Big Laguna Trail

Last weekend, Chuck and I went on a 11 mile hike at Big Laguna Trail. Unfortunately, our hiking book doesn't have very detailed directions nor the trails aren't marked well and we didn't complete our planned loop. But we did manage to get in 11 miles of hiking from retracing our steps back to the trailhead.

Laguna Lake with no water in the summer months. In the winter, it is wet and water fills in the lake.

Jennifer Visits San Diego

My sister and her boyfriend visited us over Labor Day weekend. Since Andy had never been to San Diego before, we did the more touristy attractions (San Diego Zoo, the beaches, Gaslamp District).

Of course you can't come to San Diego without going to the famous San Diego Zoo. It was my second trip there and I still enjoy watching the animals. A new baby panda was born in August, but won't be on display until he's 5 months old.

Fun tree people performing at the zoo.

My sister has taken to hiking, especially since her boyfriend is very outdoorsy. On her things-to-do in San Diego was a hike. We went up north to Poway and hiked 6.5 mile up Mount Woodson. It has tons of large boulders which are popular with rock climbers. Like our hiking book stated, the best time to hike Mount Woodson is spring, fall or winter as the summer months are just too hot....and boy are they right!! This is a moderately difficult hike because it's a good climb to the top, but the hot hot weather makes it strenuously difficult. You don't want to run out of water because you can get heat exhaustion pretty quickly.

I didn't think we would make it up to the top because it was so hot. Unlike the Pacific Northwest, the trails aren't covered with many trees and the sun beats down on you with few shady spots. Luckily, the huge boulders did provide for much needed sun relief. But we made it to the top and was happy that getting down would be easier since it all downhill. After the long hike, we quenched our thirst at Stone Brewery!

Road Trip to El Paso, Texas

Two weekends ago, Chuck and I took a road trip to El Paso, Texas. Chuck took two days off work and we had a long weekend to visit with the family, my in-laws. From San Diego, it is an eleven hour drive through Arizona and New Mexico. A long day of driving, but easier and cheaper than if we were still living in Seattle.

It has been a long time since we've seen John and Virginia, the wedding being the last time we got together. I haven't seen my nephews in a long time and was nice to hang out with them. Actually, I never met Shaun before, Virginia being pregnant the last time I visited El Paso, and Jack was three years younger. What a cute bunch of boys!

Not only did we get to visit the family, but it was Hatch green chile season! We bought thirty pounds of fresh green chiles, roasted and packaged them. Since we have a tiny freezer in our apartment, we took half for ourselves and gave the rest to the parents. So we have 16 quarter bags of frozen green chiles which to make a lot of hot and tasty dishes.

Arizona and its many cacti on the roadside. I didn't realize how tall they can get.

Halfway to El Paso, we had to stop by and eat lunch. Of course, we had to make the pit stop at a brewery. Chuck found Nimbus Brewery via Google maps at Tucson, Arizona. Really cute brewery with good food. Being from the Pacific Northwest and an ultimate beer snob, I thought their beer was just okay. Their flavors seem muddled and was shy of tasting like a stout or an IPA or a red ale, etc, etc.

Fortunately, we were able to hit up High Desert Brewery in Las Cruces, New Mexico again while we were there. Really really tasty beer and it's good to know that they haven't change since the last time I was there in 2005.

Chuck gave me a tour of El Paso and one of the touristy things we did was the Wyler Aerial Tramway. The Wyler Aerial Tramway is in Franklin Mountains State Park. It's a four minute ride up to the top of Ranger Peak where you can get a view of El Paso, New Mexico and Juarez Mexico.

We spent a day in Las Cruces, New Mexico which is just a half hour away west of El Paso. It is where Chuck went to college (New Mexico State University) and has a cute little historic district called La Mesilla. We went to La Posta for lunch for yummy New Mexican food and a margarita.

The next time we'll visit El Paso is for Christmas and hopefully, the weather won't be so hot and unbearable!

Knitting Project For Miss Julia Umayam

This was my first attempt at knitting a stuffed animal and it turned out good. The hardest part was embroidering the parts of the bear, especially the eyes. They turned out more squarish than circular.

The pattern came from 'Knitting for Baby' by Melanie Falick and Kristin Nicholas.

I used just one ball of yarn to knit this baby bolero. The back features an eyelet motif that, according to Eastern folklore, brings luck and protection to the wearer.

The pattern came from 'One Skein: 30 Quick Projects to Knit and Crochet' by Leigh Radford.

To accessorize the bolero, I knitted a pair of pink socks and a hat which both have the same edging as the bolero, a K2 P2 rib.

I love knitting hats and made a light green (hard to tell in this photo) one with a "umbrella pattern".

I got the pattern in the same book as the baby bolero.

Hiking in Escondido

Three weekends ago, Chuck and I hiked at Elfin Forest Recreational Reserve in Escondido which is 30 minutes north of San Diego proper.

Chuck crossing Escondido Creek. We had to cross it twice as we went the wrong way into a private residency.

Olivenhain Reservoir. It holds 8 billion gallons of water - an extra, temporary supply for the region in case an earthquake severs or damages aqueducts that transport water from NorCal.

Lake Hodges Overlook.

Chuck heading towards the Elfin Forest. We're on our way down to the trailhead. Conveniently, Stone Brewery is just a short drive away and we're headed there for a beer fill up.

Stressed

I am so glad that tomorrow is my last day at this particular skilled nursing facility. They asked if I wanted to work next Thursday and Friday, 1/2 day each, but I'm 99% certain I will say no. Fortunately, they didn't ask me face-to-face as it would be a very uncomfortable conversation. My point person for the agency e-mailed me and I told her I would have to mull it over.

I just can't wrap my mind around their high productivity expectations, greater or equal to 85%. This would mean 7 hours of direct-patient contact each eight-hour day. At my former job, we were expected to have a productivity of 75% (6 hours of direct-patient contact each eight-hour day). An article I read from the Physical Therapy Journal Productivity Among Physical Therapists said "productivity standards include an ideal goal of six hours of direct-patient contact each eight-hour day, an expected standard of five hours of direct-patient contact each eight-hour day".

Now I understand I'm a contract therapist so I am not expected to do case management and care conferences; and thus, my productivity should be higher than that of staff therapists. But sometimes I do have to confer with a nurse, doctor or another therapist about a particular patients or patients and that can take minutes, non-billable minutes. Also, I have documentation for every patient that I see, not to mention learning the mode of documentation which takes learning time.

So given their greater or equal to 85% productivity expectation, I should spend 408 minutes total for direct-patient care. At this facility, my planned treatment time total was 425 minutes for, I'm assuming (especially if I'm billing for this time) direct-patient care. This means I have 55 minutes left for documentation and conferring with the staff (if applicable). Not I'm including rest breaks, which by California law, requires 2 10-minutes breaks if working an eight hour day. If that is the case, then I'd have 35 minutes to document along with other non-billable tasks. For so-so documentation, it's doable. But for good documentation, it's cutting it tight. But when you have an evaluation to write or a few, it certainly is not enough time! Does that seem fair? I think not. Now I calculated my productivity and I was in the ideal goal of 75% productivity.

Some patient's can't tolerate 75 minutes of one therapy session at one time, but when you have 2 continuous 75 minute therapy sessions; I highly doubt a patient will optimally perform nor tolerate it, especially many with co-morbidities. In this facility, they do most of their treatment in a gym and most of the time, they do one therapy session after another. Anyways!!! I'm could go on and on, but I'll spare you....but not Chuck:) At least, I have only one more day there and now I think I'm 100% sure I won't go back.

My First Job in San Diego

Today was my first day back at work and boy, am I exhausted...and I didn't work a full eight hours of work! Taking a few months off has made me a bit unfit for my physical job as a PT.

My first assignment was at a skilled nursing facility, only a 15 minute drive northeast of our place. It's a typical skilled nursing facility...not that I've been to many of them. It's not the nicest facility, Bethany on Pacific is far more superior in cleanliness and appeal; but I wasn't immediately horrified...a good thing! It took a few adjustments since I am used to working at a subacute care facility, especially ETCS.

ETCS has set a high standard and thus, I'll probably be disappointed in the quality and care, especially when it comes to nurses and nurses' aides (cross my fingers, I find a few excellent ones!). Notable things that are considerably different: the agency orientation. I was given a really quick, like five-ten minute, orientation of the facility which is far bigger than the TCU. I knew the gym (where most of the equipment is stored except for wheelchairs which are stored in a shed outside...if you can find one), general location of the rooms (kept going back to the wall posting after every patient), where the bathroom was located (which I didn't use because I didn't have time), and the computerized documentation (though they failed to mention, until I asked, that I could glean more information in the hard chart for the initial evaluation at the nurses station). I wasn't introduced to the nurses or at least where I could locate them if I had a medical problem with a patient.

I guess I'm use to the thorough orientation the TCU gives agency staff, especially with the initial evaluation! I got a very interrupted introduction to the evaluation paperwork process. Fortunately, the computerized documentation is easy to follow. I guess it would of been nice to be completely oriented to it. They were pretty relaxed about it saying that I could finish the Plan of Care tomorrow....ummm, no! Anyways......it's just different. I guess as a contract therapist, I'll just have to learn to bug people a lot with all my questions. I'll adjust accordingly.

One thing I miss about the TCU is that its focus is not driven by minutes. I guess that's what you get when you work for a non-profit versus for profit. Really, and I mean really, is a 720 minute RUG level appropriate for a patient who has Alzheimer's and only receiving PT/OT....I'm thinking, not so much. And that's one thing I'll have to stick to my guns, the appropriateness of minutes for a patient.

Anyways, I think this will be a good experience for me. Hopefully, I'll be able to find a few facilities I really enjoy (and hope they enjoy me), but it's nice to get exposure to the different kinds of places and people. The good thing about it....if you don't like it, then you can decline to return back there! And I'm still undecided about this place...well, I am there until Friday. Stay tuned!