Guest guest Posted October 5, 2011 Report Share Posted October 5, 2011 Your Daily Posterous Spaces Update October 5th, 2011 Bell’s palsy disables facial muscles of about 40,000 Americans each year<http://ptmanagerblog.com/bells-palsy-disables-facial-muscles-of-about> Posted about 24 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73930008> Bell’s palsy disables facial muscles of about 40,000 Americans each year By Lonnae O’Neal , Published: September 30 | Updated: Monday, October 3, 6:21 PM That morning, I noticed first that I couldn’t spit. I was brushing my teeth, but I couldn’t close my lips around the toothbrush, and my mouth didn’t seem to work right. Weird, I thought, but I quickly put it out of my mind. I was on assignment for The Post and probably I was just tired from the overnight drive from Prince ’s County to Greensboro, N.C. Perhaps it was the two glasses of wine a couple of nights before. Maybe it was the flu. Whatever it was, I was sure I didn’t have time for it. I was traveling to Atlanta with two guys I was writing about, and as we grabbed breakfast before the second leg of our drive, my weird-face feeling intensified. Then my right eye began to ache, and a sudden fear iced my spine. I stepped outside the restaurant to stare at my reflection in the car window, and I couldn’t process what I was seeing. I couldn’t move the right side of my face, and my eye ached because I couldn’t close it. The parking lot started to swim, and I willed myself not to faint. “Something’s wrong with my face,” I told the guys haltingly. “I have to go to the emergency room when we get to Atlanta.” But they insisted on taking me immediately in Greensboro. I’m glad they did. “My face is paralyzed, and I can’t blink. I think I’m having a stroke,” I told the receptionist at the Moses Cone Urgent Care Center, though it all felt so surreal. I’m only 44, and I’m healthy! “You are either having a stroke or you have Bell’s palsy,” the receptionist said as an EMT ushered me to the back. Turns out I had Bell’s palsy<http://www.ninds.nih.gov/disorders/bells/bells.htm> .. Bell’s palsy, which affects perhaps 40,000 Americans <http://www.bellspalsy.ws/>a year, is characterized by acute inflammation or trauma to the seventh cranial nerve, disabling the muscles of one side of the face. This can cause anything from slight weakness in those muscles to total paralysis sometimes resulting in a face that looks melted. The inability to smile and blink are classic symptoms. The cause of Bell’s palsy is unknown, but theories include a herpes virus, bacterial infections and facial misalignments that increase pressure on the nerves. And it’s more common in diabetics and women in the third trimester of pregnancy. Eight-five percent of those with Bell’s palsy have complete or near complete recoveries, often without treatment. But 15 percent are left with permanent damage ranging from mild to severe. And for up to three months, the time it typically takes nerves to begin to regenerate, no one can tell you which group you’ll belong to. The urgent-care doctor immediately put me on a 10-day course of high-dose steroids to bring down the nerve swelling. She also patched my unblinking right eye, which, left uncovered, could get scratched or sustain permanent damage. I couldn’t pucker or fully chew, and even my eyelashes pointed downward toward my cheek (I reminded myself of the “Sesame Street” character Mr. Snuffleupagus), but my face wasn’t visibly drooped. Still, the eye patch, which I had to wear continuously, was dramatic. My eye ached constantly, and I kept it filled it with lubricant and taped it shut every night. *The novelty wears off* For a few days, novelty carried me. My POV had changed dramatically. People reacted to the patch with curiosity or sympathy. Friends, colleagues and cab drivers all wanted to share stories of people they’d known — the young teacher, the guy who was about to get married — whose faces had suddenly fallen. And though little kids stared, I didn’t mind. In a strange way, it was a relief not to worry about my looks. I could still manage presentable or pulled together, but the eye patch relieved me of any duty to try to be pretty or sexy. But as days became weeks, I started each morning with a cry. Bell’s palsy had come on dramatically, overnight, and I thought maybe it would be gone overnight as well. Then I’d try to smile and realize I had at least one more day of paralysis. I compared myself with the “before” Lonnae and wondered if she was ever coming back. I wondered if maybe I would be one of the 15 percent whose faces would never fully come back. Usually after a few minutes, I’d dry my tears and spend a little time in the mirror practicing my new, enigmatic Mona half-smile. (Informed speculation has it that Mona may have had Bell’s palsy<http://www.ncbi.nlm.nih.gov/pubmed/20929717>, though once you have it, you suspect it in everyone with a funny smile.) “Ninety percent of our patients come in, and their biggest complaint is they can’t smile,” says Jodi Barth, regional director at the National Rehabilitation Hospital clinic in Rockville and a physical therapist for 30 years who has worked with Bell’s palsy patients for more than a decade. “It’s devastating.” She and her colleague Gincy SteZar each see 11 patients a day, and 80 percent of them have Bell’s palsy. Our faces are agents of personality and communication, and some patients, says Barth, have come in so self-conscious that they’ve worn scarves around their faces or wanted to be seen in private rooms. Though the precise cause is unknown, Barth says a majority of her patients report experiencing “massive stress” before their Bell’s palsy onset. Her theory: Stressed people clench and overuse muscles around the jaw joint, increasing pressure in the area. I had been dealing with difficult personal and professional issues and had been awakening with my jaws aching, and for me, that explanation felt exactly right. *Cheers all around* I’d seen an urgent-care doctor, my primary-care physician (who ruled out Lyme disease) and a neurologist, and they’d all said the same thing: My case was mild, and I’d probably improve in four to six weeks, which made me feel better. But it was in the NRH waiting room, with other patients just like me, that I felt most hopeful. Family and friends had been great, but none of them could fully understand how alone and afraid I felt. Barth saw me for the first time and said, “You’re doing beautifully,” and I was nearly overcome with emotion. Inside NRH’s large therapy room I saw a woman blow out a candle for the first time in eight years, and a 15-year-old, who’d come down with Bell’s palsy when she was 12, show off the whistle she’d just gotten back six months ago. And everyone cheered. We cheered over the reappearance of wrinkles and dimples, and every small lift of a brow. To reeducate damaged facial nerves, rehab experts such as Barth use a variety of treatments, including biofeedback, massage and a device they call the “mirror book,” which allows patients to practice making faces — my favorite was the snarl — using the functional half of their faces as a guide. They sometimes refer patients to physicians who use botox to help with asymmetry and to reduce involuntary muscle movements (such as blinking when you eat) that can develop on the palsy side of the face. Barth says her team has seen marked recovery even in patients who have had the condition for 15 or 20 years. But the biggest initial factor in recovery is steroids, she says. A recent study has backed <http://www.ncbi.nlm.nih.gov/pubmed/21099725>that up. “If you wake up with this weakness anywhere in your face, get to the doctor or ER,” Barth says. “Getting those steroids in [within] the 24-48 hours is crucial because the steroids are anti-inflammatory, and the nerve is inflamed.” Recurrence of Bell’s palsy happens in only about 5 to 9 percent of cases, according to the Bell’s Palsy Information Site<http://www.bellspalsy.ws/>. My neurologist, H. Avin, likened it to lightning striking twice. Croen, a cantor at the Temple Sinai synagogue in Northwest Washington, was eating breakfast with her son 31 / 2 years ago when she noticed “my mouth wasn’t working right,” and her son told her she didn’t look so good. “That night I couldn’t close my eye, and my face was totally drooped.” She began seeing Barth and Stevar six weeks later. She didn’t know if she could continue standing up in front of the congregation and chanting prayers. “I was really depressed,” she says. “I felt grotesque.” Today, her face shows some asymmetry, but it’s nothing like it was. “I’m still making incremental changes,” Croen says. And she notes that her singing coach says the combinations of therapy have actually made her voice better. From the beginning, I kept a Bell’s palsy diary and noted every oddity and uptick in my condition. On Day 5, I couldn’t twitch my nose. On Day 11, I could do a series of lagging half-blinks (it is very odd to watch your eyes move as if they’re set on different timers). By Day 18, I could squeeze several teeth into my half smile, and the ends of eyelashes were starting to curl up. Finally, nearly four weeks into my Bell’s palsy, my blink had largely returned, and I got rid of my eye patch. My smile was bigger, and I decided that if nothing else came back I’d be just fine. That anyone studying my face closely enough to notice something was a little off probably loved me anyway. In the following days, my face twitched constantly and my bad eye started to blink in unison with my good one. My smile began to feature all teeth, and I flashed it often. When I saw Barth and Stevar two weeks later, I was nearly my old self again. It was exactly as my doctors and the medical literature had predicted. I was a typical case with a fairly typical recovery. It has been almost three months since that road trip to Atlanta, and I am lucky. Not simply because I’ve experienced a nearly full recovery (my smile still seems a bit crooked), but because I was able to educate myself, talk to specialists and find a community of people who understood. If massive stress had brought on my Bell’s palsy, surely those human connections had helped mend it. Meanwhile, my takeaway points remain simple but profound: Pay attention to your body, seek help immediately if something seems off or “tingly,” and recognize that if you’re overly stressed, you have to find better ways of doing things, because sometimes a wake-up call can show up on your face. © The Washington Post Company PTManager Loves the DEEETROIT Tigers<http://ptmanagerblog.com/ptmanager-loves-the-deeetroit-tigers> Posted about 18 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73982004> http://mlb.jibjab.com/view/wrx3B3Yq7Qkp2Hap Medicare prescription drug abuse a problem: GAO | Reuters<http://ptmanagerblog.com/medicare-prescription-drug-abuse-a-problem-ga> Posted about 16 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73994124> Medicare prescription drug abuse a problem: GAO Tue Oct 4, 2011 2:14pm EDT WASHINGTON (Reuters) - Prescription drug abuse by elderly and disabled beneficiaries of Medicare cost the U.S. program nearly $150 million in 2008, highlighting an area where the government can seek to save health costs. According to a government report released on Tuesday, some of these patients went to at least five doctors to get multiple prescriptions of drugs that are often abused. In all, 170,000 people enrolled in the Medicare Part D prescription drug program went " doctor shopping " for drugs such as oxycodone and hydrocodone, powerful painkillers that can lead to addiction, according to the report by the Government Accountability Office (GAO). Those 170,000 who possibly abused the system were 1.8 percent of the patients who had prescriptions for these commonly abused drugs. The study began in 2010, using data from 2008, the latest year then available. Medicare enrolled about 43 million people in 2008. In one example, one individual received prescriptions from 87 different doctors during that year. Senator Brown, a Republican from Massachusetts, dubbed it " taxpayer-funded drug dealing " at a hearing about the issue on Tuesday. Brown said oxycodone could sell for over $5,000 in some areas of the country. " Medicare Part D beneficiaries are abusing powerful drugs to fill their own addictions or to sell them on the street, " said Senator Tom Carper, a Democrat and chairman of a subcommittee on federal financial management. " The controls ... put in place haven't done the trick. " The Centers for Medicare and Medicaid Services (CMS) notified doctors about patients who could be abusing prescription drugs. Blum, director of CMS's Center for Medicare, said his agency's fraud division was receiving a growing number of complaints about the issue. Fighting Medicare fraud has gained renewed urgency in recent months as a committee of Republicans and Democrats seeks ways to cut the nation's ballooning budget deficit ahead of a November deadline. " Everyone always has an angle to screw the government out of taxpayer money, " Brown said. " We're just doing things so inefficiently, it's mind-boggling. " The GAO and others called on CMS to take more stringent steps to prevent Medicare fraud, such as limiting patients to one doctor and one pharmacy to better monitor abuse. However, Blum said some patients with cancer, multiple-sclerosis or other diseases with complex treatments, or those without primary care physicians, may need to see several doctors. " Some beneficiaries are bouncing around from emergency room to emergency room, " Blum said at the hearing. " We have a very uncoordinated healthcare system today that we are working hard to reform. " " There is a balance between stopping behavior that is clearly fraudulent and illegal, and ensuring that beneficiaries have access to medication, " he said. (Reporting by Yukhananov; editing by Michele Gershberg<http://blogs.reuters.com/search/journalist.php?edition=us & n=michele.ge\ rshberg & >and Gerald E. McCormick) via reuters.com<http://www.reuters.com/article/2011/10/04/us-medicare-fraud-idUSTRE7\ 935LD20111004> Why we need stereotypes<http://ptmanagerblog.com/why-we-need-stereotypes> Posted 24 minutes ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=74113779> Why we need stereotypes 05 Oct 2011| *This morning , my fourteen year old daughter said, " I hate shopping! " She's excited about going to homecoming this weekend and she likes to dress up. But she has no interest in all the hassle involved in trying on different outfits and spending hours at the mall.* As if that isn't enough, she's ambivalent about Facebook, she enjoys an evening at home with my wife and me, and she does all her weekend homework on Friday afternoon so she isn't cramming on Sunday night. No - you can't adopt her. And believe me, there are some very " typical " adolescent characteristics of too. But she's a reminder that to assume certain things about a particular cultural group (in this case, U.S. adolescent girls) might not be entirely inaccurate. Stereotypes are more offensive to most of us than a four-letter word. The very idea makes us cringe. How many of us have heard a full culture described with one sweeping statement that may have a kernel of truth in it but hardly applies to everyone from that culture? And who of us likes to be on the receiving end of a stereotype? But I'm going to suggest that stereotypes get a bum rap. Hear me out. I'm the first one to speak up when someone starts to say, " When you negotiate with an Indian, remember xyz. " See - I'm so paranoid about stereotypes that I don't even want to perpetuate what would typically be said about negotiating with an Indian. And when hearing that, I'd usually ask, " Which Indian are you talking about? And do you mean an ethnic Indian who was born and raised in Toronto, someone who lives and works in Mumbai, or someone who grew up in Delhi but has worked for the last 10 years in Silicon Valley? " But this was supposed to be an article about why we need stereotypes. It's simply irresponsible to think you can interact, manage, and negotiate with everyone uniformly. In other words, we can't just " treat everyone the same " and research shows we don't anyway. Subconsciously, we're making snap judgments about new acquaintances as soon as we meet them. Our interactions with people from different cultural backgrounds often occur so quickly that we need to at least be prepared for some of the differences that are likely to emerge. For example, if you're making a presentation to an organization in a culture where authority and chain of command are taken seriously (e.g. high power distance), you want to plan your presentation in light of who has the most authority, how to appropriately interact with individuals according to their " status " , and how to refer to yourself and your role with your organization. Even where to sit, how to describe your credentials, and how to facilitate discussion are things that better consider the predominant view of authority held among a particular group of people. Now there's a chance you'll prepare a presentation for what you expect will be a very top-down culture. For example, let's say you're going to make a presentation to a group of Koreans at their organization in Seoul (a culture that scores very high on power distance). After some initial interactions, perhaps you find out that this is an organization that actually operates with very little hierarchy and that the adaptations planned for a top-down culture are unnecessary. Then it might make sense to revert back to the way you would have presented to a group in a low power distance culture. Although be forewarned. Even a " low power distance " organization in Korea is still likely to be very different from a parallel organization in Israel, one of the lowest power distance cultures in the world. In today's flattened world, the more typical scenario will be presenting to individuals and organizations who span the scope of low to high power distance, which then requires an adaptive approach to leadership and speaking that accounts for many different preferences. We can't be all things to all people but we surely better account for the varying tastes and preferences possible in any multicultural group and do the best we can to get a read on peoples' cultural values. Here are some rules of thumb for how to constructively use stereotypes or knowledge about cultural values in your work and relationships: 1. ALWAYS avoid negative stereotypes. It's never appropriate to refer to a certain culture as " lazy " or " deceitful " . But knowing that some cultures place a higher priority upon " work/life balance " or upon " indirect communication " will make you much more effective and less disoriented. 2. Treat stereotypes as your best first guess. Stereotypes follow the bell curve. About 80% of Koreans are " high power distance. " But you'll meet some who are very low power distance. Most U.S. girls love to shop. But is an outlier. 3. Be open to changing your assumptions. Keep your " best first guess " to yourself. Don't immediately apply a stereotype to an individual or situation. Check to see if your first guess was accurate and if not, change it. There are 14-year-old girls who love football more than shopping. 4. Move as quickly as possible to get to know an individual and an organization in it's own right rather than in light of broad generalizations. Few of us like to be on the receiving end of stereotypes - even if they're somewhat accurate. We want people to know us personally. So whenever possible, move beyond the generalization and get to know the specific organization and people. The Cultural Intelligence Center <http://www.culturalq.com/> offers CQ assessments that include an inventory and feedback on where individuals fall personally along the continuum of seven cultural values (e.g. individualism/collectivism, power distance, high and low context, etc.). Or check out chapter 5 of Leading with Cultural Intelligence<http://www.amazon.com/dp/0814414877/?tag=wwwdavidliver-20/>for practical ways to manage in light of different cultural values. via management-issues.com<http://www.management-issues.com/2011/10/5/opinion/why-we-\ need-stereotypes.asp> [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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