Tag: OT

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Out in Healthcare: Jonas Raider, MOTR

Name: Jonas Raider

Pronouns: He/him/his

Identity: Gay/Queer

Background: I grew up in the suburbs outside Philadelphia, and have spent the past 5 years living all over the US and Europe between grad school, travels, and a year teaching American culture in Spain. I was recommended OT by my older sister who is also an OT, and it came naturally as I wanted to find a profession that focused on helping individuals to increase their independence through collaboration and open dialogue. Outside OT, I value learning about languages, street photography, thrifting, cooking, biking, hiking, and house/techno music.

Profession: Occupational Therapist Turned User Experience (UX) Researcher

Area(s) of Practice or Interest: I love advocating for OT in non-traditional settings and paving the way for our role in areas we haven’t previously existed. Refugee resettlement, community health, and the design world are my preferred areas of practice, and I hope to continue expanding upon this and advocating for our importance!  

What does being ‘Out in Healthcare’ mean to you?: Unfortunately, many within the LGBTQIA+ community have experienced and continue to experience difficulties in accessing affirming healthcare services. Although I plan to work outside of direct client care in the healthcare sphere, being out means advocating for queer clients’ and coworkers’ voices in the design world to address more inclusive products and experiences. It also means setting an example for younger generations to see themselves represented and thriving, something I didn’t have many models of when I was younger.

What is one thing everyone should know about your identity?: Since coming out publicly at 16, I’ve been fortunate to have the opportunity to learn and grow in the ways I connect to the queer community over the years. I think it is important to realize that just like other aspects of life, your queer identity fluctuates in the role it plays! Years ago due to internalized homophobia, I would distance myself from queer people as I felt the proximity would take away from my perceived idea that living closer to a “straight passing” identity was important. Although this may work for other individuals and I in no way look down upon people who feel that needs to be an important theme intertwined with their queerness, it was liberating over the years to unlearn this perceived necessity, and just exist. My queerness is as integral to who I am as the fact that I love spending time outdoors.

How do you feel when your identity is included?: When I see other cisgender people put their pronouns in their profiles, emails, or other spaces, it makes me happy to see that it is finally becoming more of a movement. It is on us cisgender people to normalize this so that our trans and non-binary friends, coworkers, students, and clients don’t have to put in extra emotional energy to advocate for their livelihood. I feel whole when the actions of my peers allow my trans and non-binary friends to feel safe, heard, and seen.

What does “taking up space” mean to you?: Taking up space means showing up in straight spaces with confidence and remaining unapologetic in how I present my queer identity and exist. It also means constantly questioning the systems that exist that center whiteness and heteronormativity and making room for others who deserve a seat at the table. Taking up space in queer spaces means realizing the privileges I embody in being white and cis-gendered, and taking a step back to center, hear, and listen to the lived experiences of Trans, Non-Binary, and BIPOC (Black, Indigenous, People of Color) within the community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: If you’re unsure of how to interact or honor your patients, be honest with them and ask questions! Honesty in admitting when you don’t know something and a commitment to seeking out information to expand your expertise goes a long way in terms of affirming the care, safety, and trust of your clients. If you want to validate your clients, ask them what their lived experiences and preferences are, take criticism when you are corrected or informed, and go from there. 

Has your identity influenced healthcare that you’ve received?: Returning to the suburbs where I grew up to see a doctor for check ups occasionally, there have been (many) frustrating moments of internalized homophobia and unnecessary awkwardness that have been displayed by healthcare providers towards me.

Where can people find you?: You can find me on LinkedIn or contact me via email at Jonasianraider@gmail.com! 

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Blog Out in Healthcare

Out in Healthcare: Madison Kirkpatrick, SPT, M.S, CSCS, LSVT BIG

Name: Madison Kirkpatrick

Pronouns: She/Her/Hers

Identity: Pansexual and asexual cisgender female

Background: I was born and raised in Eureka, CA. I grew up in an extremely conservative household that made me feel unsafe and forced me to repress my emotions and my identity. I completed my B.S. in Kinesiology: Pre-Physical Therapy with a Health Education minor in three years and then earned my M.S. in Kinesiology: Exercise Science in one year, after which I published my thesis research. I was accepted into the Doctor of Physical Therapy program at the University of St. Augustine for Health Sciences- Austin, TX campus. I will graduate with my DPT at the end of November 2020. I met my now wife during my M.S. and we got married in 2019. In my free time I enjoy spending time outdoors with my wife and our two puppies.

Profession: Physical Therapist

Area(s) of Practice or Interest: Pelvic floor PT with an emphasis on the LGBTQ+ population and outpatient orthopedics so I can treat other types of impairments beyond the pelvic floor.

What does being ‘Out in Healthcare’ mean to you?: Being out in healthcare means being visible to others so the future generations have the representation I did not have growing up, and it means fighting for health equity, justice,  and healthcare inclusion for all marginalized communities. As someone that understands what it is like to have to deal with healthcare disparities simply based on my identity, being out in healthcare is taking on the system full force to improve the lives of my community and the lives of all marginalized communities.

What is one thing everyone should know about your identity?: I don’t like labeling my identity. I label my identity for the people that “have” to know. I am asexual, an identity that doesn’t get a lot of attention, and where I am on the asexual scale personally is that I have never been attracted to anyone I have ever met other than my wife. I am theoretically attracted to all identities of humans, hence why I use pansexual, but in reality, my asexual identity and my lack of interest in the labels another person uses are more who I am at my core (I respect everyone’s labels, but that doesn’t influence whether I am attracted to them or not).

How do you feel when your identity is included?: I feel seen and respected when my identity is included. I feel like my identity is as valuable as the heterosexual identity has been systematically respected historically.

What does “taking up space” mean to you?: Taking up space means taking ownership of the space that has historically given to heterosexual people but denied to members of the LGBTQ+ community. It means demanding that my identity and needs get as much attention as anyone else and it means fighting for more and more space for those that come after me. It is advocacy, it is radical, and it is vital to equity and justice for the LGBTQ+ community.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Put the work in to find the answers to the questions they have about how to honor the identities of their patients. It is not the job of a marginalized community to educate the majority, but there are a number of people from marginalized communities that do fill the role of educator and their resources are plenty and widespread. All it takes is a little Google searching and/or social media perusing. Once they have answers to their questions, it is time to put in the work and put those answers into action. Once the action is being taken guess what? It’s time for more work. It is time to continue to learn and grow, and it is time to teach others and fight for the rights of their patients. The work never stops.

Has your identity influenced healthcare that you’ve received?:  My identity has caused me to deal with subpar care from my primary care provider who asked me about my sexual activity and then spent a lot of time asking if I could be pregnant (multiple questions about this, to which I answered no every time), didn’t ask me if I was using protection, and then was shocked when I told him I was in a relationship with a woman, which I only told him because he wouldn’t stop grilling me about pregnancy. The visit was really uncomfortable after that, and it felt like he was rushing to get my visit done as quickly as possible. Ultimately, I was not educated on STIs, asked if I felt safe in my relationship (thankfully my wife isn’t an abusive person), or anything else that would normally be routine.

Where can people find you?: I am on Instagram @lgbtqphysicaltherapists and my email is lgbtqphysicaltherapists@gmail.com.

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Blog Out in Healthcare

Out in Healthcare: Caroline Cuyler, LMSW

Name: Caroline Cuyler, LMSW

Pronouns: She/Her/Hers

Identity: Pansexual Cisgender Female

Background: I was born and raised in a suburb of Rochester, NY. I went to the University at Buffalo for my bachelors in psychology and did 1 year of my masters in social work at Hunter College in New York City and my 2nd year at the University at Buffalo. I now live in Rochester with my fiancé and our fur children. I have spent my career working with many different populations beginning with survivors of sexual assault and domestic violence.  I am newly out as of about 2 years ago and it was a rollercoaster ride of an experience but, overall, quite positive. In my free time I enjoy camping, traveling and playing video games.

Profession: Medical Social Worker

Area(s) of Practice or Interest: I pretty much do it all in the inpatient medical world. The main unit that I work on is an adult medicine unit that is staffed by resident medical teams.

What does being ‘Out in Healthcare’ mean to you?: Being out in healthcare for me is about visibility and representation. I wear a rainbow pin on my nametag every day as visibility but also to signal to other LGTBQ folks that this is a safe space. I also see LGBTQ folks in all different roles in the hospital and it really creates a culture of inclusivity.

What is one thing everyone should know about your identity?: When trying to find the “right” identity for me, bisexual never felt right because it excluded folks that didn’t fall into the gender binary. I felt pansexual really suited me and my attraction to people for who they are rather than based on their gender. My fiancé is non-binary and is starting the first steps with top surgery and low dose hormones. I am proud that she is becoming the person she always knew she was.

How do you feel when your identity is included?: When my identity is included I feel seen. There is nothing better than when your identity is not something you have to explain or review over and over with others. That is why I focus so much on educating staff on practices such as asking for preferred pronouns and not assuming a patient is in a heterosexual relationship.

What does “taking up space” mean to you?: Taking up space is really about being your most authentic self, whatever that means for each person. I think it can be easy to shrink down who you are to make a situation feel more “comfortable” for everyone but when you take up space it paves a path for others to be able to also take up space. It’s a form of activism and advocacy for others as well as yourself.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: This is a part of my role every day as a social worker. Constantly educating staff about how to honor patient’s identities. My number one piece of advice is ASK QUESTIONS. Our patients are the experts on their own lives. You can never assume anything about anyone’s identity and just ignoring or not seeing parts of someone is not treating the whole patient. If you make a mistake about someone’s identity, apologize. We are all humans who make errors but it’s important to commit to correcting the mistake. I think it’s also important to take an intersectional approach to honoring our patient’s identities. Each person’s experience is unique and much of that has to do with how the different parts of our identity shape how we experience the world.

Has your identity influenced healthcare that you’ve received?: I have only been out for 2 years but even in that short amount of time some things have come up. Specifically around sexual health there is always the assumption that I am in a heterosexual relationship and constantly having to correct my providers can get a little exhausting.

Where can people find you?: I am on Instagram (private account) @cecuyler and if you are ever at Strong Memorial Hospital, I am sure you will see me floating around!

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Blog Out in Healthcare

Out in Healthcare: Enrique Puentes, OTS

Name: Enrique Puentes

Pronouns: He/Him/His

Identity: Gay

Background: Both of my parents immigrated from Colombia, and I was born in Washington, D.C. I grew up in Northern Virginia but have spent the last fourteen years living in Central Florida. I have spent the past eight years working in catastrophe property insurance but have always had a longing for wanting to be in a profession that helped others improve. I finally decided to make the career transition and now am in my second term of my master’s degree.

Profession: Occupational Therapy Student (MOT)

Area(s) of Practice or Interest: I have huge interests in both Mental Health and Inpatient Rehabilitation but am unsure of where I may ultimately end up.

What does being ‘Out in Healthcare’ mean to you?: For me, being out in healthcare for me means inviting people to see my truest self. Representation of LGBT people in healthcare is important because not only does it create safe spaces for clients to feel they are being advocated for, but it also can help demystify misunderstandings that non-queer people have of the very community that I am a part of. I see being out in healthcare as a form of activism for anyone who has ever felt either marginalized in a society that has long celebrated heteronormativity.  

What is one thing everyone should know about your identity?: I want people to know that I am embracing the best possible version of myself by being out as an individual in healthcare. It is important for me to not be ‘discrete’ about my sexuality, because by me fully loving all aspects of my identity, I can in turn emanate the same level of love and care for others. 

How do you feel when your identity is included?: When my identity is included as both brown and gay, I feel included and seen as an equal amongst a group.

What does “taking up space” mean to you?: Taking up space means feeling pride about my own visibility and feeling the confidence in the fact that my visibility matters. I unfortunately did not always think/feel this way, so it’s empowering for me to live in this truth.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I think with any profession that involves interacting with all kinds of people (with varying cultures, backgrounds, political and religious beliefs, sexual orientations or gender expressions), we will almost certainly at some point, come to meet someone that we lack the education on, on how to honor and respect these individuals. Maintaining a sense of humility when engaging in these interactions is key to posturing yourself in a manner that is receptive to learning from these interactions. For healthcare professions in particular, it would behoove the practitioner to educate themselves on available resources that speaks on best care practices. Remember the importance of being client-centered in your approach and advocating for the client’s desires and wishes. 

Has your identity influenced healthcare that you’ve received?: My identity has impacted the healthcare that I have received. I have encountered practicing physicians who have not been aware of pre-exposure prophylaxis medications. It’s an odd feeling having to educate your own doctor on what this is and why you are requesting a prescription for this. I have also had experiences where healthcare professionals made assumptions of my sexual orientation. I greatly see the need for education of healthcare professions in working with LGBTQ clients.

Where can people find you?: Follow me on Instagram! (@ProudOTStudent)

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Blog Out in Healthcare

Out in Healthcare: Ryan Ellenbaum, MA CCC-SLP

Name: Ryan Ellenbaum 

Pronouns: She/Her/Hers

Identity: Cisgender Woman, Queer/Lesbian 

Background: I was born and raised in Philly, PA. I live with my wife and our two dogs. I love anything creative – lately I’ve been obsessed with weaving but I’ve dabbled in just about every textile craft. I also enjoy powerlifting and Olympic weightlifting. I studied Russian in undergrad which sparked my interest in communication sciences. Now I work with Russian-speaking families in early intervention and I’m co-owner of a private practice that specializes in gender affirming voice modification for the trans and non-binary community.

Profession: Speech-language Pathologist

Area(s) of Practice or Interest: Gender affirming voice modification, pediatrics, stroke rehabilitation.

What does being ‘Out in Healthcare’ mean to you?: The SLP field is full of compassionate and good hearted people but it can be a pretty homogeneous crowd in terms of race, gender, and sexual orientation. I’m proud to be a queer provider who is in tune with the issues that impact queer people seeking healthcare, especially working in trans voice. It’s important to me to make the services I provide a safe space that helps queer people access care that they might otherwise not feel comfortable seeking. 

What is one thing everyone should know about your identity?: I am generally “assumed straight” based on how I look and dress, which has been both a form of privilege and source of frustration since I came out when I was in high school. In my early intervention work, I am often subjected to unsolicited political opinions and people’s views on the LGBTQ community (while treating in families’ homes). This often forces me to make the split-second decision between being an advocate for my community and feeling safe at work. The message I would spread is not specific to me, but it is to never assume someone’s identity based on how they look. Challenge yourself to be inclusive and to provide space for people you meet to identify themselves as uniquely them, whatever the context.

How do you feel when your identity is included?: Safe and validated.

What does “taking up space” mean to you?:  Taking up space and being visible as a queer person is a form of advocacy. Queer people are everywhere, in every setting, in every town. The more visible we are, the more included we are in the conversation. The more included we are as healthcare providers, the more we can educate and guide our fellow providers to be more compassionate caregivers to patients. 

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Take the time to thoughtfully educate yourself. Seek out positive, affirming resources – especially ones that amplify real voices and experiences of the population you are seeking to learn about. Don’t make assumptions about your patients, give them the opportunity to identify themselves by using inclusive language and questioning.

Has your identity influenced healthcare that you’ve received?: I’ve been fortunate enough to not experience any healthcare nightmares directly related to my sexual orientation, but I always consider queer-friendliness or referrals from queer friends who have had good experiences when seeking healthcare providers. 

Where can people find you?: You can find me on Instagram at @authenticvoicesllc, my website www.authenticvoicesllc.com, or reach out by email to authenticvoicesllc@gmail.com!

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Blog Out in Healthcare

Out in Healthcare: Oliver Hoad, OTS

Name: Oliver Hoad

Pronouns: He/Him/His

Identity: Queer Trans Man

Background: I’m 23 and grew up in a coastal town on the east coast of Australia called Coffs Harbour. I am currently in the second year of my Bachelor of Occupational Therapy. I came out as bisexual when I was in high school, but as I grew into my identity I realised that queer was a better fit. I came out as trans in 2018 which was a huge change for everyone in my life but luckily it has been a mostly positive one! Where I live is fairly regional, and there is not a lot of acceptance towards the queer community so unfortunately there are not many opportunities for interaction with other queer people, especially those my age. When I’m not studying I am a member of a group for LGBTQIA+ young people, a peer educator for a sexual health organisation and enjoy gaming, baking and going to the beach.

Profession: I am an Occupational Therapy student and I teach primary school (elementary school) kids how to create video games afterschool on the side!

Area(s) of Practice or Interest: Interested in sexual health and paediatrics/adolescents.

What does being ‘Out in Healthcare’ mean to you?: Australia is not very progressive when it comes to the healthcare of transgender people. After I came out and had to go to the emergency department of the hospital I told them I was trans and that my name was Oliver yet the doctor continued to address me by my deadname* and female pronouns. Being out in healthcare would allow me to reduce the chances of this happening to other trans people, particularly youth, and would increase attendance and inclusivity within spaces that cause so much anxiety for young people.

What is one thing everyone should know about your identity?: People should know that we are not all the same and we do not have to all be the same. Not all trans people look like the stereotypical trans man or trans woman that may be portrayed in the media, and a lot of us have values and beliefs that are different from each other. That is ok and it doesn’t make someone any less trans.

How do you feel when your identity is included?: I feel hopeful for the future. The inclusion of trans people in different conversations is so important. It shouldn’t be a question whether or not to include us in conversation whether it be political, health related, in sports, or religion, and when this occurs it feels like progress is being made.

What does “taking up space” mean to you?: As queer people, we are often told that we are taking up too much space. We are told that we are too visible within the media, we should be so “gay” in public, that our stories are being told too often and we are asked why we need a whole month to celebrate our community and their history when it “isn’t necessary”. These opinions of individuals are all such negative things that are brought up way too often! However, they bring about important conversations between two communities that may not occur if our presence wasn’t questioned so often. The space that we take up is so important even if other people don’t think that it is.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honour the identities of their patients?: Ask as many questions as possible. Ask what your patient they are comfortable with, what their pronouns are, and if they would like you to know anything about their identity. In saying that, also be respectful when asking the questions. Oh and don’t always assume that somebody fits into a binary gender simply because that is how they present!

Has your identity influenced healthcare that you’ve received?: It has definitely influenced my healthcare experience, probably being trans more than anything else. Finding a doctor who is LGBTQIA+ friendly and educated in transgender medicine is difficult in a regional area so you have to go in blind and hope for the best. There are also limited services available in these areas for transgender healthcare. In the past, I was often misgendered and called my deadname* even after telling doctors my preferred name and pronouns which is unfortunately a common problem for trans youth and people who are transitioning, especially in regional and rural areas like the one I live in. Luckily now I have found a good network of supportive doctors and allied health professionals that are educated in the needs of the LGBTQIA+ community.

Where can people find you?: You can find me on Instagram @onespicyegg or via email at olivermaxwellhoad@outlook.com

*Deadname: A deadname is the birth name of someone who has changed it. The term is especially used in the LGBTQ+ community by people who are transgender and elect to go by their chosen name instead of their given name. (Resource)

Deadnaming: Deadnaming occurs when someone, intentionally or not, refers to a person who’s transgender by the name they used before they transitioned. You may also hear it described as referring to someone by their “birth name” or their “given name.” (Resource)

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OT and Transfeminine Equipment: Breast Forms, Gaffs, and Tucking Oh My!

Transfeminine equipment or equipment for those with feminine gender expression among people assigned a male sex at birth, particularly transgender and gender non-conforming individuals may include: prostheses, breast forms, gaff, tape, tucking, padding.

Padding: Padding refers to the use of undergarments to create the appearance of larger breasts, hips or buttocks. Padding may also assist in minimizing dysphoria.

            Some padding-specific garments include:

–       Padded undergarments: Typically, useful for facilitating appearance of wide hips or full buttocks

–       Bras with pockets: Also known as mastectomy bras, they are designed to accommodate breast forms and other associated prostheses

–       Padded bras: May be preferable if breast growth is present but not at the desired size.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a breasts, penis, scrotum, or other anatomy.

Breast forms: Prostheses that have the appearance of breasts. Typically made of soft silicone gel and adhere to one’s body or are placed in a bra. Can be considered a form of padding.

Tucking: Tucking is the practice of arranging and supporting external genitals between the legs, including the penis, scrotum, and testicles so they are not visible in clothing. There are many ways to tuck, such as pushing the penis and other anatomy between your legs and then pulling on a pair of undergarments, to tucking the testicles inside of you. People tuck for many different reasons. One might tuck in order to feel more at ease in their body (minimize dysphoria), to feel more comfortable in their clothing, or to facilitate affirmation as one’s gender. There is minimal research on the safety of tucking.

Gaff: compression underwear that minimizes the appearance of a penis, scrotum, and testicles.

Tape: tape may be used with or instead of a gaff to “tuck” or minimize the appearance of the penis, scrotum, and testicles.

Important gaff considerations:

o Choosing the right size gaff is like choosing the right size underwear. One can also measure the circumference of their waist, just above the hips for correct sizing.

o Safe tucking/gaff techniques mirror those of binding:

o Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.

o Minimize duration of wearing, as in reducing the wear time throughout the years. Bottom surgery is an alternate to tucking, however it is important to note that not every individual that tucks will want bottom surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

o Unsafe tucking can affect the circulatory system, musculoskeletal anatomy, fertility issues, sex and intimacy, and skin integrity.

Gaff/ tucking garment maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. Pay special attention to skin folds, folding in the tucking garments (gaffs), bulging skin adjacent to the gaff or selected garment, redness, skin abnormalities, and prolonged indentations. Pay extra attention to the effects of the trans affirming/generally affirming care that you provide.  

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕥𝕦𝕔𝕜𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe tucking practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! Anotha time for the people in the back: we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe tucking practices.

Sources:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.gendergear.ca/pages/all-about-gaffs

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OT and Transmasculine Equipment: Binders, Packers, and Prostheses Oh My!

Transmasculine equipment or equipment for those with masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals may include: binders, packers, prostheses, and bandaging.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a penis, scrotum, testicles, or other anatomy.

            Packers: A prosthesis with the form a penis

Binders: commercially produced binders designed for binding. Other options (usually less safe options) are sports bra, neoprene/athletic compression garments, plastic wrap, duct tape, and more. The benefits of binding far outweigh the risks, however 𝕥𝕙𝕖 𝕣𝕚𝕤𝕜𝕤 𝕒𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕥𝕒𝕜𝕖𝕟 𝕧𝕖𝕣𝕪 𝕤𝕖𝕣𝕚𝕠𝕦𝕤𝕝𝕪.

Binding: Binding involves wearing tight clothing, bandages, or compression garments to flatten out one’s chest and/or other anatomical features. 

Safe binding practices include:

  • Donning neoprene/athletic compression garments or commercial binders. The limited research supports using neoprene/athletic binders over commercial binders.
  • Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.
  • Minimize duration of wearing, as in reducing the wear time throughout the years. Top surgery is an alternate to binding, however it is important to note that not every individual that binds will want top surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

Binding maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. A binder should never be too tight. Pay special attention to skin folds, folding in binding material, bulging skin adjacent to the binder, redness, and prolonged indentations. Pay extra special attention to the effects of the trans affirming/ generally affirming care that you provide.

According to research, some benefits of binding include:

– Increased self-esteem, confidence, ability to go out safely in public, positive mood

– Decreased suicidality, anxiety, and dysphoria

The research also notes the following risks and contraindications:

– Pain related to the musculoskeletal system and at times internal systems

– Musculoskeletal system changes including bad posturing, shoulder joint ‘popping’, fractures, and muscle atrophy

– Neurological system changes like numbness, dizziness, and more.

– GI system changes, decreased motility, and more

– Respiratory changes like SOB, coughing, and more

– Skin and tissue change like skin breakdown, wounds, and infection

𝕃𝕖𝕥’𝕤 𝕓𝕖 𝕤𝕦𝕡𝕖𝕣 𝕔𝕝𝕖𝕒𝕣

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕓𝕚𝕟𝕕𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe binding practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! I don’t want to hear any of that “we don’t have room in our curriculum for LGBTQIA+ topics” anymore. Sis, honey, darling, we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe binding practices.

Sources and Citations:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.lgbtq-ot.com/terminology

Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19, 64-75. doi:10.1080/13691058.2016.1191675 

Categories
Blog Out in Healthcare

Out in Healthcare: Wade Robinson, OTD

Name: Wade Robinson

Pronouns: He/his

Identity: Gay man 

Background: While completing my undergraduate degree, I became passionate about the field of sexual wellness while working with various non-profit organizations that provided HIV-related services and raised scholarships for LGBTQ students. Those experiences emphasized the importance of education around sexuality, and after beginning graduate school I was delighted to discover that sexual activity is included in the domain of occupational therapy. I was able to bring OT and sexuality education together and collaborate with @sexintimacyOT for my doctoral capstone project to create a continuing education course on LGBTQ0-inclusive practice.

Profession: Occupational Therapy

Area(s) of Practice or Interest: Sexual activity and education, pediatrics, hand/orthopedics

What does being ‘Out in Healthcare’ mean to you?: I believe that generally people have many misconceptions about what it means to be LGBTQ until they know that they know LGBTQ people. In my day-to-day life, I live by the mantra of “advocacy through visibility”, and I try to do the same in a professional setting by being authentic about my own sexual identity. I think this normalizes conversations about sexuality, models to colleagues how to respond, and indicates a safe-space to clients.

What is one thing everyone should know about your identity?: Overall I think that LGBTQ visibility is a good thing, but I’ve noticed that a lot of the mainstream media highlighting LGBTQ people are pretty narrow in their scope. I just want people to check themselves for implicit biases that are easy to subscribe to and know that being gay does not mean being into interior design, subscribing to a particular style of drag, or being into drag at all for that matter. Part of allyship is celebrating LGBTQ people for their identities, so just recognize that there are countless ways for identities to differ and each is as valid as the next.

How do you feel when your identity is included?: We [LGBTQ people] have gone so long without seeing proper representation or inclusion that I definitely notice when we are included in policies and media, even with little things.

What does “taking up space” mean to you?: To me this goes back to the idea of advocacy through visibility. It’s not like I always talk about being gay, queer culture, or anything like that, but I do think it is important to share my sexual identity with the people around me. I think its personal relationships that create allies. It’s so obvious to LGBTQ people how cisnormative/heteronormative everything is by default, and that creates a lot of marginalization that the majority never considers. I think that we can use that lens for the better to recognize how other minority groups could be excluded and erased, then aim for more inclusive, mindful practice.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I know for OT in particular, there are not very many resources, which is why I created the LGBTQ-inclusive course for my capstone project. For healthcare professionals in general, I think the National LGBT Health Education Center is the best resource for practice guidelines. Time in the clinic is precious and the experience is often stressful for clients; it would be very unusual that that time would be best spent with the client educating the clinician about their sexuality. Being educated about sexuality before interacting with clients is best practice. If somebody finds themselves in a situation where they still are unsure, I think the most import thing they could do is approach the situation with humility. 

Has your identity influenced healthcare that you’ve received?: There are two instances that come to mind in which providers made assumptions about me after I disclosed that I am gay, and both instances were regarding sexual health interestingly enough. The first time I was just completing a routine check-up and getting some vaccinations to start graduate school, and the physician suggested that I complete a battery of STD tests. Even after I explained that I have worked in sexual health, am very aware of my relative risks, and was current on all my tests, the physician suggested that I at least get an HIV test. The second time, the nurse told me that they were going to ask me some questions about my sexual health, but once I said that I was gay, they moved on to ask me about other areas of health. Afterwards, without knowing any of my risk factors or sexual habits, they proceeded to try to administer a test that was completely inappropriate and did not apply to me at all. At this point, I said I would not be doing that test, explained that I previously worked in sexual health, and commented that I was surprised that they did not ask more questions to assess which tests were appropriate. The nurse brushed off my response and quickly said that there were more questions on the template but they were optional to ask and this was standard procedure. 

Where can people find you?: Hidden away studying for the NBCOT exam, hiking, or on Instagram at @Wad_the_robin

Categories
Blog Travel OT

LSVT and Me

Picture property of https://www.lsvtglobal.com/
Citation

What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

“While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

“Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!