**********************************
************************************ 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 Achilles tendon to get the flexibility
back again and get the foot flat on the floor but the trade off is loss of some
strength. This tightens the toes so they snip the tendons to allow the foot to
lie flat in the shoe.
Cavus – a high arched foot. To help you
get a foot or foot and brace into a shoe your foot needs to be flatter. If
there is no arthritis they can release the ligament on the bottom of the foot
and let the bones go back into their normal position. If there is a lot of
arthritis then they add a little wedge of bone. She showed a video of a patient
whose foot and ankle were fused in the toe down position with the idea that it
would push her knee back/stabilize her knee and so not need a brace. Now in her
50’s she was having knee pain so Dr. Keenan cut through the mass of fused bone
to flatten the foot and gave her a new brace, which solved her problem.
Valgus – foot that rolls over and pronates, flat foot. Having this type of foot can make it
difficult to fit a brace, so realigning the foot into a better position will
give a better base of support. Abnormal feet put abnormal forces on knee and
hip which can cause pelvic wiggle movements and back strains, causing knock
knee or valgus deformity. This can be caused by one
leg shorter, weakness of hip muscles, tightness of the band on the side of your
leg, or a crooked foot. A lot of different factors to be
considered before treating. It may just need a lift on your shoe and a
cane, or Dr. Keenan may need to release some tendons, realign the bone and
sometimes if significant arthritis replacement joint surgery is necessary.
Varus – bow legs. There is no surgery to
tighten up the ligament and joint capsule behind the knee. Long leg bracing can
control this unless it’s really severe with lots of arthritis when knee
replacement is considered.
Quadriceps weakness -very common in polio
survivors. The quadriceps are
the muscles that help us stay upright. If our knees are flexed – not able to
straighten them – then we ask the quads for more help. If we have weak quads
and flexed knees then we are more vulnerable to falls and we lean more heavily
on our arms. If bracing does not work then surgery is considered to lengthen
some tendons, cut the bone, realign the knee or replace the joint.
Hip
flexion problems -make us lean forward and put strain on
our muscles and back using up an enormous amount of energy to compensate;
energy which we are already short on as polio survivors and should not be
wasting.
“If
you let go of a plastic skeleton it collapses. It is the muscles that control
the flexibility of joints and depending on where your body weight is in
relation to how a joint moves normally, then you either need
to have the muscles control that flexibility or a brace that controls it.”
Joint
replacement – for polio survivors there are a lot of
special considerations regarding all the other implications of the combinations
of patients’ muscle strengths. It is imperative that patient and medical
personnel work as a team. Patients need to understand the ultimate restrictions
that this surgery will place on them. If you have already damaged a normal
joint then you will wear out the metal and plastic joint in the same way unless
you change how you do actions. Other leg deformities have to be corrected as
well and it may be necessary to use a lower leg brace as well.
·
Contracture of a joint – you don’t have
normal motion. You can have laxity in one direction or the other because of
stretched out
ligaments and joint capsules. With little muscle strength you
need to compensate.
·
Bones – if you have a lot of weakness or
paralysis in a limb then bones are much weaker, and there may be more osteoporosis,
making fixation of the knee or hip joint challenging.
·
Hip Abductor and Hip Extensor Muscles –
you need pretty reasonable strength of these muscles to keep the ball and cup
of the hip joint together. There is a certain inherent stability to a ball and
cup design and they can pop out of position if you don’t have the muscle
strength to hold it together.
·
Arthritic hip and low muscle strength –
make it impossible to do a hip replacement and alternatives have to be
considered.
·
Constrained hip joint replacements – not
used with polio survivors with weak muscles because it is just going to
transmit all the forces onto the bone making it weak or osteoporotic
and the replacement rip out from its setting. An alternative to get some pain
relief might be to control the position of the leg by cutting the pelvis making a
roof over the hip joint. A video was shown of a lady who had this surgery and six years
later is still walking and has pretty reasonable relief of pain.
Planning
for surgery and post-op rehabilitation – Dr. Keenan
coordinates with Dr. Esquenazi and the team at Moss
Rehab and all treatment is pre approved. As surgery realigns the leg the brace
maker comes into the operating room to make the mold and it’s fast tracked so
rehabilitation can proceed.
Dr.
Keenan then showed short videos of two patients.
1.
A 56 year old with bad deformity
presenting with back pain. She has no muscle strength in left leg, significant
weakness in right leg. Left arm also completely paralysed.
Total knee replacement, long leg brace for left leg and short leg brace for
right leg. 14 years later and she is still walking and going well. BUT she had
to promise me that she would never stand on her left leg without the brace to
protect it.
2.
Knee bending inwards – valgus
or severe knock knee, given total knee replacement. Shown walking two weeks
after surgery with the knee joint locked to protect some tendon repairs. Now
able to walk without the knee joint locked because as much motion as possible
is wanted. This shows her two years post op and it is now six years later and
she is still doing quite well.
Special
considerations for polio survivors pre surgery
– because of weakness, paralysis, osteoporosis, and/or abnormal shaped bones,
there needs to be a lot of work done ahead of time.
·
Look at the whole person not just the leg,
or both legs, and how they do actions of daily living.
·
Each patient is different and we need to
understand that the pattern of strength and weakness, and the compensations that
have been developed over time.
·
Coordinate with anesthesia team regarding
anesthesia and for inter and post operative pain management.
·
Coordinated team approach with
rehabilitation and bracing.
·
Custom joints may need to be made.
As
Keenan stated, “Our job is to avoid your garage or closet being filled with a
bunch of failed and discarded devices”.
Dr.
Keenan then told the audience that they had helped produce
a booklet, freely available on the Einstein Website, to help us save our
shoulders.
Booklet
- Save Our Shoulders: A Guide for Polio Survivors by Jennifer Kuehl, MPT, Roberta Costello, MSN, RN, Janet Weschler, PT. Investigators, Mary Klein, PhD, Mary Ann
Keenan, MD, Albert Esquenazi
MD available for download at:
http://www.einstein.edu/rx_files/yourhealth/mrri_sos9510.pdf
Reprinted by permission from
Lincolnshire Post-Polio Network
FECPPSG Editor’s Note:- Dr. Keenan did my polio surgery in 1995 and
Dr. Esquenazi did the brace immediately
thereafter. I still go up to Dr. Keenan every year for checkups and am
still wearing the brace made by Dr. E.
************************************
Reprinted from Polio Heroes of Tennessee, March 2006; reprinted from The Seagull Newsletter,
SINUS INFECTION
AND PPS
(E-mail submitted by Joyce Insley) – I wanted to say a little something about sinus
infections. I even had sinus
surgery. As soon as I was off the
antibiotics from the surgery, I got another sinus infection. I stayed in the doctor’s office, getting
shots and different kinds of antibiotics.
As soon as I would go off the antibiotics, I would get another sinus
infection. I went through all the tests
twice and four different specialists. It
wasn’t until the late Dr. Anne C. Gawne diagnosed me
with PPS that I finally found out what was causing the sinus infections. Dr. Gawne let me
watch a video and then she explained “why: the infection. I was told that you have four very small tiny
gland pockets at the top of your throat.
Food goes into the tiny pockets when we eat. It is a normal process for humans.
The problem for PPS’ers is that
our throat muscles are weakened by PPS.
When we eat, the food is not squeezed from those tiny glands and
swallowed. Food stays in them, thus
letting bacteria grow, causing infection to “back up” into your sinus
cavities. I was told to take small (not
tiny) bites, followed by several swallows of water. Tuck your chin down to your chest or turn
your head to one side when you swallow.
This will clear the food from the tiny glands. Do not chew meat too much, as it tends to get
larger the more you chew. I was told to
stay away from potato chips, corn bread, and rice. These foods tend to stick in the glands worse
than most foods.
It is important that you get used to ticking the chin or
turning your head sideways and drinking plenty of fluids with your food. I was taught this method of eating in October
2001, and I have only had one sinus infection since I started using this method
to eat. I had been having sinus
infections, back to back for approximately 6 years before I saw Dr. Gawne. I think this
is a problem that you need to speak to your doctor about. It was such a simple change in eating habits
that changed my health problems. The
bites that you take of your food can’t be so small or they will go into the
glands. Drinking plenty of fluids will
keep the glands washed out. I hope this
information helps some of you.
FECPPSG Editor’s Note:- After reading the above
article I realized how few articles we’ve had in our newsletter relating to
this problem. Below is another one –
from the same newsletter. Most apropos that
they follow one another.
************************************
Reprinted from Polio Heroes of
DYSPHAGIA
By Carol Bratcher,
Speech Language Pathologist
(This presentation was
given in 1991, but is worth an ENCORE.
Carol Bratcher’s father is a polio survivor.)
There are 3 phases to swallowing: oral (mouth), pharyngeal (throat), and
esophageal (tube to stomach). Two things
are important: the tongue and larynx
(voice box). If either is weak, there is
a problem of swallowing. When the bite
goes into the mouth, as you’re chewing, your tongue is moving the food to each
side of your cheek to form a ball. If
the (your) tongue is weak, you already have trouble swallowing, moving the ball
to the back of the throat and forcing the food ball down the esophagus (slam dunk)
– the tongue, not the muscles of the throat, as one might think. The throat muscles then close the door behind
the food so it doesn’t go back up. When
this process doesn’t happen smoothly, there is a swallowing problem.
The type of polio you had, treatment, your history, and
breathing should be evaluated if you are choking. A videofluoroscopy
is a very good test for this evaluation.
In the swallow, we want to make sure there is no aspiration (food
entering the airway). When a person
truly chokes, something blocks the airway.
As you swallow, breathing stops.
If the airway is blocked, you have trouble breathing again.
Swallowing is a muscular function. The tongue is made up of 8 muscles. It must function in an organized manner. Your whole throat, uvula, soft palate, voice
box, vocal cords, 20-30 muscles are involved in the swallow. The tongue must be strong to push the food
through or it will stop along the way in ledges and pockets like the pyriform sinus and epiglottis. Something “stuck” in your throat may well be
in one of these pockets. Normal
swallowing takes less than a second. If
it takes longer, it’s a sign the muscles are weak. Sometimes
in polio one side of the swallowing mechanism is weaker than the other, one
side is going down faster than the other… one side is doing all the work.
If you fatigue at the end of the day, eat a light supper,
take smaller bites and wash down “the pockets” by alternating solid and
liquid. Fatigued and
weak muscles increases your chances of difficulty. More than half the problems of post-polio
swallowing can be improved with proper diagnosis and instructions.
************************************
Reprinted from Elder Update. March/April 2006,
Health and Wellness Column. As
you will read in the opening paragraph of this article, March has been
designated as Poison Prevention Month but you will be reading this in our
May/June newsletter – sorry…..
Be Cautious with
Over-the-Counter
Medicines
Submitted by JoAnn
Chambers-Emerson, RN, BSN, CSPI
Last year, 423 senior citizens in
Top Reasons Why Seniors Call Poison Control Centers.
·
They feel ill after combining OTC products with prescription
medications
·
They inadvertently take someone else’s medications;
·
They have abruptly stopped taking prescription medication
and have switched to OTC medications; or
·
They have taken a higher than recommended dosage of OTC
medications.
Four Interaction Facts
An “interaction” refers to
a problem occurring when a medication is taken along with certain foods,
alcohol or other medication. The
following are four facts about interactions:
·
Interactions don’t always make someone sick immediately;
sometimes the medications just stop working entirely. If this happens, and a physician is not
notified of the OTC medications, they may believe the prescription isn’t
working and call for different prescriptions or an increased dosage, leading to
more problems.
·
Interactions don’t refer only to combinations taken at
exactly the same time, problems may occur even if the
two items are taken hours apart.
·
Herbal and dietary supplements aren’t safe for everyone;
they should be viewed as medications requiring approval by your physician or
pharmacist, particularly if you are already taking prescription medication.
·
Avoid grapefruit products unless approved by a
pharmacist. Grapefruit juice interferes
with enzymes that break down certain drugs in the digestive system, which can
cause components of those drugs to build up in your system causing serious side
effects.
Herbal Hints
Public surveys show most people believe herbal/dietary
products have been tested for safety, however, the U.S. Food and Drug
Administration is prohibited by law to put herbal products through the same
testing required for prescription drugs.
Despite what you read on the label, herbal or dietary
supplements have been found to contain varying amounts of the advertised
ingredients. The opposite is true about
prescription drugs that have to meet higher standards. Physicians feel more comfortable with
prescription medications because of these higher standards.
With March being Poison Prevention Month, take this
opportunity to learn as much as you can and prevent yourself from being
poisoned.
JoAnn
Chambers-Emerson is a certified specialist in poison information for the
FECPPSG Editor’s Note:- I’m sure that whatever state you live in they have a
~*~*~*~*~
The Three C’s of
Poison Control Safety
To protect yourself from
being poisoned, follow the three C’s:
1.
Create a list. Write down
all your current medications – prescription and overt-the-counter – and keep it
with you at all times.
2.
Check for interactions.
Anytime a new medication or over-the-counter product is being
considered, show your list to your pharmacist or physician.
3.
Call for advice. If you
think a medicine is making you ill, call your physician or the poison control
center.
FECPPSG Editor’s Note:- Further on in this newsletter there will be a
list of herbs and supplements telling
you what could happen if you take them with a particular drug.
************************************
Reprinted from
CARPAL TUNNEL:
Stop blaming your
computer –
If pain, tingling and
weakness in your fingers wake you at night, and if you have trouble making a
fist during the day, you may be one of the 2% to 3% of Americans who has carpal
tunnel syndrome.
But guess what? Your
long hours at the computer didn’t cause it, according to “Hands,” a special
health report from
True, other musculoskeletal disorders often called
repetitive stress injuries are linked to heavy computer use, says Barry P.
Simmons, M.D., of
Unfortunately, there’s no specific way to prevent carpal
tunnel syndrome. Early diagnosis,
however, is vital to avoid permanent damage. – By Susan T. Lennon
~*~*~*~*~*~
6 TIPS FOR CARPAL PAIN
·
Get a full medical exam.
Diabetes and arthritis may worsen carpal tunnel pain, so treat them
first.
·
Take a break from activities that worsen the pain.
·
At night, wear a wrist splint.
·
Ask your doctor about corticosteroid injections.
·
See if yoga and other exercise helps.
·
Consider surgery if pain has lasted at least six months.
FECPPSG Editor’s Note:- Guess what – I now am in that 2% - 3% of Americans
with carpal tunnel syndrome. Glad to
know that it’s not caused by excessive use of the computer (typing) as
otherwise this newsletter would be an awful lot shorter….. The pins and needles in my right hand often
reach a point where it’s difficult to grasp the steering wheel in my car (also
makes it difficult to hold cards when playing Saturdays with my friends – NO,
not Texas Hold Em).
The left hand is also showing signs but not as bad. Oh, well – wrist brace(s) here we come…..
************************************
Reprinted from
Too much of a
GOOD THING
By Linda Formichelli
Experts
on why more isn’t
always better.
If brushing your teeth for two minutes is good, then
brushing for 10 must give a brighter smile, right? And if eight glasses of water per day is
healthy, then constant quaffing is even better, isn’t it? Not really.
Actually, too much of a good thing can be, well, bad, according to a top
panel of health experts assembled by
Too much FIBER
The expert: Melina Jampolis, M.D., who
explores the myths and realities behind some of today’s most popular diets on
Fit TV’s Diet
Doctor.
“The average person needs 25 to 30 grams of fiber per day
to help lower cholesterol and even out blood sugar levels. Most Americans get just 10 to 15 grams daily,
so they need more. Fruits are good for
this. For example, a half cup of
raspberries has about 4 grams of fiber.
Or, if you prefer, try cereal with at least 5 grams of fiber per
serving. Still increasing your fiber consumption
too quickly can be bad. If you start
from a low point – say, 10 grams per day – and jump to 25 or more grams per day
all of a sudden, you can experience diarrhea, abdominal cramps, gas and
bloating. Ramp up over a couple of
weeks, and space out fiber throughout the day so you don’t have a huge amount
traveling to your colon at the same time.
“Once you make this transition, you shouldn’t keep ‘piling
on’ the fiber either. Once you get past
40 to 50 grams per day, the fiber can interfere with vitamin and mineral
absorption. It’s hard to get that much,
but you can do it if you’re eating a whole bag of dried plums, or if you’re a
vegan who eats a lot of beans for protein.”
Too much BRUSHING
The expert: Grace Sun, a Los Angeles-based cosmetic dentist with
celebrity clients such as Jennifer Love Hewitt.
“Brushing your teeth too long or too hard can wear away the
enamel. Two minutes is fine, but some
people brush for four or five. That’s a
long time. Also, a hard toothbrush can
abrade the enamel. Softer is safer. If you use a specialty toothpaste with, say,
whitening, check the active ingredients.
If you use toothpaste with an abrasive such as baking soda, don’t overdo
it. Consult with your dental professional
for advice.”
Too much WATER
The expert: Arthur Siegel, M.D., an assistant clinical professor of
medicine at
“People participating in endurance events such as marathons
have been programmed to ‘drink, drink, drink!’ That’s fine for high-performance athletes
because they’re losing tremendous amounts of fluid through sweat. But those who are slower and less experienced
don’t need so much water. Drinking too
much water too quickly --- say, more than a liter per hour for more than four
hours --- can cause a condition called hyponatremia,
or water intoxication. The water
overload causes cells in the body, including the brain, to swell like
sponges. This is a problem for the
brain, where there is no room to expand, and that causes headaches, nausea,
vomiting and delirium. This can lead to
a sudden collapse with a seizure, then unconsciousness and a coma – and it can
be fatal. Runners have died or been in
comas from water intoxication.”
Too much SCRUBBING
The expert: Dermatologist Nicholas Perricone,
M.D., author of The Perricone Weight-Loss Diet: A Simple
3-Part Program to Lose the Fat, the Wrinkles and the Years.
“People who have breakouts think it’s because their skin is
dirty. So they wash more than the
necessary two times daily and use harsh cleansers. Overwashing can
create chemical irritation, which can make breakouts worse. Also, if you strip all the natural oils off
the skin, the oil glands compensate by becoming even more active. The result? More breakouts. So wash your face twice a day using a mild
cleanser. And rinse with warm water, not
hot.”
Too much EXERCISE
The expert: Jason Pulido, the national
personal training director for Crunch Fitness, a health club chain that has
more than 30 locations.
“Overexercising can make your
muscles smaller. You’re creating
micro-tears in the muscles, and they build back even stronger. If you don’t give them rest, they won’t
repair themselves and get stronger. The
top factor with results is genetics. The
second is rest.
“People often do cardio and weight training to burn
fat. Maintaining or developing that lean
muscle tissue is the key to increasing your metabolism. Tearing down that lean muscle tissue will
slow your metabolism. So exercising too
much can slow your fat loss.”
FECPPSG Editor’s Note:- Being polios, I would basically forget about the last
“thing” – too much exercise….. we know just how much our bodies can handle (or should
know…)
************************************
DUES FOR 2006:- Please take a look
at your mailing label - on it you’ll see the month and year we
received your 2005 dues, i.e., 01/2005 means it was received in January 2005,
so your 2006 dues was due in January 2006. If your mailing label has the year
first and then the month, i.e., 2005/01 it means that you indicated to us in
January 2005 that you wanted to receive the newsletter but paid no dues. That’s OK as we still believe that anyone who
wants information should receive it – but we do need you to return the tear
sheet with either the “Dues” box checked or the “Keep me on the Mailing List”
box checked.
Your dues covers the supplies we need to send out the
information packets to all inquiring about Post-Polio Syndrome, any other
correspondence we do, and postage for publicity and for the out-of-country (25)
newsletters that we send out. We’re
fortunate in that the “Free Matter for the Blind and Physically Handicapped”
status takes care of the postage for the over 450 newsletters sent out within
the United States. We network with
approximately 60 other support groups throughout the
***********
WHEN YOU MOVE PLEASE be sure to
send us your new address. Sometimes the
post-office will return the newsletter to us with a “forwarding period expired”
notice on the front with your new address but most of the time they are just
returned to us with “address unknown” on it.
SO, if you want to continue receiving the newsletter it is UP TO YOU to
make sure we have your new address.
************************************
CALENDAR WATCH
Abilities Expo 2006: New York Metro, April 21-23, Edison,
NJ; Southern CA, June 16-18, Anaheim, CA; Metro Detroit, Novi, MI, August 18-20;
Northern CA, Santa Clara, CA, November 3-5; and TX, Houston, TX, December
1-3. For further information call
800-388-8146 or www. Abilitiesexpo.com.
Tallahassee Orthopedic Clinic & FL Disabled Outdoors Association is hosting Sportsability
Expo 2006 on
http://www.doh.state.fl.us/Family/chronicdisease/walk_index.html. This is free.
Polio Network of NJ will host its 16th Annual Conference on PPS,
The Central VA Post-Polio Support Group will be hosting its annual Retreat
on
ADDITIONALLY
Boca Area Post Polio Group will be going on their fourth cruise –
************************************
FLORIDA EAST
COAST POST-POLIO SUPPORT GROUP
12 Eclipse
Trail /
386-676-2435 /
e-mail address: bgold@iag.net
DATE:
TIME:
PLACE: Red Lobster Restaurant
Right off I-95 – Exit 261–
(head EAST for about 1/4 mile)
PROGRAM:- GUEST
SPEAKER:- Dr. Carolyn Geis, Director
of the Post-Polio
Clinic at
Clinic, physical therapy, and rehabilitation updates.
Cost of the Luncheon is
$10.00 all inclusive. As usual we will have a choice of several
different menu items.
Please send in your reservation tear
sheet and check
no later than
Any questions call Barbara at 386-676-2435.
===================================================================
R E S E R V A T I O N F O R M
Name:- _______________________________
Phone No.:- _________________
Number of People Coming:- _________ Number in Wheelchair(s):- ___________
Amount of Check Enclosed:- ________________ @ $10.00 per person
Make check payable to and mail same to:
FLORIDA EAST COAST POST-POLIO
SUPPORT GROUP
12
Eclipse Trail --
05/2006
***********************************
FLORIDA EAST COAST POST-POLIO SUPPORT
GROUP
12 ECLIPSE TRAIL
386 676-2435
e-mail:- bgold@iag.net
DATE:
TIME:
PLACE: Red Lobster Restaurant
Right off I-95 – Exit 261–
(head EAST for about 1/4 mile)
PROGRAM:- GUEST
SPEAKER:- Dr. Carolyn Geis, Director
of the Post-Polio
Clinic at
Clinic, physical therapy, and rehabilitation updates.
For further information call:- Barbara 386-676-2435
===============================================================
2006 DUES/MAILING LIST
____ Dues Enclosed ____ Keep me on mailing list
If sending dues, please make Check
($5.00) Payable to and Mail to:-
FLORIDA EAST
COAST POST-POLIO SUPPORT
GROUP
12 Eclipse Trail,
NAME:-
__________________________________________________________
ADDRESS:-
_______________________________________________________
E-MAIL
ADDRESS:-__________________________ FAX #:- _______________
TELEPHONE NO:-
Home _______________________ Office ________________
Date of
Birth:-_________________ Wedding Anniversary:-
________________
Name and Date of Birth of
Spouse:-_____________________________________
05/2006