CONTENTS
My Adventures
Whatever Happened to Polio
Anesthesia Precautions…..
Cashews Deserve Respect
Overview of Medicare Part D
How to Choose an Assisted Living Facility How It Feels to be Old
Your Health
Act Against Incontinence
Stressbusters
Be a Better Caregiver
Upcoming Conferences
Mis-Matched Shoes
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MY ADVENTURES
Since our last newsletter,
I’ve been doing some traveling. Thanks
to funding by
When I was up on
My flight to
As I left that scooter on
Now, a little about the conference in
St Louis – there were seminars from anesthesia – to PT and OT – to bracing – to
emotional eating – to sleep apnea – to updated research…. and many other
topics. In fact, my only real complaint
about the conference was that there were times when two of the “talks” I wanted
to go to were at the same time and I just couldn’t divide myself in two. The ones I did attend were most
informative.
I enjoyed seeing “old” friends that I
see only at these conferences and meeting new friends, including some that I
have been networking with, via e-mail, for several years – it’s nice being able
to put a face to a name/voice.
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Whatever Happened
to Polio
This summer I went to
the "Whatever Happened to Polio" exhibit at the
The most interesting display
was about the March of Dimes. What I learned from that display is that if
each family gave ten cents to polio research, scientists could have found a
cure much earlier. I really liked the display because it showed dimes dropping
into a March of Dimes bucket.
In another part of the
exhibit a lady taught us about polio. She told us that children who got
the polio vaccine got a green ink stamp on their pinky. The green ink
told people who did and didn't get vaccinated. She also told us about
Candyland. She told us that a little girl with polio made up the
game so children with polio would have something to do while they were in
the hospital.
Another display that we saw
demonstrated how an iron lung works. When you put your arm in the
machine, you could feel the pressure like an iron lung. And we saw a big
real iron lung that once helped somebody breathe.
I wish my grandmother never
had polio. But because she does, we also learned that if you had polio,
the effects never go away even after the virus dies.
Joseph Buda
FECPPSG Editor’s Note:- The above article was written by my grandson. The Smithsonian exhibit is teaching the
generations that came after the Salk and Sabin vaccines
what polio is/was all about. My only
wish is that it would be taken throughout the
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The following article is the first of several that is
being reprinted from the program guide for the Ninth International Conference
on Post-Polio Health and Ventilator-Assisted Living’s Strategies for Living Well,
ANESTHESIA PRECAUTIONS FOR PEOPLE
WITH NEUROLOGIC CONDITIONS
The objectives of this session are to briefly review
anesthesia care for common operations in polio patients, to review anesthesia
safety in general in the United States today, to discuss how to increase the
chances of getting the best anesthesia care available in your area and,
finally, to answer questions on anesthesia practice and safety from the
audience. The audience should leave the
session under-standing what particular issues need to be discussed with an
anesthesiologist when surgery is anticipated, how to increase the chance of
getting the best anesthesia care available in their geographic area, and how
safe anesthesia is today, especially compared to the risk of hospitalization
itself. Handouts of the slide
presentation and a single page of recommendations related to anesthesia for
post-polio patients will be available at the session.
CHOOSING AN
ANESTHESIA PLAN: I’m often asked what anesthetic is best for post-polio
patients. It just depends. It depends on that patient (with their
particular health problems) having that operation (with its own risks and
problems) at that point in time and by that particular surgeon
(with his/her issues) and that particular anesthesiologist (with their
own skills and issues). And, all these
factors interact and interplay with each other.
Excellent
anesthesia depends on understanding a patient’s diseases (this is true for any
patient, with any disease, not just post-polio patients) and how the diseases
might affect anesthesia management. Also
the planned operation must be considered because different operations have
different anesthetic requirements, and not all operations can be done with a
particular anesthetic technique. For
example, it is difficult to do a laparoscopic (lap) cholecystectomy (removing
the gall bladder through a laparoscope instrument) using regional anesthesia (a
spinal or epidural anesthetic). The
operation begins by injecting many liters of CO2 gas into the
abdomen, to grossly distend it so the surgeon can reach the needed organs. The distension is extremely uncomfortable for
an awake patient, and also breathing is inadequate if the patient is breathing
on their own. And, the distension can
interfere with venous return to the heart, causing low blood pressure. Low blood pressure can also result from spinal
or epidural anesthesia, so using these techniques in this setting is not
helpful. All lap choles need to be done
with general anesthesia, with controlled breathing. Other factors entering into the choice of an
anesthesia plan include a surgeon’s ability to operate under regional or local
anesthesia and also the anesthesiologists’ particular skills.
POLIO
CHANGES AND ANESTHESIA:
What about the disease polio might be important in
anesthesia management? Polio is an
inflammatory disease of the nervous system.
We typically think that it involved only the spinal cord, but numerous
anatomic research studies document that all parts of the nervous system were
affected, not just the spinal cord. This
explains the wide-ranging issues that reveal themselves as post-polio patients
age.
Starting
at the brain, central neuronal changes may contribute to the common sensitivity
to sedative medications, and can result in a long emergence from
anesthesia. The poliovirus also affected
the neuromuscular junctions (the connections between a nerve and its muscles),
and this may be one cause of sensitivity to muscle relaxants. There is also a decrease in total muscle
mass, and a standard dose of relaxants may be an overdose for a post-polio
patient. Postop pain may be an issue;
this is most likely due to inflammatory changes in the spinal cord, with
resultant scarring. This could affect
the transmission of the pain signals through the spinal cord. The inflammatory process of polio “spills
over” to a spinal cord area where autonomic nerve fibers travel. The autonomic nervous system (the system that
keeps your GI tract moving, keeps your heart beating at an appropriate rate and
so on) can also be abnormal. This can
cause gastro-esophageal reflux, tachyarrhythmias and sometimes, difficulty
maintaining blood pressure under anesthesia.
Because of respiratory muscle weakness, there can be respiratory
inadequacy postoperatively. Laryngeal
weakness, including cord paralysis, can also add upper airway obstruction,
swallowing problems and aspiration. Body
asymmetry due to muscle mass loss and scoliosis can be an issue. Osteopenic limbs and exposed peripheral
nerves add further positioning problems.
Patients
of particular concern are those using ventilators, even part-time, and those
who were in iron lungs, even if they don’t use ventilation presently. Preop pulmonary functions tests are the first
step in anesthesia planning for them.
Depending on the results of pulmonary function tests, the surgery and
the type of anesthesia needed, it may be possible to continue to use the
patient’s ventilator intraoperatively.
If not, the patient’s ventilator can often be initiated after surgery,
in recovery room. Postoperatively, there
has to be careful consideration of any respiratory depression from narcotic
pain medications and adequacy of the patient’s ventilation. By careful planning, all polio patients
should be able to have surgery without excessive risk.
WHAT KINDS
OF ANESTHESIA ARE AVAILABLE? General Anesthesia is not the only way!
GENERAL
ANESTHESIA: The patient is completely asleep. Usually anesthesia begins with an intravenous
injection (usually propofol or pentothal).
With the help of a short-acting muscle relaxant, a breathing tube is
often (but not always) placed in the trachea (windpipe) to insure that oxygen
(O2) can reach the patient’s lungs.
Then anesthesia continues with inhaled gases (often nitrous oxide and a
vaporized liquid anesthetic such as sevoflurane) supplemented by injected
narcotics, amnesic drugs and muscle relaxants if needed. At the end of the case, any residual muscle
relaxant effect is reversed with drugs, the inhaled gases are stopped and the
patient breathe on their own. In some
cases it is left in, to allow assisted ventilation if needed.
REGIONAL
ANESTHESIA: This means that only the part of the body being
operated on is numb. The patient can be
awake or asleep (using injected drugs) during surgery. An anesthesia provider should always be present
to monitor you, to detect any possible problems early on, and to induce general
anesthesia if the block is not satisfactory.
The usual types of regional anesthesia follow:
1. Spinal:
A small amount of local
anesthesia is injected into the subarachnoid space, around the spinal
cord. See diagram of spinal cord.) The procedure is like a lumbar puncture. The lower half of the body is numb; higher
levels can result from higher doses.
Prostate, bladder and rectal surgery are often done with spinal anesthesia. It usually gives good solid pain relief
unless the abdomen is open and the surgeon pulls on the bowel.
2. Epidural:
Instead of putting local
anesthesia in the fluid-filled space around the spinal cord, a larger amount
(and perhaps some narcotics) is placed in a potential space, the epidural
space. In the lower back (occasionally
higher). (See diagram of spinal
cord.) The anesthestic drug migrates
across several levels of tissue to reach the spinal cord itself. The advantage to this is that a small plastic
catheter can be placed in the epidural space and used for additional anesthesia
and additional pain-relieving drugs in the postop period. Physiologically, this is safer than spinal, the
block is of slow onset, it is a little less predicable than a spinal. It is used for the same operations as spinal
and also for vascular operations on the legs.
3. BLOCKS OF THE ARM: The
nerves to the arm can be approached from above (supraclavicular block) or below
(infraclavicular) the clavicle and through the axilla (axillary block), usually
giving good relief for most arm and shoulder surgery. An IV block of the arm (also called a Bier
block after the German surgeon who first did it’ occasionally used for the leg
in unusual situations) is an easy block in which the venous structure of the
arm are emptied and then filled with a dilute local anesthesia solution. Although seemingly easy and safe, there have
been deaths when this is done in emergency rooms or plastic surgeons’
offices. Because these blocks require a
larger volume of local anesthetic, there is a risk of local anesthetic
toxicity. This can be prevented by
careful placement and calculation of the maximum dose for that patient.
Nerves
to the hand and lower forearm can be easily blocked at the elbow and wrist.
4. BLOCKS OF THE EYE: A
retro-bulbar (behind the eye) block is the standard regional anesthetic for eye
surgery. In most parts of the country,
the surgeon places this rather than an anesthesiologist. An anesthesia provider is still present, to
detect any complications of the block, to give any needed sedation and to
induce general anesthesia if needed.
5. BLOCKS OF LOWER EXTREMITY: The nerves to
the leg can be relatively easily blocked in the inguinal area.
MONITORED
ANESTHESIA CARE (MAC): The surgeon injects local anesthesia at the site of
surgery; anesthesia staff is present to sedate and monitor the patient and to
induce general anesthesia, if needed.
Not all operations can be done with MAC; it is best with superficial,
simple surgeries such as carpal tunnel release.
The surgeon’s skills contribute greatly to the success of MAC.
ANESTHESIA
SAFETY: There has historically been a great fear of anesthesia
in the polio community because of patient reports of problems allegedly due to
anesthesia management, especially related to muscle relaxants. Although there are issues for post-polio patients having anesthesia, the
general level of fear of anesthesia in the polio community is probably
excessive, and there are many other, much higher incidence problems that can
harm polio patients when hospitalized.
Anesthesia
today is safe! Over the last three
decades, the number of deaths attributed to anesthesia dropped from 1 in 10,000
cases to 1 in 250,000 cases. This is a
remarkable achievement, especially considering that 40 million anesthetics are
now administered each year in the
Also at
the national level, the American Medical Association (AMA) recognized our
specialty’s leadership when they patterned their patient safety institute, the
National Patient Safety Foundation (established in 1996), after our Anesthesia
Patient Safety Foundation (APSF). The
APSF was created in 1985, to raise awareness of patient safety issues. The APSF publishes a quarterly newsletter,
funds research on safety issues, presents educational sessions and exhibits at
the annual ASA meeting and maintains a web site. In 1986, the ASA adopted monitoring standards
for the first time. These list monitors,
such as EKG, temperature and so on, that must be in use for each anesthetized
patient. This was the first expected
standard of care for our specialty.
In the
mid-1970’s, anesthesiologists began to analyze malpractice cases that had
“closed,” (settled) to try to identify what clinical practices might be
associated with malpractice claims, so these could be improved. This became an official ASA project, the
“Closed Claims Study” in 1985. Volunteer
reviewers do a standard analysis of settled claims at 35 malpractice insurance
companies. Currently, 6,448 claims are
in the data base. Trends are analyzed,
results summarized, and then these analyses are published in the anesthesia
literature.
Some
extremely important results have come out of these analyses. Two of these papers are among the 50 most
cited scientific papers in the anesthesia literature. The first report, published in 1990 (Caplan RA, Posner KL, Ward RJ, Cheney
FW. Adverse respiratory events in
anesthesia: A closed claims
analysis. Anesthesiology 1990:
72;828-833),showed that airway (breathing) problems were the most common
cause of a closed claim. As a result,
major efforts to anticipate airway problems and to devise alternate approaches
to usual airway management began, have been very successful and continue to
this day. Each annual meeting has many
sessions on the latest in airway management.
This is just one example of how our specialty works to improve patient
safety.
Finally,
advances in technology such as in monitoring, anesthesia machines and airway
devices made critically important contributions to improved patient
safety. To illustrate this, we will see
a video of a monitor of neuromuscular transmission. This monitors the effect of muscle relaxants,
one of the areas of fear for polio patients.
This standard monitor allows muscle relaxants to be used safely in all
patients.
Hopefully,
this section makes it clear how committed the specialty of anesthesiology is to
improving patient safety and what significant progress has been made in
decreasing harmful anesthesia incidents.
Post-polio patients who will be hospitalized for surgery have a much
greater chance of dying or being harmed during hospitalization from other medical errors, such as
getting an incorrect drug, rather than their anesthesia. At the current rate, 160 would be predicted
to die from an anesthesia accident each year, compared to 44,000 to 98,000 from
other hospital errors. Clearly
hospitalization itself should become the worry, and there could be a decrease
in concern about anesthesia.
GETTING THE
BEST ANESTHESIA: This is a difficult issue. The first step is an adequate evaluation by
your usual polio physician, the surgeon and a pulmonologist. After group evaluation of your situation and
a decision about exactly what surgery will be done, the hospital to be used can
be chosen. In most areas of the country,
you can have several choices of hospitals.
An academic hospital with an affiliated rehab hospital would be ideal. In general, academic centers tend to have the
best anesthesia departments. If your
hospital is not an academic center, you might ask how many of the
anesthesiologists are Board-certified and also is the hospital JCAHO accredited
(you can check this yourself on the JCAHO web site). The surgeon may know of a particular
anesthesiologist who might have experience in this area or at least listen to
patients’ concerns. A preop evaluation
would be done and an anesthesia plan, with a backup plan in place, made. You are welcome to use my handout when you
visit the anesthesiologist. And, don’t
forget the operation! It’s best to go to
an institution that specializes in whatever surgery you are to have.
There
is a significant shortage of anesthesiologists today, and many are seriously
over-worked. That might result in
another anesthesiologist replacing one that you’ve talked with, at the last
minute. (Usually this would be because the
first anesthesiologist has been up all night, on call.) That may not be preventable and, hopefully,
communication between the two will take place.
Through the entire operative process, I urge polio patients to make
clear what their expectations for care are and to not be satisfied until you
get what you need. This can be wearing,
and hopefully a companion can carry out some of this for you. Today, all American health care organizations
are under enormous stress, and this tends to show in the patient care area; it
helps to be a “squeaky wheel.”
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SUMMARY
OF ANESTHESIA ISSUES
FOR
POST-POLIO PATIENTS
Polio results in wide-spread neural changes, not just destruction of
the spinal cord anterior horn (motor nerve) cells, and these changes can get
worse as patients age. These anatomic
changes affect many aspects of anesthesia care.
No study of polio patients having anesthesia has been done. These recommendations are based on extensive
review of the current literature and clinical experience with these
patients. They may need to be adjusted
for a particular patient.
1. Post-polio
patients are nearly always very sensitive to sedative meds, and emergence can
be prolonged. This is probably due to
central neuronal changes, especially in the Reticular Activating System, from
the original disease.
2.
Non-depolarizing muscle relaxants cause a greater degree of block for a
longer period of time in post-polio patients.
The current recommendation is to start with half the usual dose of
whatever you’re using, adding more as needed.
This is because the poliovirus actually lived at the neuromuscular
junctions during the original disease, and there are extensive anatomic changes
there, even in seemingly normal muscles, which make for greater sensitivity to
relaxants. Also, many patients have a
significant decrease in total muscle mass.
Neuromuscular monitoring intraop helps prevent overdose of muscle
relaxants. Overdose has been a frequent
problem.
3.
Succinylcholine often causes severe, generalized muscle pain
postop. It’s useful if this can be
avoided, if possible.
4. Postop pain
is often a significant issue. The
anatomic changes from the original disease can affect pain pathways due to
“spill-over” of the inflammatory response.
Spinal cord “wind-up” of pain signals seems to occur. Proactive multimodal postop pain control
(local anesthesia at the incision plus PCA, etc.) helps.
5. The
autonomic nervous system is often dysfunctional, again due to anatomic changes
from the original disease (the inflammation and scarring in the anterior horn
“spills over” to the intermediolateral column, where sympathetic nerves
travel). This can cause
gastro-esophageal reflux, tachyarrhythmias and, sometimes, difficulty
maintaining BP when anesthetics are given.
6. Patients who
use ventilators often have worsening of ventilatory function postop, and some
patients who did not need assisted ventilation have had to go onto a ventilator
(including long-term use) postop. It’s
useful to get at least a VC preop, and full pulmonary function studies may be
helpful. One group that should all have
preop PFT’s is those who were in iron lungs.
The marker for real difficulty is thought to be a VC<1.0 liter. Such a patient needs good pulmonary
preparation preop and a plan for postop ventilatory support. Another ventilation risk is obstructive sleep
apnea in the postop period. Many
post-polios are turning out to have significant sleep apnea due to new weakness
in their upper airway muscles as they age.
7. Laryngeal
and swallowing problems due to muscle weakness are being recognized more often. Many patients have at least one paralyzed
cord, and several cases of bilateral cord paralysis have occurred postop, after
intubation or upper extremity blocks.
ENT evaluation of the upper airway in suspicious patients would be
useful.
8. Positioning
can be difficult due to body asymmetry.
Affected limbs are osteopenic and can be easily fractured during
positioning for surgery. There seems to
be greater risk for peripheral nerve damage (includes brachial plexus) during
long cases, probably because nerves are not normal and also because peripheral
nerves may be unprotected by the usual muscle mass or tendons.
Please feel free to call me (pager 818-529-0325,
office 818-364-3019), email scalmes@ladhs.org) if you have any questions. This brief summary may not cover everything
you want to know.
Clinical Professor of Anesthesiology, UCLA
FECPPSG
Editor’s Note:- As you know our newsletter does not do graphics. If you want a copy of the “slide”
presentation of Dr. Calmes’ presentation, just let us know and we’ll mail you a
copy.
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Reprinted from
EatSmart by Jean Caspar
Cashews deserve respect
Q: I eat a lot of cashews. How do they rate as a healthful nut?
Very high, although they rarely make health
headlines. Cashews have almost as much
magnesium as almonds, and more zinc and selenium than most nuts. Like almonds, cashews are rich in
monounsaturated fat ad are apt to improve cholesterol and cut heart disease
risk, says Gene Spiller, a leading researcher on nuts and director of the
Health Research and Studies Center. But
cashews rank far below pecans, hazelnuts, walnuts, pistachios and almonds in
antioxidants, finds recent USDA research.
FECPPSG
Editor’s Note:- I was thrilled to read this as cashews are my favorite
nut. However, let’s not overdo the
cashews and forget about the rest. An
equal serving of all nuts is really best for us.
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The following
article was distributed at a meeting of the Volusia/Flagler Senior Association
Coalition on
OVERVIEW OF
MEDICARE PART D
Eligibility and Enrollment
The new Medicare Part D prescription
drug coverage begins on
Anyone entitled to Medicare Part A or enrolled in Part B is eligible to
join the new Medicare drug benefit plan.
Joining will involve selecting an approved PDP or MA plan offering drug
coverage, and enrolling in that plan for the year. While full dual eligible beneficiaries and
other individuals who are eligible for the low income subsidy will be
auto-enrolled after having the opportunity to select a plan themselves,
enrollment for all other beneficiaries is entirely voluntary. However, beneficiaries who choose not to join
at the first opportunity may face a late enrollment penalty if they later
choose to enter the program. This
penalty is similar to a penalty currently in place for late enrollment in
Medicare Part B and is meant to make sure that people don’t wait until they are
sick to sign up, thus skewing the risk pool.
Beneficiaries who have other sources
of drug coverage – through a former employer, for example – may stay in that
plan and not enroll in one of the new drug plans under Medicare. If their other coverage is at least as good
as that offered under Medicare (*and therefore considered “creditable
coverage”), the beneficiary can avoid any late enrollment penalties when or if
they lose that coverage and choose to enroll in a Medicare plan at some later
date.
The new drug benefit has an “opt-in”
rule. That means that, with limited
exceptions, beneficiaries will need to make an affirmative statement to enroll
in a prescription drug plan by filling out an enrollment form and joining an
approved plan. This will be different
from the “opt-out” rule that exists in Part B, where people are deemed to have
enrolled in the program when they turn 65 unless they notify Medicare
otherwise.
Low-income beneficiaries who need help
with Medicare drug costs can file for subsidy eligibility determinations with
the Social Security Administration (SSA) or with the States. SSA has developed a simplified application
that is scannable and an application to be used via the Internet. Beneficiaries will be able to complete the
application themselves or with the help of State or other community based
support organizations. State personnel
and other partners assisting beneficiaries will use the SSA application and
eligibility determination process.
Keep in mind that beneficiaries who
are dually eligible for Medicare and Medicaid, about 6.4 million, as well as
those eligible for SSI or in a Medicare Savings Program (QMB, SLMB, and QI
beneficiaries – about one million individuals) will not have to complete an
eligibility application. These
beneficiaries are deemed eligible and will automatically qualify for the
subsidy. Non-full benefit dual eligible
individuals will still need to enroll in a plan offering prescription drug
benefits. If they do not do so before
the end of their enrollment period, CMS will enroll them in a plan; they will
have the option of disenrolling.
Premium, Deductible and Cost Sharing
Beneficiaries who do not fall into one
of the several low-income categories, and therefore do not qualify for
additional assistance available to these individuals, will be responsible for
monthly premiums, annual deductibles and cost sharing, up to a certain point.
The standard benefit features a $4250
annual deductible and 25 percent beneficiary cost sharing, up to an initial
coverage limit of $2,250. After that,
catastrophic coverage begins once a beneficiary reaches $3,600 in out-of-pocket
expenses ($5,200 in total drug spending).
To be counted as out-of-pocket expenses, the beneficiary (or another
individual, such as a family member) must actually be paying the costs. In general, the costs cannot be paid by
another insurer and count toward the $3,600 limit, though contributions by
state pharmacy assistance programs do count.
In the catastrophic coverage range, the beneficiary pays the greater of
5 percent cost sharing or $2 and $5 co-pays.
This catastrophic coverage is something that has not been available to
most Medicare beneficiaries, even those with supplemental coverage, since the
Medicare-approved Medigap plans did not allow such coverage.
Currently, Medicare beneficiaries
without coverage pay full retail prices.
With coverage under one of the Medicare prescription drug plans,
beneficiaries will save in two ways – first through the direct coverage, and
second when they pay for drugs out of their own pockets, they will be making
purchases based on prices that are substantially reduced from what they
otherwise would pay as a result of their plan’s negotiated discounts with manufacturers.
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Reprinted from
HOW TO….
Choose an Assisted
Living Facility
Services ease transition from living on your own.
If you or a loved one suddenly has a
need for an assisted living facility there are a lot of options to consider
before making a selection.
First, it is important to understand
that assisted living is not a nursing home, but a bridge to that step from
living on your own. Assisted-living
residences are designed to meet special personal services and housing needs,
and sometimes healthcare needs as well.
When selecting a facility, choices can
include single or double rooms and sometimes even suites and apartments.
Typical services that may be provided
include meals, assistance with daily living activities such as bathing and
dressing, help with medications, housekeeping, laundry, transportation and
shopping.
When the time comes to make that
transition, research is the best way to ensure that you make the right selection
for your loved one.
It is a good idea to visit several
assisted-living residences before making a choice. Ask those who live in the community to be
sure the facility and the owner or sponsor have a good reputation. Talk with residents about life in the
facility. Be sure the staff is
respectful and friendly. Also, make sure
the activities are appropriate for your individual needs. Find out how much input you will have in your
daily life and care, and how much flexibility there is in the schedule. For example, if you need assistance with
bathing, will you be able to choose when and how often?
Requirements for staff and
administrators for assisted-living facilities vary from state to state. Many assisted-living facilities have very
minimal hiring standards. Some of these
may include:
·
Administrator must be at least 18 years of age.
·
Workers may have a high school diploma or GED.
·
Some previous experience working with the aged.
When you begin your search, consider the following questions as a
starting point::
·
What kinds of services are available and are services
provided by the facility’s employees, or are arrangements made with other
agencies?
·
What types of accommodations are there?
·
Do family and friends have unlimited and/or convenient
visitation?
·
What is included in the daily or monthly rate? What services are available for extra
charges?
·
Can furniture and other personal items be brought from home?
·
What kinds of activities and recreation are available and
how often?
·
What happens if you need additional assistance later
on? Do you have to move, or can the
facility provide the care you need?
In addition, pay attention to physical aspects of the facility,
including cleanliness. Look for features
designed for safety, such as well-lit stairs and halls, handrails in bathrooms,
exits that are well marked, and a way to summon help if needed.
Another major consideration when selecting an assisted-living facility
is cost. Depending on the services and
accommodations offered, costs could range from $1,800 a month to $3,200. Some states have funding available for those
who cannot afford assisted living.
Check to see if your state has an American Association of Homes and
Services for the Aging (AAHSA) affiliate.
~*~*~*~*~*~*~
CONSUMER TIPS
ONE:- Talk with residents about life in the
facility. Be sure the staff is
respectful and friendly.
TWO:- Look for features designed for safety, such
as well-lit stairs and halls, handrails in bathrooms, exits that are well
marked, and a way to summon help if needed.
THREE:- Make sure the activities are appropriate for
your individual needs.
FOUR:- Find out how much input you will have in your
daily life and care, and how much flexibility there is in the schedule.
FIVE:- If cost is an issue, check to see if your
state has funding available.
FECPPSG Editor’s Note:- Another point to remember is to be sure that the
facility is fully handicap accessible. Under
“Consumer Tips” number “Two” – where it mentions handrails in bathrooms, make
sure that there are “handrails” – or – “grab bars” attached to at least two
sides of the shower or bathtub, as well as on the side of the commode.
************************************
These two “gems” were e-mailed to me several times last
month. Barbara
HOW IT FEELS
TO BE OLD
The other day a young person asked me how I felt
about being old. I was taken
aback, for I do not think of myself as old. Upon seeing my reaction, she was
Immediately embarrassed, but I explained that it was an interesting question,
and I would ponder it, and let her know.
Old age, I decided, is a gift. I am now, probably for the
first time in my life, the person I have always wanted to be. Oh,
not my body! I sometime despair
over my body – the wrinkles, the baggy eyes, skin spots and bumps, and the
sagging butt. And often I am taken aback by that old person that lives in my
mirror, but I don't agonize over those things for long.
I would never trade my amazing friends,
my wonderful life, my loving family, for less gray hair or a flatter belly. As
I've aged, I've become more kind to myself, and less critical of myself. I've
become my own friend. I don't chide myself for eating that extra cookie, or for
not making my bed, or for buying that silly cement gecko that I didn't need,
but looks so avant garde on my patio. I am entitled to overeat, to be messy, to
be extravagant. I have seen too many dear friends leave this world too soon;
before they understood the great freedom that comes with aging.
Whose
business is it if I choose to read until
I know I
am sometimes forgetful. But there again, some of life is just as well forgotten
-- and I eventually remember the important things. Sure, over the years my
heart has been broken. How can your heart not break when you lose a loved one,
or when a child suffers, or when a beloved pet gets hit by a car? But broken
hearts are what give us strength and understanding and compassion. A heart
never broken is pristine and sterile and will never know the joy of being
imperfect.
I am so blessed to have lived long
enough to have my hair turn gray, and to have my youthful laughs be forever
etched into deep groove on my face. So many have never laughed, and so many
have died before their hair could turn silver. I can say "no," and
mean it. I can say "yes," and mean it. As you get older, it is easier
to be positive. You care less about what other people think. I don't question
myself anymore. I've even earned the right to be wrong.
So, to
answer your question, I like being old. It has set me free. I like the person I
have become. I am not going to live forever, but while I am still here, I will
not waste time lamenting what could have been, or worrying about what will be.
And I shall eat dessert every single day. (And enjoy it!!!)
~*~*~*~*~*~*~
THE CAR JACKING!!
This is a true story.
An elderly
The four men didn't wait for a
second invitation. They got out and ran like mad. The lady, somewhat shaken,
then proceeded to load her shopping bags into the back of the car and got into
driver's seat.
She was so shaken that she could not get her key into the ignition.
She tried and
tried, and then it dawned on her
why. A few minutes later, she found her own car parked four or five spaces
farther down. She loaded her bags
into the car and drove to the police station.
The sergeant to whom she told
the story couldn't stop laughing. He pointed to the other end of the counter,
where four pale men were reporting a car jacking by a mad, elderly woman
described as white, less than five feet tall, glasses, curly white hair, and
carrying a large handgun.
No charges were filed.
************************************
The following came to me through
several distant sources on the Internet and was in one of our newsletters back
in 2000.
~
YOUR HEALTH ~
The road to good health and
fitness isn’t as long as you think. By
making small, even subtle changes, you can be more vital, energetic and
healthier in only a few days. Here are 8
fast working ways to get started.
MAKE A
JOKE
A good chuckle lowers
stress hormones while increasing the activity of our immune system.
SURROUND YOURSELF WITH GREENERY
Having just a few large,
leafy plants in a room boosts humidity and reduces airborne molds and
bacteria. Try
EAT MORE
COLORFULLY
The more deeply hued the
produce, the more disease fighting antioxidants. Choose leaf lettuce, red grapes, tomatoes and
pink grapefruit.
GET MORE
ZZZs
Sleep revitalizes the
immune system and bolsters our growth hormones, which are vital for tissue
repair.
DRINK UP
Water that is. Have a big glassful and lower your chances of
catching colds or flu, you will even get an energy boost!!
SIT UP
STRAIGHT
Try this experiment ~
While sitting down, slump
over. What happened? Your chin dipped and your chest sank. Just try to take a deep breath. Now, sit tall, breath deeply. See the difference? Slumping lowers oxygen intake, causing
fatigue.
WALK FAST
AROUND THE BLOCK
Even a 10 minute walk may
be enough to help reduce tension and anger that can raise your blood pressure.
FECPPSG Editor’s Note:- This last one on walking may be a little difficult
for the majority of us, but try doing the 10 minutes using your
wheelchair or scooter. Just the
“exercise” of getting out and “walking” can help reduce tension.
************************************
Reprinted from the
HEALTHSMART
By Dr. Tedd Mitchell
Act Against
Incontinence
There’s
help for urinary problems, whatever the cause.
When I
was in medical school, I had a long bookshelf over my desk. Over time, the weight of the books took their
toll. Any extra weight made the middle
of the shelf sag. The problem was both
too much pressure coming from above the shelf and not enough support provided
by the shelf. So there were only two
solutions: either decrease the load from
above or shore up the support from below.
A similar situation happens in many adults as we age.
Urinary
incontinence comes when the muscles that make up the pelvic floor (the “shelf”)
can no longer support the weight of the bladder and other pelvic organs, or
when the bladder muscles (the “books”) contract forcefully enough to overrun
the support of the pelvic floor muscles.
Both lead to incontinence.
Here
are three major types:
Stress incontinence. In
women, this occurs when the pelvic floor muscles stretch to the point that they
no longer support the bladder. The
bladder falls downward, making it difficult for the muscles that “pinch” the
urethra to do their job.
Pregnancy/childbirth and weight gain (both of which overload the
“shelf”) make this more likely to occur.
In men, the muscles, that pinch the urethra become lax; this can happen
after prostate surgery or pelvic radiation
therapy. People with stress
incontinence leak urine while coughing, laughing, bending over or exercising.
Urge incontinence. This occurs when the pressure above the
pelvic floor muscles overrides the capacity of those muscles to hold
urine. If the bladder muscle contracts
harder than usual, urine leaks. Possible
causes, in addition to aging:
neurological issues (strokes, Parkinson’s disease); pelvic and abdominal
tumors; bladder polyps, and kidney and bladder stones.
Overflow incontinence. This occurs when normal urine flow is
stopped (such as in a man with a very large prostate) or when the bladder
becomes so weakened or disabled that it can’t contract at all. Urine collects until small amounts trickle
out. Because this type of incontinence
can mean serious underlying health problems, it needs to be addressed
immediately.
See your doctor if you develop
incontinence. Telling your story and
getting an anatomy check is the only way to tailor a program for your
needs. Some forms of incontinence
require medical therapy; others, surgery.
So, see your doctor as a starting point.
~*~*~*~*~*~*~*~
If You Are a Sufferer…
► Urinate regularly.
Go whether or not you feel the
need. Then do it again. This is called “double voiding.”
► Eliminate diuretics.
Coffee, tea, cola and alcohol
produce more urine than normal. You
don’t want to increase your urine output.
► Don’t over- or under-hydrate. Drinking too
much water has the same effect as a diuretic.
But don’t drink so little that you become dehydrated.
► Try pads. Both men and women can use sanitary napkins.
► Practice Kegels.
These exercises strengthen the
pelvic floor muscles. Imagine urinating
and stopping in midstream. You’ve just
done a Kegel.
► Consider
other non-surgical options.
Women can use
pessary devices to support the pelvic floor and lift the bladder back into
position. Some doctors recommend electrical
stimulation for those with urge incontinence.
Contributing
Editor TEDD MITCHELL, M.D., is the medical director of the renowned
Wellness Program at the Cooper Clinic in
FECPPSG Editor’s
Note:- One of our local members,
Dr. Tom Brown, a urologist, after reading the article, said "it is a good
basic article that could be of help to some people". You may recall that Dr. Brown was one of our
presenters at our 2000 conference.
************************************
STRESSBUSTERS
Courtesy of High Desert Medical Group
Health Smart – An Approach to Wellness
► Get up fifteen minutes
earlier in the morning. The inevitable
morning mishaps will be less stressful.
► Don’t rely on your
memory. Write down appointment times,
when to pick up the laundry, when library books are due.
► Procrastination is
stressful. What-ever you want to do
tomorrow, do today, whatever you want to do today; do it now.
► Plan ahead. Don’t let the gas tank get below one quarter
full, keep a well stocked “emergency shelf” of home staples, don’t wait until
you’re down to your last bus token or postage stamp to buy more, etc.
► Don’t put up with
something that doesn’t work right. If
your alarm clock, wallet, shoe laces, windshield wipers whatever – are a
constant aggravation, get them fixed or get new ones.
► Be prepared to
wait. A paperback can make a wait in a
doctor’s office (or even the post office) almost pleasant.
► Pollyanna-Power! For every one thing that goes wrong, there
are probably 10 or 50 or 100 blessings.
Count ‘em!!
► “Worry about the pennies
and the dollars will take care of themselves.”
That’s another way of saying:
take care of the todays as best you can and the yesterdays and the
tomorrows will take care of themselves.
► Eliminate
self-destructive talk:: “I’m too old
to…, “I’m too fat to…, etc.
► Create order out of
chaos. Organize your home and workplace
so that you always know exactly where things are. Put things away where they belong and you
won’t have to go through the stress of losing things.
► Become more flexible. Some things are worth not doing perfectly and
some issues are well to compromise upon.
“Whatever is worth doing is worth doing poorly.”
► Add an ounce of love to
everything you do.
► SIMPLIFY, SIMPLIFY,
SIMPLIFY!!!!
FECPPSG
Editor’s Note:- Found this in the
December 1997 newsletter from the Post-Polio Resource Group of
************************************
Reprinted from the Daytona-Beach
HEALTHSMART
BY DR. TEDD MITCHELL
Be
a better caregiver
The Terri Schiavo case
in
Consider Needs. That includes your own
and those of your loved one. If your
day-to-day schedule is already overwhelming because of work or other
obligations, or if your loved one has several illnesses requiring frequent
attention, then perhaps an institution is the best place for him to be. On the other hand, if you have the time, your
home is conducive to chronic care and your loved one is otherwise stable, then
the home environment may be just fine.
Accept Help. As our
population ages, groups like the Alzheimer’s Association have formed to provide
family members with useful information on available resources. Also, accept help from friends, family
members, church buddies, etc. Getting
other folks to handle simple tasks (such as house-work) relieves a tremen-dous burden.
Realize Limits. This is
where you need to be honest with yourself. My grandfather died at home from Alzheimer’s
disease, but a major reason we were able to take care of him there is that my
father is a physician. Be realistic
about your capacity to handle a chronically ill person in your home. On the other hand, it’s important to be
realistic about the limitations of long-term-care facilities. Expertise and an ability to address a
patient’s medical needs should be expected, but the TLC aspect of care may
prove disappointing.
Expect Setbacks. There is a saying in
medicine: Bad things happen to sick
people. It’s difficult to face, but it’s
important to understand that chronically ill patients are on a health roller
coaster. Ups and downs are to be
expected, even when the care they are provided is stellar.
Get Moving. Exercise is one of the
best stress-management tools avail-able, so make it a priority in your daily
routine.
Imitate. This is important
whether care is given at home or in an institution. Observe the experts. Feeding, bathing and dressing someone who can’t
help you is an art form. Helpful tips
from those who have done it can make your routine much easier, even fulfilling.
Vacation. Yes, you need to take
breaks. Disengaging from the day-to-day
care is important. Although spending the
summer in
Eat Right. When
caring for others, there is a tendency to neglect ourselves. Energy for the day means good nutrition;
giving your body what it needs during this time is important.
Rest. Becoming sleep-deprived
is a mistake far too many people make when caring for the sick. If you’re not adequately rested, you can’t
take care of someone else.
Contributing
Editor TEDD MITCHELL, M.D., is the medical director of the renowned
Wellness Program at the Cooper Clinic in
************************************
UPCOMING CONFERENCE
FECPPSG
Editor’s Note:- Dr. Gudni Thorsteinsson
has been at our own support group meetings and our 2000 Conference - we all know that he is quite knowledgeable
about PPS. Dr. Selma Calmes was one of
the presenters at the recent Polio Health Intl conference I attended (in fact
her anesthesia article is in this newsletter) and also an excellent speaker
with knowledge of PPS. Both doctors are
also polio survivors.
************************************
FECPPSG Editor’s
Note:- The following came via e-mail right
after our May/June newsletter went out.
Don’t know anything about the sender or her web-site but I do know that many of us do need
mis-matched shoe sizes and they are hard to find (especially for women). Please let me know, if anyone uses this site,
how it turns out.
MIS-MATCHED SHOES
Dear Post-Polio Support Groups,
I am a post-polio survivor, from the west coast of
Please share my WebPages with your Post-Polio Support
Groups or anyone needing this
service.
Also, if you know any other groups, etc., that may want to
be included, please send any suggestions to me via e-mail.
Thank you for helping,
Catherine Beausoleil
MermadeArt@comcast.net
"PED-PALS" web page
for mis-matched shoe listing service:
www.mermade.homestead.com/ped-pals.html
************************************
HAVE A GREAT SUMMER
SEE YOU IN SEPTEMBER!
************************************