Lebanon Valley College Study Abroad

PT Clinical Week #6

Week six has come to a close, which means Kristin and I only have 2 more weeks in the clinic before we start Part 3 of our journey.

This week I did a lot more hands on with patients than the previous week. But it was a mix of observing, helping, and then working independently, so I was able to learn in different ways.

The patient I am treating independently goes to occupational therapy following her morning treatment session with us. So I am allowed to follow and observe her there. At first I was just watching, but then no one was really telling her what to do or even watching her so my instructor told me to come up with exercises for her to do to work on the deficits I found in PT! Didn’t know I would become an OT on this journey too! I have her drawing, building block towers, and using a tiny peg board (fine motor skills). I work with coordination and proprioception of the UE but also endurance. It’s different from the US because a therapist would normally be 1v1 with a patient working or at least working with a group of patients.  But sometimes I am the only person in the room, and I am supposed to be with PT!

PT’s here are able to use the hoyer lift and don’t have to get the nurse to do it for them. I’ve never actually seen one used fully before, and the one they have is so easy to use! One of my patients has tetanus and has been bedridden for quite some time due to the infection. She is on an NG tube and isn’t able to go down to the gym for treatment; so we visit her room twice a day of which she shares with 2 other roommates. I was worried that Italians did not take tetanus shots as seriously as we do, but they do.  She just happened to be someone who didn’t get one.  Definitely a new diagnosis for me.

Friday, Saturday, and Sunday here there is a course going on Bobath NDT (Neuro-Developtment Treatment). A lot of the therapists are involved and are using some of my patients as participants. Italian therapists use a lot of Bobath concepts here, even though there isn’t a lot of evidence supporting it. We touch upon it briefly at LVC, but don’t harp on it because of the lack of evidence.

DIFFERENCES:

They have a break room where there are tons of goodies from patients or that the staff brings in. For instance, my patient is being discharged today, so he ordered a huge box of pastries for everyone. Not only do they have caffé and biscotti/pastries in the break room but they also have wine! Some of the therapists drink wine during lunch.

Apparently Italians don’t use hand sanitizers too much. It is not located in the clinic (to use after treating each patient) and it is actually really expensive for a tiny bottle in stores. So instead, therapists wear rubber gloves when treating, or they just be sure to wash their hands after each patient. They also don’t utilize spray sanitizer for the plinths like the US does after every patient. Here, they have the paper that they roll over the beds like you see in the doctors offices. Only if the bed is really dirty do they use the spray (I saw it for the first time today).

 

~Jordan

A Country Within A Country-San Marino

Torture Museum

Torture Museum

Saws used for beheadings

Saws used for beheadings

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Mega pizza

Mega pizza

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Sunday, Kristin and I decided to travel abroad yet again! This time we went to the little republic of San Marino, which lies within the Italian borders. The other 5 girls opted out of this trip, so it was just the two LVC girls making the journey. And it certainly was a journey indeed. It was a 2 hour drive from Umbertide and ¾ of the trip was up and down the mountains with switchbacks after switchbacks. I have never driven on ANYTHING like it before. It was absolutely INSANE.

Once we got there, we ate lunch that consisted of two individual small pies (yes, we each ate our own pie). The best part of the restaurant was that it was right on the side of the mountain and you could see the whole countryside and mountains from the windows that lined the wall.

After lunch, we walked the city and visited some shops. Before heading home, we stopped into the torture museum (6 euros). It was one of the best museums (partly because I love that kind of stuff). It had two floors filled of ancient torture devices with pictures and descriptions underneath as to how they were used. I was not aware of the crazy torture techniques that were used in the past. Some torture mechanisms are still used today in parts of the world. They literally did anything and everything to the human body. Here are some torture examples:

  • Horses: They would tie the 4 limbs of a person to individual horses and then have the horses run in opposite directions. Because the body is so strong, the executioners would cut the tendons, genitals, breasts, beforehand.
  • A lot of the mutilation consisted of having things pushed or cut into the genitals of males or females. They would do so by hanging the person upside down so the blood would rush to their head so they would remain conscious. And only when the saw reached the mid stomach-breast bones would the person lose consciousness.
  • Not only were people hung by their necks they were also hung by their wrists from behind their backs in order for the shoulders to dislocate.

FACTS:

  • San Marino, officially the Republic of San Marino, is an enclaved microstate surrounded by Italy, situated on the Italian penisula on the north-eastern side of the Apennine Mountains. It is just over 24 square miles and has the estimated population of 32,000.
  • San Marino claims to be the oldest surviving sovereign state and constitutional republic in the world.
  • Governed by the Constitution of San Marino, a series of six books written in Latin in the late 16th century, that dictate the country’s political system, among other matters. The country is considered to have the earliest written consitution still in effect
  • The country’s economy mainly relies on finance, industry, services, and tourism. Despite having an extremely small economy for a nation state, it is one of the wealthiest countries in the world in terms of GDP (per capita), with a figure comparable to most developed European regions.
  • It has a highly stable economy, with one of the lowest unemployment rates in Europe, no national debt, and a budget surplus. It is the only country with more vehicles than people.

~Jordan

 

Weekend in Madrid

This weekend marked the beginning of Carnaval in Spain and many other European countries. This is a celebration of the beginning of Lent, with parades, and festive costumes, very similar to Halloween in the United States. To enjoy the Carnaval festivities, Rachel, Olivia and I headed to Madrid for the weekend. We arrived Thursday afternoon after an hour on the high-speed train and enjoyed the warm, sunny afternoon in a quaint park near Elise’s apartment (Olivia’s cousin who generously let us stay with her for the weekend). Exhausted from a hectic week we relaxed for the evening and slept in late Friday morning before heading into the city center to see el Palacio Real (the Royal Palace) and the cathedral nearby. We started by exploring the crypt underneath the cathedral, which was impressive to say the least!

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Next we headed upstairs to the huge cathedral and spent about 30 minutes admiring the architecture and breathtaking ceilings.

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After the cathedral it was off to el Palacio Real, where the king and queen of Spain address the public and have meetings; however, they do not live there. We admired the Palace from afar, opting out of the expensive guided tour. Before heading back to Elise’s for lunch and siesta, we walked through the neighboring royal gardens. For dinner, we headed to a restaurant and got burgers, hungry for some American food.

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Saturday was another lazy day, but we made ourselves get out of bed in order to see a parade for Carnaval. As soon as we walked out of the metro, we were met with hundreds of excited people waiting for the procession. We pushed our way through the crowd to find a spot where we could see the parade. Each Spanish speaking country was represented and we had the opportunity to see traditional dance from each country.

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After the parade ended, we made our way back to the metro station and returned to Elise’s where we had tacos for dinner. What a treat to have spicy food (Spanish food tends to have very little). However, our cravings for American food continued so, for dessert, we baked chocolate chip cookies and topped them with ice cream and hot fudge. Sunday proved another lazy day as Rachel and I headed into the city center to explore a bit. We ended up at the botanical gardens on the edge of Retiro Park, and spent nearly 2 hours enjoying what little green there was during this time of year. Unfortunately we won’t have the opportunity to see the gardens in the summertime, but nonetheless they were still amazing! Sunday evening we headed back to Valladolid by bus, which is about a 2-hour ride. Determined not to miss the Superbowl, I met up with my friend Álex, a devoted Broncos fan, to stream the game online. American football is very unpopular here, few know much about it and actually confuse it with rugby so I feel very lucky to have found a Spaniard who understands and enjoys football! Because of the substantial time difference, the game didn’t come on until midnight, but we stayed up and watched the entire game to see the Broncos take Superbowl 50! This weekend proved to be yet another great weekend, especially with no classes on Monday or Tuesday!

Adios!

McKenna

 

Lake Trasimeno

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Another weekend down! This weekend, Kristin and I had dinner and breakfast cooked by our landlord-2 times. It is always so delicious, so it was great having it twice in one weekend! His food is so amazing that we asked him if we would be able to have our own cooking lessons, and he agreed. So Saturday after breakfast, he and his chef taught us how to make homemade: bread, ravioli, and tiramisu. He showed us and even let us help with some of the steps. Then we got to eat what we made!

We originally planned to stay around and explore our town of Umbertide, but we made an unexpected trip to Lake Trasimeno instead. We walked the streets, vineyards, and docks. We walked a total of 6 miles in a short time there. On our way back to the car we caught a glimpse of the sunset over the water. It was beautiful.

~Jordan

Valladolid Portraits I

Having lived all my life in a small town and then moved to a small town college, a city on a weekend night is a special kind of magic.

The days are slow in Valladolid, with meandering figures occupying the streets in scattered packs as individuals on bycicles glide past. They mingle with cars like delicate birds, flirting into traffic and out into the bicycle lanes that serve as a constant companion to the regular roads. The cycle of pedestrian traffic ebbs and flows throughout the day, swelling after siesta as the hour for tapas grows nearer. Soon swarms of people roam the streets to stand around high tables in boisterous groups of revelries celebrating life and good company.

Streets close to Plaza Mayor, the city’s center, contain tapas bars on both sides and are impossible to pass through without a constant repetition of “perdón” and “lo siento.” Enticing smells of hot bocaditos and tostadas envelop the streets in a warm aroma of strong spices and sizzling chorizo, courting with the laughter and conversation that saturates the air. Wine glasses are situated in every hand, clinking in merry, melodic tones in time with the rapid cadence of Castilian Spanish. After a round of tapas and an hour of conversation the tab is paid, and the group moved to another bar for a second, third, or fourth round of the savory morsels. The picture of elegance, overcoats and topcoats swirl on turned heels and exquisite clothing, meticulously matched from tartan scarf to leather oxford.

The streets pulse with another barrage of activity: groups of high school students burst forth from their homes in clusters of giggling girls and raucous boys eager to enter the nearest discoteca until the early morning hours. A strange juxtaposition to the poise and immaculate crowds that occupy the tapas bars, like deer they totter about on spindly legs; pale, thin, and shivering against the cold, the essence of youthful confidence tailing their stilettoed footsteps. Teenage exuberance exposes their awkward adolescence, hidden beneath a layer of short skirts, heavy makeup, and revealing tops–glance too long and risk the realization that underneath they are children, and painfully young. Let them glide by on their iridescent wings–look away without seeing the cracked exoskeleton and glittering eyes, empty and starved.

The hours pass, and the farther the clock moves from midnight the greater the number of students who appear, dominating the streets in self-assured strides to meet friends in favorite and familiar bars. Money is tight and time is fleeting, but they can pay to avoid responsibilities for a night or two. The real world looms, but a toast of “¡Salúd!” banishes its shadow for the night, its tenuous grip replaced by the playful embrace of insouciant frivolity. These hours are theirs, and they rule them with wanton abandon, princes of vice rich in the jewels of gaiety.

At all stages of the night the streets teem with life, bursting with infectious electricity and the tantalizing potential of unplanned adventure. The vibrancy of city nightlife is unparalleled; a vivacious celebration without intent or direction, marked by the underlying current of sophisticated ebullience that characterizes the central regions of Spanish society. Stepping into the streets is an immediate and invigorating connection to this atmosphere of liveliness, of pure and absolute energy unmatched by that in American cities.

Together the vitality of the people of Valladolid carries the city into the early hours of morning, until the last of the bars and discotecas Close their doors to the slight breaking of a six a.m. sunrise. In a moment of calm and quiet, the city briefly slumbers before a new cycle of citizens once again incite the flurry of city life: joggers rise, mercadillo vendors prepare their wares, and church bells ring to signal the beginning of a new day.

M. Gorman

PT Clinical Week #5

This week I started downstairs in inpatient neurology. Such a change of pace from inpatient orthopedics. My new clinical instructor is Roberta, and she speaks very little English. This week, another student who is living with me is working with Roberta as well (as she has been for the past 4 weeks), so I did a lot of observing while she did most of the hands on work.

The schedule is much different in neuro than ortho. We see 4-5 patients in the morning for 50 minutes and then see the same patients in the afternoon. We focus on ROM and mobility in the morning and then do more functional activities in the afternoon. Our caseload consists of: patient with tetanus and previous stroke (1998) // patient previous ischemic stroke & patellar fracture // patient previous TBI (2014), hip calcification, femur fx, and tibia fx // and patient previous ischemic stroke with shoulder dislocation.

On Tuesday, Kristin and I drove to Perugia to see surgery! The surgeon was the nicest guy and even waited 30 minutes to start the surgery for us, which would never happen in the US! He spoke great English and told us every thing he was doing and why in great detail. There are very little rules in the operating room, and therefore, we only wore a mask and a hair net along with scrubs and covers on our shoes. We did not have to wear gloves, long sleeves, or remove any of our jewelry. We could literally stand right over the surgeon and the patient to see unlike the US where I had to remain far away. I stood so close for one of the surgeries that I managed to get blood on me during the hammering of the bone! We talked to most of the patients pre-op. The surgeries we saw consisted of:

Hemi Knee Replacement

ACL reconstruction

Total Hip Replacement

Tumor Resection in the medial knee.

The patient with the tumor (benign) was a young girl who during the surgery woke up and started screaming in pain! It was absolutely insane. One of the doctors quickly injected more anesthetics and she went back to sleep. Two of the other patients were awake for the entire procedure, but could not feel a thing.

 

MORE DIFFERENCES:

PTs here get 5 weeks of paid vacation time throughout the year. Most split it up: 3 weeks in the summer and 2 weeks during the winter. In terms of sick days, they can go to the doctor and get a written excuse and then it can become a paid sick day. Also in the Italian PT world, as soon as a woman becomes pregnant, she can take leave until the baby is born. After the birth, she gets approximately 6 months then if needed, can add on her vacation time. Once this time is over, she can work part time until the baby is one! Here in Italy, there are a lot more holidays than in the US, and the PTs get off for almost, if not all of them.

~Jordan

Venice-Carnevale

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Italian Opera

Italian Opera

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Room in Air B&B

Room in Air B&B

View from kitchen

View from kitchen

Kristin reading an Italian newspaper

Kristin reading an Italian newspaper

Wooden castles in San Marco Square

Wooden castles in San Marco Square

Library full of books

Library full of books

Outside the library with a book staircase

Outside the library with a book staircase

Gondola x2

Gondola x2

My mask for Carnevale

My mask for Carnevale

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Millions of people in the square

Millions of people in the square

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On Friday, as soon as work was over, we traveled for a 2 night stay in Venice for Carnevale! Because this is one of the biggest events in all of Europe, we did not stay on the mainland but stayed across the canal in an Air B&B in La Palanca, Giudecca. I was skeptical to stay in a B&B, but it was absolutely amazing (see pictures below). The best part? Our view out of our kitchen windows was right over the canal. Couldn’t have asked for a better place.

We took the water taxi to and from our place to get to the mainland. Everyone (tourists & townies) was dressed up with masquerade masks and fancy cloaks and dresses. Others had their face painted and wore various wigs. And then there were some who dressed like it was Halloween with characters from movies or TV shows.

Saturday in San Marco Square they had wooden castles set up with actors putting on skits. There was a big screen broadcasting the audience and the show to the crowd. We ventured through the streets, ate pizza/gelati/tiramasu/pasta. We also walked through St. Marco’s Basilica. Before heading back to get ready for dinner, we bought tickets to see an Italian Opera for that night! The opera was not exactly what I expected since I was picturing a big theatre with high ceilings so the sound could reverarate, but instead it was in a standard big room that they put folding chairs in. The music and singing was still wonderful, and I even managed to know a few of songs! After the show, we went out to some local bars for drinks and didn’t reach our place until 3am the next morning.

Sunday was absolutely insane in Venice. There were millions and millions of people packing the streets; you couldn’t move. We went to San Marco square where people were taking videos and pictures of a lady flying from a tower down to the square on a wire dressed up throwing confetti. Picture NYC on New Year’s Eve with the millions of people. That’s exactly how it was. We tried to leave the square, but all the major exits were blocked off with policemen and barricades. It took us 30 minutes or more to exit. While crossing over the bridges, policemen would ask you to remove your masks for safety.

Leaving Venice, I would have to say this is still my favorite city thus far. I absolutely love it’s uniqueness, and can’t wait to come back in the future.

FACTS:

  • Carnival of Venice (Carnevale di Venezia) is an annual festival that ends with the Christian celebration of Lent, forty days before Easter on Shrove Tuesday (Martedi’ Grasso or Mardi Gras), the day before Ash Wednesday. World-famed for its elaborate masks.
  • It is said that Carnevale started with the victory of the Serenissima Repubblica against the Patriarch of Aquileia, Ulrico di Treven (1162). In honour of this victory, the people started to dance and make reunions in San Marco Square. In the 17th century, the baroque carnival was a way to save the prestigious image of Venice in the world.

~ Jordan

PT Clinical Week #4

Last week was my last time inpatient orthopedics, as this week I will be venturing downstairs to inpatient neuro!

Last week, many of my routine patients were discharged home- a bittersweet moment.  It was great to be able to work with them for a period of time, see them improve, and then see them leave to go back home to their families.

On Monday and Tuesday afternoons, I was able to observe and work with patients in Aqua therapy. Monday I only observed. The PT only got into the pool for about 20 minutes to work with 2 patients because all of the other patients already knew their workout routines and were doing them independently. Patients with a pool prescription are in the pool for either 3 days per week or 5 days per week. There are many patients in the pool at one time which was a nice change from the aqua therapy I experienced in my last clinical where only one person was able to fit/and use the hydrotherapy pool at a time. It’s nice to see because the other people in the pool can be motivating factors for one another. It’s a time to socialize while also getting their therapy.

I was able to observe the PT perform treatment on two patients (one stroke; the other back pain).  The following day I performed mobilizations and prescribed some exercises for a patient with hip pain.

MORE DIFFERENCES:

  • In the inpatient facilities I have been in in the US, they usually receive 3 hours of therapy per day. Here they receive 5 hours! Instead of only focusing on manual therapy for maybe 10-15 minutes back home, here they spend up to an hour on just stretching and mobs! I often get sick of repeating the same manual techniques over and over again within the hour, but then I realize that there are other stations taking care of the other modalities that I would normally cover myself (exercises, ambulation, e-stim, etc).
  • All therapists carry their cellphones with them around the clinic. The purpose is so they can reference it when needed to help patients. Also, because documentation is lacking, there is a decrease in communication between therapists who are treating patients whose normal therapists are off or home sick. But there are some times when you look around at some therapists in the gym who do not have a patient and they’re on their phones on FB or instagram. You would not see this in a US clinic because this would be seen as impolite and there is hardly any down time due to the loads of documentation!

~Jordan

An action-packed weekend

After another busy week in Valladolid, we all were really looking forward to the weekend, which technically starts Thursday night for us since we don’t have classes on Friday’s. Every Thursday evening, my fellow students and I head to a quaint cafe to meet our intercambios group. We meet with Spanish students learning to speak English. For half of the meeting we speak English and the other half Spanish (this serves as a great opportunity to practice our speaking skills, learn many colloquial words and phrases, and to discover more about the city.) After the intercambios meeting, a few of us from the group headed to our first tapas bar for dinner. Thursday is tapas night, and a little overwhelmed by the ordering process, Alisha, Marie, Andrew and I (U.S. students) were glad to have two Spanish students with us to show us where to go and how to order. I should be clear when I say Spanish students here, most of our group is between 30-45 years old. Nonetheless, the six of us headed to our first bar, all pitched in 10 euros, and ordered our first round of tapas with red wine (the typical accompanying drink).

Tapas varies greatly; it’s basically just a general word for bite-sized appetizers so our first order was an assortment of flatbreads with various toppings like ham, cheese, fish, vegetables, well basically anything! They were delicious but after our first round we were ready to head to another place. At this point, Marie and Andrew decided to go meet some other friends, so our group was reduced to 4 as we found our tapas bar. Here, were ordered larger portions of tapas meant to share called raciones. We ordered sepia or cuttlefish, one of the most popular tapas here, lightly seared and served with lettuce, mayonnaise and bread. In addition we got chicken and french fries (proving the versatility of tapas). After finishing, Luis, one of the Spanish students with us, directed us to a live flamenco show in a nearby dance club. It was so much fun hearing live Spanish music and pretending to know how to dance. Luis was an extremely talented dancer, however he failed at trying to teach me the Spanish Rumba. My feet just can’t move that fast!

Despite getting home quite late, Rachel, Olivia, Alisha and I (all studying physical therapy) got up early the next morning to walk about 2 miles to meet the director of the mental health care facility we will be volunteering at while here. It seems like a great opportunity for all of us to see physical therapy and interact with patients in Spanish, I look forward to spending time there in the upcoming weeks! After the long walk, we headed home for a quick lunch so we could catch the bus to Peñafiel, a neighborhood of Valladolid and home of the Mueso de Vino (museum of wine) which is housed in a castle constructed in the 15th century! After about an hour bus ride, we arrived in the small town, a bit unsure of where to go, but we could see the castle off in the distance!

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We continued walking through Peñafiel, until we reached the base of the mountain. There was not a soul in sight as we arrived conveniently in the middle of siesta (everyone was at home asleep!) Expecting a bus or shuttle to the top of the mountain, we continued to search in hopes of anything or anyone willing to take us to the top. As it turns out, there are no buses to the top, you either drive a car or walk… we had no choice but to begin our ascent.

Time to get climbing!

Time to get climbing!

Just have to keep going!

Just have to keep going!

Abby and Olivia enjoying the impressive view!

Enjoying the impressive view!

 

 

 

 

 

 

 

 

 

Although a bit treacherous, we all successfully made it to the top after a 25 minute hike. We absorbed the breathtaking views of the town and countryside as we waited for the museum to open and our castle tour to begin.

Finally we made it!

On top of the world!

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The castle was impressive and our tour guide was great! We enjoyed the wine exhibits and although we wished we had more time, we had to head back down the mountain to catch our bus home. A bit nervous we missed our bus, we had a few minutes of panic as we contemplated what to do. Then, in the distance we saw the bus! Thank goodness!!

As busy as our Friday was, we headed to our favorite bar, called the Negra Flor. After an exhausting day and night ( we didn’t get home until 4:30 am), Saturday was a day for sleep; however, I promised to take my host sister, Ana, iceskating so we headed on the bus to the rink on the edge of town. Although quite a small rink, we had so much fun! Still tired from Saturday we only ventured out Saturday night for food and then we all headed back to our beds. Today is a day to catch up on school work, relax, and prepare ourselves for another busy and exciting week in Valladolid! I can’t wait to see what next weekend holds in store for us!

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Basilica of San Francesco

Basilica of San Francesco

Basilica of San Francesco

Basilica of San Francesco

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Basilica of Santa Chiara

Basilica of Santa Chiara

My new mug!

My new mug!

Ceramic plates at Enoteca Prosperzio

Ceramic plates at Enoteca Prosperzio

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Wine tasting!

Wine tasting!

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Temple of Minerva

Temple of Minerva

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Basilica of San Francesco

Basilica of San Francesco

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One of my favorite pictures :)

One of my favorite pictures :)

After sleeping in on Sunday, three of us headed to Assisi, since the other girls were not feeling well. I decided at the last minute to go, and I am really glad that I did! I think Assisi was one of my favorite places I have visited so far.

The city is placed precariously on a mountain with Basilica of San Francesco in high regards. We just HAD to stop to get pictures in the middle of the road haha. We did a lot of climbing up and down hills, saw the Cathedral of San Rufino & Basilica of Santa Chiara. My favorite part was where we could enter the crypts and see the tomb of St. Francis. When we came out from the tombs, the sun was setting and we got so many great pictures all the way back to our car.

On our way home we stopped at Enoteca Prosperzio in Spello for a wine tasting. It was a little more than a wine tasting as we got a glass of each wine, and a full course meal! Our coordinator paid for it all. There was a wine that was celebrating it’s 25th anniversary that was produced in one of the best wineries in all of Europe. Then we had this balsamic vinegarette that came in this tiny tiny bottle that sold for 100 euros a bottle (it was very delicious). After the wine tasting, several of the girls bought bottles to take home to their families. We really liked the ceramic plates that we saw and asked the owner to see his collection. The collection was huge and he was selling everything for a discount price. Every girl bought something, and I bought the mug below. I am going to have to send lots home in order to be able to fit all the souvenirs in my suitcase to come home!

~Jordan