Monthly Archives: September 2008

In search of … Mentors

In search of … Mentors

Local woman demonstrates how to give back

By JENNIFER VOGELSONG

Daily Record/Sunday News

Joa’shaney Viera, 5, left, Joanne Borders (center) and Noreen Freeland pose for a photo at the community police resource center on West Princess Street in York. Freeland considers Borders her mentor. Vierra is one of the many neighborhood kids who frequents the York center. (DAILY RECORD/SUNDAY NEWS – BIL BOWDEN)

When Noreen Freeland settled in York’s Salem Square neighborhood three years ago, she wanted to get involved in the community, but she wasn’t sure how. Because Freeland struggles with back problems and a complex regional pain syndrome, she didn’t know what she could contribute.

Her landlady suggested she talk with Joanne Borders, then a community mobilizer for the Salem Square Community Association.

Borders, who has her own health problems, encouraged Freeland to do what she could, even if it was simply talking with people about taking ownership of the neighborhood and maintaining a certain quality of life.

“Even if you’re incapacitated, you can still do something,” Borders told her.

So Freeland began attending neighborhood meetings. Today, she’s a block leader and was recently elected to the neighborhood association’s board of directors.

She’s a member of the Elm Street Advisory Council for the west end. She has organized clean sweeps, assisted with National Night Out and completed a leadership training program. She secured speed limit and “children at play” signs for the streets and raised funds for a neighborhood block party.

The list goes on.

“Ms. Borders let me know that I can do almost anything I want, regardless of my disabilities,” Freeland said. “She has shown me that there is always something we can do to make our community a better place.”

Borders said, “We just talk about everything.”

Freeland said it is because of Borders’ mentoring that she has done things she lacked the self-confidence to attempt before: “She has taught me so much.”







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Vitamin C helps with prevention of CRPS-I in traumatology and orthopaedic surgery.

PERSBERICHT

Vitamin C helps with prevention of CRPS-I in traumatology and orthopaedic surgery.

Complex regional pain syndrome type I (CRPS-I), formerly known as Reflex Sympathetic Dystrophy, can occur after a trauma to an arm or leg. CRPS is frequently seen after wrist fractures. The diagnosis of CRPS is based on clinical signs and symptoms. It is often characterized by unexplained diffuse pain, differences in skin colour and temperature relative to the other limb, diffuse oedema, and limited ac¬tive range of motion. These signs and symptoms occur or increase after use and are present in an area larger than the area of primary trauma.

CRPS is one of the most important causes of invalidation after an injury to an extremity and the therapy is difficult, time consuming and costly. When it occurs it has a devastating impact on the patient in personal, social and economic view. The emphasis of treatment should therefore be on prevention.

In his thesis Zollinger, gives an overview of the evidence-based therapy of CRPS in an outline of the Dutch clinical practice guideline ‘Complex regional pain syndrome type I’. A general exposé on the chemical, pharmacodynamic and clinical aspects of vita¬min C (ascorbic acid) is presented. In two placebo-controlled randomized clinical trials Zollinger et al. show that 500 mg vitamin C daily, reduces the chance for the occurrence of CRPS after wrist fractures. In addition, this application of vitamin C is proposed in hand surgery as well.

The thesis titled: Vitamin C for prevention of CRPS-I in traumatology and orthopaedic surgery has been published by Sidestone Press and is now available at http://www.sidestone.com. The thesis contains an alphabetical list of the relevant literature and summaries in English, Dutch and German. The book may be of interest for a variety of health care professionals (general practitioners, physiotherapists, trauma and orthopaedic surgeons, etc.).

About the book “Vitamin C for prevention of CRPS-I in traumatology and orthopaedic surgery”:
Author: Dr. Paul E. Zollinger
Publisher: Sidestone Press, http://www.sidestone.com
Language: English (with summaries in English, German and Dutch)
Categorie: medical science
ISBN: 978-90-8890-009-9
Format: Paperback, sewn-and-glued binding
Pages: 176
Price: € 29,95


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Easing pain the self-help way

Easing pain the self-help way

BACK pain accounts for up to five million lost working days a year.

The cost to the economy is put at about £5 billion a year.

It is one of the most common conditions managed by GPs, but clinical trials have shown that a self-help method called the Alexander Technique is effective in reducing back pain.

* The teacher

THE Alexander Technique quite literally changed the course of Jorrun Kristofferson’s life.

A native Norwegian, Jorrun was hoping to pursue a career in classical singing but was having difficulty hitting high notes.

It was suggested that she try the Alexander Technique to help overcome the problem, and she became so intrigued by all the other benefits of the system that she decided to learn how to become a teacher herself.

This led her to England for training and she has been here ever since.

The mum of two, who lives with her husband and family in Stratford, has been an Alexander Technique teacher for five years.

She practises part-time from a number of centres, including the Lifeways Complementary Health Centre in Albany Road, Stratford.

Clients come in with a variety of ailments but back, shoulder and neck pain are the main conditions.

Jorrun explained: “The technique focuses on coordination, how we use ourselves as a whole and how we co-ordinate our bodies.

“It is more than simply having good posture – although that is usually the first result – it’s how you think about your body and how you move.” n For more information call 01789 297378 or Life-ways on 01789 292052.

* THE ALEXANDER TECHNIQUE

* THE Alexander Technique is a taught self-help method that gets people to recognise and avoid poor habits affecting postural tone and neuromuscular co-ordination.

* LESSONS involve an individualised approach designed to provide lifelong skills for self-care that can lead to a wide variety of benefits.

* IT WAS developed in the 1890s by Frederick Alexander, an Australian actor who was worried that the hoarse voice he had developed towards the end of performance would end his career.

* HE believed he was straining his vocal organs through tension in his head, neck and his entire neuromuscular system, so he developed a technique to relieve it.

* THE technique aims to re-establish the natural relationship between the head, neck and back which form the core of the body, so reducing tension, pain and stress.

* Case study

A NAGGING pain in her lower back prompted Bethan Thompson to seek a solution from the Alexander Technique.

The 44-year-old PA was recommended to practitioner Jorrun Kristofferson in Stratford and she has not looked back.

She believes that the method of moving she has learned has staved off chronic back problems which could have seriously affect her lifestyle.

After two years of regular lessons she now suffers no back pain and cannot recommend the Alexander Technique highly enough.

Bethan, who lives with her husband Heath in Sudeley, south Warwickshire, said: “I found my lower back was quite stiff and there was always a gnawing pain there.

“If you have back problems it affects everything you do; even getting up from the settee was a chore.

“It was painful at night when I turned over in bed and it meant I wasn’t sleeping very well. We changed the mattress on the bed and I tried doing other things, but it didn’t really help.

“When things became too much I was able to see my GP who does acupuncture and manipulation on the NHS so I got treatment which relieved the pain for a few weeks, but it always came back.”

After suffering on and off for about a year Bethan opted for a new approach.

She had read general-interest articles about the Alexander Technique and while talking to someone who had had lessons, it was suggested she try a teacher in Stratford.

That was 2½ years ago and Bethan could not be happier with the results.

For the first year she had lessons every couple of weeks or so. She cannot pinpoint when she felt a change as it was a gradual, evolving process. But there is no doubt the technique has worked.

“People imagine the technique is just about posture. It’s not just about that, it’s about how you move and use your body and primarily about the way your head aligns with your spine.

“I didn’t think I had a bad posture as I had done yoga for years, but it was just small tweaks I needed to make, which made all the difference.”

Lessons involve lying on a couch, with the teacher moving your head and limbs in certain ways to relieve tension and pressure. Then some time would be spent in front of a mirror in both seated and standing positions, with the teacher guiding you gently in the best ways to move.

It is up to you then to put what has been taught in the lesson to use in your daily life.

Bethan continues to have lessons every six to eight weeks and believes the £25 fee is worth every penny.

“It is not a quick fix and you probably will not see an immediate difference, it is something you need to persevere with. But it does work. The person who recommended me to Jorrun had chronic back pain, could hardly walk and was being encouraged to have surgery, which she wasn’t keen on.

“But after she had lessons in the Alexander Technique she was able to walk without any problem.”

Bethan added: “Luckily my situation did not get that bad. I was keen to do something about the pain quite quickly because to me the sooner you try to solve a problem, the easier it is to resolve.

“I am sure that if I had ignored it and not taken action, it could have become a chronic condition. It certainly would not have improved on its own.”

* A GP’s view

FROM a discal neck injury in 1990 I developed progressive spinal problems. By 2002 I had suffered mechanical neck and back pain, several episodes of nerve-root pain at different levels, with loss of power and reflexes in my arms.

I saw four neurosurgeons who all recommended (different) neck operations. I then developed complex regional pain syndrome and could barely use my right arm.

I was in unbearable pain and virtually unable to move my neck. I started taking Alexander Technique lessons and began to experience improvement and lessening of pain after some 12-15 lessons.

I did regular Alexander Technique for about four years. Progressive improvement since 2003 is such that I now have no neck or arm pain. Alexander Technique lessons from a good teacher are an effective technique and were instrumental in my recovery. Based on simple applied principles it can afford sustained relief from pain of spinal origin.

It teaches the body to undo neuromuscular tensions and reduce strain in normal motor function and probably would be cost-effective were it taught in primary health care.

Dr Nick Mann, 45, GP, London.







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Symptoms, treatment and hope

Symptoms, treatment and hope

09/10/2008, 9:19 am


Kate Reynoldsewsroom@mywebtimes.com, 815-433-2000

While Reflex Sympathetic Dystrophy is considered a rare disorder, it is a growing public health concern. According to the executive director of the Reflex Sympathetic Dystrophy Syndrome Association, Jim Broatch, “severe cases can cost $500,000 to $1 million in health and financial costs.

“A recent Internet-based epidemiological survey of 1,462 people with RSDA conducted by The John Hopkins School of Medicine exposed the financial devastation:

  • 41 percent suffered a work-related injury;
  • 60 percent reported being disabled; and only
  • 16 percent reported being employed full time and 6 percent reported being employed part time.”

    One of the problems with this chronic neurological syndrome is that it may not show up for several days or even weeks after the injury.

    “Another problem is that most medical professionals are unaware of the telltale symptoms and individuals who develop Complex Regional Pain Syndrome visit an average of five physicians prior to receive a diagnosis and beginning appropriate treatment,” Broatch wrote in 2007.

    RSD or CRPS advances in four stages.

    The first is an acute stage that lasts for anywhere from one to three months. Symptoms include deep aches, sharp stabbing pain, warmth, coolness, increased sensitivity to touch and accelerated nail and hair growth. After three months, bone changes can be seen with X-rays.

    The dystrophic stage can last from three to six months. The symptoms in the acute stage now are constant. Hair loss may occur and nails may become brittle. Joints may swell and X-rays may show the development of osteoporosis. Short-term memory loss often is a common symptom.

    The atrophic stage can last indefinitely. The acute state symptoms fluctuate and may also spread to other parts of the body, especially a newly injured area. Skin becomes thin. Loss of movement and limited mobility can be experienced. When a patient gets to this stage, irreversible tissue damage is possible.

    The fourth stage is one that many health care professionals do not recognize. RSD patients do not go into remission. Pain-blocking treatments no longer work effectively. Insomnia and stress grow to the point that depression is insurmountable. RSD has been known to lead to suicide in many patients because they can no longer stand the pain.

    Treatments are available, but they do not keep symptoms away indefinitely. An outpatient treatment called nerve blocking is a relatively painless procedure where medication is injected directly on the spine so nerve activity is reduced. Morphine blocks also are used to treat the pain. Surgery is an option, but is not often used because symptoms usually re-appear.

    Some researchers claim if RSD is diagnosed within the first six months, there is an 80 percent reversal rate. After six months, reversal odds decrease every month.

    Until ongoing research can find a cure, most RSD patients attend support groups.

    To see the reality of people who have RSD, visit www.rsdfoundation.org/en/en_howtohelp_transcript.html to read a transcript of a video made by the RSD Foundation and see photos of people who seem normal on the outside while they suffer inside with this disease.

    For more information on RSD, visit the Reflex Sympathetic Dystrophy Syndrome Association at www.rsds.org.


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    RSD: An invisible disease

    RSD: An invisible disease
    Group joins with Dahl in fight for awareness

    09/10/2008, 9:19 am addthis_pub = ‘sngii’; addthis_brand = ‘QCOnline’;

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    Kate Reynoldsewsroom@mywebtimes.com, 815-433-2000

    Imagine not being able to sleep every night. Imagine that when you finally do get to sleep, you wake up in constant pain from your head to your toes. Imagine waking up every morning with a foggy brain that coffee can’t fix. This is an unfortunately normal day for more than seven million Americans.

    The problem is few people have heard much about this condition or its symptoms. The key to a cure is public awareness. And that’s what one woman and the Reflex Sympathetic Dystrophy and Fibromyalgia-Chronic Pain support group want to see happen.

    Since approximately 2006, Streator resident and support group leader Bea Danko has been working to get the Reflex Sympathetic Dystrophy Education Bill passed in Illinois.

    “After months and months of speaking and writing letters to our senators for support, Sen. Gary Dahl is the only one who has stepped up to help us by sponsoring Senate Bill 1861,” Danko said.

    The bill has already been rejected once in Springfield, but an extension has been granted, allowing Danko, her support group and Dahl, R-Granville, more time to get more support. The group has been successfully creating RSD awareness to the point that in one month “we collected over 600 signatures on a petition to get this bill passed,” Danko said.

    Dahl’s office has received more than 2,000 letters in support of the bill and his office is contacting other senators to garner their support when it comes up for a vote again.

    Dahl visited the support group in June to learn more about this unknown disease.

    “As a result of that meeting, Sen. Dahl would like to visit additional support group meetings throughout the state,” Jennifer Riva, Dahl’s legislative aide, wrote to Danko.

    RSD is a chronic neurological syndrome with symptoms that include severe burning pain, medical changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch. Though anyone can get RSD, more women than men suffer from it, four or five women to one man.

    According to the Reflex Sympathetic Dystrophy Syndrome Association, http://www.RSDS.org, the pain often is described as a deep, aching, cold and burning sensation, along with increasing skin sensitivity.

    “I may look healthy, but I am often suffering from unbearable, unrelenting nerve pain,” said one support group member, who asked to remain anonymous. “This pain I live with makes me very depressed, especially because there is no cure right now.”

    A very negative effect of the disease is that it is many times invisible.

    “No one believes there is anything wrong because you look healthy on the outside,” the member said. “I have good days and bad days. I never know how any day may be like. Most of the time, it hurts to be touched anywhere. If I’m in a store and someone accidentally bumps into me, I’m in severe pain.”

    While no one in the medical profession can really say what causes RSD, it can begin with an injury to nerves, bones or joints and muscles, ligaments or tendons. A wrist fracture, heart attack or stroke could trigger RSD.

    RSD is a nerve disorder. The public awareness efforts of Danko and her support group are gaining support from not just Dahl, but doctors and associations around the state.

    On June 18, Dr. James M. Kelly from Kankakee wrote a letter of support to Danko.

    “In 21 years as a pain management specialist, a significant percentage of my patient population battles the effect of this syndrome and many suffer silently without the crucial support that could be generated through greater awareness of RSDS,” he wrote.

    “I urgently request Illinois state senators combine their efforts with yours to create public awareness and municipal support for those that suffer (from) RSDS.”

    In 2007, Jim Broatch, executive director of the Reflex Sympathetic Dystrophy Syndrome Association, wrote a letter with information about public awareness for the disease and thanking Danko for her “iniative to pass a Complex Regional Pain Syndrome Awareness-Education Bill. Every day RSDSA receives heartbreaking, desperate phone calls and letters from individuals with CRPS who are floundering financially. They may lack adequate health insurance, cannot afford medication or treatment and may be in eminent danger of losing their job, car, house or even their marriage.

    “Some states have taken pre-emptive action,” he continued in his letter. “The state Legislatures of New York, Pennsylvania, Delaware and Michigan have passed awareness and education bills. These bills have contained a call to action, such as producing brochures to educate consumers or creating materials for health care professionals to help promote greater awareness. The Michigan bill established a work group of medical professionals and the public to create an awareness campaign and mandated educational workshops.”

    Danko said she and the support group will never give up hope because so many people suffer from the disease.

    “Every day I get phone calls from people with RSD or fibromyalgia,” she said. “We are all usually told that it’s in our heads or we should just suck up the pain and get over it. I’m in constant pain. There are nights when I cry quietly so that I don’t wake up my husband.”

    Danko often wonders about the long-term effects of RSD medications.

    “I get a lot of questions from people about medication effects. Well, they create bone damage to the point that they look like honeycombs. They can also damage the heart. But often morphine pumps can revive your body for a while. We just have to look for ways to find other alternatives because this disease is so devastating.

    “I once got a call from a 68 year-old woman who just developed RSD,” she continued. ” ‘Bea,’ she told me, ‘I can’t go on. I have grandchildren that I can’t be with because of this unbearable pain.’ She ended up committing suicide.”

    But Danko remains upbeat and positive, despite her illness.

    “There are ways to make the lives a little easier for those that suffer from RSD. I get calls all the time about what you can tell people who want to shake your hand or hug you. I tell them to write up a card and hand it to the person saying you have RSD and cannot be touched today. This way, you won’t be perceived as being rude and they’ll get a better understanding of our disease.”

    Support groups also help. One member of the Streator group spoke about her first time visiting.

    “I came here because I had a problem that none of my doctors could help me with. Today I know what the problems with RSD are. I learn a lot from everyone who is going through the same thing I am. I can get advice about what to do for certain symptoms. And the best part? I can help someone else.”

    The group usually meets the fourth Friday of each month at 3 p.m. in the lower level conference room of St. Mary’s Hospital in Streator. For more information about the group or to offer help in getting Senate Bill 1810 passed, call Danko at 815-672-1182.

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    CRPS suit resolved on day of scheduled trial


    CRPS suit resolved on day of scheduled trial
    Constant ‘stinging’ pain affects up to 1.2M people
    DANNY JACOBS
    September 8, 2008

    A lawsuit brought by a Dundalk woman who claimed she lost use of her right arm after an orthopedic surgery procedure was dismissed last month on the same day it was scheduled to go to trial in Baltimore County Circuit Court.

    Lawyers for Donna McNeal and Dr. David B. Lumsden agreed to dismiss with prejudice the medical malpractice case Aug. 25, the same day the trial was to start.

    E. Philip Franke III, who represented Lumsden and Orthopedic & Hand Surgery Associates P.A., said the case had been “resolved” and that his clients had been dismissed. Franke, of Baxter, Baker, Sidle, Conn & Jones P.A. in Baltimore, declined further comment.

    H. Briggs Bedigian, McNeal’s lawyer from The Law Offices of Wais & Vogelstein in Owings Mills, also declined to comment on the case.

    The lawsuit, filed in January 2006, alleges McNeal developed complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy. McNeal described the pain in her upper extremities, particularly her right arm, as “cold, sharp, pins and needles, throbbing, burning, under armpit feels like thousands of bees stinging.”

    Hard to identify

    The neurological condition causes nerves to “send constant pain signals to the brain” and is characterized by a severe, burning pain and tissue swelling, according to the Reflex Sympathetic Dystrophy Syndrome Association, a national advocacy group. Between 200,000 and 1.2 million people are affected by the condition, according to the association. It can be brought on by any type of “traumatic” injury from sprains to falls to accidents, the RSDSA says.

    The condition is often seen following surgery to treat carpal tunnel syndrome, said Steven E. Goren, a Michigan lawyer who handles CRPS cases. But identifying the nerve condition can be difficult following surgery because surgery by definition involves injuring nerves, he said.

    Different doctors can also come to different conclusions about what is causing a patient’s pain, Goren added.

    “It’s a diagnosis of exclusion,” he said.

    McNeal first saw Lumsden in late January 2003 complaining of neck, hand and elbow pain as well as “tingling” in her hands, according to the lawsuit. A previous doctor had diagnosed tendonitis; Lumsden determined McNeal had tennis elbow and possibly nerve damage in her neck, the complaint said.

    Lumsden recommended finger and hand braces, limited activities and heat and ice as the initial treatments, and McNeal declined injections, according to the lawsuit, which does not specify the type and location of the injections.

    McNeal returned to Lumsden two weeks later experiencing the same problems and again declined injections but agreed to undergo surgery involving manipulating the joints and receiving injections while under anesthesia, according to the complaint.

    Following the Feb. 25, 2006, surgery, McNeal awoke with pain in her elbows and was unable to move her arms or straighten her fingers, the lawsuit says. McNeal was still feeling pain, particularly in her right arm, during a follow-up exam three days later, according to the lawsuit.

    Lumsden gave McNeal a sling and noted the possibility of CRPS. By the end of March, Lumsden had prescribed formal physical therapy and painkillers for McNeal while recommending she see pain specialists who ultimately diagnosed CRPS, according to the lawsuit.

    Causation an issue

    McNeal has been unable to return to her job as a data entry clerk and suffers from pain in all of the joints in her right arm, according to the lawsuit.

    In court filings, Franke argued Lumsden took a conservative approach in caring for McNeal and that the doctor found stable joints and no abnormalities when he performed the procedure. An orthopedic surgeon serving as a defense expert witness said he found no medical literature showing a patient developing CRPS following the common procedure Lumsden performed, Franke said, adding the plaintiff’s expert witness reached a similar conclusion.

    R. Steven Shisler, a Philadelphia lawyer who specializes in CRPS cases, said such medical malpractice cases can be difficult to prove because it can be unclear if the condition existed before or was a result of surgery.

    “Causation is always an issue in a medical malpractice case involving CRPS,” he said.






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    National Invisible Chronic Illness Awareness Week

    Have you heard about National Invisible Chronic Illness Awareness Week? September 8-14, 2008 will feature 20 seminars via Blog Talk Radio, (4 per day, M-F) plus tons of people are helping spread the word by blogging about invisible illness issues. Do you get tired of hearing, “But you look so good?” or weary of the stares when you park in a handicapped spot? This is our chance to educate the public as well as remember we are not alone. Nearly 1 in 2 people in the USA live with an illness and 96% of it is invisible.

    So join the cause today! They have daily guest bloggers at http://www.invisibleillnessblog.com, lots or prizes, articles, and it’s a great way to make some new friends and attend a conference without ever leaving your home. The main web site is: www.invisibleillness.com .





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