Saturday, April 21, 2018

Inside the O'Brien's

I just recently read the book Inside the O'Brien's and, wow, it was tear jerker. This book is about a middle aged man living in Boston who inherits Huntington's Disease. In this particular case, Joe, the main character, inherited the disease from his mother. With Huntington's, if you have the disease, each of your children have a 50 percent chance of inheriting the disease as well. Joe and his wife had already had 4 children before Joe started showing symptoms and found out about the diagnosis.
It was very sad, but interesting and inspiring to watch a family go through what they went through, and to see how each member of the family handled it in a different way. With Huntington's, there is no cure, but you can have a test done before you start showing symptoms to see whether or not you carry the gene. Some of Joe's children wanted to know, others didn't, and another who wasn't sure. To see how they weighed the pros and cons of finding out was something like no other, and is something I don't think anyone would fully understand unless they were in the situation, or a similar one. From a psychological perspective, it seemed emotionally draining to go through each day wondering if and when the symptoms were going to begin in some of the family members. To wonder if every little mishap such as dropping something or getting off balance was the beginning of the Huntington's cycle would take an emotional toll on anyone. To watch Joe go from being an independent, strong, unwavering police officer for the Boston PD to being someone that struggled with simply walking across the street was heart breaking.
However, there were times in the story where the family showed great support for one another. Huntington's can result in violent mood swings and personality changes, but this family was very understanding of that, and helped each other through the most difficult times. Reading the book from an OT perspective, I was constantly thinking about the types of things that Joe found meaningful and trying to think of ways that could be incorporated into therapy sessions for him. With any disease or disability, you need to find what that person loves to do, and what they find meaningful because then their life, which they might have thought was over or meaningless, suddenly becomes something that they want to do. They want to fight and push through the adversity, they want to overcome their disability or at least overcome some of the symptoms they can have.
Overall, this book gave great insight to what Huntington's disease is about. It gives a great description of the physical and mental setbacks and advances it can cause, and how certain people may cope with these changes. I would HIGHLY recommend this book to anyone. It is a great, easy read and it would be enjoyable to anyone, not just individuals who are interested in therapy or the medical field.



Occupational Profile
Client: Joe O’Brien
DOB: N/A He is 44 y/o
Date of Report: April 22, 2018 by MaKensie Bawcum
Text Box: Client Report
Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)
Client is seeking to improve symptoms of Huntington’s Disease because the symptoms are affecting work, driving, and social participation
Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)
Joe is successful in sleeping, personal hygiene, and dressing with clothes that don’t have buttons,
The barriers Joe has includes: walking, holding onto things, dressing/undressing with shirts that have buttons, remembering/organizing things, proprioception, paranoia, anosognosia, and mood swings. Joe’s work is affected because he is a police officer, and the chorea symptoms don’t allow him to handle a gun, and he can’t fill out his reports accurately due to his memory and organization issues. His driving is affected because of the chorea as well, and his social participation is affected because of his change in temperament, and mood swings. 
Personal interests and values (p. S7)
Joe enjoys walking their dog, he loves St. Patrick’s Day, spending time with his wife and family, and he absolutely LOVES the Boston Red Soxs
He values his career, his wife, and his family
The client’s occupational history/life experiences
Joe lives in a 3-story home in Boston. He and his wife live downstairs with their son Patrick, and their dog. His son JJ and his wife and newborn baby live on one floor, and his two daughters Katie and Meghan live on one floor. Joe has to park on the side of the street to get to his home, and it could be a few blocks away. Joe is a police officer for the Boston PD.
His main responsibilities include: taking care of his family and wife, going to work, and walking his dog
Some of his family history includes: his mother had died from Huntington’s disease, and after Joe had been diagnosed, they found out that at least two of their 4 children were gene positive
Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)
Joe’s roles include being a husband, a dad, a grandfather, and a co-worker
Joe wakes up in the morning
Walks the dog
Eats breakfast with his family
Goes to work
Drives home
Eats dinner
Watches TV
Goes to bed

Joe also eats Sunday dinner with his family every Sunday. Also, Joe has somewhat of an unpredictable work schedule. He may not be able to come home at a reasonable hour, so this can throw off this schedule. Joe also goes to the church sometimes to work out by walking the stairs
Text Box: Context
Aspects of the client’s environments or contexts, as viewed by the client (p. S28)
Supports to Occupational Engagement:
Barriers to Occupational Engagement:
Physical
It seems as though he can get around on the floor of the home he and Patrick and his wife live on, pretty well.
Getting into Joe’s home can be an issue because of having to search for a parking spot and walk a few blocks. He also has many stairs to climb to go to his daughters and son’s spaces on the second and third floor. It seems as though his home may be a bit small as well considering the fact that Joe decided to knock down a wall to make more room for a kitchen table. He also likes to take walks around the block but experienced a few falls during this activity.
Social
Joe has the support of his wife, his children, and his best friends/co-workers
Social interaction with his family can be an issue because of Joe’s mood swings and sudden outbursts. They can sometimes become violent, especially when something is wrong.
Cultural
He doesn’t go to mass on Sunday, but he does go to the church to pray weekly. His wife is very religious, and they both practice some Catholicism.  His family is also very proud of their Irish background and try to make it a point to marry someone whom shares that same cultural background.  
He and his wife struggle a little with why this disease is occurring in their family, so the stress, the questioning, and the unknown can get in the way of their religious beliefs
Personal
He is a 44 year- old male. I would say he is low- middle class for SES, and he is part of the Boston PD
He is very caring, but sometimes his mood swings and overall temperament can get in the way.
He also likes to drink almost daily.
Temporal
At times, his work schedule can be normal, and he can get home at a reasonable time. Also, his home environment can be a safe, calming place when Joe can come home and watch the Red Sox.
On the other hand, Joe’s work schedule could be from 8:00 to 5:00pm or it could last until midnight or later depending on where and when he gets assigned for his job. Also, with so many people living in the house, his home environment can become fast-paced and more active depending on the activities he attends for his children.
Virtual
Joe has a cell phone that he can use to help him communicate with his wife and family. This helps him to be reminded on when and where he is supposed to be when it comes to events for his children. He also watches T.V. to keep up with the community after he lost his job, and to keep up with his favorite sports team.
Some of Joe’s virtual barriers would be that because of his impulsivity issues from the disease, Joe sometimes calls or texts his wife multiple times a day to ask the same question, or to check on her to be sure she is o.k.
Text Box: Client Goals
Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)
Joe’s goals include:
·      Muscle strengthening (core)
·      Walking without the use of a walker or wheel-chair, even though it may be needed as the disease progresses
·      Finding ways to cope with his new, permeant lifestyle
·      Reducing the effects of chorea or finding ways to adjust to the involuntary movements



1 comment:

  1. MaKensie, I just read this book as well and agree wholeheartedly that it is a tear jerker! Nevertheless, it is such a great read and can be a great resource to better understanding the reality of living with a diagnosis like Huntington's.

    ReplyDelete

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