Saturday, May 06, 2006

Week 7, 8, and THE END!

Note to readers - I started this post 2 weeks ago, and saved it as draft. Now I'm adding to it week 8 and my final thoughts. Sorry about such a delay!!! I've had a lot on my mind lately, which I'll probably write about in my other blog, xanga.com... I'll try to fill out info later when I"m more free. I just watned to give a final update about graduation and my hours. =)

Week 7
It's been an interesting week. I'd better go day-by-day.

Monday
Saw the usual caseload of patients for cognitive-linguistic evals and therapy. Oral-mech-ed one guy. He was in the psych department for other things, but had gradual onset dysarthria. Kim and Caroline said we'd go see him together, but when we got to the room and stepped in, they didn't say anything like usual (that is, introduce themselves and me, explain why we're here, etc.) We all walked in, and then they looked at me expectantly. So I catch on, and start to feel flustered. Anyway, they said I did fine, even though they jumped in a couple times with tasks that I forgot, and explained for him in more detail why we were sent to see him. Afterward, I was asked to describe what I saw and thought by going through the subsystems (resonance, respiration, phonation, articulation, prosody). Felt like a quiz!

The psych ward was a creepy place to be in. They don't have the hand sanitizers attached to the walls in the hallway like the rest of the hospital, and there were several other things missing (like trash cans, gloves containers, etc.) in the area because of concerns that the patients can use them to harm themselves or others. In fact, the entire area is closed off under lock and key - we had to wait by the door for someone to let us out!

Tuesday

morning - L BG infarct - why do you think she had it?
aneurysm?
if it were aneurysm, where is it usually?
subarachnoid
what else? stroke

I should've expected it. I should've been prepared. We did another bedside swallow on a guy in the surgical intensive care unit. Had right facial weakness in the past, and was in the hospital again for a new lesion which caused left facial weakness. Speech was almost 0% intelligible, flat affect, slow movement of articulators, strained-strangled voice. Unable to raise his eyebrows. Anyway, after I did the oral mech on him and gave him an ice chip, he coughed several times. Caroline asked me what we should do next. Well, I clearly remember being examined by Karen Bryant, Michael Karnell, and Alice Smith about bedside swalllows, not even mentioning info by Jeri Logemann herself, who all say to do two (2!!) trials of everything. So I said we should give him another try with a second ice chip.

Then Caroline asked if I thought it would tell me anything else about his abilities if we gave another, and (based on the way she asked the question) I said no. "What should we do next?" she asked. Again, based on the way she asked, I said we should do a video study. ::PHEW:: that was the right answer. Good gravy I hate being asked pop questions like that on-the-spot!!!! Then she says to go ahead and explain that to him. Which I do. Then she steps in to explain also that we'd like to help him with his speech. Darn it I should've remembered that.

So, we finish and step out of his room into the hallway. This time I was prepared to talk about what I saw on the oral mech based on subsystems. But I wasn't at all ready for the grilling that was to follow. I was honestly near tears. I never gave a second thought to reviewing the dysarthrias for PRAXIS, and truthfully, I only gave it a once-over for the COMPS. I know that Caroline in her heart wants me to understand the information and get to it on my own, but I don't do well under pressure at all. And I know she is not trying to pressure me or quiz me or anything. But the way she talks is hard and fast, like a Chicagoan, I guess, so it comes out sounding harsh. She asked me to give detailed info about cranial nerves, where they decussate, what innervates what, how does his etiology correlate with what we saw, if XYZ then what kind of dysarthria... AHHHHH! I mean, in the end, it really helped me to put it all together and understand, but I was already frazzled from that morning's conversation.

Week 8
Just Caroline and me. Among the noteworthy patients I saw: oral motor exercises with man who had R medullary hemorrhage (therefore, resulting right facial hemiparalysis) and a tracheostomy, 13 year old girl in the psych ward for a language eval, infant VFSS...

THE END
Graduated yesterday!! The ceremony took 2.5 hours and was seriously quite boring. But important to note for the first years (that is, the new SECOND YEARS!! Congrats guys!!) -- all the speech path girls sat together in the A-L section of all the graduates. That's right, even though a ton of us were in the wrong alphabetical section, we wanted to sit together as tradition (apparently the class before us did it, too). Besides, it was so great to sit and chat together as we waited (and waited and waited...) our turn. hehe.

Final hours count:
Eval speech (adult): 0.75
Tmt speech (adult): 2.0
Eval lang (child): 1.0
Eval lang (adult): 25.75
Tmt lang (adult): 40.5
Swallowing: 5.25
Total: 75.25

I guess that's really not that much.

Saturday, April 29, 2006

Week 6

Hello again, loyal readers. :-)
I'm home (parent's place) tonight after taking the Praxis this morning. 120 multiple choice questions in 2 hours wasn't bad - I finished a half hour early. I didn't study much for it because a) Comps was only last month, b) Praxis has been rumored to be much easier, and c) I've run through several practice questions, and the above two reasons were sufficient to make me confident that I'll do fine. (I've probably just jinxed myself, and 4 weeks from now when I get my results I'll probably have failed it.) By the way, you only need a 75% to pass, so that means don't get more than 30 wrong!

I also wanted to update to warn all y'all that the www.ets.org website is a torture chamber, a disaster area, a hell-hole, a... a... stupid website! I personally spent hours on end trying to figure things out, and I know I'm not alone (b/c I've been quite outspoken about it, so I've heard stories).
Here are a few tips: 1. You CAN register online. You just have to find the link. (sorry i can't remember how I got there)
2. Avoid the phone. Not only do they put you through a full 10 minute gauntlet of recorded messages, but also charge you a lot extra $$ to register by phone.
3. Note that they only have paper-based versions of the Praxis at this time. I didn't know until last night! I honestly thought I registered for the computer based version. You can't use mechanical pencils, and they don't provide pencils at the center. You need your own set of #2's.
4. The registration thing will log you out after inactivity for like 2 minutes, so before you start:
- Find the testing center that you want to go to before you start the registration process. I can't remember how I found that out either, b/c the process was so convoluted. But it kicked me off for taking too long to find a place closest to me. Ugh.
- Find the institution codes for the places you want your scores sent. You HAVE to put ASHA as a recipient at the time you register, or else pay $35 later, like me. You won't be able to modify your registration at all after you submit (or at least I couldn't, after an hour's worth of frustration). The directions for this section when you get to it are confusing. For example, when it asked for the "certifying agency" I put ASHA, and somehow I thought it meant it would get a copy of my scores. Not true. Ick. Anyway, you can find ASHA's code at the ASHA website under Praxis info. I put U of Iowa as a recipient. If you want to work in the schools, I think you'll have to put the state's department of education as a recipient, too. Not sure what else.
- Create a password with at least 8 characters, nonwords, containing uppercase, lowercase, and numbers. I spent too long trying to make something work and it kicked me off, even though my created password fit all criteria. Oy. And you might want to write it down along with your login name and security question answers. Why? See #5 below.
5. Finally, do all that registration stuff, and be sure to print out your order b/c it'll be your admission ticket. And have it emailed to yourself just in case. The ticket will say that they may change testing centers without notice, so 3 days prior to your exam day, go back to the website and check to see if it has changed. Marie, Michelle and I all forgot our login names AND passwords by that time, and had to go through another process to find them out.
6. Check out your order summary to double check info. And get the heck out of ets.org before it sucks out your soul.
7. Oh yeah, order a sample test booklet. I didn't, but Marie shared some of its info with me. We found it somewhat helpful, although we disagreed with some of its answers! At least it was a good representation of what to expect, and good practice, too.
8. One more thing about studying for the test. Textbook knowledge from Comps studying will help, but don't forget to take time to bore yourself with reviewing: ASHA guidelines & policies, state regulations, legislative regulation info (like public laws), managing culturally & linguistically diverse (CLD) populations, and research and design methods.

::PHEW:: I hope that's it. I only meant to update and say it's over with for me, but then I got carried away with how mad I've been at the whole ETS system. Hope the info above can save you some grey hairs.

In terms of clinic, week 6 has also been uneventful. I managed to see 7 people within 3 hours on Wednesday! At the time, I was afraid Kim was going to say I didn't spend enough time with each patient, but instead she said she doesn't usually assign students such a full load by their 6th week, much less expect them to complete it efficiently. She said a lot of students usually spend time between patients gathering thoughts and planning for the next, or somethign like that. For me, I think I was just lucky that day. I mean, 5 of the patients were ones I'd seen before, and so I only followed the previous plans. The last 2 were new cognitive evals, which don't require planning, since it's an eval! They both happened to be very sweet people, and performed well to boot. So between patients, I only took time to write notes on the session, then moved on. I was also lucky because each patient was free whenever I wanted to see them, and if not they were easy to fit into the schedule. That hardly ever EVER happened. I'm amused to think that when I started the placement, I admired Caroline for seeing 7 people while I only saw 1 or 2 people in that same time span. Remember that post? Ah, those were the days. Less people mean less SOAP notes, of course. ;-)

Oh, I can also update on the hours I've gotten so far. I hope this long post makes up for the lack of posts previously. ^_^ Wait I don't remember them off the top of my head (they're posted in my office). But I currently have a bajillion hours in Neuro/Language-Dx and Tx, but 2.5 hrs in swallowing! Oh well, dysphagia has not been very interesting to me lately.

Ok, ok. It's now 1:26am and I'm exhausted. Let me know how things are going on your end, and also feel free to tell me what you want me to tell about my experiences!

Tuesday, April 25, 2006

Weeks 4-5.5

Update coming someday hehe... sorry! A lot has happend, and yet not much has changed. Among the events, I haven't had internet in my apartment for a couple weeks now, cept what I can get via wireless that I haven't paid for, which means I only get a few minutes of slow internet after lots of waiting. In the hospital, I've had another tearful day (no death though), done some more bedside swallow evals (saw someone with leukemia for the first time), had my midterm eval, and been given more clients to see per day (about 8). So I haven't had free time to update this blog at work, nor the opportunity to do it at home. Anyway, I've got Praxis this Saturday already!! So I really should be studying now... but not as nervous as for comps.

Saturday, April 08, 2006

Week 3: Part 2

I (practically) saved a life!
I had been seeing a patient for language therapy for about a week. Non-fluent aphasic. He moved from the acute floor to the rehab floor on Wednesday, so I did the BDAE (Boston Diagnostic Aphasia Examination) with him. Then Thursday, I saw him for our first official therapy session (on the acute floor, it's more informal). Well, he was very different that day, practically nonverbal! He couldn't even repeat. I was concerned so I called my supervisor from her office to help. She came and did some of her own eval with him, like having him repeat automatic sequences (which I forgot to check!). She was concerned as well, and called his doctor in. Doctor did her eval (which was neat to watch), and decided to call the neurologist in. So yesterday we got some preliminary results- they think he had another stroke.

It made me feel so useful, because the PT, OT, and nurses all saw him earlier that day and didn't notice anything! They thought that's the way he talked. It took a speech path student to recognize something was very wrong!

Tuesday, April 04, 2006

Week 3: Part 1

Lots of significant updates over the past couple days, so I'm a little early posting...

COMPS
My excuses
I submitted my Comps rewrite Monday at 6:12pm. Yes, I did not fully pass all my questions that fateful day. It was about speech/language/auditory development pre- and post-cochlear implant, and in my defense, I've had very little experience in this area (my FOCUS kid was a 2x no show) and had only one class in my early undergrad career about AR. That textbook has long since disappeared. And this was back when CIs were not all-the-rage yet (you know, around the same time cell phones only came in black and couldn't fit in your purse). I know I'm not the only one with the same background. So all I'm saying is, when your Comps time comes, study EVERYTHING.
Timing
I was told my results 12 days after Comps via email, which included instructions on completing my rewrite to be submitted (via email) by April 3rd, about 10 days. I wouldn't call it a "rewrite", because they didn't give me the same question again to "rewrite" a better answer. Instead, I was given a prompt to write about some important information that I did not include in my original answer, which was appropriate except for that (again in my defense, the question could've been more clear about what they wanted!). I didn't start it till last weekend, mainly because I had been sick. I'd say it took me a total of about 5 hours, which was 4 hours longer than I expected.
I wanted to finish by Sunday night, but I couldn't, and my supervisors here were super nice about it. As usual! They said it's going to be a slow day (though I saw 6 people! 30-45 minutes each!), and I could leave early if I finished early. Well that didnt' happen. Anyway, I got an email from Mary Jo today (4-5-06, 1.5 days after submission) saying I passed!

Scary stuff
Interrogation
At the end of the day on Monday, I was called to Caroline's office, where she and Kim were both waiting for me. They pulled up a CT scan of one of my patients, and asked me what her diagnosis was. Well, I didnt' have my notes with me, but luckily I knew most of my patients had anterior-communicating artery aneurysms clipped, so that's what I said. Kim says students usually need to have everything written down and get freaked out when they are asked that question. Lucky me!
We looked at the CT scan, and below are the proceedings (C=Caroline, K=Kim, M=Me)
C: So they scan the person, and find that there is a sub-arachnoid hemorrhage. What do they do next?
M: Uh... they drain the blood?
C: Yes, but how do they know where it was coming from?
M: *thought for ages* I honestly don't know.
C: Arteriography. (opens the images)
M: Oh, that's where they inject something into the artery and follow it's path!
C: That's right. (points out the aneurysm) What do they do after they find it?
M: Well they clip it (didn't really know exactly how that works, but I said it cuz of the diagnoses I've had)
C: That's one option; what's the other?
M: Uh.. Bend... they bend... something to do with turning or bending... (nervous laugh)
K: You're on the right track. They can coil it.

In my mind, I thought that meant literally twisting the artery around like a coil, but I didn't say that. Caroline explains what they both mean, and even draws me a diagram, which was very helpful! I even drew the same thing for a patient the next day who was wondering why she was there. The rest of the session involved me asking a lot of stupid questions, and them patiently explaining the MRI images and etc. I especially liked learning how surgeons got to the anterior communicating artery by lifting the frontal lobe and reaching from underneath, which explains the huge scar along the top of my patients' heads.

Anyway, this anecdote was just to exmplify that even though I was caught WAY off guard, and kind of intimidated by these blunt knowledge-check questions, I still felt free to be wrong and even continue to embarass myself by asking questions that would make anyone wonder how I got past high school bio. My supervisors really know their stuff in terms of anatomy and procedures, and I fully appreciate them trying to help me undersatnd what I'm doing, too.

Death
I saw a patient with Caroline last week as she did an impromptu bedside swallow with her. She and her family were super nice and appreciative of our services. I later saw her again for a full cognitive-linguistic eval, taking about a half hour. Near the end, she said she was really tired. I explained the results to her and her sister who was there at the time. Still great people.
Yesterday, I learned that overnight, she developed hypertension, cardiac problems, and a PE (pulmonary embolism, where a clot forms in the lower extremities, and travels to the lungs, causing lots of harm). So I was told I didnt' need to see her for followup that day.
Walking by the hallway yesterday, I noticed commotion in the room, family members crying by her door, and a male voice crying out in a trembling voice, "Oh my God Oh my God..."
She passed away.
I couldn't help but cry. I didnt' know her well, except those two incidences, but enough to feel personally saddened by the loss. Please keep her family in your prayers.

Escape attempts
I've been seeing this other guy for the past couple weeks. He's the typical ACOM aneurysm; confabulatory, tangential, poor recall of information... Except he scares me. He often tries to get out of bed, which is NOT good when he has tubes coming out of his head to drain the excess cerebralspinal fluid. He also tries to pull things off of him, including his IV, the staples and stiches in his head, etc.
He nearly got the best of me once last week, when he was trying to get off the bed and wouldn't listen to me. I was also physically trying to keep him down. No nurses came to answer the nurse call button that I kept pressing, and the door was nearly shut to his room so that people couldn't hear me calling for help! After about 10 minutes of debating with him that he needed to stay down and his physically resisting, I was also afraid of all the struggle causing somethign to come loose on him, AND I didn't want to alarm him by REALLY calling outloud for help. I finally made the huge mistake of a decision to run outside to get the nurse's attention. First thing I said was XX's trying to get out of bed, I need help. First thing the nurse said was I should never ever leave him alone in the room.
For pete's sake! No one was coming to help! Guess shouting outloud and risking him getting alarmed (and his blood pressure up, etc.) would be better than me leaving the room and risking him falling over and getting things yanked out of his skin. Sheesh, I couldnt' think straight at the time!
Since then, they have strapped his arms down to the sides of the bed. He still manages to twist around and strain the flow of his IV and things, but I've felt less anxious going into his room. Every time I go in (which is every day for the past couple weeks), he still attempts to get up and/or pull stuff off. He just doesn't understand right now.
Today, he has a new restraint. Yesterday (fortunately, when I wasnt' there), he fell off his bed and hurt his nose. His new restraint covers his upper body and looks like a small shirt. Four straps are tied to the back and side of his bed, so he can't even sit up. "Whew" i say.

I should stop complaining
When I was sick, I had to take 2 Tylenol pills every 4 hours. I hated it! I find swallowing pills really difficult. Before Tylenol, I took the liquid Nyquil at night before bed -nasty taste! I complained in my head all the time.
And then I get well enough to return, and I happen to be doing tx while several patients in that day are getting their medicine. They have to take like 7 pills at a time, drink little individual containers of nasty liquid medicines, and get one or two shots to boot! Twice a day, every day! Talk about a wake-up call, Linda.
And today, I was completing another cognitive-linguistic evaluation when a nurse came in to shave a guy's head in the area surrounding the scar. Now, I naively thought that didnt' sound so bad. Well, razer to scalp, the guy was shouting in pain, begging for her to stop (I need to never complain about my job again). I clearly forgot that the area was still swollen, sore with stitches and staples, and super sensitive. Plus, all my patients complain of itchiness in that area, and are always picking, pulling, scratching, or rubbing at the scar. All I need to do with them usually is pull the hand down and tell them to stop, since it was more out of subconsious reaction to the itchiness. I only worry about my escape artist patient.

Saturday, April 01, 2006

Week 2

I was sick, quite sick, since last Thursday. Over last weekend, I had a fever and an impenetrably stuffed nose. Monday, the 27th, I showered in the morning and thought I'd give work a shot. That was a big mistake. I saw 4 patients from 8:30am-11am, and couldn't handle being upright any longer, so I was sent home, without even having to write SOAPs (I gave my handwritten notes to Caroline, wrote them for me!).
Tuesday, my supervisors were so thoughtful - I walked in, and just after I said 'Hi' they both said they decided that it would be another halfday for me, so I can get more rest. So I saw about 5 people, wrote my SOAPs, and went home!
The rest of the week, I've been seeing the same people on rehab doing language and/or cognitive tx, and "checking up" on the people on the neurosurgery floor, just asking some cognitive questions to make sure they are not getting worse than before, and to maybe do some cognitive tx. I was taught how to do tx with a pack of cards. :-) Yup, regular deck of 52 cards. Ask if you wanna know.
I've started observing them seeing pts at bedside after i finish seeing my patients in the morning. I've also observed them doing video swallow studies on adults finally. They do them together if they can. They let me feed twice! hehe. It was weird that of the 6 people I've watched, there were no aspirators! Next week, I'll start doing oral mech exams. I was supposed to start this week, but there's that setback of getting sick. Plus, they've been really busy lately with paperwork, something about updating policies, so it shouldn't take too much longer. Incidentally, turns out there are 2 other SLPs in the peds department! But they do more stuff like outpatient therapy stuff.
Anyway, I dont' have a lot to update. I'm still given a list of patients in the morning, we talk about some of the ones I haven't seen for about all of 2 minutes, and then I'm off.

Monday, March 20, 2006

UIC Hospital: Week 1

March 20-24

Hi everyone!

Today ends the first week here, and I think it's great! My biggest complaint is the 1 hr-45 minute commute. Tough business, considering I've had such an easy commute to my other placement, and to WJSHC while I was in Iowa (where I lived across from the dental school).

They are the only two SLPs in the hospital, Kim and Caroline. Kim's supposed to be my official supervisor, but she's out this week. Caroline was out last week, so she has been in charge of me while trying to catch up from being out. Caroline is awesome. She is a fast talker, laid back, and super knowledgable. I assume Kim is too. They insist on the hands-on learning approach, with little observation, where I do a lot of things on my own so I can get my own "groove" before I'm observed later. If that doesn't make sense, keep reading.

I start at 8am, and finish by 3 or 3:30 every day!!! No staying late, No student project, No work at home! I've got my own office, computer, and phone, but I'm not there often because I have to use one of their computers to write SOAP notes - something to do with security. I basically put my stuff in my office, and maybe sort the papers and stuff I'll need for the day. I've got to wear scrubs and a white coat all the time. I also got a radiation badge (what you wear when you do video swallow studies).

The first day, I told Caroline that I observed most of the time at Children's, and insisted that I'll be very independent here ("You'll be in charge of your own day"). She explained a couple orientation things, then sent me to get my radiation badge. When I came back, I hung out in my office and my phone rang! Picked it up, and it was Caroline saying to meet her on the 6th floor in 20 minutes, and in the meantime look over the BDAE because I'll administer it soon!

When I met her upstairs and we stopped outside the patient's room, and she told me her diagnosis and everything. She explained that she had a sub-arachnoid hemorrhage some time ago, but the residual blood left in the area is an irritant on the brain which causes vasospasms. She went into a lot more detailed than that (regarding pressure in the brain and etc.), but that's the gist. I could tell immediately that she's big on knowing and understanding the anatomical basis of behavioral symptoms! She's JUST what I need, because I feel like that information is only floating around in my head (especially after cramming for comps so recently ago) and it all needs to come together. Later my thoughts were confirmed after we looked at her MRI on the computer (she said "only radiologists are supposed to analyze these, but I can't see why we can't look at them too"), and she pointed out parts of the brain down to the globus pallidus of the basal ganglia in an axial view! Oh, further confirmation when she said later that day that the most important things that we want to find out is whether their symptoms make sense with their brain damage. Personally, I thought we were taught to consider the functional impacts of their symptoms. But oh well, to each her own :-) I'm sure she was only referring to these acute patients when we are doing a diagnosis.

We went into the room and she introduced both of us to the patient, explaining that I'll be doing the test. Then she asked me if I'm ready. I said I thought so, then she said "alright, I'll be out there if you need me" (pointing to the nurse's station), or page her if I couldn't find her.

"HOLY COW", I thought to myself -- I'm gonna be all alone! This is within the first couple hours of meeting me and she wasnt' even planning on seeing how I do! I don't think I had ever been completely alone with a patient before like that. At first I was really nervous, but very soon after she left, I realized that this person has neurological damage, and there's no family around so there's no way I can make a fool of myself! I was able to really relax then, and sit on her bed and proceed calmly, taking my time, and feeling free to flip pages around and write what I want. At UIHC, I always felt pressured - to perform, to do everything right in the right order with the right timing... etc. Can't really compare to the VA because we didnt' see acute patients.

Well, to sum up, the rest of the week I've gotten even more independence. In the morning, she gives me a list of patients (and she's got her own, much longer list). These are all language/cognitive rehab or eval patients, so no dysphagia yet, which is fine by me. There's usually 6-7 on the list, and I only end up seeing 3-4 on my own. We go over each of them because she has to tell me the dx of the ones I haven't seen yet (since I'm not allowed access to the system), and asks me if I have any questions or if I want her to join me for any of them. Now, her definition of "join" is different from mine. She'll usually just introduce herself and me, explain what I'll be doing, and then leave. There were a couple which she did the whole thing - one where the wife was present and had a lot of questions (thank goodnes Caroline was there), and the other the guy was too sedated to participate fully in the test I was supposed to give.

So I only see Caroline for part of the day. I write my SOAP notes in Kim's office since she's out, and they are a bit longer than at Children's, but still definately not Dr. Gordon's lengths... hehe. After I finish writing, I save to a disk and bring it to Caroline, who looks it over and copy/pastes to the system. By the way, I can eat lunch whenever I want! She really doesn't care how I spend the day, as long as I see the patients and write up the notes. I think I do have to finish the notes by 2:30 so she can review them and we can leave on time.

Caroline likes to see all the patients in a row in the morning, then write all her notes during lunch and in the afternoon. I like to try that, but first of all I can't remember all the informatino from one patient to the next without writing it down right after, and second of all, not everyone's available when I want.

Anyway, this post is getting long. One more thing to mention that I did yesterday - a pediatric videoflouroscopic swallow study! I haven't seen any VFSS with Caroline yet except for this one. The baby was 14 days old and had a lot of neuro problems. The way they do it here is super duper extremely way opposite of Children's! Caroline put me in charge of THAT session, and THAT was another surprise! She said I should know a lot more htan she does about it, so I am in charge. Turns out I think I do know more! The pediatric radiologist, Dr. Shay, is an old guy who works both here and Childrens, and he says he gets really annoyed with the SLPs there because they are so picky about everything. Good grief, don't get me started about that - I happen to agree with the SLPs at Children's (probably because I just spent 8.5 weeks with them), because there were SO many things that I wanted to change even from that one session! But then again, Dr. Shay has ... let's say... 'been around the block' for a really long time, and he's got to know what he's doing.

Well, this post is long enough. I could've gone for just as long about how the VFSS went, but I'm tired, and I called in sick today :-( But I should be fine - just a cold I think. Till next time, then, girls! Don't forget to comment about what you want me to comment about! :-) Otherwise I'll just ramble on like this post haha. Cheers!