Hi guys, I am t9-t11 and ready to attend a conference in Frankfurt Germany. The travel will be via emirates via Manila with a stopover at dubai and then frankfurt. The trip of 9 hours is quite long.

Could I get suggestions how to minimize the attack of spasticity of my legs? 9 hours can be quite long, for the travelers here in the forum, what exercises do you do to keep the legs relaxed. I think it will be impossible to straighten them unless I get a good seat for it to be stretched.

When we arrive in dubai, there will be a 6 hour stopover, until we fly to germany for another 6 hours. How grueling can this be. YOur suggestions will be a big help.

One more thing. I am a paraplegic and an ostomate. that means I have to go to the toilet. Any experience if this is possible for sci patients to go to the cr to change bags and to catetherize.

All suggestions will be a big help.

Some patients who suffer due to SCI or spinal cord injuries can get the best from Viagra with proper preparation and right intentions. Hope the write up below becomes a helpful source for the use of the blue pill

Viagra is a safe and effective treatment for erectile dysfunction. It helps to restore your natural response to sexual excitement, enabling you to get a firm and reliable erection again. Here is some simple advice to help you to get the best results from it.

Good sex takes two!

Although Viagra can help you regain a normal, firm erection, it is important to remember that good sex involves much more than this. You need to feel sexually excited for it to work well, so ensure that both you and your partner are in the right mood for sex. Time, privacy, comfort and a loving relationship are essential. Being tired, anxious or in a hurry will tend to make it less effective or even stop it from working at all.

Good sex usually involves two people. So do remember your partner’s emotional needs, as well as their sexual needs. They may be worried about you or your treatment, or they may not be as interested in sex as you thought, particularly if you have been unable to make love together for some time. It is important to talk to your partner about your sexual relationship, rather than just taking Viagra and hoping for the best. If they aren’t enjoying it, the chances are you won’t, either.

How does Viagra work?

Viagra works within the tissues of the penis, enabling blood vessels to dilate more effectively in response to sexual excitement. Viagra is not an aphrodisiac and will not improve sexual endurance or performance. It is not a treatment for premature ejaculation. There is no evidence that it has any beneficial effects on men who do not have erection problems.

Like most drugs, Viagra does not work immediately and, for best results, it is important to allow adequate time for it to work properly. As a guide, you should take Viagra about one hour before you are likely to make love. If you have had food and drink at around the same time, it might take longer before it starts to work.

How long does it work for?

Usually, Viagra will start to work about one hour after you have taken it and its effects will then last for about four hours. If you are in a sexually exciting situation during that time, you should be able to get an erection. If you are not sexually excited, it will probably have no effect. You should take Viagra no more than once per day, adjusting the time at which you take tablet to suit your preferred time for lovemaking. As a guide, though, if you take a tablet at 8.00pm, it will start working around 9.00pm and remain effective until around 1.00am.

What will the erection be like?

Your erection should be similar to those you experienced before you developed impotence. It will not be harder or last longer, but can be just as good as it used to be. The erection should be reliable and not fade during lovemaking, before you have and orgasm and ejaculate. The erection should go down after orgasm. If you still feel sexually excited during the four-hour window, you may get another erection.

Does Viagra have side effects?

Viagra is well tolerated by most men. Some men may experience mild dyspepsia (indigestion), facial flushing and headache. Less frequently, some will experience nasal congestion or changes in colour vision (this may be important to men working with colour coded materials, such as electronics engineers). If you do experience any side effects, they should pass off within a few hours, as the drug is eliminated from your system. If Viagra makes you feel unwell, you should stop taking it and discuss this with your doctor.

There have been some very rare reports of men developing prolonged, painful erections, requiring medical attention, after using Viagra. If your erection fails to subside after four hours, you should seek urgent medical advice. This condition is known as priaprism, needs hospital treatment and you should go to the nearest major hospital accident and emergency department for advice. Delay in seeking such advice may result in permanent damage to the penis.

What does should I take?

The doctor who has prescribed Viagra for you should advise you about the correct dose. Viagra is available as 25mg, 50mg and 100mg tablets. Most men will start on 50 mg, although elderly men or those who might be especially sensitive to its effect (such as those with spinal injuries or multiple sclerosis) may start with 25mg. The dose can be increased if Viagra is not effective at the starting dose.

There is a lot of psychological pressure on both you and the Viagra tablet to work first time. Don’t be too disappointed if the results with your first tablet are less than you’d hoped for. It is worth persevering at each dose and trying at least four times, on separate days, before changing to the next dose. There is no point in increasing the dose above 100mg and doing so may provoke more side effects.

Who shouldn’t take Viagra?

There are some men who should not take Viagra or, at least, should only take it on specialist advice. These include:

• Men who are unfit for sexual activity, as the exertion might be potentially dangerous to them. This would include men with severe heart or respiratory disease, who experience chest, breathlessness or exhaustion during sex.
• Men who are taking drugs known to interact with Viagra. These include nitrates, nicorandil and nebivolol, usually used in the management of angina and some other heart and circulatory conditions. You should NEVER take Viagra with these drugs. It is safe to take normal doses of aspirin, paracetamol, and sensible quantities of alcohol, with Viagra. If you are prescribed any new drug, you must tell the doctor who prescribes the Viagra for you.
• Men with conditions that might predispose them to have prolonged erection. These include leukaemia, multiple myeloma and sickle cell disease.
• Men with Peyronies disease should only use Viagra on specialist advice. In this condition, you may have noticed a painful lump in the penis, or found that the erect penis appears bent.
• Viagra is only suitable for men. There is currently no research evidence on the use or safety of Viagra when taken by women. For the present at least, women should not take Viagra

Will I always need to take Viagra?

Some men find that they are able to get normal erections again, without treatment, having used treatment for impotence in the past. It is impossible to predict who will recover in this way and there is no good research evidence as to what proportion of men will do so. Men with predominantly psychological causes for impotence are probably more likely to recover normal erections.

Experience shows that some previously impotent men, finding themselves in a sexually exciting situation and not having taken Viagra, do sometimes get erections and can sometimes make love successfully without treatment, either some of or all of the time.

What should I do if I develop a new medical problem?

It is vitally important that you tell any doctor, or paramedical personnel, that might attend you that you are taking Viagra.

If you develop any significant new medical problem or are prescribed any new drug, you must tell the doctor who has prescribed Viagra for you as soon as possible.

DO NOT TAKE ANY VIAGRA TABLETS UNTIL YOUR DOCTOR OR PHARMACIST HAS CONFIRMED THAT IT IS SAFE TO TAKE YOUR NEW MEDICINE WITH VIAGRA.

If it isn’t, there are alternatives to Viagra that may be suitable for you. You should discuss this with your doctor.


Reproduced with kind permission of Dr John Dean

Lioresal (Baclofen)

I am an SCI patient and am being withdrawn already from the use of Lioresal manufactured by Novartis. I use to take 80 mg a day and have worked out in months to bring it down to 40 until I am now switching to clonazepam. I have about 6 boxes which i will not be able to use. I bought it from Mercury drug store and expiration is 2013. Please help me in case you are interested to get it in a much lower price so that i can use the money to buy other medicines. My injury is T9 - T11. Maraming salamat po.

Do you experience heavy legs when you wake up in the morning?
That which you cannot do and lift?

My friend more exercise?


When your legs are heavy, it's because the muscles are weak and having a hard time moving them around. When you recover from the flare, your legs should go back to normal.

From my own personal experience, mobility comes from nerve control of the muscles of your legs. When your leg fails to respond to a signal, or gets the signal crossed, and the symptoms don't resolve a year after the flare, then it's residual damage and will affect your mobility.

I have muscles in my right leg that are atrophying because they no longer receive signals from the brain. I can still walk, fortunately. Every once in a while my right knee folds, but I can catch it in time. But on days when I'm fatigued, or flaring, then my right leg feels like it's not really there - kinda weak and floppy, and feels like it's asleep. (not asleep as in when your circulation is cut off, but more like the sensations you get in your limbs when you just wake up. Hard to describe!)

Hope this helps! Get to feeling better.



http://www.msworld.org/forum/showthread.php?t=77609
__________________

HYPER EXTENDED KNEE




Is this caused by spasticity?

I am suffering from a hyperextended knee. The left leg is so tight and spastic that the hyperextension is so prominent. It has been like this for several years.

Will there be a way to correct it? My left knee is already aching. I use to ambultate with forearm cruthces but have to go back to the walker just to avoid any risk.


(T9 - T11)


1. You might want to look in to getting a knee brace which would inhibit the knee from hyperextension.

This may be even more important since you are a walking para.

Hopefully more people will chime in with other thoughts and ideas.

Mike

2. SCI-Nurse
08-09-2007, 04:19 AM
Unfortunately this is a common problem if you learned to walk by locking your knees passively and were not properly braced. It can cause damage to the knee joint over time, and can be quite painful if you have sensation.

Bracing and PT to learn a safer gait technique can be used to manage this somewhat. NSAIDs are the most common medication used for this type of pain, although TENS can sometimes be helpful as well.

3. skippy13
05-13-2008, 07:37 PM
Hyperextension can cause meniscus damage. Meniscus damage is very painful. It can cause locking of the knee. A lot of damage can be done to the joint if you have blunted sensation. You should try to have it evaluated by an orthopedic surgeon before doing too much with it. Bracing or wrapping with elastic bandage is a good idea until you can get the all clear from a doctor. Im not sure if botox would work on such large muscles. It would take an awful lot of shots.

I sometimes have the same problem with my left knee since that leg is slightly longer than the right. I agree it is very painful. You have to be very careful. I recently hurt my right knee and am now aggravating the left knee by trying to rely on it more. Back to the walker for me.
daveh0

4. daveh0
Can't emphasize enough what everyone has already stated about protecting that joint. The longer you continue to put weight through it while it's hyperextended, the more damage you'll do (possibly severely interfering with your walking progress) and the more pain you'll have to endure.

If not for the spasticity in that leg, are your quads, glutes, hamstrings and calves strong enough to support your weight without locking your knee? If not, a rigid AFO that puts you into dorsi-flexision might be what you need. It will make it impossible for the knee to hyperextend and give that leg the support and stability you need to walk.

If the hyperextension is being caused just by the spasticity and not as a way to compensate for weaker muscles surrounding the joint, a knee brace or wrap may be more appropriate.

Bottom line - work with a good PT and ortho to make sure that knee is getting the support it needs to prevent any further damage and allow you to get back on the crutches.

The PWD is also entitled to at least twenty percent discount
on admission fees charged by theaters, cinema houses, concert halls,
circuses, carnivals and other similar places of culture,
leisure and amusement for the exclusive use of enjoyment of persons with disability.

At least twenty percent discount is given to the PWDs for the purchase
of medicines in all drugstores for the exclusive use of the person with disability.

The law also mandates the provision of express lanes for persons with disability
in all commercial and government establishments; in the absence thereof,
priority shall be given to them.

The abovementioned privileges are available only to persons with disability
who are Filipino citizens upon submission of any of the following as proof
of his/her entitlement thereto,
an identification card issued by the city
or municipal mayor
or the barangay captain of the place where the persons with disability
resides;
the passport of the persons with disability concerned;
or transportation discount fare Identification Card (ID) issued by the
National Council for the Welfare of Disabled Persons (NCWDP).

The PWDs may get registration forms available at the Department of Social Welfare
and Development Offices, the Department of Health Online Registrations or
at the office of the mayor or the barangay captain in their respective areas.

The discount granted may then be claimed by the pertinent establishment
as an allowable deduction from its gross income for income tax purposes
in the same taxable year that such discount is granted. The tax deduction shall
be based on the net cost of the goods sold or services rendered.

Grants of privileges and incentives are inherently a good thing.
They are made even better when taken in conjunction with efforts to integrate
the differently-able brethren into mainstream society by helping them to be self-reliant,
to the extent possible.
Who can argue with the old proverb that wisely asserts "Give a man a fish
and he will eat for a day. Teach a man to fish and he will eat for a lifetime." (PIA 8) [top]

- - -


List of cities and provinces issuing IDs for persons with disabilities

February 13, 2009 in Anything Filipino, Deaf Experiences, Discrimination Issues, Laws on Disability
Tags: Luz Cabauatan, Magna Carta for the Disabled Persons, Makati City, Manila, National Capital Region, National Council on Disability Affairs, persons with disabilities, Quezon City, RA 9442

Republic Act 9442
Republic Act 9442 or the amendment of Magna Carta for the Disabled Persons and for Other Purposes (RA 7277) states that a Person with Disability shall be entitled to the following:

* Twenty percent (20%) discount from all establishments like hotels, restaurants, etc.;
* 20% discount on admission fees charged by theaters, concert halls, amusements, etc.;
* 20% discount for purchase of medicines in all drugstores;
* 20% discount on medical and dental services;
* 20% discount on fare for domestic air and sea travel;
* 20% discount in public railways, bus, etc.;
* educational assistance through scholarships, books, etc.;
* discounts in special purchases;
* provision of express lanes in all commercial and govt. establishments; and
* additional tax incentives.

However, persons with disabilities cannot avail of these privileges if they don’t present their
special identification cards. According to the law and the Implementing Rules and Regulations,
only the municipal, city and provincial government units are allowed to issue these IDs.

In my pre-employment preparation subject, I assist my deaf students in getting vital documents that they
would be needed before they apply for jobs. Since most of them live in the National Capital Region,
we were also able to visit some government offices of the surrounding cities. To my surprise, out of the seventeen
highly urbanized cities, only six of them issue these IDs!

Special “thank you” goes to Quezon City government most especially to one of their well-loved officials,
Ma’am Luz Cabauatan for assisting us. She said that our students simply show our school’s ID.
That’s already a proof that they are a PWD. No need to submit any other requirements.
Congratulations too to the mayors of cities of Manila, Malabon and Makati.
Their processing procedure is very efficient and fast. Aside from that, Makati City also provides
free all-day entrance to any movie theaters for their PWD constituents.

I received a copy of the list from National Council on Disability Affairs (NCDA) office.
To my PWD brothers and sisters, here is a list that will guide you in getting your IDs.
Some LGUs require you to present your Barangay Certificate,
ID photos and medical certificate indicating your disability.
They will then give you a form which you can fill up and submit together with the other requirements
I mentioned. As of October 2008, here are the cities and provinces that has issued special IDs:

1. National Capital Region - Manila, Muntinlupa City, Malabon City, Makati City, Pasay City, Quezon City, Valenzuela City
2. Region I - Dagupan City, Candon, Agoo, Aringan, Aringay, San Fernando City
3. Region II - Enrile, Santiago, Kasibu
4. Region III - Gerona, Olongapo City, Bulacan, Tarlac, San Fernando, Palayan City
5. Region IV - Binan, Dasmarinas, Sta. Rosa, Tagaytay City, Cavite, Cuenca, Calapan
6. Region V - None
7. Region VI - Iloilo
8. Region VII - Cebu, Garcia, Talisay City
9. Region VIII - None
10. Region IX - None
11. Region IX - Malaybalay, Gingoog
12. Cordillera Autonomous Region - Baguio City, Ilogan, Atok
13. CARAGA - Bislig, Surigao, Butuan, Tandag City
14. Autonomous Region of Muslim Mindanao - None

Ito lamang po ang listahan ng mga mabubuting bayan at lungsod na nangangalaga sa kanilang mga nasasakupan
na may kapansanan. Maraming salamat po sa inyong pagmamahal sa mga may kapansanan.
(Here is the list of good cities and municipalities that care for their constituents who are disabled.)
If your local government has begun issuing IDs and are not included in the list,
kindly post a comment here so I can add it.

Dun naman po sa mga mayor ng lungsod na wala pa dito sa listahan, mahiya naman kayo!
(For those mayors of cities and municipalities that are not on the list, shame on you!)
This law has already been passed by the Philippine government since April 2007.
Pebrero 2009 na po! Kailan pa kayo susunod sa batas at mangangalaga sa mga taong higit na nangangailangan?
(It’s already February 2009. When will you follow the law and take care of people who need it the most?)

Identification of a Klebsiella pneumoniae Strain Associated with
Nosocomial Urinary Tract Infection

To differentiate between relapse of infection and reinfection of the urinary tract due to Klebsiella pneumoniae, 33 K. pneumoniae isolates collected from 20 patients with spinal cord injury (SCI) over 2 years were typed by genomic fingerprinting by repetitive-element PCR. Clinical isolates obtained from the same patients with
recurrent episodes of urinary tract infection (UTI) revealed identical genomic fingerprints indicating relapse of UTI due to K. pneumoniae, despite appropriate antibiotic therapy. Seventeen isolates obtained from 8 of the 20 SCI patients shared a common genotype, termed RD6. Among non-SCI patients residing in other nursing
units, the RD6 genotype was found in 5 of 10 patients with K. pneumoniae UTI but in only 1 of 20 patients with K. pneumoniae infection that did not involve the urinary tract, suggesting a strong association of this genotype with UTI. All RD6 isolates exhibited strong adherence (>50 adherent bacteria per cell) to HEp-2 cells, whereas
other K. pneumoniae isolates generally did not adhere to or adhered very weakly to HEp-2 cells (<5 adherent bacteria per cell). Adherence was inhibited either by 4% D-mannose or by anti-type 1 fimbrial rabbit serum. These results suggest that the capacity of K. pneumoniae RD6 isolates to cause UTI may be mediated by its
striking adherence to mammalian cells

-----------------------------------------------------------------------------

Enterobacteriaceae, has become one of the most common causes of urinary tract infection (UTI) in patients with spinal cord injury (SCI)(2, 5, 13). Although the incidence of UTI has been reduced by the use of intermittent bladder catheterization, recurrence of UTI continues to be a troublesome problem in many patients.

Recurrence of bacteriuria may indicate either relapse of infection caused by the same bacterial strain which can persist at sites adjacent to the bladder, despite seemingly appropriate antibiotic therapy for UTI, or reinfection with a different bacterial strain (18). The differentiation between relapse of infection and reinfection has significant management implications. Patients with a documented relapse of UTI may need to be investigated for anatomic abnormalities such as renal stone, urethral stricture, and abscess or functional alterations such as
vesicoureteral reflux that may potentially impede complete eradication of the bacteria.

Adherence of K. pneumoniae to mammalian epithelial cells, regarded as a prerequisite for colonization or infection of mammalian tissues (12), is mediated by the adhesins FimH and MrkD that are associated with type 1 and type 3 fimbriae, respectively (4, 8, 16), and by other R-plasmid-encoded adhesins (3). The genes for type 1 fimbriae are conserved among most species of the family Enterobacteriaceae (1), while the
genes for type 3 fimbriae are not (14). Type 1 fimbriae facilitate mannose-sensitive adherence of K. pneumoniae to rat bladder cells (7) and ciliated hamster tracheal cells (6), whereas type 3 fimbriae facilitate adherence to trypsinized human buccal and tracheal cells in a mannose-resistant manner (9). Host receptors for the FimH adhesin of type 1 fimbriae and for the MrkD adhesin of type 3 fimbriae are believed to involve a D-mannosecontaining glycoprotein (10) on epithelial surfaces and type V
collagen of basal membrane (17), respectively. The objectives of this study were to (i) differentiate between a relapse of K. pneumoniae UTI caused by the same bacterial
strain and reinfection with a different bacterial strain by PCRbased DNA fingerprinting of clinical isolates and (ii) study the relationship between the development of UTI and the in vitro adherence of K. pneumoniae to human HEp-2 cells derived from a human laryngeal carcinoma.