The Not so Spring Chicken Doesnt Play Games

I am at times the voice of reason. I am at times the sounder of alarms. I am no longer the little one with something to prove.

If you have a cancerous growth i will find it, note it, and coordinate with nursing to get a doc’s eyes on it, get a biopsy on the books, and then i will follow up to make sure your wound is clean, dry, and infection free after the cancer is surgically removed.

If you have a uti i will get nursing on that like white on rice, in and out cath for a urine sample, bed alarm, chair alarm, and notify all staff that you are a high fall risk in this state and must be supervised when out of bed until cog state clears. You will not fall and break a hip on my watch.

If you are a fix it dude and you cant fix your permanent or progressive diagnosis and you’ve lost your way in life i will lend you some of my projects or issues around the homestead that can be fixed, seek your advice, take it, and then bring you pictures of how it went. You may not be able to fix the problem in your life but often times fixing small problems for others gives a sense of purpose and accomplishment, especially to some of my more traditional older male patients who arent sure what they are to do in a nursing home if there is nothing to build, maintain, or oil.

If you are 104 years old and you want a tootsie pop i will get you that tootsie pop and if you’re 95 and craving sweet potato fries, i will find a restaurant that makes them and we’ll clock out and eat lunch together and give them a proper taste test and rating.

If your eye sight is failing and you need me to read to you while you exercise i will do so. If you want me to describe every song bird that comes to the feeder outside your window because you cant see them, i will do that too.

If you are afraid for your test results or grieving a loved one who has passed i will pray with you. If you need a hug i will give you one. if you are dying i will sit with you and hold your hand until your family comes.

If you are anxious i will encourage you and soothe your fears. If you need a pep talk i will be your cheer leader.

If you have safety awareness that is just the pits i will call you out on it and we will have a discussion about why standing on one leg during dressing, transferring with unlocked brakes, or cutting fingernails with a knife is a terrible idea.

I will make sure no one chicken wings you during a transfer and tears your rotator cuff. I will be the gait belt police. I will check you constantly for dehydration by pinching your skin and seeing how quickly it returns to its shape. I will check your O2 and insist upon the nasal canula when you are hiding it and denying you need it at a sat of 73. I will monitor the healing of your wounds and sound the alarm if i see signs of infection.

I will grade your exercises so that you are handling a few more reps and an additional pound here and there so that one day you find yourself able to lift 5 lbs instead of 1 above your head.

I will drag you to every activity i can get you to say yes to and i will celebrate gleefully when you score in bowling, bingo, balloon toss, and trivia. I will bribe you with candy, ginger ale, or cheerios if i have to. Whatever makes exercise and activity worth while for you, i am here for it. I will mercy water the garden plants you have forgotten about and come get you in a hurry when that little bitty tomato plant ends up with 7 little green baby tomatoes on it.

if you are soiled i will help you get clean. If you are hungry i will get you a snack. If your tv is broken i will get the tech guru from the office and she and i will work on it until we’ve beat the tv service from **** one more time.

If you are losing hope i will bring you scripture and quite possibly a dog depending on the day.

I will remind you of your goals, encourage you to work towards them, and sequence and outline the steps required to make them happen.

I will do all of this on 1 to 3 hours of sleep a night and i will never let you know if something personal is bothering me because its not your job to know that.

I am 5 ft 0 in, maybe 105 lbs. i am no longer the little one with something to prove. My inability for muscle repair means exercising for hours daily flares up my arthritis and renders me so sore i cant walk straight for days. So i can no longer total assist dead lift you out of the chair and onto the toilet. If you come to me able to participate in transfers zero percent, im not going to 100 percent lift you onto the commode during our treatment session. Im going to give you exercises that strengthen your arms until you are able to help me 25 percent while i do 75 percent of the lifting. Then we will “work on” toileting, because me dead lifting you to the toilet helps no one. Me giving you the tools and skills needed to participate in the toileting transfer is a better use of our time.

I can no longer dead lift patients and i cant afford to climb on the head board like a spider monkey and pull them up in bed by myself. Yes, i have to ask a CNA to grab one side of the bed pad and help me scoot you up. Yes, what would have been a very difficult one person transfer has now become a two person transfer for me. And when we are short staffed and the CNAs need help to toilet, bathe, dress, or pull someone up in bed, i never say no, because we are a team, meant to help each other to meet the needs of the patients in safe ways that allow us all to return to work tomorrow to continue providing care.

I am no longer the youngest strongest option on the team and i wont pretend i am. What i am is a good advocate who pays attention and has your best interests in mind. However, if you express to me that you would like a stronger, taller therapist i will not be offended or upset by this. I will arrange for you to be seen by someone else who can better meet your expectations.

What i will not do is play games. I do still have something to offer as a therapy practitioner. It is not what everyone needs and it is not what everyone is looking for, and so if you express to me on day 2 that i am not what you are looking for in a therapist and my comrade is, i am going to arrange for him to treat you. So dont give me an impassioned speech with a long list of reasons you are concerned you will get sub par therapy if you stay with me instead of going with my comrade and then refuse to see him because you “dont want to rock the boat.” I still have great things to offer my patients, but if you would like a therapist who can dead lift all 200+ lbs of you without any assistance, it is not me and im going to take steps to make sure you end up on my comrade’s schedule.

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    1. Yeah, thats the most common misconception we hear with our patients in the nursing home. They think that they are supposed to get better before engaging in exercise, which if you really think about it is crazy because if you were all better, why would you need the exercise? You’d just go home. Exercise is for sick people. You can tell anyone who will listen that i said that. Its not what you will do again once you are well. This is progressive graded exercise designed to get you well. Unlike p90x or crossfit, your therapist is going to start you out with the minimal amount of exercise you can physically handle in the condition they find you in, and then quietly add a little more weight and a little more resistance each time or each few days depending on the length of time they have before discharge. Studies show that if you take a young healthy fit individual and put them on bedrest, within three days of zero movement their muscles have atrophied. It happens that quick. So, half of the battle therapists are fighting with you is to keep what muscle mass you currently have as you adopt a more sedentary routine than you’ve had up until this moment. The other half of the battle is that its our job to get you as strong, balanced, safe, and independent as possible. So, not only do we want to maintain the strength a patient has but build slightly upon it each day. We do this through graded exercise so contrary to mass public belief, a patient should not be so sore they cant move after participating in therapy. I wish i could get patients to believe we were not drill sergeant crossfit instructors expecting them to climb ropes, jump hurdles, and flip tires down sidewalks daily. We’re simply going to lift some 1 or 2 lb weights, get on the nustep for fifteen minutes, practice safety during toileting tasks and practice utilizing a reacher and sock aid during dressing, and then physical therapy is going to count how many steps you can take down the hall before needing a rest while reminding you to take bigger steps than you’re taking, keep a space between the sides of your feet, look up and not at the floor, and tuck your bottom in and straighten your knees so you’re standing upright as you take strides. I’ve learned, very few people are self motivated to participate. They just dont come to you wired that way. Society and movies has told them you rest when you’re sick or injured. Thats what they think they need to do, and they’re programmed to believe this healing and recovering will happen peacefully while they sleep. I know, you have to put the work in if you want recovery and strength, but they dont. My job is to get them to exercise and progress, and im not above bribery to do that. I dont care if they recover because they wanted to or because they liked fiery hot cheetos, as long as they recover. I buy their progress in any way i can. Food, hugs, reading chapters of their book to them, getting their favorite staff member from another building to record a hello and im proud of you video message…i have one patient who works in return for visits with a therapy dog. Another is a flight risk and cant go outside. She agrees to work if we do it outdoors so she can feel the sunshine and wind since she’s an escape artist and not allowed to go out otherwise. 3 days. That’s all it takes. Time is unforgiving and decline is a ruthless onward march. Some patients wake up and smell the coffee when they see their own progress and realize the work put in was worth it and necessary and others will always need that outside push and unrelated motivation. Others will remain oblivious to the difference in their quality of life with and without regular exercise. Its important to continue doing an exercise routine after therapy pulls out due to insurance denying coverage of services. If they have a restorative aid they will put them on daily restorative services or 3 times a week depending on need, insurance, and participation. If not, even a w/c exercise video is something. Just pop it in once a day and make it part of the routine. If you do nothing, your muscles will not stay. It is important to keep enough strength to transition from lying down to sitting edge of bed and if possible from sitting to standing because facilities are under staffed always. The patients who can do for themselves get the best care. If i am an aid and i see two call lights flick on and i know one patient needs a hoyer lift and 75 to 100 percent assistance for all tasks and the other patient in room 302 just needs me to pull down their pants while they stand holding onto the bar with both hands and then they’ll pull the light again when they are finished and need 25 percent help wiping…im going to answer 302’s light first. 307 will be there forever waiting to toilet and eventually the dried caked excrement will create skin breakdown and an open wound and with constant exposure to fecal matter it can easily become infected and cause sepsis. Daily exercise is everything. Try anything within reason you think might work, including bribery, because society and movies really does teach people you lie in bed when you’re sick and magically get better but in actuality it is progressive graded activity and vitamin c and fluids that does all that. If you are weak, the only way to strength is to exercise. Most insurance companies give us a maximum of three refusals of service before they force us to discharge the patient. If she says no three times it will be very hard to get insurance to cover the cost of services again and they will have to document that she’s had a change of heart about participation and why and hope the insurance decides not to be awful because they love to use lack of motivation to participate as reason you need to pay them in case of future injury and they dont need to pay for you when you need something. Okay, this is way too long winded but you’ve caught me on the subject im most passionate about, lol. If she does end up getting discharged, there are always home exercise programs with weights or theraband, and the staff should make her one upon discharge, if not…make sure to request one, sometimes they dont do if they think patient wont participate…but home exercise programs are self conducted so herself or family member would have to make sure she does it. Gotta keep moving man…when they quit exercising weakness gets worse and they can end up with orthostatic hypotension where position changes drop their blood pressure and they pass out. We are meant to be moving participating beings. Bed is for night-time. With muscles, use it or lose it man.

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