There are still PT patients that stump me or who require knowledge way beyond my bag-of-tricks . . . and when that happens, I call in the virtual-cavalry and get expert opinions via email from Physio colleagues around the world. It's kind of like our own form of distance learning, just without the exams or tuition fees.
About a year ago I started getting consulted for dysphagia (swallowing difficulties) with stroke patients. It pulled me out of my comfort zone a little bit, but going off the advice of a Speech and Language Pathologist from my Philly days, I got by. But last week a visiting ENT (Ear-Nose-Throat doc) arrived and that's when it got really
It all started with a patient who had experienced a double fracture of her mandible--the jaw bone. The bone became infected (osteomyelitis, for those of you playing along at home) and after a few months of pain and difficulty eating, she came to the hospital in hopes of some relief. Due to the extent of the damage done by this infection, R. had to have a hemi-mandibulectomy . . . in other words, the doc removed the right half of her jaw.
Despite only being 30, R. had already lost a good number of her teeth before the surgery . . . and our goal was to help her be able to chew and swallow with what was left.
Unfortunately, the left-half of her jaw, which was still intact, was deviating so far into the middle of her mouth, that it dislocated!
Over the weekend, the surgeon reduced it, but it just happened again. So today, a special set of bars were placed on her remaining teeth, her jaw was put back into place, and the bars were wired shut.
Now, I don't know about you, but if I was suddenly functioning with about a 1/3 less of my mouth than normal and then that last 2/3 was wired shut, I'd be pretty cranky!!
But not R.! She was just as chatty and sunny after the surgery as she was before!
I had been doing several short sessions with R. before the wiring in order to try hold off the residual jaw deviation as well as to increase the mobility of her TMJ.
R. liked therapy . . . she enjoyed how we would sing 'AH AH AH AH AH AH AH AH!!!!' as we tried to open our mouths as wide as possible and would giggle at me as we completed our handful of exercises.
Now, I would like to take this opportunity to state that 1) I am not a Speech & Language Pathologist, 2) I speak less Hausa than a Nigerien toddler, and 3) R. has severe lifelong cognitive deficits which, from our interactions, I would put her understanding to be about that of an eight year old.
With all that was working against us, R. still managed to have a good time.
So, needless to say, she was quite disappointed when I came into the room to work with the 20 year old woman in the bed across from her.
I pulled up a stool and faced M. as she was sitting at the edge of her bed, minding her own business. M. had come to the hospital to have a major oral abscess drained and several teeth pulled. A secondary effect of her infection was loss of function of the right side of her tongue and her bottom lip. I was there to teach her how to stick out her tongue, curl her bottom lip, blow kisses and make fish-faces.
As I sat in front of M., I heard a tiny voice say 'Déborah, can I help you work?'
I turned to find my sweet-and-spicy 4 year old burn kiddo, H., standing next to me wearing nothing but waterproofs over her bum and a gauze roll around her head.
What can I say, I'm a sucker for cute kiddos in bandages.
She climbed into my lap and picked up my oral exercise cheat sheet.
Pointing to the first picture, H. mimicked. 'Wike dis?' she asked with her tiny tongue still protruding from her mouth. 'Yeah, just like that', I smiled, and nodded at M. to let her know it was her turn.
M. was not amused. She had no interest in me and my silly exercises. Her tongue and lip didn't work, and she wasn't about to try to change that.
Before I knew it, R. had scooted across the floor and was tugging on my skirt, 'Débowah, wook at me! Wook at me!' Not wanting to be left out, R.'s tongue peaked out the side of the wiring that held her remaining top and bottom teeth together. 'Do wike dis!' R. prodded her neighbor.
Reluctantly, M. gave it a try.
We moved on to the next exercise, touching the tip of the tongue to the corners of the mouth.
I'm not sure how it happened exactly, but I'm pretty confident that it had to do with little H.'s spicy side . . . the next thing I knew the other five patients and everyone's family members were engaged and watching and joining in on the tongue shifting.
Little H. couldn't quite coordinate her tongue to go where she wanted it to, and R. could only access one corner of her mouth.
M. sat there and stared at all of us making the silly faces she was supposed to be making . . . and before she knew what hit her, she started to laugh!
And her laughter wouldn't stop. She tried to cover her mouth to keep it from happening, but she just couldn't over power the sheer splendor of that moment.
Neither could we. The lot of us laughed together at how ridiculous we must have looked.
But as they say, laughter is the best medicine . . . and it was all M. needed to concede to her sorry-excuse-for-a-Speech-Therapist.