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There are moments in the madness that it is worthwhile to remember the joy in SLPing.

The excitement of starting a new patient and thinking of the potential he/she holds.

The excitement of being a hop, skip, and jump away from discharging a client you have had for years.

The excitement of a patient making progress on the one goal you’ve been working on forever.

The hilariousness of stuff my kids say.

Watching the wonderful, heart-warming interactions of supportive families.

The excitement of having a honest-to-God break from it all coming up.

I love SLPing.

 

 

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Ever have one of those moments where you think you’re having a Perfectly Normal Social Conversation when you realize those involved in the conversation have asked a really good question about something you happen to know about that’s specifically related to your job and you’re suddenly vomiting up All The Knowledge on them?

Yeah.

Anyway. I was fact-checking myself later because I had an insecurity panic attack about All The Knowledge I had shared wondering if I had word vomited wrong information, and I realized something: I love being an SLP because I get to learn new stuff all the time. I mean, I get paid to be nerdy about stuff I love. How awesome is that?

(Full title of this post redacted for brevity and pithy-ness: “This post might be cheating as a real post with substance, but it’s true.”)

While reading a book by Steven Pinker, I came across this fantastic quote.

This should pretty much be every grad student’s mantra when making lesson plans and remind us all on bad days that our patients are, above all, human.

“…the Harvard Law of Animal Behavior: ‘Under controlled experimental conditions of temperature, time, lighting, feeding, and training, the organism will behave as it damn well pleases.'”

Word.

It’s done (well mostly).

I have finished my externships. (The grade is even in!)  I defended my thesis.  (All that’s left is to get it bound and turn it in.)  I have a job interview.  (Now the petrifying process of preparing for it…and maybe even getting the job. Ha!)  I have the check list for getting my paperwork in line for my temporary license as a CF and then my CCCs. (Now to do it.)

For me, grad school, and in turn, the externships, have been a microcosm of life. Lots of work, long hours, the best friends you’ll meet to help you get through it, brief moments of relaxation that are duly treasured, and enjoying it overall despite the insanity.  The joy and pride of accomplishing something difficult and the low moments where you think you’ll never try to accomplish anything again. The stress and the silliness all wrapped into one.

Along the way, I thought I grew a lot both personally and professionally.  I was challenged by things I never expected, but also by things that I expect will challenge me for much of my life.  But at least I know what they are.

The biggest reward at the end?  Knowing that I still love what I’m doing.  That I can always look forward to speech-language pathologizing.

My advice to you this:

  • Words to live by:  Fake it until you make it.  Be less afraid.  Do it and you’ll be surprised about how often you succeed.
  • Laugh as much as possible, but cry (or however you relieve your feelings of failure) when you need to.
  • You always know more than you think you do.
  • Make contacts and keep track of them.  People are more willing to help you out than you might think.
  • Listen to what the people you meet have to say.  You’ll learn a lot from all of them, either patients or supervisors.  Sometimes it will be what to do.  Sometimes it will be what not to do.
  • Call back at the places you apply until you either have an interview set up, they’ve told you about another upcoming job, or they’ve told you that you are not what they are looking for.
  • Enjoy it.

Good luck!  I am off on my next big adventure….

I get to meet the most amazing, wonderful, interesting people in the this job.

Aspiring authors who need character studies?  I have all you need right here.

I get to hear their story, their experience, and their take on life.  I love it.  And that’s why I SLP.

Old Guy (after I’ve gracefully flicked some liquid barium on to my face during an MBS):  Wait, can you show me how to do that one again?

This one’s going to be fun.

Have I mentioned I love the brain?  Because I love the brain.  Love it in a way that probably disturbs other people who don’t love the brain.  More accurately, I love cognition, an important part of which is understanding the neuroanatomy of the brain.  That’s why I love aphasia and cognitive-linguistic disorders:  because they involve the brain.  (Reason #639 why I SLP.)

Some exciting developments in the past 48 hours that relate to my love of the brain:

  1. I have a case presentation topic and it has to do with aphasia!  (I thought for sure it would be swallowing because, well, we do a lot of swallowing.)
  2. I got to spend a wonderful half an hour with a fabulously generous-with-his-time neurologist who gave me a crash course in reading the brain MRIs and also some tips on how to navigate the program that stores the images on the computer here.
  3. I saw Awesome Neurologist again while waiting for my ride home and he offered to take me down to radioneurology to learn more about brain imaging and that they all love to teach about the brain.  I told him I would absolutely take him up on that offer.

The reason why the dogs are barking in your neighborhood?  Is because of the high-pitched squealing noise I keep making.  I have got to make sure I hunt Awesome Neurologist down to follow-up on this.

I lucked into this.  (I am feeling very lucky right now.)  For those of you interested in the brain, I highly encourage you to hunt down your nearest neurologist or radioneurologist or your own SLP if they are knowledgeable about it (brains and MRIs aren’t my CIs thing) and ask if they can find some time to show you the ropes with MRIs.  So.  Awesome.

I SLP because of all the interesting people I get to meet on a daily basis.  You walk into people’s lives for a brief moment and can witness some amazing human interactions.  I love it!

And that’s why I SLP.

Whew.  Week one over.  I can tell I’m going to have fun.  I just hope it doesn’t lull me into a false sense of security that will result in massive FAIL.

Anyway, there have been a lot of bedside swallow evaluations this week, so I thought I would talk about those.  A referral (from a doctor) for a bedside swallow can happen for a lot of reasons, including having a stroke, or suspecting aspiration may be causing the patient to have pneumonia.

First, there is a chart review so we can have an idea of what we might expect to see.  (Did they have any cranial nerve damage that might affect the swallow?  Were they intubated and extubated, possibly causing trauma to the vocal folds?)  Then we grab some jello-type stuff (puree), water (think liquid), and graham cracker (regular consistency), plus a spoon and straw and go to the room.  We introduce ourselves and explain why we are there and what we are going to do.  Then we give the oral mech exam.  (Does it need to be said that we wash our hands and glove up?)  We look at tongue symmetry, range of motion (can it move in/out, up/down, side to side), lip symmetry, lip seal (blow out your cheeks), lip range of motion (pucker/smile), and tongue strength.  You can do tongue strength by asking them to stick their tongue inside one of their cheeks and you are going to press on the cheek and they should resist.  Do this for both sides.  Look inside the mouth, check out dentition, tongue, uvula and velum.  Have them say “aaaaah” so you can check out some velar movement (is it symmetrical, timely).  That’s pretty much the oral mech.  You can also check out sensation of lips and tongue if that is a concern by having them close their eyes and using a tongue depressor to lightly brush or touch different parts of the lips and tongue.

Food time.  My CI likes to give puree consistency first, but some SLPs might start with the thin liquid.  So in my case, we start with the puree.  Tell them you are going to be placing your fingers against their throat to feel how things are moving down the throat.  You are feeling for hyolaryngeal elevation and the timeliness of the swallow reflex (is it delayed?  absent?).  If they can feed themselves, tell them to take a bite of puree; if not, then you give them a small spoonful.  After they swallow wait and see if they cough, suggesting their was penetration and/or aspiration.  (This is NOT foolproof way to determine if aspiration has occurred; people can aspirate silently meaning there is not cough triggered when the food goes down into the airway.  If there is any concern that the patient might be a silent aspirator, you should do a modified barium study.)  Ask them a question so you can hear them speak, or just have them say “aaaah” so you can hear the vocal quality.  If it’s clear, food probably didn’t go into the airway.  Check the mouth to make sure there is no food residue (otherwise they are likely having problems with the oral stage of swallowing).  Ask the patient if they feel like all the food is down and/or if they feel like anything got stuck.  Obviously, this is not objective evidence, but it can sometimes give you information about where food might be getting stuck (and that you might want a modified barium study to confirm what is going on).  You can give another bite if the first one seemed to go down okay and repeat all that was mentioned above.  Do the same for first the thin liquids, then the graham cracker.  Really encourage the client to take small bites/sips if they are feeding themselves, and if not give them small bites.  If they are going to aspirate, you don’t want them to aspirate a lot.  Nectar thick and honey thick liquids can also be trialed if the thin liquids did not seem to go down well.

You can also trial some strategies at the bedside.  For example, if they have a lot of residue after eating, try alternating thin liquids after every bite of regular consistency.  That’s basically the bedside swallow evaluation.  After it is over, you can give recommendations for the food consistencies the patient may have and/or recommend a modified barium study and/or recommend the patient be NPO (nothing per oral).

I enjoy the swallowing more than I thought I would.  Probably because it’s like a puzzle, trying to figure out what is wrong and then figuring out what would help this person remain PO (per oral).  Guess that’s reason #354 why I SLP.

It has been a week of lasts.  On Monday and Tuesday I had my last therapy sessions with my kids at School 1 and School 2.  On Thursday, I said my goodbyes to the speech ladies left here in town.  On Friday, I had my final group language classes.  Today, I had my final evaluations and my goodbye to my supervisor.

All those goodbyes can wear a girl out.

All in all, it has been a great school experience.  I learned a lot about how therapy functions in a group setting, how goals are set in the schools, how to write an IEP, how to give several children’s diagnostic tests, and how to run a class language group.  I got to work with a lot of kids who live in and around the poverty line.  I met a lot of teachers who are doing an amazing job and who are doing their best for the kids.  I got to work with children who have severe disorders.  I helped kids learn something.  I met and worked with several  intelligent and lovely SLPs.  I made and have the materials to make many different activities appropriate for a school/group/20 minute session context.  I was reminded why community is important.  I learned I could handle working in the school.  I learned I’m not the social screw up I feel like I am when meeting a lot of new people for the first time.  I gained confidence.

Here’s to the next ten weeks of insanity.

“Faire et se taire.” -Flaubert

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