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Glioblastoma Multiforme

GBM in the right hemisphere (the left side of this picture)
source of photo

Otherwise known as GBM, is a tumor I've been seeing quite a bit lately. The sad part about this tumor is that the prognosis is very poor. People diagnosed with this tumor usually have from 3 months to 2 years to live. What bothers me about this is that when we see patients and discharge them, we're basically sending them home to die. Many of them need acute rehab care but some of them refuse, stating that they'd rather spend their remaining time with their family. I don't blame them, really. But seeing this diagnosis really bothers me because these patients know they are going to die and their families know this as well. I just can't imagine.

GBM is treated the same as most other tumors--surgery (which is popular where I am), radiation, chemotherapy, steroids, etc. But let me back up and bit and give you a bit of info on this tumor. GBM is a very aggressive brain tumor of the glial cells. Glial cells are cells that support neurons by protecting neurons from foreign invaders, providing nourishment to neurons and destroying old neurons. Glial cells also hold neurons in place, assist with neuroplasticity and help repair neurons when they are injured. What I find interesting is that glial cells are not neurons themselves, they only serve as bodyguards.

As you can probably infer, glial cells are very important to the nervous system. GBM is more common in males, particularly white and Asian men over 50. Unfortunately, the tumor can grow without symptoms until it has become a dangerous mass. As an occupational therapist (student :-) in an acute hospital setting, we work on a variety of functional activities, such as orientation (making sure the patient knows who they are, where they are and the date), upper extremity active range of motion, functional mobility that is comparable to walking a distance within the home, putting on shirts, pants and socks, sitting balance, walking balance, vision and perception and fine motor coordination. We work on other things depending on the needs of the client but these are the most common.

Here's a website that has contacted me twice. They have occupational therapy jobs and other resources, including other occupational therapy blogs! (click on the Resources link)

I've checked it out and it looks interesting, to say the least. I am not endorsing or attesting to the validity of their service or ANYTHING of that nature. I think this is an interesting site and they asked me to put the link on my site and I agreed to do so, so here it is:

http://www.GetOccupationalTherapyJobs.com

View at your discretion... :-)

Week Four!

This picture gives you a a general idea of what the ICU is like. Now imagine a patient in the bed with lines coming out of their head, nose, neck, chest, arms, wrist, hand, genitals and legs. Yes, seriously, that many lines. The entire visual is very...busy. I'll write a post about it later to give you an idea of what to expect if you ever have the opportunity to work in the ICU. As usual, this is not my ICU, just a random pic :-)

Wow! One third of the way through my first Level I Fieldwork. Again, Wow!

It dawned on me that I didn't actually explain what I'm doing. At least, I don't remember explaining...anyway, I'm a student in Neurology-Acute Inpatient. I don't know if that is the official name, but that's what I'm doing. I only see patients that have neurological diseases or medical concerns, such as brain tumors, multiple sclerosis, strokes and a host of other diseases that are rare neurological disorders. Many of the patients are in the ICU, and that is exciting and scary for me because the ICU is BUSY. There are so many lines, monitors and noises, you have to be focused on 10 things at once. At another time I'll write a post just on that. It's sooo interesting.

This hospital treats A LOT of diseases that are far and few between; outside hospitals send their patients here when they are unable to provide further care or determine the exact problem. As a result, I see a host of interesting disorders that are very uncommon. Sometimes, I also see burn patients or 'general medicine' patients.

Please note that hospital inpatient acute is different from rehabilitation (inpatient) acute care. It's confusing I know...I've noticed that clinicians often use them interchangeably, depending on with whom you are speaking. However, they are different.

As a hospital inpatient acute therapist, I work with people who have come to the hospital with an illness or problem, the doctors have diagnosed the problem or are medically managing it and the doctors require the occupational therapist to see the patient to determine if the patient is safe and stable enough to go home or participate in other forms of care, such as outpatient, acute, day rehab, etc. The patients are only in the hospital for 7 days or less, rarely longer, hence the term 'acute' for this setting. These patients are acutely sick.

A rehab acute therapist works with people who require a long-term hospital stay, 24-hour nursing care and daily medical supervision AND they must need (and be able to tolerate) at least 2 hours of therapy a day of AT LEAST 2 skilled services--occupational, speech and/or physical therapy. This is the key to acute care-- inpatient stay, 2 or more services, 3 hours a day. Please note that rehab acute care is not offered at all hospitals. As a result, it may take place in a hospital or another facility, but the premise is the same, regardless of the location.

Hope this clears things up, even if just a little; I hope I explained it well. So, back to me. As an inpatient neuro acute student therapist, I assess the patient's current function and abilities, perform a verbal investigation of their functional history before they were injured and determine how what they can do now compares to what they were previously able to do.

I make a discharge recommendation, stating if they are able to go home (safely, of course) or if they need additional care, such as further acute care, outpatient care, day rehab, home health, 24-hour supervision, etc. The purpose is to determine how functionally independent AND safe the patient would be if they were to walk out of the hospital at that exact moment and return to their normal living conditions.

As you can imagine, most of the patients I see are not safe and require additional care. In the meantime, while they are still inpatient patients at the hospital I continue to see and work with them. We work VERY closely with the PTs, we work in teams. We work together to evaluate and treat patients. Because patients are so acutely sick, 99% of the time they are laying in bed 24 hours a day. As you know, this is a recipe for pressure/bed sores.

So, we work on sitting them up in bed, balance while sitting on the edge of the bed, standing and walking. We also work on other functional activities, such as dressing, eating, cognition (do they know where they are, the date and the president? You'd be surprised how many people who have not been medicated are clueless), following - multi-step commands, safety awareness, sensation, vision, L/R discrimination, toileting, transfers, attention, and memory, to name a few. Our goal is to get them healthy enough to leave the hospital and return home or to the next level of care.

I hope this has clarified some things a bit...Some people expressed some confusion.