Clint Carter perked up the minute Hershey entered the room.
With dog treats in hand, Carter invited the 14-year-old English springer spaniel onto his hospital bed for a snack.
He didn't have to ask twice. Hershey stepped up on a chair and was eating out of Carter's hands in a flash. Hershey might be getting up in years, but her appetite hasn't waned.
"Easy! Easy!" Carter said with a chuckle as Hershey devoured the food.
On her last day of rounds at VCU Medical Center, Hershey did what she has been doing for nine years: enjoying dog biscuits and affectionate pats, but giving so much more in return.
As one of the first dogs to participate in the Dogs on Call program, Hershey has brightened the days of hundreds of patients at the hospital. She began her volunteer career with children in the pediatrics wing. She'd show off a bit for them, rolling over, begging, chasing her tail and dancing on command. As she grew older, she moved to the palliative care area to interact with older patients.
"She started with kids and ended up with the old folks," said Hershey's owner, Susie Burtch. "She's aged with them."
Last week, Hershey bade farewell to them all. During her retirement party, she licked cake off a fork with Riley, another retiring dog, then the two went on final rounds.
"This is very emotional," Burtch said. "This has been part of our lives for nine years. Now, it is over."
Hershey's hearing faded out a couple of years ago, and now her eyesight is failing, Burtch said, so it is time to say goodbye.
"I know this is something she's enjoyed," Burtch said. "Before going to the hospital for a visit, I'd give her a bath the night before. Every time I'd dry her off, she'd run downstairs and stand by the door as if to say, 'Can we leave now?'"
Started in 1995 as Paws for Health, the program changed names to Dogs on Call in 2001 with establishment of the Center for Human-Animal Interaction at VCU Medical Center. Today, about 30 dogs visit the pediatrics, physical rehabilitation, psychiatry, oncology, internal medicine and other departments. Most visit once a month.
But they can't keep up with demand. The hospital receives requests from about 60 clinical departments, said Dr. Sandra Barker, director of the Center for Human-Animal Interaction.
"These dogs are just wonderful," Barker said. "Not only do patients look forward to them coming, but so too does the staff."
Dogs like Hershey and Riley help patients by reducing their stress and feelings of depression and anxiety. They take a patient's mind off an upcoming surgery or lengthy rehabilitation.
"It's uplifting to see the dog and pet it," said Jimmie Wilson as he scratched Hershey behind the ears. The Colonial Heights resident is battling colon cancer. "Anytime you are in the hospital, you are down a bit. This brightens your day."
Four-year-old Karyn Alexandra Griggs, hospitalized for a few days for gallbladder surgery, said she felt much better after Riley paid her a visit. The golden retriever lay in bed with her and let her stroke his head.
"He's soft!" Karyn said as she gave Riley a hug.
Her parents, Jonathan and Paula, were thankful for the visit.
"I didn't think they did anything like that here," Jonathan Griggs said. "But I'm glad to see it. It boosts her spirits and gives her the chance to forget how she feels."
Riley, 8, has been in the program since 2000. His owner, Charlie Aldinger, wanted to volunteer because Riley loves people. But Riley is retiring early after being diagnosed with malignant melanoma.
"He loved going to see the kids," Aldinger said. "He'd put his head on their beds and just be with them. I think it made a huge difference in their lives. For five minutes, at least, they aren't in the hospital. They aren't sick."
Visiting with the dogs brings back memories for many patients. Carter, 79, has had pets most of his life and was eager to reminisce with Burtch about how his dogs would chase ducks and rabbits.
Seeing Hershey took Wilson on a trip back in time, too. He used to have a dog by the same name, a long-haired dachshund. The dog passed away a few years ago. Wilson and his wife, Gail, keep their pet's ashes in an urn in their bedroom.
To keep track of such stories, Burtch has written vignettes through the years about the patients she and Hershey have come to know. She didn't keep track of the exact number, but a few stand out.
There's the girl, for example, who had a brain tumor and couldn't speak. But she was determined to give Hershey the command for sit. After numerous visits, the words finally came and Hershey obliged.
"Looking back, it strikes me what a difference Hershey has made," Burtch said. "Her life has been an enrichment to others."
Contact staff writer Janet Caggiano at
or (804) 649-6157.
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A procedure that injects cement into the sacrum can dramatically reduce low back and buttock pain caused by sacral insufficiency fractures, according to a small new study being unveiled this week at the North American Spine Society’s (NASS) 21st annual meeting in Seattle. The procedure, called sacroplasty, stabilizes fractures in elderly patients with bone weakened by osteoporosis.
Newswise — The injection is safe when performed by physicians experienced with the technique, and pain reduction is both swift and sustained, according to the one-year, multi-center cohort study.
Among the 25 patients enrolled in the uncontrolled study, the mean pain score on a 10-point visual analog scale was 7.3 at baseline, 2.7 immediately post-procedure, 1.4 at two weeks, 0.5 at 24 weeks, and 0.3 at 52 weeks, according to Michael Frey, MD, a NASS member and physiatrist at Advanced Pain Management and Spine Specialists in Fort Myers, FL.
There are currently no treatments for sacral insufficiency fractures. Recovery is typically slow, and pain may linger for up to a year. In some cases, symptoms and disability last longer.
To calm the pain, physicians often prescribe bed rest, painkillers, corsets, or other measures. However, these can put patients at increased risk of thromboembolism, skin breakdown, pressure ulcers, constipation, depression, progressive osteoporosis, and reduced muscle strength and cardiac function.
“These patients are miserable,” said Frey, who has performed sacroplasty on nearly 50 patients.
To explore better alternatives, Frey and others have adapted techniques developed for vertebroplasty in the lumbar spine. In vertebroplasty, physicians use fluoroscopic guidance to inject polymethylmethacrylate (PMMA) into osteoporotic compression fractures. After injection the acrylic bone cement hardens. The technique was designed to stabilize the fracture, reduce pain, and improve function.
Frey and colleagues reported on consecutive patients with osteoporosis who had incapacitating low back or gluteal pain and a sacral insufficiency fracture documented on MR imaging or CT scan, and who failed or could not tolerate conservative care. The authors excluded patients with fractures caused by malignancies.
About one in seven patients experienced complete relief of pain within 30 minutes, said Frey. Approximately one-fourth were pain-free at two weeks and about one-third at four weeks. Frey said there were no complications associated with the procedure at any time, though one patient died of what was deemed unrelated pulmonary disease within four weeks of undergoing the procedure. Excluding this patient, all but two patients reported 75% to 100% satisfaction at one year.
“Sacroplasty is a dramatic leap forward,” said Frey.
Most previous reports about sacroplasty have been small case series with short followup. They suggested that the procedure is technically feasible and leads to short-term pain relief. But there is scant prospective evidence on the safety and efficacy of sacroplasty in larger cohorts followed for longer periods of time.
Frey says the procedure can be technically demanding, and recommends physicians have extensive experience in vertebral augmentation. Potentially, cement can leak outside the sacrum and compromise the sacral nerve root, the sacral spinal canal, or sacroiliac joint.
Several years ago, the FDA issued a surprisingly sharp warning about the risks associated with vertebroplasty, including pulmonary embolism, respiratory and cardiac failure, and death. (FDA Public Health Web Notification: Complications related to the use of bone cement in vertebroplasty and kyphoplasty procedures, October 31, 2002; http://www.fda.gov/cdrh/safety/bonecement.html.)
Frey noted that sacroplasty is an off-label use of PMAA, and there is no Medicare code for the procedure, so reimbursement is problematic. His cost for one kit is about $400. He said he performs the service at no charge and receives no industry funding for his research.
Frey would like to see controlled trials to compare sacroplasty to a sham procedure. It is conceivable, he said, that sacroplasty is no better than placebo. In his study, none of the patients who declined sacroplasty was pain free at 12 weeks, though at six months and one year their pain had subsided to a level comparable to that of patients who received sacroplasty.
Source: Abstract #81. Michael Frey, MD, et al. “Efficacy and Safety of Sacroplasty for Sacral Insufficiency Fractures: A Prospective, Multi-Center Study.”
About NASS
The North American Spine Society (NASS) is a multidisciplinary organization that advances quality spine care through education, research and advocacy. NASS members are MDs, DOs and PhDs in 22 spine-related specialties including orthopedics, neurosurgery, physiatry, pain management and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators and other allied health care professionals involved in spine care are also represented in NASS as affiliate members. For more information on spine care or to find a spine specialist in your area, please contact 1-877-SPINE-DR or visit http://www.spine.org.
Regardless of gender, generation or income group, more and more people are going to the dance floor for a workout versus a gym and an exercise physiologist at New York City's Hospital for Special Surgery, a leading center for sports medicine, thinks she knows why.
“The best exercise program is one that is safe, balanced, promotes fitness and importantly, one people will do regularly because they enjoy it,” according to Polly de Mille, exercise physiologist at the Women's Sports Medicine Center at Hospital for Special Surgery.
“The social aspects of dance help to make it very attractive for an increasing number of people versus, say, an elliptical training machine. Scientific studies are now also telling us that many things make dancing an excellent fitness regimen with attractive benefits,” de Mille said.
Of course, balanced, targeted gym workouts can provide excellent fitness benefits as well but for some people, the “fun factor” is missing at the gym.
“Those working out in gyms are often plugged into their iPods or their reading material, following their own regimen. Those dancing, however, are often moving in unison, possibly facing one another or touching, and having a communal experience. Connection and cooperation with others is integral to the experience,” she said.
Dance is also very good for balance and posture, according to Beth Shubin Stein, M.D., an assistant attending orthopaedic surgeon in the Women's Sports Medicine Center at Hospital for Special Surgery who is trained in sports medicine and shoulder surgery.
“Dance is also a great aerobic workout and in addition tones many different muscle groups,” Dr. Shubin Stein said.
Popular TV programs like ABC-TV's “Dancing with the Stars,” which returns for its third season September 12, underscore the romance and passion sometimes involved in dance. De Mille cautions, however, that people need to know their limits and pace themselves before considering some of the acrobatic moves seen on TV.
While dance may not be for everyone (de Mille personally finds regular runs in Central Park to be very calming) and a few precautions need to be kept in mind, she says studies clearly show the health benefits of dance compared to gym workouts are impressive. Specifically:
Dance movements are multi-directional versus the straight forward motion on treadmills, ellipticals, Stairmasters etc. Joint mobility may benefit from the varied movements. One study demonstrated improved range of hip motion and flexibility of the spine on young adults who followed a three-month program of dance training.
Dance movements are weight-bearing and varied compared to a stationary bike. That is important for maintaining or improving bone density. Studies of recreational ballet dancers between the ages of 8-14 show higher bone mineral content in their hips and spine than in girls who did not dance.
Dance requires agility and balance as well as various speeds of movement, skills that are generally not a focus of typical gym workouts. Studies of older populations who engage in dance-based exercise programs demonstrate improvement in balance and agility. This may be important in reducing risks of falls in this population.
Dance is mentally stimulating, requiring focus on coordination and learning movement patterns. Most people will read, listen to music, or watch TV to alleviate the boredom associated with most indoor exercise equipment. Dance requires being mentally engaged with physical movement, a constant mind-body connection.
Emotional responses are common in dance and would rarely occur in a gym workout. The music, movement patterns and mental engagement involved in dance often evoke emotions. One study showed that breast cancer survivors who participated in a 12-week dance and movement program not only improved their shoulder range of motion but showed improvements in measures of body image and quality of life.
Dance also can be a substitute for a cardiovascular gym workout. Depending on the type of dance, dance can be an excellent cardiovascular workout when done regularly. It would result in the same health benefits associated with any form of activity that involves sustained effort in the target heart rate zone such as improved cardiovascular function, lipid metabolism, endurance and body composition.
De Mille advises people considering dance as fitness therapy to keep three key points in mind:
Treat any pain first -- People should see their doctor and perhaps a physical therapist to have their pain issues diagnosed and treated properly. Pain is a warning signal that something can be wrong.
Wear good shoes -- Dance shoes often don't have the kind of cushioning and support that other exercise shoes offer. Style should not completely replace sensibility. Dancers should be careful about the footwear they select.
Don't get swept away - People can challenge themselves more than they should. As with any activity, pacing yourself, listening to your body and knowing your limits is important.
“From a mind-body perspective, anything you do successfully on the physical end will positively affect your mental and emotional states. Dancers have excellent posture and just standing a little straighter can have a surprising transfer of power to your next board meeting or challenging conversation,” commented Jenny Susser, Ph.D., a sports psychologist at the Women's Sports Medicine Center at HSS.
The first of its kind in the United States, the Women's Sports Medicine Center at HSS is a nationally recognized health resource for active women of all ages and abilities, from eager novices to professional athletes.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked as No. 2 in orthopedics, No. 3 in rheumatology and as among the best in geriatrics and neurology by U.S.News & World Report, and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu.
Hospital for Special Surgery
535 E. 70th St.
New York, NY 10021
United States
http://www.hss.edu/
# After years of luxury or lewd stigmas, service rising in popularity
ST. LOUIS — Two years ago, Jeni Wideman, 29, injured her neck in a traffic accident. The injury became another layer of pain atop her diagnosis of migraine and cluster headaches.
"I had a migraine that lasted for three weeks," says Wideman, a middle school teacher. Making matters worse, she found that she was allergic to one of the medicines.
Dr. David H. Jansen, a chiropractor with offices in Creve Coeur, Mo., suggested visits to a massage therapist who works in his office.
"I'd been reading up on massage therapy for some time, looking for different ways to deal with migraines," Wideman said. So when the accident happened, she visited the therapist that same day. She was hooked and has been visiting about once a week since then.
"I rarely have to take my migraine medicine anymore," she said. "I'd read that a lot of people had success controlling migraines through massage therapy without medicine. It was just a coincidence that I got into a car accident and needed massage therapy even more than I had previously."
Massage therapy has rapidly become a popular alternative treatment for everything from stress to pain relief to rehabilitation.
According to the American Massage Therapy Association's 2005 fact sheet, 47 million Americans received massages in 2005 - 2 million more than in 2004. It is estimated that by 2012, the number of massage therapists will have increased by 20 to 35 percent.
The upswing in the popularity of massage has followed two decades of newly enacted state laws that recognize massage therapists as allied health practitioners.
Nowadays the occupation, whose services once were seen as a luxury in country club locker rooms (or a front for prostitution), is among the fastest-growing vocations of choice for young people seeking their first career, as well as for those who want to start second or supplementary careers.
"In the last 20 years, it's become a part of the medical community," said Matt Meyers, a licensed massage therapist with Barnes-Jewish Hospital. "But it had such a terrible stigma, with massage parlors being a cover for everything else, and that's not what it is."
Modern therapists, he said, "have gone through the trouble to take the training and the trouble to pass that state board's test - it's grueling."
"As massage therapists, we own the name now; we own the word," said Joe Horn, program chairman at Missouri College, a school in west St. Louis County that prepares students to take the licensed massage therapist certification exams in Missouri. "That's the first step toward getting your profession into a better light."
Massage therapy is the practice of manipulation - kneading, stroking, pounding - of muscles, skin, anything that's not bone or connective tissue. The purpose of the manipulation ranges from simply making a client feel good up to helping to aid in the rehabilitation of injuries.
"What used to be a feel-good practice that only people with money could indulge and afford," Meyers said, is now "more mainstream, more of a necessity than a luxury."
"By relaxing someone, you lower their blood pressure and their heart rate, things of that nature. But there are parts of the body, positions, strokes and different types of maneuvers to create ... to get the desired effects."
Trisha Becker teaches massage therapy at St. Louis University. She's a physical therapist who specializes in orthopedic therapy and is a licensed massage therapist.
She practices and teaches "outcome-based" massage, meaning she uses massage for the rehabilitation of physical problems.
Massage comes in more than 100 forms, maybe more if you take into account that some form of massage has been identified in every culture and country that has pocked the earth.
The federal government and medical community consider it complementary and alternative medicine.
The most basic massage, the Swedish massage, is the grandparent of all massages in the West.
The licensed massage therapist will squeeze, stroke, bend, wring and manipulate muscles. The method produces a series of effects.
"Physically, you are moving fluid," Becker said. "That produces physiological effects, which changes the biomechanical effects, which causes psychological effects, reflex effects because you change the nervous systems and psychoneuro-immunological effects, which enhance your immune system.
"When you contract a muscle, you have waste products - oxidants, lactic acid, irritants. If you have a lot of tightness in a muscle, that stuff doesn't go anywhere," she says. Massage basically wrings the muscles out as you would a sponge, she says. The waste products go into the lymphatic system and then are flushed from the body, she said.
The release of waste materials can be so effective that it sometimes can cause nausea when the massage is complete, Becker says, which is why once a massage is over, clients sit quietly for a while and drink a lot of water to help flush their systems.
A massage therapist brings relief, not cure.
"Be careful to know that we don't cure anything," Meyers said. "We assist; we help alleviate pain."
So if a massage therapist claims to be able to cure an illness or a disease, run in the other direction, he says.
Also, don't confuse massage with "reflexology," the practice of massaging feet and palms to affect other parts of the body. People with the placard of reflexologist do not have to be licensed by the state, although a licensed massage therapist may know reflexology and any number of Eastern techniques through his or her continuing education.
If you just need to relax, a therapist working in a spa is fine, Becker said. If you have something really ailing you, especially pain, you need to start with your physician and either get a referral or get an OK to visit a licensed massage therapist.
Therapists aren't trained to recognize diseases and other conditions that require a physician's diagnosis.
By CATHERINE SAINT LOUIS
Source: The New York Times
FITNESS clients can make unreliable sources. They may tell their personal trainer about their recurring back pain, but neglect to mention their hypertension medication. They may disclose on a health questionnaire that they are diabetic, but not disclose a bad ankle sprain. They may feel embarrassed to share that they had a pectoral muscle removed to treat breast cancer. Conscientious trainers say they would love to have a better relationship with their clients’ doctors, mostly to make sure that while working their cardiovascular systems and muscles they will do no harm. But breaking down the wall between the gym and the consulting room has been difficult, say trainers who have tried.
“I’ve been rejected or blown off or gotten the ‘Give me your card’ kind of thing,” said Derek Dodd, a certified trainer and a registered nurse in West Palm Beach, Fla., referring to his contacts with some doctors.
Some doctors are reluctant to form an alliance with trainers, since it’s hard to know whom to trust, when far too many have certifications that are questionable, at best.
But some personal trainers not only have more demanding certifications, but also academic degrees in relevant fields. And unlike those who push “no pain, no gain,” they say they are concerned not only with how many pull-ups their clients can do, but also with how their medications and old injuries may affect their workouts.
And many of them contend that now, more than ever, doctors need to start thinking about them as part of their patients’ health care. For one, Americans over 55 are the fastest growing segment of gym members, according to American Sports Data, a market research firm.
“We are seeing more people coming to gyms with hypertension, diabetes and old musculoskeletal injuries,” said Michael Jones, the founder of the American Academy of Health, Fitness and Rehabilitation Professionals, an educational organization in Sacramento. “They need good exercise programs that are developed in conjunction with fitness and medical professionals to avoid injuries and improve function.”
In addition, many health insurers are limiting the number of physical therapy visits a patient can make, and trainers are inheriting more half-mended patients.
“The insurance company is looking for roughly 75 to 80 percent overall improvement, at which point the insurance company stops authorizing visits,” said Dr. Craig Antell, who practices physical medicine in Manhattan. “You’re left with a patient who is 80 percent better, still needing work. That’s where personal trainers come in.”
Dr. Antell, the medical director at Madison Avenue Physical Rehabilitation and Wellness, is one doctor who understands the importance of a good relationship with personal trainers. He estimated that last year his practice referred about 50 patients to trainers, up from a dozen five years ago.
He said he does not make such referrals indiscriminately: All 10 trainers he works with have bachelor’s or master’s degrees in exercise science or a relevant field. And to ensure that the trainer is in tune with a patient’s needs, he requires the first trainer-patient session to occur at his office so he can supervise. “If I get a trainer that hurts someone, I’ve got a world of trouble,” Dr. Antell said.
