Thanks-giving

The holiday was yesterday, our baby girl sat in her high chair and happily ate an entire container of squash while we ate our grown-up meal. She, of course, had no concept that she was involved in a celebration that she will doubtless partake in for years to come, but we were thrilled to have our daughter there. Bwa-bwa-bwa, ma-ma-MA-ma, her contributions to the conversation were genuine and well-stated. Yup, she has been officially babbling for a few weeks now, and it is wonderful to hear. My co-workers were thrilled for me when I reported that she had begun this important communicative stage. But, although I am immensely grateful for my happy and healthy baby, and excited that her communication is progressing perfectly, this entry is not really about all that.

As the year's end rapidly approaches, I'm reminded that I have a major goal that I haven't been able to try out yet. That is the goal of a private practice, a situation where I see only the types of patients that I want to see and structure the treatment exactly as I see fit, rather than being constrained by the typical practices of a large organization. Personally I prefer the adult patients, as the diagnoses and treatments are more interesting. I do enjoy working for Kaiser, and most of my pediatric patients are immensely cute and fun to work with. The adult patients, however, are the ones that I feel passionate about. They are the ones that run through my head late at night as I ponder the best way to help them achieve their goals, and that inspire my internet research.

I enjoy working with adults because they are fully formed people, with an entire life history and distinct personality. They are people who probably had something very precious taken away from them very suddenly, and they are motivated and determined to get it back. These people tend to be enormously appreciative for the guidance that therapy provides. When they say thank you, they shake my hand and look me square in the eye. They are sincere in their appreciation and they express it frequently.

Speech pathology is a helping profession, and those of us in the field are there because we like to help people. That in itself is gratifying, and at the end of the day I know I've done my part to make someone's life a little easier. But like anyone else, it's nice to hear that a job has been well done. It's especially rewarding to hear the thanks from the very person I'm trying to help. So thanks for the thanks, it helps me know that yes, I'm doing something right.

Now to get on with the private practice, so I can do more of what I love with the people who are grateful that I'm doing what I do. Plan begins January 1, with business open date of June-ish. Get to it . . . .

With a Sudden Squeal

Squeals and happy, high-pitched shouts are some of my favorite sounds these days. Raspberries and drool have taken on new meaning, and I find myself returning them often. Well, returning the raspberries at least, with the occasional errant saliva droplets vibrating off my tongue as I encourage my baby to keep expressing herself.

At 6 months old, Cleo is rapidly approaching the time when she will prefer to repeat a single syllable over and over, mamamamamaMAma-mamaMa, or perhaps dadada-daDAdadada (to allow equal opportunity babbling), and the speech pathologist in me looks forward to that time eagerly. That time known as "reduplicated babbling" will herald my daughter's foray into intentional articulation, choosing to make the same consonant-vowel combination over and over again simply because she knows how, and wants to practice her skill with making a specific speech sound.

But in the meantime, she expresses herself with wonderful combinations of non-speech sounds, squeals and growls and raspberries, often with a big smile on her face. Every morning she wakes up and begins loudly vocalizing her happy shouts and sliding-pitch squeals. My husband and I, after shaking our heads in disbelief that we're being awoken shortly after 6:00 a.m. -- AGAIN -- will lay there and listen to her for a while. Even the sounds she has made before are so enthralling for us, and she frequently manages to come up with new variations that leave us laughing and delighting in her self-expression.

Cleo conveys so much about her world and her perception of it with her unrestrained proclamations that she is having a good time, that she feels well, that she is enjoying our attention, that she is fascinated with her hand or one of her toys, that she just had a very tasty meal and all is right in the universe. She enjoys using her voice, she likes to stick her tongue out and feel the funny raspberries that she makes, she likes the tickly buzz in her lips when she makes "MMMmmm" sounds, and most of all she loves to open her mouth wide and feel the huge sounds coming out of her that fill the room, including her very own ears, giving her all the encouragement she needs to do it again.

"AAAAaaaahhhhhhhhhh--aaaaAHHHHHH--ppththththth--AHHH!" That's right, Cleo Tell us all about it -- we're listening and loving every note.

More of . . .

I once read that speech pathology is a combination of science, linguistics, medicine, psychology, and teaching. I'd have to add counseling in there as well. For my undergrad I double majored in creative writing and communicative disorders, which to me made perfect sense. I got a lot of quizzical looks whenever I told people my majors, as if there wasn't much in common between the two. But really, it was all about a love of language.

And it still is. Language takes so many forms -- nonverbals, speech, gestures, writing, laughter. I forget the exact number, but it's something like 60% of communication is nonverbal. Some people do really well with this, and if they're having trouble putting sentences together after a stroke, the family will say that they're still doing a decent job communicating. Other people seem paralyzed without their spoken words, and will sit there helplessly wondering how to convey something.

That's one (of the many) reason why "speech therapy" is somewhat of a misnomer. Sometimes a session consists of helping people exaggerate their facial expressions, learn the value of pointing, and encouraging them to become animated with their gestures. A 19-year old girl I worked with who had a severe head injury was at first refusing to try to communicate if she couldn't speak. She eventually went on to string 2 and 3 gestures together to convey a variety of basic needs -- Put the bed down, Close the drapes, Turn on the TV, to name a few. It was so empowering for her, and really gave her a sense of hope. She went on to start speaking again, but that was three years after her injury. Three years is a long time to go without communicating, and fortunately she found a way around that.

I was just sharing a minor victory with my husband, regarding a 50-ish year old woman who is recovering from a brain tumor surgery. I knew she had made significant gains, but I was feeling like my therapy wasn't focused enough. Much of our sessions are spent in counseling to help her and her husband deal with some of the frustrations of everyday life. At our most recent meeting I had to refer to the original evaluation report to answer a question for them, and I was pleasantly surprised to re-read the details of her original skills. It made me realize that she had, in fact, made TREMENDOUS gains. This realization helped me to see that while our treatments were often a series of curvy, intersecting lines rather than a single straight line from point A to point B, this was entirely appropriate to serve this patient's needs. She is progressing fabulously and is in much better spirits overall.

That, I think, is exactly why I do what I do.

So, WHAT do you do?

What I do for my job, is speech pathology. Or more specifically, speech-language pathology (SLP). Which also includes swallowing disorders, since swallowing is in the head and throat area.

And still you probably don't know what I do. You're not alone, oftentimes it seems that no one really understands what a speech pathologist does. My mom doesn't get it, my non-SLP friends don't get it, one of my sisters doesn't get it. My relatives don't get it, my nanny is fuzzy, my neighbors think I'm either a teacher or a nurse. As a matter of fact, there are doctors who could be referring patients to speech pathology don't really understand what it's about either.

My husband, ever willing to listen to my rants and aspirations, does get it. When a glassy-eyed stare follows my remark that I work a lot with swallowing disorders, he jumps in and says, "Quick, try not to swallow for the next minute. You can't do it, can you? Now imagine that you couldn't swallow if you wanted to, pretty freaky, right?"

Back in the day, speech pathology was more commonly known as "speech therapy." But that didn't help people understand what SLP's did, so our big accrediting organization (ASHA, the American Speech-Language Hearing Association, www.asha.org) decided to officially change our job title. The big difference is that therapists do treatment, whereas speech-language pathologists diagnose and do treatment.

"But diagnose and treat what?!?" you may ask. True, that was the original point of this entry. SLP's are known for being rather chatty. So, to get to the point, a clinical description of my job is that I diagnose and treat communication, cognitive-communication, and swallowing disorders in all ages.

Some people think of stuttering, and others think of correcting a slushy s-lisp or an Elmer Fudd "R." That's certainly part of it, SLP's do dysfluency (aka stuttering) and articulation (speech sounds, including the S and R). We also do language therapy for children with delayed language development and social language therapy for individuals on the autism spectrum. Some speech pathologists are also pediatric feeding specialists.

Beyond the pediatric side of speech pathology, there are adults who benefit from speech therapy as well. People who have suffered a stroke or head injury, people with progressive neurological diseases such as Parkinson disease or multiple sclerosis, and people with head and neck cancers may require interventions for the way their speech sounds, difficulty understanding or communicating with others, difficulty with memory and mental organization, or problems with eating and swallowing.

Then there are the voice patients. This group includes people who overuse their voice such as teachers and singers, people with poor vocal habits such as smoking and dehydration, and people who use their breath and vocal cords inefficiently. You know Stevie Nicks' signature raspy singing voice? It was from recurrent vocal nodules, which are basically calluses on the vocal cords.

So what do I do? I interview patients and their caregivers to help determine the areas of difficulty, I play on the floor with toddlers, I administer tests to score strengths and weaknesses, and I educate families about relevant diagnoses and work with them to set goals for treatment. I play card games and board games, I pull out the Legos and Barbies, I discuss current events and upcoming vacation plans. I blow bubbles, instruct patients in oral care, recommend food textures and swallowing postures, and provide recipes to make eating safer. I counsel patients and caregivers through frustrations and provide encouragement and strategies to try to make life a little easier. I help to shape and reinforce correct responses and train families to implement home programs so that the skills carry over into the real world.

In short, I help children learn how to interact with the world and I help adults regain parts of their lives back.

I'm a speech pathologist, and I have an awesome job.

Completely unrelated to speech pathology is my beautiful daughter Cleo.