Volume 5 Issue 3 “Education, Fellowship, Resources & Support” December 2005 – January 2006

Disclaimer

The San Antonio Polio Survivors’ Association Newsletter, THE PHOENIX, is intended to share, with our readers, information of interest to them, including medical opinion of others. It is not intended to offer specific advice or as a substitute for professional health care. Opinions, products, or services mentioned, herein, are not necessarily endorsed by the San Antonio Polio Survivors’ Association or the Warm Springs Resourcenter for People with Disabilities or Warm Springs Rehabilitation Foundation, Inc.; 5101 Medical Drive; San Antonio, Texas 78229-4801

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The following article is from www.azstarnet.com by the Arizona Daily Star and was published the 18th of October. The article presents some interesting insights into the Medicare medicine coverage as it pertains to seniors. Think you’ll be interested in them. If you have questions you can either contact the authors of the two articles or www.medicare.gov or www.eldercare.gov. or phone 1-800-MEDICARE.

Mind the Gap: How to Fill the Medicare Donut Hole

Written by:

Eric Sabo -

As seniors begin to sort through the hundreds of private insurance plans now offered for Medicare, there is one number that stands out from the fine print: $3,600. This is the surprise medical bill that could greet many enrollees, unless they are careful to choose the right plan.

Set to take affect next year, the latest government benefits are far more generous in paying for needed medications. Yet the new Medicare rules can also saddle older Americans with rather hefty co-payments, which is why some insurance companies may be better than others when out-of-pocket costs are a concern, experts say.

"For someone who is not counting on $3,600 in expenses, it's a big deal," says Deane Beebe of the Medicare Rights Center, an advocacy group in New York.
Seniors can scrutinize the various insurance offerings on the government Web site, www.medicare.gov. A new search tool that will allow people to comparison shop has just been unveiled. Although the deadline for choosing a prescription drug plan is not until May 15th, 2006, you need to decide between November 15th and December 31st to get the new Medicare coverage by the first of the year.

In considering the different policies, experts suggest that you check whether your new insurance covers the amount that government will not. The initial out-of-pocket expense is relatively painless. Medicare does not fund the first $250 spent on prescription drugs, but some insurance companies will pay for these costs, while charging only slightly higher monthly premiums.

The Big Expense

Far harder to get around is the big chunk of cash needed in the middle. This gap in coverage, nicknamed the donut hole, kicks in if you run through more than $2,250 worth of prescription drugs in a year. Once your medication needs reach $5,100 and above, Medicare starts to pick up 95 percent of the tab.
In between, it's up to you or your insurance company to pay for this $3,100 donut hole. The hardest hit will be patients with chronic diseases who rely on expensive new treatments. But as drug prices continue to rise, Beebe says that it will not take much for others to rack up such a tab. "The donut hole is only going to get bigger," she says.

A study by the Commonwealth Fund found that 38 percent of Medicare enrollees are likely to experience this costly interruption in care. Moreover, the benefits must be renewed each year, meaning that the coverage gap repeats itself if you reach the donut hole again. Over the next three years, researchers estimate that the average Medicare recipient will be paying about 44 percent of all drug costs out of their own pocket.

"Even while they're in this donut hole, they will still be paying monthly premiums for insurance," adds Beebe.

Hard Choices

Various companies offer coverage to make up for this gap, often for an extra cost. The average monthly premium is $37 a month, but some of the plans that pay for drugs during the donut hole charge several times as much. In some states, the extra coverage is not an option.

For local plans that do cover the donut hole, Beebe says that it's important to check if these plans cover the treatments you need during the gap. Some only cover generic drugs, which will not help for conditions where a specific therapy is needed. And for those who want to go to Canada for cheaper drugs, beware: buying treatments from a foreign country will not count toward the $5,100 needed to reach additional Medicare coverage.

The government has announced that they will offer financial assistance to make up for this gap in those who fall below a certain income. "Everyone in Medicare, no matter what their income or how they get their health care, can chose coverage that reflects what they want," said Mark McClellan of the Centers for Medicare & Medicaid Services.

But Beebe worries that many seniors will have to make more difficult choices than finding the right insurance company. For those who are ill and likely to need the most prescription drug coverage, the Commonwealth study suggested that high spenders will have to pay as much as two-thirds of their own drug costs.

As concerns about the budget deficit grow, Beebe says that people who can barely pay for treatment now face an uncertain future.
"For those on a low income, the choice will be between food and medicine," says Beebe.

© 2005 Healthology, Inc. Published October 18, 2005
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
From: "Gary Burroughs"
To: "Michael Beard"
CC: "TPSA"
Subject: TPSA: for distribution
Date: Fri, 18 Nov 2005 16:12:06 -0600

TPSA, Inc.
P.O. Box 41325
Houston, Texas 77241-1325

713-690-0695 Fax 713-690-0696
Physical office address 6701 Pinemont, Suite 209 Houston, Texas 77092
Our office has moved, but P.O. Box is the same. Our old office was broken into and we lost some names, address, etc.(our computer was attacked.) While we were moving, our storage was broken into and we don't know what was lost there.

We are blitzing Texas for TPSA and polio survivors. If you haven't heard from us, please feel free to contact us via telephone, fax or email tpsa@flash.net

Sincerely,
Gary--Treasurer TPSA

I was asked by Michael Beard to include the above notification in the Newsletter in addition to sending it out to the members who have e-mail addresses. We are considered to be semi-associate members of the Texas Polio Survivors Association (TPSA).

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The following article was sent via e-mail and is a little bit tongue in cheek and thought you might enjoy this little bit of “humor”.

Subject: Pillsbury Doughboy died yesterday

It is with the saddest heart that I must pass on the following news:
Please join me in remembering a great icon of the entertainment community. The Pillsbury Doughboy died yesterday of a yeast infection and trauma complications from repeated pokes in the belly. He was 71.

Doughboy was buried in a lightly greased coffin.

Dozens of Celebrities turned out to pay their respects, including Mrs. Butterworth, Hungry Jack, the California raisins, Betty Crocker, the Hostess Twinkies, and Captain Crunch.

The grave site was piled high with flours. Aunt Jemima delivered the eulogy and lovingly described Doughboy as a man who never knew how much he was kneaded. Doughboy rose quickly in show business, but his later life was filled with turnovers. He was not considered a very smart cookie, wasting much of his dough on half-baked schemes. Despite being a little flaky at times he was still a crusty old man and was considered a roll model for millions.

Doughboy is survived by his wife Play Dough, two children, John Dough and Jane Dough, plus they had one in the oven. He is also survived by his elderly dad, Pop Tart.

The funeral was held at 3:50 for about 20 minutes. If this made you smile for even a brief second, please take time to pass it on and share that smile with someone else that kneads it.
_________________________________________________________________

Elder CareTips:
Mastering The Eldercare Maze™
October 15, 2005

The newsletter for all elder caregivers. Sent twice a month, and only by request. You are welcome to pass on Elder CareTips™ to anyone you think might be interested. You'll find information about how to get your personal subscription below.

Veterans Benefits

I recently was privileged to accompany a new client as he made "pre-arrangements" with a local funeral home. His wife passed away this year and he is in the process of putting his own affairs in order. Prior to her passing neither of them had made any provisions for disability or death, and he has seen first hand the benefit of planning ahead.

This wonderful gentleman served with pride in two wars, World War II and in Korea. Although he's quiet about it, he would really like to have a simple military funeral.

But, there's a but...isn't there always a "but."

His wife always took care of the paperwork. After her death he had lots of help from family, who helped him clean out his home and move to an assisted living residence. Somewhere, somehow, his military records went missing.

He needs to give a copy of his official discharge (his DD-214) to the funeral home so they can arrange the final ceremony he wants.

Luckily, he's in relatively good health and there was time to get the document. Time isn't always a luxury we have.

I went to the military archives on the web, followed the instructions, and in just about a month he had the form he needed. (Of course, the minute it arrived I immediately ran it down to the office to make multiple copies.)

If your elder served in the military there are benefits available. In order to access benefits, just about the first thing a veteran will need is the DD-214. Finding it is the tricky part. As soon as you get the chance, ask your elder where his or her military discharge papers are. If the answer is a blank look, see if he remembers his service number. It's amazing how that number has stuck in the memory of most who served.

Then go ahead and request an official copy. Immediate family members (spouse or children) can request one with minimal hassle. It will probably be easier in the long run to get a replacement than to find the original if you got that blank look.

And, don't forget the women in your family. A whole lot of women served in WWII, Korea, and Vietnam (not to mention the Gulf). They are entitled to benefits, too.

A 6-year old was asked where his grandma lived. ''Oh,'' he said, ''She lives at the airport and when we want her we just go get her. Then when we're done having her visit we take her back to the airport."

It's Medicare Part D (Again)

Yes, I promised that I would try to stay away from the new Medicare programs in this newsletter, but there is a new development, and it's imperative that we get the word out.

A booklet called "Medicare and You" was recently sent to everyone on Medicare. It supposedly covers what you need to know to make a decision about selecting a prescription drug plan under the new Medicare Part D plan.

The problem is, the booklets were sent out with a major error.

Eligible low-income Medicare beneficiaries are being offered assistance with paying the Medicare Part D premium. For those who are eligible, the government will pay a basic premium to cover the cost of a Part D prescription drug plan.

The problem with the booklet, which the government attributes to a misprint, begins on page 97-a. That's where highlights of the various plans are listed: what they cost per month, the co-pay and the yearly deductible.

The error is in the last column of the comparison chart. Many of the "yes" answers should actually say "no," meaning the government does *not* pay for the extra prescription coverage above the basic plan.

If you select a plan that costs more than the basic plan, and you are receiving what is being termed "extra help" with paying the Part D premium, you will have to pay the balance of the premium yourself.

If your elder is in the low-income program and she chooses a plan because of the information in the Medicare & You 2006 Handbook there is a strong possibility that she could find herself with an unexpected bill. And she won't be protected because it was "in the book." There's a disclaimer on the second page that reads: "Medicare and You 2006 explains the Medicare program. It isn't a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations and rulings."

In other words, just because the government printed the information, you can't rely on it to be correct.

This program is so unbelievably complicated. You will probably have to get involved to help any elder who isn't extremely competent and computer-savvy. You will have to talk to the carriers individually to be sure you understand the coverage and what it will really cost.

There's a telephone number to speak with a Medicare representative: 1-800-633-4227. However, I have very little faith that the information you get from this telephone number will be any more reliable than what you get when you call the IRS hotline.

Elder CareTip
The television remote controls that come with new televisions are so complicated I'm terrified of hitting the wrong button. All kinds of strange things happen when I do and there's a devil of a time getting back to the regular screen. Imagine how your elder feels.
Why should changing the channel be terrifying?

If you don't have a simple control box...on, off, louder & softer (order a big universal control as a gift - they're great if you can find one that works on your machine)...paint or nail polish to the rescue.

You can get all kinds of strange nail polish colors where teens shop - Target, WalMart and such. Put a dab of red on the power button. Use other colors for louder/softer/channel up & down. Keep the bottles as the polish will eventually wear off.

For elders who can see the little buttons this does help a lot.

It's flu shot time again. If you want to know where
to go to get yours, check the flu clinic locator.

The really frightening thing about middle age is that you know you'll
Grow out of it.
Doris Day

Don't keep us a secret. If you know other people who should be reading this too, then do them and us a favor by telling them about Elder CareTips™. Just send them this link: http://eldercareteam.com/resources/newsletter.htm

© 2005 Molly Shomer, All rights reserved. You are free to use material from Elder CareTips: Mastering The Eldercare Maze™ as long as you include complete attribution, including live web site link and email link. I would appreciate it if you
would let me know where the material will appear.

The Eldercare Team
SeniorLink, LLC
P.O. Box 700291
Dallas, Texas 75370
Phone (972) 395-7823 Fax (972) 395-7164
email: info@eldercareteam.com
©1999-2005
Advanced Professional Member
National Association of Professional Geriatric Care Managers

POST-POLIO-MED@MAELSTROM.STJOHNS.EDU

Polio: A Virus' Struggle
By James Weldon

The Science Creative Quarterly

A graphic cartoon novelette with an anthropomorphic polio virus
telling its story in a "group therapy session".

pdf file (14pages, ~2.7Mb)

http://www.bioteach.ubc.ca/quarterly/?p=45 (you’ll have to type this http:// out yourself.)

Please look this web site up. I think that you’ll find it interesting. If you don’t have pdf all you have to do is to download it free by going to their web site www.AcrobatAdobe.com and down loading the reader (Adobe reader.

There are two more sites that might be of interest regarding the Medicare D Discount Card information. Albeit some of both the sites are, a little confusing at times it’s either that are my memory and mind is going a little faster than I thought. [:>) . The sites are http://www.medicare.gov/ or www.eldercare.gov. There are two booklets –one is called “Guide to choosing Medicare Covered Drug Discount Card” 11602 and the one from www.eldercare.gov.(They took this site off the net as soon as I read the booklet) .

If you're at this point in your life, you can relate...if you're not...check out what you have to look forward to!!!

Copied from an e-mai sent by a member & thought you would enjoy!

Twinkies and Root Beer


A little boy wanted to meet God. He knew it was a long trip to where God lived, so he packed his suitcase with Twinkies and a six-pack of Root Beer and he started his journey.

When he had gone about three blocks, he met an elderly man. The man was sitting in the park just feeding some pigeons.

The boy sat down next to him and opened his suitcase. He was about to take a drink from his root beer when he noticed that the man looked hungry, so he offered him a Twinkie.

The man gratefully accepted it and smiled at boy. His smile was so pleasant that the boy wanted to see it again, so he offered him a root beer.
Again, the man smiled at him. The boy was delighted! They sat there all afternoon eating and smiling, but they never said a word.
As it grew dark, the boy realized how tired he was and he got up to leave, but before he had gone more than a few steps, he turned around, ran back to the man, and gave him a hug. The man gave him his biggest smile ever.

When the boy opened the door to his own house a short time later, his mother was surprised by the look of joy on his face. She asked him, "What did you do today that made you so happy?

"He replied, "I had lunch with God." But before his mother could respond, he added, "You know what? God's got the most beautiful smile I've ever seen!"

Meanwhile, the elderly man, also radiant with joy, returned to his home. His son was stunned by the look of peace on his face and he asked," Dad, what did you do today that made you so happy?"
He replied, "I ate Twinkies in the park with God." However, before his son responded, he added," You know, he's much younger than I expected."

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. People come into our lives for a reason, a season, or a lifetime. Embrace all equally!
~author unknown~

MERRY CHRISTMAS, KWANZA, HANAKA, AND ALL OTHER SPIRTIUAL BELIEFS

BEST WISHES AND A HAPPY, PROSPEROUS NEW YEAR!

The following is a farewell to our group from Michael Spell who past away on November 10th. We do express our sorrow to Marilyn, his wife, at his loss as well as his family and friends. We rarely saw him due to his illness but he was still our fellow member and we do know that his passing does send him to a better place where there is not any pain or illness. We wish him Bon Voyage on his last trip.

(I am copying his last communiqués to all of his friends, including us, which was written very lovingly by his Mother.)

Michael Spell had Polio most of his life and from the farewell below you can see that he had lived a very full life, particularly, with Marilyn his wife.
Sent: Thursday, November 10, 2005 7:19 PM

Subject: Farewell

Dear Friends,
I have known each of you in different degrees of friendship but I love each and every one of you for who you are to me and the times of joy or laughter we have shared.
Please accept my apologies for the grouping of email addresses but time restricts addressing each one of you at this time.
As you know I have been restricted to a bed or wheelchair all but 7 months of my life but if a book were written all would be amazed at the experiences and adventures I have enjoyed. Also some of the close calls and challenges. But God had put a desire in my heart to live my life to the fullest.
At times I tried (as most of us do) to go my own way but in the midst of heart failure and facing death I turned to God again and was spared to live out my destiny. Sent to San Antonio (I needed a ventilator now) for care I met an angel who was my nurse and became my wife three years later.
Marilyn and I will be married 8 years on November 16 (her birthday). She has made the past 11 years of my life the most fulfilling, joyous and incredible I could ever imagine. Together we could do anything. We cooked together, built "stuff" together, went to Canada on a Dart, Chicago, and even attended college. We prayed together and saw my nephew return from Iraq unharmed.
You all have been my friends and I pray you all have as good a life as I have enjoyed. Please keep my lovely wife in your prayers as she is about to embark on a new life. I was in the hospital after about two months of gradual weakening and a breathing crisis. She was by my side and took care of me for the month I was there. I was feeling better, eating and gaining back some of the weight I had lost when I was ill. My mom came down from Dallas and we had a pre-birthday visit. Mine was the 7th and hers the 8th. On my birthday friends brought balloons and the female nurses came in and sang "Happy Birthday". My wife bought me another "Boy Toy", a portable DVD player and we watched "Batman Begins" in the hospital.
After being on a ventilator for 11 years I decided to go to Dallas and attend college (with my wife) to be a Respiratory Therapist. We were excited about the move and the future.
Finding it difficult to breathe I asked Marilyn to check the machines and see what was going on. When she went to the nurses desk it was the last time I would see her (this side of Heaven). They tried to bring me back but were unsuccessful. T.O.D. 4:15pm. I will always be with you, my Angel, in spirit.
But don't feel bad for me. I will be where my brother, Uncle, Grandmas and Grandpa are waiting to see me and with my Lord and Savior Jesus Christ, where there is no sorrow, tears nor crippled limbs. I told my pastor, Mike Hayes, that I was "spiritually homesick" just last week. Well, God took me home and if Jesus is your Saviour I will meet you there.
Thank you for your friendship, God bless you and Fairwell My Friends".
Mike
+++++++++++++++++++++++++++++++++++++++++++++++++++

Michael Beard’s Mother also passed away in November prior to Thanksgiving. Our condolences go to you and your family also, Mike.

Written by:

Eric Sabo -
Published on: June 2, 2005

A rapid, severe headache has long been considered an early warning sign of stroke. Along with other clues, such as a sudden numbness on one side of your face or body, an extremely painful headache that seems to come out of nowhere may require an immediate trip to the emergency room. Strokes are more common as you get older, but these so-called "brain attacks" can strike at any age. The faster you get to the hospital, the better your chances of preventing serious damage to the brain.

But new research suggests that migraines and other headaches are not just an early sign of stroke, they may even put you at risk for one. Looking at some 12,700 men and women who were involved in the Atherosclerosis Risk in Communities Study, published in May in Neurology, investigators found that people who have a history of severe migraines were more likely to suffer an ischemic attack, the type of stroke that is caused by blocked blood vessels. Compared to those who reported few serious headaches over their lifetime, migraine sufferers also showed greater symptoms of having a stroke or mini-stroke, known as a transient ischemic attack.

This connection appeared strongest in men and women who suffer from aural migraines, which are associated with blurry vision and strange smells, in addition to pain. Intuitively, a link between migraines and stroke would seem to make sense. Severe headaches are believed to cause a disturbance in blood vessels, and there is an unusually high prevalence of strokes in younger migraine sufferers.

How to Tell the Difference

But these recent findings also cause some confusion. For those who frequently get serious headaches, how can one tell regular pain from a possible stroke?
"There is a great overlap in symptoms between migraine and stroke," says Philip Stang, MD, lead author of the study and an associate of the department of epidemiology at the University of North Carolina. "And there are types of migraine that include stroke features and vice-versa."

Keeping that in mind, experts say there are some potential differences as well. For one, most migraines will clear up relatively quickly, whereas stroke symptoms are constant.

The presence of certain risk factors may also make one more suspicious that a headache could be a sign of stroke. For example, younger women with migraines, especially if they smoke or take oral contraceptives, are more likely to suffer a stroke than others, says Stang. In older patients, hypertension is a more serious risk factor for stroke than severe headaches.

It may turn out that the link between migraines and stroke risk is not a serious concern. In an editorial that accompanied the study, the authors argue that there are more questions than answers at this point. Stang is cautious as well. "Since there is no laboratory test to confirm migraine, it is difficult to be so precise and assured," he says.

Still, there is little question about the importance of seeking medical help at the first signs of a stroke, including severe headaches. Specially trained hospital staff can determine if you are having a stroke and initiate treatment, which can prevent significant harm if started early. Experts recommend that you seek help immediately if you experience the following, sudden symptoms:

• Numbness or weakness of the face, arm or leg, especially on one side of the body

• Confusion, trouble speaking or understanding

• Trouble seeing in one or both eyes

• Problems walking, dizziness, loss of balance or coordination

• Severe headache with no known cause

Here’s the 2nd article: It is very interesting and one most of us, including the medical profession including nurses, don’t realize the dangers to the patient and family are concerned.

Right-Sided Stroke Harder To Detect

Written by:

Karen Barrow –

Published: August 25, 2005

Strokes that occur on the right side of the brain go undiagnosed more often than left brain strokes, said a new study.

Since the left side of the brain controls coordination and language, left-brain strokes usually cause clear symptoms, like slurred speech or weakness in the right hand. However, since the right side of the brain controls judgment, symptoms are more subtle.

"It is intuitive that patients, their families and their physicians might be more likely to recognize a disturbance of speech or language than a cognitive deficit," said Dr. John N. Fink of the Christchurch School of Medicine and Health Science in an editorial accompanying the study, which was published on July 30 in The Lancet.

With more right-side strokes going undetected, however, the speed and quality of care may suffer during the early stages of attack, the most critical time in preventing permanent damage. Fink points out that strokes on the right side of the brain may influence relationships, one's abilities at work and the ability to safely drive.

The study is based on data from 11,328 stroke patients in Germany. Of these, 56 percent were found to have had a stroke on the left side of their brain, while 44 percent had one on the opposite side. About 15 percent more patients with left-sided strokes were treated or admitted to the hospital within 3 hours than those with right-side strokes.

A stroke occurs when a blood vessel in the brain becomes blocked or ruptured, resulting in a lack of blood supply to a particular region of the brain. The longer this region goes without blood, the more damage that occurs. Treatments are available to stop the progression of the stroke and to prevent further brain damage.

Diagnosing a right-sided stroke is complicated for two main reasons, the researchers state. First, current stroke-diagnosing methods are designed to look for the symptoms of a left-sided stroke, making a right-sided stroke much harder to diagnose. Secondly, since a right-sided stroke affects awareness and reasoning, a patient is less able to realize that they are acting unusually and seek help in the first place.

"Right sided events are probably perceived by patient or doctor as being less severe or are not identified as a stroke at all," said study author Dr. Christian Foerch, from the Johann Wolfgang Goethe University in Frankfurt, Germany.
The study authors call for an increased awareness of right-sided strokes. But since the symptoms are so unclear, the responsibility resides mostly in the ability of doctors to be better able to identify these strokes and begin treatment quickly.

"It is up to physicians who assess patients with stroke to train other physicians and organize stroke services to improve our standard of performance," said Fink.
© 2005 Healthology, Inc. ________________________________________________________________
Stroke Information for Seniors Added to the NIHSeniorHealth Web Site: National Institute of Neurological Disorders and Stroke (NINDS)

Stroke Information for Seniors Added to the NIHSeniorHealth Web Site

For release: Tuesday, August 23, 2005

Each year in the United States, there are more than 700,000 strokes. Nearly three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55. To help older adults learn more about the signs and symptoms of stroke and the need to act quickly, the National Institutes of Health is adding four new topics on stroke to its NIHSeniorHealth web site:
Act Quickly, Warnings Signs and Risk Factors, What Happens during a Stroke, and Treatments and Research.

The site features easy-to-read stroke information, developed by the National Institute of Neurological Disorders and Stroke (NINDS), and may be found at www.nihseniorhealth.gov.

“Stroke is an unmistakable event. Few other medical conditions come on so suddenly or are so noticeable to a bystander,” said John R. Marler, M.D., associate director for clinical trials at the NINDS.

A stroke occurs when normal blood flow to the brain is disrupted. Brain cells die when deprived of oxygen and nutrients provided by blood. Because stroke injures the brain, the person having a stroke may not realize what is happening.

But to a bystander the signs of a stroke are distinct:
• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)

• Sudden confusion, trouble speaking or understanding speech

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness or loss of balance or coordination

• Sudden severe headache with no known cause

In treating a stroke, every minute counts. New treatments are available that greatly reduce the damage caused by a stroke, but must be delivered quickly after symptoms begin. Knowing the stroke symptoms, calling 911 immediately, and getting to a hospital are critical to preventing long-term disability.

Risk factors for stroke include family history, high blood pressure, smoking, diabetes, physical inactivity, advancing age, and being overweight.

Older Americans are one of the fastest growing age groups using the Internet, especially when searching for health information. In fact, 66 percent of “wired” seniors search for health and medical information when they go online. NIHSeniorHealth, a joint effort of the National Institute on Aging (NIA) and the National Library of Medicine (NLM), was designed especially with seniors in mind.

The site, which is based on the latest research on cognition and aging, features short, easy-to-read segments of information. The new section links to other information on stroke on the NINDS website at www.ninds.nih.gov.

The site also links to MedlinePlus, NLM’s premier site for news on diseases and wellness, drug information, clinical trials, and other consumer health resources.
The NINDS is the nation's primary supporter of biomedical research on the brain and nervous system. It is dedicated to research and education on the causes, treatment, and prevention of stroke. The NIA leads the federal effort supporting and conducting research on aging and the health and well-being of older people. The NLM, the world's largest library of the health sciences, creates and sponsors web-based health information resources for the public and professionals. All three are components of the National Institutes of Health in Bethesda, Maryland, part of the U.S. Department of Health and Human Services.

The National Institutes of Health (NIH)—The Nation's Medical Research Agency—is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Date Last Modified: Tuesday, August 23, 2005

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ms Hartman is a nutritionist who contributes quite a few articles with an approach which anyone can understand. This article is about the nutritional value of Flax seed and how it can substitute for other foods in our daily diet.

What about Flaxseed?

Jann Hartman,
Baltimore, Maryland

Fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon contain two omega-3 fatty acids – eicosapentaenoic and docosahexaenoic acids (EPA and DHA). A third kind, alpha-linolenic acid, is less potent. It comes from soybeans, canola, walnut and flaxseed, and oils made from those beans, nuts and seeds.

Flaxseed oil and flaxseeds (which need to be ground into flaxseed meal to be properly utilized by your body) each provide omega-3 fatty acids. Research shows that the omega-3 fatty acids, especially those in fish, have cardioprotective benefits, but that all omega-3 fatty acids, including alpha-linolenic acid, the one in flaxseed, are needed for good health Flaxseeds are also a great source of soluble fiber as well as providing thia-min, riboflavin, niacin, trace minerals and even some high quality protein. You must consume them because your body cannot manufacture them.

To add this supplement to your diet, you can either use the flaxseeds whole or use the flaxseed oil. Practically, it is easier to use the oil and not have to bother with grinding the seeds. Remember, the oil must be refrigerated so that it does not turn rancid.

Nutritionally, flaxseeds will give you more bang for the buck. They have a pleasant, nut-like flavor and taste good sprinkled on a variety of foods. You must either chew the seeds very well or grind them, because whole seeds pass through the body without their essential nutrients being absorbed. You can purchase ground seeds, but they are much more perishable than the whole seeds. Either way, they need to be kept in the refrigerator, too. The seeds can also be bought in bulk and kept in the freezer for even longer storage.

The recommendation for adults is to use one or two tablespoons of flaxseed meal or oil daily. You can stir it into hot cereal or into your juice. It can also be used as a replacement for an egg in some recipes such as muffins or pancakes. To replace one egg, use one tablespoon flaxseed meal plus three tablespoons water (or other liquid). You can also mix one to three teaspoons of flaxseed oil with a little ketchup as a condiment. Be careful not to exceed recommended amounts as flax can have a laxative effect.
The US Department of Agriculture recently released MyPyramid, an updated guide to healthful eating and active lifestyles. You can find it online at www.mypyramid.gov.
Enter information about yourself into “My Pyramid Plan” and get a customized food guide that tells how much from each food group you need every day.

Jann Hartman, a polio survivor, has a degree in Home Economics and Nutrition and has written and lectured on nutrition for the past 20 years.

A consumer brochure, “Finding Your Way to a Healthier You: Based on the Dietary Guidelines for Americans,” can be downloaded from www.health.gov/dietaryguidelines/dga2005/document/html/brochure.htm.

Post-Polio Health (formerly called Polio Network News)
Issue: 21.2
Article title: What About Flaxseed
Author: Jann Hartman, Baltimore, MD
Page (s)/column location: Page 8
Reprinted from Post-Polio Health (formerly called Polio Network News) with permission of Post-Polio Health International (www.post-polio.org). Any further reproduction must have permission from copyright holder.

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A TEXAS BLESSING

Note: If you are not a resident of TEXAS or never have lived in the humid Southwest, you may not understand the weight of this blessing!

Bless this house, oh Lord, we cry. Please keep it cool in mid-July. Bless the walls where termites dine, while ants and roaches march in time. Bless our yard where spiders pass fire ant castles in the grass. Bless the garage, a home to please carpenter beetles, ticks and fleas. Bless the love bugs, two by two, the gnats and mosquitoes that feed on you. Millions of creatures that fly or crawl, in TEXAS , Lord, you've put them all!! But this is home, and here we'll stay, So thank you Lord, for insect spray.

HOLD IT.............there's more....................

YOU KNOW YOU ARE IN TEXAS IN JULY WHEN. . . .
The birds have to use potholders to pull worms out of the ground.
The trees are whistling for the dogs.
The best parking place is determined by shade instead of distance.
Hot water now comes out of both taps.
You can make sun tea instantly.
You learn that a seat belt buckle makes a pretty good branding iron.
The temperature drops below 95 and you feel a little chilly.
You discover that in July it only takes 2 fingers to steer your car.
You discover that you can get sunburned through your car window.
You actually burn your hand opening the car door.
You break into a sweat the instant you step outside at 7:30 a.m.
Your biggest bicycle wreck fear is, "What if I get knocked out and end up lying on the pavement and cook to death?"
You realize that asphalt has a liquid state.
The potatoes cook underground, so all you have to do is pull one out and add butter, salt and pepper.
Farmers are feeding their chickens crushed ice to keep them from laying boiled eggs.
The cows are giving evaporated milk. Ah, what a place to call home.
God Bless Our State of TEXAS !!

POLIO POST NEWS North Central Florida Post-Polio Support Group

Polio Survivors are Long-Time Pioneers

By Joan Swain

“Polio Pioneers” was the name given by the March of Dimes to the 1,829,916 children in grader 1-3 who participated in the 1954 field trial of the Salk poliomyelitis vaccine that was joyfully proclaimed “safe and effective” in April 1955. In her talk at the 14th Annual Conference on Post-Polio Syndrome last April, Joan Headley, Executive Director of Post-Polio Health International, asked, “Is Our Work Finished?”

Probably not, was her answer. To help us reach that conclusion, Ms. Headley outlined the many ways in which polio survivors have served as pioneers throughout their lives. She describer “pioneer” as one who goes into previously uncharted or unclaimed territory with the purpose of exploring and possibly colonizing it. Pioneers suffer hardships but they often form societal structure for those who follow.

Polio survivors were pioneers when they went back to their neighborhood schools with crutches, wheelchairs, and braces. They went through high school, and when it came time for collect, they were frequently financed by vocational rehabilitation scholarships. They were frequently the first in their occupation, their work or their school.

Pioneered independent living movement

They were pioneers as educated jobseekers who sometimes were denied positions because of their disability. Surprised and indignant, a core of these polio survivors were pioneers in the independent living movement. Their demand for societal change coincided with other movements of the 60s.

Doctors learned about the musculo-skeletal system, muscle testing, reeducation of muscles, physical and occupational therapy, brace making, and other improvements from polio pioneers. They then applied this information to other disabilities. Survivors who originally needed the help of an iron lung wanted lighter weight ventilators so that they could be more mobile, and thus more independent.

In the late 70s and early 80s, polio pioneers were important in bringing their problems with increasing weakness to the medical community. And in 1981, the first conference on the topic was held. Over the next 10 years, support groups sprang up all over the world.

Successful self-help implementers

Polio survivors have been the most successful in implementing the philosophy of self help, according to Ms. Headley, who described self help as assuming the responsibility for your own care and helping each other get the skills to be able to do that. This is basically what is now known as chronic disease self-management, and important part of the control of diabetes and other chronic conditions.

Being on the leading edge of people with disabilities, along with World War II veterans, polio survivors have the opportunity to be examples to people—we’re aging with disabilities. Issues such as Where are we going to live? Become problematic when some assisted living centers don’t want wheelchairs in the dining room. “There’s a perception of wheelchairs out there that it’s up to us to challenge and to change,” Mr. Headley said.

This article is intended for personal use only. It may not be reproduced without express written permission of the author, the North Central Florida Post-Polio Support Group, or of the publication listed in its credits.

0297 - Polio Survivors are Long-Time Survivors.doc
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These last two or three items are meant to leave a smile on your faces. You never know if they will be appreciated or if they will offend someone . They are meant to be light and to be not of the thought provoking kind of thing!

Your Age By Chocolate & Diet Stuff

YOUR AGE BY CHOCOLATE MATH

DON'T CHEAT BY SCROLLING DOWN FIRST!

It takes less than a minute... Do the math as you read.
Be sure you don't read the bottom until you've worked it out!
This is one of those waste-of-time things, but it's pretty fun.

1. First, pick the number of times a week that you would like to have chocolate. (more than one time, but less than 10)

2. Multiply this number by 2 (Just to be bold).

3. Add 5. (for overindulging on Sunday or whatever day).

4. Multiply that number by 50 (we'll wait while you get the calculator...)

5. If you have already had your birthday this year add 1755. If you haven't, add 1754.

6. Now subtract the four digit year that you were born.

You should have a three digit number...

The first digit was your original number (i.e., how many times you want to have chocolate each week).

The next two numbers are...YOUR AGE! (Oh YES, it is!!!!!)

Supposedly, THIS IS THE ONLY YEAR (2005) IT WILL EVER WORK.
ITALIAN PASTA DIET, IT REALLY WORKS !!

1) You walka pasta da bakery.

2) You walka pasta da candy store.

3) You walka pasta da ice cream shop.

4) You walka pasta da table and da fridge.

Also:
For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to hear the truth after all those conflicting medical studies.

1. The Japanese eat very little fat, lots of carbs, consume a lot of liquors, and suffer fewer heart attacks than Americans.

2. The Mexicans eat a lot of fat, eat a lot of carbs, drink lots of alcohol, and suffer fewer heart attacks than Americans.

3. The Chinese drink very little red wine, eat lots of protein & carbs, and suffer fewer heart attacks than Americans.

4. The Italians drink excessive amounts of red wine, tons of carbs, and suffer fewer heart attacks than Americans.

5. The Germans drink a lot of beer, eat lots of sausages and fats with carbs on every dish, and suffer fewer heart attacks than Americans.

CONCLUSION:

Eat and drink what you like.
Speaking English is apparently what kills you.
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If you are pretty good with numbers and puzzles you’ll find this web site entertaining and head scratching for quite a few hours. One thing for sure, you don’t get to terribly bored???? They have puzzles from easy to very hard and over 25000 of them. They also have little buttons to push to see how you are doing which I found kind of intriguing.
http://www.websudoku.com/?level=1

PLEASE REMEMBER THE CHRISTMAS PARTY SCHEDULED FOR 13 December 2005 @ 12:30PM – 3PM. It is to be in our meeting room at Warm Springs Resource Center. We need to have a RSVP by November 15th as to the number who plan to attend.
We realize it is a little early to start planning the party this far in advance to some but a lot of details have to be confirmed by the management of Warm Springs.
The Director of the Resource Center has already reserved the room for our usage for that day for those particular hours. The planning so far is to have a barbecue brisket, potato salad, & beans (with drinks provided by Warm Springs). It will be discussed at our meeting in September and October. The plan is to use some of the dues for the food and charge a fee of $2.00/plate to defray any other costs—like the paper plates, table clothes etc .

My Piggy Bank after filling up my car today!!!!

Poor thing.....don't know what we'll do if things don't get better.....
I think this kind of expresses all of our opinions about the current outrageous gasoline prices. I don’t get out very often now a days but when I do, just seeing the prices displayed on the gasoline pumps just takes your breath away.
THE DAILY MOTIVATOR
Wednesday, September 7, 2005
Leave doubt behind
Doubt is nothing but a thought you choose to have. Just as easily as you choose to have doubt, you can choose to let it go.
Doubt has no power other than the power you give it. Yet the power you give it can be enormous.
When you focus on doubt, your problems and limitations become greatly multiplied. When you give yourself to doubt, your resources and abilities lose much of their value.
So why would you want to hold yourself back in this way? There's really not even a single good reason.
As soon as you sense that doubt is pulling you down, make the decision to leave it behind. Remember that each doubt is your own creation, and once you stop sustaining it, it will no longer be.
Choose to walk away from doubt. And you'll set yourself free to achieve great things.

Ralph Marston

Copyright ©2005 Ralph S. Marston, Jr. All rights reserved.
(From The Daily Motivator. http://greatday.com/v.html?1157h05BAxxq
This site has both the printed version and the slide show version with beautiful pictures. Mr. Marston lives in the Hill Country in the Travis Lake area just outside of Austin, Texas.

Happy Thanksgiving!

There was a couple who used to go England to shop in a beautiful Antique store. This trip was to celebrate their 25th wedding anniversary. They both liked antiques and pottery, and especially tea-cups. Spotting an exceptional cup, they asked, "May we see that? We've never seen a cup quite so beautiful."

As the lady handed it to them suddenly the tea-cup spoke, "You don't understand." It said, "I have not always been a tea-cup. There was a time when I was just a lump of red clay. My master took me and rolled me pounded and patted me over and over and I yelled out, "Don't do that. I don't like it! Let me alone", but he only smiled, and gently said; "Not yet!!"

"Then. WHAM! I was placed on a spinning wheel and suddenly I was spun around and around and around. 'Stop it! I'm getting so dizzy! I'm going to be sick!', I screamed. But the master only nodded and said, quietly; 'Not yet.' He spun me and poked and prodded and bent me out of shape to suit himself and then......

"Then he put me in the oven. I never felt such heat. I yelled and knocked and pounded at the door. 'Help! Get me out of here!' I could see him through the opening and I could read his lips as he shook his head from side to side, 'Not yet'.

"When I thought I couldn't bear it another rminute, the door opened. He carefully took me out and put me on the shelf, and I began to cool. Oh, that felt so good! 'Ah, this is much better,' I thought.

"But, after I cooled he picked me up and he brushed and painted me all over. The fumes were horrible. I thought I would gag. "Oh, please stop it, Stop it!!", I cried. He only shook his head and said. "Not yet!".

"Then suddenly he put me back in to the oven. Only it was not like the first one. This was twice as hot and I just knew I would suffocate. I begged. I pleaded. I screamed I cried. I was convinced I would never make it. I was ready to give up. Just then the door opened and he took me out and again placed me on the shelf, where I cooled and waited ---- --- and waited, wondering what's he going to do to me next?

"An hour later he handed me a mirror and said "Look at yourself." And I did. "I said, 'That's not me; that couldn't be me. It's beautiful. I'm beautiful!

"Quietly he spoke: I want you to remember, then,' he said, 'I know it hurt to be rolled and pounded and patted, but had I just left you alone, you'd have dried up. I know it made you dizzy to spin around on the wheel, but if I had stopped, you would have crumbled'. I know it hurt and it was hot and disagreeable in the oven, but if I hadn't put you there, you would have cracked.

I know the fumes were bad when I brushed and painted you all over, butif I hadn't done that, you never would have hardened. You would not have had any color in your life. If I hadn't put you back in that second oven, you wouldn't have survived for long because the hardness would not have held. Now you are a finished product. Now you are what I had in mind when I first began with you.'

The moral of this story is this:

God knows what He's doing [for each of us]. He is the potter, and we are His clay. He will mold us and make us, and expose us to just enough pressures of just the right kinds that we may be made into a flawless piece of work to fulfill His good, pleasing and perfect will.

GENERATIONAL “FLOW-ON” OF POLIOMYELITIS
By Eddie Bollenbach, PhD

I'd like to give my impressions and ideas about transplacental transmission of the poliovirus.

Do you know how viruses are cultivated to produce vaccines? They must Be grown inside living tissues and a very convenient way to do this is to use chicken embryos inside eggs. The reason this is convenient for so many viruses, from influenza to polio, is that embryonic and even fetal tissue is very susceptible to infection by a wide variety of viruses. The point of this is that if a human fetus in-utero was infected by a pregnant mother, the fetus would be severely damaged and would very likely die. This is because the viruses grow inside these cell producing a "cytopathic effect". This means the cells get altered in ways which, especially in fetuses, would result in catastrophic damag.For example, large cells with more than one nucleus, cells with visible bodies inside, and other anomalies.

Dick Bruno, in his New Mobility magazine column, addressed the issue of pregnancy and fetal safety by providing the following facts. In the 1950's thousands of women came down with polio while pregnant. In Los Angeles and Illinois there was a study of 1000 such women and at birth or stillborn not one fetus showed any sign of polio. Even with the normal rate of stillbirths, on autopsy of these fetuses showed no sign of the polio virus or even a cytopathic effect. However, having polio while pregnant did pose a serious health risk for the mother as more deaths during pregnancy and childbirth occurred for them. Pregnant women were 5 times more likely to die if they had polio.

In another study addressed in the same article, babies less than six months of age, born between 1897 and 1956 were studied. 150 cases were identified. Four of these babies showed signs of paralytic polio at birth. So it seems that in very rare cases the mother's antibodies do not protect the fetus. I believe, in some of these, there was a misshapen placenta.

Let's move on to some more data: Lauro S. Halstead, MD, Director of the Post-Polio Program at the National Rehabilitation Hospital in Washington, DC, and member of PHI'S Medical Advisory Committee, stated about this question::"I know of no study that indicates there is a connection. To the contrary, we know that mothers who got polio when pregnant did not pass on the virus to their children. Some viruses cross the placental barrier, but polio is not one of them."

Following Halstead's lead, I found comments by the CDC in Atlanta, on the danger of oral live polio vaccine administration during pregnancy. The CDC reiterates the lack of evidence for fetal damage due to poliovirus but if the mother is vaccinated with live Sabin vaccine, there is a concern about SV40 which is a virus that apparently does cross the placenta and can infect the fetus. Such infections may cause an increased risk of cancer.

If your mother had polio during pregnancy there is a chance that during birth her shedding of virus from feces, or less likely blood, could have caused an infection. If this occurred, it might be difficult to tell, in an infant, if some motor neurons were damaged. Virus shedding occurs for as long as a month in some individuals although they are not infectious, generally, because the virus has a very high mutation rate and all virulent virus is cleared within a week or two after an active infection. But that is a possibility.

I don't know if anyone here has PPS because of a fetal infection. All the evidence on this taken since the late 1800's have been unremarkable and rare. With all the polio in the 40's and 50's one would expect positive information about fetal contraction of virus if it were a common event. We would have seen it. I do know there are a lot of physical problems that are common in our age group: fibromyalgia, chronic fatigue Syndrome, back problems, arthritic problems, lupus, MS. heart problems, chronic infections, Crones disease, and the list goes onto the point where we would all fall asleep. None of us escape all of these and many have common symptoms to PPS. Currently the guidelines at the NIH to help diagnose PPS include a history of paralytic polio. It would be pretty hard to convince them that PPS is the result of a parent's polio during pregnancy although I believe, and wrote an article in the Jan/Feb 2000 issue of the The American Journal of Physical Medicine and Rehabilitation, on Late Functional Loss in Non-Paralytic Polio. In that same issue were similar papers by Bruno and Halstead. soa history of paralytic polio, to many of us at least, is not required. In summary, I think anyone who feels they have PPS as a result of transplacental infection will have a hard road in convincing health care professionals of it unless an EMG shows typical old polio damage with resprouting. You might also show a higher titer of anti-polio antibodies for one of the three strains. Now if that happened I would be convinced. My co-author Marcia Falconer worked with live poliovirus at MIT and they did the anti-body test there but it is not generally available.
*References*

http://www.newmobility.com/review_article.cfm?id=358&action=browse

Post-Polio International (Halstead)
http://www.post-polio.org/netwkg_a.html

Improving Communication with Our Doctors

Henry D. Holland, MD,
Richmond, Virginia
(Henry4FDR@aol.com)

Why am I qualified to offer these suggestions? I have had the experience of being a patient many times in my life.

I have used a ventilator since I had a permanent tracheostomy in 1970. This treatment resulted from the damage initially caused by polio in 1950. I have an intensified interest in post-polio syndrome because I have experienced its effects since about 1990.

I have been a physician since 1966, and my specialty is psychiatry. I am currently a clinical professor at the School of Medicine of Virginia Commonwealth University (formerly the Medical College of Virginia), and each year I instruct second year medical students in the technique of interviewing patients.

Jon* is a 16-year-old Vietnamese citizen who does well in school and dreams one day of being a doctor. Thom* is a charming and articulate 25-year-old Haitian who is starting his own import/export business. Jim* is 46 and a devoted father of three teenaged girls who is a former missionary and now teaches high school English in Arizona. Bob* is a 52-year-old fast-food franchise owner with three kids in college. Joe* is a 65-year-old banker who is thinking of retiring. Fred* is a 78-year-old golf course developer who loves to fox hunt.

What do these men have in common? Polio. They all contracted polio at some point in their lives, which dramatically and irrevocably changed them all, both physically and emotionally.

There has never been and never will be another disease quite like polio. An infectious disease caused by a virus, polio has been around for centuries. Some of the first references to polio are Biblical. There is an ancient Egyptian carving that appears to depict a man with classic polio findings who is leaning on his staff. Initially, polio was a rather unusual occurrence, which lulled the medical community and the public into a sense of complacency. And then during the first half of the 20th century, millions of people were devastated by polio as epidemics swept across the world. Polio's transformation from a sporadic disease to one of epidemic proportions in the early and mid-1900s was paradoxically due in large part to technological advances. Improvements in sanitation unpredictably allowed some diseases, including polio, to flourish because when water supplies consistently were contaminated with the polio virus (prior to improved sanitation), people would be exposed to polio in infancy during which time they had protection from the virus due to their mother's antibodies (from breast milk). With cleaner water, people were now exposed to polio at a later age when they were no longer protected by maternal antibodies. Thus, epidemics began and continued until the develpment of a vaccine in the mid-1950s. Blind to age, gender, and race, polio affects men, women, and children.

Polio's return

With the advent of the polio vaccines, America's polio plague ended. The vaccines were effective not only in eliminating the disease but also in erasing it from its place of prominence on political and health care agendas. In an amazingly short period of time, polio was so completely dismissed it was as if it never existed. Polio survivors moved on with their lives. The March of Dimes changed its mission and went on to fight birth defects, and politicians and celebrities promoted other causes. Even medical doctors learned about polio as merely an historical footnote, if they studied it at all.

However, polio's legacy was far from dead. First, polio continued, often occurring in poverty-stricken countries. Although polio will likely be the second disease eradicated worldwide (smallpox is the first), this has not happened yet. Also, after a long dormant period during which vaccines prevented new cases of acute polio in America and many other countries, in the late 1970s and early 1980s, the vestiges of a virus long gone returned to haunt the very people who had survived its initial onslaught.

With increasing frequency, polio survivors began reporting new problems that bore a remarkable resemblance to symptoms they had experienced at the onset of the disease decades ago. At first these odd complaints were attributed to a variety of other maladies, including malingering. But as more and more polio survivors described a nearly identical set of symptoms, clinicians realized that perhaps these new manifestations were somehow related to the original polio infection. These characteristic symptoms were described in various ways as post-polio sequelae, the late effects of polio, post-polio muscular atrophy, and post-polio syndrome (PPS).

PPS is characterized by new symptoms that occur in people with a history of paralytic polio after a long period of stability (generally at least 15-20 years) in which whatever strength they had remained unchanged. Frequently, the most prominent and alarming symptom is new weakness either in a limb that was known to be involved in the acute illness or in a limb that was not thought to have been affected by the initial polio. This new weakness often heralds a more pronounced level of disability in polio survivors who thought that the worst was over. Some survivors are so taken aback by these new symptoms that they do not seek treatment until years after they begin having manifestations of PPS. In some instances, individuals simply deny that they are having new problems until their condition becomes so pronounced that denial is no longer possible. For others, there is a lack of understanding that keeps them from seeking the medical care they need. Still other polio survivors, who are experts at managing adversity, may genuinely be unaware that anything out of the ordinary is occurring. In fact, sometimes the symptoms are so subtle that the only way to measure them is by taking a careful history that spans many years.

Sequelae

PPS is obviously a syndrome that, by definition, is a collection of symptoms that characteristically occur together. By definition, a syndrome does not have a single test that is able to identify it. Thus, a syndrome is attributed to someone only if they meet specific criteria established by the medical community and only after all other reasonable (and testable) conditions have been eliminated as possibilities. Therefore, in order to diagnose any syndrome, the following must occur: (1) an individual must present with specific symptoms, (2) all other possible causes for these symptoms must have been ruled out, and (3) the individual must meet the criteria established for the diagnosis of the syndrome.

Because syndromes do not have specific tests that can undeniably identify them, they are subject to interpretation and often their validity is challenged within the medical community. PPS is no exception. Although most physicians believe that PPS exists, there are a few who do not.

The symptoms of PPS are listed below.

1.It is important to note that one does not need to have all of the manifestations; however, if someone complains of symptoms that are not listed, other diagnoses should be considered. Some of the symptoms are weigted more heavily than others, and new weakness, the "sine qua non," is the most important criterion.

The symptoms consistent with the diagnosis of PPS include:
1. new weakness,
2. unaccustomed fatigue,
3. pain,
4. new swallowing problems,
5. new respiratory problems,
6. cold intolerance, and
7. new muscle atrophy.

Someone with new weakness may not specifically complain of it, but may report a history of recent trips or falls, difficulty lifting a gallon of milk, or needing to use two handrails on the stairs instead of one. New weakness may also present with respiratory or swallowing involvement with symptoms such as dyspnea on exertion or choking when eating.

Future Considerations

In May 2000, the March of Dimes in collaboration with the Roosevelt Warm Springs Institute for Rehabilitation held an international conference on PPS. The results of this conference were summarized in a report (available from the March of Dimes) that focused on "identifying best practices and care" for PPS.2 The report suggested that polio survivors be treated in a manner similar to how rehabilitation professionals routinely treat individuals with complex neurological and/or musculoskeletal conditions (including polio and PPS) with a multidisciplinary approach.

The polio treatment team may consist of physiatrists, pulmonologists, otolaryngologists, physical therapists, occupational therapists, speech and language pathologists, mental health professionals, orthotists, and many others. It is important to recognize that polio survivors, regardless of their age or whether they have been diagnosed with PPS, will likely need a comprehensive and multidisciplinary approach to their care.

Polio will be with us for at least another 100 years. It is not, and never has been, an historical footnote.

Julie K. Silver, MD, is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is the author of Post-Polio Syndrome: A Guide for Polio Survivors and Their Families (Yale University Press) and is the director of the International Rehabilitation Center for Polio at Spaulding Rehabilitation Hospital, Boston.

References
1. Silver J. Post-Polio Syndrome: A Guide for Polio Survivors and Their Families. New Haven, Conn: Yale University Press; 2001: 17.
2. Post-Polio Syndrome-Identifying Best Practices in Diagnosis and Care. White Plains, NY: The March of Dimes Birth Defects Foundation; 2001.
*Names and identifying characteristics have been changed to protect the privacy of individuals.