Archives : pathologist
Today’s blog comes from the mind of an Infinity Rehab Director of Rehab – Cathi Lamoreux, CCC/SLP. Cathi oversees rehabilitation services for several therapy departments around Spokane, WA. The therapy teams she manages serve multidimensional senior populations, which requires her and her teams to adopt flexible thinking patterns and have resources assembled and ready to use at a moments notice. In this article, Cathi strikes a chord that might be familiar to many therapists who serve an aging population and have switched to a new facility setting.
How were we to know just how messy this rehab business really is? You go to school, graduate, interview for the first job, get yourself into something you have absolutely no idea what is in store, either figure it out quickly or leave for other pastures. Then, repeat.
Those of us who land in the world of skilled nursing find our niche with our little band of patients dealing with a multitude of fractures, neurological disorders, and aging issues. We settle into a routine of ambulation, transfers, ADLs, equipment needs, cognition, swallowing, and strengthening. We occasionally see people go home, or at least move onto a lesser level of care, but we often see people who arrive on our doorsteps with an acute diagnosis remain as long-term residents.
The pressure felt by the therapists is applied more frequently from afar – Medicare regulations, insurance company protocols, productivity expectations, etc. We get into a “been there, done that” routine which serves us and our patients well. We get good at what we do, attend continuing ed to enhance our knowledge-base and skills, learn the regulatory ropes, and put in a good day’s work.
Fast forward to a new contract. You are asked to be a team member in a new facility for your company and you accept. After all, skilled nursing is skilled nursing, right? You arrive at the new facility full of hope, anticipation, and confidence. But, very quickly you learn that not all skilled nursing facilities are created the same.
Your new facility is in a Continuing Care Retirement Campus. This facility is really its own little village. There are independent seniors living in their own homes who travel, play golf, hike, drive cars, go to the theater, volunteer. Heck, some even are still working! There are independent seniors living in lovely apartments and eat dinner prepared by a European-trained chef in an elegant dining room. There are seniors who live in three different assisted living settings, requiring a range of just a little extra help to a locked dementia area with 24-hour supervision. Then, there is the skilled nursing area. Finally! Something you recognize!
But, do you?
It isn’t business as usual because being its own little village means that the skilled nursing beds are for residents of THIS community, not the greater community. What happens when there are empty beds? Nothing. You just wait until someone from your village needs that level of service. It doesn’t really matter that they are Med B, private pay or Med A. What’s a therapist to do?
Looking around you realize that there is a vast, untapped pool of people who just need little tune-ups, rehab for broken wrists from falling off their bicycles, people still living independently with progressive neurological disorders, rehab after elective surgery or recovering from an illness which wasn’t severe enough to require going to skilled nursing.
Before you know it, you are running a very robust, active outpatient practice. But, wait a minute! You haven’t used this body of knowledge and skills for a long time and this wasn’t really what you were expecting. For some of the original team members, this wasn’t what they expected and they have moved on. But, for the team members who have gelled into a little band of troopers, this is what it is all about.
First of all, we feel like we are leading by example. We saw an opportunity and are making the best of it. We have a good balance in our practices and it keeps us on our toes. We have people who fit us into their busy schedules because they see the value in our services and tell us so. We have developed new programs specifically targeted for our outpatient residents. We have turned what appeared to be a negative – empty skilled nursing beds – into a positive by helping people stay active and healthy rather than letting them quickly deteriorate and eventually require a higher level of care.
We could conclude that we are our own worst enemy by perhaps contributing to the lower census in the skilled nursing section because we help people stay active and in place longer. Like any small village, word travels fast. Word of mouth keeps our robust outpatient practice hopping. Word of mouth also helps when there is a need for skilled nursing. For some, they saw us before they got there and are thrilled to see a familiar face come through the door. Another benefit of working in this setting is that we get to follow people when they go home, unlike the traditional stand-alone skilled nursing facility that has to hand over the in-home treatment to another agency.
Is it easy in this reimbursement climate to run primarily a Med B practice with expectations driven by Med A standards? No. But, for those people who we have helped, we mean the world to them and that is all that truly matters.
This is the second part of Amy Uebelhoer’s remarkable story of overcoming significant odds. To read the first part, please click here. Born with a rare brain disorder that caused years of turmoil and pain, Amy underwent corrective surgery in 2008. This final installment follows Amy through another brain surgery, recovery and therapy.
I developed a rare surgical complication called pseudomeningocele after undergoing surgery to correct the Chiari Malformation (CM) at the base of my skull. A cavity formed in the soft tissue around my cerebellum and the top of my spinal cord, which allowed spinal fluid to build up and put excessive pressure on both my brain and spine. This occurs in less than 2% of patients who have neurosurgical repairs performed. On the first MRI scan the pocket of fluid measured 2.4 cm. My doctor said normally the body would reabsorb the fluid and not to worry. One month later the lump was much larger and began to bother me when I laid down. I again had an MRI that revealed the lump had doubled in size to almost 5cm. The doctor advised to keep a close watch on it and if it was still present in six months we would talk about draining it.
I didn’t have to wait six months. In October the pseudomeningiocele ruptured at the base of my skull and blew a hole out of the back of my head. That is not an exaggeration. When I got to the hospital, the doctor was able to easily swab the hole with cotton balls – to my extreme discomfort – where the incision from my first surgery used to be. This resulted in surgery to repair the hole and repair the damage done to my previous surgery. Additional neurosurgery would be needed to prevent future fluid build up, which was scheduled for November 18, 2009.
On top of all the trauma I had endured I was devastated to learn I had no other vacation/benefit time to use. But I was blessed to have such a dear co-worker, Karla Draves, COTA, who put out an email to all Infinity Rehab staff asking for people to donate PTO time so I could have this urgent surgery. I was overwhelmed at the response by my wonderful co-workers, giving away PTO, to me, someone they didn’t even know. I am still touched by this gesture, by Karla and by those who donated that I have never met or may never meet.
My second surgery was not as easy as the first. There was a lot of damage to repair. The doctors had a diversion shunt implanted to remove excess spinal fluid from my brain. A tube came out the lower part of my back into a catheter bag to drain. I had to lie motionless on my back in ICU for five days. The pain was even more intense than with the first surgery and the slightest movements made the pressure in my head unbearable. I was shocked one day when I woke up to realize I couldn’t hear anything. I was very dizzy and kept vomiting which was difficult considering I couldn’t move.
After five days the shunt was pulled and I was allowed to sit up. It was then I realized my recovery this time was going to be immensely more difficult than my previous surgery. My arms and legs were very weak and I could hardly hold up my head because my major neck muscles had been cut through two times. My hearing slowly returned but I noticed new, frightening deficits in my body, such as memory issues. I was given a phone to make and receive calls. I knew in my head what the device was but had absolutely no idea how to use it. Even the knowledge of how to use the TV remote escaped me. When I returned home it was even more frustrating. I was still unable to keep food down and I couldn’t hold my head up because of the dizziness and headaches.
As I got stronger some deficiencies improved and new ones developed. My balance was completely shot after the second surgery. It was difficult to walk, to say the least. My arms and legs were very weak. My memory was permanently impaired and word finding was still difficult. As a Speech-Language Pathologist I knew what to do for the memory and word finding but the balance and walking were scary. Some days my hearing would come and go, as would my vision. I was unable to sleep more than 2 to 3 hours per night, which remains a problem nearly a year and a half out from surgery. My neurosurgeon warned me this might be my new “normal” and this was the best I might get. But I had to remind myself to be thankful – I was still alive.
Just like the last surgery, after four weeks of rest I was back to work part-time with Infinity Rehab. I found myself carrying around a little notebook in my pocket so as not to forget important details. My co-workers also helped me when I couldn’t think of the names of things. Thank goodness I have such understanding coworkers! It would have been very difficult if it wasn’t for their understanding dedication and patience. I was sent to physical therapy to strengthen my neck muscles to hold my head up and decrease pain from my surgeries. It was very odd to be on the other side – being the patient – and not the therapist. It took a lot of patience and restraint to not jump in and offer my suggestions during consultation. As my recovery progressed I was eventually discharged from therapy and told to continue to stretch my muscles.
About a year after my second surgery I developed difficulty walking again. I noticed myself losing my balance and running into things. I would trip walking down the hall when there was nothing there but my own two feet. I was sent back to physical therapy to assess my balance/gait. I miserably failed my Neurocom testing – a set of internationally standardize balance and mobility tests.
Still, to this day I receive physical therapy to work on my balance and gait. I basically have coping skills when I lose my balance. If for some reason I lose my balance gravity takes over and sends me to the floor. I have had to learn new ways to walk or compensate for my deficits. It has been a sobering experience to not be able to do things that seem so easy for others to do. I have been very frustrated by this. There are times when the trained therapist in me wants take control of the therapy and tell the attending therapist what to do! But I remind myself that they are working very hard to help me recover.
My life has drastically changed after being diagnosed with CM and the subsequent surgeries. It is a chronic disorder that I will have to deal with the rest of my life. I may or may not develop more symptoms. I may or may not need another craniotomy. I am thankful for every day I am given. I have met others with CM through the Conquer Chiari organization. Not all of them have been as fortunate as me. One friend has undergone 23 craniotomies for his CM. Another is in a wheelchair. While another has not had a single surgery. We all have the same disorder but fight different battles in our day-to-day struggle with CM.
I was angry at first and wanted to know “why me?” Then I realized what a blessing my CM really is. I have reflected on what is really important to me in life and what isn’t. I have come to realize that life is precious and we need to be thankful for each and every day we are given. I am working on relationships that became damaged by the CM as I was not the most pleasant person to be around when I was scared, confused and in pain. I also realize how much of this experience I have kept bottled up inside of me. I have tried to remain strong and not let others know the difficulties I have gone through.
One of the most important lesson I have learned is a new respect for our therapy patients. Being a patient myself with a severe chronic disorder, I understand their frustrations and struggles on an entirely new and different level than before. I am happy to show them my scar or let them feel my head where there is no bone. Somehow it helps them when they know I really mean it when I say “I understand what you are going through”, because I do. And I know how hard it is.