Walking 500 miles

IMG_5129Ok, so it felt like 500 miles, but it was actually only 31 miles. This weekend I took part in a 50km walk around our Bush Capital, for the CBR100 Challenge. Some beautiful views, and lovely places to walk, even in the mid-30 degree dry, dusty heat. The course took us through Hall, One Tree Hill, Mulligan’s Flat, Goorooyarroo Nature Reserve, Mount Majura and finished with Mount Aislie.

I’d never walked that distance before. The most I’d done had been about 25k, touristing around Paris a few years ago, with frequent cheese, wine, and potatoes cooked in goose fat breaks. So I figured I’d either blow out in the first 30k, or make it all the way. As it turns out, I almost lost it around 47k, when my feet were essentially blobs of pain (burst blisters, mostly). It then took a really long time to do the last 3k, which was a bit miserable both physically and mentally, especially as the sun had set by this time. But, such as it was, I finished, and with the knowledge that I’d made good time for most of the 50k.

I enjoyed Mount Majura the most, even though it was well into 30k that we reached it, essentially because I like the challenge of going up mountains (coming down is another story though). Mount Aislie I liked the least, because I wasn’t sure when, or if, it would end. Goorooyarroo Reserve was also beautiful to walk through. This is a research and restoration area free of introduced species (except us pesky non-Indigenous humans), for supporting endangered native animals such as the Eastern Quoll. Here we were on mostly flat fire trail which was peaceful, and as you didn’t need to vary pace that much, this portion of the walk had a meditative quality.

Things I’ve learned from this walk:

  1. Wear shoes with plenty of room as feet swell considerably. I did this walk in my Brooks PureGrit 2 shoes, which I usually use for 5-10km trail running, but found that 0.5 size larger than my usual shoe size was not large enough.
  2. Band-aid, pad, vaseline any problem areas early.
  3. You need to eat more than you think you do, and really keep electrolytes up. I learned this as I was going up the first bit of Majura, when I started to feel faint, which reversed with food and electrolyte drink.
  4. There are different phases to conquering a long distance. When things are tough, putting one foot in front of the other will still eventually get you there.
  5. Training would have probably helped? I did this with no specific training, apart from doing the usual 5 to 10k runs a couple of times a week.

Would I do it again? Probably. Would I do the 100k course? Part of what I found exciting about this walk was that I had no idea if I’d be able to do it or not. So maybe I’d consider doing the longer course in the future – with solid training, different shoes and a very good music playlist.

On blog reading and writing

I really like blogs, and I read a fair few. Apart from friends’ blogs, I mostly read those of other health professionals, health students, scientists or researchers. It helps if they post food pictures, are snappy dressers or creative, or discuss both professional and personal matters. Being in the health field, its tricky discussing the last two due to confidentiality constraints, both concerning patients, and the professional’s life, in the Google-your-healthcare-provider-or-potential-employee age that we live in. I realise, however, that the blogs I enjoy the most are ones that discuss the personal, at least to some extent: reactions to tricky professional situations, travel, self-care, family. So with this in mind, I’ll try injecting a bit more of myself into this (so far, pretty dry) blog.

This week, I felt more like the bug than the windscreen. I didn’t get a job that I had pinned my hopes on and that would have been a really good fit, my research participants all cancelled, there are some family health issues, and exercise (which I use, not just for fitness but also for mood) felt painful and like a chore.

There are quite a few jobs out there in my field, but I had not realised how stiff the competition is. Not getting this job makes me worry that I won’t get a job, and feel angry at the thought that I’ve spent so many years studying and working hard, and there might not be light at the end of the tunnel. Of course, no one’s promised that there would be a shiny job at the end of the hard slog, but being human* means you assume things such as hard work -> some sort of reward. It’s also especially frustrating when you know that the mental health needs of Australians are far from decreasing, and that all the services you’ve done training with are stretched beyond capacity, with high rates of burn-out for clinicians – and yet there aren’t enough new jobs. (I should mention that I haven’t been applying for heaps of jobs, just very specific part-time ones, since I’m still doing my research. Not to mention that many/most positions are not available for people still finishing their clinical degree, which is fair enough.)

This brings me to the second point: I’m trying to finish my research, and even though I am still really interested in it, I also feel disheartened by the publication cycle and how hard it seems to get my last lot of participants. People are very generous to volunteer their time to participate in studies, and many have already done so for my research. So much goes on “behind the scenes”, before I meet with participants: out of those who contact me to say they’re interested, I end up talking to and screening about 2/3rds. Out of these, maybe half are eligible. Then I have time set aside for assessments, and it sucks when people don’t turn up. Even when they do – there’s a lot of forward and backward emailing, calling, schedule-checking, etc. Of course, there’s no reason for participants to know all this background information. TL;DR – research is really time-intensive and it makes me sad when participants cancel or don’t show up, which happens regularly. (Even so, I’m grateful that so many people have been interested in my research.)

Running, which is my preferred form of exercise, normally helps with life’s bumps and jolts, such as the above. I’ve recently come back from an (amazing!) overseas trip (honeymoon, actually), with some unwelcome residual sinus issues probably made worse by rapid changes in climate and aggressive airplane air conditioning. This has made running painful for the past couple of weeks. Bad breathing -> huge stitches -> sad runner. I’ve powered through: two painful Parkruns, a painful trail-running race, and a painful short run with a friend. I’ve tried to stay mindful, and the beautiful scenery of the trail run helped, but still, not the best outlet. Happy to report that this morning’s Parkrun was relatively-pain free, probably helped by sucking it up and taking some antihistamine medication.

So where to, from here? I’ll apply for other jobs that seem suitable to my stage in training. I’ll keep screening research participants, whether or not they end up coming in. I’ll keep going. And I’ll also see how this personal-and-professional blogging thing goes.

 

* Really, an instrumentally-conditioned animal.

Headspin

Finishing a placement and then having to prepare for a new one is disorienting. You still have your old cases whirling around in your head, as well as reminders about weekly to-dos like team meetings, case reviews, referrals, bits of theory you want to read up on, things to chase up like metabolic screening, questionnaires, and you remember the nice Japanese and Thai cafes and the little greengrocer right next to the train station and the amazing Greek cake shop and how convenient it was to have a Woolies basically inside the station…and then it all changes. You have to let go of all that, and make yourself familiar with a new team, new names, new admin, a new hospital/clinic, a new way of doing notes, and a completely new location where you don’t know all the good places to eat, the coffee shops, if you’ll have time for breaks, what parking is like, etc etc etc. (My next placement happens to be somewhere I used to work a long, long time ago so I’m somewhat familiar with the location, although it’s all changed now.) It’s like starting a new job every 6 months.

Not to mention an entirely different patient group. So far my external placements have been in adult settings, whereas the one I’m going to is in paediatrics. I haven’t worked with children and families in about a year. I need to dust off my developmental books and my family therapy skills. I was fortunate to get a good amount of time in the university clinic both assessing children with suspected learning disorders and attentional difficulties, as well as doing therapy for different age ranges and presenting problems, but I still feel unprepared. What if…?

I was lucky enough to get a 1.5 week break between placements, which I’m using to recruit and test participants for my research, and to catch up on TV shows (The Killing, The Fall, and Jonathan Strange & Mr Norrell are current favourites) and on knitting. I’ve also got a weekend trip out of the city coming up, where the plan is to walk around a lot, eat lots of food, play lots of games – can’t wait. I hope it clears my mind a bit.

The Real World! First External Placement

Hello! It’s been a while.

Mid-last year I was sent out into the Real World on my first external placement, in the neurology department of a large hospital. Got to see plenty of interesting presentations, both in inpatient and outpatient. I learned to use lots of cognitive assessment instruments, and I’d like to think that I improved my history-taking and assessment skills. I also got to shadow neurologists, neuropsychologists and techs, become very familiar with the ward, and see some interesting procedures, and some neurosurgery. This was a full-on assessment placement, meaning no therapy. This is somewhat uncommon for clinical psychology interns, but because of my love of brains and the nervous system in general, and because of my area of research, I decided to do it, even though it meant taking a 6-month break from psychological therapy.

While clinical neuropsychologists are experts in assessment in a neurological context (i.e. when there is an organic basis for perceived deficits, such as stroke, traumatic brain injury, etc.), all psychologists are trained to do some types of cognitive assessment in the general population. Cognitive assessment is a core aspect of any psychologist’s training and duties, and yet it’s not very common in the popular perception of psychologists – certainly not as much as therapy is. Many psychologists also do capacity assessments.

Before starting in my course, I’d considered doing a Master of Clinical Neuropsychology instead, due to the aforementioned love of the brain. And I continued toying with the idea of doing this later on in life. However, this placement made me reconsider, to my surprise: I found the short-term nature of involvement with patients, and the fact that you don’t typically do any treatment yourself, unsatisfying. That being said, I do very much enjoy doing cognitive assessments, so ideally I’d like to work in an area needing both therapy and some assessment.

To respect confidentiality, I’m not going to talk about any specific cases. But I thought I’d write about the general process of getting a neuropsych assessment, as I understand it from this placement. It is possible that this process is different in other settings where these assessments are often done, such as brain injury units.

1. You, or your family, develop concerns about a change in some aspect of cognition or behaviour: increased forgetfulness, problems following directions, recklessness or impulsivity, lack of concentration, speaking/reading/writing difficulties, not coping with job or education demands, etc. Maybe your family have concerns about your capacity to manage finances, consent to medical procedures, or manage day-to-day life.

2. You see your GP, who does the first-line investigations, but if these do not suggest an immediate answer/solution, will refer you to a neurologist. (Or to another type of specialist if a non-neurological problem is suspected.)

3. The neurologist will often get some further investigations done (e.g. neuroimaging), and if appropriate, will then make a referral for a neuropsychological assessment. A neurologist may also make such a referral following a stroke, or for chronic diseases affecting the nervous system such as multiple sclerosis, Parkinson’s disease, etc.

4. For the assessment, you come in for 1-2 sessions, during which a history is taken from you and (preferably) a close family member as well, and an assessment is conducted, tailored to answer the referral query (which is sometimes really vague: “X may be prone to being taken advantage of by others”; “please assess cognitive function”) and taking other factors into consideration, such as your English language fluency, general cognitive status, if an interpreter needs to be used, physical impairments such as missing limbs, blindness, pronounced tremor etc. The assessment consists of a test battery – different tasks that look at different aspects of cognitive function such as memory, speed of information processing, attention, verbal abilities, reasoning, problem-solving, etc depending on the referral question and clinical judgement.

5. The assessment is then scored, and a report is written up and sent to the referrer, that typically includes a brief history, findings, and the impression (i.e. if the findings appear to support or not support a particular diagnosis, opinion regarding capacity, etc).

6. Feedback is often also given to the patient and family, with easy-to-understand major findings and general recommendations on what would be helpful in terms of managing day-to-day activities, given the pattern of deficits found (if any). Often the recommendations will involve having other investigations (e.g. sleep studies – if the patient reported having disrupted sleep), seeing other professionals (such as a clinical psychologist – for adjustment to a diagnosis, implementing day-to-day strategies, or if the cognitive deficits found seem more in line with depression or an anxiety disorder), or becoming involved in support groups (e.g. for MS, PD, etc).

7. There will often be a recommendation for follow-up testing in 12 months’ time, or sooner if further changes are noted.

And that’s all for today…I’m now almost at the end of my second external placement, in a very different setting – but I’ll cover this in a future post.

World Mental Health Day 2014

World Mental Health Day is on 10 Oct, and (Australian) National Mental Health Week is between 5-12 October 2014. The theme for WMHD2014 is “Living With Schizophrenia”.

The ABC will be running a week’s worth of mental health-centred programming – check out the highlights here: ABC’s Mental As.

About 1 in 2 Australians will experience a mental health problem at some point in their life, and we are all affected by mental health issues: our own, those of our family and loved ones, and in our communities. Mental health Week is a good incentive to get people to think a bit more about their own mental health as well as those of others, to reduce stigma around mental health, and to connect with others.

With these three points in mind, I will post a few resources to check out:

1. Mental health info and services.

    BeyondBlue is a good place to start reading about mental health issues, especially depression and anxiety, which are the most common mental health conditions.

    For young people, ReachOut is also a good place to visit when things get tough.

    Project Air Strategy, maintained by the University of Wollongong, is a resource specifically for personality disorders, and includes a state-by-state treatment directory.

    National Eating Disorders Collaboration is a repository of good information about eating disorders and their treatment.

    In NSW there is a great resource for schizophrenia: The Schizophrenia Fellowship.

2. Stigma is alive and well.

    Not only is there stigma towards having a mental health condition, but also stigma and discrimination towards other personal characteristics (such as race, sexuality, gender) can greatly contribute to mental health problems. Check out BeyondBlue’s Stop. Think. Respect. campaign – they have some great videos on this issue.

    Think before you call someone “mad” or “crazy”, before you assume that people with mental health issues are “lazy”, “attention-seeking”, “manipulative” or “aggressive”, or before you ascribe mental health difficulties to behaviour that seems unusual *to you*.

    This goes not only for the more well-known mental health issues, but also for ones that don’t garner as much attention or support, such as personality disorders, which are often described in pejorative terms or not taken seriously, despite the fact that they represent long-standing, severe difficulties that can pervasively affect many aspects of life.

3. Get connected.

    SANE Australia has forums for people with mental health issues, as well as carers’ forums.

    BlueBoard, maintained by the Australian National University, is another good forum for sharing experiences with mental health difficulties.

    ReachOut also have forums for young people with mental health concerns.

If you’re after a mental health professional (such as a GP with an interest in mental health, a clinical psychologist or psychiatrist) in your area, check out this “Find a Professional” service provided by BeyondBlue.

And of course, if in crisis, call Lifeline (13 11 14) – they are there 24/7 to lend an ear.

Season change

I much prefer autumn and spring to summer and winter – I see them as transitional seasons, which of course isn’t quite accurate, as every season is a transition. But in spring and autumn, it feels like the transition is somehow more extreme, and so it’s not as monotonous as three months of heat or cold.

This summer has left me battered and bruised, and I’m glad it’s now autumn. I can feel the cool change in the air, especially in the morning and at night, a touch of crispness. It feels like I’m slowly waking up – opening my eyes, moving on. This is not really a personal blog so I won’t go into the details, but the past few months have played havoc with my internal and external life. I hope now is the time to get some distance and heal.

My course continues and I still love it, although it’s hard at times. In this clinical rotation the emphasis is much more on process, a notion which is hard to describe. Basically it’s focusing on the dynamics in the therapy room between therapist and patient, rather than solely on the presenting problems. This is challenging for me as a novice therapist, as it is quite a confronting process, both for therapist and patient, as it involves pointing out the “backstage” elements of what is a constructed social interaction. Therapy is about being truthful, rather than being nice, but it’s hard to be truthful in a nice way at times. I’m also learning about different ways of “being” in the therapy room with different types of patients, which is also challenging. Being “nice, supportive therapist” will not get some (most?) people to shift.

There’s also only a couple of months until we are released into the “real world” for our external placements, which is quite scary/exciting. In the mean time, I’m also learning lots of neuro, and there may be some brain dissectin’ going on in the future. Not having done a human brain before, this is exciting.

Things I am loving right now: coffee, Swedish crime fiction (everyone in these books drinks so much coffee), and that it’s cool enough to wear leggings. Yes, sometimes it’s the little things that get you through.