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Health & Rehabilitation

Gentry White

2012-11-19 11:24:40

Q- If speech pathology did not work as a child, would it be worthwhile to pursue it as an adult if some of the same issues are still present?

A- Great question. I would consider a referral for the following reasons; if you feel that your speech is impeding your skills as a professional within your chosen career, your speech deficit is negatively impacting your social life or if you have recently noticed a change in your speech (i.e. rate, word finding issues, intelligibility). I would then consider speaking with a Speech Pathologist about your specific communication needs. Whether your speech deficit is a specific phoneme sound (ex. /s/ or a /r/ misarticulation) or if it is a fluency issue (ex. fluctuating rate of speech), it is never too late to determine a compensatory strategy for speech production. The amazing part of the human race is that each and every one of us is different and speech makes up who we are; voicing, oral structure, dialect and language can characterize each and every one of us in a unique way.

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Health & Rehabilitation

Dr John Yost Jr

2012-11-19 11:19:40

Q- Last year my daughter had some sort of a hamstring pull or tear in both of her legs during her 1st week of high school basketball practice. The back of her legs, slightly above her knees turned black & blue. After some rest, she began wrapping her legs and ended up making it through the season. What are the most common basketball related injuries, what are some physical signs of the injury (bruising, pain, etc) and how can they be avoided?

A- The winter season will be here soon and with it comes basketball, and unfortunately, basketball injuries. Basketball is a contact sport that is played on hard surfaces. It requires quick acceleration and deceleration, rapid changes in direction and a great deal of jumping. This is why so many types of injuries may occur. Most basketball injuries consist of sprains, strains, contusions or fractures. To begin with, let me define those injuries. • A sprain is an injury to a ligament which is the tissue that holds bone to bone. Sprains may be mild, moderate or severe. They can range from something as simple as a turned ankle to more severe injuries such as a dislocated shoulder or an ACL tear of the knee. • A strain is an injury to the muscle tendon unit. A tendon is the tissue that attaches the muscle to the bone. A pulled hamstring, a ruptured Achilles tendon and a torn rotator cuff are all examples of strains. These can also be mild, moderate or severe. • A contusion is a result of blunt trauma with bleeding in the soft tissue, muscle, and if severe enough, bone. Examples include a bruise of the skin, a hematoma in the muscle, or a bone bruise. • An acute fracture is a break in the bone due to force, and repetitive stress over time can lead to a stress fracture. Most common acute fractures are finger and wrist fractures. These usually result from being struck by a ball or breaking a fall with your arm. Most common stress fractures are due to repetitive loads to the spine, hip, and foot. The management of basketball injuries is approached in 3 phases: Prevention, Diagnosis and Treatment and Rehabilitation. Prevention is the first priority in sports medicine and should begin in the preseason to ensure as safe a program as possible. Training should emphasize three primary areas: strength, flexibility and endurance. Even when proper training protocols are set in place, injuries can still occur. Remember that initial treatment for injuries should follow the acronym RICE (Rest, Ice, Compression, Elevation) of the injured extremity. Evaluation by a trainer, nurse practitioner, physical therapist, or physician is recommended for any injury that has not improved after 24 hours. Sprains, strains, contusions and fractures resulting from contact sports such as basketball require treatment by individuals well versed in injuries of the musculoskeletal system.

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Health & Rehabilitation

Dr John Yost Jr

2012-11-07 11:47:31

Q- What is a growth plate injury?

A- First things first…to understand a growth plate injury, let me first give you a better understanding of what a growth plate is: Growth plates are the regions of the bone where growth occurs. They are located at the ends of the bones near the joints. The growth plate itself can be broken down into four separate layers or zones. • Zone 1 is the resting zone and is made up of inactive cartilage cells. • Zone 2 is the proliferative zone and is made up of actively growing cartilage cells. • Zone 3 is the mature cartilage zone and is made up of enlarged mature cartilage cells that produce the cartilage matrix. • Zone 4 is the zone of calcifying cartilage and is a thin layer where the cartilage cells have died and are surrounded by a calcified matrix. This is the weakest area of the growth plate and is where new bone is added. Growth plate injuries/fractures are classified by the severity of the damage to the growth plate and effect on future growth. • Type I fracture is a separation of the growth plate without involvement of bone. This occurs through the zone of calcification away from growing cartilage cells and usually heals without affecting future growth. • Type II fracture involves separation of the growth plate in the zone of calcification…a variable distance, out through the adjoining bone. This is the most common type of growth plate fracture and is away from growing cartilage cells. It usually heals without affecting future growth. • Type III fracture is through all layers of the growth plate and extends into the joint. This is an uncommon injury, but requires restoration of a normal joint surface. An operation is usually necessary. • Type IV fracture occurs when the break extends from the joint surface through all layers of the growth plate and a portion of the bone on the other side. An operation is usually necessary to restore the joint surface and alignment of the growth plate. • Type V fracture is the result of a crushing force through the growth plate. This is uncommon and usually involves the region around the knee or ankle. Initial x-rays may appear normal yet as the cartilage cells die from the crush injury, growth ceases. This injury has a poor prognosis but fortunately is uncommon. The type of injury and age of child help to determine prognosis with a growth plate injury. The older the child (less growth left to occur) and the lower the fracture type, the better the prognosis.

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Health & Rehabilitation

Dr John Yost Jr

2012-10-03 11:07:53

Q- Is it possible to return to sports after a spinal injury?

A- Not only is this possible, but it is encouraged and desired. Depending on the type and severity of injury, time for recovery and return to sports varies. There are several different types of spinal injuries: The most common spinal injury is a sprain. A sprain is a tear of ligaments which are the tissue that connect bone to bone. A sprain can be mild, moderate or severe. Most people begin activity immediately following a mild sprain. Severe sprains are sometimes associated with a disk injury where the tissue can displace into the spinal canal and pinch a nerve. Though the majority of these injuries heal without surgery, recovery can take longer. Although less frequent, spine fractures may occur with the most common being a compression fracture. As we mature, our bones lose density and become more susceptible to fractures with even mild injuries. Compression fractures are stable but can take up to 6 months to completely heal. Again, early activity as tolerated is recommended. When my patients have a spinal injury I always recommend a daily back exercise program that takes 5-7 minutes in the morning and 5-7 minutes in the evening. I suggest they supplement that with activities such as jogging, swimming, and cycling. Other sports tolerated include golf, bowling, low impact aerobics, a supervised weight lifting program and skiing (which can be hazardous for beginners). More risky activities that should be performed ONLY with proper medical clearance include football, soccer, volleyball, ice hockey, and trampoline. Remember that overall fitness is vital both before and after injuries and requires exercise, proper weight, good diet, control of stress, and other healthy life choices: • Don’t Smoke! Smokers are at risk for more severe and longer lasting back attacks. Why? Smoking reduces circulation in small vessels including those that nourish the spinal disks. • Good nutrition is important! Most people need to reduce fat intake and increase vegetables, fruits, and whole grains. • Take your vitamins! Calcium and vitamin D help reduce Osteoporosis. Vitamin C aids in building collagen needed by disks. • Drink water! Staying well hydrated will slow the disk degeneration process. • Exercise! Whole body exercise is a part of fitness. Aerobic exercise beginning at 15 minutes building to a goal of 30 minutes a day is recommended. This is best accomplished through walking, swimming, bicycling.

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Health & Rehabilitation

Gentry White

2012-08-30 08:38:49

Q- When is it time to consider speech pathology?

A- Speech Pathology is utilized when you, the caregiver, feel that there is a gap in your child's communication. You might not understand your child's communication attempts, other's may not understand the child's attempts and look to you for clarification or you may feel that when your child communicates he/she is frustrated with not being understood. During a well-child check-up the physician may ask for number of words to count effective communication but a therapist looks for content in that child's communication. For example a 2-year-old should be using pronouns (I, me), using questions (why?, where?) and clarifying misunderstood information when he/she is not understood by others. A Speech-Language Pathologist will also look for receptive language milestones to ensure that the child's vocabulary and language skills are age-appropriate. If there is concern, don't wait to bring it up at a well-child check-up because 6 months is a long time to wait in your child's development.

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Health & Rehabilitation

Dee Staudt

2012-08-29 13:05:23

Q- I did not go kicking and screaming into alcohol treatment. I knew, as most addicts do, that it was time to get help. I had lost everything except the ability to make more excuses and I was running out of those. Treatment and recovery helped me regain my sense of purpose; I am healthy again, have a group of friends who support one other and most importantly I have found hope. Do you need help?

A- In the United States, drug use is on the rise. Twenty-three and a half million Americans are addicted to alcohol and drugs. That’s approximately one in every 10 Americans over the age of 12, and sadly only 11 percent of those with an addiction receive treatment. From January 1 through December 31, 2011, there were 3,297 adult admissions into publically funded alcohol and drug treatment programs in Sedgwick County. The primary drug of choice was alcohol, followed by marijuana. Four hundred sixty-six adolescents, age 18 and younger, were also admitted into publically funded treatment programs in Sedgwick County. The primary drug of choice for this group was marijuana followed by alcohol. Today across the United States, there are more than 20 million people in recovery from substance use disorders. Recovery is a lifelong process. Through the Substance Abuse Mental Health Services Administration (SAMHSA), the Recovery Support Initiative has outlined four major dimensions that support a life in recovery: • Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and making informed, healthy choices that support physical and emotional well-being. • Home: a stable and safe place to live. • Purpose: meaningful daily activities, such as a job, school, volunteering, family caretaking, or creative endeavors, and the independence, income and resources to participate in society. • Community: relationships and social networks that provide support, friendship, love and hope. • Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies and others. Hope is the catalyst of the recovery process. Recovery may be the best word to summarize the positive benefits to physical, mental and social health that can happen when alcohol and other drug-dependent individuals get the help they need. National Recovery Month every year in September promotes the societal benefits of prevention, treatment, and the recovery from substance use and mental disorders. We celebrate people in recovery, applaud the contributions of treatment and service providers, and promote the message that recovery in all its forms is possible. Recovery Month spreads the positive message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover.

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Health & Rehabilitation

Gentry White

2012-08-02 12:24:53

Q- "My daughter was in a very horrific car crash and sustained brain injury and currently going through physical therapy. However, her doctors have not yet addressed the problems with speech. When is it time to address those issues?"

A- To the parent of the child who was in the car crash: I can’t imagine what your family has been through since your daughter’s car accident. The most important factor in any recovery is the support system that that person has in place. Traumatic brain injury generally involves two areas of the brain; the coup (impact side) and the countrecoup (opposite side of impact). These injuries can range from focal (more localized) to more diffuse (wider area of impact). The speech centers of the brain are in the temporal lobes but the way that a person reacts to things is contained within the frontal lobe (forehead area) which is a common injury sustained from an accident. The brain is tied together through the motor cortex as well as memories and associations built up from that person’s life. When the brain sustains injury, those associations can be sheared and damaged from that accident often resulting in difficulty with areas that would be related to speech, language and social communication. The person who sustained the car accident may have difficulty with word-finding errors, reasoning, social language, as well as memory. When your daughter is medically stable and okayed for rehabilitation by her primary care physician she would benefit from a speech and language evaluation through a Speech Pathologist. An evaluation may assist with looking at your daughter’s weaknesses as well as her strength within the areas of speech, language and cognition. In-order-to return to her previous function, an evaluation may indicate what areas may need further rehabilitation. Best wishes on your daughter’s recovery and rehabilitation.

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Health & Rehabilitation

Gentry White

2012-06-01 09:38:01

Q: What is feeding therapy?

A: All kids move through a specific set of skills that allow them to complete tasks independently as they grow and mature. In-order-to explain disordered feeding, one has to understand sequential feeding for a typically developing child. For the first six months of life, most babies are exclusively breast or bottle fed. Following this period, first foods are then introduced as baby is able to tolerate these pureed foods then thickness and lumps are added as the baby matures physically as well as cognitively. By the time the baby is 12-15 months old he/she is eating modified table foods with the rest of the family. The baby’s feeding development mimics growth development, for example, as he/she is able to hold up his/her head; the suck-swallow pattern changes to integrate these systems to reduce the time it takes to feed. Eating requires that all eight sensory systems (olfactory, gustatory, auditory, visual, tactile, vestibular, interperception and proprioception) work together in-order-for tolerance and digestion of foods to occur. Because eating is a learned behavior, any disruption (ex. procedures during hospitalization) or pain (ex. reflux) to the system in the first few years of life may cause problems feeding. Problem feeders may have a limited or restricted variety of foods that they consume (less than 20 different foods). The child may refuse or cry when presented with “new foods.” This type of child’s food habits differ from that of the family and most often the child does not eat with the family at meals. Children who have difficulty feeding may also be reported as a “picky eater” during several well-child check-ups with their health practitioner. These children are not always “behavior” problems but may have issues with their feeding habits. A child can be obese and be malnourished at the same time. A Speech-Language Pathologist who is trained in pediatric feeding therapy can assist the child and his/her caregivers to make that progression from being a problem feeder to a healthy and active member of the family who engages during meals with the family. The goal of feeding therapy is to add foods into his/her repertoire while engaging the child’s sensory systems in a sequential and child directed order. This therapist will work on skill set, environmental modifications, diet changes as well as caregiver education for at-home carryover. We as adults need to think like the 2-year-old and remember that feeding is one of the most difficult sensory tasks that will occur in that child’s life within his/her first two years of life.

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Health & Rehabilitation

Gentry White

2012-04-19 16:44:44

Q: How does Speech-Language Pathology fit into the treatment of a child with Autism?

A: Autism rates are on the rise in the U.S. It appears that no matter who we talk to this diagnosis impacts someone we love and care about. It could be a child, a grandchild, a school mate or a friend. Autism is a language processing disorder in which social skills are directly affected during communication. The majority of the children that are diagnosed with Autism are diagnosed prior to five years of age. There are several areas within the realm of speech and language that might be an indicator of Autism. In no way does this mean that your child has Autism but he/she may demonstrate one or all of the following behaviors: 1. Limited or absent cooing/babbling during the first 24 months of age 2. Limited gestures to make his/her needs and wants met during the first 12 months of age 3. Reduction or absence in two-word phrases by 24 months of age 4. A sudden speech/language loss at any age in development 5. Unusual behaviors or sounds that are repeated over and over throughout the day A Speech-Language Pathologist is a person who specializes in the treatment of language disorders. Autism impacts the child’s language processing and interpreting skills that are utilized to formulate letter sounds, blending sounds into words, and forming statements about objects and directing conversation to others. A skilled therapist can assist in working with the child as well as the caregivers to make the link in communication and “break-through” the barrier that is inhibiting the child from making connections and interacting with his/her peers as well as caregivers. Early intervention is the key to getting a head-start on treating the child’s symptoms, as every child is different and unique in his/her own special ways.

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Health & Rehabilitation

Robb Rose

2009-08-01 12:16:00

Question: What is an inpatient rehab facility and why are some of the nursing homes I see advertising rehab therapy?

Answer: The primary difference has to do with federal guidelines and accreditation as an inpatient rehab facility (IRF). A true inpatient rehab facility has made the commitment to meet rigorous federal standards, and additionally pursues accreditation as an IRF. An IRF must perform a combination of at least two therapies per day for a minimum of three hours for at least five out of seven days. That minimum of two therapies must be a combination of physical therapy, occupational therapy and speech therapy. Other therapies which involve audiology (such as vestibular balance programs), recreational therapy and others do not count in the minimum standards, but are offered additionally. An accredited IRF must have a physiatrist (a physician who specializes in physical medicine) orchestrating the care of the patient daily. A skilled nursing facility and care home will have a physician visiting patients as few as one to two times a week.. A quality IRF will have a Fellowship Trained Clinical Neuropsychologist on staff to conduct specialized diagnosis and treatment for head and brain injury patients, to include stroke and neurology based conditions. An IRF patient receives 24 hour, seven-days-a-week rehab nursing care with combined therapies for three hours per day. An individualized plan of care is based on the patient’s diagnosis and needs, and includes a reasonable discharge goal of back to the patient’s home with appropriate support. Inpatient Rehab is a multidisciplinary team approach. An IRF’s focus on stroke, neurology, amputations, spinal cord, brain injury, rheumatoid arthritis, congenital deformities, vascularities, hip fractures, multiple joint replacements and severe osteoarthritis, are all defined by national standards. A consumer of inpatient rehab care will want to ask: 1)Is this inpatient rehab facility part of a nationally accredited Stroke/Neuro Center of Excellence through The Joint Commission? This means it provides a true continuum of care at a high level, based on the highest national standards for this type of complex patient. 2)Is this IRF dual-accredited? Does it meet both the basic standards for accreditation and have a specialized focus specific to rehab? For example, an IRF having accreditation from The Joint Commission plus accreditation from the Commission on Accreditation of Rehabilitation Facilities, specific to rehab, shows a real commitment to rehab high standards. 3)Does this IRF not only have a physiatrist, but also a full-time, on-campus medical intensivist to provide medical management of all medical issues? Such a facility has a physician that is an Internal Medicine specialist on campus full time to care for patients, while the physiatrist orchestrates the overall rehab issues. 4)Is there a good balance of new rehab technology plus qualified people? New technology is important to stay up-to-date with leading-edge proven therapies, but rehab is about people working and caring for people. Bonding, trust and caring are key to a patient’s successful outcomes. 5)Does this IRF have a true Community Reintegration Program? Community reintegration has to do with shopping, driving, going out to eat, going to a movie, banking, gardening, playing video games — the activities of daily living. Look for a facility that has these functions to practice on the IRF campus. Many specialized facilities have these types of reintegration programs, with names such as “Easy Street.” Patients and their families can practice in the facility’s in-house theatres, grocery stores, banks and actual automobiles; even video games such as WI Therapy can assist with achieving the rehab goals for each patient. 6)Does this IRF have spiritual, musical, and psycho-social support? An on-site chapel with chaplains and the opportunity to openly pray and/or attend religious/spiritual programs, attend professional music therapy programs and have access daily to psycho-social support such as a clinical psychologist and support groups are very important. 7)What access do they provide to specialty care on site, such as dialysis, or an accredited sleep center for sleep apnea diagnosis, treatment and education? I hope this helps answer your question so you know what a properly accredited inpatient rehab facility (IRF) is, and can differentiate one from other places advertising rehab therapy.

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Health & Rehabilitation

Robb Rose

2009-07-01 11:56:00

Question: My dad suffered a stroke (CVA) and is now home with mom after going through the acute care phase, inpatient rehab, and then home with some home health care therapies. Dad and mom love each other so very much and always have. Can they resume their physical intimacy (sex)?

Answer: Thanks so much for this question, as it is often left unanswered — or not even asked, due to embarrassment. Touching, kissing, hugging, cuddling, smiling, talking and listening are all needs we have as human beings, and they are part of our sexual existence that includes the ultimate intimate act of intercourse. Patients who have suffered strokes or any other traumatic event that interrupts or disturbs their lives can be left with the very question you have asked. Leaving it unasked or unanswered can lead to increased anxiety and depression. Fear of having another stroke during sex, fear of body image that may have been affected by the stroke, fear of rejection as an intimacy partner and fear of performance can all lead to depression and anxiety. The depression and anxiety then can perpetuate the fears, and on and on the cycle continues. Psychosocial support and communication are important. Inpatient Rehab and home health staff should provide education and support opportunities, and there are specialists in this area: psychologists, counselors, physicians, disability analysts and others. By all means, talk about it and ask questions. Depression symptoms can include: •A loss of interest in sex/intimacy •Generalized feelings of inadequacy or worthlessness •Constant fatigue, sadness, negativity and irritability •Restlessness and insomnia •Changes in weight and appetite •Memory changes •Decreased interest in socializing or pursuing pleasurable activities •Suicidal thoughts and attempts Depression itself needs to be addressed with regard to intimacy and sexual relations for stroke patients. Always talk to your physician about challenges whether you are the patient or the caregiver, and always discuss medications with your physician. Your physician can help assure you that the correct medications have been prescribed. Some medications work differently from person to person and have side effects that are the challenge. Simply changing medications under physician supervision can have huge positive effects. There are appropriate medications for use, as well as psychosocial support, and even medical mechanical devices that can be prescribed and/or suggested by your physician and medical team, to improve or enhance your individualized intimacy. The sooner a couple is able to resume intimacy (within medical approval) after a stroke, the less likely that anxiety, depression or fear will create roadblocks. Partners should try not to monitor performance based on previous history (prior to the stroke). Be patient, slow and communicate. Being well-rested and allowing enough time for intimacy can reduce anxiety, and can help overcome slowed physical response time. Depending on the severity of the stroke, patients and their partner may need to modify their activity to accommodate body strength, and levels of paralysis, and even bowel and bladder function. A adequate education by therapists and planning ahead can help keep these from becoming a barrier to intimacy. If the stroke patient’s intimacy partner is also the primary caregiver, consideration for caregiver breaks are needed. Caregivers need their time and space, as we all do, and this allows for that mutual renewal time. Always remember not to create false expectations. Communicate, consult with your medical team and then have fun together intimately.

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Health & Rehabilitation

Robb Rose

2009-05-01 11:45:00

Question: I continue to have pain and tingling in my joints and muscles, long after my accident and recovery. Is there anything else I can do besides medications?

Answer: Depending upon what kind of accident you originally suffered, the answer could very well be “Yes.” Many times muscular and joint pain can cause us to tighten up even more in a natural protective reflex manner that can increase the pain even more. This perpetuates the pain cycle, and then we react by doing less and less in terms of exercise and stretching. Exercise and stretching increase blood flow, which warms and heals the area of pain. Many patients look forward to therapeutic massage by a physical therapist or even a certified massage therapist, as it brings physical and even emotional relief. A therapeutic massage by an educated and trained therapist can be a much needed “healing touch.” Dr. Sunil Mathews, a neurologist at North Texas Neuroscience Center in Irving, Texas, recommends massage therapy as an adjunct to prescribed physical therapy after consulting your physician. Patients with hypersensitive nerves can end up with worsening pain, and patients with numbness can receive too deep a massage that causes further damage, due to the inability to provide sensation feedback to the therapist. Your doctor will know if either of these conditions exists. Therapeutic massage generally has few serious risks when done by appropriate professionals, and all involved are aware of the patient’s condition. Massage relaxes muscles, reduces pain and improves blood flow. Many neurologic diseases such as Parkinson’s and Multiple Sclerosis respond well to massage therapy. Benefits of Massage Therapy •Stress reduction •Pain reduction •Reduced swelling and inflammation •Circulation increased •Muscle and tissues relaxed •Release of accumulated toxins •Improved energy levels •Emotional improvements Massage therapy is known to stimulate the release of serotonin. Serotonin is a natural chemical in the body that improves mood and reduces pain, along with reducing cortisol which is a natural stress hormone. Benefits of massage therapy can be felt the day of the therapy and the benefits can extend as far as a week afterward. Different types of massage can relieve muscle stiffness, headaches, neck and back pain, as well as deep muscle tissue healing. Postoperative massage therapy can greatly improve healing and mobility as it can prevent scarring and fibrosis, which tighten muscles and joints. Regular massage has proven the most beneficial over the course of time, versus sporadic massage. A physical therapist or a certified massage therapist can teach a patient self-massage and stretching exercises that can get you through some of the pain on your own. Consult your physician and always listen to your body, as it can let you know your limits and possibilities.

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Health & Rehabilitation

Robb Rose

2009-05-01 11:45:00

Answer: Depending on your husband’s specific and individual situation, the answer could very well be yes, there are other options for pain relief. Pain is being looked at as not just a symptom, but an actual disease process. By doing this, the focus for pain relief is very different from years ago. Unfortunately, this progress comes from military physicians treating our injured soldiers. They are often treated very quickly with morphine, epidural pain blockers and a mix of other medications to ease the associated pain, and the forthcoming surgeries with more related pain. Virtually every soldier injured gets some type of pain management. The assortment of medications ranges from ibuprofen (Motrin, Advil, etc.) and epidural blocks to low dose infusions of an anesthetic known as ketamine and another product used since the Civil War: morphine. Morphine can be a miracle drug on the battlefield, but can lead to what has been called “soldiers disease,” due to the high addiction levels with its use. Until the war in the Middle East, pain treatment stopped at morphine. Military physicians have realized that the nervous system becomes overwhelmed with associated pain and maladaptive pathways develop in our nervous systems leading to chronic pain. Military physicians are now using a mix of narcotics, anti-seizure medications, non steroidal anti-inflammatory products and nerve-blocking products. Also used are peripheral nerve stimulators, along with the insertion of pumps that deliver anesthesia at the injury or site of the pain. The peripheral nerve blocks have had great success in Iraq since 2003. Anesthesia can be delivered directly to the injury site with greatly decreased side effects such as drowsiness, because less anesthesia circulates in the body. It’s interesting that pain is the body’s natural indicator of an injury and also can interfere with a quality healing process. This is why pain is being looked at more intensely as a disease process with specific treatment needs, rather than just a side effect from an injury. Pain specialists outside of the military are adopting this focused treatment of pain. In the February 2007 issue of The Journal of Pain, researchers tested the benefits of psychological interventions, cognitive behavioral therapies, hypnosis and neural feedback in dealing with pain. We know that pain is processed by sending nervous system feedback from the injury to the brain. Primary information is sent through the spinal cord to an area of the brain called the thalamus. From the thalamus the nervous system impulses branch out, and the brain lets us know where the pain is coming from, the severity, and even how we should respond physically and emotionally. This information goes to the frontal cortex of the brain and brings it all together for us in context of the situation. The multidisciplinary approach - and as soon as possible, by a knowledgeable medical team - is generally the best way to deal with pain. Untreated pain can be a huge barrier to healing.

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Health & Rehabilitation

Robb Rose

2009-04-01 14:39:00

Question: What is the difference between an Inpatient Rehab Facility and some of the nursing homes I see advertising rehab therapy?

Answer: The primary difference has to do with federal guidelines and accreditation as an inpatient rehab facility (IRF). A true inpatient rehab facility has made the commitment to meet rigorous federal standards, and additionally pursues accreditation as an IRF. An IRF must perform a combination of at least two therapies per day for a minimum of three hours for at least five out of seven days. That minimum of two therapies must be a combination of physical therapy, occupational therapy and speech therapy. Other therapies which involve audiology (such as vestibular balance programs), recreational therapy and others do not count in the minimum standards, but are offered additionally. An accredited IRF must have a physiatrist (a physician who specializes in physical medicine) orchestrating the care of the patient. An IRF patient receives 24 hour, seven-day-a-week rehab nursing care with combined therapies for three hours per day. An individualized plan of care is based on the patient’s diagnosis and needs, and includes a reasonable discharge goal of back to the patient’s home with appropriate support. Inpatient Rehab is a multidisciplinary team approach. An IRF’s focus on stroke, neurology, amputations, spinal cord, brain injury, rheumatoid arthritis, congenital deformities, vasculidities, hip fractures, multiple joint replacements and severe osteoarthritis, are all defined by national standards. A consumer of inpatient rehab care will want to ask: 1) Is this inpatient rehab facility part of a nationally accredited Stroke/Neuro Center of Excellence through The Joint Commission? This means it provides a true continuum of care at a high level, based on the highest national standards for this type of complex patient. 2) Is this IRF dual-accredited? Does it meet both the basic standards for accreditation and have a specialized focus specific to rehab? For example, an IRF having accreditation from The Joint Commission plus accreditation from the Commission on Accreditation of Rehabilitation Facilities, specific to rehab, shows a real commitment to rehab high standards. 3) Does this IRF not only have a physiatrist, but also a full-time, on-campus medical intensivist to provide medical management of all medical issues? Such a facility has a physician that is an Internal Medicine specialist on campus full time to care for patients, while the physiatrist orchestrates the overall rehab issues. 4) Is there a good balance of new rehab technology plus qualified people? New technology is important to stay up-to-date with leading-edge proven therapies, but rehab is about people working and caring for people. Bonding, trust and caring are key to a patient’s successful outcomes. 5) Does this IRF have a true Community Reintegration Program? Community reintegration has to do with shopping, driving, going out to eat, going to a movie, banking, gardening, playing video games — the activities of daily living. Look for a facility that has these functions to practice on the IRF campus. Many specialized facilities have these types of reintegration programs, with names such as “Easy Street.” Patients and their families can practice in the facility’s in-house theatres, grocery stores, banks and actual automobiles; even video games such as WI Therapy can assist with achieving the rehab goals for each patient. 6) Does this IRF have spiritual, musical, and psycho-social support? An on-site chapel with chaplains and the opportunity to openly pray and/or attend religious/spiritual programs, attend professional music therapy programs and have access daily to psycho-social support such as a clinical psychologist and support groups are very important. 7) What access do they provide to specialty care on site, such as dialysis, or an accredited sleep center for sleep apnea diagnosis, treatment and education? I hope this helps answer your question so you know what a properly accredited inpatient rehab facility (IRF) is, and can differentiate one from other places advertising rehab therapy.

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Health & Rehabilitation

Robb Rose

2009-02-01 14:22:00

Question: I’ve noticed one of my friends who is healing from a traumatic injury respond to certain types of music, and seems to actually perk up some too. Is this for real?

Answer: Yes, it could be for real. In fact Music Therapy is for real, and is being used successfully at Inpatient Rehab Facilities. We have heard how Music can calm the savage beast within, well it’s pretty true. We’ve heard how different types of music can change the way we drive, or even help us go to sleep at night. Have you ever noticed the types of music at restaurants, shopping centers, and at places of work, and how it affects people? Every therapeutic relationship revolves around trust and caring, and music is a shared opportunity. People can become very isolated when healing from major events such as; a stroke, head/brain injury, spinal cord injury, major traumas, worsening of Parkinson’s disease, etc.. Music in a group setting can have tremendous bonding effects. People not only respond to the music, but become more aware of each other through the music. Music has incredible ability to calm, animate, engage, and focus people. The power of music can actually outlast the music experience for hours and even long term. Someone who has been struggling, confused, or even agitated can experience major turn around. Even intensive care units have documented evidence of the healing power of music for patients. Dr. Sacks, who is a well known neuroscientist and has written a book called “Musicophilia” states; “I would see people with Parkinson’s who couldn’t move a step or utter a syllable, but could dance or sing”. He also states; “You find some people with aphasia (inability to speak) who can’t utter a sentence in the normal way, but can sing a song with lyrics”. Music seems to sooth the brain; provide a rhythm, a flow, or reorganization for the brain. When things don’t seem possible the regular way, the brain has the capacity to find a way to do it another way, and music can help this re-routing process. Different types of music will have different effects on the brain, and the healing process. The more melodic, and rhythmic the music, the better the healing process. Music seems to have the power to bring out almost every motion, mood, and state of mind. Even if you can’t carry a note like me, music is part of your memory, your appreciation, your understanding, and your very being. Music exists in every culture, and the people can communicate even when language is a barrier.

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Health & Rehabilitation

Robb Rose

2009-02-01 11:16:00

Question: During recent large family dinners I noticed several family members kind of choking as they swallowed and even later in the day doing the same during simple conversations. Is there treatment or therapy for this?

Answer: There is a name for difficulty swallowing: dysphagia. There are several treatments or therapies which can be used, based upon correct diagnosis. Simple X-ray exams can uncover such anatomy-related issues as constrictions, blockage and spasm of the esophagus. These can be due to aging, injury, neuro-muscular issues, and simple tumors or growths. Surgical options and dilations of the esophagus are available. If simple X-rays don’t define the issue, the physician can gain a more precise picture of the esophagus with a CT or MRI diagnostic procedure, and then choose options for treatment. Another diagnostic is a “swallow study,” which uses X-ray imaging while the patient swallows thick liquids or barium. Interestingly, one of 17 people will deal with swallowing difficulties in their lifetime. About 15 million people in the United States suffer some form of swallowing difficulty, and more than 60,000 die from complications associated with swallowing disorders each year. As recently as 10 years ago there were only thermal-tactile stimulation techniques and repeated swallowing exercises for patients diagnosed with dysphagia. Now “VitalStim Therapy,” more defined and specific, has been approved for use by the Food and Drug Administration. The inpatient or outpatient therapy is done by a credentialed speech therapist, who places electrodes on the patient’s throat and then uses gentle electric stimulation to help with the swallowing stimulus and process. Electrode placement is specific to each patient, as is the stimulation used. “VitalStim” is used with patients who have had strokes, Parkinson’s disease, trauma, another neuromuscular diagnosis, cancer, etc. In studies, it has proved to be up to 98 percent effective with as few as 10 one-hour treatments. Acute care hospitals, inpatient rehab facilities, and outpatient rehab clinics that employ speech therapists generally can provide this treatment with a physician order.

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Health & Rehabilitation

Robb Rose

2008-12-31 10:25:00

Answer: An Electromyogram (EMG) measures electrical activity of your muscles during rest and during work or contraction. A Nerve Conduction Study measures how well and how fast your nerves send the electrical signals to your muscles. In short an EMG measures muscle activity and a Nerve Conduction Study measures your nerves electrical activity. Both are inter-related, yet define different things for a better and more specific diagnosis. When both studies are to be done, the nerve conduction study is usually done prior to the EMG. Nerve conduction studies take from approximately 15 minutes to an hour, depending on the area to be tested, such as a single arm vs. the entire side of ones body or more. In the study, several flat metal disc electrodes are placed on the skin. A shock emitting electrode is placed over the nerve to be studies, and a recording electrode is placed over the muscle that is supplied by the nerve. A very low voltage electrical current is used to create several brief pulses that are measured for speed or conduction velocity. This is how fast the electrical current traveled, and compared to what is the medical standard for normal. Each pulse lasts less than a millisecond. Patients can experience a brief tingling, twitching, burning sensation, or even a nervousness, that subsides fairly quickly. Electromyogram studies involve the insertion of very small needles (i.e. similar to acupuncture needles) into specific muscles to be studied. Electorodes are attached to the needles, and electrical measurements are monitored at rest and at work (contraction of the muscle). The needles with electrodes are moved to different positions in the muscles being studied. An EMG takes approximately 30-60 minutes to do. Patients may experience a short, sharp pain as the needles are inserted; and even a tingling or tenderness at the location of the muscle testing. Because of both studies using electrical current (i.e. very low voltage), and the EMG study using small needles, some patients can become anxious just at the suggestion of the study. The actual time length of the studies is pretty short, with both being less than an hour generally and that includes set up and completion. Actual pain thresholds for most patients is pretty minimal, and compared to the information that the studies provide, the benefits far exceed the short period of discomfort. The tests, when conducted in expert hands, greatly decreases the discomfort as well. Having these tests done at an Accredited Rehab Facility and/or Hospital or Clinic, by an approved technologist under the supervision of a physician specialist such as a Physiatrist (i.e. Physical Medicine Rehab Specialty Physician), or Occupational Medicine Physician greatly improves the outcomes. The testing can be done as an outpatient or inpatient, can diagnosis numerous neuromuscular disease states that can be treated once diagnosed. Friends, family and myself have been the patient for both of these type of studies and they proved to be well tolerated with beneficial useful outcomes for treatment. Once the studies are conducted, analyzed, and confirmed the doors for beneficial and appropriate Rehab Therapies such as PT, and OT can begin.

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Health & Rehabilitation

Robb Rose

2008-12-01 14:19:00

Question: What kind of outcomes/results can be expected for someone suffering a Spinal Cord Injury (SCI)?

Answer: First, it’s important to know what part of the spine was injured and how quickly the injury received medical treatment. A rehabilitation team involved early in treatment can provide substantial positive outcomes. Spinal cord injury is one of the most debilitating and devastating injuries in our country. About 11,000 spinal cord injuries occur every year, and 225,000-296,000 Americans live with an SCI. SCI Goals •Early diagnosis and intervention •Treatment and prevention of further complications •Limiting the extent of the injury •Initiation actions that prevent further predictable complications Most SCIs (44 percent) are the result of motor vehicle accidents, followed by violence (24 percent), and then accidental falls (22 percent). Think of the spinal cord as the body’s largest nerve. Damage to: •Higher cervical (neck) areas result in breathing, neck, arm, and leg issues •Thoracic or trunk of the body can affect thoracic body systems and legs •Lumbar/sacral (lower back) areas can affect the legs Damage to the spinal cord also can result in issues related to bowel, bladder and sexual function. Medical anatomy has differentiated nerves coming off of the spinal cord and their functions, so understanding where the specific damage occurred provides an understanding of the expected outcomes and impact upon resulting abilities/disabilities. With a solid team approach in a rehab setting, most patients can return to their home; fewer than 3 percent will go to a nursing home. A team providing physical therapy, occupational therapy, rehab nursing, speech therapy, audiology, respiratory therapy, dietician, psychology, vocational therapy and recreational therapy — led by a physiatrist (physician specializing in physical medicine) — can have amazing results. Support of family, friends and other caregivers and involvement in support groups is crucial for the immediate and long term. Basic rehab can be a real challenge when dealing with something as intense as a spinal cord injury, so look for an inpatient rehab facility that provides some fun such as a movie theatre, Wii™ therapy, outings to restaurants and shopping, music therapy, animal therapies (dogs, birds, fish for assistance and stimulus). For dealing with a spinal cord injury, seek professionalism with trust and honesty as you face mobility issues, bowel and bladder challenges, sexuality education and technologies, skin care, social-psychological changes and other complications such as respiratory and urinary tract infections. A tight team of inpatient rehab professionals can help get you back to your life!

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Health & Rehabilitation

Robb Rose

2008-10-01 15:56:00

Question: What is “hydrotherapy” or “aquatics therapy?”

Answer: Hydrotherapy or aquatics therapy is therapy and/or exercise that is done in a pool. Athletes have exercised in water for sometime now, knowing that it provides positive outcomes for regular exercise, as well as rehabilitation after accidents or surgeries. The Arthritis Foundation has realized the benefits for arthritis patients for the same reasons. The viscosity of water provides an excellent source of resistance when exercising. Aquatic therapy uses hydrostatic pressure, which greatly decreases swelling and greatly improves joint positioning and awareness. Joint positioning and awareness is important especially for joint sprains, when ligaments have been torn, and to decrease joint and soft tissue swelling that has resulted from arthritis and/or injury. Warm water therapy also helps relax muscles, dilate blood vessels, and increase blood flow to the injured areas. Patients with muscle spasm, back pain, fibromyalgia, knee injury, ankle injury, post-stroke patients, post-orthopaedic surgery patients, Parkinson’s patients and multiple sclerosis patients, as well as athletes or middle age week-end warriors, benefit from water therapy. Hydrotherapy also provides balance improvement, and positive outcomes for movement or mobility issues. According to the Journal of Strength Conditioning Research, pain levels are significantly less in patients using aquatics therapy. Another study in Arthritis Care Research showed significant improvements physically and emotionally in patients after just one month of aquatics therapy. Warm water therapy relaxes the body and provides a much more tolerable level of exercise for individuals that have difficulty and pain exercising on hard land. Aquatics therapy can use water cycles and treadmills, as well as such fine motor skill exercise for hands as simulated piano playing with hands/arms under water. In water that is waist deep you bear only 50 percent of your total weight. When walking in chest deep water you lose another 25 percent of your body weight. You are much lighter in water, so the exercise becomes more tolerable and much less painful for arthritis and post-surgery patients. Many participants will exercise in aquatics programs twice a week for 30-60 minutes, while others will participate as much as every other day, or even daily. Many of the best programs across the country have certified aquatics instructors, and are Arthritis Foundation-endorsed. Group exercise programs are available, as well, done with accompanying music and fun. Participants wear swimsuits or loose fitting shorts and shirts. Pools offering these programs have chair lifts and/or easy to use stairs to enter and exit the pool. The benefits are almost guaranteed. Regardless of age, the combination of heat, water and motion gives people a respite from pain, swelling and stress.

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Health & Rehabilitation

Lucy Lavelle

2008-10-01 15:56:00

Question: My son returned from the war in Iraq with a brain injury. His therapist suggested we start using something called the Interactive Metronome to help with his behavioral issues and motor impairments. Can you tell me more about this technology?

Answer: The Interactive Metronome (IM) is an excellent tool for helping patients with impairments resulting from traumatic brain injury as well as other neurological conditions. Like the metronome device used by pianists to establish a steady tempo, the IM system establishes a rhythm for patients to follow by emitting a computer-generated tone pattern through a set of headphones that the patient wears during therapy. A therapist instructs the patient to match the IM’s tone pattern by tapping their toes on a floor mat equipped with sensors, clapping their hands or reaching towards objects, etc. while wearing a specially designed glove. The mat and gloves record patient responses in milliseconds and feed them into the IM system. The system scores the patient’s responses and provides immediate feedback, which challenges the patient to alter their reactions in an effort to improve their score. IM therapy has been proven extremely helpful for improving deficiencies in the areas of cognition, communication, behavior, and motor function. Therapy using the IM helps patients learn to filter out distractions and stay focused longer, improve stamina and endurance, regain their coordination, and control physical and mental activities. In addition to traumatic brain injury, the Interactive Metronome has been found to be a great tool for patients dealing with amputations, spinal cord injury, multiple sclerosis, Parkinson’s disease, balance or development disorders, or just general functional decline.

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Health & Rehabilitation

Robb Rose

2008-10-01 08:48:00

Answer: TBI stands for traumatic brain injury. Traumatic brain injury is a major public health challenge, particularly among young males 15-24 years old and in both sexes 75 and older. Children younger than 5 are at high risk as well. Behaviors and life skills are obvious risk factors in these three groups: Young males, from risk behaviors involving cars, motorcycles, skiing, drugs and alcohol; older individuals from falls; and children, from trauma and abuse. TBI health care costs in the U.S. are greater than $65 billion a year, and more than 5 million Americans are survivors of TBI. These survivors generally live and function with disabilities that include cognition or thinking issues, loss of memory, loss of reasoning skills, personality changes, sensory-related issues (i.e., smell, touch, hearing, taste, seeing), communication challenges, and behavioral/mental health issues such as depression, anxiety, aggression/irritability and inappropriate response to regular activities of daily living. Within days to weeks after a mild, moderate or severe head/brain injury, 40 percent of TBI patients will realize post concussion syndrome symptoms such as those mentioned above. The most common cognitive impairment is memory loss, characterized by loss of specific memories and the inability to form or store new memories. Many of the symptoms of TBI are very similar to those of a stroke (CVA) patient, and share the trauma or insult injury to the brain. Advances in imaging/radiology allow for rapid diagnosis and appropriate acute care treatments and triage. Once stabilized, over days, weeks or months most patients benefit from progressive rehabilitation that includes a multidisciplinary approach with nursing, physical therapy, occupational therapy and speech therapy. Recreational therapy provides additional benefits that include social interactions and even video games, to stimulate the brain for healing and rerouting of neurological pathways. Behavioral counseling for patients and their caregivers is important, as the road to healing can be long and challenging. Neuropsychological evaluations by a qualified clinical psychologist are essential to coordinating the individual patient’s needs and plan of care. Each patient’s head or brain injury is unique to that patient and needs individualized attention. Because a fair number of similarities are known about TBI in general, care is modeled around nationally known standards of care. In recent years, awareness of TBI has been raised from conflicts in Afghanistan and Iraq, due to the methods used in attacks on our military that result in our soldiers sustaining head/brain injuries. As medical care stretches to provide immediate and long term care to these TBI-affected soldiers, the technologies and functional rehab care will continue to be better understood and implemented. Early interventions, and proper diagnosis and interventions, followed by progressive rehabilitation programs, provide quality outcomes. But prevention is always better than treating TBI.

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Health & Rehabilitation

Robb Rose

2008-08-01 09:35:00

Question: My father is 55 and has recently experienced a lot of shaking and what seems to be temporary paralysis. Is this “Parkinson’s”? What kind of treatment should we seek?

Answer: Parkinson’s disease is a progressive nerve disorder caused by degeneration of brain cells that control movement. It shows up as tremors, muscle stiffness, rigidity, loss of balance and slowness of movement. As many as 1 million Americans are believed to have the disease, with 60,000 new cases diagnosed each year, according to the Parkinson’s Action Network. Conservative estimates of costs in the United States are over $25 billion a year. The average age of a Parkinson’s patient is 60 — although actor Michael J. Fox was diagnosed at age 30 — and slightly more men than women get the disease. Other famous patients include former U.S. Attorney General Janet Reno, Muhammad Ali and Pope John Paul II. It is important to detect and treat Parkinson’s as early as possible, by consulting a specialist (neurologist) or an internal medicine specialist, before nerve damage is permanent. Your father should begin by consulting with his primary care physician. Treatment should focus on preventing falls, contractures and disability, and slowing the rate of decline. Physical therapy helps patients be more active and less rigid with less slow movement. It improves their walking, balance and coordination, and that enhances their daily activities — always with a goal of safety and independence. Occupational therapy uses adaptive equipment and modifies patients’ personal environment and personal items. Speech therapy focuses on voice volume, speech pattern modification, breathing, memory and vocal exercises. Swallowing assessment and therapy for dysphasia and drooling has good outcomes. Psychotherapy and/or support groups help patients with coping skills, depression and anxiety. Support from you and other family members and friends will go a long way to ensure positive outcomes from whatever treatment your father receives.

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Health & Rehabilitation

Robb Rose

2008-08-01 09:35:00

Question: Can depression result from a stroke or other cardiovascular-related events?

Answer: Yes. In fact, heart disease continues to be the leading cause of death in North America and, according to the World Health Organization, depression has been cited as the leading cause of disability worldwide. Many studies that link depression and heart disease include stroke, coronary artery disease, hypertension, dyslipidemia, congestive heart disease and even diabetes. According to the Journal of Neuroscience Nursing, “Depression is common during the first few months after stroke and is associated with a significant morbidity and mortality.” Early diagnosis and treatment of post-stroke depression can significantly improve the patient’s progress, outcome and survival rate — an important reason to identify health care facilities, such as inpatient rehabilitation centers, that provide post-stroke depression plans of care for their patients. Severity of the disease process is directly linked to the severity of depression and correlates closely to patients’ ability or inability to care for themselves, continue with the regular activities of daily living, communicate effectively and be socially involved. In a recent article in American Journal of Managed Care there was a suggestion that the more risk factors the patient has, the higher the risk of depression. It also suggested patients are healthier if they stop smoking, reduce body mass index and improve their diet and exercise regimen. Communication between clinicians involved with a patient’s care is critical, allowing early recognition of symptoms to be shared with the entire team as it plans care for depression related to the stroke and/or heart disease. Family and other caregivers also must communicate effectively, sharing information with and asking questions of the clinical care team. Treatment for depression related to stroke and heart disease may include: •early acute care hospital treatment •discharge to an inpatient rehab hospital with depression identified •consultation and treatment planning with a neuropsychologist •early implementation of a behavioral health protocol •participation in patient/family support groups •effective communication with primary care physician(s) Solid communication from acute care to rehab to home creates a continuum of care for positive patient outcomes. With heart disease, stroke and depression being so closely intertwined it is very important to address and effectively treat them together — which is possible at an inpatient rehab facility that provides post-stroke care and is accredited by the Commission on Accreditation of Rehab Facilities or the Joint Commission. During their inpatient stay, patients receive 24 hour, 7 days a week rehab nursing care and are involved in three hours of combined therapies per day for a minimum of five days per week. This type of progressive rehab care will identify depression-related issues and address them.

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Health & Rehabilitation

Robb Rose

2008-06-01 13:45:00

Question: What is inpatient physical rehabilitation and who needs it?

Answer: Physical rehabilitation is one-on-one training to help patients get back to their lives as fully and quickly as possible after a head or spinal cord injury, serious bone break, joint replacement or other joint repair surgery, loss of a limb, stroke, arthritis, multiple sclerosis or other neurological disorders. Inpatient rehabilitation is the most intensive treatment of this sort and requires participation from many different professional disciplines, including physical, occupational and speech therapists. An inpatient rehab facility must provide at least three hours of direct therapies a day, five days a week. In addition, the patient must require 24-hour inpatient nursing care. In most cases, a patient’s medical insurance requires precertification or permission before inpatient rehabilitation is covered. If you or someone you love needs inpatient rehabilitation care, look for a facility with national accreditation, something that indicates the highest standards of care. Major independent nonprofit accrediting organizations include CARF - Commission on Accreditation of Rehabilitation Facilities, and The Joint Commission. Ask to visit the facility and choose one where you or your loved one feel comfortable and welcome.

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Health & Rehabilitation

Lucy Lavelle

2007-09-01 14:51:00

For the person who is about to enter a nursing facility, and for caring family and friends, the days just before and during the move can be traumatic. Anticipation, fear and guilt -- often combined with illness or the recent loss of a loved one -- mean that the individual faces the future with fear and doubt. This is not unusual. With love, understanding, help and planning, the uncertainty of entering and adjusting to life in a nursing facility can be greatly minimized. Though not always possible, the involvement of the resident in selecting a nursing facility can make a critical difference in the final adjustment. If able, the resident should have input into choosing a nursing facility that fits the resident’s personal style of living. As far in advance as you can, begin planning for the move. To the extent possible, plan the move with the help and participation of the resident. Remember, the professionally trained staff understands your concerns and is eager to help you make this period as calm and positive as possible. It’s a good idea to get a head start on paperwork and financial details. Before admission day arrives, fill out the forms to the best of your ability, making note of any questions you and the resident may have. Provide a complete medical and personal history for the resident. Check on Medicare and Medicaid eligibility requirements. Review your understanding of payment, money management and other details. Don’t hesitate to ask questions. It is the resident’s right to make decisions. Family input is welcome, but ultimately the resident has the final say. Should the resident be incapable of making key decisions, the legally designated responsible party makes decisions. It is this individual’s responsibility to communicate information to other family members. If you have questions about handling the decision making process, or deeper questions about advance directives, guardianship, or powers of attorney, contact the nursing facility administrator or your family attorney. On the day of admission, family and close friends should plan to spend several hours in the facility helping the new resident set up the room, learn his or her way around, and meet some of the staff and residents. Family and friends might also plan to attend the first meal or a planned activity. When family members depart from the facility, they may be faced with an emotional reaction from the resident. Assure the resident that family will call and visit often and soon. Remember that when you make plans, you should make every effort to keep them. It is never our goal to spend time in a nursing home. But if you take some of these things into account and do as much pre-planning and research as you can to assure your loved one is in the right place and receiving appropriate care and services, the stress will be minimized.

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Health & Rehabilitation

Lucy Lavelle

2007-09-01 14:51:00

Answer: What your friend is referring to is a device known as the NESS H200 Neuroprosthetic and Rehabilitation System, trademarked by the Bioness Company of California. The NESS H200 is a brace-like device that fits over the hand and wrist, which, through electrodes custom-fitted over key motor points, provides stimulation to paralyzed muscles. The device is portable and, with the aid of a trained occupational therapist, can be repositioned and reprogrammed to redirect the stimulation as the muscles become active. The paralysis in your friend’s hand can also occur as the result of a traumatic brain injury, spinal cord injuries or other disorders of the central nervous system. Needless to say, when a person is left with limited use of the hand or other upper extremities, it can be difficult for them to manage simple daily tasks without assistance. Even performing such activities as eating with utensils, drinking from a cup, brushing teeth, buttoning a shirt or combing hair can be tiresome or impossible without someone else’s help. Used as part of an occupational therapy regimen, the NESS H200 can help patients regain their independence by improving functionality in the hand and wrist. The device is designed to facilitate active hand movement, reduce stiffness, improve circulation and increase strength. As a result of using the device as part of a therapy regimen, patients have seen an increase in range of motion, mobility, sensation and functionality of their hands. The NESS H200 has proven effective for people in the early stages of recovery as well as for those who have seemingly reached a plateau in recovery post-injury or illness. For patients at either end of the recovery spectrum, the device has made it possible for them to participate in their therapy and given them an exciting new avenue of hope as they work to regain their independence.

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Health & Rehabilitation

Lucy Lavelle

2006-10-01 10:27:00

QUESTION: I am 40 years old and have recently been diagnosed with type 2 diabetes. I have been advised to eat an overall healthy diet and to set a goal of at least 30 minutes of exercise daily. Why is exercise important in diabetes care?

ANSWER: Excess fat is the “enemy” in a range of diseases. In the type 2 diabetic, the body is either not making enough insulin or incorrectly using the insulin that is being produced. Excess fat in a type 2 diabetic can further complicate matters by causing a resistance to the insulin the body already produces. One way to prevent excess fat is to exercise. Type 2 diabetics face a build-up of sugar when the body is not using its own insulin correctly. It is important to keep blood sugar as near normal as possible so that you feel better and prevent complications that occur from elevated blood sugars over time, such as heart attack, stroke, or amputations of the foot or leg. Regular exercise helps to lower blood sugar levels and allows the body to use these sugars for energy. If you exercise enough to lose weight, even as little as 5-10 percent of your total body weight, your body will begin to more effectively use the insulin it produces. Proper exercise, along with a good meal plan, may even keep you from having to go on diabetes medicines such as oral agents or insulin. Exercise is good for everyone. In addition to the above benefits it also helps reduce stress, increase your energy level, control blood pressure and blood fats, and just makes you feel better. But before you begin it is important to have a medical check-up. Talk with your health care team about a plan. Learning about a healthy diet and self blood glucose monitoring are also important tools in controlling diabetes. Going to a diabetes education program is also a wonderful way to learn more about your diabetes. There you will likely meet others who will help you stay motivated to take care of yourself and provide you the support you need to manage your diabetes. Finding someone to walk or exercise with can make your workout more enjoyable. When exercise is enjoyable and social, it is its own reward. Remember also to wear good cotton socks, supportive shoes, and to check your feet after exercise for any signs of poor fit or injury. Best of luck to you!

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Health & Rehabilitation

Robb Rose

2005-07-01 11:46:00

: With various construction always going on, whether tearing down a building or building a new one, is asbestos still a risk?

ANSWER: Asbestos is still a high risk. Although it is not used in new construction, it can be found in older residential and commercial buildings. Asbestos is a group of minerals with separable, long, thin fibers that can remain airborne and thus inhaled into the lungs. Once inhaled it can take as long as 40 years to become a health illness and be diagnosed. It will manifest in generally 3 ways; Lung Cancer, Mesothelioma, and Asbestosis. Asbestos Lung Cancer is indistinguishable from Lung Cancer associated with smoking, but smokers who are exposed to asbestos are 52 times more likely to end up with Lung Cancer than non-smokers exposed. Mesothelioma is a rare type of cancer that involves the thin membrane that surrounds the lungs, stomach, and heart, and is a very aggressive Cancer. Asbestosis occurs when the natural defenses of the lungs causes scar tissue to develop, which makes the lungs less elastic and able to move air in and out.The Centers for Disease Control (CDC) expect the death rates from Asbestos to rise over the next couple of decades. In 1968 there was a reported 77 deaths related to the inhalation of asbestos. In the year 2000 over 1,493 deaths occurred due to the same. The British Medical Journal (Feb. 05) states an expectation of over 2,500 deaths due to inhaled asbestos between 2001 and 2015 in England alone.

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Health & Rehabilitation

Robb Rose

2005-06-01 10:48:00

: As a health care professional for over 25 years I often wonder what has happened to our health care in this country. It seems to be all about paperwork, and the bottom line. What's the deal and what can we do?

ANSWER: This is an ever increasing stressor for front line health care providers. In a 2004 Gallop Poll it was found that among professionals that exuded the most honesty and ethical standards were nurses and other frontline clinicians. They ranked 79% out of a possible 100, and physicians ranked 67% out of 100. This may serve as a reminder of some of the health care providers training that is often over looked years later. To fight the challenges of paperwork, boredom, and bottom line pressures, we can always remember that; It is about the patient! We can practice "Agape Care". Agape is a Greek word meaning selfless and unconditional love of human beings. A health care provider who practices Agape Care is above all humble, respectful, and not rude. They take the time to; first make eye contact and listen to their patient rather than all the equipment and paperwork; second they literally reach out to patients and provide a healing touch; third they show their patients respect by user surnames such as Mr. or Mrs.; forth they remember to speak the patients language rather than trying to impress with a lot of medical jargon.  By practicing what we learned early on in our medical training we can avoid the stress of the new medical economics, care for our patients, and thus even improve their health and recovery. Dr. Scott Diering, an emergency room physician at Washington County Hospital in Hagerstown, MD is a noted expert in "Agape Care" and more information is available at his website entitled; http://www.loveyourpatients.org/

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Health & Rehabilitation

Robb Rose

2005-04-01 10:50:00

: I have Asthma, and when we dine out I'm always looking for a smoke free restaurant because the smoke triggers my asthma to flare up. What is the status of indoor smoking bans?

ANSWER: As of this answer, seven states have completely banned smoking in work sites, bars, and restaurants. They are Rhode Island, California, Delaware, Massachusetts, and Maine. Note again that California and New York are leading the way. New York, Connecticut, and several cities in Kansas have done this for their restaurants with great results and support from the community. From Guadalupe, AZ to Lincoln, NE to Columbus, OH, cities have assumed the smoke free status. Dr. Hyland, from Roswell Park Cancer Institute in Buffalo, New York predicts that within 5-10 years all states will be smoke-free. He states that, "second hand smoke is completely unnecessary, and people are recognizing this". Dr. Hyland has also noted that the argument that a smoking ban would hurt or shut down restaurants and bars has proved false. Across the globe other countries are moving to create smoke free zones at a rapid pace. Cubans no longer have cigar smoke in offices, schools, and sports facilities. Italians no longer have the complimentary cigarette with a cappuccino. The Irish stamp out their smokes before entering their local pub.Smokers who work in smoke free zones doubled their chances of stopping the smoking habit according to Dr. Hyland, who conducted a study over 13 years following smokers. It creates an environment that nurtures their effort to quit smoking. He states; "2nd hand smoke kills people and causes sickness".

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Health & Rehabilitation

Robb Rose

2005-04-01 09:21:00

: I'm hearing a lot about Multiple Sclerosis lately. What is Multiple Sclerosis or MS?

ANSWER: Multiple Sclerosis is a neurological disease of the brain and spinal cord (central nervous system). The specific cause is yet unknown, but it is thought to be caused by a virus, which in turn causes demyelination. Demyelination is a stripping away of the myelin sheath of the nerve fibers. The virus disrupts the bodies' normal autoimmune system or protective system, and cells that would normally protect the body in turn react against its own body. The myelin sheath is the covering over the nerve fibers, which ensures rapid transmission of nerve impulses from the brain to parts of the body. Since the sheath is not there, nerve impulses or transmissions are not effectively interpreted. This results in lack of coordination, impaired movement, and impaired basic functions. Basic functions that can be impaired are seeing, walking, talking, hearing, and even slurring of speech. Other sensations are tingling, numbness, tremor, disrupted equilibrium or balance, weakness, fatigue, and even paralysis.Symptoms vary greatly from person to person, and involve serious attacks or exacerbations and partial to complete recovery or remission. MS is not considered a fatal disease and life expectancy is 93% of a person's life span. The disease is a definite medical physiological disability.The average MS patient is a Caucasian woman between the ages of 21-40. A white female is 3 times more likely than a white male to have MS. Over one quarter of a million Americans has MS, and over 200 new cases are diagnosed each week. There is no current cure for MS, and treatment is aimed at the symptoms. Various types of anti-inflammatory and immune boosting therapies are utilized. Healthy lifestyles including; exercise, eating healthy foods, use of vitamins and supplements, plenty of rest, drinking plenty of water, avoiding emotional and mental fatigue, and treatment for depression are all facets of treating MS. Lessening intensity of symptoms and reducing the number of attacks is the goal.

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Health & Rehabilitation

Robb Rose

2005-02-01 11:24:00

: What actually happened to Reggie White, the famous football player?

ANSWER: Although all the information is not 100% completed and autopsy results are pending completion; Reggie White appears to have died from fatal cardiac arrhythmia brought on by cardiopulmonary sarcoidosis complicated by sleep apnea. This is according to Dr. Mike Sullivan, the forensic pathologist and medical examiner from Mecklenburg County, North Carolina where White resided.Sarcoidosis is a chronic disease in which granulomatous, inflamed tissue forms and attacks your own body systems. Mr. White's heart and lungs were being attacked by this disease process, which causes permanent damage. The actual cause of this condition is not known, but TNF-alpha (i.e. cytokine tumor necrosis factor) plays a major factor in the bodies inflammation during sarcoidosis. The "Sarcoidosis Research Institute" based in Memphis, Tennessee is looking at TNF-alpha as well as many other factors.Sarcoidosis actually affects 800 individuals out of every 100,000 people, so it is much more common than expected. Prednisone, which is an effective steroid is generally given to reduce the bodies inflammation, and methotrexate which is a steroid sparing agent is an alternative treatment. Both do have side effects and must be managed closely. In general, Mr. White's sarcoidosis combined with his sleep apnea (i.e. cessation of breathing periods during sleep), and took a toll on his cardiopulmonary system causing an eventual fatal cardiac disturbance. If any breathing problem is suspected, contact your physician immediately, as therapies exist to minimize and treat the diseases.

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Health & Rehabilitation

Robb Rose

2005-02-01 11:24:00

: What is a Medical FIM? My father is in the hospital recovering from trauma. He will probably go to a Rehab Hospital when he stabilizes.

ANSWER: A quality rehabilitation hospital will help your father achieve his highest level of independence through medical teamwork. The team can consist of: your father, his family, Physiatrist (a physical medical rehabilitation physician), Neurologist, PCP (primary care physician), rehabilitation nurses, Physical Therapist, Speech Pathologist, Audiologist, Dietitian, Vocational Counselor, Neuropsychologist (studies brain behavior), and many others. The rehab process is individualized and may take weeks or months, and outpatient therapy after discharge.Prior to admission to a Rehabilitation Hospital a "Functional Independence Measurement" (FIM) is completed. The FIM scoring measures a patient's level of function at that time. The scoring provides a baseline for developing a rehab plan and admitting a patient to an in-patient or outpatient status. The same FIM assessment is done in an on-going process during rehab, as well as during the discharge. This way patient's therapies can be changed based on the real time changes of actual functioning.FIM scoring was developed in 1984 for the Uniform Data System for Medical Rehabilitation. FIM is required by the Centers for Medicare and Medicaid Services (CMS), and functions as a standard of care.FIM is based on a 7-point rating scale, measuring 18 separate activities. The activities include self-care, bowel and bladder management, ability to transfer, locomotion/ ambulation, communication, and social cognition. Each area is evaluated as independent (no help needed), modified dependence (help needed), or complete dependence. The FIM information comes from a combination of the patient, family, medical records, medical staff, and direct observation.

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Health & Rehabilitation

Robb Rose

2005-01-01 09:20:00

: I've started noticing urgency when I need to urinate; sometimes so much that I feel I'm not going to make it to the bathroom in time. Other times when I laugh really hard, or cough really hard I leak or dribble some. What is going on?

ANSWER: What you described could be several things, so it's really important to start by ruling some things out. You want to make sure you don't have a urinary tract infection, which can be treated with medications. You may also want to review what other medications you are taking (i.e. both over the counter and prescription) with your physician, as some medications can cause this. While with your physician they can do a physical to determine if there is a physical reason, such as pressure on the bladder, an obstruction, etc.. Other things to talk to your physician about include any past abdominal surgeries, obstetrics-gynecologic surgeries, pregnancies, back surgeries or current pain, or any other things that may have occurred to your abdominal/pelvic area. Anytime nerves or muscles are damaged due to any of the aforementioned reasons, you can have weak muscles in the pelvic floor area, reducing contractibility of the muscles that control urination. Ligaments may have been over stretched as well. This is also a primary reason that conditioning before and after pregnancy, surgical procedures, or general care as we age are so important.Urinary control is something we take for granted until we lose it. It is a major cause of decreased socialization, depression, and embarrassment. It is something that is not commonly discussed either. There are medications that can help, as well as Physical Therapy. Yes, Physical Therapy. Exercise of the involved muscles, sometimes with mild electrical stimulation can have enormous positive results in a short while. Strengthening of the abdominal, pelvic, and lower back muscles and nervous system is paramount.

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Health & Rehabilitation

Robb Rose

2004-12-01 10:02:00

: As a patient, do I have a choice as to what acute care hospital, pharmacy, rehab. hospital, or outpatient clinic I go to? Who does have the choice?

ANSWER: With Health Care being what it is currently, this is a great question. The overall answer is; yes, you the patient do still have choice as to what facility, health care system, pharmacy, rehab. hospital, outpatient clinic, or diagnostic center you want to go to.There are a few exceptions to this though. Your health care insurance carrier may have specific contracts with specific health care providers, clinics, services, etc. which will dictate as to where you may get the best coverage (i.e. Preferred Provider Networks). In other words, less out of your pocket and more paid for by your insurance carrier due to the contracts if you go where they have the contractual services. You may still elect to go elsewhere, but the out of pocket would be more. So, yes you do still have a choice. It is always a good idea to know who, and where your health care provider has contractual services with. You can always give them a call.It is Federal Law that when discharging a patient from an acute care setting to a rehab. hospital, outpatient services, home health, home medical equipment, pharmacies, etc., the patient is to be allowed a choice in the process. Getting an objective view about your discharge to one of these services and how they may compare to your individual circumstances is always a good idea. The same holds true with discharges/transfers to and from all health care settings in general. Call and get information on health care providers, get tours, and ask several of your health care clinicians including your physician. Being informed and educated as to your decision is imperative and required.

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Health & Rehabilitation

Robb Rose

2004-10-01 15:07:00

: Is there anything available to help someone with a swallowing difficulty?

ANSWER: Until recently there was only thermal-tactile stimulation and repeated manual exercises for patients with swallowing difficulty. Swallowing difficulty is referred to as "Dyspahgia". There is a new therapy available now using controlled and specific electrical stimulation whereas electrodes are placed on the patients' throat area and gentle stimulation is applied. The placement of the electrodes is specific to the needed area after a barium swallow is done to see what is, or is not occurring via the neuro-muscular and vascular anatomy. The new therapy is used with Stroke, Trauma, Cancer and Cancer related therapies, Parkinson's, etc.. Once the diagnosis and cause is determined, the placement of the electrodes then is determined and therapy initiated. In several clinical studies the results are 98% effective, many times in less than 10 treatments of approximately 1 hour in duration. The therapy is available as an in-patient or an out-patient and is conducted by a credentialed Speech Therapist. The therapy is FDA approved and is called "Vital Stim Therapy".Interestingly 1 of 17 individuals will deal with swallowing difficulty (i.e. dysphagia) during their lifetime. Each year over 60,000 people die from complications associated with swallowing disorders. Close to 15 million people in this country suffer swallowing difficulty.

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Health & Rehabilitation

Robb Rose

2004-10-01 15:07:00

: With the shortage of Flu Vaccine this year, does Vitamin "E" work to prevent the flu, a cold, or any infection?

ANSWER: Generally speaking, anything that keeps your autoimmune system healthy or strengthened can lessen your chances of an infection, or lessen the severity and duration of the infection. This can include vitamins, exercise, eating healthy, drinking clear fluids; and avoiding high fat foods, alcohol, and smoke. Some health care professionals even suggest elderberries or any dark berry due to their high level of antioxidants, and locally produced honey. As for Vitamin "E" specifically there was a study published in the August edition of "JAMA" (i.e. Journal of the American Medical Association), in which 600 people over the age of 65 were followed to see if Vitamin "E" had an effect on the common cold and upper respiratory infections. These individuals lived in retirement centers in the Boston Mass-achusetts area. The individuals were randomized to take 200 IU of Vitamin "E" or a placebo. Interestingly, the people receiving Vitamin "E" did demonstrate a protective effect on upper respiratory infections (i.e. ear, nose, throat), and specifically the common cold. The investigators felt that this does merit further study.One cannot say that Vitamin "E" specifically prevents an infection, but it appears that it can lessen your chances of the common cold or an upper respiratory tract infection. Practicing good hand washing technique often, and covering ones mouth and nose when coughing or sneezing go a very long way in preventing any respiratory infection.

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Health & Rehabilitation

Robb Rose

2004-08-01 11:28:00

:  Does our attitude affect our health and even our response to diseases?

ANSWER: Absolutely. Unfortunately our culture doesn't see or hear as much about positive attitude as it does negative news. It is a simple fact that it takes more muscles to frown than it does to smile. An excellent practice is to force yourself to reach down deep and put a smile on while looking at yourself in the mirror for at least 30 seconds. I mean really smile! Your body releases endorphins when you are happy, smiling, in love, doing something healthy that you love to do, and when you exercise. When you have the right attitude you can tap your own health potentials.Numerous studies exemplify the power of a positive attitude. A book entitled "The 100 Simple Secrets of Happy People", by David Niven, PhD, shares short and sweet examples of how to be happy and thus healthy. The book is a short essay of vast amounts of research. Surrounding ourselves with close friends, family, having purpose and perspective, and giving of yourself in the community will produce positive health effects. Numerous studies specific to cardiovascular disease and oncology (i.e. cancer) show positive benefits of a positive attitude. A positive attitude comes from turning off the TV and exercising, and looking at the big picture instead of ourselves. One could argue; is it the exercise, is it turning off the news, or is it focusing on helping others? The fact is all of them work, and together they work even better. Our autoimmune system works better when we are happy and have a sense of purpose in our life.Prayer is a well documented benefit for our health. When we pray in a positive manner for ourselves or with, and for others, it does have documented positive effects. The rule is to be in love, have positive focus, have a positive spirituality with our maker, and take care of what our maker gave us. Laugh more, even at yourself. Hope this helps, and God Bless!

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Health & Rehabilitation

Robb Rose

2004-07-01 09:14:00

Question:  I've read that there are certain medications that can be used for Sleep Apnea. What are they, how can I obtain them, and where?

ANSWER:  It's important to look at the entire Sleep Apnea treatment picture. When Sleep Apnea was first reviewed in the Lancet Journal 1981, the medical community paid little attention to it. In fact the only option at that time was an extreme surgical technique. Since then the medical community has realized that Sleep Apnea is at a severe level in this country. Over 100,000 motor vehicle accidents are associated with Sleep Apnea. These accidents lead to 71,000 injuries and 1,500 deaths. Major accidents like Chernobyl, and the Exxon Valdez have been associated with Sleep Apnea and Sleep Deprivation.The "Gold Standard for Sleep Apnea Treatment is CPAP" (i.e continuous positive airway pressure provided by a mask attached to a medical machine). The FDA (i.e. Food and Drug Assoc.) has not approved any medications for the primary treatment of Sleep Apnea.There are numerous studies, which have identified the combined use of CPAP and a class of medications called SSRI's for mild to moderate Sleep Apnea. This class of medications has over 14 medications, each with separate pros and cons. This class includes the most commonly used Prozac, Zoloft, Paxil, etc.. Not all of the 14 SSRI's are equal, and it is important to note that Obstructive Sleep Apnea is just that an obstructive process in the majority of patients. Obstruction is generally a physiological/anatomical issue, and not pharmaceutical treated by and large. Another class of anti-depressants has been studied as well for combined therapy. It is the piperazino-azepine group with Mirtazapine being studied the most.Always see your physician for the diagnosis and treatment of Obstructive Sleep Apnea. Ask questions and be up front as to what your signs and symptoms are. Your physician has more information on this disease process than ever before, with more and more options. Lastly, this disease needs to be treated, as the untreated consequences are severe.

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Health & Rehabilitation

Robb Rose

2004-06-01 16:14:00

Question:  My family has a history of Respiratory Diseases, and we've been hearing about a disease called Alpha 1 Antitrypsin Deficiency….what is it?

ANSWER:  Often this is called "Genetic Emphysema" because the signs and symptoms are very much the same as emphysema. It is a very serious disease and is often undiagnosed. It is more common than Cystic Fibrosis with an estimated 25 million undetected individuals carrying the abnormal alpha 1 antitrypsin allele.  Alpha 1 Antitrypsin is a protein made in the liver and carried in the bloodstream. Its' main function is to neutralize another protein or enzyme called neutrophil elastase (PMN) which is found in white blood corpuscles. In a normal cycle the PMN would attack bacteria in the lungs as a defense or protective mechanism, but if not inactivated or broken down by alpha 1 antitrypsin the PMN can go ahead and break down the good elastin of the lung. Without alpha 1 antitrypsin to break down the PMN the good elastin is broken down causing permanent damage in the lung similar to emphysema itself. Two possible explanations of this disease being so unknown is 1) the individual never develops symptoms, or 2) the individuals are not ever diagnosed. The following are some of the signs and symptoms; early onset of emphysema symptoms (less than 45 years of age), emphysema without traditional reasons for the disease, and unexplained liver disease. Management of the disease includes; stop smoking as it will worsen the disease, oxygen use, bronchodilator/inhaler use, use of pneumonia and influenza vaccines, pulmonary rehabilitation, and the intravenous infusion of purified alpha 1 antitrypsin protein given weekly or monthly for life.

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Health & Rehabilitation

Robb Rose

2004-05-01 11:35:00

:  I'm hearing more and more about Multiple Sclerosis lately. What is Multiple Sclerosis or MS?

ANSWER:  Multiple Sclerosis is a neurological disease of the brain and spinal cord (central nervous system). The specific cause is yet unknown, but it is thought to be caused by a virus, which in turn causes demyelination. Demyelination is a stripping away of the myelin sheath of the nerve fibers. The virus disrupts the bodies normal autoimmune system or protective system, and cells that would normally protect the body in turn react against its own body. The myelin sheath is the covering over the nerve fibers, which ensures rapid transmission of nerve impulses from the brain to parts of the body. Since the sheath is not there, nerve impulses or transmissions are not effectively interpreted. This results in lack of coordination, impaired movement, and impaired basic functions. Basic functions that can be impaired are seeing, walking, talking, hearing, and even slurring of speech. Other sensations are tingling, numbness, tremor, disrupted equilibrium or balance, weakness, fatigue, and even paralysis.Symptoms vary greatly from person to person, and involve serious attacks or exacerbations, and partial to complete recovery or remission. MS is not considered a fatal disease and life expectancy is 93% of a person's life span. The disease is a definite medical physiological disability.The average MS patient is a Caucasian woman between the ages of 21-40. A white female is 3 times more likely than a white male to have MS. Over one quarter of a million Americans have MS, and over 200 new cases are diagnosed each week. There is no current cure for MS, and treatment is aimed at the symptoms. Various types of anti-inflammatory and immune boosting therapies are utilized. Healthy lifestyles including; exercise, eating healthy foods, use of vitamins and supplements, plenty of rest, drinking plenty of water, avoiding emotional and mental fatigue, and treatment for depression are all facets of treating MS. Lessening intensity of symptoms and reducing the number of attacks is the goal.

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Health & Rehabilitation

Robb Rose

2004-04-01 08:49:00

Question: My high school age child continues to smoke regardless of what I say. What are some of the specifics on smoking in this day and age?

ANSWER:  Cigarette smoking continues to be the primary causative agent of "Chronic Obstructive Pulmonary Disease" (i.e. COPD or emphysema), which obliterates lung tissue permanently. Smoking makes other conditions much worse and increases risk factors in individuals who have diabetes, cardiac conditions, high blood pressure, pregnancy, etc.. Risk factors for stroke and heart attack go up tremendously when a person smokes. As of 2001, approximately 23% of Americans still smoke. Smoking is a modern day epidemic that costs this country over $80 billion in direct medical consequences, and over $82 billion in loss of productivity. This is 8% of all annual health care expenditures. The sad thing about this is, it is preventable. Smoking overall is on the decline in this country, except in high school students, where there is a slight increase. This should alarm us all as nicotine is highly addictive and thus could have these teenagers hooked for some time. Second hand smoke kills over 36,000 people annually and is obviously preventable as well.The most important success factor for quitting the habit of smoking is that the smoker wants to quit, and has a support system in place. Behavioral interventions, counseling, effective medication programs, aversive therapy, acupuncture, and support groups are just a few of the primary proven ways to quit smoking. All quitters should be counseled as to "relevance, risk, rewards, roadblocks, and repetition" regarding the quitting process. Then when the smoker truly decides to quit, they should use the 5-step system of "ask, advise, assess, assist, and arrange". This 5 "A's" and 5 "R's" program is advised by the United States Department of Health and Human Services (USDHHS). An ideal smoking cessation program is individualized and involves respiratory health care professionals. The patient will have to want to quit, and then be patient yet very persistent. The health consequences will be evident in the short term and long term. The cost of a pack of cigarettes is approximately $3.15, and a pack a day cost per year is $1,149.75. Interestingly the calculated aggregate cost of that same pack of cigarettes based on associated medical care that will be needed and loss of productivity is over $7.18 per pack. The cost of nicotine patches are at about $3.57 and stopping the habit looks pretty good for everyone.

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Health & Rehabilitation

Robb Rose

2004-03-01 16:16:00

Robb Rose Question:  My husband snores extremely loud and has moments where it sounds like he stops breathing. During the daytime he is very tired, sleepy, and even forgetful. Is this Sleep Apnea, and what can we do?

ANSWER:  The cessation of breathing that you describe sounds like sleep apnea. The snoring, and daytime sleepiness, and even forgetfulness sound like the results of sleep deprivation caused by the apnea. The Greek word "Apnea" literally means "without breath". Risk factors for sleep apnea include; being male, overweight, and over the age of 40. Females, and even children can be at risk though. Symptoms other than snoring can include decreased ability to concentrate, think critically, and communicate effectively.Side effects of undiagnosed and untreated sleep apnea can include; high blood pressure, stroke, heart attack, kidney disease, diabetes, heart failure, Parkinson's, and even Alzheimer's. The reason is related to decreased oxygen to major body systems due to cessation of breathing (i.e. apnea). The apnea spells are caused by actual blockages of the airway, central or neurological issues related to breathing, or a combination of both.  Medical literature agrees that U.S. obstructive apnea problems cost over $150 billion dollars per year. The National Institute of Health estimates that less than 10% of all sleep apnea is being treated.To diagnose and effectively treat this disease a person can be scheduled for a Sleep Lab visit to diagnose the apnea, what kind, as well as severity. Once diagnosed a number of options exist. Some of the options are life style changes such as weight loss. Other options include surgical interventions. The current standard of care though is CPAP, which stands for Continuous Positive Airway Pressure. It is a prescribed device that creates an airway splint keeping the airway open during sleep. When choosing a Diagnostic Sleep Lab it is very important to go to a lab that is Accredited or is currently being Accredited by the American Association of Sleep Medicine and has Boarded Sleep Physicians on the staff, as well as credentialed sleep technologists. This provides for a standardized diagnostic and treatment outcome, and is being required by major insurance companies.

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Health & Rehabilitation

Robb Rose

2004-02-01 09:19:00

: My Grandfather had a stroke, or as they call it a cerebrovascular accident (CVA) about 3 weeks ago. His doctors are now talking about sending him for Stroke Rehab. What can we expect and what does it involve?

Robb Rose Question: My Grandfather had a stroke, or as they call it a cerebrovascular accident (CVA) about 3 weeks ago. His doctors are now talking about sending him for Stroke Rehab. What can we expect and what does it involve?Answer: Having a stroke is a traumatic experience, but these days there is reason to have hope regarding prevention, care, and recovery. Current stroke care is focused on early diagnosis of signs and symptoms, early treatment to preserve as much function as possible, and then initiate rehabilitation as soon as the stroke patient is functionally able to participate in stroke rehab. programs. Many stroke patients recover extremely well. Sometimes the recovery process can be spontaneous, yet most of the time it requires time, determination by the patient and their family, and hard work with their therapists. A couple of famous stroke patient examples include actress Patricia Neal, and former President Dwight D. Eisenhower. Signs and symptoms of stroke include: sudden trouble walking, sudden trouble speaking, sudden severe headache, sudden weakness on one side, and/or sudden trouble seeing. Not all the warning signs occur in every stroke. Check and remember when the signs and symptoms began. If the symptoms last longer than 1 minute, contact 9-1-1 immediately!Rehabilitation for stroke can involve physical therapy, occupational therapy, speech therapy, respiratory therapy, aquatic therapy, and even acupuncture with electrical stimulation, which has proved highly successful in returning patients to their home. All of these therapies are for neuromuscular and cognitive conditioning, and strengthening. Rehab. provides the tools to do old tasks in new ways, cope and move forward. According to the American Stroke Association (div. Of Am. Heart Assoc.), there are 7 factors that predict successful stroke rehab. They are; a quick spontaneous return of some muscle movement, no severe visual or sensory loss, an ability to resume swallowing and eating, intact cognitive ability to follow instructions, bowel and bladder continence, treatable depression, and supportive family and friends. Stroke Rehab. outcomes have been proven to be extremely cost effective with enormous positive results.

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Health & Rehabilitation

Robb Rose

2004-01-01 11:10:00

: My father is recovering from an auto accident at an acute care hospital. His doctors are saying he will need further physical rehab at a rehab hospital, which will include a functional assessment. What is a functional assessment?

ANSWER:  A quality rehabilitation hospital will help your father achieve his highest level of independence through medical teamwork. The team can consist of: your father, his family, Physiatrist (a physical medical rehabilitation physician), Neurologist, PCP (primary care physician), rehabilitation nurses, Physical Therapist, Speech Pathologist, Audiologist, Dietitian, Vocational Counselor, Neuro-psychologist (studies brain behavior), and many others. The rehabilitation process is individualized and may take weeks, months, and outpatient therapy after discharge.Prior to admission to a Rehabilitation Hospital a "Functional Independence Measure-ment" (FIM) is completed.  The FIM scoring measures a patient's level of function at that time. The scoring provides a baseline for developing a rehab. plan and admitting a patient to an in-patient or outpatient status. The same FIM assessment is done in an on-going process during rehabilitation, as well as during discharge. In this way patients' therapies can be changed based on the real time changes of actual functioning.FIM is required by the Centers for Medicare and Medicaid Services (CMS), and functions as a standard of care. FIM is based on a 7 point rating scale, measuring 18 separate activities. The activities include self-care, bowel and bladder management, ability to transfer, locomotion/ ambulation, communication, and social cognition. Each area is evaluated as independent (no help needed), modified dependence (help needed), or complete dependence. The FIM information comes from a combination of the patient, family, medical record, medical staff, and direct observation.