Hi Ron I haven't posted in a while. I'm seeing such contrasts here. My husband has just had a mild right CVA. He has losses in his left rotator cuff and thenar wasting with inability to extend at his left CMC joint. His primary outpatient therapist is a PT. His case coordinator in the community is an OT who has followed him though occupational limitation due to an old, old orthopaedic condition when it became complicated by aging, knee replacement, partial nephrectomy for kidney cancer and now stroke. We are expecting a visit from her today and I hope she will be addressing the occupational effects of the ban on driving, reduced endurance and depression as well as the UE deficits. As for your UE referral - is there an Arthritis Society available to him? The Canadian society has a wonderful self management course that is facilitated by trained volunteers.
Joan Riches > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf > Of susanne > Sent: Friday, October 21, 2005 2:24 PM > To: [email protected] > Subject: Re: [OTlist] Treatment Ideas > > Hi Ron! > > Wow - he's 90, and he still had a total knee replacement - rather > recently, right? I take that as a sign that he's generally in good > health, and that prevention would still be really "medically" > meaningful - like joint protection techniques (which is much more than > saying: "don't over-stress your joints"). The equipment I had in mind > also helps with that - small stuff like the knife with a saw-like > handle - anything to make handles of kitchen tools, pencils etc. > thicker - (non-slip) help for opening bottles, cans, faucets etc... (Not > sure if you're already familiar with all that, and it's difficult for me > to translate into English, not knowing what is available etc. Can > someone else help, please?) > > In my experience, when you're living with cronic pain, even little > things you can do yourself to somewhat ease/prevent the pain is soooo > helpful - it's about who's in control of your life - you, or the pain. > (Or - the difference between helplessness/depression/social isolation - > and coping/participation.) > > I am hoping you might have the option of doing e.g. a kitchen activity > with him, where you can let him try out some simple, cheap equipment and > the joint protection techniques - often the relief is instantly felt! Of > course you'll have to consider his LE problems too - will he need to sit > down sometimes while working? Then you could help him set up his kitchen > routines for that - don't do it for him but help him explore! > > Like Kim said, I would suggest to get the elbow pain checked out. Also - > it's not usually the joint most strained during > DL/housework/self-care - so I'm not quite sure how to "unload" it. > (Elbow soft tissue can be much affected by screwing motions though. > Telling him not to use e.g. screwdriver might assist him in asking from > help from family?) > > >He could NOT identify any pattern to his pain......... > > Would prompt me to go deeper into it - like suggesting a > pain-and-activity diary for a week. Be his coach in this journey - your > being there right now is his chance to take a deeper look at himself, > activity-wise. Yeah - we "could" all do this ourselves, but do we? Same > goes for testing what is helpful from the outside - heat, cooling, pills > (how fast do they work, and for how long) - his chance to report to you > is what will make him be very aware. Most likely he'll draw his own > conclusions, and you just write them down... > > Kim wrote: > I agree with the previous > > respondent about joint protection techniques. There are lots of great > > patient handouts on this topic out there. > > And he may already have read them, but going through the motions with > you, in his own home is so different....You know? > > You wrote: > > The man may find some temporary relief from some modalities but > > these > > are just temporary measures. > > Untill you hopefully help him integrate them into his daily routines and > conciousness, right?! > > I'll pause for now, not sure how much of this you already know? IMO OT > has a lot to offer to artritis sufferers - much more than I can put into > a single mail... > > best wishes > > susanne, denmark > > ----- Original Message ----- > From: "Kim Masker" <[EMAIL PROTECTED]> > To: <[email protected]> > Sent: Friday, October 21, 2005 1:19 PM > Subject: Re: [OTlist] Treatment Ideas > > > > Any numbness or tingling in the hands? Have you ruled out compression > > neuropathy at the elbow? This can present as a very painful elbow. > > Hard to > > say without seeing him. Considering his spinal and LE hx., it's > > probably > > OA, though. Has he had x-rays of the elbows? I agree with the > > previous > > respondent about joint protection techniques. There are lots of great > > patient handouts on this topic out there. Also, sleeping postures. > > Hugging > > a pillow at night may limit the extreme flexion of the elbows that > > most of > > us have at night...that old fetal position...which might decrease some > > of > > the pain to start with first thing in the morning. > > > > -----Original Message----- > > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On > > Behalf > > Of Ron Carson > > Sent: Friday, October 21, 2005 6:31 AM > > To: susanne > > Subject: Re: [OTlist] Treatment Ideas > > > > Hello Susan: > > > > This is a 90 y/o man who has been VERY active most of his > > life, > > especially when he was younger. He played lots of contact sports and > > has > > worked with his hands all his life. > > > > Alas, age has caught up with him and while still active he does a > > lot > > less than he once did. However, he still gets up in the early morning > > to > > do his exercise which he readily demonstrated for me. > > > > I asked him how his OA was limiting him and he could not identify > > any > > specific areas. He is independent with self-care. He does > > have > > considerable pain during UE ROM (especially in his elbows) and > > even > > during rest. At times, the pain is quite debilitating (7 out of 10). > > He > > could NOT identify any pattern to his pain and has not been able to > > find > > any relief. I did not observe any deformation in his joints, > > although > > there is obviously some secondary to the OA. He is on a limited > > income > > so purchasing equipment/braces, etc may not be an option. > > > > It seems his primary complaints are related to pain. > > > > Here's the funny part. The man is currently seeing PT secondary to > > a > > total knee replacement, pain in his hip and pain in his cervical > > spine > > secondary to a stenosis. It just kills me that they referred him to > > OT > > for his upper extremity problems. Of course the order from > > the > > orthopedic doctor did state "OT/hand therapy". > > > > The man may find some temporary relief from some modalities but > > these > > are just temporary measures. Short of saying "take your pain meds, > > don't > > over-stress your joints, take it easy when it hurts, and be as active > > as > > you can tolerate", I don't know what else to say. > > > > Ron > > > > ----- Original Message ----- > > From: susanne <[EMAIL PROTECTED]> > > Sent: Friday, October 21, 2005 > > To: [email protected] <[email protected]> > > Subj: [OTlist] Treatment Ideas > > > > s> Tell us a bit more, Ron, about the OA, the pain, and his > > s> occupations. > > > > s> Also - which previous therapy? Was he taught joint protection > > s> techniques, and is he using them? Does he have the right > > s> tools/assistive devices, and is he using them? How's the pain > > s> corresponding to activity, rest, heat, cold, time of day...? > > s> How is he responding to the pain? What would he be doing > > s> (more of) if it wasn't for the pain? > > > >>> I don't think there's anything that I can do that will be > >>> medically > >>> necessary > > > > s> Like preventing joint deformities and thus further loss of > > s> function, and further pain... ? > > > > s> susanne, denmark > > > > s> ----- Original Message ----- > > s> From: "Ron Carson" <[EMAIL PROTECTED]> > > s> To: <[email protected]> > > s> Sent: Friday, October 21, 2005 1:33 AM > > s> Subject: [OTlist] Treatment Ideas > > > > > >>>I have received a referral for a client for UE rehab - gotta > >>>love > >>> THAT!!! > >>> > >>> Anyway, the guy has some OT in his UE and I don't know what to > >>> do. > >>> He > >>> has good ROM but pain. He is not limited in his daily occupations > >>> but > >>> has pain while doing them. He has found no relief from any > >>> previous > >>> therapy. > >>> > >>> I don't think there's anything that I can do that will be > >>> medically > >>> necessary. But I am looking for suggestions! > >>> > >>> Thanks, > >>> > >>> Ron > >>> > >>> > >>> -- > >>> Unsubscribe? > >>> [EMAIL PROTECTED] > >>> > >>> Change options? > >>> www.otnow.com/mailman/options/otlist_otnow.com > >>> > >>> Archive? > >>> www.mail-archive.com/[email protected] > >>> > >>> Help? > >>> [EMAIL PROTECTED] > > > > > > > > > > -- > > Unsubscribe? > > [EMAIL PROTECTED] > > > > Change options? > > www.otnow.com/mailman/options/otlist_otnow.com > > > > Archive? > > www.mail-archive.com/[email protected] > > > > Help? > > [EMAIL PROTECTED] > > > > > > -- > > Unsubscribe? > > [EMAIL PROTECTED] > > > > Change options? > > www.otnow.com/mailman/options/otlist_otnow.com > > > > Archive? > > www.mail-archive.com/[email protected] > > > > Help? > > [EMAIL PROTECTED] > > > -- > Unsubscribe? > [EMAIL PROTECTED] > > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > Help? > [EMAIL PROTECTED] > > -- > No virus found in this incoming message. > Checked by AVG Anti-Virus. > Version: 7.0.344 / Virus Database: 267.12.4/146 - Release Date: 10/21/2005 > -- No virus found in this outgoing message. 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