Alece Overload

All I do these days is go to work then come home and pay attention to my dog. It’s not exactly a thrill a minute, but it’s okay. I do hope I will be able to get a life in the somewhat near future, as Ivy better acclimates to life with John and I.  John is out right now and Ivy and I just got back from a 4 mile walk, which sufficiently wore her out and bought me a few hours to myself (hopefully).

I have to admit that last week I was feeling somewhat disheartened about the amount of attention Ivy requires at home, and the ordeal it has been to take her on walks (she chases cars like a lunatic, strains on the leash the whole time, etc). John and I talked about it yesterday and then (silly as it sounds) watched an episode of The Dog Whisperer with Cesar Millan, and I feel better today. For those of you unfamiliar with Cesar Millan (as I was up until yesterday evening), he’s a dog trainer who specializes in “rehabilitating” super rotten dogs. And he has a weekly TV show, haha.

(Cesar Millan is the one on roller blades)

Anyway, Cesar Millan’s big shtick is that dogs pick up on their owners’ energy; consequently the importance of emanating calm and assertive energy when interacting with your dog cannot possible be understated. I’ve focused on projecting this type of energy during my last three walks with Ivy, and it has actually made an immediate, noticeable difference. This is definitely boosting my morale. In regards to Ivy’s indoor behavior, until yesterday the  biggest problem for me was the fact that she more or less demanded to sit on my lap whenever I used the computer. She would leap onto my lap and if I prevented her she would sit at my feet and whine the whole time I was on the computer. Her crazy need to be near the screen is b/c she’s obsessed with YouTube and is willing to watch me write emails for an hour straight in the hopes that I will then play her a YouTube video. She’s like a crack addict, except that her crack is any mediocre quality, 30 second video with a blurry dog in it.

I'll discipline her AFTER I take this picture, I swear

This was really bumming me out- I hate having her on my lap, blocking half of my screen, but b/c I hate the sound of her whining even more after 5 minutes of whining I usually gave in. John and Cesar Millan both informed me that I need to be tough and quit giving in. Also, when I tell her “no”, I need to use that calm, assertive tone and energy (rather than frustratedly pleading with her, “Iiiiivvvvy, go awaaaayyyyy” like I was doing before). Well, Ivy is a smart, responsive dog- it only took a few times of ignoring her/calmly telling her “no” to get her off my back. Now I am happy to report that I am blogging without having to peer around a dog butt. So, all in all things are looking up!

Last weekend we got a dog! Her name is Ivy, she’s a pug, and she’s three years old. We adopted Ivy from the Seattle Pug Rescue. We don’t know much about her past, but we know she’s healthy and….crazy.  This dog has more energy than she knows what to do with. She loves walks but is so bad outside- she barks, tries to chase cars, runs directly into the legs of every person she passes, strains on the leash the entire time, etc. Also, she wants attention at all times. Turns out the only way to get Ivy to leave you alone is to thoroughly wear her out, which literally takes hours of exercise. We’ve been taking her on 2-mile walks three times a day, which seems to satisfy her. She’s very smart and super inquisitive and has a friendly disposition. She loooves to watch videos of dogs on youtube (see video below) and likes playing fetch and tug of war. Overall she’s a ton of work but is also a ton of fun.

This weekend John is participating in GiveCamp, a three-day event where technology professionals donate their time and talent to provide solutions for various local non-profit organizations. GiveCamp is occurring in 14 cities this weekend, and the Seattle chapter takes place at the Microsoft headquarters. John and his business partner Koa are creating a cross-platform (iPhone, Android, Blackberry) mobile app for a great organization called Alliance of Non Profits of Washington. John is having lots of fun and is happy to be helping fellow do-gooders fight the good fight.

Other things I feel like posting:

- I’m reading Bonfire of the Vanities right now and it’s awesome. I only read a chapter or two a week b/c I’m busy/tired/forgetful/lazy, but it’s an engaging read and I highly recommend it!
- At work I have a lot of patients who are WWII vets– therapists who worked in geriatrics 20 years ago worked with WWI vets, and in 20 years I’ll be working with Vietnam vets. This is super obvious but is interesting to think about. I also like to think about how the dynamics of my patient care and interpersonal rapport will change when I’m treating the baby boomer generation exclusively. Also, I wonder how things will be as I age and I am eventually old enough to be my geriatric patients’ child, versus their grandchild.
- Eating fresh butternut squash is one of the best parts of winter.
- I’m trying to get this volunteer gig through the Alzheimer’s Association leading support groups for caregivers of people with dementia, but the next facilitator training isn’t until April. Meanwhile I (happily) quit my volunteer job at the library welcome desk the minute I completed my 6 month commitment. What should I do between now and April?
- Here are some websites you should check out: Illustrated Guide to a Ph.D, Four Bizarre Experiments That Should Never Be Repeated , World’s Most Generic News Report

I went to Maryland for the holidays- it was fun! I had a great time with my family and got to see some friends too. I’ve been back in Seattle for a week now and am ready for another vacation, haha. Things were crazy at Columbia Lutheran this week and I worked my ass off. Now I’m relaxing in a coffee shop with John. I feel like I should write something meaningful about the end of 2010 and the beginning of 2011, but I don’t feel particularly introspective. For me, 2010 was pretty much defined by becoming an occupational therapist. I don’t know what the theme of 2011 will be, but I’m sure it will be a good year.

We are very close to adopting a pug! Earlier this month two nice volunteers from the rescue organization came to our apartment to do a “home visit”. We passed the home visit, but not without a few iffy moments. For example, the volunteers do not like our spiral staircase and insist we get a baby gate to block it off. We even have to take a photo of the gate in place and email it to them for proof. I understand their point, I trip going up and down those stairs all the time so I imagine they are pretty treacherous for a small dog. The volunteers also do not like our balcony- they say it isn’t pug proof. Now this one I don’t necessarily agree with. It’s not that the slats in the railing are wide enough for a pug to squeeze through, the volunteers are concerned that the dog will leap OVER the railing. Now this railing is pretty high, at least three feet. I have NEVER heard of a dog spontaneously jumping off a 10th story balcony. I mean, come on let’s give dogs some credit here; I know they’re domesticated but I’d imagine they have SOME survival instinct intact. So we were directed to pug-proof our balcony by putting a mesh screen flush against the railing, on the inside of the balcony. How this screen, which does not extend beyond the natural height of the balcony, will prevent the dog from jumping OVER the railing is beyond me. The volunteers explained that the screen will prevent the pug from using a lower portion of the railing as a foothold- presumably to provide a needed boost to soar over the balcony. Once again, I can’t picture this- most dogs can’t jump straight up in the air, so wouldn’t pushing off a low foothold on a flat railing only serve to propel the pug directly into the railing? Or even if the dog is able to jump in a perfectly vertical direction, wouldn’t it then need to make a mid air, 90-degree-angle change in direction in order to clear the railing? But you know what, whatever!!! We are more than happy to comply with the screened balcony, once again emailing a photo to the organization for proof. In regards to the balcony, the volunteers suggest we litter-box train our dog and keep a litter-box on the balcony. (According to the volunteers our building’s hallway is too long to traverse when the dog really needs to go!).  I’m all for this idea- I don’t know how difficult it is to litter-box train a dog, but I’d imagine it’s no harder than teaching a cat to use a toilet bowl and lots of people do that. So, other than needing to purchase a baby gate to block off our stairs, and installing a screen to trick our dog into NOT leaping to it’s death, we passed with flying colors. OH NO wait, I almost forgot- we bombed the last question of the interview: “If your pug exhibits behavior issues, how long will you give it to make a successful transition to your home?” After exchanging quick glances with John I think we settled on something like, “Um a few months? Like 6 months? But it would depend on why the dog wasn’t transitioning… Um, 3 months? A year? Yeah maybe 6 months?”. WRONG ANSWER- in fact it was a TRICK QUESTION- the only correct answer is, “AS LONG AS IT TAKES”!!!!!!! Yeah okay.

The last few weeks at work have been hard! I haven’t had many straight forward rehab patients. I don’t mean easy patients, I mean ones who have a specific problem that responds well to rehab, enabling steady progress and a discharge to the individual’s previous living arrangement. Lately I’ve had a lot of patients who have been discharged from therapy but have remained in the facility, either for short term until a medical problem is resolved or until proper discharge arrangements can be made, or for long term care. It also seems like I’ve recently had a lot of patients who are pretty high functioning at admit, and don’t have many OT needs. So basically I find myself either thinking, “What can I do with this person, they can’t do anything“, or “What am I going to do with this person, do they even need me?”. I mean, push come to shove I’m able to come up with appropriate therapeutic activities for both groups of patients but god, it’s sooo much more draining than working with patients who are better rehab candidates. This is not to say I haven’t had ANY good rehab clients lately- for example I recently discharged a woman who made an excellent recovery after a stroke, and a man who recovered well from open heart surgery, but in the last 2 or 3 weeks these are more the exception than the norm.

Chance dictates the patients I get- there are three caseloads of patients and they are assigned fairly randomly (unless they are re-admits). So rehab therapists are at the mercy of staff members of local hospitals who determine which acute care patients should discharge to a skilled nursing facility, and the staff at Columbia Lutheran who determine which patients we should accept. When I did my three month fieldwork at Virginia Mason I worked with patients in acute care. In our  initial evaluation write-up both the OT and PT were required to recommended either a discharge home or to a skilled nursing facility. I had a hard time with this portion of the write-up; how was I supposed to make this call after spending a quick 30-60 minutes with someone who recently came out of surgery, or was in the midst of a serious illness? My fieldwork supervisor explained that I needed to think of the discharge recommendation in terms of, “If this person was leaving today, where should they go?” Okay, easy enough- I recommended a skilled nursing facility for almost everyone!

My fieldwork supervisor was right to view the recommendation in this light b/c often patients are discharged from acute care after only a day or two. Consequently, skilled nursing facilities are receiving some very sick patients. They are also receiving patients who you can tell WERE really bad off, but after just a day at the skilled nursing facility are pretty much ready to go home. If the hospitals would keep these people just a day or two longer they wouldn’t wind up at a skilled nursing facility, already itching to go home yet required to stay long enough for us to evaluate them and start OUR discharge planning (which inevitably takes a few days). So in my opinion there are some problems with the way hospitals discharge patients. On the skilled nursing facility end, there are also problems with the way patients are accepted or denied for rehab. Much like those inherent to the hospital discharge procedure, these problems are systemic rather than the result of individual staff members or an individual facility.

To make a long story short, I think the methods used to determine who should be admitted to rehab at a skilled nursing facility are complicated and imperfect. That said, all I can do about it is treat patients appropriately- whether that means evaluate them and NOT pick them up for the OT caseload, or treat them aggressively, or treat them to their minimal tolerance, etc. But it sure would be nice just to have an elective hip replacement patient sometime soon……

7 Things I have in common with my dad:

• Get antsy easily and prefer to be active
• Make lists for….everything (case in point)
• Enjoy traveling and seeing/doing new things
• Listen to CCR, The Rolling Stones, The Beatles, Three Dog Night, Led Zeppelin, Simon and Garfunkel, REM, Queen, and probably a few other bands
• Hate The Man
• Have pathologically tight hamstrings, bad eyesight, and screwed up feet
• Prefer driving a stick shift

7 Things I have in common with my mom:

• Like volunteering
• Prefer shopping for others vs. ourselves
• Have beaten Plants Vs. Zombies
• Walk fast
• Have jobs we really enjoy
• Want to help others
• Write in cursive rather than print

7 Things I have in common with my brother:

• Hate horses
• First concert was The Misfits
• SMCM alums
• Drink tea more often than any other beverage
• Worry about whether we are good people
• Say “yesterday night” instead of “last night”
• Hated taking band class but did so for years

7 Things I have in common with John:

• Super high expectations for technology
• Enjoy learning new things
• Like working with our hands
• Are convinced there will never be another show as great as Arrested Development
• Want to work hard and be productive
• Think the Left Coast is awesome
• Only get sick once a year, and it’s always really mild

Just some things:

The other day I ran into the daughter of a former favorite patient. I asked how everything was and she said, “Oh Dad died and went to heaven”. My jaw dropped and I was just stunned. Then the lady was like, “No, just kidding, he didn’t die. He IS in heaven though, he loves his new adult family home.” WTF kind of humor is that???

John and I saw Gogol Bordello the other night. It was one of the best shows I’ve been to. Here’s my favorite song from their new album (try to focus on the song and ignore the super cheesy video):

I went to a continuing education conference on Thursday. It was free and I got 5 continuing ed hours for attending. (I need to accrue a minimum of 30 hours every 2 years). The conference sessions were okay, I went to talks about: Multiple Sclerosis, incontinence management, rehabing a triple amputee Iraqi war vet, home modifications for people with disabilities, and prosthetics and orthotics. I picked up some shwag, ate a free lunch, ran into a bunch of people I know from various places, and got to hang out with my friend Kim. It was also kinda nice to have a day off from work, even if it was unpaid

This morning (Saturday) I went into work for 5 hours (to make up for taking Thursday off) then met John for lunch. Now we’re in a coffee shop hiding out from a torrential downpour. Tomorrow we are going to an event called Pug-o-Ween, a fund-raiser for the Seattle Pug Rescue. I’m not fully clear on what we hope to achieve by attending this event, but we will be able to meet the pug-people and the available pugs and learn more about the “adoption” process. Also, there is a resident at Columbia Lutheran who loooves pugs. Her roommate is one of my patients so I’m in the room a lot and it’s just covered in pug paraphernalia. I told the resident about Pug-o-Ween and promised to take photos to show her on Monday. She was so excited

Mini reviews the beginning of the 2010 vegetation lineup:

House: Don’t care about House and Cuddy’s romantic relationship. Also don’t care about Chase’s personal life. The medical drama is pretty good, but could be better. I need more blood and more screaming. Overall I give it a 6.5/10.

The Office: I thought last season sucked, but this one is way better. Micheal’s character is really on target this season. I was way over Jim and Pam, and am glad that their involvement has been reduced. I think Kelly and Ryan need more screen time, but like the amount of Andy and Dwight I’m seeing. I like The Office again, hooray! 8/10

Community: This show is great. It’s really funny, I like all of the characters, and the story lines are creative and different. So far it’s right on par with last season- no better or worse, just staying the course. 8.5/10

Outsourced: So mediocre and yet easily watchable. Has the potential to be funny but they need to stop relying on simplistic cultural misunderstandings for laughs. 5/10

30 Rock: This season is off to a slow start. Did they use up all their funny ideas??? 5.5/10

Modern Family: Not nearly as clever as most shows I like, but the characters are fairly likeable and it’s easy to watch. 5/10

Running Wilde: I have high hopes for this show (it’s by the people who made Arrested Development). I think they need to introduce more characters and give the current characters greater depth, but it shows promise. Also, I love that they throw in Arrested Development references! 7/10

Parks & Rec: Oh my god when is this show coming back???  -100/10 for not being on the air yet.

The other day John and I saw The Social Network- that movie about the creation of FaceBook. I liked the movie, it was interesting to learn the back story behind a cultural phenomenon created specifically by and for people of my generation. The college kid who created FB, Mark Zuckerberg, was a total jerk but nonetheless, a really impressive guy. He was crazy smart, made a lot of tough decisions correctly, was innovative, creative, and above all totally dedicated to FaceBook. Wouldn’t it be great to be fully immersed in a massive creative endeavor? And to develop something that changed the way the Internet is used, not to mention created a brand new framework for self identity and social interaction…wow.

1. Hyperbole And A Half is a hilarious blog with great stories and drawings. Check it out when you need a laugh, especially the “best of” posts (links on the right side of the homepage).

2. Angry Birds, a video game for the iPhone, is super fun and I am very happily addicted.

#2: Skydottir cookies

3. Skydottir Cookies are vegan, gluten free, handmade local (in Ballard), and delicious. I could eat like 200 of them right now.

4. Genmaicha is my favorite type of tea. It’s green tea + roasted brown rice and I looove it.

5. Over My Head: A Doctor’s Own Story of Head Injury from the Inside Looking Out. Great book! Here’s a description from Amazon.com: “Over My Head is an inspiring story of how one woman comes to terms with the loss of her identity and the courageous steps (and hilarious missteps) she takes while learning to rebuild her life. The author, a 45-year-old doctor and clinical professor of medicine, describes the aftermath of a brain injury eleven years ago which stripped her of her beloved profession. For years she was deprived of her intellectual companionship and the ability to handle the simplest undertakings like shopping for groceries or sorting the mail. Her progression from confusion, dysfunction, and alienation to a full, happy life is told with restraint, great style, and considerable humor”.

#6 Nacho Man

6. John’s nachos (and John) rock. Ingredients vary according to whatever we happen to have at home, but typically include nachos, beans, salsa, vegan cheese, peppers, and onions.

7. Flicka is the only good Flickr app out there. Slick interface, easy to use- I highly recommend this app if you have a Droid!

8. ZPizza just opened up on Broadway, a few blocks from my apartment. John and I went there for the first time this weekend- I got a pizza with vegan cheese, a gluten free crust, marinara sauce, caramelized onions, olives, and green peppers. It was amazing.

9. Primer is a crazy indie movie about time traveling. It made very little sense, but was great. I think if I watched it 2 or 3 more times I would probably get it.

10. Baltimore City Teaching Residency is an alternative certification program that helps college grads become teachers in Baltimore. My brother, Andrew, is a resident of the program and is working hard as a special education teacher in a Baltimore Elementary School.

It’s been a while since I’ve updated. I’ve been busy (by my standards). Mostly I’ve been hanging out with John, seeing friends, working hard, and relaxing a bit too. Things at work are really weird- we are in a big transition period right now. As of September 7th the therapists at my skilled nursing facility ceased to be employees of the facility and are now employees of a company called Infinity Rehab. We all still work at Columbia Lutheran, but we no longer work for Columbia Lutheran. There are a lot of ramifications  that I won’t go into, but needless to say, things are kind of crazy right now.

John’s new job as co-founder of a startup company, MokaSocial, seems to be going well. I’m never sure how much I’m allowed/supposed to say about the company, so until I secure the proper clearance I’ll just note that John is working his ass off and enjoying every minute of it.

If things go well with MokaSocial and it looks like John is going to remain working from/near home, we are going to get a dog. We want to get a dog from Seattle Pug Rescue. The available pugs tend to have a few special needs like incontinence, bum hips, dry eyes, allergies, etc. I deal with incontinence all day long (incontinent patients I mean!!!) so I don’t think I want an incontinent dog, but I would love one with dry eyes. I have this awful thing called recurrent corneal erosion as a result of dry eyes, so I can empathize. Actually, the thought of squeezing eye drops into enormous pug eyeballs just makes me want one even more!!! But really I need to stop thinking about pugs so much because nothing’s definite and we won’t know one way or the other for quite a while. But, in the meantime, I’ll just watch the following videos on YouTube: