Wednesday, October 23, 2013

Interdependent But Autonomous (how to Raise Your Kids, hee hee O:) {Guest Post}

So here we go….
Moosey is gonna tell you how to raise your kids.
Hee Hee.  Just kidding. :)
Well sorta.
I’m just going to impart some knowledge on what I know about growing up as a child with Spina Bifida.  So I guess this entry is geared toward those mothers and fathers of children with special needs, but hopefully all parents can take even a little something from anything I write, regardless of whether or not your child was born with a disability.
So…..parents of children with special needs……I want to share with you something important. Stuff I always tell new parents of young ones with SB.  Stuff I believe they need to hear.  Ready?  Here goes: Your attitude, especially early on, will determine your child’s attitude. Children are likely to live up to what you as parents think of them. If you think your child is not capable of doing anything, neither will they. If you think they can’t succeed, or that they will do nothing with their lives, so will they.
On the other hand, if you believe that your child has potential, that your child has a future, that your child can do whatever he or she wants to do, even if it means they may need some extra assistance or need to find new and different ways to do things, then they will believe it, too. They will grow up confident young men and women and they won’t let anything stand in their way.
Sure, it may take them awhile longer to accomplish things; it may be that they will reach a goal in a different way than other boys and girls. But if you believe in them, they will believe in themselves. Your attitude early on is the single most important factor in determining what they think of themselves and what they will believe they are capable of doing.
And your attitude……needs to allow them to fail.
I have no doubt that all the parents reading this love their children. I have no doubt that you all want nothing but the best for your kids. You all want to protect your kids from pain, from sadness, from disappointment. Just like every other loving parent out there, you don’t want anything bad to happen to your kids.
However, I’ve seen too many parents, particularly in the disability community, “over” protecting their kids. It’s a hard thing for any parent of any child, with a disability or not. You question, “When do I let go?”  “How much should I let go?”  “What if my child fails?”  “What if my child tries something and finds disappointment?”
It’s hard, but I’m here to tell you that teaching your child how to be self-sufficient and as independent as possible is the best thing you can do. Obviously, as with every other kid on the planet, kids with disabilities also are different from one another. And, physically, some of our kids may not be able to do as much as others. That’s okay. Allow them to do as much as they can do. It will not only help their self-esteem when they can do things on their own, but it teaches them responsibility.
For example, I don’t know, let them help you clean the kitchen when they are younger. Maybe they can set up the dinner table. Show them how to clean their rooms, then after a while, let them do it themselves. You will be giving them skills for life. Later on when they reach adulthood, they will be better able to take care of themselves.
I understand that for some of our kids, they will always need some kind of care. That’s okay. Some of our kids will do just fine as adults and on their own.  But some will need more help.  Into adulthood, some may always need assistance of some kind. That’s fine.
That’s when I think of a phrase I first heard in 2003 from a doctor (with SB I might add) in Texas at the first SB national conference I went to…….he said……”interdependent but autonomous”.  And I loved it.
I believe that no one is truly “independent”.  Nobody.  Able bodied or not.  No one is an island and everyone needs somebody for something.  We are all “inter”dependent.  For example when you go and buy a car, you ask for advice, you check with friends, you do your research.  You depend on others for help.  You go and buy a house.  God I hope you ask advice and help on that, or it’s gonna suck to be you!  Or when you have a doctor’s appointment and you need someone to cover your shift at work, you ask for help.  We are all connected.  Nobody is truly “independent”.  And neither should our kids be.  If they need help of any kind, that’s fine, I believe that’s just the human condition.
However, “autonomous” means that even though we may depend on others for some stuff, at the end of the day we need to be responsible for our own actions and our own lives.  We can have others help us, but ultimately whatever happens at the end of the day needs to be one’s own choice and one’s own decision.
Or as Judith E. Heumannm, one of the leading disability right’s advocates in the country, so beautifully put it:  “Independent Living is not doing things yourself; it is being in control of how things are done.”
So….some of our kids, when they become adults, may need things like a home health care someone or other, coming in helping them with grocery buying or whatever.  That’s fine.  They can still be autonomous.  They are still in control of how things get done.
Parents, I know it’s scary. I know that you don’t want them to get hurt; you don’t want them to suffer. As they get older, you may be afraid of other things as well, but there are always options. When they choose to move out, they may be just fine.  All on their own.  Just fine.  But if they need help, there are always programs that teach them life skills. Voc Rehab and whatnot.  And there are hand controls for cars.  There are also home health care workers who can come to their homes once a week to help clean up, to help cook, to help buy groceries, or to help assist in whatever medical needs they might require. There are always options.
And for those that don’t leave right at 18 like you’re “supposed to” (I guess), they can still be “interdependent but autonomous”.  For some, it means they make their own appointments, do their own cooking, and provide for their own transportation. Some have cars and drive themselves wherever they need to be. They still have independence. They have friends. They do things. Some are taking college courses online. Some do volunteer work that really makes them happy and makes them feel good about themselves.
And anyway, “Independence” doesn't mean they have to move out at 18 and live alone.  But…..damn….it does mean…..jeez…..at the very least it means that if they are physically and mentally able to cath on their own (if the doctor deemed it necessary for them to do so in the first place) then oh my god they should!!
OH MY FUCKING GAWD, there is simply no reason a 14-year-old should not have some kind of outside activities or social life, simply because they don’t know how to cath. Fucking pet peeve of mine to see mom doing stuff like that.  Pisses me off and makes me sad like you wouldn't believe!!
OK Moose, calm down…..OK um, where was I….oh yeah…….so don’t misunderstand me. When I say, “let your kids be independent,” I don’t mean “Parents, leave them alone”. Unfortunately, I see it happen where a child with disabilities who is becoming an adult wants to be more independent, wants to learn to do more on their own, wants more freedom. The parents are hurt and confused. They spent their life protecting their kids, loving their kids, trying to shield them from pain and disappointment, and now the child is saying, “I want to do things on my own.”  But for you, the parent, its scary.  Maybe even offensive to hear that.  Yes, offensive.  “I am so and so’s caretaker, their protector.  That’s who I am.  That’s my sole purpose in life.  They need me.”  And I think parents fixate on that identity.  So the parents may react with hurt and confusion and say, “Okay, you want to do things on your own?  Fine. Do things on your own.”  And then they abandon their kids.
Parents, please don’t abandon your kids.
It’s understandable that you would always want to protect them.  They were born with these special needs and from the day they were born, you were all they had to protect them from the big mean scary world.  Good job, go you, you did a beautiful thing. <3
But they grow up.  And you are not doing them any favors by hanging on to that identity of “protector”.  Maybe without that label of “protector and caretaker”, you don’t know who the hell you are….well figure it out!  Because they won’t need the same amount of protecting and care that you gave them when they were 2.  Let go.  But don’t completely abandon them.  That’s just mean.  Don’t be mean.  Find that balance.  I don’t know where that balance is, but find it.
You’re their parents, and they love you, and they will always need you. They are just asking for the same thing most young men and women want: more freedom to fly, more freedom to succeed, and yes, the freedom to fail. When they do succeed or when they do fail, don’t abandon them. Be there, cheering them on, encouraging them, helping them.
I feel I should put a disclaimer here. I didn't grow up being all that independent. I didn't have a mom who, from day one, let me do as much as I could by myself. I had an overprotective mother.
On the one hand, she would have me talk to the doctors and always make my own appointments. Yes, that was very empowering; yes, that taught me some responsibility.
“Tell them what’s wrong.  You talk to them.  It’s your body” she’d say.
“Tell them it hurts. A lot,” she would always advise.
So yeah, very independent with my medical care.  That was all me basically from the time I was 9.
But, on the other hand, she was afraid of my having new experiences. She was always afraid I would get hurt, always afraid of her little boy experiencing pain or rejection or suffering.
There came a point when I finally let my mom know that I wanted more freedom and more independence. She took a long hard look at me and said, “OK. This is new and scary for me, but you’re right. You can do this.”
Whether it was, “You can go to college,” or “You can meet girls, you can date, you can marry,” (“And you can get divorced.” -2011) (“And you can get remarried.” -2013) she was afraid for me, but she let it happen. AND she was still there for me. She did not go from one extreme to another. She did not go from being overprotective of everything I did, to completely abandoning me. She did it right.  Ultimately, she did it right.  She was there when needed, and when I seemed to be doing OK on my own, she left me alone.
To this day, my mom is still like that. I see her almost every day (as every good Mexican son should do :) ) and she is still there for me, listening, caring, interested in my life. But the most she ever “does” for me is buy some milk if we run out and she happens to be at the grocery store!  She knows that she has given me so much by letting me have my independence.
Some practical stuff my mom taught me was to clean the kitchen, and she taught me to do laundry; my dad taught me how to manage money. They gave me many practical life skills that I needed for the future. I will always need them, I will always love my mom for everything she is, but I am so thankful for the chance to succeed, and yes, to fail, on my own.
The point is, parents, don’t underestimate your kids. Don’t completely abandon them.  But don’t underestimate them.  Remember that independence and self-sufficiency are two of the greatest gifts you can give your kids. Those skills will help them long after your physical bodies are no longer here to watch over them. Teach them independence and self-sufficiency and you have truly given them the greatest gifts you could ever give.

***Jesus Arroyo is 37 year old man with SB myelo, shunted, ambulatory with braces, Chiari II. But that's not the most important thing he wants you to know about him. The most important thing he wants you to know, and in keeping with the theme of his blog entry, is that life happens to everyone. Typical things and SB things. And we have to be prepared for it all. Mentally and emotionally capable to handle whatever life throws at us. Married for more than 10 years, divorced, and recently remarried, he points out that his divorce is the most difficult thing he's ever gone through. Harder than 20 surgeries, more emotionally taxing than the 2 shunt revisions he had this summer in the time span of 6 weeks, after having no problems with his shunt for 17 years. Hundreds of trips to the ER. But something "typical", something that everyone can go through, a divorce was more painful than anything SB related. Something "the normals" go through. So how do you handle that? Or surgeries? Or anything else life throws at you? With emotional strength, maturity, and the experience you got during the times you failed in life. With family, friends, loved ones and support, but also from learning from your failures. And that's what this blog is about. The power to fail.***
~~~You can follow Mr Arroyo's blog at: http://mooseysramblings.wordpress.com/ For more entries just like this one, be sure and click on his Disability Advocacy link on the right. Leave Jesus some love and tell him Dawn sent you!!! ;-)

Tuesday, October 22, 2013

Spina Bifida Occulta

What is Spina Bifida Occulta?
Spina Bifida Occulta (SBO) is a group of conditions affecting the spinal column. The spinal column is made of bones, called “vertebrae.” They support the body and protect a large group of nerves, called the “spinal cord.” The spinal cord carries nerve signals from the body to the brain.
SBO is common; 10 to 20 percent of healthy people have it. Normally it is safe and people often find out they have it through an X-ray. Spina Bifida Occulta usually doesn’t cause nervous system problems.
Forms of Occulta
There are forms of Spina Bifida Occulta that do cause problems though. They are:
  • Lipomyelomeningocele and lipomeningocele — this is like a tethered spinal cord, except it is attached to a benign fatty tumor;
  • Thickened filum terminale — the end of the spinal cord is too thick;
  • Fatty filum terminale — there is a fatty lump at the inside end of the spinal cord;
  • Diastematomyelia (split spinal cord) and diplomyelia — the spinal cord is split in two, usually by a piece of bone or cartilage; and
  • Dermal sinus tract (with involvement of the spinal cord) — the spinal canal and the skin of the back are connected by what looks like a band of tissue.
Signs of Occulta
People can have these forms of Spina Bifida Occulta even if there is nothing wrong with the spine. However, there can be neurological complications associated with SBO. The most frequently occuring complication is a tethered spinal cord. A tethered cord occurs when the spinal cord (usually at the lower end) is not attached correctly to the rest of the body. The cord gets stretched and damaged.
The signs and symptoms of a possible neurological complication like a tethered spinal cord include:
  • Pain in the back or legs;
  • Weakness in the legs;
  • numbness or other changes in feeling in the legs or back;
  • Deformed legs, feet and back; and
  • Change in bladder or bowel function.
People who could have a spinal cord problem should see a health care provider right away.
What about people with no signs of a problem?
Eighty percent of those with a spinal cord problem will have skin over the defect with:
  • a hairy patch;
  • a fatty lump;
  • a hemangioma — a red or purple spot made up of blood vessels;
  • a dark spot or a birth mark — these are red and don’t include blue-black marks, called “Mongolian spots”;
  • a skin tract (tunnel) or sinus — this can look like a deep dimple, especially if it’s too high (higher than the top of the buttocks crease), or if its bottom can’t be seen; and
  • a hypopigmented spot — an area with less skin color.
No matter the age, people who have these signs should see a health care provider who treats the spinal cord. Not every person with a skin defect of the lower back has Spina Bifida Occulta however, but that can only be determined through physical examination and diagnostic tests. This is especially true for those with sacral dimple. An ultrasound (only for newborns) or magnetic resonance imaging (MRI) may be used to confirm a problem.
This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.

Monday, October 21, 2013

Spina Bifida and Obesity

Obesity among Persons with Spina Bifida

Obesity is the most common nutritional problem in North America, and it is a serious health threat.
How does obesity develop?
All energy intake comes from food that is eaten (measured in calories) and then used by the body to meet its needs. Obesity results when a person's intake of calories exceeds his or her energy needs for bodily functions (metabolism, physical activity, the thermal effect of food, and growth). Similarly, weight loss results when the body uses more calories than are taken in through eating. On average, most (about 60%) of our energy is used for basic metabolism (which is controlled in part by inheritance). Physical activity uses about 25%, the thermal effect of food about 10%, and growth about 5%. Our bodies do a good job of balancing short-term excesses in both energy intake and use. Continued excessive intake, however, will lead to storage of energy in the form of fat which causes weight gain; and continued insufficient intake will force the body to use stored energy (fat and other tissue like muscle) for the calories it needs to function resulting in weight loss.
How is obesity determined?
Obesity can be determined a number of ways. Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI can provide a generally reliable indicator most people; and is used to screen for weight categories. The categories that may lead to health problems are overweight and obese. Anyone with a BMI over 25 is classified as overweight; and anyone with a BMI over 30 is classified as obese. BMI is not a direct measure of body fat percentage- it is calculated from an individual's height and weight which includes both muscle and fat.
It may be difficult to get an accurate measure of height in a person with Spina Bifida, so arm-span may be substituted for height in some individuals. Another method is to use calipers to measure skin-folds; and plot the results against standardized charts.
The National Center for Health Statistics / Centers for Disease Control (NCHS/CDC) has several growth charts and calculators that may be helpful. [http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm] Children whose weight for height exceeds the 95th percentile are overweight, and those who fall between the 85th and 95th percentiles are of concern.
What are the health concerns for obese people?
Obese adults are at risk for: hypertension, dyslipidemia (high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides), type 2 diabetes, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, some cancers (endometrial, breast, and colon), and psychological problems.
Similar health consequences occur in children and adolescents who are obese. Psychological problems are of special concern for children, who may be negatively stigmatized by others and could develop poor self-esteem, greater risk for isolation from peers, and depression. In some families, food is used to try to compensate for the child's disabilities.
Very young children who have Spina Bifida usually grow at about the same rate as their peers that don’t have Spina Bifida and are quite physically active, so they usually are not obese. As they grow older, and especially if they also have hydrocephalus, they have a very high risk of becoming obese. After age six, at least 50% of children who have Spina Bifida are overweight; and in adolescence and adulthood, over 50% are obese.
Special concerns for individuals who have Spina Bifida
Obesity causes greater health problems for people who have Spina Bifida. Obesity further limits mobility and the ability to manage activities of daily living. This leads to a spiraling problem of decreased energy use and weight gain, making it harder to keep up in social and work situations. Obesity puts more pressure on skin, thereby increasing the already high risk of skin breakdown, particularly in areas that hold moisture.
Social rejection, which may already be a problem due to others' lack of sensitivity and understanding of disabilities, may be worsened. Activities of daily living, particularly independence in dressing, continence management and hygiene, may be negatively affected by difficulties in moving a large, heavy body as well as decreased ability to reach private areas of the body.
Neurological impairments that lead to mobility problems make it harder for individuals who have Spina Bifida to be physically active. Due to the requirements of school and work; and due to the increasing difficulty of moving a larger body that has a mobility impairment, school age children who have Spina Bifida typically become less active as they grown older. Small children grow rapidly, so they require a large number of calories for growth. Older children and adults have slower growth, and on average will not become as tall as their peers who do not have Spina Bifida. This means that people with Spina Bifida have fewer nutritional requirements for growth. People with Spina Bifida have less lean body mass than their peers, and even when other factors like physical activity are equal, have a lower basic metabolic rate (fat cells have slower metabolic rates than other cells like muscle cells).
Preventing obesity−−a family affair
Prevention of obesity is the only sure method of promoting optimal nutritional health. Preventing obesity for individuals who have Spina Bifida is a family affair that must begin early in a child's life and continue indefinitely. Fortunately, if healthy eating and exercise habits begin early, they can become part of a very enjoyable lifestyle, rather than one that is perceived as a life of deprivation.
Most eating behaviors and food likes and dislikes are learned in the context of home and family. Thus, by modeling and teaching healthful eating habits, family members have a chance to improve the child's health. This may be difficult, especially for families where eating patterns and genetic factors have led to obesity being commonplace. When a child has Spina Bifida and family members are somewhat frustrated by their inability to correct their child's underlying disabilities, making this contribution to health and well-being can be very rewarding.
What are some strategies for success?
The most helpful strategy for preventing obesity is to help the child view food as a necessity for growth and activity rather than as a reward for managing the difficulties of daily living. The goal is to condition the child to perceive food not as an emotional, but rather a physical, necessity.
Children can learn about good nutrition as they help plan family meals and shop for ingredients. Remember, children cannot consume food that is not available! Caregivers need to purchase nutritionally sound, healthy foods. Most food servings should come from fruits, vegetables, bread and cereals, fewer from dairy products and meats, and only a small amount from fats, processed sugars and other carbohydrates. Decreasing fats can have the greatest impact on weight loss.
Food should be eaten at regular times during meals that are pleasant and that take enough time for individuals to eat slowly and realize when their hunger has been satisfied. Treats and snacks should be limited to times when a little extra energy is really needed and should be both nutritionally sound and enjoyable. Food and visual reminders of food should be removed from the environment and other cues for increasing enjoyment of life, such as posters about exercise or hobbies, should be substituted. Entertainment should rarely center on food or meals. Children should receive only non-food rewards for positive behaviors. Children need to learn to distinguish between boredom and hunger; and to enjoy foods other than those with high fat or high sugar content. Studies reveal that if such foods are strictly limited from our diets, we lose our taste for them and crave them less and less.
Help children who have Spina Bifida enjoy exercise. Physical activity has two benefits; it burns calories and decreases hunger by re-setting the body's "thermostat." Most physical activities that other children enjoy can be adapted for children who have mobility impairments. Horseback riding, tennis, swimming, and wheelchair sports, like basketball and track, are life-long activities that most children love and families can enjoy together. Community organizations such as the YMCA should be encouraged to create such opportunities for individuals who have physical disabilities. Small children can be even more active as they learn to complete some helpful tasks around the house. Such activities not only burn calories, but also help children feel good about themselves as capable people who can help others. Watching television or sitting in front of a computer are activities that demand few calories, and should be limited.
I’m obese. How do I lose weight?
Once people become obese, losing weight can be challenging. Most can only lose about 10% to 15% of their body weight, and even these individuals usually regain this weight after their strict program of diet, exercise and behavior modifications is withdrawn.
Once people with Spina Bifida have become obese, it is even harder for them to lose weight than it is for others. It is not impossible, however! If an individual is motivated to lose weight and limits caloric intake while also increasing exercise, weight can be reduced. The assistance of a nutrition consultant may help in such cases. Weight reduction strategies should be started one by one, so the individual and family can become used to new patterns of living. Trying to do too much at once is often overwhelming and self-defeating.
Any weight reduction contributes to good health and should be celebrated (but not with food)! Losing weight should be done in small measures, so may take a long time. The benefits of healthy eating and sufficient exercise for individuals who have Spina Bifida are numerous and important, and last throughout life. Perhaps no other single intervention will make such a positive contribution to long-term good health and quality of life.
This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.

Sunday, October 20, 2013

Spina Bifida and Pain

People with SB are at risk for chronic pain Pain can be felt in many ways. Sometimes (like if you smash your thumb), you know exactly where the pain started. That happens to everyone. Other times, it just hurts everywhere. As people with SB age, they often have pain associated with degenerative conditions that affect the spine, joints, or muscles. In SB, commonly seen conditions are: arthritis, osteoporosis, carpal tunnel syndrome, and tethered cord syndrome. Back pain is common in adults, and can be very debilitating. 
There are many causes of pain, and the each type determines how long it will last.
Pain is generally classified in two categories: acute or chronic. People with SB can have either type of pain, or even both at the same time.
What is Acute pain?
Acute pain is the kind that comes on very quickly, may be moderate or severe, and the cause or location of the pain can usually be identified. Acute pain can be controlled when the cause of the pain is identified. It can be treated, and it goes away within hours, days, or weeks.
What is chronic pain?
Chronic pain is a long term condition; and it lasts for weeks, months, or years. It comes on slowly over a period of time, the cause(s) may be difficult to pinpoint; and it can be very difficult to manage. Chronic pain affects every aspect of a person’s life; and the longer it persists, the more difficult it is to get under control. Therefore, it should not be ignored. Chronic pain is very serious; and should be treated as a disease in itself.
Can I prevent chronic pain?
Sometimes chronic pain can be prevented if the condition that causes pain is diagnosed and treated early. Acute pain occurs suddenly. It happens in relation to a specific tissue injury, and is often treatable. Acute pain can be severe, but doesn't last long. People who have this type of pain usually know why they hurt. That is very different from chronic pain, which is often ignored or not managed until it becomes a big problem.
How is it diagnosed?
Persistent pain-the kind that lasts a long time-for weeks or months, should be assessed by your doctor through both a physical assessment and a detailed discussion . Chronic pain affects all aspects of a person’s life. This is because the brain and the body are inseparable, so both are affected by pain, as well as the conditions that cause it. People who suffer from chronic pain often have fatigue and find it difficult to move around. Sometimes they are forgetful, have difficulty thinking clearly because they are distracted; or become pre-occupied by their discomfort, and find it challenging to focus on tasks at work or school. Many people with chronic pain find it difficult to exercise, eat properly, or sleep- that increases their risk for other health problems.
Chronic pain causes other conditions that make it difficult to cope- like anxiety and depression. Similarly, high stress or feelings of hopelessness increase levels of pain. So, it becomes a cycle that is difficult to break. This is why it is very important to treat the pain at 2 levels, the physical and the emotional level- and a team approach is the best way to do that.
Who should be on that team?
That depends on each person, The primary care doctor or physiatrist will help you determine which specialists you need. In general, the doctor who deals with the condition that is causing your pain, a psychologist, a pain medicine doctor, and a physical therapist or occupational therapist are important people to include in your care. If your pain affects your ability to work, then you might need a vocational specialist also.
How do you treat chronic pain?
Long term pain medications-If you choose to treat your pain with medications, you may need to take more than one medication. They can be in the form of pills, injections, creams, gels, or patches. Medications can be helpful in treating the pain, but have unwanted side effects, like nausea, sleepiness, and dry mouth or constipation. Some people need their dosage of medication increased or changed because they build up a tolerance to the drug, so they require higher doses to get the same relief as they once did on a smaller dose.
Pain management programs-are normally at “out-patient” hospital or clinic settings. Pain management programs are designed to help people who suffer from chronic pain. Pain management programs offer a variety of supports that treat the body and the emotions, like: physical therapy, occupational therapy,water therapy, physician care, psychology/counselling, relaxation, and bio-feedback. If a pain management program is not right for you, your doctor might suggest only one or two of these therapies.
Psychotherapy, often in the form of Cognitive Behavioral Therapy (CBT) is often helpful when treatments have not been successful. It is also helpful to receive CBT while undergoing other treatments. Counseling and CBT can help identify ways of coping with pain and its associated problems.
Intrathecal analgesia, or delivery of medication through a “pain pump” is often used for long term chronic pain, which cannot be managed through more conservative means. With intrathecal analgesia, pain medications and sometimes muscle relaxers can be given through a pump that is surgically implanted in the abdomen. The pump delivers medication directly into the spinal cord through a catheter. For some people, this method of pain management is successful for neck or back pain; and is advantageous because much smaller doses of medication can be used more effectively. However, it is not without risks, and your pain management doctor would be helpful in deciding if it is the right approach to manage your pain, when other treatments have not been successful.
Alternative Therapies- Alternative therapies can provide temporary relief from pain, and can be used with other pain management plans:
  • Massage Therapy
  • Water (hydro) Therapy
  • Acupuncture
  • Meditation or Feldenkreis
  • Music Therapy
  • Pet Therapy
Surgery is sometimes an option if the source of the pain is known.
Support groups can be sources of information, understanding and encouragement.


Saturday, October 19, 2013

Spina Bifida and Expectant Parents.

An Expectant Parent's Guide to Spina Bifida:
If you are reading this, you have likely just been told that your pregnancy is affected by Spina Bifida (SB). Like most women receiving this unexpected diagnosis, you want to know what it is, and what to expect.
What is Spina Bifida?
Spina Bifida describes a group of neural tube defects (NTD's) that occur when the baby's developing spine (neural tube) fails to close properly. When most people speak of SB, they are referring to the most common and also most severe form, called myelomeningocele, which causes the spinal nerves to bulge through an opening in the back. Myelomeningocele usually occurs in the lowest part of the spine but can occur at any level. Spina Bifida is the most common permanently disabling birth defect that is compatible with living into adulthood.
What causes SB?
There is no single known cause for SB. It is due to a complex interaction of both genetic and environmental factors occurring very early in the pregnancy (by the 4th week). The genetic factors that can cause SB are not well known. Research has shown that supplementation of folic acid ( a "B" vitamin) reduces the risk of having a pregnancy affected by SB. However, many people who take folic acid still have babies with SB, and women who did not take folic acid still have healthy babies. No one knows why. It just happens. This means that there is still much to learn about the causes of SB, and it is nobody's fault.
How is SB diagnosed during pregnancy?
  • Maternal Serum Alpha: Fetoprotein (MSAFP): also known as triple test or quad test, is a blood test performed between the 15th and 20th weeks of pregnancy to determine if there is a higher risk for NTD. MSAFP testing measures the level of a protein (AFP) made by the fetus and placenta. Small amounts of this protein normally cross the placenta into the maternal bloodstream, but when very high levels cross, it could be that the fetus has an NTD. However, MSAFP testing is not used as a diagnostic tool but rather as an indicator that further testing is needed, because the test is not specific for SB, and because high MSAFP may be present for a number of other reasons.
  • Ultrasound: is the primary diagnostic tool for prenatal diagnosis of SB and other NTD's. It is a non-invasive technique that produces an image of the fetus. It can be used to identify many different problems in fetuses, but can also be used to identify important characteristic signs of SB in both the brain and spine. Cranial markers include the lemon sign (abnormal shape of fetal skull), the banana sign (crowding of the cerebellum in the back part of the head), and hydrocephalus (abnormally large ventricles or fluid spaces in the brain). The normal fetal spine resembles a string of pearls. An SB spine will appear as a string of pearls with some broken or missing pieces.
  • Fetal MRI: May be recommended after the diagnosis is made through ultrasound to determine severity of SB. MRI is a powerful technology that uses magnetic imaging (not radiation) to give better pictures of the fetal spinal cord and spinal nerves. Through MRI, the doctors can see the size and extent of the SB. This information helps them explain the diagnosis and prognosis (expected long term condition) in greater detail. Fetal MRI is not necessary for all pregnancies affected by SB though, particularly when the ultrasound images are good.
What medical issues do people with SB encounter?
People with SB have a number of medical issues to deal with throughout their lives.
  • Open SB lesions need to be surgically closed (usually within 72 hours after birth) to prevent infection and further damage to the spinal cord.
  • Hydrocephalus is an excessive amount of cerebral spinal fluid (CSF) collecting in the ventricles of the brain. It occurs in approximately 80% of patients with SB. Sometimes it occurs before birth, but most often it occurs after the back has been closed. Hydrocephalus is usually treated by surgery to place a hollow tube called a ventriculoperitoneal (VP) shunt that transfers the fluid from the head to an empty space in the abdomen in order to prevent brain damage. (Please see the SBA's info sheet on hydrocephalus and shunts for more information).
  • Neurogenic(dysfunctional) bowel and bladder is caused by damage to the nerves that control the function of the bladder and the bottom section of bowel and anus. In recent years, a number of treatments have been developed which allow individuals to achieve varying levels of functional continence. (Please see the SBA's information sheet on urologic care and management for more information).
  • Many people with SB face mobility issues,which are dependent on the spinal level of the SB lesion. Most children are able to walk (though usually with the aid of orthopedic bracing and often with assistive devices such as crutches). Some are full-time walkers, but many walk short distances and choose a wheelchair for long distances. It is generally only those with thoracic or high lumbar spinal lesions who end up using the wheelchair as their only method of mobility.
  • Although most individuals with SB have normal IQ scores, they may have learning difficulties; but these can often be addressed when parents and teachers understand the issues and work together.
Every individual with SB is affected differently, and it is impossible to fully predict a child's outcome before oratbirth.Outcomeshaveimprovedoverthepast50 years due to medical advancements. In addition, cultural attitudes toward individuals with disabilities have also changed, resulting in improved services. While some individuals with SB have significant disabilities, others are less severely affected. Many attain advanced education, and have careers and families of their own. They become doctors, teachers, artists, athletes, and parents. Spina Bifida is only one part of their lives; it does not define them.
What are the choices for women carrying fetuses with SB?
To learn the most about the prognosis for YOUR pregnancy, it is recommended that you meet with a pediatric neurosurgeon and/or SB clinic as soon as possible. You will also need to meet with a maternal- fetal specialist or perinatologist to closely follow your pregnancy. You may also meet other specialists who care for people with SB.Use these appointments to learn as much as you can. After you have gathered enough information to understand the immediate and long term implications of SB, consider the choices available to you—terminating the pregnancy, prenatal or postnatal surgery, or adoption—what matters is that you make an informed choice about what works best for you and your family. Prenatal or Postnatal surgery: For pregnancies diagnosed earlier than 25 weeks gestation, in-utero fetal surgery may be an option to close the baby's back before birth. There are potential risks and benefits of fetal surgery, and it is not appropriate for all women. For those who choose and qualify, an immediate referral must be made to a medical center where the operation is performed. Because fetal surgery is not standard practice at this time, most newborns with SB require surgery shortly after birth to prevent infection and further spinal cord damage.
Post-natal care:
Babies with SB should be delivered at a medical center that specializes in SB so they can receive specialty care during and after birth. This gives you and the specialists every chance to prepare for the best outcome. After surgery, the baby will be monitored in the neonatal intensive care unit. The average length of stay is 2 weeks, but this varies based on the child's needs. When the baby is discharged from the hospital, he or she will have periodic follow-up appointments with a pediatric neurosurgeon, orthopedist, urologist, and possibly other specialists. Appointments will be frequent in the first year, and usually less often as time passes.

Additional information
To get more information and lifelong support, please contact Spina Bifida Association at 800 621 3141, ext 35; or via the website: www.sbaa.org. Some of the following specific resources may be helpful through the website, www.sbaa.org: SBA Marketplace, SB University,Preparations,healthinformationsheets, E-communities-parents' listserv.

Friday, October 18, 2013

Spina Bifida & Agent Orange

Agent Orange or Herbicide Orange (HO) is one of the herbicides and defoliants used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand,during the Vietnam War from 1961 to 1971. Vietnam estimates 400,000 people were killed or maimed, and 500,000 children born with birth defects as a result of the use of contaminated batches of the compound. The Red Cross of Vietnam estimates that up to 1 million people are disabled or have health problems due to Agent Orange. The United States government has challenged these figures as being unreliable and unrealistically high.
A 50:50 mixture of 2,4,5-T and 2,4-D, it was manufactured for the U.S. Department of Defense primarily by Monsanto Corporation and Dow Chemical. The 2,4,5-T used to produce Agent Orange was contaminated with 2,3,7,8-tetrachlorodibenzodioxin (TCDD), an extremely toxic dioxin compound. It was given its name from the color of the orange-striped 55 US gallon barrels in which it was shipped, and was by far the most widely used of the so-called "Rainbow Herbicides".
During the Vietnam War, between 1962 and 1971, the United States military sprayed nearly 20,000,000 US gallons (76,000,000 l) of material containing chemical herbicides and defoliants mixed with jet fuel in Vietnam, eastern Laos and parts of Cambodia, as part of Operation Ranch Hand. The program's goal was to defoliate forested and rural land, depriving guerrillas of cover; another goal was to induce forced draft urbanization, destroying the ability of peasants to support themselves in the countryside, and forcing them to flee to the U.S. dominated cities, thus depriving the guerrillas of their rural support and food supply.
The US began to target food crops in October 1962, primarily using Agent Blue. In 1965, 42 percent of all herbicide spraying was dedicated to food crops. Rural-to-urban migration rates dramatically increased in South Vietnam, as peasants escaped the war and famine in the countryside by fleeing to the U.S.-dominated cities. The urban population in South Vietnam nearly tripled: from 2.8 million people in 1958, to 8 million by 1971. The rapid flow of people led to a fast-paced and uncontrolled urbanization; an estimated 1.5 million people were living in Saigon slums.
United States Air Force records show that at least 6,542 spraying missions took place over the course of Operation Ranch Hand. By 1971, 12 percent of the total area of South Vietnam had been sprayed with defoliating chemicals, at an average concentration of 13 times the recommended USDA application rate for domestic use. In South Vietnam alone, an estimated 25 million acres, 39,000 square miles of agricultural land was ultimately destroyed. In some areas, TCDD concentrations in soil and water were hundreds of times greater than the levels considered safe by the U.S. Environmental Protection Agency. Overall, more than 20% of South Vietnam's forests were sprayed at least once over a nine-year period. 

Health Effects in Vietnam

The Vietnam Red Cross reported as many as 3 million Vietnamese people have been affected by Agent Orange, including at least 150,000 children born with birth defects. According to Vietnamese Ministry of Foreign Affairs, 4.8 million Vietnamese people were exposed to Agent Orange, resulting in 400,000 people being killed or maimed, and 500,000 children born with birth defects. Women had higher rates of miscarriage and stillbirths, as did livestock such as cattle, water buffalo, and pigs.
Children in the areas where Agent Orange was used have been affected and have multiple health problems, including cleft palate, mental disabilities, hernias, and extra fingers and toes. In the 1970s, high levels of dioxin were found in the breast milk of South Vietnamese women, and in the blood of U.S. soldiers who had served in Vietnam. The most affected zones are the mountainous area along Truong Son (Long Mountains) and the border between Vietnam and Cambodia. The affected residents are living in substandard conditions with many genetic diseases.
About 28 of the former US military bases in Vietnam where the herbicides were stored and loaded onto airplanes may still have high level of dioxins in the soil, posing a health threat to the surrounding communities. Extensive testing for dioxin contamination has been conducted at the former US airbases in Da Nang, Phu Cat and Bien Hoa. Some of the soil and sediment on the bases have extremely high levels of dioxin requiring remediation. The Da Nang Airbase has dioxin contamination up to 350 times higher than international recommendations for action. The contaminated soil and sediment continue to affect the citizens of Vietnam, poisoning their food chain and causing illnesses, serious skin diseases and a variety of cancers in the lungs, larynx, and prostate.

Effects on U.S. veterans


Some studies showed that veterans who served in the South during the war have increased rates of cancer, and nerve, digestive, skin and respiratory disorders. Veterans from the south had higher rates of throat cancer, acute/chronic leukemia, Hodgkin's lymphoma and non-Hodgkin's lymphoma, prostate cancer, lung cancer, colon cancer, soft tissue sarcoma and liver cancer. With the exception of liver cancer, these are the same conditions the US Veterans Administration has determined may be associated with exposure to Agent Orange/dioxin, and are on the list of conditions eligible for compensation and treatment.
Military personnel who loaded airplanes and helicopters used in Ranch Hand probably sustained some of the heaviest exposures. Members of the Army Chemical Corps, who stored and mixed herbicides and defoliated the perimeters of military bases, and mechanics who worked on the helicopters and planes, are also thought to have had some of the heaviest exposures. However, this same group of individuals has not shown remarkably higher incidences of the associated diseases. Others with potentially heavy exposures included members of U.S. Army Special Forces units who defoliated remote campsites, and members of U.S. Navy river units who cleared base perimeters. Military members who served on Okinawa also claim to have been exposed to the chemical but there is no verifiable evidence to corroborate these claims.
While in Vietnam, the veterans were told not to worry, and were persuaded the chemical was harmless. After returning home, Vietnam veterans began to suspect their ill health or the instances of their wives having miscarriages or children born with birth defects might be related to Agent Orange and the other toxic herbicides to which they were exposed in Vietnam. Veterans began to file claims in 1977 to the Department of Veterans Affairs for disability payments for health care for conditions they believed were associated with exposure to Agent Orange, or more specifically, dioxin, but their claims were denied unless they could prove the condition began when they were in the service or within one year of their discharge.
By April 1993, the Department of Veterans Affairs had only compensated 486 victims, although it had received disability claims from 39,419 soldiers who had been exposed to Agent Orange while serving in Vietnam.

In 1991, the US Congress enacted the Agent Orange Act, giving the Department of Veterans Affairs the authority to declare certain conditions 'presumptive' to exposure to Agent Orange/dioxin, making these veterans who served in Vietnam eligible to receive treatment and compensation for these conditions. The same law required the National Academy of Sciences to periodically review the science on dioxin and herbicides used in Vietnam to inform the Secretary of Veterans Affairs about the strength of the scientific evidence showing association between exposure to Agent Orange/dioxin and certain conditions.
Through this process, the list of 'presumptive' conditions has grown since 1991, and currently the U.S. Department of Veterans Affairs has listed prostate cancer, respiratory cancers, multiple myeloma, type II diabetes, Hodgkin's disease, non-Hodgkin's lymphoma, soft tissue sarcoma, chloracne, porphyria cutanea tarda, peripheral neuropathy, chronic lymphocytic leukemia, and spina bifida in children of veterans exposed to Agent Orange as conditions associated with exposure to the herbicide. This list now includes B cell leukemias, such as hairy cell leukemia, Parkinson's disease and ischemic heart disease, these last three having been added on August 31, 2010. Several highly placed individuals in government are voicing concerns about whether some of the diseases on the list should, in fact, actually have been included.

What is the Agent Orange Benefits Act?

The Agent Orange Benefits Act, Public Law 104-204, became law in 1996. The law established a benefits package for Vietnam veterans' children who were born with Spina Bifida, possibly as a result of exposure of one or both parents to herbicides during active service in the Republic of Vietnam during the Vietnam era.
The Act authorized the Department of Veterans Affairs to provide certain benefits effective October 1, 1997. These benefits include lifetime health care services for Spina Bifida and “any disability associated” with Spina Bifida, a monthly monetary allowance, and Veterans Affairs (VA) vocational training/rehabilitation services.
The VA defines Spina Bifida as all forms of Spina Bifida (except Spina Bifida Occulta). In establishing rules to determine the monthly monetary allowance, the VA indicated that “neurological deficit is the main determinant of disability for a person with Spina Bifida.” An estimated 10-20% of the population may have Spina Bifida Occulta; however, Occulta is not considered to have a neurological deficit according to the VA. The Women Vietnam Veterans' Children's Birth Defect Benefits Act is an act modeled after the Agent Orange Benefits Act; however, it only provides benefits to children of women Vietnam veterans whose children suffer from certain types of birth defects, with the exception of Spina Bifida.

Are any VA benefits available for children of Vietnam veterans born with Spina Bifida?

Children of Korean or Vietnam veterans born with Spina Bifida are eligible for a monthly disability allowance and for vocational training. A monthly allowance is set at three levels, depending upon the degree of disability suffered by the child. VA's Vocational Rehabilitation and Employment program administers a vocational training program to enable a qualified child to prepare for and attain suitable employment. Services may include counseling and rehabilitative services, education, training and employment services. VA pays for the costs of the services up to 24 months depending on need. For more information on Spina Bifida, please visit the VA's web site athttp://www.va.gov/hac/forbeneficiaries/spina/spina.asp or contact your local VA regional office at 1-800-827-1000.

What is the first step in establishing eligibility for VA Spina Bifida healthcare benefits?

Since VA Spina Bifida healthcare benefits are based upon eligibility determinations made by VA regional offices, prospective beneficiaries must first contact a regional office to obtain an Application for Spina Bifida Benefits (VA Form 21-0304). The local VA regional office can be contacted toll-free at 1-800-827-1000. Upon return of a completed application, the regional office will determine eligibility and notify the applicant of the determination.

Upon establishing eligibility through a VA regional office, what is the next step in obtaining VA Spina Bifida healthcare benefits?

Beneficiaries in receipt of a VA regional office Spina Bifida award should immediately contact VA's Health Administration Center (HAC) in Denver, CO, to register for health care benefits. The following information is required: name, address, and telephone number of both the beneficiary and veteran sponsor (and legal guardian when applicable); Social Security number of both the beneficiary and veteran sponsor; and, VA claim number of the veteran sponsor. Registration with HAC can be accomplished by telephone, fax, or mail
The telephone number for Spina Bifida Healthcare Benefits Information/Registration is 1-888-820-1756. The fax number is 1-303-331-7807. The address is VA Health Administration Center, Spina Bifida Healthcare Benefits, P O Box 65025, Denver, CO, 80206-9025

What other assistance is available?

The American Legion Service Officers (DSO) offer free advice and guidance for veterans who need to deal with the Department of Veterans Affairs (VA). This directory provides contact telephone numbers and addresses for the service officers in your area. Direct all correspondence to Department Service Officer. For the directory, please visit www.legion.org or call (202) 861-2700.
The National Veterans Legal Services Program specializes in legal issues and referrals for veterans. For more information, please visit www.nvlsp.org or call (202) 265-8305.
This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.

Additional resources

http://www.publichealth.va.gov/exposures/agentorange/birth_defects.asp
American Legion
www.legion.org
Help with Claims and Benefits, Health Issues Line
202- 861-2700
National Veterans Legal Services Program
PO Box 65762
Washington, DC 20035
202-265-8305
Fax 202-328-0063
Email: info@nvlsp.org
Web: www.nvlsp.org
VA Health Administration Center
Spina Bifida Healthcare Benefits Information/Registration
P O Box 65025
Denver, CO, 80206-9025
1-888-820-1756
Email: spina.inq@med.va.gov
Web: www.va.gov/hac

Thursday, October 17, 2013

Spina Bifida and Urinary Tract Infections

Urinary Tract Infections (UTI’s) are quite common in the Spina Bifida population. I, myself, have had numerous UTI's in my lifetime. There are 
two types of UTI’s: the bladder (cystitis) or the kidneys (pyelonephritis). These can present 
with no symptoms (asymptomatic) or with systems (symptomatic). I have always been taught by my doctors to never take antibiotics for an infection unless I was symptomatic. This would cut down on the chance of becoming immune to the prescriptions. However, you should speak to your own medical professional about what is best for your or your child. 

Signs of infection to look for are: 

• urine looks or smells different e.g. a 'fishy' smell 
• wet in between catheterization when usually dry 
• needing to go more often 
• burning or stinging sensation 
• blood in urine 
• temperature, headaches, vomiting 

When someone has cystitis, they generally need to pass urine more often than usual and if 
sensation is present they may have to hurry to the toilet (urgency). The urine looks cloudy 
instead of clear and may smell different from usual. Drink extra fluids and take your child to 
your GP or Paediatrician who may prescribe a course of antibiotics. Ensure that laboratory 
testing is carried out to confirm the presence of a UTI. 

A much more serious situation arises in pyelonephritis in which the infection affects the 
kidneys causing a high temperature, tummy ache, backache, and sickness and may 
cause scaring to the kidneys. 

Why UTIs are Common in Children with Spina Bifida? 

Children with Spina Bifida often lack feeling and control of their bladder and bowel in the 
same way as they may lack feeling and control of their feet and legs. This is because the 
nerves in the spine connecting the brain to the bladder (or bowel or legs) have been 
interrupted, or disconnected, by the Spina Bifida. The result is that they cannot usually feel 
when their bladder is full, nor can they empty it properly. The bladder may still contain urine 
(the residual urine) after they have tried to empty it. The stagnant pool or residual urine left 
in the bladder gets smelly and easily becomes infected and over a period of time stones 
may develop (urinary calculi) as well. Bladder Infections may affect the kidneys causing 
pyelonephritis and kidney damage, making the child ill. This happens because the bladder 
does not empty out the infected urine. It may also happen with ureteric reflux when the 
infected urine travels up towards the kidneys. 

Many children with Spina Bifida do not know when they have a urinary infection. Because 
they lack feeling they do not suffer from the scalding pain which other children feel when they get cystitis, nor do they know their bladder is not emptying properly. UTI’s should be 
confirmed with laboratory testing before treatment is administered. Treating children with 
antibiotics and extra fluids works more slowly if the bladder is not emptying. The best way to 
prevent urinary infections damaging the kidneys is to be sure that the bladder empties 
regularly and completely. One way of doing this is by clean intermittent catheterisation 
and by being vigilant with a hygiene program and following strict hygiene guidelines. (see 
“How to prevent UTI’s) 

How CIC Lessons the Chances of Urinary Infections 

Clean Intermittent Catheterization (CIC) means inserting a narrow tube (catheter) into the 
urinary passage (urethra) into the bladder. There are different length catheters available 
suitable for either boys or girls. The urine flows out of the bladder through the catheter into 
the lavatory, or into a container, until the bladder is completely empty and then the 
catheter is removed after complete emptying. This should be done 4 – 5 times a day. 
Regular drainage of the bladder will improve social continence and help to reduce UTIs. 
Catheterization should take place at least four times a day but for those who have a 
smaller bladder this may need to be increased to six times. With practice catheterization 
becomes quite easy and may take less than five minutes. Twenty-five years of experience 
of intermittent catheterization has shown that it reduces infections and prevents damage 
to the kidneys as well as improving those already damaged, if CIC and hygiene regimes 
are consistent. 

How to Prevent UTI’s 

• Maintain adequate fluid intake by encourage your child to drink at least 4 cups a day 
and carry a drink bottle with them at all times. (The aim is to increase this fluid intake to 2 
litres) 
• Ensure regular complete bladder emptying 
• Relieve constipation 
• Ensure the use of appropriate catheter size and type 
• Maintain a strict hygiene routine 

Bowels 
People with Spina Bifida are often constipated and pressure from an overfull bowel may 
add to the difficulty of emptying the bladder. They may also have poor control over their 
bowel in the same way as they have over the bladder. Since most urinary infections are 
caused by bacteria which normally live in the bowel, it is important to wash this part of the 
body carefully. Girls should be taught always to wipe from front to back and not from back 
to front. 

Medicines 
UTI’s should be confirmed with laboratory testing before treatment is administered. 
Antibiotics and other medicines are sometimes given in small doses for months or years to 
prevent urinary infections. They are mainly used for children who have reflux or for anyone 
with damaged kidneys to protect them from further harm. In spite of this, urinary infections 
may still break through and need a course of a different treatment. 

Other Remedies 
Many remedies have been used over the years to prevent or relieve urinary infections and 
two of these are worth mentioning: Vitamin C (ascorbic acid) and cranberry juice. Vitamin 
C acts by making the urine acidic and this discourages some of the bacteria which cause 
urinary infections. Cranberry juice helps to clear infections and debris after operations on 
the bladder (specifically e. Coli) 

Key points 
• In children with Spina Bifida urinary tract infections are mainly due to the bladder not 
emptying properly. 
• Poor drainage from the bladder encourages infections to spread to the kidneys where 
they may cause damage. 
• Good drainage is as important as fluid intake. 
• Intermittent catheterisation ensures good drainage and protects the kidneys. It may also 
encourage social continence.