Trapping evil spirits....I like ice cream. I really do like ice cream. One story from our family lore that I frequently tell new consumers, is that I learned the actual value of a batch of ice cream - when I had to make it. Now that I regularly make batches of communication starter, the story seems as fresh as that hot summer day.
In the early 1960's, the ice cream technology available at my house was the wooden bucket fitted w/ hand crank. My Mom made it a very simple transaction for me: you help make it, you get to help eat it! The result of what seemed like three hours (I swear!) of hard relentless churning of that peach bit + creme anglais, was that we had fluffy - and slightly saline - peach ice cream for our hot summer party. I had churned away the evil spirits of lassitude, powered by the desire for a cool summer treat. My left arm also grew back, within two weeks.
Now, the joy of a thick, frozen bite of ice cream is dulled by political backlash directed at an ice cream company. This company leads its business model with its own social values; it has chosen to restrict its product to a country, whose policy is antithetical to these values. Refer to:
I like Israel. I really like Israel. One ice cream company is not bringing down the state of Israel. State governments in the US, who see themselves as the guardian of Israel's legitimacy within the country, have swung the battle - axe of politics down on this company. It's ludicrous, and almost pathetic that Israel supporters fear an ice cream company. Rather than freeze up Israel's management of its internal affairs, the company shared its moral vision to illuminate the moral shortcomings of the nation.
The political strike against the ice cream company embodies an act of zealotry. As the late Arkansas journalist Paul Greenberg put it, a zealot either agrees with you too strongly, or disagrees with you strongly.
Some writers, like Reza Aslan, say Jesus was a zealot. Other writers like Eric Hoffer might point to the example of an Obama voter, becoming a Trump voter in the next cycle, as the zealot's mark. Not strictly is the intensity of a person's devotion considered, but also how the focus on the devotion blinds the zealot to the full measure of that devotion. What could possibly be wrong with trying to punish Ben and Jerry's parent company, for B&J supporting a people they see as oppressed?
I really like people, like Bronowski, who have strong opinions. Whether they force me to work to eat, defend my favorite dessert, or justify a clinical judgement - I do enjoy the arguments. These days, I see a lot of zealotry, in the forms of inflexibility, in the field of CSD. It could be coming from the training a clinician receives in pre-service education, or through subsequent continuing education. It also can bleed through from some social - political movements that occupy your mind, but that are tangential to this CSD gig you've secured. It could even be as simple as letting the pressures of real life get in the way, by getting entrenched in clinical 'ruts', doing the same activities with persons carrying similar diagnoses. A clinician who participates in research studies, may surmise that the protocol is always the thing. Everything.
However you delineate the actions of persons on the train of a clinical/research movement; - when every case becomes a strict research protocol, without back - channel communication that can be crucial to the consumer moving towards her desired outcomes, it's zealotry. We are selling a service, albeit a professional service, and it seems sensible to deliver the service the consumer bought.
Zealotry = evil spirits? Only in the sense that your perceptions, your judgement can be clouded by adherence to a narrow frame of reference (dogma, allegiance to mentor/leader), that has political as well as scientific implications to your effective practice.
I really like the bottle tree. It reminds me of how important it is, to trap and stow away things that don't belong - things that can prevent you from safe passage on your clinical journey.
I recently started, after a break of almost twenty years, the mentoring of two new SLP professionals. Recently, I committed to consider a third - yikes! Mind you, I've mentored a few dozen new SLP's at all levels of their career development, since taking this career path: shadows of a clinician during the undergraduate years; interns in a medical setting, prior to their receiving the master's degree; and lecturing to graduate students about aspects of the 'hidden curriculum' - that is, what actually happens during the SLP's clinical workday.
The Clinical Fellow is approaching that very imposing finish line, in the marathon race to our professional credentials. Over the weeks, months and years of classroom study and clinical training, an SLP student in the classroom injects her didactic learning into clinical learning. With necessary clinical training in the University clinic setting and selected practica done, the intern then spends the better part of a term in a community's clinical setting, where theory first meets the workday road. Following that, the newly hired CF will show how independently they can apply their knowledge, to serve their consumers and the support systems.
And - the C's are only the MINIMUM qualifications for clinical practice. Training never ends!
When I first took on mentoring of young SLP's, the time interval overlaid that for the emergence for mitigation/prevention of serial harassment in the workplace. I had to deal with my perception of being a member of a significant minority in the field, who is also perceived by some as being a significant source of these problems in the workplace. It is what it is. It's a healthier and more productive workplace nowadays, and the forces of 'quid pro quo', 'hostile working environment' and appropriate workplace banter can go bidirectional. Anyone now completing their master's degree, and who has not yet internalized the lessons of serial harassment, will not make it as a CF. Parenthetical? It only shows that relating to your peers, is one lesson learned within the seminar called "Communication".
A CF remains psychically connected to her training program, and that's a good thing - because the idealism instilled by that discipline of class, clinic and practica, can easily carry over to her first paid workplace. The job of a mentor? Helping the CF sustain that idealism and enthusiasm, when her workplace tends to blunt or temper the role SLP may take in serving consumers. The CF is the local expert for her scope of practice, and makes her workplace more and more glad of that through the experience.
THIS BLOG POST, LIKE OTHERS IN THIS SERIES, DOES NOT ATTEMPT TO PROVIDE MEDICAL ADVICE. ALWAYS CONSULT A PHYSICIAN BEFORE MAKING SIGNIFICANT CHANGES TO YOUR HEALTH REGIMEN.
Primary prevention of cardiovascular disease; yep, we're still talking about that. Primary prevention interventions work to reduce or eliminate effects of the risk factors related to, in this instance, impaired function of the heart and blood vessels. Let's apply this basic premise to the recent trivia game this blog posted (1/17/21), about decisions you might make to manage risk to your cardiovascular system. We'll address each question in the game, citing the evidence currently available on each issue, then addressing what you might expect to come in the prevention movement. Here we go. The best answer for each quiz question is underlined.
1. If you divide the total recommended weekly minutes for moderate
physical activity, into equal weekday periods, that EXACT time period
would replace:
A. Breakfast at Brennan's
B. Licking and applying a Forever stamp
C. Mixing a chocolate cake batter
D. Running a 10K race
E. Watching an episode of "The Conners"
A Brennan's breakfast easily requires one hour. Putting a stamp on an envelope rarely takes longer than a minute. The preparation time for a chocolate cake batter? 20 minutes tops. A 10K race can be run in about 45 minutes by a top - tier runner. The allotted time for a comedy like "The Conners" is 30 minutes, and that is the daily average time a person might expend on moderate physical activity. Thanks to the American Heart Association, and Department of Health and Human Services, for this recommendation.
2. To protect your cells and keep your skin healthy, eat plenty of foods high in Vitamin C.
The Office of Dietary Supplements at the National Institute of Health provides a deep review of Vitamin C's powers. Try to consume the vitamin in uncooked foods, since Vitamin C is water-soluble. Cooking otherwise limits the effectiveness of the vitamin, so that you consume additional nutrients and fiber from uncooked foods, as well get increased nutrition. And, yes, getting at least your recommended daily allowance of Vitamin C can be a cardiovascular benefit.
3. All cholesterol is bad for your heart and blood vessels. T F
The Centers for Disease Control and Prevention point to high - density lipoproteins (HDL), or "good" cholesterol, as a source for production of hormones and cell construction. Keep your HDL to LDL (low density, or "bad cholesterol") high, and manage your LDL through lifestyle changes and your healthcare provider's assistance.
4. Describe common behavioral methods for managing your triglyceride levels.
According to the Cleveland Clinic, you may have a significant chance to lower your triglyceride levels in your blood when you get regular aerobic exercise, eat healthy and maintain a weight that is good for you. For example, a diet that may be helpful in lowering triglycerides would include: low amounts of fats, of sugars, and of simple carbohydrates and alcohol. Your healthcare provider might direct you to consider medication (e.g. statins) to manage very high triglyceride levels.
5. Areas on your body that do not allow for reliable blood pressure readings include:
A. Earlobe
B. Finger
C. Toe
D. Upper arm
E. Wrist
The American Heart Association says that blood pressure cuffs, fitted around the upper arm, provide the most reliable blood pressure readings. Even though wrist cuffs are available in many 'big box' stores, their reliability is suspect. Earlobe and finger readings are not widely accessible outside research or clinical settings.
6. Supplements like ___B vitamins____ and __magnesium_____ help stabilize your blood sugar levels.
A 2015 paper in the journal Endocrine, Metabolic and Immune Disorders Drug Targets by Valdes'-Ramos et al., included the conclusions that eating foods containing ample amounts of the nutrients above, among others, is the best approach to increase control of type 2 diabetes. Use of dietary supplements to augment other medical treatments for diabetes, remains an individual decision until further research fills in the blanks about supplements' roles.
7. Reluctance to eat protein could be a sign of kidney disease. T F
A 2018 meta - analysis in PLoS One of 19 randomized controlled trials, on the relationship between protein consumption and chronic kidney disease (CKD), revealed that the rate of decline in kidney function, as well as the risk of kidney failure for persons with CKD, may be slowed by a low - protein diet. Not wanting to eat protein, by itself, indicates you may have kidney disease. There is still limited understanding of how much protein consumption among cohorts is best.
8. Explain how rheumatoid arthritis can lead to cardiovascular disease.
Inflammatory processes engaged in the body by rheumatoid arthritis (RA), can lead to buildup of lipoproteins that may bring about cardiovascular disease. Be proactive! Reduce your levels of inflammation. Treat signs of cardiovascular disease. Fight the risk factors hard!
9. Women's health risks that do not trend with cardiovascular disease include:
A. Hormone replacement therapy
B. Mommy's locked in the bathroom
C. Oral contraceptive use
D. Pre - eclampsia
E. Preterm delivery
Option "B" is a temporary respite from shocks to the heart.
10. South Asians will benefit from lower cardiovascular risk, by focusing on their best levels of _HbA1C_, _physical activity_ and _carbohydrates in the diet_ (Cardiology magazine, 5/17/2019).
11. E - cigarette use is safer for adults than smoking or otherwise using tobacco. T F
The U.S. Surgeon General, the Department of Health and Human Services, and Northwestern University Medicine each document on their websites, factors including the ingestion of toxic minerals (e.g. aluminum, tin, nickel), the consumption of high levels of nicotine relative to that in tobacco, and the potential for both injury to the developing brain, and the lungs, which point to e-cigarette use as extremely risky to health.
12. Talk about what habits of yours have most helped you maintain a healthy weight.
I keep a balance in my life, that helps me keep my weight where I need it to be. I watch the portion sizes of my meals, so I get the nutrition I need. My daily diet allows me opportunities for sufficient protein, fiber, essential nutrients and water. I exercise at the level that affords me at least moderate cardiovascular benefit. Stress I manage through my fitness work, cognitive - behavioral work, and leisure pursuits. I sleep to refresh the brain and body. It's a constant discipline, with pauses inserted to relax and 'cheat'.
13. Takeaways from any discussion of a genetic predisposition for CVD should mention:
A. If you have CVD, your siblings have a 40% greater risk of developing CVD.
B. You face a 60 - 75% higher risk of CVD, if your parents presented with CVD.
C. Nothing you might achieve from lifestyle management can lower your CVD risk.
D. Your risk for having a heart attack (myocardial infarction) is increased, if one parent had an MI.
E. The Developmental Origins of Health and Disease
framework gives researchers and clinicians, tools for better
understanding the transmission of CVD between branches of a family tree.
Two 2014 studies published in the journal Canadian Family Physician cite statistics for options "A", "B", and "D". A 2018 paper in the Journal of Physiology takes the study of pre- and perinatal effects upon the health of individuals to a mechanistic level,by comparing the fetal developments of humans with those of guinea pigs.
THERE. I hope you've enjoyed the brief experience in the wide world of cardiovascular disease. It's also my wish that you see there is a place for the SLP clinician, helping her consumers learn to manage risk factors for CVD.
Loneliness. It seems to fit this profession, speech - language pathology. At its core, SLP requires one person to engage with one other person in an isolated space, a metaphorical 'diving bell', and then - the engagement is done. You meet and make a contract, outside of real life, with a person in need; you help that person improve the quality of her life; then the person returns to real life, while saying goodbye to the deep - diving SLP. When does the next dive commence? "Come dive with me", Sinatra might have sung. The SLP helps bring the consumer out of her loneliness, borne of an impairment. The SLP lives her loneliness, part of her mission.
Thanks to the artists cited below, whose thoughts on loneliness turn it about like a newly cut gem, with facets that reflect back the truths of the issue. Is there a popular, or even an obscure song about loneliness that you feel tells a lonely tale the best? If you are an SLP doing clinical work in one or more settings, does the notion of SLP being a lonely job, resonate with your experience? Let's explore further, after the musical interludes.
https://youtu.be/eFvenjll1Bk
https://youtu.be/65PcmJRfgl0
https://youtu.be/E3MNG11oynA
https://youtu.be/ojdbDYahiCQ
https://youtu.be/djU4Lq_5EaM
https://youtu.be/kjq4wYuwgxs
https://youtu.be/6EEW-9NDM5k
https://youtu.be/Tdw7kxD8eUc
https://youtu.be/RLM0tiZ5Kf8
https://youtu.be/FXmbIRUP7k8
After all, we are the experts in what we do. Everyone thinks they can do speech therapy, but we are here because we know why - why what we do works. We go to classes with peers and friends, and we socialize with peers, partners, and friends. Still, as our skill sets are nurtured and grow, we develop the power and the confidence to effectively work alone. Each new referral to an SLP takes us on a solo voyage, but the solo voyager is the person we serve.
It's as if we are invisible; that is, we are solely a conduit for the change that the consumer seeks. That might seem a totally magical, fantastic concept, but the more you work with consumers, the more you may notice that the consumer should get all the attention. As the aspiring SLP evolves from student, to clinical fellow and then to certified clinician, the clinician celebrates becoming an autonomous, solo professional who is happy to let her consumer be ' the star of the show.'
With all that has been said in this blog, about the power and value of the therapeutic alliance, - it is equally important that the alliance be ended as easily as it is initiated, firmly. The alliance is forged at the evaluation, and the SLP initiates the plan of care, by thinking about how it might end.
I found myself back in the position of Charlie Brown at Christmas, asking if anyone can tell me what SLP is all about! I realized that the loneliness I had been feeling, was in part missing myself; missing the fullest expression of who I am, and why I do what I do. I hadn't been able to put into words in a focused manner, what I have been attempting to do in the blog for almost ten years. Yet with staying peaceful, the thoughts and feelings about what the last 38 years have included, flowed. The words finally came:
* keeping communication natural is best, and especially in the clinical setting;
* making the deepest connection during the therapeutic alliance, is ideally attainable in 'real life'.
* what the consumer and her supports may want during the alliance, should drive the plan of care;
* though addressing changes in function at the impairment level is the bedrock of our skill sets, this aspect of clinical practice isolates the consumer and the SLP from what communication does - bring people together;
* SLP intervention not only puts the consumer 'up on the greaserack' to mediate the impairments, but also to take the consumer 'out for a spin', where real life exists for the consumer;
* The SLP that is embedded in real life serves a community, as well as those who consent to the therapeutic alliance;
* the community gains an advocate for staying well, through the SLP helping everyone limit or eliminate risk factors for impairment;
* SLP's are prepared for and invested in the power of the therapeutic alliance; it is our portal to what we do;
* a healthy therapeutic alliance will, nevertheless, end in most cases, leaving the CSD professional momentarily 'lonely'
* the SLP will be in the community and for it, and for the persons who discover their needs;
Like Raymond Chandler's perspective on the private detective, the SLP is a lonely person. That person will still celebrate her community. The community is much better for that.
"We've gotten a new swallowing order; I know it's almost the end of the day, but can you do it?"
"We hire speech therapists as PRN only; you get paid for patient contact - no benefits"
"We have three therapists on the case, so your involvement we staged to start last - and you have just 2 visits "
"Others, like OT - they can work on cognition"
"I need to continually educate the nurses and doctors, about what we do"
"Good communication is basic to how the healthcare team works best"
"People need to communicate and swallow continually; if you can't do direct service, do education and counseling until direct service can start; a flat fee can be charged for the service"
"You continually GIVE your time, above and beyond the patient contact time, to do all the work that need be done."
"There's no budget for equipment, materials, supplies; it's rewarding, regardless, to hear and see satisfaction on a consumer's or family's face, when you have given them something that helped"
"Training and experience are stern teachers; the SLP can function well within any worksite, contributing to team management of successful consumer outcomes, and the discipline and focus on function the field can bring".
We were blessed last year in the upper Midwest (USDA Hardiness Zone 5b), that the summer garden took off like a rocket. The occasional heavy rains needed supplementing a few days a week with my watering labors...a 2 gallon watering can does the trick, because even though more trips are required to give the plants a drink, there's exercise. Clover made its resurgence, after three years of being dormant. More than 95% of all the seed varieties that were sown, were germinating and thriving! I couldn't ask for more from the soil - it's black, moist, and with strata allowing for plentiful movement of root growth, and - after more than ten years of continual amendment, showing signs of proliferation of good organisms that feed the vegetables, flowers and herbs.
But - when all the produce is grown to its best, harvested and processed; what to do with it all! You gardeners who work so hard, year - round to keep the garden ecology viable and productive, how do you make the fruits of your garden work for the greater good? Those clinical programs in SLP that utilize a garden for training staff; - whether they be future clinicians, current staff or those community volunteers who would like to help - they might benefit from your skill set, and they might further the movement of their mission.
What I am saying, is that CSD training programs that support training gardens should develop, alone or in collaboration with other entities, tasting kitchens that serve consumers, their stakeholders and the community. A "tasting kitchen" will provide the practicing speech - language pathologist, who works with persons having swallowing problems, opportunities to directly train the consumer in the set of swallowing skills desired, with fresh food. The tasting kitchen will afford the SLP clinician to balance the needs of consumers to eat safely, against the need of consumers to eat well.
Of course, cooking and preparing foods for persons with swallowing needs is significantly outside the field's scope of practice. But there are obvious advantages to having this unique service offered to consumers:
* the consumer is reassured that her/his quality of life - in this case - the desires and needs for nutrition and hydration- may more easily be met.
* the SLP can liaison with professionals in many fields, who have an influence over what we can buy and eat: gardeners, farmers, grocery stores, chefs, nutritionists, dieticians, food anthropologists, cookbook writers and owners, and restaurants, diners and cafes: they can be the food professionals, providing the real material for direct dysphagia treatment;
* the 900 pound gorilla in the room (who the heck pays for this?) can be assuaged by a fee - for - service arrangement, or underwritten by grants, fundraisers and other external supports;
Let's contemplate how the SLP tasting kitchen might increase the odds, that our consumers might achieve the swallowing outcomes they desire.
I think occasionally, of the total number of persons I have served during my SLP career of....thirty-eight years this August. If you had lined up all my consumers over all the years, their standing in line six feet apart, I can imagine the queue would have extended from my home, to the farthest reaches of the galaxy. My practice often has been a far - flung galactic outpost, far from the prestigious healthcare institutions, the University training grounds and the well-funded school campuses. The opportunities that have come along, and the circumstances that have steered the work from job to job, from condition to malady, have steeled me to a realization about a speech-language pathologist:
an SLP is a taxi driver, taking the person served from a temporary to a transitory location. But I almost had a lapse of awareness, for the present day. You might also say, an SLP is a ride - share driver.
Get the call, pick up a fare, head straight for the destination wanted. In spite of the desire of the professions to make patient care in CSD "person - centered", or "personal", clinical work day - to - day is a series of pick up, travel, disembark; pick - up, travel, disembark. There is no inherent reason to act otherwise, though your job is to help your passenger grow more confident, more independent and more in control. We drivers for better communication and swallowing; we are to get our passengers from Point A to Point B in a timely fashion, and precisely finding the destination. The consumer wants it. The support circle is waiting. Those who pay the rider fare expect you to arrive on time. The managers of your business have more fares ready to pick up.
But the journey! Oh, the places you'll go! The courage to be found, and the sights to be seen....those moments of insight, of pain relieved and strength bolstered....the journey is the thing, and it is why you are hired. Your consumer, your passenger shows you the way to go. It's your expertise in piloting, that gets the passenger to the endpoint (s)he wants. The sights on the journey; they make it almost sad that the journey has to soon be over.
And it does have to end, and it does end. The alliance, the bind forged at the start of the galactic journey is dissolved. But another passenger, another consumer needs you now. The galaxy awaits.
