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Helping Patients Exceed Their Expectations | NEWS-Line for Occupational Therapists & COTAs
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Helping Patients Exceed Their Expectations

Arthritis affects one in three American adults, or 69.9 million people, according to a recent government study. The Arthritis Center at Mills Health Center in San Mateo, CA, offers specialized care for patients diagnosed with any form of arthritis as well as fibromyalgia sufferers. Wanda Woo, OTR, works there, helping patients learn to manage their pain and make the most of their abilities.

Woo, who is the primary OT at the Arthritis Center, is also a hand therapist. She treats patients with repetitive strain injuries, wrist and finger fractures, and provides postsurgical treatment. Woo goes beyond simply offering therapy, however; she also strives to motivate her patients. "After a few years of working as an OT, I began to develop expectations of what patients are capable of, and I always encourage them to exceed those expectations," she says. "The hardest part is having people realize that we are here to teach them to help themselves." This is especially true of patients who arrive at the Arthritis Center desperately seeking relief from their pain. "We do our best to help our patients retrieve what they have lost and overcome some of the barriers or difficulties they now encounter in their daily lives," says Woo of the approximately 34 patients she sees each week. "It can be things as simple as getting dressed, or brushing your teeth, to things like preventing falls at home."

Although Woo and her colleagues are there to help enhance patients' level of functioning, she points out that her main task is to provide them with the tools to increase their self-reliance. "We try to teach [patients] how to take better care of themselves, how to use their joints more appropriately, and encourage a healthier lifestyle, so that they can continue to be as independent as they want, whatever their age." Education is part of this process: the more patients know about their individual diagnoses and treatment options, the better their outcomes.

Medication also plays an important role in arthritis treatment. Woo and the rest of the OT staff at the Arthritis Center work closely with physicians to devise the best treatment. "One of the rheumatologists that we work with often advises the patient that the therapy may be more important than the medication, especially if they apply the principles of this therapy at home on a daily basis." says Woo. "Patients who are compliant are the ones that visit the doctor less and seem to handle their pain better than the patients who are being treated with just medication."

The average age of the patients Woo treats is about 55, and she has noticed an increase in the number of older patients over the eight years that she has worked at the Arthritis Center. "This past month, I have treated two or three patients [who are] 90." Although many of these elderly patients have had osteoarthritis or rheumatoid arthritis for many years, they may not have received adequate education or management prior to seeing Woo. "It is amazing how some of them do not know anything about their disease," she remarks. Her senior patients require special consideration. "One thing I focus on during therapy is preventing injury in the home." Such precautions as installing grab bars at showers and toilets, nonslip matting and removing bathroom rugs help reduce the risk of falls. Woo emphasizes the importance of preventing falls in the elderly, since just one fall can make the difference between independent living and staying in an assisted living or skilled nursing facility.

Increased precautions do not mean diminished activity, however. In the past, medical professionals advised arthritis sufferers to rest and take it easy. Studies have since shown that although rest is important, a healthy balance between exercise and activity is the real key to staving off disability. Woo acknowledges that conserving energy is still a very important part of arthritis treatment, though, so she advises patients to take frequent breaks during periods of heightened activity or exercise. This advice frequently helps Woo's older patients maintain a surprising degree of independence. "The older people tend to have the expectation that when they reach a certain age, they are going to have more limitations, but therapy and studies have helped them achieve far more than previous generations diagnosed with arthritis," she observes.

Woo finds that treating youthful patients presents its own special challenges. "When a teenager is faced with juvenile rheumatoid arthritis, it can be traumatic," she states. "The teenager is at a difficult age anyway, and most are looking forward to independence. Being diagnosed with a chronic medical disease -- one which limits functions -- on top of that can affect the total outlook on life. In frustration, they often ask themselves, 'How can I have this horrible disease?' Alternatively, they remain in denial and insist, 'This not going to happen to me,' [which] can hamper therapy attempts." Woo's empathy helps her encourage young arthritis patients feel positive about the future. "Getting some kind of connection and trying to 'hook' them, and building therapy from that so they can be good self-managers" is Woo's goal when treating this population.

Woo rises to this challenge by learning about her young patients' hobbies as well as their future aspirations. "I try to find out what motivates all of the patients, and modify or make [a rewarding activity] less strenuous, or even learn how they can eventually return to that particular activity. "Socializing, playing, and learning are all [activities] that the young patients are involved with, and all of this will suffer if proper approach and therapy is not applied."

Although many patients make impressive gains in functioning and report experiencing less pain, she cannot make their diseases go away. "Certain things are not within our control," Woo admits, "but there are some things that are." In the Arthritis Center, teaching patients how to use ice or heat wraps, exploring exercises in range of motion, gentle strengthening, pain management, problem-solving and decision-making techniques all help. "Adaptive aids/devices such as shower seats, or 'reachers' to help retrieve the morning paper or use as a dressing aid," can increase independence, notes Woo. "Even rubber-based openers to help open jars can be helpful in conserving patients' energy and protecting painful wrist and finger joints. All of these things help patients perform all of the things that they do on a daily basis without a struggle. I can also fabricate custom splints or issue prefabricated splints where it is warranted."

Being diagnosed with a chronic disease at any age can be depressing, but Woo thinks that her younger patients are especially vulnerable to emotional pain. When patients experience great difficulty handling their diagnoses, Woo suggests the services of a psychologist or support group. Mills Health Center provides multiple support groups and educational classes offering ways for patients to progress towards their personal and therapeutic goals. They include exercise classes such as "Ease into Exercise," a low-impact aerobics class, pool classes including "Joint Smart" and "Water Ease" and a fibromyalgia class that emphasizes self-management.

"The eight-week fibromyalgia series is taught by an OT, PT, nurse and psychologist. We do not even call [fibromyalgia] a disease," notes Woo. "We call it a syndrome, because it is a collection of symptoms and there are no abnormalities in [patients'] lab work or studies."

Woo, who helps instruct this class, says successful management of this mysterious condition consists of teaching sufferers to pace themselves and adopt a healthier lifestyle. Encouraging the right type of exercises for those who are deconditioned due to chronic pain often provides a high degree of relief. "We had one patient in the fibromyalgia class who was sedentary and could barely walk to the class," recalls Woo. "What we suggested was that she start walking five minutes a day, and then progressively increase it. Depending on what stage they are at, this method can be very helpful. This particular patient progressed fairly significantly. At the end of the year, she was walking one mile daily and was more active in her home life. Her exercise program also included pool therapy."

Resources such as the Arthritis Center's handicapped-accessible pool allow intensive therapy with the help of buoyancy. "For the arthritis patients, this means less pain in the weight-bearing joints. This enhances the [benefit] for many conditions, even severe repetitive strain injuries, making it easier for them to stretch, do range-of- motion exercises and pave the way for dramatic results," says Woo.

Woo's own experience with chronic illness makes her especially well suited to her current career. The course of her life changed dramatically at age 19, when Woo became so ill that she wasted away to 65 pounds. Her illness, which took three agonizing months to pinpoint, was eventually diagnosed as lupus. After experiencing exceptional and compassionate care during her illness and convalescence, Woo abandoned her original plan to pursue a business career. She decided to consider working in healthcare.

"The nurses treated me like I was special, and I wanted to be part of that," Woo recalls. "I wonder if they even realized what an impact they made, and how it changed my life." As she was recuperating, Woo sought a field that she could enter to provide others with the same care she experienced. She went back to school to become a medical assistant. She enjoyed this work for five years, but felt she could do still more. The more she considered a career in occupational therapy, the more she knew that it was the field for her. Woo graduated from an occupational therapy program in 1994, did an internship in inpatient rehab and went to work at the Mills-Peninsula Health Services. She truly understands her patients' concerns and fears because she was once in their predicament. "I almost died from [lupus]. When I was sick, I was truly impressed with how much difference one interaction can make when you're not feeling well," recalls Woo.

Having lupus means that Woo must follow a lot of the same self-care advice that she gives her patients. Perhaps this is why she relates to them so well. "I don't hesitate to share my diagnosis if I feel it will contribute to their compliance with therapy. Because I am so functional, I want to serve as a model of how proper balance of treatment can help." Although Woo has her illness under good control, she still has periods of fatigue, pain and stiffness. She says that exercise, proper nutrition and keeping active help keep these setbacks from becoming too frequent or too debilitating. "We can all benefit from a healthy lifestyle," she asserts.

Seeing her patients benefit from treatment and good self-care practices is extremely gratifying to Woo. "One of my biggest rewards is to see someone who was so limited at first progress to doing the things they enjoyed doing before," she says. "Many patients credit me for their success, but I tell them that they were the ones that made it happen, because they followed through. I just educated them."

Wanda Woo is an OTR at the Arthritis Center of Mills-Peninsula Health Services (a Sutter Health Affiliate) in San Mateo, CA. She obtained her bachelor of science degree from San Jose State in 1994.

Julia Elliott is a freelance writer from New York. She is on the Editorial Staff of NEWS-Line for Occupational Therapists and COTAs.

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