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Dr. Richard Bruno, HD, PhD
Director, International Centre for Polio Education and author of The Polio Paradox
Hosts The Harvest Center’s Post-Polio Coffee House
We share his Tips and Tidbits of PPS information as he shares them.
Every issue of Bruno "Bytes" is available in PDF format at the bottom of this page. Feel free to print and share these.
Dr. Richard Bruno, HD, PhD
Director, International Centre for Polio Education and author of The Polio Paradox
Hosts The Harvest Center’s Post-Polio Coffee House
We share his Tips and Tidbits of PPS information as he shares them.
Every issue of Bruno "Bytes" is available in PDF format at the bottom of this page. Feel free to print and share these.
Bruno Bytes - January 2019
NOTE: Many of these articles are abbreviated.
Just "Click" on the word "HERE" in red for the complete article (or) download the PDF version of Bruno Bytes (below).
NOTE: Many of these articles are abbreviated.
Just "Click" on the word "HERE" in red for the complete article (or) download the PDF version of Bruno Bytes (below).
On the topic of the Effects of Winter’s Chill (1/1/2019)
Dr. Bruno’s Original Post: WINTER'S HERE! WELCOME POLIO FEET?
Polio survivors have blood flow to the skin of the legs and feet that's too good, causing hot body-core blood to dump its heat, makes leg blood vessels contract and legs and feet get cold and purple. Polio survivors' skin temperature is 20° LOWER than the outside temperature, so 65° acts like 45° at the surface of polio survivors' skin. There are several articles (under the topic “Temperature”) on polio feet and keeping legs warm in the Encyclopedia of Polio and PPS
On the topic of why Rehabilitation Physicians are best able to do EMG’s (1/3/2019)
Dr. Bruno’s Original Post: Why you WANT a rehab doc, versus just any neurologist, to do an EMG. Even if you have a rehab doc, you want to make sure that he or she does at least one EMG a week as a bare minimum…
New Study Shows Disparities in EDX Training in Residency Programs
Newswise — (ROCHESTER, Minnesota, Jan. 3, 2018) – Results from a 2017 survey shared at the 2018 annual meeting of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) illustrate significant disparities in the amount of training that neurology and physical medicine and rehabilitation (PMR) residents receive in electrodiagnostic (EDX) medicine. “Our data showed a great difference in how programs teach EDX medicine, including nerve conduction studies (NCSs) and particularly electromyography (EMG). The differences included duration of training in weeks, supervision, independence in performing NCSs and EMG, continuous or fragmented training, the training years of residency, the number of attending physicians teaching the residents, organized conferences, the number of NCSs and needle EMGs performed, and exposure to pathology material,” stated AANEM member Peter D. Donofrio, MD.
The training disparities can have a significant impact on patient care.
“Probably the biggest impact is in the area of private practice where there are many neurologists out in the community doing EMG with limited training. This does not happen in PMR where all residents are required to be fully trained within their residency – PMR requires 6 months of EMG, neurology requires zero.
This article has been abbreviated. The full article is available HERE
On the topic of understanding Medicare “Observation” Status (1/6/2019)
Original Post: Understanding the “What if’s” of hospital admissions.
Howard Gleckman Jan 2, 2019
No issue generates more anger and confusion among Medicare recipients than observation status—that hospital stay that really isn’t a hospital stay. Over the holidays, I got an earful from three people who had been treated at a hospital by hospital staff yet not admitted to the hospital.
A typical case goes like this: A person comes to a hospital emergency department with chest pain. The ED docs determine she is not having a heart attack but want her to stay overnight to monitor her health.
But instead of admitting her as an inpatient, the hospital keeps her for a day or so as an outpatient, sometimes on a separate unit but sometimes—and more confusingly-- in a regular room. This is different from a patient who stays in the emergency department, sometimes for many hours, while the hospital waits for an inpatient bed to open up. Unlike observation, which is an explicit choice, ED boarding is unplanned and forced by a temporary lack of beds.
This article has been abbreviated. The complete article is available HERE
On the topic of Anesthesia Warning Information (1/13/2019)
When having anesthesia, make sure you give the information about Polio survivors to the Anesthesiologist/Anesthetist,
not just to the surgeon.
The updated information is in the Encyclopedia of Polio and PPS under BOTH Anesthesia and Surgery and Anesthesia.
On the topic of Home Health Services and Medicare (1/15/2019)
Original Post: What Home Health Services are covered by Medicare?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services if you meet all of these conditions:
On the topic of Muscle Pain (1/16/2019)
Dr. Bruno’s Original Post: MUSCLE PAIN: Is it Cramps, Spasticity or Spasm?
There are often Coffee House questions about muscle pain and medications. Doctors often confuse muscle cramps, spasticity and spasm, which leads to prescribing the wrong treatment.
Here’s a primer on what’s what and the treatments for each…
RULE #1: Diagnose the RIGHT CONDITION and treat its CAUSE, not PAIN, first. (Always tell your doctor what medications you're taking and ask about side effects before accepting a new drug.)
CRAMPS, SPASTICITY or SPASM?
CRAMPS are due to painful shortening of a muscle caused by overuse, muscle fatigue, dehydration or electrolyte abnormalities.
Rx? None. Gentle stretching, replace fluids and electrolytes
SPASTICITY is an increase in muscle tone that causes resistance to limb movement due to the brain not “turning off” a muscle.
Rx?
Rx?
> Clonazepam is taken 30 minutes before eating to stop esophagus spasms when swallowing.
See HERE for more information.
There are more articles on this topic in the Muscle Pain/Weakness section of the ENCYCLOPEDIA of POLIO & PPS.
On the topic of Anesthesia for Minor Surgery (1/18/2019)
Original Post: I have to have surgery on my eyelid. They want to give me local anesthesia. When I have local anesthesia for dentistry it wears off very quickly. Will it do the same with the eyelid? Why does this happen to polio survivors? Last time I had dental work done, they had to do a nerve block because the novocaine kept wearing off.
Dr. Bruno’s Response: In our first research study of polio survivors we found that they were twice as sensitive to pain as people didn't have polio. The poliovirus killed off the neurons that generate the body's own morphine.
A lack of effectiveness of typical doses of local anesthetic, and the anesthetic wearing off too quickly, are typical in polio survivors. If your doctor uses Xylocaine 1%, ask for Marcaine 2% instead. Look under “Anesthesia” in the articles section of the Encyclopedia of Polio and PPS.
On the topic of Post-Polio Syndrome being “terminal” (1/23/2019)
Original Post: Is PPS considered a terminal disease?
Dr. Bruno’s Response: PPS is NEVER terminal. As I always say, "Polio survivors never die. They just limp away.”
On the topic of the 2018 Webinar with Dr. Bruno (1/24/2018)
Original Post: We are happy to announce the availability of the webinar with Dr. Richard Bruno in two formats, the short Dr. "B" only talk AND the entire presentation.
Check out this webcast (and others) on the video page of the Encyclopedia Of Polio & PPS. In addition, there are direct links to his entire inventory of updated articles, his Books, Bruno Bytes and the complete Encyclopedia of Polio and PPS Index.
Dr. Bruno’s original post: The rule in polio survivors is that "barely abnormal" blood work findings -- "barely low" (e.g., T3/T4 thyroid hormones and anemia markers) or "barely high" (e.g., TSH=thyroid stimulating hormone) -- should be treated while they would not be treated in non-polio survivors.
On the topic of Stem Cells and IVIG for PPS (1/25/2019)
Original Post: I have lost the use of my polio leg. I have been lucky not needing any aids, need a cane now. Has anyone tried stem cells or IVIg to treat PPS?
Dr. Bruno’s Response: Stem Cells and IVIG. Once again, questions are coming up about these two “Non-traditional” Treatments for PPS. Check out the Encyclopedia of Polio and PPS Articles Section: Treatment (Non-Traditional).
In addition you can go to the Encyclopedia of Polio and PPS Index By Subject. (There is a direct “link” from the Encyclopedia Main Page). Once you have opened up the Index you can hit “Control F”. Enter stem cells or IVIG in the search box that comes up. Encyclopedia and Bruno Bytes comments/article references will come up.
On the topic of PPS Fatigue (1/28/2019)
Original Post: Somedays I overdo it and have no pain, other days I take it easy and suffer the next day. What’s up?
Dr. Bruno’s Response: Remember “The 48 HOUR RULE:” Polio survivors can often beat themselves up on a Saturday, feel fine on Sunday and crash on Monday. The best way to avoid pain and fatigue? Don’t do things that cause them. "Conserve to Preserve" remaining, poliovirus-damaged neurons is the treatment for PPS.
You can find the “cause” of pain and fatigue by monitoring your activities with the Post-Polio Fatigue Log in the Articles section of the Encyclopedia.
Dr. Bruno’s Original Post: WINTER'S HERE! WELCOME POLIO FEET?
Polio survivors have blood flow to the skin of the legs and feet that's too good, causing hot body-core blood to dump its heat, makes leg blood vessels contract and legs and feet get cold and purple. Polio survivors' skin temperature is 20° LOWER than the outside temperature, so 65° acts like 45° at the surface of polio survivors' skin. There are several articles (under the topic “Temperature”) on polio feet and keeping legs warm in the Encyclopedia of Polio and PPS
On the topic of why Rehabilitation Physicians are best able to do EMG’s (1/3/2019)
Dr. Bruno’s Original Post: Why you WANT a rehab doc, versus just any neurologist, to do an EMG. Even if you have a rehab doc, you want to make sure that he or she does at least one EMG a week as a bare minimum…
New Study Shows Disparities in EDX Training in Residency Programs
Newswise — (ROCHESTER, Minnesota, Jan. 3, 2018) – Results from a 2017 survey shared at the 2018 annual meeting of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) illustrate significant disparities in the amount of training that neurology and physical medicine and rehabilitation (PMR) residents receive in electrodiagnostic (EDX) medicine. “Our data showed a great difference in how programs teach EDX medicine, including nerve conduction studies (NCSs) and particularly electromyography (EMG). The differences included duration of training in weeks, supervision, independence in performing NCSs and EMG, continuous or fragmented training, the training years of residency, the number of attending physicians teaching the residents, organized conferences, the number of NCSs and needle EMGs performed, and exposure to pathology material,” stated AANEM member Peter D. Donofrio, MD.
The training disparities can have a significant impact on patient care.
“Probably the biggest impact is in the area of private practice where there are many neurologists out in the community doing EMG with limited training. This does not happen in PMR where all residents are required to be fully trained within their residency – PMR requires 6 months of EMG, neurology requires zero.
This article has been abbreviated. The full article is available HERE
On the topic of understanding Medicare “Observation” Status (1/6/2019)
Original Post: Understanding the “What if’s” of hospital admissions.
Howard Gleckman Jan 2, 2019
No issue generates more anger and confusion among Medicare recipients than observation status—that hospital stay that really isn’t a hospital stay. Over the holidays, I got an earful from three people who had been treated at a hospital by hospital staff yet not admitted to the hospital.
A typical case goes like this: A person comes to a hospital emergency department with chest pain. The ED docs determine she is not having a heart attack but want her to stay overnight to monitor her health.
But instead of admitting her as an inpatient, the hospital keeps her for a day or so as an outpatient, sometimes on a separate unit but sometimes—and more confusingly-- in a regular room. This is different from a patient who stays in the emergency department, sometimes for many hours, while the hospital waits for an inpatient bed to open up. Unlike observation, which is an explicit choice, ED boarding is unplanned and forced by a temporary lack of beds.
This article has been abbreviated. The complete article is available HERE
On the topic of Anesthesia Warning Information (1/13/2019)
When having anesthesia, make sure you give the information about Polio survivors to the Anesthesiologist/Anesthetist,
not just to the surgeon.
The updated information is in the Encyclopedia of Polio and PPS under BOTH Anesthesia and Surgery and Anesthesia.
On the topic of Home Health Services and Medicare (1/15/2019)
Original Post: What Home Health Services are covered by Medicare?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services if you meet all of these conditions:
- You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care (other than drawing blood)
- Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe, and an effective treatment for your condition. The amount, frequency, and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.
- To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
- The home health agency caring for you is approved by Medicare (Medicare certified).
- You must be homebound, and a doctor must certify that you're homebound .
On the topic of Muscle Pain (1/16/2019)
Dr. Bruno’s Original Post: MUSCLE PAIN: Is it Cramps, Spasticity or Spasm?
There are often Coffee House questions about muscle pain and medications. Doctors often confuse muscle cramps, spasticity and spasm, which leads to prescribing the wrong treatment.
Here’s a primer on what’s what and the treatments for each…
RULE #1: Diagnose the RIGHT CONDITION and treat its CAUSE, not PAIN, first. (Always tell your doctor what medications you're taking and ask about side effects before accepting a new drug.)
CRAMPS, SPASTICITY or SPASM?
CRAMPS are due to painful shortening of a muscle caused by overuse, muscle fatigue, dehydration or electrolyte abnormalities.
Rx? None. Gentle stretching, replace fluids and electrolytes
SPASTICITY is an increase in muscle tone that causes resistance to limb movement due to the brain not “turning off” a muscle.
Rx?
- Note: Gabapentin and Lyrica decrease sensory nerve firing to treat nerve pain that can be related to a nerve injury that causes spasticity. These drugs act on the brain and can cause sedation and other “central” side effects.
Rx?
- Gabapentin and Lyrica decrease sensory nerve firing to treat nerve pain that can be related to the nerve injury that causes spasm.
- Baclofen is often prescribed but is not specific for spasm and can cause sedation and other “central” side effects.
- Skelaxin (metaxalone) and Zanaflex (tizanidine) are newer drugs, potent, but also expensive and can be very sedating.
- Flexeril (cyclobenzaprine), Robaxin and Soma are old drugs, are cheap but don't work very well and also cause sedation at doses needed to treat spasm.
- Valium (diazepam) and the “…am” drugs: Valium (diazepam) is still the go-to drug, acting in the spinal cord to turn muscle spasms off.
> Clonazepam is taken 30 minutes before eating to stop esophagus spasms when swallowing.
See HERE for more information.
There are more articles on this topic in the Muscle Pain/Weakness section of the ENCYCLOPEDIA of POLIO & PPS.
On the topic of Anesthesia for Minor Surgery (1/18/2019)
Original Post: I have to have surgery on my eyelid. They want to give me local anesthesia. When I have local anesthesia for dentistry it wears off very quickly. Will it do the same with the eyelid? Why does this happen to polio survivors? Last time I had dental work done, they had to do a nerve block because the novocaine kept wearing off.
Dr. Bruno’s Response: In our first research study of polio survivors we found that they were twice as sensitive to pain as people didn't have polio. The poliovirus killed off the neurons that generate the body's own morphine.
A lack of effectiveness of typical doses of local anesthetic, and the anesthetic wearing off too quickly, are typical in polio survivors. If your doctor uses Xylocaine 1%, ask for Marcaine 2% instead. Look under “Anesthesia” in the articles section of the Encyclopedia of Polio and PPS.
On the topic of Post-Polio Syndrome being “terminal” (1/23/2019)
Original Post: Is PPS considered a terminal disease?
Dr. Bruno’s Response: PPS is NEVER terminal. As I always say, "Polio survivors never die. They just limp away.”
On the topic of the 2018 Webinar with Dr. Bruno (1/24/2018)
Original Post: We are happy to announce the availability of the webinar with Dr. Richard Bruno in two formats, the short Dr. "B" only talk AND the entire presentation.
Check out this webcast (and others) on the video page of the Encyclopedia Of Polio & PPS. In addition, there are direct links to his entire inventory of updated articles, his Books, Bruno Bytes and the complete Encyclopedia of Polio and PPS Index.
- The direct link to Dr. Bruno’s entire inventory of updated articles the Encyclopedia of Polio and PPS is also available on Dr. Bruno’s website - www.postpolioinfo.com
- The Biography of Dr. Richard L. Bruno, HD, PhD is easily accessed any time you see his name in "RED". This is important when sharing the information with your health care providers.
Dr. Bruno’s original post: The rule in polio survivors is that "barely abnormal" blood work findings -- "barely low" (e.g., T3/T4 thyroid hormones and anemia markers) or "barely high" (e.g., TSH=thyroid stimulating hormone) -- should be treated while they would not be treated in non-polio survivors.
On the topic of Stem Cells and IVIG for PPS (1/25/2019)
Original Post: I have lost the use of my polio leg. I have been lucky not needing any aids, need a cane now. Has anyone tried stem cells or IVIg to treat PPS?
Dr. Bruno’s Response: Stem Cells and IVIG. Once again, questions are coming up about these two “Non-traditional” Treatments for PPS. Check out the Encyclopedia of Polio and PPS Articles Section: Treatment (Non-Traditional).
In addition you can go to the Encyclopedia of Polio and PPS Index By Subject. (There is a direct “link” from the Encyclopedia Main Page). Once you have opened up the Index you can hit “Control F”. Enter stem cells or IVIG in the search box that comes up. Encyclopedia and Bruno Bytes comments/article references will come up.
On the topic of PPS Fatigue (1/28/2019)
Original Post: Somedays I overdo it and have no pain, other days I take it easy and suffer the next day. What’s up?
Dr. Bruno’s Response: Remember “The 48 HOUR RULE:” Polio survivors can often beat themselves up on a Saturday, feel fine on Sunday and crash on Monday. The best way to avoid pain and fatigue? Don’t do things that cause them. "Conserve to Preserve" remaining, poliovirus-damaged neurons is the treatment for PPS.
You can find the “cause” of pain and fatigue by monitoring your activities with the Post-Polio Fatigue Log in the Articles section of the Encyclopedia.
Biography of Richard L. Bruno, HD, PhD.
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Complete "Bruno Bytes" from Previous Months
In easily printable PDF format below
In easily printable PDF format below
2019
2018
2017
2016
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2015
|
2014
“Bruno Bytes” – How it all began
“Bruno Bytes” are published monthly, through a combined effort between Dr. Richard L. Bruno, HD, PhD (biography above) and
the Pa. Polio Survivor’s Network. They are answers to questions posted in the “Post-Polio Coffee House” (on Facebook).
This partnership began in November, 2014.
“Bruno Bytes” help to teach polio survivors, spouses, caregivers and health care professionals about the many and varied topics related to the physical and emotional issues associated with having had polio and managing PPS.
“Bruno Bytes” are for education only and any personal treatment plan must be determined in association with a PPS knowledgeable health care professional.
“Bruno Bytes” are published monthly, through a combined effort between Dr. Richard L. Bruno, HD, PhD (biography above) and
the Pa. Polio Survivor’s Network. They are answers to questions posted in the “Post-Polio Coffee House” (on Facebook).
This partnership began in November, 2014.
“Bruno Bytes” help to teach polio survivors, spouses, caregivers and health care professionals about the many and varied topics related to the physical and emotional issues associated with having had polio and managing PPS.
“Bruno Bytes” are for education only and any personal treatment plan must be determined in association with a PPS knowledgeable health care professional.