Category Archives: hand therapy,

Home is Where the Heart Is

When I first decided to switch career directions I was terrified. My identity has been more about being a hand therapist than an occupational therapist. I have worked very hard to get where I am. I have put up with crazy schedules, demanding surgeons, patients in pain or just scared. I have seen patients who had fingers or thumbs amputated, had their arm snapped in two, and who were in horrible accidents. I can take out stitches, clean a wound, make a splint, and deal with whatever surprise walks into my office. But I chose to walk away from that for a new adventure.

So in the world of therapy there is this unspoken hierarchy. I guess some would say that outpatient orthopedics is near the top of that tier and they are the ones shaking their heads at my choice. Outpatient is usually clean, your patients arrive dressed, they (usually) can carry on a conversation, they usually excuse themselves to the restroom and do not require any help.

On the flip side is the hospital and SNF (skilled nursing facility) where patients can be in gowns, they usually always need help with toileting. They can be confused and sometimes combative. They don’t always smell so great. You may get barfed on or worse. A lot of therapists start out in these settings and then move on. But I have a lot of respect for those who stay in the trenches.

And I will say it now – there really is no hierarchy. It’s a bunch of baloney.

You may have to know more specific information and have more experience to fix a patient’s flexor tendon but it takes a lot of heart to sit with someone’s 89 year old grandmother and teach her how to put on her underwear after a hip fracture. Not everyone is cut out for the type of work it takes to do the not so pretty parts of OT and PT. But when done right – that part of rehab can be the most rewarding.

So where does home health fit into all of this? Well I am finding out. I will not just be an OT but a guest in someone’s home. I went on a visit with one of the PT’s and I listened as a daughter fretted about why her mother with Alzheimer’s isn’t feeding herself anymore. She made sure her mom ate every bite of her lunch while she answered the PT’s questions and reviewed the medication list. At one point she looked at us both and said “I sure hope someone takes care of me when it’s my turn.”

That’s what I want right now – I want to help all the husbands and wives, daughters, sons, nieces, and families who are trying to keep their loved one out of the hospital. I want to sit on their couch and listen to their story. I want to help each patient be able to take care of themselves as independently and safely as possible. I am not afraid to get dirty and I’m sure I’ve made the right decision.

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Homebound

It’s 8:30am and I’m on my second cup of coffee. The kids are eating breakfast at the coffee table and SpongeBob is on the TV. I’m not going to work. Usually I am wrestling with doubt and guilt at this point but today there is snow on the ground so I’m probably not canceling as many patients as usual.

So what’s the reason for this homebound day? Last night my three year old was up until 11:30 refusing to sleep. Her reasons alternated between not being tired, being afraid of the “bad stories” (aka bad dreams) and needing either food or drink. Unfortunately a small but more constant theme was that her right ear is hurting. Now she is happy as a clam and full of energy – but still says her right ear is “sick.”

The guilt comes from struggling with this question. When is my child sick enough to justify cancelling the appointments of 8-10 other patients who need hand therapy. If they are seasoned patients then I don’t worry too much – they all have homework, exercises to be done no less than 3x/day. But if it’s a patient who is brand new, who needs a splint after surgery, or exercises to keep the newly repaired part from stiffening up with scar tissue then I’m a wreck.

I wouldn’t struggle with guilt if there was another person to step in for me and take on the priority people. Then there is the possibility that the pediatrician will say “it’s just a virus, no ear infection” and I realize that she would have probably been fine at day care. Ok no judging – that’s where she got the virus in the first place (and my no-break rule is no school if there is any fever or vomiting).

So here I sit waiting for the doctor’s office to open, wondering how the snow on the road will affect my chances of getting in. I hope my patients are doing their homework and are relieved that they don’t have to venture out in the weather.

One more note: I love my job and I love my kids more. While I struggle with how to balance the needs of patients with the needs of my kids I am so grateful that I have the kind of job that I know makes a difference. I am spoiled by the instant gratification I get when someone tells me they can finally clasp their bra, open the car door, or fix dinner like they used to.

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Confessions

  
In the spirit of starting anew I thought I should admit my own “hand issues” – these are things I lecture my own patients about but have not taken care of myself. You know, the mechanic’s car never runs, the shoemakers kids go barefoot. 
Ever since my first pregnancy (over 7 years ago) I have had occasional numbness in my pinky and ring finger. At first I only noticed it in long car rides, especially if I was leaning on my right arm. Then it started to wake me up at night. I knew exactly what it was. Cubital tunnel syndrome or pressure on the ulnar nerve at the elbow. Here is more information about this condition.

 

Over the last few years I have tried altering my sleep position and tried not to lean on my elbow as much. The numbness never used to lasted long. Now it seems to hang around almost all day. The next step – wearing an elbow brace to sleep.

This is the confession part – I have made at least 10 of these braces for the same exact problem. I have lectured my patients on the importance of wearing them consistently and warned them that it will take a while to get used to the brace at night. I, on the other hand, have not worn mine for a full night since I made it. Sigh – I know exactly what you’re thinking. Well I did try one night but somehow took it off during my sleep.

Now to be fair I’ve always been very sympathetic when my patients tell me how difficult it is to sleep with a long piece of hard plastic is strapped to their arm.  But my sympathy runs deeper now. So I’m going to make some lemonade out of this situation. I’ll be tweaking my splint design until it is absolutely perfect and then maybe the next time I make it for someone else it will be less torture to wear.

Elbow Splint

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Alien Hand

Alien Hand

Tis the season to be creepy and so. . .   I have never treated or even heard of  Alien Hand. To sum it up this is a condition where one hand acts on it’s own, seemingly without permission. And I am not talking about a mere tremor or twitch. You might worry about having this condition if you look over and your left hand is cutting up the pillows on your couch or dumping out the drink you just poured for yourself. It is believed that trauma to the corpus callosum causes one hand, usually the left, to act on it’s own without the awareness of the person it’s attached to. In the article linked above one man was kept awake by his “alien hand” and so he taped it into an oven mit at night. All I can say is that keeping up with a 3 year old is hard enough, I do not need to worry about what my limbs are up to.

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Bad hair day?

As many of you women know there are times when only a ponytail will do. No other hairstyle will cooperate with our attempt to look presentable in public. But try putting your hair up with only one hand. I’ll give you an hour to keep practicing. . . not yet? I’m not surprised. I’ve tried too and so far it has been impossible. But today I decided to dig a little deeper. I found a great video demonstrating a few options with a nifty gadget called a 1-UP hair tie. I’m still working out this blogging gig so bear with me if the links don’t work. I’m hoping I can order one and try it out myself. Way to go Holly!

1-UP Demonstration

1-UP website

Please leave a comment if you’ve ever tried this. I love a good review!

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When Writing Flows

Writing is something I have always loved. Only recently have I started to enjoy using my laptop for this activity. Usually I rely on old-fashioned pen and paper. For me there is a deeper connection between my inner dialog and a pen than there is with a keyboard. Unfortunately there are times when pen to paper is not very practical. I remember watching the movie Little Women in shock as Jo wrote her first novel by hand. There were pages and pages of beautiful cursive handwriting. I also remember thinking that her ink-stained finger was like a badge of courage for enduring that much abuse.
For some, writing even a sentence or two can be painful. For me, the pain doesn’t kick in until page three. But that limit is getting shorter and shorter. One reason that my own hand hurts is the death grip I hold my pen in. I clutch it as if it’s the last one on the planet and could be confiscated at any moment. When my patients have the same issue I usually recommend a fatter pen with a gel grip. This can help, and is usually far better than writing with a very thin pen. But for myself I find I’m still using my death-grip, only on a bigger pen, and my joints still ache.
So here is my solution. When I was in college I fell in love with all things old-fashioned, including a fountain pen I found in a specialty store. I wrote everything with this pen and soon realized that if I pressed the pen too hard on the page it would separate the nib and make it impossible to use. I quickly learned to hold the pen more gently. Of course my joints were much younger then and I didn’t have any hand pain. But as I stopped using the pens and returned to my modern ways my death-grip returned as well.

The other day when I saw a disposable fountain pen at a local bookstore I could not resist. Sure enough my fingers relaxed and my hand loosened up. My handwriting became more fluid as the letters stretched across the page. I can’t say my penmanship improved any but my comfort sure did. I think that I will be bringing my fountain pen into the clinic for my patients to try. Who knows? It may not work for all of them as well as it did for me. I do know that I have rediscovered my favorite pen.

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Happy Slapping

 

Hand Chopper

I have learned to love cooking over the years. My husband is much more picky than I am so he usually does the final stages of meal prep. That’s fine with me because I like the chopping, cutting and placing ingredients in all our little ramekins. For some reason those small bowls make me feel like I’m on my own cooking show.

While I usually prefer the old fashioned method of using a knife there are times when I pull out my trusty “hand chopper.” It is especially useful when I’m cutting up onions because it cuts down on a little of the crying. A food chopper is also great for when you need to do the job one-handed. A good food chopper will have a fairly wide base so it doesn’t tip over while in use. Onions or other firm veggies and fruit are placed on a cutting board and a portion of that is placed under the chopper. You press down on the top with pretty firm and fast pressure basically hitting or slapping it. the more you chop the smaller the pieces get.

A word of warning: choose carefully which part of your hand does the slapping or the pressing. Most people hit the top of the chopper with the palm of their hand. This can end up causing lots of pain if you have Carpal Tunnel Syndrome or arthritis in the thumb or wrist. My preferred method is to hold my hand in a fist and use the side of it (pinky side). There is just a lot more cushion there for me. The bottom line is to make sure that whatever you are doing is not causing pain.

There are all sorts of kitchen gadgets out there to make life more simple. I would love to hear comments from you on what has made cooking easier, especially if you are struggling with hand pain, a disability or recent surgery.

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