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2002 District Meetings
District Meeting Presentation Recaps
2002 2001
2000
1999
1998
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November 2001 District Meeting Recap
By Tom DeFranco
Scott Brown, a registered
dietician, presented at the November district meeting "Exercise
and Medical Nutritional Therapy for Diabetes". His presentation
was very informative and well received by the membership, as we all
have treated a patient with diabetes. We are exposed to this
diagnosis in all settings as physical therapists, due to the growing
epidemic numbers of diabetic patients and the devastating
disabilities that result from the side effects of uncontrolled blood
sugar levels. Sixteen million Americans suffer from diabetes.
Diabetes is a chronic
systemic disease, in which the body has difficulty controlling blood
sugar levels due to a lack of insulin or a resistance to insulin. It
is a genetic disease. However, environmental factors such as obesity,
smoking, and lack of exercise can increase the onset of diabetes in
those individuals genetically predisposed.
There are 2 types of
Diabetes: Type 1 and 2. Type 1 is when the pancreas does not produce
any insulin. Type 2 is when there is excessive insulin production,
but the cells become insulin resistant. Both result in high blood
sugar levels. Diabetes can be effectively treated, controlled with insulin/diet/exercise
to control blood sugar levels. However, 1 in 3 people do not know
they are diabetic until developing diabetic complications. On
average, patients with type 2 diabetes have the disease for 6.5 years
before being diagnosed. Over time, high blood sugar levels cause a
decrease in arterial circulation systemically, due to accelerated
atherosclerosis. This is what causes the permanent complications of
diabetes. The list includes amputation, neuropathy, blindness, renal
failure, stroke, hypertension and cardiac arrest.
Physical therapists treat
all of the disabilities/problems that result from these
complications. When restoring function, we use many techniques and
skills, including exercise. Fortunately, exercise also plays a big
roll in managing diabetes. Exercise for the diabetic patient has many
benefits. First, it improves the function of the cardiovascular
system, improving heart function, and lowering blood pressure and
cholesterol levels. Exercise helps to offset the damage done to the
cardiovascular system from high blood sugars. Furthermore, exercise
can help to reduce obesity. Obesity places more stress on the
body’s ability to control and stabilize blood sugar levels.
There are some possible
complications when exercising the diabetic patient that physical
therapists should know. The most common complication when exercising
the diabetic patient is hypoglycemia. Hypoglycemia is a drop in blood
sugar levels, which can result in poor tolerance for exercise.
Exercise increases insulin absorption and sensitivity, which both
will decrease blood sugar more quickly. Therefore, the patient should
always have a carbohydrate snack available and exercise 1-3 hours
after a meal to maintain proper blood sugar levels, especially for
diabetics who are using insulin. The following is a guideline for
carbohydrate replacement for patients at risk for hypoglycemia:
|
Intensity |
Duration |
CHO |
Frequency |
|
Mild |
<30 min |
May not need |
|
|
Moderate |
30-60 min |
15 grams |
Each hour |
|
High |
>60 min |
30-50 grams |
Each hour |
Other
possible complications w/ exercise includes detached/bleeding
retina(retinopathy), hypotension(autonomic neuropathy),
hyperglycemia(ketoacidosis) and increased proteinuria(nephropathy).
However, all these complications can be managed with modification and
monitoring. Using lighter weights and resistance can reduce the risk
of retinal problems, HTN and proteinuria. Walking at intervals can
help those suffering from PVD. Monitoring vital signs regularly will
ensure that individuals with CAD, hypotension and HTN are exercising
at appropriate levels. Avoiding very strenuous exercise will help
reduce the problem of hyperglycemia. Lastly, when designing an
exercises program for a patient with diabetes, the physical therapist
should consider the following: Blood sugar control, medications, time/content
of last meal, fitness level, and type of exercise indicated for
their disability.
May 2001 District Meeting
Tom DeFranco
Alison Heller-Ono, a physical therapist and owner of Worksite
International, presented to the San Jose district, the role of the
physical therapist in ergonomics. Alison became interested in
ergonomics in the 1980’s, as she saw a rash of work related
upper extremity and neck problems in her clinical practice. However,
she discovered there were no regulatory standards or employer
awareness of these types of work related injuries. In the 1990’s,
OSHA was mandated to create a set of standards for safe working
conditions. Throughout this decade, this mandate led to the
development of ergonomics for the prevention of cumulative stress
disorders (CSD).
Ergonomics is defined as " the match between employee and
environment". This includes the tools, equipment and the general
environment in the work setting. The decreasing match between the
employee and environment, leads to the loss of ergonomics. Ergonomics
can further be broken down into micro and macro ergonomics. Micro
ergonomics deals with identifying and addressing factors that cause
the employee to not match his/her environment. General health,
medical problems, morbidity’s, height and weight are some such
factors. Macro ergonomics identifies factors that cause the
environment to not match the employee. This would include areas such
as vibration, motion, temperature, light, etc&ldots; The main focus
of ergonomics is proactive prevention, not reactive treatment.
Work related injuries are an international problem. Despite the
recognition of the causes and problems identified with cumulative
stress disorders in the past decade, many regulatory bodies and
employers still do not fully understand the scope of this problem.
The OSHA federal mandate in the 1990’s resulted in only basic
rules, stating that the employer must provide a safe work
environment. Regulations for ergonomics at the federal level were
attempted but did not get enough support to pass. The regulations
proposed were to long and confusing for any realistic implementation.
At the state level, California is the only state that has developed
ergonomic regulations for the prevention of repetitive motions. This
regulation, 5110, can be viewed at www.dir.ca.gov.
Alison feels that physical therapists are professionals that can play
a major part in the development and implementation of ergonomics in
the work force. A Physical therapist’s training in anatomy,
physiology, kinesiology and physics, along with our experience with
CSD patients in the clinical setting, makes us the ideal professional
for ergonomics. Alison recommends anyone interested in becoming an
ergonomist, to be trained and knowledgeable in all areas of
ergonomics. Ergonomists are trained and board certified. Oxford
Research Institute is one of the facilities offering such
training/certification. Also, Alison feels that anyone working in the
area of ergonomics should have a working knowledge and understanding
of all standards/regulations that affect the employer/employee.
Lastly, future ergonomists should have some basic understanding of
general business practices, to better understand the realistic
dynamics between the employer and employee.
A physical therapist trained as an ergonomist, is able to practice in
a variety of settings. Clinically, the ergonomist can treat the
client suffering from CSD, as well as work with the client’s
employer to improve the ergonomics of the client’s work setting.
However, the ergonomist can also work directly with business and
industry. Alison’s company, Worksite International, has
developed a complete employer/employee training program to identify
ergonomic problems, and develop a long-term plan for correction and
prevention. Alison has been able to run a thriving company that is
based completely on ergonomics, and does not involve a clinical
practice. Worksite International is able to show employers that the
cost savings from ergonomics, in decreased workman compensation
claims, lost productivity and new training, greatly exceeds the cost
of setting up the ergonomic program itself.
Anyone interested in finding out more about ergonomics or how to
become an ergonomist, contact Alison Heller-Ono at Worksite
International, at (888)288-4463 or www.worksiteinternational.com.
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April 2001 District Meeting Recap
Submitted by Marianne Damon
Tissue Was the Issue
At our District Meeting of 4/10/01 held at Community Hospital of
Monterey Peninsula. Our featured speakers were Alain Claudel, PT,
presenting "Connective Tissue, A Review", and Dr. Brad
Tamler, Radiation Oncologist, speaking on "Tissue Changes During
Radiation Therapy". Alain reminded us that connective tissue is
made up of fibers, proteoglycans, and glycoproteins. Fibers are made
up of collagen (there are 19 types!). Proteoglycans are water-soluble
molecules that are hydrators, stabilizers and spacers. Glycoproteins
are stabilizers and bonders. Dr. Tamler discussed how connective
tissue responds to heat and radiation, leading to soft tissue injury.
In the treatment of cancer, he explained the roles of surgery
(surgical oncology), radiation, and chemotherapy (medical oncology).
When using radiation for cancer, the goal is to give a strong enough
dose to damage the cancer cells, but not so strong as to keep normal
cells from repairing themselves. Normal cells should be able to
repair in 4.5 hours. The total dose determines the long-term tissue
damage; the amount per dose determines short-term tissue damage. When
chemotherapy and radiation are used for the same patient, they are
usually given separately to minimize toxicity, and each is better for
different locations ("spatial cooperation"). Dr. Tamler
advised that we as Physical Therapists should watch for fibrosis
about nine years out with a patient who has undergone radiation
treatments combined with Taxol. He also warned that radiation and
surgery interact by leaving "scar upon scar". Radiation
causes tissue anoxia which damages the micro-circulation in the area.
Radiation can also prevent good scar healing. Where a surgeon places
a scar is very important for drainage. A poorly placed scar can
compound the drainage problem resulting in increased edema and ,
ultimately, the accumulation of hard tissue. One common radiation
injury is to the lower trunk of the brachial plexus as it crosses
under the clavicle; it is often damaged by fibrosis. Surgery to the
head and neck region often causes a muscle imbalance which can be
compounded by contracture from radiation. The jury is still out as to
whether hyperbaric oxygen (21% oxygen at 2-3 atmospheres) is
beneficial for decreasing infection. Nevertheless, Dr. Tamler does
send his fibrotic patients for this treatment at times since their
decreased circulation does make them more prone to infection. For
radiology patients, neither exercise nor heat are contraindicated
unless one is unsure if the residual is scar tissue or a tumor.
Pre-treatment, exercise or heat can increase circulation and increase
the effects of radiation though it is best to avoid exercise or heat
immediately post-treatment.
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February 2001 District Meeting Recap
by Marriane Damon
At the February district meeting at the San Jose Medical Center, Dr.
Mangiapia, MD delivered a very interesting and enthusiastic
presentation on Medical Accupuncture. Dr. Mangiapia started off by
reviewing the history of medical accupuncture, which is thought to
have first originated in China as long ago as 1000-4000 BC. However,
evidence suggests that accupuncture was practiced in other cultures,
such as those in the regions of Egypt, South Africa and Brazil. The
French discovered accupuncture during colonization and translated
many of the writings on the topic into their native language, thus
bringing the ideas to Western cultures.
Dr. Mangiapia then presented research that demonstrates the
effectiveness of accupuncture in treating a wide range of systems,
including pulmonary, obstetrics, G-U, G-I, wound healing, and sports
medicine. She described two common types of accupuncture modalities.
Low-frequency, high-intensity electro-accupuncture can provide
delayed, longer-lasting relief by facilitating the release of
monoamines, Beta-endorphins, and enkephalins. High-frequency, low
intensity accupuncture provides more immediate, short term action.
She noted that the two techniques could be used in combination.
The needles used are very thin, commonly 0.25 mm. (Dr. Mangiapia
handed out sample needles to everyone who was there!) The needles can
provide stimulation in various ways: in conjunction with a power
source to provide electro-accupuncture; by temperature gradient; or
by "tonification" or manual manipulation of the needles,
such as twisting.
Dr. Mangiapia described the 12 principle meridians, which are thought
to develop in embryonic life. The different meridians are stimulated
according to the type of pathology. For example, dense organ,
musculo-tendon, energy, and endocrine dysfunctions would entail
different treatment regimes and stimulation patterns. Needles placed
close to the site of dysfunction may exacerbate pain, while
stimulation at distal points can facilitate symptom attenuating
systemic effects.
Recently medical accupuncture has become more legitimate. In 1996 the
FDA categorized it as a Class 2B Medical Device. In 1997 the NIH
acknowledged the evidence of the efficacy of accupuncture treatments.
Dr. Mangiapia concluded her presentation with her conviction that
medical accupuncture can be a very useful tool for a many
pathologies. However, it should not be considered a panacea - it does
not supercede conventional medical treatment for everyone or for
every pathology. She was quick to point out that accupuncture should
be considered a "complimentary" technique rather than
alternative medicine.
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