FLORIDA  EAST  COAST  POST-POLIO  SUPPORT  GROUP - Vol. 13 #6

12 Eclipse Trail  /  Ormond  Beach,  FL  32174  /  386 676-2435

E-Mail:-  bgold@iag.net   -  Web Site:-  home.iag.net/~bgold

 

MAY /  JUNE   2007

 

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WE  WISH  ALL  OUR  FRIENDS

 

A FLOWER FILLED and LOVING MOTHER’S DAY

A SUNNY MEMORIAL WEEKEND

-and-

A FANTASTICALLY LOVING FATHER’S DAY

 

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MEETING NOTICE

 

May  20th, 2007    --               Topic for Discussion – Where do we go from here???

September 16th, 2007 --

November 18th, 2007

 

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CONTENTS

 

From Barbara                                      

The Meaning of Disease in the Course of Life                       

Physical Therapy                                         

Growing Old                                      

Health Smart – Caffeine Culture       

Align Your Mind                                

Slow Down, Read This,         Multi-Tasker                             

Polio Particles                                  

Medicaid Assistance with Nursing Home Expenses       

PPS Questionnaire Answers                  

Wartime President – Franklin D. Roosevelt                        

 

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FROM BARBARA

 

Nothing really to report – did nothing interesting the past two months.  Flew to Long Island, spent quality time with grandchildren, saw some friends, and came back home.

 

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Reprinted from Polio Deja View, Central VA Post-Polio Spt Grp, April-May 2007.  Dr. Henry Holland, then, very kindly e-mailed the article to me so as to save me some typing.  Much Thanks, Dr. H.

 

From Henry’s Desk:

The Meaning of Disease in the Course of Life

 

Have you ever wondered who was the greatest or most admired person that you have heard speak in your lifetime; a person that you were a living witness of their presence and their words?  In answering this question I feel some comfort in having had the opportunity and experience of hearing two great physicians during my life. Of course persons that may seem “great” to me may not be an opinion shared by others.

 

A little over two decades ago I had the privilege of hearing an address by Dr. Albert Sabin at the Saint Mary’s Hospital in Richmond, VA. On that occasion Dr. Sabin talked about his and others’ efforts to develop a vaccine for the HIV virus. He did not mention polio, but after his address I talked to him briefly and expressed my admiration for his work and success in developing the oral polio vaccine, often called the Sabin vaccine. Dr. Sabin lost the race with Dr. Jonas Salk in developing the first polio vaccine. However, if polio is successfully eradicated from the planet earth it will be a direct result of the Sabin vaccine. Dr. Salk did his clinical studies in the United States and the immediate success of his vaccine brought great relief to many parents of children in the 1950s. Dr. Salk is remembered to this day for his great success. Dr. Sabin had his clinical trials done in the Soviet Union at the height of the Cold War. His trials demonstrated the success of his vaccine and the Sabin oral polio vaccine replaced the Salk vaccine as a more easily administered vaccine and probably providing a longer lasting immunity. This vaccine was given by the painless sugar cube. Today infants and children in the United States receive four injections of the dead Salk vaccine (recommended by the Center for Disease Control in 2000) because the risk of contracting polio is extremely low.  Prior to the year 2000 the oral polio vaccine was used in the USA and was effective in eliminating wild polio from the USA. On the day that I listened and spoke to Dr. Sabin he seemed like an unpretentious man, but a man of science who was still trying to find ways to eradicate viruses, especially the HIV virus. I left that meeting feeling uplifted by the encounter.

 

In the spring of 1965 while I was a third year medical student at the Medical College of Virginia I had the opportunity to listen to an address by Dr. Paul Tournier in the George Ben Johnston auditorium. This auditorium was more like a surgical amphitheater, but could seat several hundred people. The room was crowded that day.

 

Tournier was born May 12, 1898 in Geneva, Switzerland. He was orphaned by the age of six.  He was a bright student and earned his M.D. degree from the University of Geneva in 1923. He was primarily a general practitioner. Following his university days he became deeply interested in Christianity in the tradition of John Calvin. He made the decision to integrate his medical knowledge with counseling and spiritual values. He never had formal training as a psychiatrist, but his writings have established him as a pioneer in the realm of psychiatry and mental health, particularly for this writer.

 

On that day this writer was twenty-five years old and eager to learn. I remember more about his delivery than his actual words. He talked mostly about his book, The Meaning of Persons.  Dr. Tournier presented his remarks in French and an older distinguished looking lady translated his comments into English. Their alternating back and forth delivery was both spontaneous and poetic. I left that day feeling greatly uplifted and inspired.

 

Dr. Tournier wrote many books on the human condition and especially the human condition in relationship to disease, with each other and to God.  One of his books that I treasure is entitled A Doctor’s Casebook.  As survivors of polio and Post-Polio Syndrome we know and have experienced a lot about living with a disease that started at some specific point in our lives and has not finished with us yet. I will end this missive with a quotation from Dr. Tournier’s casebook.

 

“The insecurity of a man’s life will be underlined especially by disease. “Disease is a sign of the death which is to come,” writes Professor Courvoisier. “Every disease has in it the germ of death.”  Doctors at any rate will not contradict him!  Although in health men repress as far as they can the terror of death, it reappears with the slightest disease.  When, in our consulting rooms, they ask us in as detached a tone of voice as they can manage: “Well, Doctor, is it serious?”  We know well enough what they mean. They mean: “Is there any risk of my dying from it?” 

 

Mlle. S. Fouche of Paris, who has devoted her life to the rehabilitation of the crippled and the sick, made an investigation among two hundred patients of what they expected from the doctor. When I heard their replies read out I was deeply moved. What they expected first and foremost from the doctor was to be cured. But in all the replies three themes reappeared with striking urgency and regularity. They wanted the doctor to pay real attention to their suffering and distress, to treat them as human beings and not as guinea-pigs, and to tell them the truth about their disease, about its probable duration.  But many of them added that they did not want the truth to be told them brutally, so that they were cowed and shocked by it, but gently and tactfully so that they might be helped to accept it.

 

The prolongation of life and re-establishment of health, for which medicine labors with all its strength, are seen to be a blessing from the merciful God, a respite, a stay of execution.  We may ask why God grants us this respite.  It can only be that He wants us to use it to come nearer to Him, laying hold through faith on His promises of eternal life.

 

True courage – the courage which has its roots in faith – is that which listens to what God is saying to us through disease and the threat of death. If this is our attitude sickness and death will take on meaning for us, they will have something to teach us, something to bring to us and they will help to make us revive our scale of values.

 

Every sickness is a crisis of life. Every sick person who calls for our help is one who has suddenly become aware of his fragility.  He is at the same time discovering the fragility of everything that once filled his life:  work, money, affections, instincts and pleasures.  If he has regarded them as duties and blessings sent by God, the sudden stoppage caused by the sickness will be easier to bear: he still has God and will wait upon new blessings from Him in the spiritual retreat that sickness can become. But if, on the other hand, he has made them his Gods, if he has thrown himself frantically into them in order to distract and dupe himself, then suddenly and tragically he is faced with the true problems of life and of his own life.  Sickness sets him face to face with God.”

 

Reference:

Tournier, Paul; A Doctor’s Casebook, Good News Publishers, Westchester, Illinois. Pages 35 – 38.

 

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Reprinted from Triad Post Polio Spt Grp, The Seagull, February 2007.  Our thanks to Sharon Bowden for e-mailing article to me – again saving typing energy.

 

PHYSICAL THERAPY

                                                                                       By Susan I. Fish, MAPT

 

          During recent years, I have had the opportunity to meet and work with patients experiencing the late effects of polio.  Many times I have detected some frustration and anger regarding my professional’s lack of experience in treating Post-Polio patients.  I write this brief article now for two reasons:

 

  To explain and help you understand this lack of knowledge on the part of many of my colleagues.

  To provide some guidelines regarding Do’s and Don’ts when seeking physical therapy.

 

Most Physical Therapists (PT’s) (Physiotherapists in UK) working today weren’t even alive during the major polio epidemics.  Their formal education regarding poliomyelitis was more historical than factual, with little more than definitions of pathology and no clinical experience.  Post-Polio Syndrome is only recently being recognized and its existence is still questioned in some medical circles.  Both acute polio and post polio syndrome present clinical pictures which are unlike any other neuromuscular condition.  Without the experience of working with acute polio patient and with little documented information regarding the treatment of Post-Polio Syndrome, it is not surprising to find professionals lacking in know-ledge.

 

Although, there may be reasons for a lack of knowledge, a responsible professional should NOT treat any condition that he or she is not confident and knowledgeable in treating.  You may be able to direct a PT to appropriate resources.  Please see the resources at the end of this article and I would be happy to help also.

 

Reasons for seeking physical therapy will vary. You may be referred to a PT to help you with your Post-Polio Syndrome. You may be referred for rehabilitation following corrective surgery for a polio related condition. You may also be referred for a condition not necessarily related to polio at all such as arthritis, bursitis, tendonitis, fractures, osteo-porosis, low back pain, stiff neck, etc, etc. Your physical therapist is well trained to treat these other conditions. However, your post polio status should be taken into consideration when designing a program. Here is some advice.

 

  Do's and Don'ts to keep in mind when going for physical therapy:

Do trust yourself and the knowledge you have gained over the years

about your body.

Do be willing to alter your lifestyle.

Do avoid fatigue.

Do get enough rest.

Do pace your activities rather than discontinuing them.

Do conserve energy. It may make more sense to spread your activities out, allowing for rest periods, rather than eliminating interests and activities.

◄ Do recognize that your body is aging and some physical changes will occur which are not related to post-polio. There IS a normal aging process even though post-polio may be a part of it.

Do respect your feelings. This may be a difficult adjustment time for you; seeking emotional as well as physical guidance may be a wise thing to consider.

Don't follow advice regarding physical exercise if you become fatigued while doing it.

Don't become short of breath with exercise.

Don't do more than your body feels comfortable doing.

Don't cause pain with activity or exercise.

Don't gain weight.

Don't reject using aids and assisting devices without giving them serious thought. (They are meant to conserve energy and preserve anatomical structures, i.e. joints, muscles, tendons, cartilage and ligaments.) Most are delighted and surprised by the increased endurance and energy they have with the use of canes, wheelchairs, motorized scooters or the many other easily found assisting devices.

 

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This has been e-mailed to me so many times over the last few years that I felt it was time it went into the newsletter.  A quick “Thank you” to Elizabeth Frascella for sending it this time.

 

GROWING 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, and the sagging butt.  And often I am taken aback by that old person that lives in my mirror (who looks like my mother!), 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 avante garde on my patio.  I am entitled to a treat, to be messy, to be extravagant.  

 

I have seen too many dear friends leave this world too soon; before they under-stood the great freedom that comes with aging.    

 

Whose business is it if I choose to read or play on the computer until 4 AM and sleep until noon

   

I will dance with myself to those wonderful tunes of the 40 &50's, and if I, at the same time, wish to weep over a lost love ... I will.


I will walk the beach in a swim suit that is stretched over a bulging body, and will dive into the waves with abandon if I choose to, despite the pitying glances from the jet set.

 

They, too, will get old. 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 even when somebody's 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 turning gray, and to have my youthful laughs be forever etched into deep grooves on my face.  So many have never laughed, and so many have died before their hair could turn silver.   

 

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. (If I feel like it!!)

 

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 Reprinted from Daytona Beach NewsJournal, USA Weekend, March 4, 2007

 

HealthSmart

Caffeine Culture

By Dr. Tedd Mitchell

 

          Not long ago I called my brother, and his wife said he was down at “that crack house” (her name for the local coffee establishment he frequents).  She was speaking in jest, but it’s worth examining:  Can we actually become addicted to caffeine like we can to other drugs?

          According to research from Johns Hopkins University published a few years ago, that may be the case for some folks.  In the study, which appeared in the journal Psychopharmacology in October 2004, psychiatry and neuroscience professor Roland Griffiths led an analysis of more than 60 studies that had been published on caffeine withdrawal.  And Griffiths and his colleagues made some interesting observations.

          But first, what do we know about caffeine?  Medical literature is filled with contradictory information regarding its effect on health.  Some studies suggest that large amounts of coffee may reduce the risk of conditions such as gall bladder disease.  Others show it to have a detrimental effect on things like sleep, blood pressure and bone density.

          Suffice it to say, there is no clear-cut answer on what effects caffeine may have on the body’s health.  For now, let’s look at some of the evidence on caffeine’s addictive potential.

          We know that caffeine is a stimulant.  Stimulants elevate heart rate and blood pressure, can make us more alert and may even improve performance in certain sports.  In fact, the International Olympic Committee, in its doping regulations, in the past included caffeine on its list of restricted agents.  What’s more, like other stimulants, caffeine ma cause a physiological dependency.

          That’s what the Johns Hopkins researchers suggested with their study. 

          In their report, the researchers found five main withdrawal symptoms:  headaches (the most common), fatigue, changes in mood (including depression), inability to concentrate and even flu-like symptoms.  Many people had withdrawal symptoms (50% had headaches), but for most, the symptoms weren’t overwhelming.  However, one in eight (13%) were substantially impaired, experiencing headaches and/or other withdrawal symptoms severe enough to keep them from their normal routines.

          Most withdrawal symptoms started within 24 hours of the last serving of caffeine.  The symptoms peaked within the first two days and then trailed off, sometimes lingering for more than a week.  A daily dose of caffeine did matter (i.e., more caffeine, more withdrawal), but some folks had symptoms when with-drawing from even small amounts.

          Withdrawal headaches from caffeine make it difficult for people to quit.  It’s not fun to suffer when you know that a jolt of caffeine will fix the problem.  Nonetheless, studies like this one reinforce the age-old adage that moderation is key.

          Aim to find that happy medium when consuming any product containing caffeine.  A general rule of thumb is to limit caffeinated beverages to no more than two servings daily.  Still, an 8-ounce cup of coffee may contain twice as much caffeine as a 12-ounce cola, so two cups of coffee would have much more caffeine than two sodas.  In spite of this discrepancy, I think it’s a worthwhile rule to follow.  For most folks, applying this limit to their routines will keep them from the headaches and hung-over feeling that can come with caffeinated drinks.

 

 

5 Caffeine Withdrawal Symptoms

·        Headaches

·        Fatigue

·        Mood changes

·        Inability to concentrate

·        Flu-like symptoms

 

Tedd Mitchell, M.D., president and medical director of Dallas Cooper Clinic, writes HealthSmart every week.

FECPPSG Editor’s Note:-  I, myself, am not a coffee or soda drinker, but know many (including my family members) who drink more than the recommended two sodas a day – so, please, just be careful and watch your intake.  Our health, just by having PPS, is getting many of us with symptoms like fatigue – we don’t need any more problems.

 

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This came to me through

ALIGN YOUR MIND....

THE KEYS TO SUCCESS ARE IN YOUR HANDS.

 

Your life will always be what you make of it.

Your thoughts and actions will lead you to success or failure.

 

Always accept responsibility for your actions.

Always set a higher standard for yourself. No one is going to do it for you.

Only you can make it happen.

 

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Reprinted from Daytona Beach News Journal, March 25, 2007

 

SLOW DOWN, READ

THIS, MULTI-TASKERS

 

Think you can juggle calls, e-mail, instant messages and computer work to get more done in a time-starved world?

 

LIMIT IT:  Several research reports, both recently published and not yet published, provide evidence of the limits of multi-tasking.  The findings suggest that many people would be wise to curb their multi-tasking behavior.

BASIC ADVICE:  Check e-mail messages once an hour.  Listen to soothing background music while studying.  Don’t drive and talk on a cell phone.  In short, manage the technology.

WHY THE CONCERN:  The human brain is a cognitive powerhouse in many ways.  “But a core limitation is an inability to concentrate on two things at once,” said Rene Marois, a neuroscientist at Vanderbilt University, Marois and other researchers found that responses in a study were delayed by up to a second when the participants were given two tasks at the same time.  In many daily tasks, a lost second is unimportant.  But one implication of the research is that talking on a cell phone while driving a car is dangerous.  A one-second delay in response time at 60 miles an hour could be fatal, Marois noted.

-         New York Times

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The following short articles were sent to us by Dr. Mary Westbrook of Australia’s Post-Polio community, as part of her Polio Particles.  Our thanks to Dr. Westbrook.

 

POLIO PARTICLES

Immunoglobulin used to treat PPS.

As Dr. Marcia Falconer has explained in her recent seminar presentations to the Network, there is evidence that an inflammatory process may be the major cause of PPS.  Thus anti-inflammatory medications should help relieve PPS symptoms and several recent research studies have shown this to be so.  Dr. H. Gonzalez and others reported the results of a randomized controlled trial in the journal, Lancet Neurology, June 2006.  In this research patients in four clinics were randomly assigned infusion of either 90g in total of intravenous immunoglobulin or placebo during 3 consecutive days, repeated after 3 months.  There was some improvement in muscle strength in the treatment group as well as in activity levels and vitality.  There was no significant change in pain experienced.  The Summer 2006 issue of the Post-Polio Health International Newsletter  (St. Louis) had a article by Drs, Halstead and Silver evaluating and discussing the implications of this research (You can read it at http://www.post-polio.org/ipn/%20pnnback.html).  A major disincentive is the cost of the treatment which they estimate would be at least $US10,000 for the course of therapy.  They say:  It is not entirely clear who would benefit… Because the diagnosis of PPS is still imprecise, perhaps the only way to be certain if you would be a good candidate or not, is to have your cytokine [an indicator of inflammation] levels checked.  This involves having a spinal tap [lumbar puncture] to obtain a sample of CSF [cerebrospinal fluid] and access to a lab that performs these tests on a regular basis.  The length of time that the positive effects are sustained is obviously of great importance.  On the Post-Polio-Med online mailing list a spokesperson for Post-Polio Health International said it had received the following response to this question from the research group:  We have preliminary results from follow-up studies showing that the cytokine level in the cerebrospinal fluid is [still] significantly decreased one year after the treatment.  There is a statistical improvement of quality of life 2 years after the treatment.  For the individual, the effect may last from 6 weeks to several years.  It will certainly be of great interest to follow the development of this research.  Hopefully a less costly treatment will be found.

 

Enticing nerve cells to paralysed muscles

The Salk Institute for Biological Studies in California has issued a press news (15/6/06) in which Dr. Samuel Pfaff, a leading researcher there, describes how his team has ‘identified a molecule that guides a specific subgroup of neurons to connect to the muscles that line our spine and neck …piece by piece, we are uncovering general principals that ensure that the developing nerve system establishes proper neuronal connections.’  Understanding how axons find their destinations may help restore movement in people following spinal cord injury, or those with motor neuron diseases such as Lou Gehrig’s disease [ALS or motor neurone disease], spinal muscle atrophy and post-polio syndrome.  There is a lot more research to be done before this research is applied to people but they are starting to treat mice.

 

No polio vaccination, no travel

As a result of the alarming rise in polio cases in India WHO is considering asking the Indian government to issue an order whereby Indians traveling abroad will have to ensure that their children traveling with them are vaccinated against polio.  The order, if implemented, would mean that children below five years of age will have to get certificates from a doctor (Indian news website rediff.com, 25/9/06).  Last year the spread of polio to Indonesia from Saudi Arabia was thought to have occurred via Haj pilgrims.  Saudi Arabia has announced it is now mandatory for travelers who are under 15 years of age to have up-to-date proof of polio vaccination in order to obtain entry visas to Saudi Arabia.  Additionally all children under 15 arriving from countries reporting wild polio will be given polio vaccinations at Saudi border points.  In India polio free certification will be given to Hajjis by their district health official.  The Indian Health Secretary said:  The sanctity of the pilgrimage is affected if the messages  goes out that polio is spreading through Haj.  It gives the pilgrimage a bad name.  We are telling Uttar Pradesh [the Indian state with the highest rate of polio] that they will be hemmed in for traveling if they continue to export polio.  (IBNlive.com)

 

Call for development of drugs to treat polio

When we contracted polio there were no drugs with which to treat it.  With the development of the Salk and Sabin vaccines, research into possible treatments for the polio infection virtually ceased.  As discussed in previous Particles the fear remains that there may be future outbreaks of polio despite the eradication campaign.  Now a committee of the US National Research Council has recommended that antiviral medications to treat people with polio be developed (Associated Press 10/03/06).  The committee said that:  The development of one or more antiviral drugs against poliovirus, although expensive, serves as an insurance policy that provides an additional means of reacting to repeated outbreaks due to continued circulation of Vaccine-related strains, should they occur.

 

Goat with polio

Our neighbour’s goat was just diagnosed with polio.  We thought this disease had been eradicated.  Is polio in goats contagious to humans?  How dangerous is this?  This query was sent to Pete Keesling, a Californian veterinarian, who writes a bi-weekly advice column in the Gilroy Dispatch (5/9/06).  He replied:  First, let’s make it clear that polio in people has not been totally eradicated.  It’s extremely important that most children be vaccinated for this terrible disease.  Recent reports show that some people have not taken their children in for vaccinations, leaving them potentially susceptible to devastating consequences if they are exposed to this contagious virus.  On the other hand you have no need to worry about the neighbour’s pet.  Polioencephlomalacia (polio) in goats is not caused by a contagious virus, but results from abnormal Vitamin B-1 metabolism.  In many cases this polio can be successfully treated with injections of vitamins and the patient can make a full recovery. So even though the goat’s neurologic symptoms seem similar to those suffered in humans infected with the polio virus, the disease is significantly different in goats.  So the good news is that goats with the disease can recover and do very well with few long-lasting effects.

 

Feelings of déjŕ vu

The talking point at the wedding was not about the bride’s beauty.  And she was impossibly or extremely beautiful.  The dominate comment was about the bridegroom’s ‘stupidity’.  He was tall and had an athlete’s stature, not the one enhanced by steroids.  But not even steroids could do anything for the bride’s left leg.  It was thin and shorter than the right one.  Polio had made her almost a cripple.  Many people commented that the man was foolish to have chosen such an obviously deformed woman as his bride.  Someone claimed it was not love but a love potion that led the man to propose to the lady.  And there was a time during the ceremony when the bride had almost fallen on her face  dancing was apparently new to her.  She may not have had many dates before her wedding.  Not many young men care to take a polio victim dancing.  This was the beginning of the editorial in the Nigerian Tribune (31/10/06).  I’m sure this story will remind many polio survivors of feelings associated with not being considered socially or matrimonially acceptable particularly when they were young.  The editorial went on to criticize the many Nigerians who think that polio is caused by the cannibalism of a witch rather than by a virus.  Such beliefs and rumours about the dangers of the polio vaccine, the editorial said, have caused resistance to vaccination.  As a result Nigeria accounts for more than half the world’s polio cases and is transporting polio to other countries.  The editorial ended with the following scenario:  It is 2028 and a wedding reception is being held.  ‘Look at the bride,’ one woman says to her friend.  ‘What great legs she has’.  The mother of the bride is within earshot.  She smiles broadly though her own left leg is withered.  The scenario reminded me of the relief that I think most survivors felt when the advent of the Salk vaccine meant their children could never get polio.  It reminded me also of the anguish and anger we sometimes feel at some Australian parents’ refusal to have their children vaccinated.

 

FECPPSG Editor’s Note:-  Unfortunately, it’s not only Australian parents but many parents throughout the world, including some within the United States who refuse to vaccinate their children.  My oldest, BariLynn, was born in 1957 and when it was time for her first vaccination which, at that time, was to be the smallpox one, I told the pediatrician that I wanted her to have the polio shot first – this “older” man (he may have been in his mid-40’s) turned to me and said:  “Mother, don’t you know that children are immune until they are a year old.”  I looked at him and said:  “Then how come I contracted polio at 10 months of age and Bari’s father at 7 months of age?”  The doctor then went and called the Brooklyn Board of Health and told them this – they, in turn, told him to give Bari the polio shot.  I thank Dr. Salk every day when I know that my children and my grandchildren (and their children, etc., etc.) won’t have to worry about contracting polio.

 

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Reprinted from The Council On Aging of Volusia County, Inc., The Counsel, First Quarter 2007

 

MEDICAID ASSISTANCE

WITH NURSING

HOME EXPENSES

Randal L. Schecter, Elder Law Attorney

 

          When the Deficit Reduction Act (DRA) was signed into law on February 8, 2006 few people realized the extent of the changes it made to nursing home Medicaid eligibility.  Two of the biggest changes were to the “look back” period and how penalties would be calculated.  The “look back” period refers to the time before filing an application for Medicaid.  Under the old law this period was three years.  Additionally, penalties are not calculated differently, making it even more difficult to qualify for Medicaid.

          The DRA extended the “look back” period from three years to five years.  This means that an applicant’s financial records can be reviewed for the five year period immediately prior to the application date.  This is to find any improper transfers of assets by the applicant or the spouse.  An improper transfer is any transfer, gift, or other giving away of assets for which the “giver” does not receive fair compensation in return.  For example, the applicant buying a $500 television for him is not an improper transfer but buying it for his daughter is an improper transfer.

          Improper transfers may be more than just personal property of course.  An improper transfer of any type of asset can trigger a penalty.  This applies to cash, CD’s, stocks, bonds, investment accounts, life insurance policies, annuities, real estate, and more.  The reason for the transfer doesn’t really matter – just the fact a transfer was made is enough to cause a penalty.  There are no exceptions for helping a family member who needs medical care, college tuition, a down payment for a home, or for donating to a charity, church or temple.

          Let’s say Mr. Smith helped out his granddaughter with college tuition two years ago by paying $5,000 to the university.  At the time Mr. Smith did this good deed he was healthy and applying for nursing home Medicaid was the furthest thing from his mind.  Now two years later Mr. Smith has had a stroke and will need a nursing home for the rest of his life.  Even if he otherwise meets all the eligibility requirements for Medicaid he will not be eligible immediately because of the gift of tuition two years earlier.  Mr. Smith is penalized for something he did two years ago when Medicaid was not even a consideration!

          The penalty is a time penalty that punishes the giver of the asset by not allowing that person to qualify for Medicaid for a certain number of months.  Under the old law the penalty period ran from the date of the improper transfer.  Under the new law, the penalty periods runs when the application is filed.  So now that Mr. Smith is in the nursing home and needs help paying the bill, he will have to wait for the penalty period to expire and in the meantime figure out a way to pay for his care.  Keep in mind that the greater the value of the improperly transferred asset, the longer the penalty period.

          The new law penalizes people who made innocent transfers or gifts in the past, not knowing they would need a nursing home later.  In other cases people “panic” and make improper transfers or gifts when suddenly faced with the expense of nursing home care.  However, it is possible under the Medicaid rules to correct improper transfers and avoid a penalty period so don’t feel like it’s hopeless if this has happened to you or a family member.

          The DRA made significant changes to the Medicaid “look back” period and to the way penalty periods are calculated.  These changes have made it more difficult to qualify for nursing home financial assistance.  Medicaid planning is complex and the look back period and transfer penalties are just part of the eligibility process.  Because of these changes it is more important than ever to seek the advice of a qualified, experienced Elder Law attorney to help deal with these important issues.

 

FECPPSG Editor’s Note:-  Many of us don’t even want to think about possibly needing Medicaid, BUT – it is important that we look into it as, you never know, you may very well need to apply at some time in the future, especially those of us, like me, who were not able to get Long Term Care insurance because we had a pre-existing condition (polio).  I know that I will be calling an Elder Law attorney at some point in the near (not distant) future.

 

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We were given permission to reprint the below “article” by the St. Cloud chapter of  the Post Polio Awareness & Support Society of MN.  I thought it might be of interest to add my own answers to their questions – I have done that using italics so that you’ll know what answers are mine.  Would be interested in getting some input from other polios.

 

PPS QUESTIONNAIRE ANSWERS

 

The following survey was taken by the St. Cloud chapter. It may be of interest to a number of us.

 

How old are you?

  The nine respondents were between 54 and 77 with an average age of 64.4 years.

I am 72 years young.

 

What was your previous occupation?

  Nurse practitioner

§        Postal Service

Physical Education Teacher/Coach. For 31 years.

§        RN Physician Extender

Typist, helping at St. Raphael’s (former)

I worked for 17 years at the Cold Spring Granite Co. in the monumental dept. and then became a stay-at-home mother. From home I did some lettering and design work for granite companies for many years.

Secretary/Paraprofessional in science Dept at Apollo HS

§        Kindergarten teacher

My previous occupation was a machinist. I stood on concrete for 42 years. 

I was a paralegal for 50 years.

 

 

How long have you known that you have post polio syndrome?