**********************************
************************************ MEETING NOTICE
therapy,
and also rehabilitation updates.
**********************************
CONTENTS
From
Barbara
Placebo
Effect
Tea
May Help Boost Weight Loss
3
Steps to Forming Good Habits
Diabetes: The “Silent” Killer
General
Glucose Guidelines
Today
Analyzing
Your Gait: Rolls of Exercise, Bracing or
Surgery
Sinus
Infection and PPS
Dysphagia
Be
Cautious with Over-the-Counter Medicines
The
3 C’s of Poison Control Safety
Carpal
Tunnel
6
Tips for Carpal Tunnel
Too
Much of a Good Thing
Dues
Calendar
Watch
************************************
FROM BARBARA
Well, this newsletter
I have little to report. However, I did
take a three day bus trip to South Florida – to the Miccosukee
Indian Resort (casino establishment to be perfectly honest) – their handicapped
room was very good (the only complaint from my roommate that there was no
counter space to place her makeup on)… they had a “roll-in” shower with a
shower seat in it, grab bars all around the shower, and grab bars around the
commode. The buffet area was spacious
enough for me to get around with my scooter without bumping into tables,
chairs, etc. BUT, the casino itself was
almost impossible to maneuver in unless you wanted to gamble in the early,
early morning hours. The good thing
about that was I didn’t lose any money gambling!!!
The following morning we went on a boat ride around the
fabulously wealthy homes. Although they
couldn’t take the scooter onboard, they were more than willing to help me onto
the boat, which they did. It’s nice
having two big, strong men asking what can they do to
help you.
From the boat ride we went to Viscaya,
the estate of John Deering – the grounds are
absolutely beautiful and the inside (at least the first floor) not to be
believed. They had a chair-lift to get
my scooter up and into the house itself.
After exploring the first floor, they told me that it was not possible
for me to go upstairs but they did have a video for me to watch so that I could
see everything that was upstairs. I
started watching the video but, our bus was getting ready to leave so we all
had to leave before everything could be seen.
Then it was back to the Miccosukee Resort for
dinner and some “gambling” – instead of the gambling my friends and I played
cards (which we had brought with us)…. we found an area in one of the bars with
tables and just sat there and played.
The following day, we left the Resort and took a drive all
around the
I must say this – the bus we went on had absolutely no
problem putting my scooter into one of the luggage bins and the driver was
absolutely fantastic – taking the scooter in and out several times each day we
were away. My newest Rascal scooter
allows the tiller to be brought all the way down to the seat level which is a
big help in getting the scooter into luggage bins.
All I can say is I would do this particular trip again but
wish the gambling establishment was more conducive to allowing me to do some
gambling.
************************************
Reprinted from
Daytona Beach News Journal,
‘Placebo effect’ plays
games
with the mind.
Crocodile dung,
bloodletting, pills dispensed from impressive apothecary jars: Medical history is littered with treatments
that likely didn’t work – except to the extent that people believed in them. Here are some tidbits about the mind-body
connection that science refers to as the “placebo effect”:
■ The term “placebo effect” was coined by Harvard
anesthesiologist Dr. Henry Beecher. He
studied placebos after witnessing wounded World War II soldiers receive
injections of salt solution instead of morphine when battlefield supplies had
run out. The patients experienced
considerable relief, as if they had received a drug.
■ There are a few reports of patients becoming addicted to
placebo pills. One patient swallowed
10,000 placebos in one year. Another
went through withdrawal symptoms when the placebos were taken away.
■ Belief can foster ill effects as well as good ones: People who think a treatment will give them
side effects can suffer nausea, rashes, headaches and pain from what is
actually a placebo.
■ The strength of the placebo effect can be influenced by
the size and number of pills given, the number of daily doses and even the
pills’ color. (One study reported that
people were more likely to report drowsiness from taking blue pills than pink
pills.)
~*~*~*~*~
From same article….
Tea may help boost
weight loss
Tea, which studies suggest may be associated with decreased
risk of heart disease and cancer, may also help in the battle against the
bulge.
A study published in the American Journal of Clinical
Nutrition suggests that substances in tea may promote weight loss by increasing
the amount of energy spent by the body.
The researchers theorize that green tea, which has thermogenic
properties that promote fat oxidation as a result of the catechins
contained in tea, may work together with other chemicals to increase weight
loss.
************************************
Reprinted from FITSMART, Jorge Cruise,
3 steps to forming good
habits
Establishing a
good habit takes about 30 days. How to
keep focused during those Few weeks? Stephen Kraus, psychologist and president of
KeepYourResolution.com, suggests:
■ Replace bad habits with good ones.
It’s
easier to replace a habit than to just drop it,” Kraus says. If you eat under stress, replace it with a
better reaction, like power-walking or calling a friend.
■ Set a time to indulge. “Some research shows an
effective short-term strategy is scheduling bad habits,” Kraus says. If you tend to overindulge daily, set one
hour a week to eat anything. When a
craving hits, tell yourself, “I can have that on
Sunday from
■ Get past black-and-white thinking. Most people let one pitfall snowball. Reward success instead of focusing on the
slip.
************************************
Reprinted from HEALTHSMART
Diabetes: The other
“silent
killer”
Dr. Tedd Mitchell
Undetected,
it ravages bodies in an unfettered fashion.
High blood pressure long has been referred to as the
“silent killer,” because patients suffering from the illness often don’t
realize they have a problem until their organs are seriously damaged. Like high blood pressure, diabetes is a
disease that sneaks up on millions of Americans. It’s increasingly recognized as a major cause
of death and disability, yet many who suffer from diabetes are unaware they
even have it until they experience a debilitating side effect of the disease.
This disorder damages many tissues. Most complications involve the cardiovascular
system (heart, disease and stroke, for example). Other problems caused by diabetes include blindness,
kidney disease, nerve damage, impotence, amputations, inability
to fight infection and complications in pregnancy (including birth
defects). The trouble is, because many
aren’t aware they even have diabetes, the illness damages the body in an
unfettered fashion before being discovered.
Type 2 diabetes is by far the most common form of the
disease. Those at higher risk include
elderly people, people with a family history of diabetes and overweight
folks. Certain ethnic groups, such as
Hispanics, blacks, Native Americans ad those of
The good news:
Diabetes responds nicely to behavior modification. Two of the most effective tools for combating
the illness are weight control and exercise.
In fact, our nation’s growing obesity problem is linked to the increase
in diabetes over the past few decades.
Numerous studies have shown a strong association between increasing
fitness and decreasing one’s risk for diabetes.
ARE YOU AT RISK?
The best way to find out is to be evaluated by your doctor,
who can perform the appropriate blood tests and interpret them for you.
You also can pick up a glucose monitoring kit at the
drugstore and check your blood yourself.
Be sure to fast for a minimum of eight hours before you perform the test
to ensure that any food eaten recently will not alter the results. Follow the kit’s directions, and use the
guidelines below to see how you stack up against the general glucose guidelines
from the National Institutes of Health.
Contributing Editor Tedd Mitchell, M.D., is medical director of the Wellness Program
at the renowned Cooper Clinic in
~*~*~*~*~*~*~*~
GENERAL GLUCOSE
GUIDELINES
Normal blood sugar =
Less than 100mg/dl
Pre-diabetic –
100 to 125mg/dl
Diabetic =
126mg/dl or more
************************************
The following was sent to me via e-mail
some time ago –
I apologize for not remembering who sent
it to me.
TODAY!!
Today, when I awoke, I suddenly
realized that this is the best day of my
life, ever!!
There were times
when I wondered if I would make it to today; but I did!
And because I did I'm
going to celebrate!
Today,
I'm going to celebrate what an unbelievable life I have had so far: the
accomplishments, the many blessings, and, yes, even the hardships because they
have served to make me stronger.
I
will go through this day with my head held high and a happy heart.
I will marvel
at God's seemingly simple gifts:
the morning dew,
the
sun,
the
clouds,
the
trees,
the flowers,
the
birds.
Today, none of these miraculous creations will escape my notice.
Today, I will share my excitement for life with other people.
I'll make someone smile.
I'll go out of my way to perform an unexpected act of kindness for someone I
don't even know. Today, I'll give a sincere compliment to someone who
seems down. I'll tell a child how special he is, and I'll tell someone I
love just how much I care for them and how much they mean to me.
Today is the day I quit worrying about what I don't have and start being
grateful for all the wonderful things God has already given me. I'll
remember that to worry is just a waste of time because my faith in God and his
Divine Plan ensures everything will be just fine.
And tonight, before I go to bed, I'll go outside and raise my eyes to the
heavens. I will stand in awe at the beauty of the stars and the moon, and I
will praise God for these magnificent treasures.
As
the day ends and I lay my head down on my
pillow,
I will thank the
Almighty for the best day of my life.
And I will sleep the
sleep of a contented child, excited with expectation because I know
tomorrow I am going to make it the best day of my life!
Everyone should give
encouragement...
Encouragement is oxygen
to the soul.
************************************
Reprinted from
ANALYZING YOUR GAIT:
The
ROLES OF EXERCISE, BRACING OR SURGERY?
A
review of Dr. Esquenazi and Dr. Keenan’s presentation
at Post-Polio Health International’s 9th International Conference on Post-Polio
Health and Ventilator Assisted Living: Strategies for Living Well, St Louis,
MO, June 2 -4, 2005.
Compiled by Hilary Hallam from notes
taken at the presentation and an audio record.
Dr.
Alberto Esquenazi, is a rehabilitation physician and Director of the Gait
& Motion Analysis Laboratory at
|
|
“As you know quite
well there is not a lot of expertise out in the real world in the realm of post
polio syndrome. Unfortunately it’s a disease that we don’t learn in medical school.
It is a disease that is not taught in health care in general but is one that is
critical to individuals like you.” [Esquenazi]
“There
is no better way to treat Post Polio than to prevent it, so we are always
encouraging people to think about polio prevention” [Esquenazi]
Both
doctors ran the largest Post Polio Clinic in the mid
Dr. Esquenazi
defined polio, post polio and the nature of polio muscle weakness. He explained
how braces help to substitute for that weakness, and how in his clinic they optimise brace alignment and fit.
“Acute
poliomyelitis is an infection of the anterior horn cells in the spinal cord and
usually it will present as a febrile episode with weakness, with stiffness and
with pain.” [Esquenazi]
There
are about 1.5 million polio survivors alive today in the U.S.A. [USA population
of 297 million, about 0.5%] and about 20 million polio survivors in the world
[World population of 6,455 million, about 0.3%].
PPS
usually presents a variety of problems, muscle weakness, overuse syndrome,
nerve injuries, joint derangement, and the natural aging process.
He
stated that patients tend to overestimate the strength of their muscles and
often present with pain in, say, one area. However, it is not a focal disease
but a systemic disease and affects the whole body. It had a larger affect in
the areas where clinical paralysis and weakness were seen. He described polio
as “throwing a large bucket of black paint at a white wall, ending up with one
large blob and lots of little blotches everywhere else. That’s POLIO.”
Dr.
Esquenazi went on to discuss Manual Muscle Testing,
describing it as the old way that testing was done! i.e.
basically grading muscles from 0 [with no muscle strength] to 5 [normal muscle
strength]. “That is the way it was done and is continuing to be done in many
places. We have learned now that that is not a good way to do it. We now use
hand held dynamometry as a way to test strength because a grade 5
muscle—normal—could have as much as 30% weakness before Manual Muscle Testing
could detect it.”
According
to Dr. Esquenazi, the meat of the matter is calf
weakness, and everyone needs to appreciate what this means. He explained that
our calf muscles have to hold our whole body weight when we are in the stance
phase, to prevent us falling. That we have to lose a huge amount of calf
weakness before it is detected by strength testing. When we walk we take many
steps which is what needs to be assessed, not just one step.
He
explained how we also underestimate the demands that we place on our muscles
every day: just sitting, keeping our head and back straight plus demands on our
legs to cross them and move them around. Then add walking! Also as we get older
we tend to get a little bigger, and he added that Americans tend to get a
little bigger than the bigger, adding to problems and producing fatigue.
A
review of the information provided by the 500 patients in their clinic showed
that most patients complained of fatigue. A large number complained of muscle
pain, joint pain, muscle weakness, new muscle weakness, cold intolerance,
atrophy, problems with walking (almost 80%) and stair climbing.
He
then talked about the consequences of trying to walk. He explained that we have
been compensating for decades, and our joints pay a price for that. He showed a
film of a lady with a large amount of back flexibility in her knee joint,
stretching, straining and damaging not only muscles and tendons, but also skin,
nerves and vessels—ending up with a complaint of pain.
He
said “many of you got to the age of 17 and 18 and decided ‘No more braces’ with
the thought that ‘if I can get rid of my braces then I am better.’
Unfortunately we know now that that was not a good idea. Plus you hide your
braces. President Roosevelt worked endlessly to hide his so that he did not
appear to be ‘disabled’.”
In
their Gait Laboratory they put a series of little infra-red sensory stickers on
a patient that allows them to convert the human figure into a computer
animation so they can measure how we walk in great detail. This can be
manipulated and rotated and viewed from any perspective. They can measure the
speed, symmetry and displacement of joints and do this without and then with
bracing.
He
then showed a slide of a gentleman carrying a very large toolbox and asked why do you think this patient came to visit us. There was a lot
of laughter when the first person called out, ‘His fingers are tired’. ‘Yes,
and he is also likely to get backache and shoulder problems. Can you guess his
job?’ I replied, ‘something very strenuous because he is a polio
survivor’. Dr. Esquenazi
told us that he is a maintenance engineer in a huge Casino with endless corridors
and has to carry all that he might need with him; that he wrote to his
employers and the
He
then went on to explain that there are two phases to walking, the stance phase
when the foot is on the ground and the swing phase when the leg is off the
ground. Braces and adaptive postures can do a great job at substituting for
stance phase muscles but there is nothing to help swing phase muscles so they are
very vulnerable to overuse.
“There
are old style and new style braces but unfortunately
the new style braces, even though they are lighter and more visually appealing,
have become more and more ones that are brought out from a factory and shoved
on a patient. The art of making braces is dying.”
He
explained that people are not going into training, that
Insurance Companies do not want to pay for braces, and that dealing with polio
survivors is a pain because they know what they want and it never comes out
right. What does a brace do for us? It substitutes for weak muscles. The brace
produces support to the leg when standing, and when walking, where the foot is
in the stance phase. In general it does nothing in the swing phase although
there are a few exceptions. Braces do nothing for us when we are
sitting—although sometimes they make our leg uncomfortable.
Weak
calf muscles mean that the tibia bone is not held strongly, and wants to fall
forward, tending to make the knee buckle. So what do we do? We use our hand to
push back on our thigh, or maybe just snap our knee back into hyperextension.
The next thing we do is to take short steps, which do not strain our legs as
much. We may complain that we cannot keep up with our friends and are
fatiguing, but it could just be taking short steps—longer ones might cause our
knee to buckle. Or we may walk with our knee stiff so that it does not have to
make that effort. The answer is to
put a brace on it.
Braces
[AFO’s: ankle foot orthosis]
come in all colors and shapes so the first step is to try to pick one that is
visually acceptable to the patient. Although it might not seem the first
criterion, they want us to wear it. Secondly it must be properly mechanically
built. Thirdly it must not hurt. He asked how many patients in the room wore
braces; how many have a sore or callous and a few people kept their hands up.
He explained this was not unusual; that we are willing to tolerate calluses,
rubbing, high pressure, because it lets us do more, but this is not acceptable
and it shows how tolerant we can be. “Go back and have your brace reassessed.”
In
his clinic they tend to use braces that are hinged and have movement—although
that is not universal—because when the foot hits the ground it needs to get flat
to make us stable. If the foot is not allowed to do that then we need to make
extra effort, bend our knee early, flex our hip earlier, and do things to
accommodate this, which will usually strain our thigh muscles.
Back
knee deformity is another very frequent problem usually aggravated if the foot
is stuck in a toe down position. A long time ago surgery to stabilize the knee
was sometimes to put your foot into a fixed position pointed down. It can be
prevented but it’s not easy once it’s started and we tend to need a long leg
brace. Long leg braces KAFO’s [knee ankle foot orthosis] come in many flavors and shapes. At their clinic
they like to use braces that are not locked at the knee if at all possible.
Where
feasible they like to allow ankle movement but this has advantages: moving the
foot up and down gives a more natural gait, adding a little spring to kick the
foot up if necessary— and disadvantages: it has the potential for unwanted
ranges of motion; the brace can become loose, the joints not doing what they
are supposed to, and they require more maintenance, replacing parts and pieces
where necessary.
In
their clinic they use spring assisted braces, ultra light-weight carbon
graphite and the newest of all, weight activated braces that lock as your
weight goes down on them and unlocks as your weight comes off. While not
without problems they work for some people.
Shoulder
and wrist problems when walking! Dr. Esquenazi said
they have learned that if we have weakness in our legs then we will end up with
problems in our shoulders and wrists, either from pushing a wheelchair, pushing
ourselves up to stand, or leaning heavily on crutches. He then showed film of a
patient who helped with their research, followed by an animation showing how
she stood up from a chair. “She uses her head and twists her pelvis in an
awkward manner. Now we can try and figure out what is causing this. Think hard
of the extra problems, the extra stress and strain on her shoulders and wrists
if she weighed more.”
Sometimes
they can make braces for upper limbs but they are a little harder to do and
less effective than lower limb braces.
“Key
Issues to remember.
1.
The earlier you apply a brace the better
because you will reduce some of these strains and problems down the line.
2.
The lighter the brace the better because
it will take away the strain during the swing phase when you have to ‘carry’
the brace.
3.
Where possible have your brace optimized
for alignment at least twice a year. Remember you take it off at night and stand
it against the nightstand and it falls over and could now be out of alignment.
If you think it now feels a little stiff, or has a kink in it, get it checked
out.
4.
Your relationship with your Orthotist is long term. Find a knowledgeable and preferably
bracing experienced physician to work as your advocate. Take a third person
with you to help ensure that you both understand what you are saying.
5.
You are taking the brace home —the brace
maker will tell you it looks good — but does it feel comfortable?”
“I
will now hand over to my colleague Dr. Mary Ann Keenan.”
Dr.
Keenan started by talking about Exercise, saying, “We have found out that it is
really difficult to truly improve muscle strength.” She said that they do see,
and can measure, some improve-ment in muscles
strength after adjustments with bracing, lifestyle, weight etc, but they think
that once people have stopped abusing their muscles they just recover their
base line strength. It is very important to continue to exercise to maintain
that strength and flexibility and prevent disuse weakness.
Their
guidelines are:
·
Low resistance and low impact – not
exercising against a lot of force. Water exercises sometimes are helpful as you
have the buoyancy of the water to support you against the resistance of the
water.
·
Short duration -say two minutes -of
exercise for each area of the body, rotating the different muscle groups.
·
Do not exercise any group of muscles to
the point of fatigue.
·
Take frequent rest periods.
Dr.
Keenan then went on to talk about surgery. Surgery is not a huge part of caring
for people with post polio problems but if you do need surgery then it’s
important to have an
·
Anesthesiologist – “who understands the issues
of post polio and the need to go light on all their many drugs.”
·
Surgeon – who accepts and practices the
holistic approach to surgery, someone who goes beyond looking at the leg in
question, to both legs, arms and in fact the whole body.
·
Knee surgeon – who understands how the
foot impacts on the knee, how a weak calf can lead to knee problems.
People
who have a little weakness in their calf have to use their quadriceps in the
front of their thigh more strenuously leading to kneecap problems, grinding of
the kneecap and tendonitis in the thigh muscle. If the calf is even weaker with
back-knee then you can have more serious problems. Dr. Keenan has seen patients
who have had their knee scoped a couple of times, by good surgeons, nibbling
away at their meniscus because of tears, who did not realize that the problem
was being caused by the weakness in the calf. It is really important for health
professionals to look for the underlying cause.
She
explained that she performs surgery for pain relief, correction of deformity,
on occasion redirecting some muscles’ forces with tendon transfers, stabilizing
joints and to reshape a leg or foot so that a brace can be made which will
provide good structural support. “Getting rid of that brace was a 50’s and 60’s
idea but it is no longer appropriate”.
Dr.
Keenan tells all her patients that there is a lot she can do for our legs but
we have to save our shoulders, the key to our independence. We need to minimize
the mechanical force we put on our shoulders, e.g. pushing up to get out of
chairs, leaning heavily on crutches etc.
Dr.
Keenan then went on to talk about specific problems.
Rotator
Cuff Problems
– caused by overuse of shoulders. MRIs are taken of
the shoulder joint, but Dr. Keenan ensures that this also covers the muscles
that control that joint; looking at the actual tears in greater detail, and
also to get some concept of the quality of the muscles that work that joint. If
the muscle is filled with fat then you know it does not have much muscle
strength. To reattach the tendon there needs to be enough muscle fiber to work
the shoulder again. Rotator Cuff Surgery is a big investment of patients’ and
family’s time because during recovery you cannot use that arm whilst the
shoulder is healing. It is imperative to look at what actions caused the tear
so that you modify how you do the action to prevent it occurring again. Some
strength can be lost but overall the results are good.
Carpel
Tunnel Syndrome – surgery is not always necessary. It may
be as simple as changing grips on canes and crutches, or better leg bracing so
you don’t have to lean so heavily on aids. Where this has been going on for
some time with significant arthritis, where really severe, she might stabilize
the wrist to get rid of the pain but this takes away the motion so she tries to
avoid this type of surgery.
Equinnus – toe down position. When you walk and your toes go down first instead of your heel. It is like having a built-in doorstop pushing you backwards and jamming your knee backwards. Here she lengthens the