Reason for Deleteing Entry on Surviving A Heart Attack When Alone

Authored by BlueAngel on
Thursday, April 22, 2004

Today I rec'd an e-mail from the editor of The Elder Care Team Newsletter and was sent the following web site information from http://www.snopes.com/toxins/coughcpr/htm talking about urban myths that gives documentation of the dispelling of the "myth".

So, to be on the safe side, I decided to delete the article "How to Survive a Heart Attack When Alone" . The article has you coughing rhthymically repeatedly as the mechanism to perform the initial CPR by squeezing the heart muscle to stimulate the beat to restart the heart.

Claim: Doctors generally recommend that one attempt to rhythmically cough during a heart attack to increase the chance of surviving it.
Status: False.

Example: [Collected on the Internet, 1999]

This one is serious . . . Let's say it's 4:17 p.m. and you're driving home, (alone of course) after an unusually hard day on the job. Not only was the work load extraordinarily heavy, you also had a disagreement with your boss, and no matter how hard you tried he just wouldn't see your side of the situation. You're really upset and the more you think about it the more up tight you become.
All of a sudden you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home, unfortunately you don't know if you'll be able to make it that far.

What can you do? You've been trained in CPR but the guy that taught the course neglected to tell you how to perform it on yourself.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE

Since many people are alone when they suffer a heart attack, this article seemed in order. Without help the person whose heart stops beating properly and who begins to feel Faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help.

Tell as many other people as possible about this, it could save their lives!

From Health Cares, Rochester General Hospital via Chapter 240's newsletter. AND THE BEAT GOES ON... (reprint from The Mended Hearts, Inc. publication, Heart Response)

Origins: This
helpful e-mail began its life on the Internet in June 1999. Those kindhearted souls who started it on its way likely had no inkling the advice they were forwarding could potentially be harmful to someone undergoing a heart attack, but that is indeed the case.

If you knew exactly what you were doing, this procedure it might help save your life. If, however, you were to attempt cough CPR at the wrong time (because you misjudged the kind of cardiac event being experienced) or went about it in the wrong way, it could make matters worse.

Cough CPR is not a new procedure — it has been around for years and has been used successfully in isolated emergency cases where victims realized they were on the verge of fainting and about to go into full cardiac arrest (their hearts were about to stop) and knew exactly how to cough so as to keep enough oxygen-enriched blood circulating to prevent them from losing consciousness until help could be sought, or they were under the direct care of physicians who recognized the crises as they were taking place and were on hand to instruct patients step by step through the coughing. Even were the afflicted to correctly recognize they were experiencing the sort of cardiac event where cough CPR could help, without specific training to hit the right rhythms their coughing could turn mild heart attacks into fatal ones.

This is not to say cough CPR couldn't be effectively taught to patients deemed at risk of further heart attacks. According to a widely circulated news report surfacing in September 2003, a doctor in Poland has been attempting exactly that. Dr. Tadeusz Petelenz of the Silesian Medical Academy in Katowice Province claims to have successfully instructed a number of his patients in the procedure, but it should be noted his results have not been independently confirmed. While a September 2003 Reuters article detailed the Polish doctor's championing of cough CPR, a similar Associated Press report on the same subject noted that "Experts said while the concept is provocative, it needs more study" and that "Dr. Marten Rosenquist, professor of cardiology at the Karolinska Institute in Stockholm, Sweden, and an expert in heart beat abnormalities, said the concept is interesting but that Petelenz showed no evidence his patients actually had arrhythmias."

It is unclear from the news reports whether the Polish heart patients who supposedly experienced success with cough CPR were doing so under strict medical supervision in a hospital or were going about their private lives at the time of the cardiac events that prompted them to attempt the procedure. It is one thing for success to be achieved in a hospital setting where patients know intervention will swiftly follow if problems are encountered, and quite another when patients are in unscripted settings (at home, at work, or while driving in a car). Would such instruction hold up in field conditions, where those about to go into full cardiac arrest know there's no net under the tightrope?

Yet even if cough CPR can be effectively taught by physicians, it's not going to be learned from an e-mail, at least not well enough to be safe. Even if Dr. Petelenz's findings prove out, there's a wide (and dangerous) gap between in-person one-on-one training by a professional on hand to quickly correct a patient's mistakes before they become habit and generic printed instruction wholly lacking in direct feedback and guidance. Thinking one is a valid substitute for the other would be akin to believing studying a typed set of instructions is all it takes to learn how to drive a car well enough to take it down the freeway and back.

The e-mailed advice about coughing during a heart attack leaves the impression the "cough CPR" technique is endorsed by Rochester General Hospital and Mended Hearts. Rochester General had nothing to do with any of this — how its name came to be attached to this message is a mystery. See their web page which denies their having endorsed this e-mail

Mended Hearts (a support group for heart disease patients and their families) is not nearly so blameless.

Although the text of the e-mailed advice was published in a Mended Hearts newsletter, the organization has since disavowed it and for a time had a page on its web site asking readers not to take the e-mail seriously because they didn't stand behind it. The piece on cough CPR found its way into that publication through a blend of too much enthusiasm and a dearth of fact checking. From there, other chapters picked it up, spreading the notion to an even wider audience. Attempts now to distance the organization from it don't begin to undo the damage done by the piece having been picked up from there.

Darla Bonham, Mended Heart's executive director, has since issued a statement about cough CPR:

I've received email from people all across the country wanting to know if it is a valid medically approved procedure. I contacted a scientist on staff with the American Heart Association Emergency Cardiac Care division, and he was able to track a possible source of the information. The information comes from a professional textbook on emergency cardiac care. This procedure is also known as "cough CPR" and is used in emergency situations by professional staff. The American Heart Association does not recommend that the public use this method in a situation where there is no medical supervision.
Dr. Richard O. Cummins, Seattle's director of emergency cardiac care, explains that cough CPR raises the pressure in the chest just enough to maintain some circulation of oxygen-containing blood and help enough get to the brain to maintain consciousness for a prolonged period. But cough CPR should be used only by a person about to lose consciousness, an indication of cardiac arrest, he cautions. It can be dangerous for someone having a heart attack that does not result in cardiac arrest. Such a person should call for help and then sit quietly until help arrives, he says.

In other words, the procedure might be the right thing to attempt or it might be the very thing that would kill the afflicted depending on which sort of cardiac crisis is being experienced. Without a doctor there to judge the situation and, if cough CPR is indicated, to supervise the rhythmic coughing, the procedure is just far too risky for a layman to attempt.

Forget about coughing — key to surviving a heart attack is obtaining proper medical assistance within a very limited window of opportunity. Once an acute myocardial infarction (AMI) has been diagnosed, speedy injection of thrombolytic agents to dissolve clots is of the utmost importance — the more quickly those drugs are delivered, the better the chances of survival are. It's a race against the clock.

Most patients who present with minor chest pains usually look healthy and show no signs of a heart attack. Electrocardiogram (ECG) results tell the story though, so be sure to insist upon one being performed if you've any doubts at all. Often mild heart attacks are left untreated and undetected because hospital staff mistake a heart attack for something more benign because the presenting symptoms are minor.

Rather than risk killing yourself with cough CPR, those experiencing a heart attack should heed the advice of physicians the world over — down a couple of Aspirin as an emergency remedy. Doctors believe that during the early stages of a heart attack, Aspirin — which is known to prevent blood platelets from sticking together — can prevent a clot from getting bigger. In 1991 Dr. Michael Vance, president of the American Board of Emergency Medicine, recommended that people who think they are having a heart attack should "Call 911, then take an Aspirin."

Oh, and it probably makes a great deal of sense to chew the Aspirin before swallowing. The sooner it is dispersed by the stomach, the sooner it gets to where it is needed. During a heart attack, waiting for the enteric coating surrounding the pill to break down naturally could be a mistake.

In 1993 The American Heart Association began recommending a 325 mg Aspirin at the onset of chest pain or other symptoms of a severe heart attack. That bit of advice is going unheeded though — a follow-up report published in 1997 shows as many as 10,000 American lives a year could be saved if more people who think they're having a heart attack took an aspirin at the start of chest pains.

In terms of the drama of it, swallowing an Aspirin seems quite a come-down from bravely trying to induce a perfectly timed coughing fit. Less flamboyant is better, though; Aspirin saves lives, whereas coughing might well cost them.

Barbara "from coughing to coffin?" Mikkelson

Additional information: Cough CPR
(Red Cross)
Cough CPR
(American Heart Association)
Heart Attack Treatments
(American Medical Association)
Heart Attack information
(American Heart Association)

Last updated: 2 September 2003

The URL for this page is http://www.snopes.com/toxins/coughcpr.htm
Click here to e-mail this page to a friend
Urban Legends Reference Pages © 1995-2004
by Barbara and David P. Mikkelson
This material may not be reproduced without permission

--------------------------------------------------------------------------------
Sources:
Brody, Jane. "Personal Health: Saving a Life With CPR Can Be As Easy As ABC."
The New York Times. 30 March 1994 (p. C13).

Graedon, Joe and Teresa Graedon. "FDA OKs Aspirin Against Heart Attack."
The Houston Chronicle. 6 July 1996 (p. E8).

Linn, Virginia. "Coughing Is Not the Way to Stop a Heart Attack."
[Pittsburgh] Post-Gazette.com. 27 July 1999.

Ross, Emma. "Coughing - One Way to Hold off a Heart Attack."
Associated Press. 2 September 2003.

Siegel-Itzkovich. "Cough to Survive a Heart Attack."
The Jerusalem Post. 27 June 1999 (Health, p. 9).

Associated Press. "Many Fail to Take Aspirin During Heart Attacks, Experts Say."
St. Louis Post-Dispatch. 22 October 1997 (p. A9).

Toxin du jour

Medicare and Durable Medical Equipment

Authored by BlueAngel on
Wednesday, April 21, 2004

The following information about Medicare and Durable Medical Equipment is found in an article I found by accident just "surfing" the Internet. The Eldercareteam site is easily understood and the information is well archived as well as in "language most of us can understand". Molly Shomer, Senior Link,LLC and The Eldercare Team in Dallas, graciously granted us permission to reprint this article in our blog site, The Phoenix, San Antonio Polio Survivors Association. Molly can be reached at info@eldercareteam.com and the web site is http://www.eldercareteam.com.

The article Entitled "Medicare and Durable Medical Equipment" is subtitled "Buying Equipment for Someone on Medicare Can be Tricky Business".

The following is extracted from an issue brief intended for professionals who work with Medicare recipients. It is an excellent explanation for anyone who might have a need for medical equipment. Reprinted with permission of the Center for Medicare Education, www.MedicareEd.org
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Medicare coverage of wheelchairs, hospital beds and other durable medical equipment (DME) is a major source of confusion for people with Medicare, their families and the professionals who work with them. Yet, consumer publications rarely touch on it. In this brief we offer an overview of DME coverage issues and payment policies.

Many people with Medicare and their families mistakenly think getting home medical equipment is as easy as going to their local medical equipment supplier and bringing the equipment home, or calling up a company that advertises on television and having the equipment delivered right to their door. For example, there are commercials on TV that show older people riding scooters at the grocery store, the mall or the park; these often lead people to believe that almost anyone can get Medicare to pay for a scooter to run errands and perform other activities.

Unfortunately, it's not usually that easy. Medicare's coverage requirements and related rules for getting medical equipment are complex and often confusing. It's crucial for you and your clients to understand that durable medical equipment is primarily medical, and the entire process of acquiring Medicare-covered equipment starts with your client's physician. It's also important to understand that each Medicare-covered piece of equipment has specific requirements that your client must meet to ensure Medicare payment. For example, the commercials mentioned above do not tell people that they must be unable to walk to get a Medicare-covered scooter.

The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare and Medicaid, contracts with four companies, known as Durable Medical Equipment Regional Carriers, or DMERDs, to process Medicare DME claims. Each DMERC handles a specific geographic region of the country. DMERCs also provide information and assistance to providers, suppliers and people with Medicare who have questions about DME coverage. (To find the DMERC for your state, see below)

When Does Medicare Pay for Durable Medical Equipment?

The entire class of DME items includes prosthetics, orthotics and supplies (sometimes abbreviated as DMEPOS), giving us these three major three DME categories

Durable medical equipment, or DME
Prosthetics and orthotics
Supplies
In this brief, we will refer to all of these items as DME.

Medicare pays for DME if your clients require the assistance or use of the equipment to function at their best and their physician orders it. The equipment itself must meet certain requirements for Medicare coverage. It must be:

Able to withstand repeated use
Primarily used for a medical purpose
Generally useful only in the presence of illness or injury
Appropriate for use in someone's home
We'll describe these in more detail in the next few sections

Physician Order/Certificate of Medical Necessity

Medicare requires a physician's order, or prescription, for DME. A certificate of medical necessity (CMN) supporting the prescription is also often required. A CMN is a special form authorizing the use of certain physician-prescribed equipment, such as hospital beds, oxygen and wheelchairs. The Medicare-certified supplier should know which items need a CMN and work with your client's physician to submit all required documentation to Medicare.

Durable

Medicare pays for equipment that is durable, meaning that it can withstand repeated use. Expendable items such as incontinence pads, bandages and surgical stockings are not covered under the DME benefit. However, certain items such as lancets and test strips used by people with diabetes to check their blood sugar levels, while used once and then discarded thereafter, are covered.

Primarily Used for Medical Purpose and Useful Only When Ill or Injured

Medicare pays for equipment that is primarily and customarily used for a medical purpose and generally only useful when your client has an illness or injury. Canes, walkers, hospital beds and respirators are common examples of these types of equipment.

However, Medicare does not cover some devices that your client might need to recover from illness or injury. For example, while air conditioning may be useful for your clients with certain cardiac or respiratory illnesses, Medicare will not cover it because air conditioning is not primarily used for a medical purpose. In addition, Medicare will not cover equipment used primarily for your client's convenience or that of his or her caregivers, such as elevators or stair lifts.

For Use in the Home

Medicare pays for equipment that is mainly for use inside your clients' homes, whether that is their own home, an apartment, the home of a relative, or an assisted living facility or other type of institution. However, this institution cannot be a hospital or skilled nursing facility, as such facilities are required to provide necessary equipment to residents.

For example, Medicare will cover a power-operated vehicle, or scooter, when your client requires it to get around inside his or her home. Medicare will not cover it if your client primarily needs it to get around outside the house, such as going to the grocery store.

Prosthetics and Orthotics

Medicare covers prosthetic devices that replace all or part of an internal body organ or its function and orthotics devices that support weak or deformed body parts. Prosthetics include artificial limbs, eyes and lenses, and orthotics consist of leg, arm, back and neck braces. Medicare also covers enteral and parenteral nutrition therapy supplies (such as food pumps and intravenous poles) as prosthetics. However, Medicare generally doesn't cover dental devices such as dentures.

Supplies

Certain supplies, even though generally disposable in nature, fall under Medicare's coverage of DME, including testing items used by people with diabetes, as well as catheters and ostomy supplies.

DME: Renting or Purchasing?

Medicare approves some DME items for purchase, others for rent and others for either purchase or rent. Your Medicare-certified supplier should know and explain whether Medicare requires purchase or rental of your client's physician-ordered DME. In general:

DME for purchase: Equipment that is a customized device

If your clients want to buy a customized device ordered by their physician (such as a narrow or other specially-constructed wheelchair to accommodate their condition), Medicare and your clients pay their portions of the cost in respective lump sum payments. Your clients then own the equipment. If the cost of the equipment is high and the supplier is willing, the one-time lump sum payment may be divided into monthly payments, with Medicare and your clients still paying their respective portions of each month's payment.


DME for rent: Equipment that needs to be serviced often, such as oxygen equipment and some ventilators and aspirators

Medicare and your client pay their respective portions of the monthly rental payments.


DME that is a "capped rental item": Equipment that must be rented for a period of time before the individual has a choice to buy it or continue renting it

Capped rental items, such as wheelchairs and hospital beds, must be rented for nine months in a row. Medicare and your client pay their respective portions of the monthly rental payments. In the 10th rental month, the supplier must offer your client the option to buy the equipment.

If your client chooses to buy the equipment, Medicare will pay an additional three months of rent, after which the supplier must transfer ownership of the equipment to your client. The supplier may be allowed to charge your client an additional monthly amount on top of each of these final rental payments. Thereafter, Medicare covers necessary repair or replacement of the equipment.

If your client chooses to rent the equipment, Medicare makes rental payments for an additional five months only. After that, the supplier must continue to provide the equipment to your client free of charge and can only charge for service and maintenance. The supplier, however, owns the equipment

NOTE: A supplier that accepts Medicare does not necessarily accept Medicare assignment. Before getting any medical equipment, your clients should call their DMERC for a list of participating suppliers. They can also find a supplier that takes assignment by calling 1-800-MEDICARE or by going to the Medicare Web site at www.medicare.gov

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Durable Medical Equipment Regional Carriers

Region A
Region C

CT, DE, ME, MA, NH, NJ, NY, PA, RI, VT
AL, AR, CO, FL, FA, KY, LA, MS, NM, NC, OK, SC, TN, TX, PR, Virgin Islands

Health Now Upstate Medicare Division
1 (800) 842-2052
www.umd.nycpic.com
Palmetto GBA
1 (866) 238-9650
www.pgba.com

Region B
Region D

DC, IN, IL, MD, MI, MN, OH, WI, WV, VA
AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, American Samoa, Guam, Mariana Island

AdminiStar Federal
1 (800) 622-4792
www.administar.com
CIGNA Healthcare
1 (800) 899-7995
www.cignamedicare.com

Return to Articles Index

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© 2003 Molly Shomer, SeniorLink, LLC and The Eldercare Team. All rights reserved. Please visit http://www.eldercareteam.com for more articles and caregiving resources.

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The Eldercare Team
SeniorLink, LLC
P.O. Box 700291
Dallas, Texas 75370
Phone (972) 395-7823 Fax (972) 395-7164
email: info@eldercareteam.com
©1999-2003 SeniorLink, L.L.C., The Eldercare Team

Reality Check???

Authored by BlueAngel on
Wednesday, April 21, 2004

The following comparison price checks between a gallon of gasoline and a gallon of various food products (commonly used by most of us) is a unique way of performing a "Reality Check".

I think that you will find it interesting. Albeit a little tongue in cheek, it does cause one to stop and ponder.

As the friend who sent it to me said, "I hope we will always be able to buy gasoline at some price because I don't like walking............"

COMPARED WITH GASOLINE

Think a gallon of gas is expensive?
This makes one think, and also puts things in perspective.

Diet Snapple 16 oz. $1.29..............$ 10.32 per gallon

Lipton Tea 16 oz $1.19...................$ 9.52 per gallon

Gatorade 20 oz $1.59.....................$ 10.17 per gallon

Ocean Spray 16 oz $1.25................$ 10.00 per gallon

Brake Fluid 12 oz $3.15..................$ 33.60 per gallon

Vick's Nyquil 6 oz $8.35..................$170.13 per gallon

Pepto Bismol 4 oz $3.85..................$123.20 per gallon

Whiteout 7 oz $1.39........................$ 23.42 per gallon

Scope 1.5 oz $0.99.........................$ 84.48 per gallon

And this is the REAL KICKER........

Evian water 9 oz $1.49....................$ 21.19 per gallon?! $21.19 for WATER and the buyers don't even know the source.

So, the next time you're at the pump be glad that your car doesn't run on water, Scope, or Whitout, or God forbid Pepto Bismol or Nyquil.

Just a little humor to help ease the pain of your next trip to the puimp.......

Have a great day!

Big Hugs

A DANGEROUS PRANK

Authored by BlueAngel on
Wednesday, April 21, 2004

The ubiquitous Internet is where the following information has come from. A friend of mine (of over thirty years) sent to me so it could be passed along to the community. She does not claim nor do I that this particular prank has occured here in this vicinity but it is worth passing along as a preventative matter concerning possible infection(s) or harm to all.

She rec'd this information from friends in Jacksonville, Florida.

Subject: GAS PUMP

Addendum

30 May 2004

Since posting of this "blog", "A Dangerous Prank", I rec'd a correction on the validity of the item. It was descovered to have been a hoax that has been around for about 4 years. It is truly unfortunate that this has occurred. For this, I do apologize.

It was never intended that anything should be placed in this informational type journal that would be detrimental to anyone or their loved ones. I am not going to delete the hoax so that people will realize that we can all fall prey to the many hoaxes that are out there not only in cyberspace but in real life.

Thank you.

"Read this before your next gas fill-up:

Please take a couple of minutes to read this warning about Gas Pumping Handles.

WARNING: Look at the gas pump handles BEFORE you pump your gas. Please read and forward to anyone you know who drives a car.

My name is Captain Abraham Sands of the Jacksonville, Florida Police
Department. I have been asked by state and local authorities to write this email in order to get the word out to car drivers of a very dangerous prank that is occurring in numerous states. Some person or persons have been affixing hypodermic needles to the underside of gas pump handles! These needles appear to be infected with HIV positive blood.

In the Jacksonville area alone, there have been 17 cases of people being stuck by these needles over the past 5 months. We have verified reports of at least 12 others in various states around the country. It is believed that these may be copycat incidents due to someone reading about the crimes or see them reported on the television. At this point no one has been arrested and catching the perpetrators has become our top porioity. Shockingly, of the 17 who were stuck, 8 have tested HIV postive and because of the nature of the disease, the others could test positive in a couple of years.

Evidently, the consumers go to fill their car with gas, and when picking up the pump handle, get stuck with the infected needle. IT IS IMPERATIVE TO CAREFULLY CHECK THE HANDLE OF THE GAS PUMP EACH TIME YOU USE ONE. LOOK AT EVERY SURFACE YOUR HAND MAY TOUCH, INCLUDING UNDER THE HANDLE.

If you do find find a needle affixed to one(handle), Immediately contact your local police department so they can collect the evidence. PLEASE HELP US BY MAINTAINING A VIGILANCE, AND BY FORWARDING THIS INFORMATION TO ANYONE YOU KNOW WHO DRIVES. THE MORE WHO KNOW OF THIS, THE BETTER PROTECTED WE CAN ALL BE.

Rose Lambert,
Chief Aide to Supervisor Gerry Hyland, Mount Vernon District
2511 Parkers Lane
Alexandria, Virginia 22306

PLEASE READ THIS AND PASS IT ON TO EVERYONE IN YOUR ADDRESS BOOK"

(MY COMMENT: I HOPE THIS IS NOT TRUE BUT IF IT IS A WORD TO THE WISE SHOULD BE SUFFICENT. It could happen with other types of infectious diseases than HIV that can be just as deadly. Ethel Taylor aka BlueAngel).

Polio Myths & Half Truths

Authored by BlueAngel on
Saturday, April 17, 2004

(This article is reprinted from IPN's Polio Network News (now Post-Polio Health) Spring 2002 Vol. 18 No. 2. Any further reproduction must have permisssions of the copywrite holder. Post -Polio Health International; 4207 Lindell 4207 #110; Saint Louis, Missouri 83106-2915. www.post-polio.org / info@post-polio.org.)

Polio Myths and Half-Truths

Julie K. Silver, MD, Medical Director, International Rehabilitation Center for Polio, Spaulding Rehabilitation Hospital, Framingham, Massachusetts

Julie K. Silver, MD, is the medical director of the International Rehabilitation Center for Polio at Spaulding Rehabilitation Hospital in Massachusetts (www.polioclinic.org). She is also an Assistant Professor at Harvard Medical School and has published several books including the book Post-Polio Syndrome: A Guide for Polio Survivors and Their Families (Yale University Press). Dr. Silver’s mother, uncle, and grandfather all contracted polio in the summer of 1946. During her medical training, she worked with Lauro Halstead, MD, and they have worked together on polio-related projects throughout her career.

Myth #1: Some medications are bad for polio survivors and should be avoided at all cost.

Many polio survivors have read that some medication classes are bad for them – the most common I am asked about is probably the “statins” (e.g., fluvastatin, simvastatin, etc.) These are medications that end in statin and are used to lower cholesterol levels. The fear is that these drugs will cause muscle pain or weakness (a known side effect) and compound the weakness that a polio survivor is already experiencing.

Heart disease is the leading cause of death in men and women as they age. Stroke is a leading cause of further disability. Both conditions are directly linked with high cholesterol levels and “statin” drugs that reduce cholesterol are critical for many people in order to lower their risk of stroke and heart attack.

But, why give a drug to a polio survivor that may cause him or her to become weaker? The answer is because it may save a life.

It is important to understand what the actual risk may be of developing musculoskeletal problems if you take a particular medication. For example, the drug Zocor (simvastatin) underwent fairly vigorous testing prior to it being approved by the Federal Drug Administration (FDA). More than 2400 people were tested on the medication.1 No one in the study knew if they were actually taking the drug (it was blinded), and the results showed that more people complained of muscular side effects when taking a sugar pill (1.3%) than when taking the actual medication (1.2%). The point here is that even if you do take simvastatin, there is nearly a 99% chance that you won’t develop muscular side effects.

So, my advice always goes like this: talk to your doctor – the one who prescribed the medication in the first place. Ask him or her whether it would be okay for you to stop the medication for a period of time to see whether it is indeed causing you to feel weaker or more pain or whatever you are concerned about. A “drug holiday” is a good way to see whether you are actually experiencing side effects from medication. When you go off the medication, pay attention to whether you feel any different. If you do not, that medication is probably fine for you. Keep in mind that every drug has a huge list of potential side effects. This does not mean that you will experience them – it just means that in studies that were done on the drug, some people had these side effects.

At the same time, ask your doctor whether there are other alternatives that you can try – including medications and life-style changes. For example, exercise, smoking cessation, and weight loss have all been associated with reducing cholesterol levels. Although I used the example of the statin class of medications, this advice applies to any medication that concerns you.

Myth #2: Polio survivors should rest, rest, rest!

This is another myth that has some truth to it, but taken to an extreme is dangerous. All bodies become extremely deconditioned without the constant use of the muscles. Even polio-weakened muscles can become weaker from disuse. Not using muscles results in weakness, and diminished endurance and cardiac fitness. If you are at complete bedrest, your muscles will lose 10-15% of their strength per week.2 If you stay in bed for a month, you will have lost about half your strength. Muscles need to be contracted regularly in order for them to maintain their size and strength.

On the other hand, it is important to note that the opposite of disuse – overuse – can also cause further weakness in polio survivors. So, the trick is to balance your daily activities with rest and also do an appropriate exercise program.

This sounds easier than it is, and I always recommend that people talk to healthcare professionals who are experienced in prescribing exercise programs for polio survivors. But some simple suggestions are as follows:

Nearly everyone, including polio survivors, should exercise regularly.

Exercise is not what you do in your daily activities, but rather is a set program that has a time limit and a certain number of exercises with a particular amount of weight or resistance that is used.

Doing the same exercises over and over may lead to further weakness. Instead, exercises should be alternated regularly so all of the muscle groups are used and no one muscle group is overused. The concept of cross-training that is widely accepted in sports medicine is what we promote at our center.

Include some strengthening, range-of-motion, and aerobic exercises to be sure you maintain optimal fitness.

If you experience pain or undue fatigue, check with your doctor. This generally means that what you are doing needs to be modified or even stopped altogether.

Myth #3: Swimming is good for you

If you love to swim, do it regularly, and have easy and safe access to a pool, then swimming probably is good for you and you should continue to do it. However, if you do not swim for exercise and you feel guilty about it, then let me relieve you of your guilt – because swimming can be dangerous for your health.

Famous polio survivor, Franklin Delano Roosevelt, loved the buoyancy of water and the freedom it gave him to move his paralyzed body. The fact that much of his swimming was done in the beautiful Warm Springs, Georgia, only added to the benefits he received from this exercise. But swimming is not for everyone and there are some good reasons why you might not want to swim.

First, getting ready to go swimming is a lot of work. For most people swimming involves many or all of the following steps:

Locate your bathing suit and towel.

Go from your house to your car.

Drive to the pool.

Go from the parking lot to the locker room.

Change into your bathing suit.

Go from the locker room to the pool.

Swim.

Go from the pool to the locker room.

Change out of your bathing suit.

Go from the locker room to your car.

Drive your car home.

Go from your car to your house.

Hang your bathing suit and towel up to dry.

Of the 13 steps I listed, only one of them involves the “exercise” of swimming. But, in order to get that exercise, you must do at least 12 other things that may just serve to wear you out. So, although I am a huge advocate of exercise that promotes cardiovascular fitness for polio survivors (keep in mind that post-polio syndrome is disabling, but cardiovascular disease kills more middle aged and older people than any other condition), swimming is a lot of work.

Second, you may be at risk to fall as you do these 13 steps. In one study, 46% of polio survivors noted that walking outdoors was difficult.3 In another study, 82% of polio survivors reported increasing difficulty with walking.4 Yet another study revealed that 64% of survivors reported falling at least once within the previous year and of this same group, 35% reported they had a history of at least one fracture due to a fall.5 Given these statistics, the number of steps it requires to go swimming (often both literally and figuratively) and the likelihood that there may be some slippery surfaces in the locker room or around the pool, it is easy to see how someone might fall and sustain a serious injury while going swimming.

I think it is really important to not discourage anyone from exercising in a safe manner and swimming can be a great exercise for polio survivors. But, it is not a great exercise for ALL polio survivors. If you love to swim and you can do it safely, then definitely continue. But, if you find yourself overly fatigued after swimming, or if you think you are at risk to fall and have a serious injury then consider other exercise options.

References:
1. Physicians’ Desk Reference. (2002). (pp. 2222-2223). Montvale, NJ: Medical Economics Company, Inc.
2. Rehabilitation Medicine Principles and Practice. (1993). DeLisa, J., & Gans, B. (Eds.) (p. 689).

A Statement for Exercise about Polio Survivors

Authored by BlueAngel on
Saturday, April 17, 2004

( The article is reprinted from Post-Polio Health, Spring 2003, Vol. 19 No.2 with permission of Post-Polio Health International. Any further reproducation must have permissions of the copywrite holder: Post -Polio Health International, 4207 Lindell Blvd. #110; Saint Louis, Missouri 83106-2915; {www.post-polio.org} E-mail: info@post-polio.org)

Advising all polio survivors not to exercise is as irresponsible as advising all polio survivors to exercise.

Polio survivors who experience marked pain or fatigue following any exercise should hold that exercise until contacting their health professional. Researchers and clinicians cannot make a more definite statement until additional studies on the long-term effects of exercise and the effects of exercise on function and quality of life are undertaken.

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*Criteria for diagnosis of post-polio syndrome

Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neurologic examination, and signs of denervation on electromyography (EMG).

A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neurologic function.

Gradual or sudden onset of progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of inactivity, or trauma or surgery.) Less commonly, symptoms attributed to post-polio syndrome include new problems with breathing or swallowing.

Symptoms persist for at least a year.

Exclusion of other neurologic, medical, and orthopedic problems as causes of symptoms.

Source: Post-Polio Syndrome: Identifying Best Practices in Diagnosis & Care. March of Dimes, 2001.
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References

Agre, J., Grimby, G., Rodriquez, A., Einarsson, G., Swiggum, E., & Franke, T. (1995). A comparison of symptoms between Swedish and American post-polio individuals and assessment of lower-limb strength – a four-year cohort study. Scandinavian Journal of Rehabilitation Medicine, 27, 183-192.

Agre, J., Rodriquez, A., & Franke, T. (1997). Strength, endurance, and work capacity after muscle strengthening exercise in postpolio subjects. Archives of Physical Medicine & Rehabilitation, 78, 681-685.

Agre, J., Rodriquez, A., & Franke, T. (1998). Subjective recovery time after exhausting muscular activity in postpolio and control subjects. American Journal of Physical Medicine & Rehabilitation, 77, 140-144.

Agre, J., Rodriquez, A., Franke, T., Swiggum, E., Harmon, R., & Curt, J. (1996). Low-intensity, alternate-day exercise improves muscle performance without apparent adverse affect in postpolio patients. American Journal of Physical Medicine & Rehabilitation, 75, 50-58.

Agre, J.C., Rodriquez, A.A. (1997). Muscular function in late polio and the role of exercise in post-polio patients. Neurorehabilitation, 8, 107-118.

Ernstoff, B., Wetterqvist, H., Kvist, H., & Grimby, G. (1996). Endurance training effect on individuals with postpoliomyelitis. Archives of Physical Medicine & Rehabilitation, 77, 843-848.

Grimby, G., Stalberg, E., Sandberg, A., Sunnerhagen, KS. (1998). An 8-year longitudinal study of muscle strength, muscle fiber size, and dynamic electromyogram in individuals with late polio. Muscle & Nerve, 21, 1428-1437.

Jones, D.R., et al. (1989). Cardiorespiratory responses to aerobic training by patients with post-poliomyelitis sequelae. Journal of the American Medical Association, 261(22), 3255-3258.

Kriz, J.L., Jones, D.R., Speier, J.L., Canine, J.K., Owen, R.R., Serfass, R.C. (1992). Cardiorespiratory responses to upper extremity aerobic training by post-polio subjects. Archives of Physical Medicine & Rehabilitation, 73, 49-54.

Prins, J.H., Hartung, H., Merritt, D.J., Blancq, R.J., Goebert, D.A., (1994). Effect of aquatic exercise training in persons with poliomyelitis disability. Sports Medicine, Training and Rehabilitation, 5, 29-39.

Spector, S.A., et al. (1996). “Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy. Muscle and Nerve, 19, 1282-1290.

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Medical Advisory Committee

Martin B. Wice, MD, Chair, St. John's Mercy Rehabilitation Center, Saint Louis, Missouri

Selma H. Calmes, MD, Anesthesiology, Olive View/UCLA Medical Center, Los Angeles, California

Marinos C. Dalakas, MD, National Institute of Neurological Disorders & Stroke (NINDS), Bethesda, Maryland

Burk Jubelt, MD, Neurology, SUNY Health Science Center, Syracuse, New York

Julie G. Madorsky, MD, Clinical Professor of Rehabilitation Medicine, Western University of Health Services, University of California-Irvine, Encino, California

Frederick M. Maynard, MD, U.P. Rehabilitation Medicine Assoc., PC, Marquette, Michigan

E.A. (Tony) Oppenheimer, MD, FACP, FCCP, Pulmonary Medicine (retired), Los Angeles, California

Oscar Schwartz, MD, FCCP, FAASM, Advantage Pulmonary, Saint Louis, Missouri

Mark K. Taylor, MLS, CPO, Director, Clinical and Technical Services, Orthotics and Prosthetics Center, University of Michigan, Ann Arbor, Michigan

Daria A. Trojan, MD, Assistant Professor, Physical Medicine and Rehabilitation, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada

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Endorsers of ‘A statement about exercise for survivors of polio’

Developed by the Medical Advisory Committee of Post-Polio Health International

Ulrich Alsentzer, MD, Greenville Rehabilitation Medicine Associates, Greenville, North Carolina

Patti Brown, MD, HealthSouth Rehabilitation Hospital of Reading, Reading, Pennsylvania

William L. Bockenek, MD, Charlotte Institute of Rehabilitation, Charlotte, North Carolina

K. Ming Chan, MD, FRCPC, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada

William DeMayo, MD, Conemaugh Health System, Johnstown, Pennsylvania

Marny Eulberg, MD, St. Anthony’s Family Medical Center West, Denver, Colorado

Stuart J. Glassman, MD, HealthSouth Rehabilitation Hospital, Concord, New Hampshire

Gunnar Grimby, MD, Sahlgrenska University Hospital, Göteborg, Sweden

Lauro S. Halstead, MD, National Rehabilitation Hospital, Washington, DC

Pesi H. Katrak, MBBS, MD, FRCP, Prince Henry Hospital, Little Bay, New South Wales, Australia

Mary Ann Keenan, MD, University of Pennsylvania, Philadelphia, Pennsylvania

Kerri Kolehma, MS, MD, Coastal Post-Polio Clinic, Charleston, South Carolina

Julian Lo, MD, FRCPC, FAAPMR, West Park Healthcare Centre, Toronto, Ontario, Canada

Burton W. Marsh, MD, Ocala, Florida

Frans Nollet, MD, PhD, Academic Medical Center, Amsterdam, Netherlands

Richard R. Owen, MD, Eden Prairie, Minnesota

Paul E. Peach, MD, Palmyra Post-Polio Clinic, Albany, Georgia

Susan L. Perlman, MD, University of California Los Angeles, Los Angeles, California

Raymond P. Roos, MD, University of Chicago Medical Center, Chicago, Illinois

Alexander Shapira, MD, Assaf Harofhe Hospital/Tzrifin, Tzrifin, Israel

Andrew Sherman, MD, University of Miami School of Medicine, Miami, Florida

Julie K. Silver, MD, Spaulding-Framingham Outpatient Center, Framingham, Massachusetts

Jennine Speier, MS, MD, Sister Kenny Rehabilitation Associates, Minneapolis, Minnesota

Walter C. Stolov, MD, University of Washington Medical Center, Seattle, Washington

Katharina Stibrant Sunnerhagen, MD, PhD, Sahlgrenska University Hospital, Göteborg, Sweden

Carol Vandenakker, MD, University of California Davis Medical Center, Sacramento, California

William Waring, III, MD, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin

Jane Pendleton Wootton, MD, Sheltering Arms Rehabilitation Hospital, Richmond, Virginia

Stanley K. Yarnell, MD, Saint Mary's Medical Center, San Francisco, California
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Visit www.ncpad.org and review “To Reap the Rewards of Post-Polio Exercise” by Sunny Roller, MA, University of Michigan Health System, Ann Arbor, Michigan, and Frederick M. Maynard, MD, U.P. Rehabilitation Medicine Associates, PC, Marquette, Michigan.

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Back to Contents of Post-Polio Health

Spring 2003, Vol. 19, No. 2
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Past issues of Post-Polio Health, listed by issue and date

Past issues of Post-Polio Health, listed by topic

"Timeless" articles by Health Professionals

"Timeless" articles by polio survivors

Updated 4-8-04

Ruminations and Observations of an Obsolete Retired Nurse/Mother/GrandMother ?

Authored by BlueAngel on
Tuesday, April 13, 2004

Over the next few days, weeks, months and (hopefully) years, I will be trying my hand at putting down my remembrances of years gone by of my life as a nurse (student and RN), Mother and GrandMother. Some, may be, a little too serious and some might be a little entertaining but I hope none will be too terribly boring. None of the "ruminations or observations" will be in chronological order or in any particular order for that matter----that way it will keep you guessing.

I have been told in years past "You ought to write a book", "that would be good enough to include in a book or story"--Well, the ought to be's and the good enough's are here to either entertain or torture you (whichever the case may be).

I do hope that some of the ruminations and observations that have been made by myself will be of value to the reader in some form or another. Well, here goes nothing--as has been heard to have been said.

RETIREMENT:

As a way to introduce my attempt at writing, I thought that I would start off with this particular article which I wrote several years ago for the Medical
Gazette here in San Antonio. The Gazette had a column which was called The Forum. The idea behind the column was to have Nurses from different areas of Nursing to write articles (to be published in the weekly paper) of a subject that might be of interest to themselves and hopefully to the readership. It was a good idea while the paper was being published. I eventually had two articles published which I never saw myself but was told by people who had read them. The consensus was that they were good (nothing like patting yourself on the back).

Retirement is, by definition, is kind of scary and pleasant to think of at the same time. Everyone looks forward to that particular time of life (the so-called "Golden Years") as one of being able to fulfill a lot of delayed desires and dreams because we now have time to do anything and everything. Little do we realize that it won't necessarily pan out as planned. We learn due to whatever frailty we might have (be it chronic illness or the so-called aging process) puts a damper on our most grandiose plans of travel, loafing, learning new things that we alwys wanted or just existing. This is not some great tome but a little tweak, so to speak, to get you thinking of some of the opportunities awaiting you in your retirement.

There are many opportunities for taking courses at some of the colleges and universities in our area at little or no cost to someone 65 and over (on a space available basis with the permission of the different colleges/universities). All you have to do is call the registrars or administrator's offices to find out what their programs are. You would be surprised at the number of senior citizens in our community that avail themselves of these programs. "You are never too old to learn new things" according to the old saying. It can give one a joyous sense of accomplishment. It also keeps your mind alert and active. Who knows, you might actually encourage someone to perform to the best of their abilities and guide them into an area they have never thought of before.

There are different social and health groups that can help you to maintain your health and social skills to your optimum level.They have programs for social gatherings to help you meet and form friendships with people that are compatible with your life style. Some health programs are also available through community programs, HMO's, Hospitals, Health Agencies, Support groups, etc. available at little or no cost to you. You would be surprised at how you find comfort and enbcouragement if you are surrounded by programs that are not "pity parties".

You can keep being a productive person by voluneering your time and skills at something you like to do----like mentoring, telephoning people (person, to person) to check on their well being or using your talents to encourage someone along the way. You, not only, help someone else but you help yourself by keeping your spirit and mind active and healthy.

One of the most frequent problems that we have as senior citizens is depression. It can be from mild to severe. Some of the causes of depression are very predictable like the loss of loved ones, friends, colleagues, and our life's work. Some are not so predictable like the changes that occur "normally" when you are aging. There is still some stigma attached to depression as being mentally ill and most don't want to admit they have depression for fear of being thought of as being "crazy". The symptoms can mimic symtoms of other physical illnesses and can be very difficult to diagnose. Talk with your physician or your health care provider and even a community mental health program.

I think that I have rambled on long enough this go round. Now, it is your turn (both old and young) to offer your comments, suggestions and opinions. I have been retired from active nursing now four a few years after being active in the field since 1953. I have seen a lot of changes---some good and some not so good. It is difficult to remind oneself of age when the mind and spirit is more like that of a twenty or thirty year old than that of a 69 year old. (I am now 72 -- and not much has changed that particular perspective)

Thank you for reading and listening!

Respectfully submitted by Ethel E. Killgore Taylor

OCULAR HEALTH AND PULMONARY ASSIST MACHINES

Authored by BlueAngel on
Saturday, April 10, 2004

"Ocular Health and Pulmonary Assist Machines"
by Richard E. Hector, MD, FACS, Bradenton, Florida
(www.DrHector.medem.com)

This article is reprinted from Polio Network News, now--Post-Polio Health, Winter 2003, Vol.19, No. 1, with permission of Post-Polio Health International. Any further reproduction must have the permissions of the copywrite holder. Post-Polio Health International;4207 Lindell Blvd. #110: Saint Louis, Missouri 83108-2915, USA; www.post-polio.org E-mail info@post-polio.org.

Maintaining good ocular health and comfort is a challenge even under "ordinary" conditions. It is especially difficult when you use a pumonary assist machine, such as C-PAP, BiPAP, etc with a face mask, because such use can affect the stability of your tear iflm. A stable protective three layer tear film is particulary responsible for good vision and comfortable, healthy eyes.

We are most familiar with reflex tears, those watery tears you experience while watching a sad movie or cutting onions. If these reflex tears are present for no particular reason, the culprit is usually a dry eye condition. This exists when the other, more protective and less familiar "tear" is absent, either due to producation or increased evaporation.

Numerous small glands in your eyelids produce the protective three layer film that is necessary for the health of the external surface of your eyes. If the tear film is absent, the external surface breaks down , which can be very painful and increase the risk of severe infection, scarring and loss of vision.

Using a pulmonary assist machine with a face mask can increase the rate of evaporation os your natural tear film, and will, at first, stimulate your rweflex tears, causing your eyes to tear inappropriately. If other conditions are present that reduce the production of the very valuable tear layer, an advanced dry eye condition can develop to the point that your eyes will not tear or water at all. The use of hormone replacement therapy that includes estrogen, allergy medications such as antihistamines and diuretics, and Rheumatoid arthritis and Parkinson's Disease are all associated with advanced dry eye condition.

The treatment is similar in most cases. Over-the-counter artificial tear solutions of various compositions and thickness need to be used. The frequency of applying these solution depends on the severity of the dry eye condtition. Avoid those that "take the red out" and look for a bland lubricating product such has Refresh Tears/Gel or Thera Tears/Gel; Bion Tears or Tears Naturel Forte Hypotears or Tears Naturel Free; Genteel Tears/Gel; Refresh Endura. If artificial tears are needed more than five times a day, preservative free solutions should be used.

In very severe conditions of dry eye, the tear drainage system can be modified; either temporarily or permanently, by using small plugs that fit inside eyelids and/or the eyelids themselves can be sutured partially closed to further protect the surface of the eye from exposure and drying.

"Blog" Author's Comment:
PLEASE, ALWAYS CHECK WITH YOUR HEALTHCARE PROVIDER BEFORE USING ANY OVER THE COUNTER MEDICATIONS.>