Dementia

This was my first experience of a person who had (for want of a better word) obvious dementia. I've seen plenty of people with early stage dementia who forget the odd thing, but this is different.

A bit of background.

As a student I never treated a person with dementia, I had lectures on dementia and heard stories of people with dementia, but nothing can really prepare you for the patience you need, the communication difficulties and the struggle with any form of rehabilitation when they just decide they don't want to.

The amputee I was treating was also blind which did not help, as they believed they were at home and all the noises of a ward further added to his confusion. They forgot that they had an amputation and when being asked to stand they would try and place the end of the stump on the floor. You cannot weight bear through cut bone and he was at a huge risk of falling.

As a physiotherapist treating this patient has been difficult I will admit, I was not prepared for the different challenged involved and the complete change in expectations of a session. Sadly this patient has deteriorated mentally whilst at hospital due to a urinary tract infection, and whilst writing my notes on a session for him which to sum up simply said "completed 5x sit to stands using a rota stand, patient declined any further rehab continuously" was really difficult, I felt like I had achieved nothing. Luckily I have really supportive senior staff and after discussing this with them they were really positive about how much I had managed to complete, which made a huge difference to my view on it. 

The single most useful tool whilst treating this person was their "My name is" booklet, It was great! for those who don't know, it is a book with things they have done in their life, the job they used to do, what they enjoy, who their family are and it is brilliant, I would look in it have a read and then throughout the discussion just chat about things that interested my patient throughout the session, it significantly improved his willingness to take part and made the sessions much less stressful. If you are ever in need grab it and have a look.

This person really opened my eyes to the struggles of caring for people with dementia, and the incredible patience and perseverance the staff within the NHS have.  I will never forget the struggles and challenges presented to me whilst treating this person and I believe I have become a better physio for it. 

Liam

18/01/17

It's a new year but there was no Christmas holiday!

It's something everyone has to get used to, no 4 weeks off to fill your time with nothing!

I was really lucky and my rotation currently doesn't cover bank holidays so I at least had 2 bank holidays over Christmas which was great! 

I'm loving amputee rehabilitation, I'm learning loads and really getting to grips with some really intense rehab. This is hands on intensive rehabilitation, with 2 sessions a day the patients really progress.

I am enjoying prosthetic rehabilitation and teaching patients how to use these exciting new pieces of equipment they havnt seen before. There is so many ways of teaching that's it's a really good place to experiment with how you deliver information and I'm working out what's I find works best, with the help of some excellent colleagues!

The training on this rotation has been great, coming into a specialist area was daunting but I have been allowed to learn and grow my skills. I have had regular in service training and as we all treat patients in the same room lots of tips and help whilst I'm doing sessions. All of the therapists have been so much fun to work with! 

So let's talk about a few great story's, one patient has been on crutches for 3 years and now that their leg has been amputated they can walk inside without crutches and use a walking stick for long distances, such a massive change for them but so good! When they left and said it was all thanks to me, I felt that really summed up why I became a physiotherapist. 

11/12/16

So just to touch on the differences between being a student and qualified physio...

1. As well as all the new clinical skills and language to learn, there is the paperwork for lots of different things, for example referrals, discharge summarys, and outcome measures that as a student you fill out occasionally but as a qualified they really matter!

2. You don't have to write Student physio or get it countersigned, to start with I wrote student and had to cross it out a few times, you get used to it though!

3. Mandatory training, there is a lot more than you think and it takes time!

4. Well you get paid, big bonus that money, however you never seem to have more money! Ive been paid more in 2 months than last year but I somehow havn't managed to save anything! 

5. You are a professional and your opinion matters, that's real. You can make a difference on your own....it's great!

07/12/16

So December all ready!

Wore a Christmas jumper today and feeling festive! 

Amputee rehab is great! I'm really enjoying it, I'm on top of all my work and discharge reports and am really getting to grips with trans tibial amputee rehab, one of my patients left this week and they were so grateful to be walking out of the doors, they told me I made all the difference to them and I felt proud to be a physio! 

Rotation choices came out this week, I have no clue currently. It I am gonna ask for paediatric respiratory as that was the placement I enjoyed most, fingers crossed! 

More soon!

15/11/16

Today was the first delayed train day, a train broke down outside our station and all trains were cancelled, it happens, I got over it and didn't let it ruin my day, currently on the way to London Bridge little bit late. But hey I've been early everyday for the past month so it's okay. As the incredibles put so well, "We get there when we get there!" 

I have been doing lots of in service training recently, this is where the experienced members off staff pass on their knowledge and teach the new ones. It makes a lot of sense and I'm really lucky that I get so many where I am working!

Today's in service training was on discharge planning at the amputee rehabilitation unit. Planning for discharge is such an important aspect, as they are returning home in such a different state to the one they left in (at least 1 limb less). This can be a stressful time for patients and we need to make it as comfortable and positive as possible because its a really big step in the right direction! We have been working 6 weeks for this moment! Discharge planning should ideally start pre operativly, but we don't get to see our patients until they are referred post operativly so we start it straight away, getting all the little jobs done early, means I don't have to write loads in the last few days!

Really enjoying work, and the commute! 

08/11/16

So end of a Tuesday, let's talk about a brief section of amputee rehabilitation, and that's the exercise group.

 

Nearly everyday an exercise group is run by the rehab assistants , which I sometimes assist with, if one of them is away, this always looks enjoyable for the amputees and in addition to doing strengthening exercises such as squatting and bridging, a wide variety of sports are used such as seated volleyball, wheelchair tennis and even darts! 

I think it really helps patients feel better about their situation and realise they won't be confined to their wheel chair all the time!

Exercise makes everyone feel better about their life and it's no different for amputees, Whenever I'm irritated or annoyed a good hour in the pool just takes it all away and in exam periods allowed me to focus and relax. Exercise is good in every way!

Start of week 4

So it's the 07/11/16

It's the start of week 4! 

I've nearly been here 4 whole weeks and it still feels like I've just started, on student placements I would be nearing the end and thinking wow I've done so much. This time is different I still feel I have loads to learn, and there is a lot more paperwork than normal. 

As a student I didn't write discharge reports or referrals because I was unqualified, I've really been working on my writing for these letters and especially my style, I have a tendency to write like I'm chatting to someone and that's not particularly useful. At my trust all our note writing is on computers which is great for me because I'm a fast ish typer and am happy to not use all those acronyms, in one trust these were 2 confusing acronyms:

SOEOB, it's quite fun to say and stands for Sitting on edge of bed. 

However lots of people use the acronym 

SOBOE, again a good one to say out loud, and stands for Shortbess of Breath on Exertion. 

But these are so similar and can lead to a bit of confusion when used in the same sentence, for example: Pt SOBOE, returned to SOEOB.....luckily typing out in full is quicker than working out the proper order of letters!

I don't mind acronyms and they are useful but they can sure be confusing and often most other disciplines have no idea what we are on about! I'm currently learning a load of new ones from our allowed list and I can see why other staff get confused. 

See you soon.