It's 6:30 a.m. I sit on my sofa, coffee next to me, tablet on my lap. The house is quiet and still. The dog, curled in a ball in the corner, breathes heavily and lets out an occasional sleep-whimper. This is my time. This is how I start my day. No distractions; no interruptions. It's my time to finish my documentation from the previous day's visits and review the day ahead. It'll begin at 8 a.m. with Care Conference via Zoom. Since the COVID-19 pandemic hit, all of our meetings have been remote. Then five visits will follow (all patient names and details have been changed). I'll be covering for a therapist in the next county over, so my travels today will take me across three counties and many miles of country roads and small-town streets. I work in Adams County, Pennsylvania. Gettysburg. Civil War country.
For me, Care Conference is held in my car. I'm parked along a little-traveled road that winds through the battlefield just outside of Gettysburg. Views of open fields and granite monuments stretch out in all directions. It's a nice area, quiet save for the occasional bird singing its morning hymn. Care Conference consists of all clinicians on our county's team. We briefly discuss new patients, those getting close to the end of their certification period, and those coming up on the 30-day mark. I listen, jot some notes, contribute where I can. In all, the meeting lasts about an hour.
By 9 a.m., I'm on my way to my first patient's home. Elva lives with her son and his wife in an 1800's farmhouse off a 5-mile gravel road through state forest land. Every time I drive this back-country road, I keep my eyes peeled for any sign of a large, hairy bipedal woodland creature. But as usual, Sasquatch remains elusive. At the house, I'm greeted by a flock of chickens, a small gaggle of geese, and a curious peacock who keeps his distance but isn't shy about flaunting his spectacular plumage. Elva fell 6 weeks ago and fractured her hip. Every time I see her, she makes sure to mention the bad experiences she's had with physical therapy in the past. For that reason, I've taken progression of exercises and mobility very slowly with her and pay extra attention to offering lots of encouragement along the way. She is polite and friendly, and thanks me sincerely when our session is over. After saying goodbye to the chickens and geese and waving a farewell to the precocious peacock, I drive nearly 30 miles to the next county where I'll see three patients for a colleague who is off for the week.
Ed, my next patient, is a 77-year-old Air Force veteran who also fell. But instead of fracturing his hip like Elva did, Ed fractured the odontoid process of the C2 vertebral body. He is in a hard neck collar for immobilization. Upon arrival, Ed's wife greets me and states that Ed isn't doing so well today-he's having a bout of vertigo, something he's wrestled with on and off for a couple of decades. He is agreeable to doing some sitting exercises so we focus primarily on that portion of his treatment. As I'm leaving, I see the occupational therapist waiting in her car. I give her a brief update on Ed's condition and after some small talk head to my next patient's home.
One of the most challenging logistical aspects of being a home health clinician is finding a restroom when you need one. In some rural areas, the nearest restroom may be 10 or more miles out of the way. And with the local lockdown orders due to the pandemic, finding a suitable restroom is even more difficult. So, after successfully locating an available portable john, I head off to see Frank.
Frank lives at the end of badly rutted, gravel lane that at times is sloped so steeply the tires on my Hyundai Accent struggle to find traction. His son-in-law, Andrew, who officially resides in Virginia, has been living with Frank and caring for him during the week for the last 2 years. Frank also had a fall and while he was unharmed, his fall landed him in the hospital for a week with kidney complications. He came home severely deconditioned and unable to walk. One of Frank's short-term goals is to be able to use a bedside commode. His long-term goal is to be able to walk 40 feet to the bathroom and use the toilet. To accomplish this, we must work on both transfers and standing and walking tolerance. Today, Frank requires maximum assistance of both myself and Andrew for standing from his lift chair. Once standing, he uses his walker to find his balance and can then support himself without assistance. He wants to try walking, so we move the commode about eight feet from his chair. He makes it there safely by taking small steps, but due to severe arthritis in both knees, every step elicits a painful wince. After safely making it back to his lift chair, Frank says he's done. The walk was successful and I praise him for the accomplishment that was all he could handle for the day.
From Frank's I head out to see Earl, a retired minister who is being seen after hospitalization for electrolyte imbalance. He lives in a neat and tidy mobile home that smells of roasting beef. One of the first things Earl tells me when I walk into his home is that he has a bum left knee-since 1963-and he needs to be careful with exercises so he doesn't aggravate it. I find out rather quickly that Earl is a talker and at the conclusion of our session (one in which we take it very easy on the left knee) he says, "Well, I feel like I spent the whole time talking about myself." And he's right; he did. But I don't mind. Sometimes we're there to carry a conversation, sometimes to educate, sometimes to encourage, and sometimes we're there just to listen.
My last stop of the day, some 30 miles from Earl's mobile home, is Tony, an older man who loves to talk about his favorite Italian dishes at his favorite Italian restaurants. Being of Italian descent as well, we have some great conversations and I always leave Tony's place feeling hungry and in the mood for pasta and sauce. We're seeing Tony after an exacerbation of heart failure that landed him in the hospital for 3 weeks. He's a tough ex-Marine who does what's asked of him and then some. If anything, we need to make sure he doesn't overdo his activity, which is often a hard sell.
At the close of my day, and after a final restroom break in a local grocery store, I do some documenting (I'll finish up the rest in the morning) and make phone calls to patients on my schedule for tomorrow. I finish my day just after 4:30 with my laptop's battery power at a thin red line.
Autism Risk Estimated at 3 to 5% for Children Whose Parents Have a Sibling With Autism
NIH: Roughly 3 to 5% of children with an aunt or uncle with autism spectrum disorder (ASD) can also be expected to have ASD, compared to about 1.5% of children in the general population, according to a study funded by the National Institutes of Health. Researchers also found that a child whose mother has a sibling with ASD is not significantly more likely to be affected by ASD, compared to a child whose father has a sibling with ASD. The findings call into question the female protective effect, a theory that females have a lower rate of ASD than males because they have greater tolerance of ASD risk factors.
The results, derived from records of nearly 850,000 Swedish children and their families, appear in Biological Psychiatry. The study was conducted by John N. Constantino, M.D., at Washington University in St. Louis, and colleagues in the United States and Sweden.
"The results offer important new information for counseling people who have a sibling with ASD," said Alice Kau, Ph.D., of the Intellectual and Developmental Disabilities Branch of NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. "The findings also suggest that the greater prevalence of ASD in males is likely not due to a female protective effect."