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A
CORNOCOUPIA WITH THANKSGIVING GOODIES
A
LIGHT-FILLED CHANUKAH
and
the
MERRIEST
OF CHRISTMASES!!
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will
talk about Social Security Problems and the Prescription Drug Plan.
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CONTENTS
My “Adventures”
Expired Drugs – Toss Them
Information about Generic Drugs
Keys Locked in Your Car?
Research 1 – What is Being
Done?
What
Needs to be Done?
Telemarketers
FYI – ICE
A Clarification of Non-Paralytic Polio
No More Excuses
Gonna Be a Bear
Feed Your Heart
Odd Shoes
Anesthesia and Post-Polio Today
Credit Reports – Be the First to Know
Just a Smiler
Purging Polio
Ain’t it da Truth
******************************************
“MY ADVENTURES”
Well, this time I really don’t have any “adventures” except to tell you
what happened when I brought my car into the dealership to have the
air-conditioning looked at.
Everytime I take the minivan in for
service I make sure to tell them that I have a left-sided gas pedal and ask if
they want me to remove it. I’m always
told words to this effect – No, we all know you have the left sided gas pedal,
so don’t worry about it.
Well, that day after waiting to hear
that the air-conditioning had been fixed, I received a call from the dealership
that, somehow or another, the mechanic, when ready to drive the car out of the
shop, somehow stepped on the pedal and crashed into two other cars being worked
on in the repair bay. One of these cars,
it seems was on a lift soooooooo, the lifted tire wound up putting quite a dent
into the roof, the rest of the damage (fortunately) was also on the outside of
the car. There were, maybe, two panels –
the driver’s door and another one – that were without a dent of some kind.
The dealership agreed it was all their
fault and would take care of repairing it BUT first they had to contact their
insurance company who, they said, would contact me. After a two week period without hearing from
anyone, I called the dealership – they gave me the telephone number of their
insurance company, who I called and who then gave me the name of the adjustment
company they use for repair estimates.
When I called that company the young lady who answered when I told her
my name, said: “Oh, that’s the file that
we don’t know what happened to it – it’s somewhere in ‘la-la’ land.” However, she did take all the information
from me and promised that an adjuster/appraiser would be calling me either that
day or the next. Well, four days later,
after I again called, the adjuster called me and said they had given him the
wrong number for me. Anyway, he came
right over – checked over the minivan, taking numerous digital pictures of it,
and told me I would have the estimate within a day or two.
The next day the insurance company
called to tell me they had the estimate and that it came to $7,063.24 and said
that they would be sending me a Release to sign and a check made out for that
sum. She then faxed me over a copy of
the adjuster/appraiser’s findings – three pages.
I took the papers over to the
dealership and the service advisor took me over to the Body Shop, to speak to
the body advisor who would be in charge of repairing the damage. This young man told me it would take
approximately three (3) weeks (YES, 3 weeks) to repair it ONCE all the parts
were ordered and received. It seems they
are allowed to work on a particular car only 5 hours a day and, according to
the adjuster/appraiser, the minivan needed 87 hours of work….
Now, of course, they said they would
give me a car to use during that time.
But, as you know, I use a left-sided gas pedal, and after first shaking
his head that he didn’t know if they could find one, I gave him the number of
Van Get-a-ways to see if they could help out.
Well, seems they only have hand controls – so, still have a
problem. May be resolved by them giving
me a “good will” allowance enabling me to fly to my son’s on
******************************************
Reprinted
from
HealthSmart
By Dr. Tedd Mitchell
EXPIRED DRUGS:
TOSS ‘EM?
Dear Dr. Tedd:
Must I throw out any medication that’s past
its expiration date? If a drug expires
on one day, does that really mean it’s no good the next day?
BACK in 1979, a law was passed
requiring drug manufacturers to print an expiration date on the bottle or
package. That date is generally two to
three years from the date the drug was made.
The manufacturer guarantees that the medication (over-the-counter as
well as prescription) will have its full potency and safety through that date –
if left in the original, unopened package.
Does that mean it starts to degrade,
or break down, soon after that date? Probably not. It’s
important not to confuse a drug’s expiration date with its shelf life. As long as you don’t unseal the
manufacturer’s container, a drug may be good far beyond its expiration date.
We know this because back in 1985 the
Air Force wound up with a stockpile of medications that were just about to
expire. Not wanting to throw away
medicine (and money) unnecessarily, the Air Force asked the Food and Drug
Administration to check the drugs for safety and effectiveness. The FDA estimated that 80% of the medications
would remain safe for nearly three years past their expiration date.
Some people suspect that expiration
dates have as much to do with marketing as science. By dumping expired drugs and restocking,
pharmacies and families keep the economic machinery of the manufacturers
running. Of course, folks in the
pharmaceutical industry have a different view.
They say replacing medicines promotes public safety. Indications for medications change, and
labels need to be updated. New drugs are
developed that sometimes are more effective than the older ones.
The American Medical Association wants
more testing to see whether expiration dates can be lengthened. The AMA also points out that the downside of
expired drugs is lost effectiveness, not toxicity. Many people believe that taking an old
medication can be harmful, but the data just doesn’t support that.
PLAY IT SAFE:
SOME MEDICINES DON’T LAST
Even though testing has been
limited, I think it’s safe to say that using most medications for three years
after their expiration date is all right, with a few caveats:
□ Liquid or suspension medications. These don’t retain their potency
nearly as well as solid medications, so stick to the expiration date on the
package.
□ “Lifesaving” medications. Someone taking a medication for a
severe cardiac arrhythmia probably shouldn’t rely on an older drug to do the
trick.
□ Medications bottled by the pharmacist. Remember that expiration date
guarantees come from the manufacturer and are based on unopened packages. After a pharmacist breaks the seal, counts
out pills and puts them in a pharmacy bottle, he places a new expiration date
on that bottle. It’s generally limited
to about a year from the time the prescription is filled. This is called the “beyond use” date. So drugs you pick up from a pharmacy that are
in one of the pharmacy’s bottles may not last quite as long, although the three
year rule might still apply. Ask your
pharmacist.
A TIP: To improve the efficacy of the
medications in your home, store them in a cool, dry spot; the refrigerator is
probably best. That will help ensure
their long-term effectiveness.
FECPPSG Editor’s Note:- I, for
one, always ask either my pharmacist or doctor as the how long the particular
drug retains its effectiveness.
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The
following is reprinted from “Elder Update”, May-June 2005 – and most appropos after the previous article….
INFORMATION ABOUT GENERIC DRUGS
1.
What is a generic drug?
A generic
drug is a copy of a brand-name drug that is equivalent in drug in dosage, safety,
strength, how it is taken, quality, performance and intended use.
2.
Are generic drugs as safe as brand-name drugs?
Yes. The Food and Drug Administration (FDA)
requires that all drugs be safe and effective.
Since generics use the same active ingredients and are shown to work the
same way in the body, they have the same risks and benefits as their brand-name
counterparts.
3.
Are generic drugs as strong as brand-name drugs?
Yes.
FDA requires generic drugs to have the same quality, strength, purity
and stability as brand-name drugs.
4.
Do generic drugs take longer to work in the body?
No.
Generic drugs work in the same way and in the same amount of time as
brand-name drugs.
5.
Does every brand-name drug have a generic counterpart?
No.
Brand-name drugs are generally given patent protection for 20 years from
the date of submission of the patent.
This provides protection for the innovator who laid out the initial
costs (including research, development and marketing expenses) to develop the
new drug. However, when the patent
expires, other drug companies can introduce competitive generic versions, but
only after they have been thoroughly tested by the manufacturer and approved by
the FDA.
6.
What is the best source of information about generic drugs?
Contact your physician, pharmacist, or
insurance company for information on your generic drugs. You can also visit the FDA web site at
http://www.fda.gov/cder/ ogd/index.htm for more information.
Source:
******************************************
Keys
Locked In Your Car????
Did you know this??
If you lock your keys in the car and the spare keys are at home, call
someone on your (or someone else's) cell phone.
Hold your cell phone about a foot from your car door and have the other person
at your home press the unlock button of your key fob (clicker), holding it near
the phone on their end. Your car doors will unlock. Saves
someone from having to drive your keys to you.
Distance is no object you could be hundreds of miles away, and if you can
reach someone who has the other "remote" for your car, you can unlock
the doors (or the trunk!).
FECPPSG Editor’s Note:- The above article
was sent to me by Professor Michael Kossove who has been an avid PPS advocate
for the past 20 odd years. Thanks, Mike…
******************************************
The following article
was presented at the Post-Polio Health International’s Ninth International
Conference on Post-Polio Health and Ventilator-Assisted Living,
RESEARCH
1: WHAT IS BEING DONE? WHAT NEEDS TO BE DONE?
Update
on Modafinil Study
Olavo M. Vasconcelos, Md,
Post-Polio Syndrome (PPS) Fatigue: The New Challenge 50 Years After
the Salk Vaccine
Post-Polio Syndrome (PPS) is
the term used to describe the reemergence of symptoms decades after recovery
from acute poliomyelitis. Symptoms
include increasing muscle weakness, pain, and atrophy, fatigue, breathing and swallowing difficulties, sleep disorders, and cold intolerance. After starting, symptoms progress overtime
and lead to gradual functional loss.
Usually, but not always, PPS symptoms begin after 15 or more years of stable
function that follows recovery from paralytic polio.
Among the PPS symptoms, fatigue is the
earliest and most disabling. Because of
fatigue, many polio survivors are forced to leave work or lose the ability to
live independently. The fatigue of PPS
is not only debilitating, it affects the vast majority of polio survivor
population. Estimates show that 79% to
89% of patients with PPS suffer from fatigue.
A 1985 survey of 676 polio survivors showed that 91% of the sample
experienced new or increased fatigue, with 41% claiming an interference of
fatigue in performing work and 25% in self-care activities. A questionnaire completed by 276 Norwegian
subjects with PPS showed
that the prevalence of fatigue in PPS patients is significantly
higher than in matched controls.
The cause of fatigue in PPS patients
is only vaguely understood. It is
thought that multiple domains of subjects’ function are involved. In PPS patients, at least in part, fatigue is
related to the gradual loss of individual nerve cells that make contact with
other nerve cells (within the central nervous system), or with muscle fibers
(within the peripheral nervous system).
This results in subsequent loss of nerve transmission to these circuits. During the original polio infection, the
poliovirus destroys nerve cells in the brain and spinal cord, particularly but
not only, motor neurons. Among other
things, this can result in loss of muscle function, including weakness or
paralysis. However, to compensate for
this loss, surviving neurons sprout out extra branches that are able to
reestablish synapses (contacts), especially with orphaned muscle fibers that
have lost their original nerve supply.
Because of this process of reinnervation the
individual is able to regain function.
This is easily noticeable within the muscle system: body muscles are able to work again,
sometimes as well as before. Ironically,
these repaired circuits appear to wear down with aging. Some researchers have suggested that PPS
develops because these extra sprouts cannot “hold” forever, but instead get
weaker over time due to “over-use”.
Eventually, the sprouts degen-erate, and
function mediated by the neural contacts they have secured for years decline or
disappears. This explains why recovered
muscles gradually weaken and loose bulk when PPS settles in. An important lesson from the facts outlined
above is that the fatigue faced by PPS patients is complex and involves
multiple domains of function (emotional, intellectual, social, etc.) not simply
the physical (muscular) dimension.
Unfortunately, except for supportive
care, effective pharmacological therapies for the fatigue of PPS remain
elusive. This problem remains as one of
the most difficult new challenges faced by survivors of the last epidemics 50
years after the Salk vaccine.
Attempts at symptomatic management of
other PPS symptoms have not met with much success either. In the past, several groups of researchers
worked independently while investigating the origin of PPS and ways to reduce
the burden of the incapacitating fatigue.
About half a dozen clinical trials directed to reduce fatigue, the most
common and disabling problem faced by patient, were done but arrived at
negative results.
In year 2001 the PPS Program was
funded. The PPS Program is sponsored by
the Uniformed Service University (USUHS) and administered under the auspices of
the Henry M. Jackson Foundation (HMJ).
The mission of the PPS Program is to advance knowledge on the cause and
treatment of post-polio syndrome. To
achieve this goal several independent studies are taking place, some in the
form of clinical trials intended to test the effect of medications to reduce
the symptom burden in PPS patients.
Currently, the PPS Program is
enrolling volunteers to participate in a clinical trial on PPS fatigue. This study will test if a medication called modafinil (Provigil) can help
reduce the fatigue of patients with post-polio syndrome. This research is being done because, despite
intense work, there still is no effective treatment for PPS fatigue, the most
debilitating problem in persons with PPS.
The nature of PPS fatigue is poorly under-stood but a central element is
likely. This is supported by the damage
caused by the poliovirus to neurons is supra spinal areas of the central
nervous system, particularly the basal ganglia and reticular formation. Drugs reducing fatigue in neurological
conditions usually act by facilitating central catecholaminergic
tone. The centrally-acting a-adremergic agonist modafinil may help lower fatigue in PPS subjects. Modafinil has been
used successfully to reduce fatigue in patients with other neurological
disorders, including multiple sclerosis.
Other studies in our program are directed to investigate different
aspects of PPS. A second study (also
actively enrolling) is looking at alterations in the brain and spinal cord of
polio survivors that might help explain the development of PPS and the origin
of PPS symptoms. This one is not a
treatment trial. Instead, we are
employing electrophysiology techniques and magnetic resonance to map possible
residual abnormalities in the central nervous system induced by the poliovirus
during the original infection.
A third study is coming up soon. This one will examine if cognitive problems
that are common is survivors with PPS, by measuring the brain ability to
concentrate, sustain attention, register and memorize information, etc., with
the use of traditional neuropsychological tests. These studies aim to advance knowledge in
several different areas of PPS and hopefully, help us design and test
therapeutic interventions that can be safely used to reduce disability in polio
survivors. For more information, please
contact our research nurse coordinator, Ms. Kay Kelley, at 301-295-0231.
Olavo M. Vasconcelow,
MD
Post-Polio Syndrome Program (PPSP)
Uniformed
Henry M. Jackson Foundation (HJF),
FECPPSG Editor’s Note:- Although the conference was in June, I think that
if you are interested in taking part in any of the studies, you can still call
Ms. Kay Kelley as stated above.
This article was slightly edited.
************************************
The following was also e-mailed to
me by one of our members, Lisa Haines, from PA.
Thanks, Lisa. It’s another way to
“get even” with telemarketers…
TELEMARKETERS
The phone rang as we
were sitting down to dinner. I answered it and was greeted with, "Is
this William Wagenhoss?"
This didn't sound anything like my name, so I asked, "Who is
calling?"
The telemarketer said he was with The
Rubberband-Powered Freezer Company or something like that. I asked him if
he knew William personally and why was he was calling this number. I then
said, off to the side in a low voice, "Get really good pictures of the
body and all the blood."
I turned back to the phone and advised the
caller that he had called a murder scene and must stay on the line because we
had already traced this call and he would be receiving a summons to appear at
the local courthouse to testify in this murder case.
I questioned the caller at great length as to
his name, address, phone number at home, at work, who
he worked for, how he knew the dead guy and could he prove where he had been
about one hour before he made this call. The telemarketer was getting
very concerned and his answers were given in a shaky voice.
I proceeded to tell him we had located his
position at his work place and the police were entering the building to take
him into custody. At this point, I heard
the phone fall and the scurrying of his running away.
My wife asked me as I returned to our table, why
I had tears streaming down my face and so help me, I couldn't tell her for
about fifteen minutes. My food was cold, but oh-so-very enjoyable.
******************************************
E-mail is wonderful – the following
was sent to us by several of our members as well as some of my non-polio
friends…. It’s good advice.
FYI:- ICE
Paramedics will turn to a victim's cell
phone for clues to that person's identity. You can make their job much
easier with a simple idea they are trying to get everyone to adopt: ICE –
ICE stands
for In Case of Emergency. If
you add an entry in the contacts list in your cell phone under ICE, with the
name and phone # of the person that the emergency services should call on your
behalf, you can save them a lot of time and have your loved ones contacted
quickly. It only takes a few moments of
your time to set up.
Paramedics know what ICE means and they look for it immediately! ICE your
cell phone now.
FECPPSG Editor’s Note:- I just ICEd my cell phone.
******************************************
Reprinted from
Polio Heroes of
A
CLARIFICATION OF
NON-PARALYTIC
POLIO
By
Ernest W. Johnson, MD
(Dr. Johnson is editor of the
American Journal of Physical Medicine and Rehabilitation. He is a well recognized expert on Post-Polio
Syndrome.) Reprinted from Polio
For many years, most
physicians have understood that non-paralytic is a loose clinical term implying
that neither the patient nor the clinician-examiner reported functional
weakness. This determination was often
made without the understanding that 50% of the motor units can be lost before a
manual muscle grade of four occurs. This
means that many patients with acute polio were tabled non-paralytic
incorrectly, but certainly in a well-meaning way.
When the polio virus is
in the gastrointestinal tract of an individual and causes symptoms, the term
abortive polio has been used. This is
the condition that confers immunity on the individual and also prevents the
carrier state. This is why the Sabin (attenuated, live poliovirus) vaccine prevents the
invasion of the poliovirus into the central nervous system, but not the
poliovirus from living in the gastrointestinal tract.
In those individuals
whose immune systems, for whatever reason, permit the invasion of the central
nervous system by the poliovirus, a population of anterior horn cells will die. The number of these cells that die will
determine whether the clinician will be able to identify paralysis.
In
the late 1950s, our electromyographic studies
suggested that in all patients who experienced the invasion of the central
nervous system by the virus, pain, meningismus, and
positive spinal fluid findings revealed abnormal irritability (fibrillation and
positive waves) in many muscles that were clinically “normal”.
It
should be absolutely understood that patients who were told that they had non-paralytic
polio did, in reality, have polio which affected their anterior horn
cells. Now, 30 to 40 years later, these
patients are potentially subject to all of the vagaries and insults to the body
that affected other persons with post-polio syndrome.
******************************************
Reprinted from
Polio Heroes of
NO
MORE EXCUSES!
A
powerchair (not Manual) or scooter is not an
instrument of torture. (Although a
manual chair can be!) Using a powerchair or scooter will
not make you look stupid – at least not as much as pretending you don’t
need one while taking pain meds and stumbling around, falling down, requiring
surgery on hands, elbows, shoulders, knees, etc.
Using
a powerchair or scooter will give you more energy because you won’t be using all your
energy in trying to accomplish the impossible (i.e. – looking like you don’t
need one). Using a powerchair
or scooter will actually be more freeing. You will have the freedom to go where ever
you want, without having to have someone chained to you to push you here and
there – and then go off to look at something else that interests them and leave
you stranded. (Been there, done that!)
Using
a powerchair or scooter will relieve the strain on overtaxed shoulder muscles and joints
that were never meant to be walked on in the first place, thereby eliminating
much of the unnecessary surgeries which, by the way, will not last unless you change the way you do things. You may also find that you don’t need as much
or any of the pain meds.
Using
a powerchair or scooter will show that you are winning the battle! But you need to define your battles. You already had polio. No way to change that. You are having post-polio sequelae. Another done deal. These are battles people frequently think
that they need to fight against, but there is no way to win here. It’s happening. Live with it.
But the battle you can win is
the battle for independence! You can be
your own person again. It has been said,
“Fight only the battles you can win”.
Living life on your own terms is possible only if you have the stamina,
the balance, and the heart for it. We
all have the heart for it. . . we are polio survivors! What we don’t have are the balance and the
stamina. A powerchair
or scooter can help.
Do
you always walk to the grocery store 5 miles away? Do you walk to work? To
Church? Of course not! You use the technology available to you – a
car or public transportation. Do you mix
your cake batter with a spoon? Or do you
use an electric mixer? These are devices
that help to make our lives easier. So are powerchairs
and scooters. You are not giving in. . . you’re stepping up to an easier way of doing things.
And Boy! Are they ever fun!
If
you are thinking about it, it is probably past time to do it. And the sooner you start using a power
mobility aid, the longer you might retain the ability to walk and the easier it
will be on your arms and shoulders in the long run. I wish
you well.
(PH of TN Editor’s Note: This
article was not authored by name. I wish
I had written it! It sounds very much
like words of Dr. A. C. Higgins, MD of
FECPPSG Editor’s Note:-
As most of you know, I use a scooter – in fact, I’m on my third Electric
Mobility Rascal. Whenever I see a polio
(or other mobility impaired individual) that should be in a powerchair
or scooter I cringe. If I question them
as to why they’re not using a powerchair or scooter,
they’re answer is usually that they don’t need it – they aren’t that bad. Hopefully, this article will help some
realize that using such an aid will open many doors that have been closed to
them – such as going to the mall, going to theme parks, taking a “walk” with
the grandchildren…. Please, if you need
a powerchair or scooter, look into getting one.
******************************************
Now that we are finally getting into
the cooler weather, I thought I would reprint an e-mail I received a while ago
and had inserted into a newsletter a year or two ago – however, it’s still
appropriate. Soooo, here it is…
GONNA BE A BEAR
In this life I’m a
woman. In my next life I’d like to come
back as a bear. When you’re a bear, you
get to hibernate. You do nothing but
sleep for six months. I could deal with that.
Before you hibernate,
you’re supposed to eat yourself stupid.
I could deal with that too.
When you’re a girl bear,
you birth your children (who are the size of walnuts) while you’re sleeping and
wake to partially grown, cute, cuddly cubs.
I could definitely deal with that.
If you’re a mama bear,
everyone knows you mean business. You swat
anyone who bothers your cubs. If your
cubs get out of line, you swat them too.
I could deal with that.
If you’re a bear, your mate EXPECTS you to wake up
growling. He EXPECTS that you will have
hairy legs and excess body fat.
YUP, gonna be a bear!!!
FECPPSG Editor’s Note:- So, what do you think????
Oh, and thanks to Gary Fredericks for sending it to me last month.
******************************************
Reprinted from HealthSmart
–
FEED YOUR HEART
by Dr. Tedd
Mitchell
Trans fats are a main culprit in raising “bad” cholesterol, says a key study of women.
What
we know about the impact of diet on cholesterol has evolved over time. This is best evidenced by the changes in the
USDA food pyramid: the guidelines now
call for more liberal amounts of fats in the diet, while discouraging the
consumption of specific fats associated with hardening of the arteries.
Two
of the biggest offenders are saturated fats and trans
fats. Both are associated with coronary
heart disease and now are being targeted by nutritionists and the health care
industry. One reason for this is a study
published in The New England Journal of
Medicine in 1997 in which researchers looked at the type of fat intake in
coronary heart disease in women. In the
study, saturated and trans fats “took the cake” (pun
intended) when it came to heart disease.
Let’s
take a closer look at trans fats. They are produced by partially hydrogenated
vegetable oils, which make them into solid fats (such as margarine or
shortening). Some trans
fats also are found naturally in foods.
A high intake of trans fats raises the LDL (the
“bad” cholesterol), which in turn raises the risk for heart disease.
Trans fats are used in many products, including candies,
cookies, baked goods, fried foods, crackers and other processed foods made with
partially hydrogenated vegetable oils – a rather extensive list.
Unfortunately,
some in the food industry understand the potential problem with trans fats in the diet; they’ve worked to reduce the amount
in the products we buy. Frito-Lay, for
example, has made sweeping changes in many of its snack products, dramatically
reducing the amount of trans fats. In
But
it’s not up to others to improve our health.
We are responsible for our own health.
It is up to us to bone up on the facts.
The first step in improving our diet is understanding
more about it. To keep your heart
healthy, learn what raises cholesterol.
The new food guide pyramid can help you; visit mypyramid.gov for
details.
The
knowledge that you gain from learning more about cholesterol can help you and
your family. The heart attack you
prevent may be your own!
Contributing
Editor TEDD MITCHELL, M.D., is medical director of the Wellness Program at the
renowned Cooper Clinic in
==================
THE GOOD FATS
Increase your intake of these fat
sources:
nuts – vegetable oils – fish
THE BAD FATS
Limit these solid fats:
butter – shortening – margarine – lard
******************************************
ODD SHOES
Catherine has a shoe service. Do you need two different
size shoes? Do you need split-size shoes? She has a free listing web site which
also helps connect people with mutual shoe size needs at, www.Mermade.homestead.com/pedpals. html.
Her name is Catherine Beausoleil.....
4476SymcoAvenue
******************************************
Anesthesia and Post-Polio Today
with
Reported by Mary Clarke Atwood
Editorial Assistance by
Virginia Duboucheron and S.H. Calmes, M.D.
This report is based upon Dr.
Aspects of anesthesia included in this report are:
·
Requirements for
Excellent
Anesthesia
·
Post-Polio and
Anesthesia
Management
·
Types of
anesthesia
·
What Should your
Anesthesiologist Know or Do?
·
What Type of
Anesthesia is Best?
·
Preparing for
Surgery
·
Frequently Asked
Questions
Excellent anesthesia for any patient depends upon the
anesthesiologist under-standing the patient’s disease(s) and knowing how those
diseases might affect anesthesia. The patient needs to be evaluated beforehand
and an appropriate anesthesia plan for each operation and for each patient
needs to be prepared in advance.
Operations are performed for different reasons and
each operation has various requirements for anesthesia. The anesthesiologist
must be aware of these conditions and develop an appropriate plan for each
patient having every operation; different anesthesia plans might be used for
subsequent operations.
The anesthesiologist needs to know the patient’s current
health conditions and also his or her medical history to determine what the
most serious problem is for that patient. The surgery patient may be a polio
survivor and also have other diseases; post-polio may not be his or her most
serious problem. Some polio survivors have already had multiple surgeries and
exposures to anesthesia. There might have been an unfavorable experience that
could play a role in what is planned.
There is also a psychic component that needs to be
addressed: Patients who had polio may have negative feelings about being
hospitalized. Being admitted to a
hospital and losing control again may bring back unpleasant memories of
childhood hospitalization.
The personalities of surgeons are varied. Most are
calm, but some scream or throw instruments. This is very disruptive to the
patient on the operating room table. So for certain surgeons, local anesthesia
is not an appropriate choice. If local anesthesia is strongly recommended for
the procedure, the anesthesia staff can occasionally negotiate for another
surgeon -- someone who can be gentle, calm, and speak in a quiet tone of voice
during the operation -- if local anesthesia is strongly indicated.
Some anesthesiologists might be particularly good at
one technique, so it might make sense to choose that method if it were a
suitable choice. Conversely, the anesthesiologists might want to practice a new
technique, or renew their skills on some technique they had not used for a
while. The operation, the patient, and the surgeon are all considered in
developing the plan for excellent anesthesia. There is also a back-up plan,
possibly even two back-up plans in difficult situations, in case the first plan
needed adjustments.
Polio is a systemic disease.
The poliovirus likes to live inside the spinal cord, especially in the anterior
horn cells. These horn cells supply the motor nerves.
Traveling in the nearby intermediolateral
columns are the nerves to the sympathetic and parasympathetic nervous system
that make up the “autonomic” nervous system - the nervous system that controls
how the bowel moves, how the stomach empties, how the legs respond to a cold
environment. These nerves were often damaged during acute polio. These
transformations were evident in a photo of a section of spinal cord.
Another photo, from 1870, the first picture of a
cross-section of a spinal cord in a polio patient, showed how shrunken and
destroyed one side became. In addition to the motor changes, the left side
lower extremity paralysis showed that this patient would also have had changes
in the autonomic nervous system. This is very important for anesthesia
planning.
The ANS also regulates the movement and work of the
stomach, intestine and salivary glands, the secretion of insulin and the urinary
and sexual functions. The ANS acts through a balance of its two components, the
sympathetic nervous system and parasympathetic nervous system.
http://www.americanheart.org/presenter.jhtml?identifier=4463
1)
The stomach may not empty well (emptying is often
delayed).
2)
Person may have reflux of stomach acid up into the
esophagus and then into the lungs if the person cannot close the larynx to
protect the lungs.
3)
Blood pressure may be low when the person is
anesthetized.
4)
Pain sensitivity may be exaggerated, especially in the
affected extremities.
These are everyday problems for anesthesiologists.
There are many ways to deal with these problems if the anesthesiologist knows
about the possibilities and plans for them.
Polio didn’t just affect the spinal cord; it was a
systemic disease that went throughout the body. The body’s response to the
original polio inflammation resulted in scarring and fibrosis, which changed
things anatomically. Studies in the 1940s showed there were also lesions in the
brain; its reticular activating system, which keeps us awake, was often
affected anatomically. This is thought to explain some of the excessive
tiredness that is seen in many people with post-polio. Several scientists have
reported changes in the white and gray matter in the brain, observed in MRI
studies of the brains of people with PPS. This confirms that the brain was
indeed affected by polio in many people.
There are also lesions in the hypo-thalamus, which is
very deep in the brain. That is the center where different hormones are
secreted: corticoid-releasing hormones release cortisol
(a stress hormone), ACTH stimulates the release of the
stress hormones, and cortisol itself. These are all thought to be decreased in many
post-polio patients because of changes from the original disease. However this
is extremely variable from person to person. Not every patient has this.
There is very good evidence that, during the original
disease, there was damage done to the neuromuscular junction, where the nerves
and muscles interact. This is probably why polio survivors are sensitive to
injected muscle relaxants used for anesthesia. Nobody has really studied this
in modern times; this information is all coming from past anatomic work.
1)
Loss of anterior horn cells would cause motor weakness
so an extremity might be smaller.
2)
The intermediolateral column
where the sympathetic nerves are traveling had “spill-over”,
so many polio survivors don’t have a normal autonomic nervous system.
3)
The brain had changes in the reticular activating
system that can affect wakefulness. So a person could be sensitive to the anesthetic
agents that put patients to sleep.
4)
There is a question of whether polio survivors can
release an adequate amount of stress hormones while undergoing surgery.
5)
The poliovirus may have damaged the neuromuscular
junctions; so affected patients may well be sensitive to injected muscle
relaxants used for anesthesia.
Anesthesia requirements may vary depending upon the
surgeon and the operation. Some surgeries need a particular kind of anesthesia;
others can be done with just sedation and don’t require general anesthesia.
A typical post-polio surgical patient may have:
1)
Anxiety about having anesthesia, possibly due to past
experience or what he has read.
2)
Obesity
3)
Paralysis of extremities or perhaps contractures that
could affect positioning on the operating room table.
4)
Pharyngeal and laryngeal muscle weakness, including
voice change. This is appearing increasingly and is due to central changes from
the original polio.
5)
Ventilatory muscle weakness (chest muscles and diaphragm).
6)
Autonomic dysfunction from sympa-thetic
nervous system changes, including reflux.
7)
Sensitivity to anesthesia be-cause of central nervous
system changes from acute polio.
8)
Possible increase in post-operative pain.
At the Seventh International Post-Polio Conference,
Dr. Calmes stated that short-acting muscle relaxants are often used at the
start of general anesthesia to help place a breathing tube. The new LMA
(laryngeal mask airway) does not require muscle relaxants to place it. However,
many post-polio patients are at risk for aspiration because they often have gastroesophageal reflux or hiatal
hernia, and the LMA would not be safe for them. A breathing tube prevents
aspiration, which can be a serious and possibly fatal complication.
The current recommendation is still to NOT use the LMA
when there is the risk of aspiration – unless it is a life-threatening
situation and is needed to save a life.
Many drugs are available for use in anesthesia. Some
are liquids that are vaporized and inhaled by the patient; many others are
injected. For an average case the anesthesiologist might have seven or eight
syringes of different drugs ready and could possibly need more. There are three
basic types of anesthesia:
1)
General (completely asleep)
Muscle relaxants are often used along
with the inhaled and injected drugs so that less of the very potent and
possibly harmful anesthetics are needed. The muscle relaxants are monitored by
an electrical nerve stimulator box, which is connected by electrodes to a nerve
in the arm, hand, face, or foot during surgery. When the nerve is stimulated
there is a muscle response that can be measured. There are many things that can
be learned by using this nerve stimulator. It can even be set up to produce a
paper strip record of the reactions, including the strength of the contraction.
When the muscle relaxant is injected, the strength of the
contraction decreases. By using the nerve stimulator as a monitor and by
using moderate doses of muscle relaxants, there is usually no problem with
muscle relaxants in post-polio patients.
At the end of surgery the effect of the muscle relaxant is reversed and
the muscle response is measured using the nerve stimulator to ensure that the
patient has normal neuromuscular trans-mission.
Curare, an antique drug that is no longer used, was
the muscle relaxant most focused on in the past as a problem for post-polio
patients. Muscle relaxants are not contra-indicated for polio survivors, but
they should be in the proper dose and their use should be monitored. The thing
to remember is: The problem is not the specific drugs but it is the way they
are used.
2)
Regional (only part of the body is anesthetized)
Dr. Calmes thinks this is a really great technique.
Anesthetizing the spinal cord or the nerves blocks the signals (terrible pain)
coming from the areas where the surgeon is working. This is very favorable for
the body as it prevents the release of stress hormones.
Types of regional anesthesia:
·
Spinal
Local
anesthesia is injected into the space around the spinal cord (subarachnoid space) and goes on the surfaces of the spinal
cord and the nerves departing the spinal cord, causing anesthesia.
·
Epidural
The local anesthesia is placed in a fat-filled space between some ligaments near the spinal cord. The advantage of an epidural is that a tiny catheter can be inserted and repeat doses of the local anesthesia can be given. This epidural catheter can also be used for post-op pain control following painful surgeries; a narcotic such as morphine can be put in the catheter to achieve pain relief for 24 hours or more. This knowledge of the effect of placing narcotics in the epidural space is a result of research done because of drug abuse problems. It has a very sound scientific basis.
If a person has
severe scoliosis it is sometimes difficult to get into the spinal and epidural
areas, but it is often possible.
·
IV block of the
arm
Hand and carpal
tunnel surgery are often necessary for post-polio patients. A tourniquet is put
on the upper part of the arm; the venous system is emptied below the
tourniquet, and then the empty venous system is filled with dilute local
anesthesia. This type of anesthesia does have some safety considerations, but
an IV block of the arm is very effective and works well for simple hand
surgery.
·
Other arm blocks
Other arm blocks can
be done through the axilla and above and below the
clavicle. Shoulder surgery anesthesia is usually done with a supraclavicular block, affecting the top part of the shoulder
all the way down to the hand. The patient is also put to sleep. Blocking first
means that less general anesthesia is needed. Post-op, the block can give pain
relief for 24-48 hours.
This block can
also move up and anesthetize the larynx and can also paralyze the diaphragm, an
important muscle for respiration. It has even been reported in healthy people
that vocal cord and diaphragmatic paralysis has occurred.
If a person with PPS is facing
shoulder surgery, he or she needs to be sure that the vocal cords are normal
before agreeing to one of these other arm blocks. An Ear-Nose-Throat specialist can easily determine
this.
·
Ankle block
Many people who had
polio need foot surgery. Local anesthetic injections can be made in the ankle
for this surgery.
3) Monitored Anesthesia Care (MAC)
MAC involves simple IV sedation given by
the anesthesiologist with local anesthetic given by the surgeon. The anesthesiologist sedates, monitors blood
pressure, the EKG, oxygenation, and talks with the patient to be sure he or she
is comfortable. The anesthesiologist needs to be there because things can go
wrong and also because general anesthesia may be needed.
The process of anesthesia includes the pre-op
evaluation and plan, intra-op, the recovery (during which some problems may
arise for polio survivors), and the post-op visit or call by the
anesthesiologist to learn how the patient experienced the anesthesia and his
recovery.
Many hospitals today have an anesthesia pre-op clinic. At
Usually patients are seen up to two weeks before
surgery. This is very good for a post-polio patient because he or she might
need a respiratory evaluation, e.g. pulmonary function tests. This scheduling
allows time for the necessary tests to be completed before surgery. The
anesthesiologist would have all the information by the time of the surgery.
1) Learn your history.
He or she needs to
know if you were in an iron lung and if you need or needed other ventilatory assistance. Have you had a trachesostomy
in the past? What is your laryngeal functioning? Do you have reflux? Do you
have obstructive sleep apnea?
2) Do a brief physical exam.
At least listen to
your heart and lungs and look at your mouth and neck.
3) Your needs and your preferences should be discussed.
4) There should be a plan for post-op pain control.
All of these pre-op things take time. There is an
extreme shortage today of anesthesiologists, especially in the
Post-polio surgery patients have to make themselves
known ahead of time, generally through the surgeon. Make it clear that you are
a special case, and that you need evaluation. If you cannot have this pre-op
evaluation, move on to another hospital.
1) If muscle relaxants are used, be cautious and
monitor their effect.
2) Be careful when positioning because of
contractures, etc.
Limbs that are small or are contracted don’t have
normal bone strength, so occasionally these become fractured during positioning
in the operating room. This possibility needs greater attention.
3) Expect autonomic dysfunctioning
(possible low blood pressure, delayed stomach emptying, etc.)
These are everyday problems for an anesthesiologist
but it helps to call them to the attention of the anesthesiologist.
During the recovery period:
1) Watch for signs of respiratory problems (the
recovery room nurse usually does this and reports to the anesthesiologist)
2) Treat pain promptly
The patient needs to be a “squeaky wheel” about pain.
Later:
The anesthesiologist should make a post-op visit or
call.
1) It depends on the person’s health. If the patient had
severe cardiac disease as well as PPS, another kind of anesthesia might be
chosen due to the cardiac disease.
2) It will also depend on what type of operation is
planned and who will be doing the surgery. The anesthesialogist
chooses the drugs to be used.
3) Patient preference
The patient might have had a bad experience in the
past with a spinal anesthetic for example, and might always want to be asleep.
No one type of anesthesia is best; have confidence it
will be safe for you.
·
Be in the best
possible health condition. If a person were extremely overweight, losing some
weight would help a lot.
·
If you smoke,
stop smoking for as long as you can before the operation. There is a distinct
improvement in lung function, even if a person stops for 24 hours.
·
No colds,
bronchitis, etc. (six weeks free of symptoms)
·
Arrange for help
at home during the post-op period. Surgery is quite an assault on polio
survivors and some assistance will be needed. Don’t be a martyr and try to do
everything.
Q 1: Should a post-polio patient have a spinal or epidural
anesthetic?
A: The benefits of good spinal or epidural anesthetics
are so great in many instances, that they should be considered for polio
survivors. That recommendation could change as knowledge of the spinal cord
increases.
Q 2: Do the injected muscle relaxants have any precautions
or long-term effects before and during surgery?
A: No. The muscle relaxants used during surgery help
make the patient’s muscles relax and a patient will not require as much of the
more potent drugs. The effects of these drugs end by the conclusion of the
case. The new muscle relaxant drugs in use today hydrolyze themselves (fall
apart) over a certain period of time. At the end of the case reversal drugs are
given to deal with any residual effect that might be there. If monitoring is
taking place, and the dose is appropriate, there should be no problem using
muscle relaxants in surgery.
Q 3: Will injected muscle relaxants used for surgery affect
my breathing?
A: Muscle relaxants do affect breathing; the
anesthesiologist is responsible for monitoring breathing and giving any
assistance needed.
These drugs are often used to help place the breathing
tube (the endotracheal tube) for surgery. This allows
optimal conditions (open the mouth easily, see the larynx) without being deeply
anesthetized. The breathing tube is a valuable safety measure.
Q 4: How can a person relate his fears and concerns about
anesthesia without getting a paternalistic response?
A: There is still a huge amount of paternalism in
medicine today. One thing that may help is that there are more women doctors
today, so there may also be a maternal response to help you through this…not
always, but sometimes.
Dr. Calmes urges every polio survivor to be a “squeaky
wheel” as to what you need and what you expect. You have the right to ask for
what you need. If you can’t get it, you need to move on. If necessary, have the procedure done at a
different hospital. In the
Q 5: What should a person discuss with the
anesthesiologist?
A: Ask if the nerve stimulator will be used to monitor
the dose of muscle relaxants. Tell him or her you need a pulmonary function
test evaluation. Discuss positioning.
All the anxiety about anesthesia for polio survivors
should really end.
The specialty of anesthesiology has been the leading advocate for patient safety by sophisticated monitoring, by analyzing data, better education, etc. Anesthesia today is extremely safe. Careful evaluation and planning need to be emphasized. If the anesthesialogist assesses the patient correctly and plans correctly, and if the patient is in the best possible physical shape preoperatively, there is not often a problem with anesthesia for polio survivors.
© Copyright 2005
Mary Clarke Atwood
Reprint permission must be obtained
directly from
Rancho Los Amigos Post-Polio Support
Group
RanchoPPSG@hotmail.com
Reprinted from the Rancho Los Amigos
June 2005 newsletter with permission of Mary Clarke Atwood. Thank you Mary.
******************************************
Reprinted from Elder
Update, September/October 2005
Credit
Reports –
Be
the First to Know
Submitted by Charles H. Bronson
Florida Department of Agriculture and Consumer Services Commissioner
What
is a “credit report?” A credit report
contains information about your credit history, including a listing of all your
credit cards, whether bills have been paid on time and whether you have been
sued or filed for bankruptcy. National
consumer reporting agencies sell the information to credit card companies and
other creditors, insurers, employers and businesses that use it to determine
whether to approve an application for credit, insurance, loans and
employment. A poor credit history can
result in rejection of credit or higher interest rates on a loan.
Consistently
examining your credit history is one of the most important things you can do as
a consumer to protect your-self from identity theft. It enables you to identify if someone else is
using your identity to obtain credit cards or loans without your knowledge.
Identity
theft is not the only concern. It is
important to regularly review all your credit reports for any mistakes. Businesses inspect your credit report/
history when they evaluate your applica-tions for
credit, insurance, employment and even leases.
They can use it to give or deny you credit or insurance, provided you
receive fair and equal treatment. It is
very important to ensure the information is accurate and up to date, especially
before making a major purchase.
A
recent amendment to the federal Fair Credit Reporting Act (FCRA) requires each
of the nationwide consumer reporting companies (Equifax, Experian
and TransUnion) to provide you with a free copy of
your credit report, at your request, once every 12 months. The law has been phased in across the
If
you are a resident of
When
you order your report, you need to provide your name, address, Social Security
number and date of birth. To verify your
identity, you may need to provide some information that only you would know,
like the amount of your monthly mortgage payment or any outstanding loans you
may have. If you have moved in the last
two years, you may have to provide your previous address. Each credit bureau may ask you for different
information because the information each has in your file may come from
different sources.
Create and
Maintain a Positive Credit History
·
Print
clearly when applying for credit.
·
Consistently
use your complete
name.
Providing complete, accurate and consistent identification on your
credit applications helps set up your credit history correctly from the
beginning. It also minimizes the chance
that your credit file will be incomplete or mixed with another consumer’s file.
·
Review
your credit report 60 to 90
days before making a major purchase
(such as a house or car).
·
Pay
your bills on time. Delinquent
payments and collections can have a major
negative impact on a score.
·
Keep
balances low on credit card
and other “revolving credit.” High out-standing debt can affect a score.
·
Apply
for and open new credit
accounts only as needed.
·
Just
because you pay off a credit
Card is no reason to close your
account. One little known fact about the
Credit to Debt Ratio is the reverse effect it has on your credit score. If you pay off a credit card, and close the
account, you are actually negatively impacting your credit score.
To obtain a free copy of
your credit report, visit www.annualcreditreport.com. You can also order your report by calling
toll-free 1-877-322-8228.
The Florida Department
of Agriculture and Consumer Services works for the consumer to prevent
fraudulent, deceptive and unfair business practices and to provide information
to help consumers avoid them. To file a
complaint or to get free information on consumer issues give us a call at
1-800-HELP-FLA (435-7352), or 850-488-2221.
You can also visit us online at www.800helpfla.com
.
******************************************
JUST A SMILER
While
I sat in the reception area of my doctor’s office, a woman rolled an elderly
man in a wheelchair into the room. As
she went to the receptionist’s desk, the man sat there, alone and silent.
Just
as I was thinking I should make small talk with him, a little boy slipped off
his mother’s lap and walked over to the wheelchair. Placing his hand on the man’s, he said, “I
know how you feel. My mom makes me ride
in the stroller too.”
FECPPSG Editor’s Note:- As they say – you never know what’s going to come out of a
youngster’s mouth…. Most
of the time they are little pearls of wisdom.
******************************************
PURGING
POLIO
By Paul Garwood,
Associated Press
AZ ZUHRAN,
In
this dirt-poor region along the
The
parents to boycott the vaccine for fear it
was part of an American anti-Muslim plot.
The polio that then erupted in
“The
Islamic world took a real beating because of what the clerics did in northern
FECPPSG Editor’s Note:- In countries where so many children
need vaccinations, the oral vaccine (Sabine’s live virus) is still being given
as it is much easier to give to a child, and less expensive than the “shot”
(Salk’s dead virus). I, as a polio
survivor have no problem with them giving the children the oral. However, once this possible “epidemic” is
over, they (
******************************************
Maura Lerner, Star Tribune
How did a baby in central Minnesota
contract the virus that causes polio, a crippling disease that was essentially
wiped out in the United States a quarter of a century ago.
That question has mystified state
and federal health officials since tests confirmed the polio virus in an
unidentified infant last week.
The case is especially puzzling because the baby, who
was born in this country, was somehow exposed to a strain of virus found in
oral polio vaccines, which haven't been used in the
"[It] is not a public health concern for the
general public," said Kris Ehresmann, chief of
immunization at the Minnesota Health Department. "But it is definitely a
situation that is of great scientific interest. It's a unique situation."
Investigators now are testing relatives and others
who have had close contact with the child to see whether anyone else may have
been infected. They suspect that someone contracted the polio virus in another
country and unwittingly passed it on.
The baby had no symptoms of polio, Ehresmann said. The virus was discovered during tests while
the child was hospitalized for an unrelated immune condition. Officials
declined to identify the child's gender or age, saying only that he or she is
less than a year old.
The Health Department was asked to run lab tests to
find out whether a virus was making the child sick. When no routine viruses
showed up, they started looking for obscure ones. And they found the polio
virus.
The child hadn't been vaccinated against polio,
apparently because of underlying medical problems.
But health experts were astonished at the test
results, to put it mildly. It's been 50 years since the polio vaccine was
developed, in the midst of an epidemic that paralyzed as many as 21,000
Americans a year at its peak. By 1979, the disease had been wiped out as a
natural threat in the
For the next 20 years, virtually the only cases
reported in this country -- an average of eight a year -- were caused by the
oral vaccine, which used a modified live virus. Five years ago, the
Since then, federal officials say, no one had
contracted polio in the
To make sure of their findings, state officials sent
samples of the virus to the U.S. Centers for Disease Control and Prevention in
"It's an unusual thing in any country,"
said Dr. Jim Alexander, a vaccine specialist at the federal agency. "There
are many more questions so far than we have answers."
But they learned something remarkable, Ehresmann said. Using genetic finger-printing, the CDC
experts discovered that the virus strain had been used in an oral vaccine two
years ago.
That means that someone got the oral vaccine
elsewhere -- it's still used in much of the world --and inadvertently
transmitted the polio virus to someone else.
"You could have somebody who ... would appear
completely healthy who could be unknowingly shedding virus," she said. It
is transmitted by direct contact with stool (i.e. diapers).
Typically, she said, people can only infect others
for about a week. But people with immune problems may harbor it indefinitely.
The baby is still hospitalized.
"I really hope that we'll be
able to figure things out," Ehresmann said.
"But it certainly is a possibility that there will still be some missing
pieces to this puzzle when all is said and done."
Maura Lerner can be reached at:
mlerner@startribune.com
******************************************
|
Ain't it da truth Thought I'd let my doctor check me, He could find no real disorder To the hospital he sent me I was fluoroscoped and cystoscoped, I was checked for
worms and parasites, Doctors came to check
me over,
So now I’m going to
take a NAP!! |
******************************************
DUES FOR 2005
Please take a look at your mailing
label -
on it you’ll see the month and year we received your 2004 dues, i.e., 01/2004
means it was received in January 2004, so your 2005 dues was due in January
2005. If your mailing label has the year first and then the month, i.e.,
2004/01 it means that you indicated to us in January 2004 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.
*****************************************
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:- --
An
attorney from the law firm of
Hill & Ponton
will talk
to us about Social Security
Disability and the new Prescription Drug Plan.
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 --
11/2005
***********************************
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:- An
attorney from the law firm of Hill & Ponton will talk
to us about Social Security Disability and the new
Prescription Drug Plan.
For further information call:- Barbara 386-676-2435
==================================================================
2005 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:-_____________________________________
11/2005