May 22, 2017

Rehabilitation for postpolio sequelae.

Author information

Department of Medicine, University of Melbourne, and Melbourne Extended Care and Rehabilitation Centre, Royal Melbourne Hospital, Victoria.



Postpolio sequelae (PPS) are new, late manifestations that occur many years after the initial poliomyelitis infection. Recurrence of symptoms and fear of reactivation of the polio virus is particularly distressing to polio survivors.


This article outlines the diagnosis, pathophysiology, and management of PPS disabilities using a case vignette.


Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. Diagnosis can be complicated particularly in nonparalytic cases of poliomyelitis.
Disabilities in PPS may not be obvious to the observer but significantly affect the quality of life of the PPS patient. 
Previous rehabilitation intervention focussed on physical effort and determination to overcome disability at all costs. The treatment in PPS is now modified, and aggressive physical measures that may exacerbate muscle weakness are avoided. 
Most disabilities in PPS can be well managed with rehabilitation interventions that address limitations in patient activities of daily living, mobility and cardiopulmonary fitness.

May 21, 2017

I Tried to Get Off Ativan

Harriet Brown

And learned some dark shit in the process.

In 2006 I had a really, really bad year. My older daughter got sick and nearly died, my younger daughter got depressed, and my beloved mother-in-law developed terminal lung cancer. For weeks all I could do was cry and panic and cry some more. 
When a psychiatrist suggested I take a small dose of lorazepam (the generic name for Ativan) three times a day, I said yes please. The relief was immediate: I could sleep. I could think. I could cope with the multiple traumas our family was facing. 
I was in good company. According to a new report based on government data, one in five American women (and one in ten men) has taken at least one psychiatric medication, mostly antidepressants or anti-anxiety drugs like Ativan. And most of these patients take the meds regularly, many for years and years. Like me. 

Our annus horribilis eventually came to an end: My daughters got better and my mother-in-law died. But eight years later I was still slipping a tiny white pill under my tongue three times a day, and I wanted to stop. I asked my doctor if he could help me get off it, and his response, more or less, was "If it ain't broke, don't fix it." 
The thing was, it was sort of broke. My once-excellent memory had become unreliable. I felt dull and stupid. My balance got so wobbly I tripped over nothing one day and face-planted myself into a broken nose. The doc reassured me that the class of medications known as benzodiazepines were benign, but I was reading research linking benzos with dementiamemory lossfalls, and overdoses.
Some percentage of people who've taken benzos for more than a few weeks can stop cold turkey and have no problems. But I knew I wasn't one of them. Whenever I was late with a dose I'd feel my anxiety spike and my heart pound. After eight years I'd become physically dependent on the drugs. Getting off them wasn't going to be easy.
When you can't sleep or eat or breathe without feeling like you're about to die, you'll do pretty much anything to make it stop. Benzos really are a miracle drug in that moment.
Benzodiazepines were the pharmaceutical miracle of the 1960s. Librium, Valium, and other benzos were prescribed for everything from insomnia to seizures, and by the late 1970s they were the most prescribed medication in the world

"There are plenty of appropriate uses for them," says Joseph Lee, medical director of the Hazelden Betty Ford Foundation Youth Continuum. He names seizure disorders, catatonia, and life-threatening withdrawal from alcohol and other sedatives.
But by far the most common reason benzos are prescribed is for anxiety. And I get why. When you've gone a week or two with your body and brain in panic mode, when you can't sleep or eat or breathe without feeling like you're about to die, you'll do pretty much anything to make it stop. Benzos really are a miracle drug in that moment.
Unfortunately, for most people those miraculous anti-anxiety effects last only a few weeks or, if you're lucky, months. In one of the few studies ever done on the long-term effectiveness of benzos, people who took Xanax to manage anxiety did worse after eight weeks than people who took a placebo. "That finding has never been repeated because nobody will fund it," says Reid Finlayson, an associate professor of clinical psychiatry and behavioral sciences at Vanderbilt University in Nashville. 
People who took Xanax to manage anxiety did worse after eight weeks than people who took a placebo. 
Doctors keep right on writing scrips for benzos for years, even decades, despite the fact that they're linked to treatment-resistant depressionsuicidecognitive impairmentAlzheimer's disease and other dementias, and traffic accidents. The number of benzodiazepine prescriptions in the US has tripled in the past two decades. A 2015 study showed that more than 5 percent of the US population filled prescriptions for benzos; up to a third of them were long-term users (this despite the fact that the label usually recommends otherwise). 

When I contacted Pfizer, makers of Xanax, with questions about the longterm use of their drug, a rep there offered this bland statement: "When prescribed and taken as indicated, Xanax is an important treatment option for patients. As with all our medicines, Xanax should be administered in accordance with local product labeling. Patients who have questions should speak with their healthcare provider."
Ideally, says, Thomas L. Schwartz, a professor of psychiatry at SUNY Upstate Medical University in Syracuse, New York, benzodiazepines aren't the go-to treatment for treating anxiety. "Classically a patient is treated with psychotherapy, an SSRI, or an SNRI," he explains. "After these three things fail, a benzo is allowed per most treatment guidelines for many of the anxiety disorders."  
Schwartz feels that for some people, benzos remain effective long term. "I have some patients I have seen since 2000 and their [anti-anxiety effects] have not worn off," he says. My question is, how can you tell? My doctor certainly thought benzos were still working for me. But after eight years I wasn't so sure. 
I felt a deep sense of shame about using lorazepam, despite the fact that I'd taken it only as prescribed. I'd never upped my dose or popped a handful for fun or gone doctor-shopping for more. I didn't particularly like the way it made me feel. I didn't think it was doing much for my anxiety, either; an antidepressant now took care of that.

I went online to find out how to get off the meds, and what I read freaked me out. There were whole websites devoted to supporting people who were tapering themselves off the drug because no doctor could or would help. Some of them had been at it for months or years. Many struggled with such profound symptoms they'd become disabled. "It's incredibly hard to get off benzos, and it has nothing to do with addiction," Lee says. "It just has to do with physiologic dependence."
One of those long-term patients was Christy Huff, a cardiologist in Fort Worth, Texas. Huff was prescribed daily Xanax after dry eye syndrome made it impossible for her to sleep. It worked for a few weeks, but then she started to develop anxiety during the day, which she'd never had before. She needed more and more Xanax; she thought she was going crazy. She had no idea what was going on until a psychologist asked her to stop the Xanax for 12 hours before a biofeedback session. "My whole chest clamped down," remembers Huff. "I couldn't breathe. Suddenly it was like, Wait a second, this is not anxiety—I'm dependent on this stuff." 

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Postpoliolitaff.- Asociación Post Polio Litaff A.C Primera Organización oficial sobre Síndrome de Post Poliomielitis En México.

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