and use hand sanitizer so frequently that some days my hands hurt. I am over-conscious about giving myself and others space. I am fully vaccinated yet I am hesitant to do voluntary things like group runs/races and social gatherings that would require me to be with a lot of people. We are living in a pandemic world.

Some states have “opened back up”. I pass by a barbershop a few days per week where I can see employees are unmasked. That upsets me. That makes me feel nervous for the people inside. I have heard of too many tragedies from people within my community who have lost family members or know someone who now faces other health concerns because of this terrible virus.

Recently, due to some changes in health status, my family has changed their mindset about COVID to keep each other safe. We always took COVID seriously (more than most people I would say). But now we have an air purifier in our living room with UV features to sanitize our space. We keep our distance from each other. I even quarantined myself to my room for 4 days after I was exposed to someone who tested positive (even though I am fully vaccinated). Our priorities and mindset have shifted to keep safe and healthy.

I genuinely miss running with other people. I ran 2 miles with a family friend unintentionally/unplanned last week. This was the first time I ran with another person since September. I don’t plan on signing up for any races anytime soon either. I miss having a goal but I feel like now is not the time to prioritize a running goal. I’ll just continue to maintain my fitness level (avg ~3 miles/run) and go from there.

So… one year ago (almost). We are still in a pandemic. People are still getting sick. People who are exposed still have to (/should be) quarantining. People are getting vaccinated. People are allowed to make their own choices about what they feel comfortable doing, who they feel comfortable being with, etc.

I don’t see an end in sight. Honestly, how does one even mark the end of a pandemic?

It is so strange for me to think back on what life was like a year ago – so much uncertainty, naivety, ignorance. In a way, time has slowed in the past year. Yet…I can’t believe we’re already at the one year mark.

I’m not sure what I got out of writing up this blog post. It wasn’t really cathartic. My thoughts seem really jumbled. I can’t tell if I’m sad about the health of this world or just indifferent to it.

I just want everyone to be safe and healthy, to enjoy the things you want to enjoy, to pursue the dreams you want to pursue.

Wash your hands. Wear a mask. Choose wisely who you spend time around. Be safe. Stay healthy.

2020 in review

2020 in review

2020……

A year where a lot happened in the world, yet nothing was done.

A year when nearly every plan you thought you had broke into pieces months, weeks, and sometimes even days beforehand.

A year where events, gatherings, and life milestones were postponed or cancelled altogether.

A year that will go down in history.

I’ve put off writing this yearly review because I feel like so little got accomplished this year. A lot of things got lost in the chaos. A lot of things we grieved over. It’s weird reflecting on this year. A year nobody saw coming. A new decade that promised so much potential, yet we were greeted with a global pandemic that affected every. single. person. in the world somehow or another. But, as I look over from my desk where I will type cathartic words onto the screen, Gwin & Zoey are basking in the warmth of the sun which is just enough to inspire some light into the following post:

Josh and I kicked off the new year/decade with a run (as we always do) at Camp Edge.

My parents were sick for most of the first week of January so I spent that week with Josh. Looking back, we think they may have had COVID before COVID was even “a thing” in the US. Little did I know, I already learned the importance of quarantining before “quarantine” even became a part of my daily vocabulary.

During this week with Josh, I also had to bring my car to the mechanic because something was wrong with my tire. They fixed it but, unbeknownst to me, this was probably the start of the bad luck of 2020.

I set a goal to do at least 20 push-ups per day. I maintained this routine for about two months. Then the world turned upside down and that was that.

I worked at a special services school over my winter break (the same school I worked at in the summer of 2019). This time around they bounced me from classroom to classroom, working with kids from pre-k up to high school.

My last official in-person semester began. I think my friends & I were all at the point of wanting to be done with school forever.

On January 18th, Josh & I hosted our first ever race event – a scavenger hunt race. We crammed 65+ people into S&S that Saturday. I remember days/weeks leading up to race day, I was having difficulty sleeping with an ever-growing checklist in my head for race day. I would have dreams related to the race. Josh woodburned the awards. The day was a success & everyone loved our unique event!

Toasting to our first time as race directors!

I continued to re-read the Harry Potter series and was able to finish the series this year. Still to this day, it is a great series to read!

My last Level I fieldwork placement was at an outpatient neuro-rehab office. This was by far my favorite fieldwork placement and I learned so much from the clients and my fieldwork educator. My FW educator allowed me to lead multiple sessions throughout my time there which was soooo beneficial to my learning and really made me feel like I was an OT, rather than a student. The downside was that the commute was 45 minutes (without rush hour traffic) and up to 1.5 hours during rush hour. Regardless, I loved it at this site!

S&S had many group runs in the winter months which was good to maintain motivation.

For grad school, we had to lead an exercise/nutrition group at a nearby senior living center. I was able to use the chair Zumba routine I had created years ago as an activities director at an assisted living. The residents LOVED it and I had a lot of fun leading them through each song/dance.

S&S hosted a Leap Day trail run. We had a great turnout despite it being frigid that morning.

Midterms week turned into Hell Week in a matter of about 2 hours or less. COVID had entered the United States. Stockton said they were closing down until two weeks after spring break. We prepared for several weeks of virtual grad school. Little did we know the pandemic was going to last more than a month.

The start of the pandemic in the United States – March 14th, 2020 – is date I don’t ever have to look up. The first day of spring break. One week before my birthday. The same day Josh & I had planned for months ahead of time to go to a Flyers game (which was cancelled a few days before). And for some reason, a S&S group run – the last official group run of 2020.

I spent my spring break with Gwin, Zoey, and our foster dog at the time, Royce.

For my birthday, Josh & I went to Fair Hill followed by ordering Grain on Main take-out.

In March I thought it would be cool to run 26.2 miles when I would be 26 years and 2 months old. I did start training for this goal; however, as the pandemic started to get worse, I knew running a marathon distance could potentially compromise my immune system and put me at greater risk for becoming sick. Therefore, this goal was pushed aside. As I was training though, I had some great long runs through Josh’s town where I challenged myself to run as many north to south roads and then east to west roads. It kept me entertained and increased the miles without ever being too far from home base.

I wrote over 60 letters/notes to be sent to three different assisted living homes in southern NJ. A pandemic forced residents into isolation from their families which broke my heart. I knew from an OT-perspective that the isolation would lead to both physical and mental health declines which prompted me to write the notes/letters to promote social engagement, even from a far.

Sometime in the beginning of the pandemic I started watching Gilmore Girls on Netflix. I ended the series sometime in the summer. I enjoyed it!

Through most of the spring and summer, I sent my grandparents weekly puzzles (cryptograms, word searches, crossword puzzles, etc) to keep them feeling connected and less isolated. I think they enjoyed them.

My mom (along with many other people) celebrated her birthday in quarantine. We made this cake for her.

Comic relief during the pandemic

In April, I was supposed to go to Boston to present research at the AOTA national conference. That was cancelled and I fought with airline companies for weeks to refund me my tickets.

I started the Quarantine Miles Challenge through S&S to give people motivated to get outside and exercise. Individuals consistently participated for two weeks which I deem as a success. I know it was motivating for me and held me accountable to get out and move despite living in a pandemic.

Stockton made the entire rest of the semester virtual. Every day I felt like my entire day was spent on Zoom or completing online assignments. Screentime sky-rocketed! Stockton also pulled us all out of our fieldwork placements. This was sad for me because I was really enjoying my time and learning at my site.

On April 15th, my cohort was informed that our first Level II FW placement would be in September rather than May, delaying our graduation by 3+ months. THIS WAS A SUCKY DAY.

My mom and I started to do puzzles – a pandemic trend! We completed two 1000 piece puzzles some time in April/May.

For Easter, we delivered food to Mommom and Granny since we could not have our typical dinner gathering.

I participated in a few birthday drive-bys in the spring/summer. They are quite the quick & easy way to celebrate with someone!

Josh & I spent some weekends in the spring biking to Fort Mott to lounge in our hammock. That was a fun way to pass the time without being in close contact with other people.

Hammocking at Fort Mott!

I logged out of Zoom class early one day just to go watch the Blue Angels and Thunderbirds fly over Wilmington. The park was packed with people hoping to catch a glimpse of the planes.

S&S continuously updated our policy for services. Most of the spring, the entire summer, and into part of the fall we only offered curbside services. Yet, despite the change in service delivery, S&S saw its busiest year yet. Due to the pandemic and gyms being closed, more and more people turned to outdoor activities for exercise and leisure. The biking industry EXPLODED. We went to being concerned in March about how the shutdowns would effect the business to being completely overwhelmed and mobbed with people wanting their old bikes repaired and wanting to purchase new bikes. The demand for bikes skyrocketed but the supply chain had been broken when China shut down. This year has been chaotic and overwhelming for S&S but with an “all-hands-on-deck” approach, we made it through.

I desperately started looking for work knowing that grad school was delayed. I painted parking curbs and picnic tables at the winery…. you gotta do whatcha gotta do.

At the end of April, I started the Miles for Heroes Challenge as a way to support frontline healthcare workers and local eateries. Ninety-three people participated in the Miles for Heroes Challenge, covering over 2,500 cumulative miles, and $1,145 was raised. My mom and I made deliveries to Inspira Mullica Hill, Inspira Vineland, and Salem Hospital by delivering food from Rode’s Fireside Grill, Sweetsboro, Marino’s of Mullica Hill, Liscio’s Bakery, and Italian Kitchen. The support for this idea was incredible and I felt that this challenge was the least I could do to support those who were facing challenges in the healthcare world day in and day out.

The GCC XC Nationals team of 2012 was named the RCSJ Team of the Decade. That was exciting!

I stopped using Instagram for most of the summer. I stopped uploading my runs/bikes to Strava. I just needed to disconnect from people and take a break from social media hubbub.

The day the spring semester ended, I started working at Amazon *gag*. I was THAT desperate for a job and so frustrated that grad school was delayed. One, I loatheeee Amazon. Two, working in a warehouse sucks. Three, the physical strain of lifting, transporting, and stacking people’s crap was enough to make me quit (on top of the fact that they were making me do stupid things like follow the cleaning people around to make sure they were doing their jobs correctly and forcing us to use the shuttle (which I refused to do and rode my bike to/from the alternate parking lot until I got sick of that and figured out a way to park at the warehouse itself without getting caught)). NEVER. AGAIN. I lasted less than two months.

Josh & I planted our garden again this year. The garden produced an excessive amount of eggplant.

We also started grilling every weekend and enjoyed some very tasty asparagus, corn, and burgers (veggie for me).

Grilling at its finest!

I went hiking with Robert in the beginning of June to Ceres and Parvin. We had a nice time exploring the trails!

For Father’s Day, we went mountain biking to Tall Pines and GCC. Due to the storm the day before, everything was flooded out which made for a mtb adventure that we didn’t really expect.

Josh spent June/July in a medical boot due to an overuse injury (torn plantar interossei muscle of the 3rd metatarsal) and 6+ weeks on short-term disability.

I helped Uncle Mike keep his tradition of participating in the Pitman 4 Miler alive by running with him and Tammy Fourth of July morning. Even though this year’s race was virtual, he has done this race 39 years in a row. We couldn’t break the tradition this year, pandemic or no pandemic.

In July, I rode over 500 miles on my bike, motivated by the Trek Century Challenge. I sacrificed a lot of sleep that month but it felt great achieving that goal. Completing the challenge earned me a mug and stem cap LOL (along with a good feeling of accomplishment of course!)

In July, Josh & I repainted the interior of his house. That was a hot and long week of labor!

In August, I started working for Instacart as recommended by Brianna. Since Amazon didn’t work out, I figured I’d try another “millennial” job by shopping for others. It was a lot better than Amazon and provided me with flexibility to help at S&S and to have a source of income once fieldwork began.

At the end of August, I organized a surprise drive/bike-by for my parents for the 5th anniversary of S&S. They were very surprised and so excited to see everyone! This was also the only unofficial-official group ride of 2020 for S&S.

S&S Drive-by – the biggest group I was physically with all year.

On 9/11, I organized a small group run of running friends to honor the lives lost and impacted by that tragic day 19 years ago.

My first day of Level II FW was 119 days overdue but on September 14th, I was able to finally start my first placement at an outpatient office. I learned a lot at this placement and was able to complete all 12 weeks providing in-person OT! My FW educator was extremely nice and willing to teach me whatever I needed to learn. The clients I got to work with will always hold a special place in my heart as I enjoyed getting to know them and seeing their progress through the weeks I got to work with them. I am grateful I completed this rotation with only one minor COVID scare. One down, one to go!

Brianna got engaged and asked me to be her maid of honor! She said yes! I said yes!

We volunteered at the Cow Run again, playing 80s music and dancing in the street while handing out water (masked of course).

Alex Trebek passed away.

I really missed group runs and running with people but every time I saw a picture of a big group of runners, I’d instantly get anxious thinking “they’re putting themselves at risk for getting sick”. As much as running solo 80% of this year sucked, I came to enjoy it for the most part. I’m also eternally grateful for dogs to run with.

Josh & I knocked down his fence one weekend day.

On October 2nd, Josh & I adopted Burton from SJRAS. He has stolen our hearts ever since.

Burton’s adoption day!

My dad helped Josh put up a fence in Josh’s backyard.

Burton cut his paw pad on glass about 2 weeks after we got him which resulted in him wearing a sock for 2 weeks and the cone of shame. This also resulted in Josh & I sifting through dirt in his backyard for hours and hours and hours and hours to prevent him from cutting his paw pad again. This was a stressful time.

Granny helped me sew a fasteners board as an OT project I wanted to create.

I participated in the only “race” of the year – the virtual Sasquatch 5k… that was supposed to happen in April. It was moved to October as an in-person event, then changed to a virtual event when the pandemic continued.

My cohort learned that we would be getting another FW coordinator for our last FW rotation. My cohort has now had a total of three FW coordinators over the course of a 2.5-3 year program.

Election year – the year we submitted out ballots to marked election mailboxes. Biden won, Trump was/is in denial he lost, and there was a celebration in Wilmington. Josh & I didn’t go to watch the fireworks across the river.

I went on my own Halloween lights run one night. Lots of cool displays!

On Halloween, I set up a bench at the end of Josh’s front walkway and spread out pieces of candy all along the bench so kids wouldn’t be sticking their hands into a bowl of candy. I sat on Josh’s front step all night (masked even though I was about 15′ from the bench). Sadly, only four kids came by and we had a lot of extra candy leftover.

Burton has had many playdates with Gwin & Zoey. Burton exhausts them!

We learned that Burton likes to bite the leaf blower and vacuum, that car rides give him extreme anxiety, and that he loves socks and soft items like winter hats, shoes, and any other article of clothing. He also loves chasing Josh on his bike and snuggling once he gets tired! Josh & I also got to take him on hikes and runs to Camp Edge, Brandywine, and Fair Hill.

Josh installed an exterior outlet so I could decorate his front porch with Christmas lights! Yay!

I became obsessed with reading. My goal this year was to read at least 10 books – I’ve read 19 books this year. Silver lining of the pandemic? I also restarted my GoodReads account – social media for book lovers! WOO!

I hosted a bonfire with Megan, Emily, and Aaron on a windy, cold November night after Thanksgiving. We enjoyed our time together (socially-distanced) but were all shivering by the end of the night!

Josh and I started watching Stranger Things on Netflix.

I reread my “2019 year in review” and it said “A year from now, my yearly review should say “finished grad school” somewhere in it”….. well, I’m here to tell you that I can’t write that in this year’s review.

Mom & I created a 25 days of Christmas gift for the grandparents since we would not be hosting a normal Christmas gathering this year. They loved opening a gift each day and I loved putting each “package” of gifts together for them.

The COVID vaccine started to be administered in the United States a week or so before Christmas.

S&S hosted a modified Santa Run. We collected and delivered over 1200lbs of dog/cat supplies! SJRAS was so appreciative and I was so grateful we were able to pull off a modified version of this event to continue to show SJRAS my gratitude for providing our homes with years with Hope, Gwin, Zoey, Burton, and many foster animals!

1200 lbs of donations dropped off!

My car exceeded 328,000 miles.

We bought our Christmas tree the week of Christmas and made chocolate chip cookies, dried cranberry oatmeal cookies with white chocolate chips, pizelles, and Swedish tea cakes.

On Christmas Eve, a rain/wind storm passed through our area, resulting in power outages and downed trees.

On Christmas morning, Mommom came over to stay warm and we ate breakfast socially distanced and masked up when we weren’t eating. Granny required emergency service for her heater so she didn’t come over until the day after Christmas, where again we opened gifts in the sunroom masked up.

This was also Burton’s 1st Christmas! My parents gifted me, Josh, and Burton red flannel shirts so we would all match!

This year my family fostered Royce, Bourbon, & Gloria – all precious dogs – and Otis, Roger, Starr, and Skyy – all cute kittens.

Weird COVID things that I want to look back on thinking “wow, that’s what it was like during the pandemic” (in no particular order):

  • There was/is a toilet paper and paper towel shortage. So much so, that stores put a one item limit on these such products.
  • I wipe down groceries from the store with sanitizing wipes after every shopping trip.
  • Purell hand sanitizer does not exist in stores anymore. Lysol is also obsolete.
  • During fieldwork, clients never got to see the bottom half of my face.
  • During March, we thought grocery stores were going to close down which resulted in panic shopping. I remember telling Josh to stock up on canned items, pasta, and other non-perishables. We were thinking very unrealistically.
  • I walked into a Shoprite without a mask once. I realized it two seconds after walking in the door and instantly gasped and sprinted out the exit door.
  • Grocery stores attempted to promote social distancing by putting arrows on the floor to make aisles directional. Unfortunately, people do not know they have to follow the arrows.
  • At Wawa, there are signs that instruct you to roll your window down only 3 inches.
  • The first time I went to eat AT a restaurant (outside) was in September (the night before Brianna got engaged actually). The second time was a few weeks later (outside again). I do not feel comfortable dining inside.
  • For Christmas, I got hand sanitizer in my stocking and face masks from Mommom. What a world we live in!
  • I quarantined from Josh for two weeks after Thanksgiving when his co-worker was with someone who tested positive for COVID. This was also the last two weeks of my FW rotation and I did not want to take any risks that would delay me finishing. Everyone turned out to be ok.
  • I do not foresee myself flying or using public transportation any time soon.
  • I am glad in March I did not know the pandemic would last countless months. I think many people, myself included, didn’t see this as something that would still be affecting us in December. But, here we are.
  • I want to get the vaccine when it becomes available to me.
  • There was limited availability of outdoor equipment/merchandise, such as bicycles, kayaks, in-ground pools, and lumber for decks and fences.
  • Trail systems became very popular places as more people participated in more activities outside.
  • Hair salons, among other businesses, were shut down for a few months.
  • I have a bag of homemade masks in my car (that Granny made from fabric and recycled bike tubes for the ear straps). I always have a mask hanging from my rearview mirror. No mask, no service.
  • Mom did grocery shopping for Granny in the beginning of the pandemic.
  • People think it’s ok to wear a mask that doesn’t cover their nose. News flash: that’s not ok.
  • People wore masks in their cars, on the trails, and (of course) inside public spaces.
  • Stores had limited capacity which resulted in an employee standing outside to monitor how many people were going in/out.
  • We watched church virtually through Facebook on Easter and Christmas Eve. Churches were at limited capacity in the summer and fall. At the beginning of the pandemic, churches were closed with the exception of the priest, deacon, lectors, and a musician during masses.
  • Zoom is wonderful technology and has provided me with the opportunity to stay connected with my closest friends from Stockton and family members during holidays.
  • I was scheduled for a car inspection two days after the pandemic “started”. The DMVs and inspection stations were closed and rules had to change for cars that had expiring inspections.
  • For doctor’s appointments, waiting rooms in the office became non-existent. The new, safer, waiting room became your car.
  • “Social distancing” means standing 6 or more feet apart from someone else.
  • “Quarantining” means staying home for at least 10-14 days (which I think some people don’t fully understand).
  • Stimulus checks were distributed to help the economy. Yet, I never got a stimulus check. *cue sad music*
  • The NHL and NBA completed their seasons “in a bubble” meaning they lived in hotels that were quarantined from the public and no spectators were allowed in the bubble.
  • Each night my parents put the money that was given to them at S&S into our dryer on high heat because it kills the germs. “Laundering money” at its finest, folks.
  • Spending more time at home resulted in more time spent with the dogs! That’s a win for me!
  • Eventually, the pandemic will end. When? I’m not sure. I just know we’ll be wearing masks for a very very long time!

Running Stats of 2020:

  • Total miles: 1,008 miles (vs 2019 at 1,025.1 miles)
  • Highest monthly mileage: April (151.3 miles) (vs 2019 at May 103.5 miles)
  • Races: virtual Sasquatch 5k
  • Shoes worn: Altra Superiors & Altra Escalantes
  • States I ran in: New Jersey, Maryland, & Delaware

Cycling Stats of 2020:

  • Total miles: 874.4 miles (vs 2019 at 1,111.7 miles)
  • Highest monthly mountain bike mileage: July (129.6 miles) (vs 2019 at May 93.5 miles)
  • Highest monthly road bike mileage: July (373.2 miles) (vs 2019 at August 287.9 miles)
  • Highest monthly combined mileage: July (502.8 miles) (vs 2019 at August 325.4 miles)
  • Total Road Bike Miles: 527.1 miles (vs 2019 at 739 miles)
  • Total MTB Miles: 347.3 miles (vs 2019 at 372.7 miles)
  • Races: none

Total woman-powered miles: 1,882.4 miles

This year has been a wild rollercoaster. It feels like March was a very long time ago. There are some months I reflect on and think “what did I even do that entire month?!”. April and May in particular feel like an absolute blur. Come to think of it, June does too.

I guess because there wasn’t much we could do, in terms of vacationing or doing fun things with friends, we spent a lot of time doing the same things. For me, that included running, biking, taking pictures of cute dogs, working, reading, watching Netflix, cooking, and sleeping.

For 2021, it’s hard to set expectations and long-term goals. Each week of FW is an accomplishment which means I’ll aim for 12 consecutive smaller accomplishments to start off the year. I also hope to finish grad school, take the NBCOT, and be able to add “OTR/L” to the end of my name. I want to become employed as an OT. I want to spend time with my dogs, running and hiking. I want to spend time with friends and family (safely). I want to bike more, run more, and maybe do an ultra (or some other race that Josh & I are brainstorming). I also hope to host another scavenger hunt race and start up group runs again when it’s safe. I want to read more books. I want a real job with a steady income. Better health care coverage would also be nice. I want my family, friends, and dogs to be healthy. I want to be the best maid of honor I can be in my best friend’s wedding!

This sure is a long list of things I aspire for. I will do my best with the cards that are dealt to me. I’m not signed up for any races. I’m not setting a specific date I want to take the NBCOT. These things are out of my control. I need to do step 1 before I can progress to step 2. One step at a time.

If you’ve gotten to this point in the blog, thanks for listening to my ramblings! This year has been a year that’s felt like 5 years. So many hopes, dreams, aspirations, and lives were lost. So many families affected one way or another. Yet, there were some good things that came out of this year – like a booming family business, helping healthcare workers with kindness and unity, adopting Burton, finishing one of two FW rotations, reading a lot for leisure, house projects with Josh, spending time (although limited) with friends, and, in general, good health.

I pray that 2021 brings good things, gratitude, and joy for my family & friends!

October Update

October Update

Hello, mid-October! Since my previous posts (when I was so enthusiastically preparing for fieldwork), I have completed a total of 5 weeks of fieldwork, continued running intermittently, and adopted a dog with Josh, along with many other good and “eh” things.

Fieldwork:

Fieldwork is going well (I think). I am currently in a small private practice outpatient office where I work with clients with a variety of diagnoses from orthopedic upper extremity injuries to post-CVA (stroke). I have struggled and I have succeeded. I have learned. I have discovered that I do not foresee myself ever working in an outpatient office. Orthopedic injuries are just not interesting or motivating to me.

I have enjoyed working with clients who have lost function related to isolation from the pandemic. I have enjoyed working with clients who are recovering from a CVA (even though this is the most challenging diagnosis I have been exposed to thus far). I have enjoyed creating client-centered and occupation-based treatment sessions. And honestly, documentation isn’t all that bad (as of right now).

I have not enjoyed working with individuals recovering from fractures. Doing range of motion manual techniques is just too mundane for me. I have not enjoyed feeling like I don’t know enough. I have not enjoyed feeling like I’m running out of intervention activities.

So, at least I know outpatient offices aren’t the place for me. I hope I’m doing well enough to do well during my midterm evaluation next week. I never have high expectations for myself.

I have also enjoyed feeling like I have more time for self-care and friends/family time. I don’t feel guilty going for runs because I feel like I have more time to run. I actually have relaxing time at night now instead of doing assignments until bedtime. That’s the perks of fieldwork thus far. More time for self-care is so good for the soul.

Running:

Even though I have technically have more time to run, I have needed time to transition into a new routine. Some days I would get home and have a pounding headache from not eating/drinking enough throughout the day (I blame the masks for my dehydration because taking a sip of water isn’t automatic anymore when you wear a mask 8 hours/day). I have tried dark morning runs again but they’re not enjoyable for me.

I have given myself grace though by allowing myself more than one rest day per week. Some weeks I only run 3-4 times. Although this is a hard pill for me to swallow some weeks, I need to recognize that my schedule is once again evolving. For what seems like years and years and years, I haven’t had the same routine for more than 2-3 months. Between this work schedule or that work schedule, grad school, COVID, what have you, I just can’t establish a routine that sticks. And I hate it. I want to know that 5 days/week I am working a certain shift that starts and ends at relatively the same time. I want consistency. And I realize that life will throw curveballs, but even just having a semi-consistent work schedule for the length of 365+ days would be nice. Maybe one day.

I still want to run an ultra. My brain is constantly spinning with running goals I hope to one day achieve. I’m not signing up for any races the remainder of this year. The one race I signed up for that was supposed to be in April which got postponed until October was made into a virtual race (I dislike virtual races) so now I have to submit a time for a virtual 5k. Yipee.

Over the past 3 days, I have been obsessed with the drama unfolding at Bigs Backyard Ultra. GO TEAM USA! And now I want to host my own Backyard Ultra. 2021???? Who’s in? (@Angela I hope you’re reading this and I hope you can fly to NJ so we can run for miles and miles and miles and miles together).

Burton:

Josh & I adopted an Australian Cattle dog on October 2nd. We named him Burton (shelter name was Boomer). They told us he was approximately 8 months ago so we chose the birthdate of February 4th. He is very very energetic and tends to nip at any part of your body. We knew these were characteristics of a cattle dog before we adopted him. He just needs some training.

Unfortunately, Burton cut his paw pad 8 days ago so he’s been in a little boot sock to promote healing. This has been stressful because he hated when we put the boot on and would try to bite it off (or bite us). We have come up with a system and it has been working after many instances of trial and error. Once his paw pad is healed, we will be able to take him for walks/runs again and socialize him with other pups. The entire thing has had bad timing because for the first 10 days we had him, he couldn’t do much activity because he was neutered. On the 9th day of his recovery, he cut his paw pad so we’ve been dealing with that for over a week. Once it’s healed I will be happy to go on trail adventures with him (obviously easing him into it just like a person would ease into building their mileage).

Other things:

I am excited to be in a wedding next spring! #MaidofHonor

COVID still exists. Wear a mask. Respect other people’s opinions about COVID.

I miss group runs terribly but I am not sure if it’s safe to run with others because I don’t want to test positive for COVID and then have to miss weeks of fieldwork.

My car exceeded 326,000 miles recently.

Instacart is a dud right now because people aren’t as afraid to go grocery shopping anymore.

The bike industry is a mess still. Preordering 1-2 years out is just crazy.

Health insurance in this country is an absolute disaster.

I can’t wait to have a full-time job with benefits.

I’ve been craving tater tot nachos for weeks.

Also, I want to make vegetarian chili now that it’s colder outside.

The leaves are pretty.

I hate politics.

I want to go to a corn maze but there’s no good ones around here.

Stay away from cougars in Utah. They’re scarrrrry.

The Eagles are doing terrible. I don’t even waste my time on them anymore.

Old gameshows are being remade. Recently I’ve watched The Weakest Link (I can actually answer these questions unlike Jeopardy) and Supermarket Sweep (the original version is way better).

I don’t foresee myself getting on a plane anytime soon.

I really like sleep and I hate waking up when I know it’s cold outside.

Hot chocolate season is back though!

I hope everyone is doing well, staying healthy, and living their dreams.

Keep at it, whatever you’re doing.

Chapter 15: Traumatic Brain Injury

Chapter 15: Traumatic Brain Injury

Kicking off this week with a review of traumatic brain injury.

What is traumatic brain injury?

A traumatic brain injury (TBI) involves any injury to the brain from an external force (Tipton-Burton, 2018). A TBI may be caused by a fall, motor vehicle accident, gun shot wound, or assault, among other causes. Any impact to the head may cause a TBI of varying severity. Fatal TBIs are more common in men and adults older than 65 see the highest rate of TBI (mostly due to falls) (Tipton-Burton, 2018).

Two words that you should know include coup (pronounced “coo”) and contrecoup (pronounced “counter-coo”). Coup involves the directly injured area where contrecoup involves the indirectly injured area (Tipton-Burton, 2018). Another way to think about this is that coup is the first impact of the brain against the skull and the contrecoup is the second impact of the brain against the skull. Think of it like whiplash.

Experiencing a TBI may or may not result in coma. The Glasgow Coma Scale is used to assess an individual’s level of consciousness (Tipton-Burton, 2018). This scale takes into consideration the individual’s verbal response, motor response, and eyes opening. The Ranchos Los Amigos Scale is then used to measure levels of awareness and cognitive function for individuals who are emerging from a coma and throughout their length of recovery (Tipton-Burton, 2018).

In one of my fieldwork experiences, I got to work with several individuals who were recovering from TBI. Some individuals were in their 20s, some were in their 60s, 70s, and 80s. TBI knows no age. Some individuals were in tragic motor vehicle accidents, some were assaulted, some were caused by poor decisions, some were caused by pregnancy complications. We must remember that the brain is the control center of the body. Any damage to the control center can affect many areas of one’s life.

What does TBI “look like”?

Individuals recovering from TBI may experience physical, cognitive, visual, emotional, and behavioral symptoms. The severity of the symptoms depends on the severity of the TBI and the location of the damage to the brain. Every individual recovering from a TBI will present with a different combination of symptoms. Some may be stronger physically but struggle with cognitive functions, or vice versa.

Physical challenges may include rigidity, muscle spasticity, re-emergence of primitive reflexes (the reflexes we all had when we were babies), decreased muscle strength and endurance, changes in range of motion and/or sensation, and postural deficits (Tipton-Burton, 2018).

Cognitive challenges may include difficulty with executive functioning (decision making), attention, concentration, memory, self-awareness/judgement, safety, processing, and initiation/termination of activities (being able to start and stop activities in an appropriate timeframe and/or with/without need for cueing) (Tipton-Burton, 2018). The cognitive aspect of TBI is extremely interesting to me and I was privileged to be able to work on cognition with clients during my fieldwork experience.

Visual challenges may include changes in acuity (ability to see clearly), accommodation (ability to adjust to near/far objects), convergence (ability to fixate vision on a single object), and scanning (ability to look around one’s environment in an organized manner) (Tipton-Burton, 2018). Other visual diagnoses related to TBI include nystagmus (“shaky” eyes), hemianopia (vision field cuts), reduced blink rates, ptosis (drooping eyelid), lagophthalmos (incomplete eyelid closure) (Tipton-Burton, 2018).

Emotional and behavioral symptoms are related to emotional regulation, changes in social roles and independent living, and dealing with loss. Often, upon emerging from a coma an individual may be angry and threatening. This will eventually lessen as an individual continues to recover. Other behavioral symptoms may include impulsivity, yelling, swearing, or displaying inappropriate gestures. An individual may experience depression and anxiety as a result of changes in social roles (i.e. changes in friend groups as a result of one’s disability or changes in one’s ability to take care of their children).

As mentioned previously, these challenges related to TBI recovery vary from individual to individual and may include more or less than what I just reviewed.

How do OTs help individuals with TBI?

OTs are part of the recovery process from the beginning. If the individual is still in a coma, the OT can help maintain range of motion, prevent pressure sores, and provide family education to keep the family involved and informed throughout the recovery process. Depending on the severity of the coma, sensory stimulation may also be utilized to start the “rewiring” process of the brain.

When the individual emerges from a coma, further treatment can be provided to assist with the presenting physical, cognitive, emotional/behavioral symptoms. Additional family education would be provided to keep the family involved in the recovery process.

As the continuum of care progresses, OTs can be involved with cognitive and visual retraining by teaching compensatory strategies. Cognitive strategies may include using phone reminders for important appointments/occasions, breaking down instructions into smaller chunks, and keeping important identifying information readily available in the case of emergency (among many many others!).

One of my favorite visual strategies is called the lighthouse strategy. Think of the eyes as the light of a lighthouse. When reading the eyes should start left, scan the right, then return to the left side, just like a lighthouse. Back and forth.

Family education is imperative throughout the continuum of treatment and recovery. I have read several books (true stories) this summer about traumatic brain injury recovery. Most of the books were told from a family member’s perspective (often the spouse). These books have taught me a lot about the impact TBI has on family members. Often, the family member will grieve the loss of their spouse/parent/child/sibling as a brain injury often changes many aspects of one’s personality and their related family roles. The severity of the brain injury may cause the individual to appear like a whole new person. I highly recommend these books for both clinicians and family members of an individual recovering from brain injury as I believe these books provide wonderful insight to brain injury recovery. The books are listed below:

Left Neglected by Lisa Genova – This book provides insight from both the individual and family’s perspective after a tragic motor vehicle accident.

Where is the Mango Princess? by Cathy Crimmins  – This book provides insight from the family’s perspective after a tragic boating accident.

In an Instant: A Family’s Journey of Love & Healing by Bob Woodruff & Lee Woodruff – This book provides insight from both the individual and family’s perspective after Bob Woodruff, an ABC world news reporter, experiences an IED explosion in Iraq.

I feel like this post doesn’t dive deep enough and it’s a little all over the place considering how I find this population to be so interesting to work with. For that, I apologize. However, I hope you found this post informative and learned at least one thing. If you didn’t, pick up one of those books to get a glimpse into the world of traumatic brain injury. It will enlighten you!

Stay tuned for more posts this week.

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Tipton-Burton, M. (2018). Traumatic brain injury. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 841-870). St. Louis, MO: Elsevier.

 

 

Chapter 14: Dupuytren’s Disease

Chapter 14: Dupuytren’s Disease

I’m tackling another common upper extremity condition today – Dupuytren’s Disease.

What is Dupuytren’s Disease?

Dupuytren’s is a condition in which the palmar fascia of the hand progressively tightens (Coppard, 2020). Fascia is connective tissue that sits right under the skin. Fascia holds nerves, muscles, and tendons in place. When this tightens, the finger(s) are pulled into a flexed position (pulled in towards the palm).

Risk factors for Dupuytren’s include genetics, diabetes, alcoholism, trauma, & epilepsy (Coppard, 2020). Unfortunately, due to the genetic predisposition of Dupuytren’s, there is a chance the disease will eventually return after surgery.

What does Dupuytren’s Disease “look like”?

Typically, Dupuytren’s affects the ulnar side of the hand (the pinky side); therefore, the pinky and ring fingers are commonly pulled into a flexion contracture (Coppard, 2020). A contracture is a fixed position of a joint(s). In this case, the pinky & rings fingers are unable to extend or straighten. They are essentially “stuck” in a flexed position.

Along with the flexion contracture, nodules often appear at the distal palmar crease (Coppard, 2020). Imagine nodules as permanent tiny little bumps. The distal palmar crease (DPC) can be located by trying to practice palm reading. The DPC is “highest” most crease before reaching the base of the fingers. If you begin to flex your fingers down, this is the first crease you see wrinkled. The nodules may not be painful at first but can most definitely impact the ability to perform daily tasks.

The severity of the contracture will influence the type of treatment provided. Severe contractures (>30 degrees of flexion) often warrant the need for a surgical procedure (Coppard, 2020). Contractures <30 degrees of flexion are typically treated with conservative treatment (Coppard, 2020).

How do OTs help individuals with Dupuytren’s Disease?*

Humans use their hands for basically every task of the day. Next time you pick up your phone to talk to text, try keeping your pinky & ring fingers flexed into your palm. Not so easy, right? Or try typing on your computer using only your thumb, pointer, and middle fingers. Dressing would become more difficult. Reaching into the pocket of your jeans for your wallet or keys may become troublesome. OTs consider all these tasks (and more) when working with an individual with Dupuytren’s. How can we adapt activities in a way to promote independence and successful engagement?

Certified hand therapists (OTR/L, CHT) may frequently work with individuals with Dupuytren’s, especially post-surgery; however, there is a chance that OTs outside of the hand therapy environment may work with an individual with Dupuytren’s.

Conservative treatment may include soft tissue manipulation using Graston (a “knife”-like tool) and functional adaptations (Coppard, 2020). Soft tissue manipulation is completed in hopes of “loosening” the soft tissue that is pulling the fingers into flexion. Functional adaptations are recommended to promote engagement in occupation and to slow the tightening of the fascia over time.

Non-conservative treatment involves surgery. There are multiple surgeries that could be performed. The surgical procedure would depend on the surgeon’s preference, the disease’s severity, and the disease’s location. OTs would be highly involved in the post-surgical process by fabricating an orthosis and recommending exercises to help with healing, educating individuals on tendon glides, and providing treatment for scar management for optimal scar healing (Coppard, 2020). As mentioned previously, there is a high likelihood that Dupuytren’s could return even after surgery; therefore, it is important to optimize healing and educate individuals on ways to slow the progression of Dupuytren’s occurring again.

I hope you learned something from today’s post! Stay tuned for more!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Coppard, B.M. (2020). Hand immobilization orthoses. In B.M. Coppard & H.L. Lohman (Eds.), Introduction to orthotics: A clinical reasoning and problem solving approach (5th ed., pp. 187-212). St. Louis, MO: Elsevier.

 

Chapter 13: Carpal Tunnel Syndrome

Chapter 13: Carpal Tunnel Syndrome

Moving right along to carpal tunnel syndrome! Most people can say they’ve heard of carpal tunnel somehow at one point in their lives. I’m here to explain the anatomy, the causes, and the ways that OTs can help an individual with carpal tunnel.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is an upper extremity disorder caused by compression to the median nerve (Walsh & Chee, 2018). The median nerve provides sensory information along the volar aspect (palm side) of the thumb, pointer, and middle fingers, in addition to the medial aspect of the ring finger. The median nerve runs through the carpal tunnel along with multiple tendons that are responsible for flexing the fingers.

CTS is caused when the median nerve becomes compressed due to swelling or a smaller carpal tunnel (Walsh & Chee, 2018). Repetitive or sustained activities in which the wrist is flexed, extended, or ulnar deviated (positioned toward the pinky side of the hand) for long periods of time may cause the compression. Activities or work that involves repetitive forceful gripping or pinching may also cause compression. Lastly, prolonged exposure to vibration, cold, or constriction over the wrists could contribute to the existence of CTS. Pregnancy, rheumatoid arthritis, and congestive heart failure may also be contributing conditions to CTS as increased inflammation exists throughout the body (Walsh & Chee, 2018).

What does carpal tunnel syndrome “look like”?

Individuals with CTS will often report pain/tingling upon waking at night within the median nerve distribution (volar aspect of thumb, pointer, and middle fingers, medial aspect of the ring finger) (Walsh & Chee, 2018). An individual may also report that they frequently drop items. Pain/tingly during repetitive activities that require wrist flexion, extension, or ulnar deviation may also be a sign of CTS.

There are two tests to quickly assess for CTS. Tinel’s test involves tapping along the pathway of the median nerve. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present. Phalen’s test involves placing the dorsum (top) of both hands together in an upside downish position (very scientific description right?) so that the fingers are pointing towards the floor. The wrists should be flexed in this position. The individual stays in this position for up to 60 seconds. The individual is asked to report if/when tingling is felt within that time frame. If paresthesia (tingling) is felt during the test, there is a possibility that CTS is present.

How do OTs help individuals with CTS?*

There are a few ways that OTs can help individuals with carpal tunnel. Depending on its severity and potential interference with successful completion of daily tasks, an orthosis could be fabricated to help position the wrist in a less stressful way. Nerve glides could be taught to the individual which is a way of giving the nerve space to move. Education regarding safe and stress-free positioning would also be emphasized to relieve symptoms.

If conservative treatment is ineffective, a carpal tunnel release could be performed by a surgeon. The OT would then have a significant role post-surgery to ensure optimal scar healing and to prevent further or repetitive complications. If the release was done in the right wrist, it would be highly beneficial for the individual to learn ways to prevent carpal tunnel from occurring in the left wrist.

I hope you learned something from today’s post! Stay tuned for more!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Walsh J.M. & Chee, N. (2018). Hand and upper extremity injuries. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 972-1003). St. Louis, MO: Elsevier.

Chapter 12: Multiple Sclerosis

Chapter 12: Multiple Sclerosis

Today I am reviewing multiple sclerosis (MS)!

What is multiple sclerosis (MS)?

MS is a degenerative disease involving nerves within the central nervous system (CNS). The CNS is composed of the spinal cord and the brain, both of which are essential structures that communicate and facilitate sensory and movement information throughout the body. Myelin sheath within the CNS becomes impaired and lesions (plaques) exist, causing a disruption in messages being sent throughout the body. MS is most commonly diagnosed between the ages of 20-40 years old (Schultz-Krohn, Foti, & Glogoski, 2018). MS involves periods of exacerbations (periods of time in which symptoms are present) and remissions (periods of time in which symptoms are not present).

There are four types of MS which include the following:

  • Relapsing-remitting (85% of those diagnosed with MS): This type of MS involves periods of exacerbations and remissions with symptoms disappearing after each exacerbation or the appearance of residual deficits occurring after each exacerbation (Schultz-Krohn, Foti, & Glogoski, 2018).
  • Primary progressive (10%): This type of MS involves a steady progression of deficits after each exacerbation resulting in progressive deficits as the course of MS lengthens (Schultz-Krohn, Foti, & Glogoski, 2018).
  • Secondary progressive: This type of MS initially begins as relapsing-remitting MS but progresses with fewer remissions, resulting in decreased independence and more deficits (Schultz-Krohn, Foti, & Glogoski, 2018).
  • Progressive relapsing (5%): This type of MS involves steady declines from the beginning but deficits do not occur as quickly as with primary progressive (Schultz-Krohn, Foti, & Glogoski, 2018).

Honestly, it has been difficult for me to wrap my brain around each type and their differences; however, I think if you take the time to understand and interpret the name of each type, it will become clearer which is which.

What does MS “look like”?

MS presents itself differently in each individually. The most common symptoms include fatigue, numbness/weakness in 1+ limbs typically on one side of the body, vision problems, bowel/bladder dysfunction, and cognitive deficits (like a “fog”) (Schultz-Krohn, Foti, & Glogoski, 2018). Individuals may also experience motor disturbances including tremors, decreased coordination, unsteady gait (causing balance concerns!), dizziness, slurred speech, and sexual impotence (Schultz-Krohn, Foti, & Glogoski, 2018).

Individuals diagnosed with MS are cautioned to avoid extremely hot temperatures (Schultz-Krohn, Foti, & Glogoski, 2018). During exacerbations, individuals with MS should rest as much as possible. Vision may fluctuate; therefore, it is important one’s meaningful occupations are adapted or flexible when needed. Cognitive changes may also occur, including deficits in short-term memory, attention, and orientation (Schultz-Krohn, Foti, & Glogoski, 2018). In continuation, individuals may experience difficulty with fine motor skills related to sensory loss which could impact one’s ability to complete daily tasks.

How do OTs help individuals with MS?

OTs can work with individuals with MS during periods of exacerbations and remissions. During exacerbations, in which the individual may be on bed rest, OTs can utilize passive range of motion to prevent loss of joint mobility, modify activities to minimize exertion, and provide education to family members to promote optimal care.

During remissions, OTs can help an individual return to their prior level of function through physical conditioning (when appropriate), providing adaptive equipment, and educating an individual on energy conservation and fatigue management. Such recommendations may include establishing a sleep routine, encouraging healthy diet choices, and stress management techniques.

Energy conservation is also important as fatigue is often one of the most influential barriers to independence and quality of life. The checkbook analogy explained in “Chapter 11: Osteoarthritis & Rheumatoid Arthritis” would be applicable for individuals with MS. Likewise, strategies for energy conservation could expand into other occupations such as bathing/dressing, meal preparation, shopping, and leisure activities. These general recommendations may include:

  • Prioritizing what needs to be done throughout the day. Can some items on the to-do list wait until tomorrow or later in the week? Balance that checkbook!
  • Planning what needs to be done strategically. Plan for periods of activity versus periods of rest throughout the day.
  • Sit to work when possible. Sit while cutting veggies for dinner or while doing dishes. Use a riding mower instead of push mower when cutting the grass. Sit to dress or shower (tub bunch required).
  • Use appliances. A dishwasher saves you energy from scrubbing dishes. A dryer saves you energy from hanging clothes on the clothes line. An electric can opener saves you energy from using a typical twisty can opener. Use them when possible!
  • Plan your shopping trips. Make a list. Try to visualize the store to avoid walking down aisles multiple times. If fatigue is too limiting of a factor, try Instacart in which a personal shopper will do all the shopping for you and deliver to your home!

If vision and cognition are impacted, remedial or rehabilitative strategies would be recommended by an OT. Magnifiers or audiobooks could be recommended to ensure participation in meaningful activities. Phone reminders for important appointments or events could be implemented to compensate for memory deficits. Cognition apps, such as Lumosity, could be recommended for daily cognitive activities.

Fine motor skills and sensory functions are often impacted; therefore, an OT can make recommendations for adaptive equipment or alternate strategies to promote independence. This may include use of built-up handles for kitchen and writing utensils. To promote independent medication management, if an individual has difficulty feeling the small pill within their fingers or knowing if they dropped it or not, the weekly medication box could be positioned on top of a baking sheet. Therefore, if the pill is accidentally dropped, the sound of the pill hitting the baking sheet would alert the individual that it had been dropped. Changing the environment in which medications are taken through this simple change could make a significant difference in prescription compliance.

Referrals to support groups for both the individual and one’s family member(s) may also be beneficial. This is a nice way of connecting individuals to support, educate, and inspire each other!

There are countless other ways that OTs can help individuals with MS improve their quality of life and independence. This is merely a brief overview of the OT-MS relationship. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Schultz-Pendleton, W., Foti, D., & Glogoski, C. (2018). Degenerative diseases of the central nervous system. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 871-903). St. Louis, MO: Elsevier.

Chapter 11: Osteoarthritis & Rheumatoid Arthritis

Chapter 11: Osteoarthritis & Rheumatoid Arthritis

Welcome to my 2nd educational post. Today we’ll tackle arthritis!

What is arthritis?

Arthritis means “joint inflammation” (Deshaies, 2018). There are two types of arthritis that I will review today: osteoarthritis (OA) and rheumatoid arthritis (RA).

What is osteoarthritis (OA)?

OA is a joint condition in which the cartilage between joints wears away, causing stiffness and pain (Deshaies, 2018). As the cartilage wears away, the bones within the joint begin to rub together.  This causes inflammation (swelling) and crepitus (noise of bones crunching or popping). Unlike rheumatoid arthritis (explained later), OA typically attacks individual joints such as a joint within the fingers (distal and proximal interphalangeal joints), knees, and hips.

What does OA “look like”?

OA presents with multiple symptoms including joint pain, stiffness, tenderness, limited range of motion (movement), inflammation, and crepitus (Deshaies, 2018). The symptoms typically present themselves after activity and will subside with rest or at night. An individual with OA may also experience morning stiffness or stiffness after prolonged sedentary activity (this is called “gelling”).

Nodules may also appear on either or both of the last two joints of the finger (distal interphalangeal (DIP) or proximal interphalangeal (PIP) joints). Nodules that appear at the DIP joint are called Herberden’s nodules. Nodules that appear at the PIP joint are called Bouchard’s nodules. A mnemonic to remember which is which is listed below:

HD = high definition = Herberden’s DIP

BP = blood pressure = Bouchard’s PIP

What is rheumatoid arthritis (RA)?

RA is a chronic, systemic inflammatory autoimmune condition (Deshaies, 2018). Let’s break that down. “Chronic” means long-term and “systemic” means within the whole body’s system; therefore, RA is a long-term whole-body inflammatory condition. Unlike OA, RA effects joints bilaterally (on both sides) rather than unilaterally (on one side). RA symptoms can occur acutely, chronically, or intermittently (with periods of exacerbations and remissions).

What does RA “look like”?

RA presents with the following symptoms, which are very similar to OA: inflammation, redness, prolonged morning stiffness (>1 hour), joint pain, generalized weakness, and/or low grade fever (Deshaies, 2018). Bouchard’s and Herberden’s nodules may also be present (do you remember which is which?!). Other deformities that may occur include ulnar drift (hand positioned more towards the pinky side of the hand), Boutenneire or Swan Neck deformity (google them!), and countless other wrist, elbow, and upper and lower body joint deformities.

How do OTs help individuals with OA & RA?*

Because there is no cure to either form of arthritis described here, treatment goals include relieving symptoms, improving function, limiting disability, and avoiding drug toxicity (via nonpharmacological treatments!).

OT treatment may include establishing a home exercise program to strengthen muscles in order to protect joints from further damage and to decrease stiffness. Low impact exercises are often recommended, such as walking, biking, or swimming.

Clients will also be educated regarding joint protection principles and ergonomics. This means that clients will be taught safer, more protective ways to prevent further damage to arthritic joints. Such principles may include avoiding positions of deformity. This could mean using adaptive devices to help open jars, lifting a coffee mug with two hands instead of one to decrease joint strain, and avoiding prolonged periods of the same joint position. Ergonomic recommendations could include the use of an adjustable desk to offer both sitting and standing options, keeping items close to the body when carrying heavy (or light) loads, or distributing a load across two joints instead of one. An example of this would be wearing a backpack instead of using a shoulder bag or purse to carry your items. Joint protection is key!

Clients will also be educated regarding adaptive equipment to promote joint protection. Adaptive devices may include electric can openers, utensils with built-up handles, dressing/bathing devices (refer to Chapter 10: Parkinson’s Disease for a list of such devices), doorknob levers, and/or extended key holders, among many other possible adaptive devices.

Education will continue with fatigue management/energy conservation strategies. These are best described using a checkbook analogy. Imagine all the energy you have reserved for one day as your entire checkbook. You must balance your checkbook in order to maintain the energy that you have earned through a full night’s slumber. To balance your checkbook, you may do some activities in the morning hours, followed by a period of rest, followed by a few more activities, followed by rest. You mustn’t expend all your energy in a small amount of time or your daily checkbook will quickly show zero. Energy conservation can be achieved by strategically scheduling your day to balance high exertion activities (i.e. cutting the grass or grocery shopping) with low exertion activities (i.e. reading the newspaper, managing your finances, or calling a friend). Alternating between high and low exertion activities is one way to balance your checkbook. Additionally, high exertion activities could be spread out over the course of a week, rather than a day. Perhaps Monday could become grass cutting day and Wednesday could be grocery shopping day. Energy conservation is important for individuals with OA/RA in order to prevent overstraining of joints or overexerting joints in awkward and/or strenuous positions. As mentioned previously, joint protection is key!

Depending on the severity of symptoms and related complications, orthoses may also be fabricated for individuals with OA/RA. Orthoses are “splints” made of hard material (kind of similar to the material you would see for a cast after a broken wrist) to protect joints, prevent further damage, and allow certain joints to rest. Entry-level OTs know how to make basic orthoses and, as long as materials are available, be able to make such orthoses for clients who might benefit from them.

There are countless other ways that OTs can help manage symptoms for OA/RA. This post provided a brief overview of what OA/RA is and how OTs help clients who have been diagnosed with arthritis. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Deshaies, L. (2018). Arthritis. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 945-971). St. Louis, MO: Elsevier.

Chapter 10: Parkinson’s Disease

Chapter 10: Parkinson’s Disease

I’m finally adding to my “OT Chronicles” page! I am in desperate need of a way to review for my upcoming fieldwork placement and (eventually) my boards. Writing is a way for me to solidify what I know and determine what I still need to learn; therefore, I’ve decided to start going in depth about certain conditions and injuries that OTs may work with. This is my way of educating myself and others by using both medical and layman’s terms. By doing so, I’ll learn all the “fancy” words and try my best to teach others in simpler terms. If you’re interested, keep on reading. If you’re not, keep on scrolling. I’m going to start this “series” with Parkinson’s Disease.

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a progressive neurodegenerative disease (Schultz-Krohn, Foti, & Glogoski, 2018). Let’s break that down. “Progressive” means that the condition and its related symptoms will slowly worsen over time. “Neurodegenerative” means that neurons within the brain are degenerating (breaking down). Neurons are the communicators within the brain. Neurons receive and send signals throughout the brain to help produce movement. As a result of the degeneration, movement becomes progressively impaired for individuals with PD.

PD is associated with loss of dopamine and the presence of Lewy bodies (Schultz-Krohn, Foti, & Glogoski, 2018). Too many science-y words? Let’s break it down. Dopamine is a “chemical messenger” within the brain that is responsible for relaying messages that plan and control body movements. A loss of dopamine results in less effective message relaying, which, in turn, results in decreased ability to plan and control body movements. This causes the movement impairments mentioned in the previous paragraph. In continuation, Lewy bodies are globs of protein found in the brain which cause cell death. As a result of their presence, cognitive impairments occur.

What does Parkinson’s Disease “look” like?

There are three common signs/symptoms of PD: tremors, rigidity, and movement deficits (Schultz-Krohn, Foti, & Glogoski, 2018). Tremors often start unilaterally (on one side of the body) and tend to look like a “pill-rolling” motion. To understand the “pill-rolling” motion, rub your thumb in a constant circular motion over the palm side of your middle and pointer fingers. As PD progresses, the tremors will appear bilaterally (on both sides of the body). Rigidity is described as stiff movements. This means that movements aren’t as smooth as an individual who does not have PD. Movements are rigid.

Movement deficits vary. This may include akinesia (difficulty initiating movement), bradykinesia (slow movements), and hypokinesia (small movements). Individuals who experience akinesia may present with “freezing” which is a sudden cessation of movement or inability to initiate or maintain movement upon changing directions while walking and/or walking through doorways/thresholds. Individuals who experience bradykinesia will simply move slowly. Picture this as an individual who slowly reaches for their coffee mug or slowly walks through their home. This presents much differently than someone who is purposefully moving slow because they are distracted by their phone or a child who is moving slow to annoy their parent. Hypokinesia (small movements) sounds like what it is. Their steps while walking will be small. Their arm swing while walking will be small. Handwriting will become very small (this is called micrographia). As a result of these movement deficits, balance becomes impaired and fall risk increases, in addition to difficulty with movement in general.

Along with these primary signs/symptoms, PD includes a mask-like expression (also known as flat affect). This means that the individual may not change facial expressions upon hearing sad or happy news. They will appear “mask-like”. Similar to hypokinesia (small movements), an individual with PD will also have a “small voice” – muffled speech, monotone, and decreased volume (like a whisper). Just imagine everything “getting smaller” for an individual with PD. Other impairments include issues with attention, decision making (executive functioning), bowel/bladder function, sexual dysfunction, fatigue, and sleep disturbances, among others. Depression is also possible due to changes in function/independence or embarrassment of one’s presenting symptoms.

How do OTs help individuals with PD?*

OTs have a role in PD treatment throughout the disease progression. In the early stages when an individual with PD may still be working, OTs can educate the individual about workplace modifications to ensure safety. This may include requesting a different shift time or a shorter shift to accommodate for fatigue or altering one’s work environment to promote optimal posture, decreased fall risk, and energy conservation.

As PD progresses, home modifications could be recommended to decrease fall risk and to decrease the likelihood of  “freezing” in doorways or rooms. Such recommendations may include removing throw rugs, cleaning up clutter within the home, and making walkways as unobstructed as possible.

Adaptive devices will be beneficial as well. These may include built-up handles on utensils or writing devices (“built-up” just means thick/wide handles), use of bathing/dressing devices (i.e. long-handled sponge, reacher, dressing stick, shoehorn, sock aid), and installation of grab bars and a tub bench in the bathroom for increased safety and independence.

Special programs specifically for individuals with PD include Rock Steady Boxing and LSVT-Big. Both of these programs focus on making movements BIG. Punch big, walk big, dance big, big, big, big. OTs can become certified and specially trained for these programs or referrals can be made to locations that offer these programs.

There are so many other ways that OTs can help individuals with PD improve their quality of life and independence. This is merely a brief overview of the OT-PD relationship. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Schultz-Pendleton, W., Foti, D., & Glogoski, C. (2018). Degenerative diseases of the central nervous system. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 871-903). St. Louis, MO: Elsevier.

Rollercoaster Ride

Rollercoaster Ride

This blog post has been a long time coming.

2020 is just over half way done and it’s been a rollercoaster of a ride so far. But not your basic, whoop-de-doo, 30 second rollercoaster ride. This one is the craziest rollercoaster ride you can imagine. Kind of like going backwards through a corkscrew, upside down loop, another corkscrew, the steepest drop you can safely engineer, an upside down loop followed immediately by another corkscrew, and arriving back to the loading area just to get immediately reversed into the same loop again… and again… and again.

Got the idea?

Good.

Everything started on Tuesday, March 10th. Honestly that week was the semester’s hell week. That Sunday was Day Light Savings where we lost one hour of sleep. It was also around the time of full moon. This week included a Friday the 13th. Two weeks prior, we had celebrated a Leap Day. That week of the semester included two exams, a practical, a presentation, and three major assignments that were due (two of which were group assignments….. Have I ever told you how much I despise group assignments?!).

It was also the week that we learned our semester was being thrown into a EF5 tornado. Following spring break, our classes would be virtual until some time in April. On the bright side, spring break was the following week & if our classes were virtual for a few weeks I would save money on gas.

Josh & I were supposed to go to a Flyers game the first Saturday of my spring break. It got postponed (and eventually cancelled when the NHL decided the regular hockey season was done).

I was supposed to go to Boston for the AOTA Conference. It got cancelled. I fought with the airlines for days on getting a refund for my flights. I eventually got both refunds.

I spent my birthday in quarantine.

I started sending my grandparents weekly cryptograms to ease social isolation.

I busied myself with organizing the Quarantine Miles Challenge in attempt to keep myself busy (& motivated) and to connect community members through social media. It was fun for the two weeks I organized it but then people lost interest and that was that.

The semester became easier (in my opinion) virtually. Other than sitting at my computer 10-12 hours/day “attending” classes on Zoom, doing busy work assignments, posting on discussion boards, keeping up with emails, trying to navigate the group projects we still had to do virtually, and trying to actually learn what grad school was supposed to be teaching me, I liked working from the comfort of my home, saving gas, miles, and driving time, and having more time to walk the dogs.

April 15th. My grad school projectory was shot out of a cannon and obliterated into thin air right in front of my eyes. Level II fieldwork placements were postponed for three months. (It still kills me inside to type that out). I was supposed to start my first placement May 18th and my second placement September 14th. As of April 15th, 2020, I would not be starting my first placement until September 14th and my second placement until some time in January. As of April 15th – a horrible, no-good Wednesday afternoon – I would not be graduating in December. I would not be studying for my boards in January. I would not be taking my boards in February/March like I had envisioned. I would not be job hunting in the spring of 2021. Everything obliterated.

They told us there might not even be a guarantee that we’d start in September. Excuse me? I have a life to live. I have debt to pay off. I have a job I need to obtain. I have crappy health insurance and a car that keeps chugging along even with 322,000 miles on it. I can’t keep postponing my life. Something needed to be done. Yet, every inquiry regarding a contingency plan was responded with “we don’t think we’ll need a contingency plan so we don’t have one right now”.

Ok…..

Okay………….

OKAY!

No, not OKAY!!!!!!!!

It makes me want to scream.

I bottled up my angry energy and exerted it on finding a job. There was absolutely no way I was going to spend the three months of my postponed grad school education sitting around doing nothing.

I accepted mini jobs at the winery like painting parking curbs and picnic tables just to earn a buck while the semester was still going on. I became quite the painter for a few week’s time.

I also applied to jobs on Indeed. Good ‘ol Indeed. I started receiving phone calls from places I swore to myself I never wanted to work in (or ever needed to work in ever again)…. retail. I was miserable. I was angry. I was frustrated.

I declined each one and said I was in the process of starting another job. Which was true. Very true. I had applied to Amazon. The enemy. I loathe Amazon. Amazon ruins small businesses….small businesses that I hold near & dear to my heart as my family’s business is a small, local “mom & pop shop”. The kind of place Amazon probably dreams of stomping on across America.

Yet, I felt it was my only option. In my mind, essential retail establishments would present a higher chance of contracting COVID-19 than a warehouse. Dealing with 200+ customers/day as a cashier (disclaimer: that number is probably far from being accurate because I’m horrible at making estimations) seemed far riskier than working in the same warehouse with the same people every shift.

So I took the Amazon job. It would be a place where I wouldn’t think twice about resigning from once I needed to resign. Nobody would know my name. I would be a number or a username in their system. I would clock in at the exact minute of my shift start time and listen for the bell to clock out at the exact shift end time. In. Out. Done.

I started that job on May 8th – the last day of finals and my semester. I completed all my paperwork during the semester so I could start immediately. No time to waste, no time to think about the fact that my grad school projectory was on hold for three months.

I’ve been working 5 days/week since May 8th. Sweating in the warehouse. Bruises on my arms from carrying heavy and large boxes. Sore back. Sore arms. Sore shoulders. A five hour gym session I was getting paid for.

Pick up box. Scan label. Place box on palette. Scan label. Repeat.

Still, nobody knows my name. Fine with me!

Even as the semester was winding down, a week or so after that dreadful Wednesday afternoon, I busied myself with my next quarantine/Stay at Home challenge – the Miles for Heroes Challenge. It was an amazing success and I got to deliver food to three nearby hospitals from the money that was generously donated. Doing good for others felt good. Pay it forward. Do good. Be kind.

Since May 8th, my days have become a routine. My family’s business has been the craziest we’ve ever seen. So, I’ve been working there 5 days/week in the mornings before my Amazon shifts.

Routine: wake up, run/ride, shower, breakfast, walk dogs, check emails & do social media marketing, work for 3-3.5 hours at bike shop, drive to Amazon lot, bike to Amazon building (I refuse to take the shuttle they started forcing us to take because I skeeve public transportation during this time so I bike 1.6 miles to/from the building every shift), drive home, shower immediately, eat dinner, check emails, watch Gilmore Girls or read, go to bed, repeat. I’d rather fill my days with crazy, hectic, busy job-to-job work than sit around dwelling on what should’ve been.

The pay checks have been nice too. I hope to earn enough money this summer to pay for my tuition for both my placements so I don’t have to take out more loans. That is the goal. I hope I can achieve this goal but I don’t know how much tuition is because they keep withholding the tuition statements until they “figure things out”.

All I’ve been doing consistently is working.

I’m not motivated to run. I’m not signing up for any races (mtb or running) because I cannot face any more cancellations or postponements on things I hope to do this year. Races I hoped to run in in April and May were cancelled. I don’t have the energy to organize more running/cycling challenges. I barely even have the intrinsic motivation to run 3 miles.

It’s funny though. All I wanted to do when I was in grad school was run far. I wanted to train for an ultra. I wanted to go trail running on my favorite trail systems in DE/MD. I wanted to train strong…. run strong. Now, all I can muster up the energy and drive to do is 3 miles at 9:30 pace. Pathetic.

March 14th was the last group run I attended. I haven’t ran with anyone since April 10th (with Josh). In April, I was running 10-15 mile runs solo on the road or nearby trail. Delaware & Maryland made out-of-state visitors quarantine for 14 days before doing anything (although I’m not quite sure how they were enforcing that) but I didn’t even risk crossing the bridge to my favorite trail systems. Leaving NJ was cancelled.

The pandemic challenged the country. I think we all grieved the things that we lost as the pandemic crossed America (staying longer in NJ than most other states). High schoolers, college students, hopeful job applicants, engaged couples, couples having babies, families missing their older loved ones, and healthcare providers making endless sacrifices all had something to grieve at some point in the last three months. All that was lost. All that was cancelled. All that was postponed. All of it.

Still to this day – June 21st – the pandemic continues to challenge us.

Will wearing masks in public be the new norm?

Will we fear not wearing a mask?

Will there ever be a day when we don’t have to worry about using Lysol wipes to clean groceries?

Will there come a day when we’re not afraid to touch door handles?

Will we ever feel safe to fly again or go to a restaurant?

How many people is it safe to invite over for a BBQ or bonfire?

When will it be safe to go back to churches?

Will healthcare facilities or schools every let students in for fieldwork placements?

Will students even go back or start?!

No answers to any questions.

To regain some sanity, I disconnected myself from most of social media. I use Facebook to continue social media marketing for my family’s business. I only use the business account on Instagram. I haven’t logged into my personal one for quite some time. I deleted GroupMe to disconnect from my cohort. I mindlessly scroll through Strava but I’ve stopped posting my runs. I rarely even record my runs on my watch anymore. I don’t want to know my pace. Social media became too much, too overwhelming, too much of a horrible dark hole. I don’t miss it.

Yesterday was the first day of summer. I feel like I barely even remember the spring season. April and May are a complete blur. There isn’t much to look forward to this summer. I don’t even feel comfortable going to races that have been “altered”. I’m definitely not going anywhere on a vacation. I’ll just work. Earn that money. Make that dough. Day in. Day out.

The world is a weird place right now. It’s been weird for months. I don’t know what normal looks like in the future. I can’t picture it without seeing people in masks.

I check the state and county’s numbers for new cases every day. I don’t know if I’ll be starting fieldwork in September. I’m not overly optimistic. No point in getting my hopes up again just for it to get cancelled.

Where ever you may be reading this – masked or unmasked – I hope you get through the challenges that you are facing. There will come a day when I can look back at this post – the countless struggles that were cathartic to write out – and that I can reflect on everything that was overcome. Every obstacle, crappy job, and hectic workday will hopefully just be a stepping stone to something better, something less crappy, something more enjoyable and self-fulfilling. Something meaningful.

Here’s to the craziest backwards, corkscrew-y, upside down loopy rollercoaster ride you can imagine. If you’re the passenger, it’s ok not to enjoy the ride. I’m fairly certain I’ve been stuck on this ride since March 10th. Eventually, I hope for myself and for you, that the ride will end and you’ll get back on the basic, whoop-de-doo, 30 second rollercoaster ride and everything will be ok. Maybe you’ll even get to watch a nice sunset.