A common factor in every one of us with PPS is the fact that we cannot control one, or a set of, or a whole lot of muscles. They just will not move they way that they are supposed to. In us polio survivors, the brain sends a message to the muscle through a motor nerve...... "brain to muscle, brain to muscle, move two inches to the left." and the brain gets a message back...... "muscle to brain, muscle to brain, - who? me??"

So..... because our muscles don't work the way that they are supposed to, I thought that it might be an idea to look into what muscles are, and what they are supposed to do. What follows is a very general article on various types of muscles, their classifications, physiology, one or two neuromuscular diseases, muscular inactivity and atrophy as a result of that inactivity. It isn't an in-depth article at this time, but I could publish a far more scientific discussion in a later issue - write to me at magazineeditor@ippso-world.org and let me know if that is what you would like to see.

Some of you might already know that our IPPSO President, Barbara Gratzke and her husband, are presently on an extended tour of America in their wheelchair accessible motorised home, visiting PPS organisations and Conferences, amongst which is the 10th International Conference at Warm Springs, Georgia. Barbara has sent me a report of their tour of the USA together with a lot of photographs which I am sure that you will find very interesting. Barbara's report is fairly lengthy and at the time that it arrived, I had already compiled most of this issue, so watch out for her report in

the next issue of our Magazine.

Magnificent Magnolias!

I crept out

Pyjama clad

To capture

The boughs of heavy tulip cups

Swaying in sunshine

In pink and white abundance.

Inside the house

I gaze upon

Magnolia Stellata

Fragrant stars

White in their purity

Carelessly tumbling

Against my window pane.

Muscles, the word is derived from the Latin musculus. (The diminutive is mus which means "mouse". but the one has absolutely nothing to do with the other, so there's a bit of absolutely useless information for you.)

Muscles are classified as skeletal, cardiac, or smooth muscles. Their function is to produce force and to cause motion. Muscles can cause either locomotion of the organism itself or movement of internal organs. Some work without conscious thought - these are the "involuntary" muscles which work and keep working all through our lives, whether or not we want them to. The heart, which is a muscle is an example of an involuntary movement. So are the muscles which control peristalsis, which pushes food through our digestive system. Without these movements, we would not survive. Voluntary contraction of the skeletal muscles is used to move the body and can be finely controlled. Examples are movements of the eye, or gross movements like the quadriceps muscle of the thigh. There are two broad types of voluntary muscle fibers: slow twitch and fast twitch. Slow twitch fibers contract for long periods of time but with little force while fast twitch fibers contract quickly and powerfully but fatigue very rapidly.

The three types of muscle (skeletal, cardiac and smooth) have significant differences. However, all three use the movement of actin against myosin to create contraction. In skeletal muscle, contraction is stimulated by electrical impulses transmitted by the nerves, the motor nerves and motorneurons in particular. Those are the nerves that don't work if you have had polio. Cardiac and smooth muscle contractions are stimulated by internal pacemaker cells which regularly contract, and propagate contractions to other muscle cells they are in contact with.

Muscular activity accounts for much of the body's energy consumption. All muscle cells produce adenosine triphosphate (ATP) molecules which are used to power the movement of the myosin heads. Muscles conserve energy in the form of creatine phosphate which is generated from ATP and can regenerate ATP when needed. Muscles also keep a storage form of glucose in the form of glycogen, which can be rapidly converted to glucose when energy is required for sustained, powerful contractions. Muscle cells also contain globules of fat, which are used for energy during aerobic exercise. Cardiac muscle though, can readily consume protein, glucose and fat aerobically without a 'warm up' period and always extracts the maximum ATP yield from any molecule involved. The heart, liver and red blood cells will also consume lactic acid produced and excreted by skeletal muscles during exercise.

Without going into too much detail as to exactly how it happens, the nervous system is responsible for conveying commands to the muscles, and is ultimately responsible for voluntary movement. In addition, muscles react to reflexive nerve stimuli that do not always send signals all the way to the brain. Imagine that you have touched the hot stove by mistake, and that the tip of your finger is burning. In this case, the signal from the nerve doesn't reach the brain at all. There isn't enough time - your finger is in danger of being destroyed, so it produces a reflexive movement by direct connection with the nerves in the spine. This is the exception to prove the rule that most muscle activity is voluntary, the result of complex interactions between various areas of the brain.

Genetics also comes into the equation. An individual born with a greater percentage of Type I muscle fibers would theoretically be more suited to endurance events, like triathlons, distance running, and long cycling events, whereas a human born with a greater percentage of Type II muscle fibers would be more likely to excel at anaerobic events such as a 100 meter dash, or weightlifting. People with high overall musculation and balanced muscle type percentage engage in sports such as rugby or boxing, but often also engage in other sports to increase their performance in their preferent sport.

Neuromuscular Disease

These diseases are those that affect the muscles and/or their nervous control. Polio is one of them, and we are all very familiar with that particular disease! There a lots of others too, like Stroke, Parkinson's disease, Creutzfeldt-Jakob disease, all of which result in a loss of motor nerve control which causes paralysis. Generally speaking, these paralytic diseases cause a decrease in muscle mass, and that leads to muscular atrophy. Example include Cancer and AIDS, which induce a body wasting syndrome called cachexia. Other syndromes or conditions which can induce skeletal muscle atrophy are congestive heart disease and some diseases of the liver.

During aging, there is a gradual decrease in the ability to maintain skeletal muscle function and mass, known as sarcopenia, the exact cause of which is unknown, but it may be due to a combination of the gradual failure in the "satellite cells" which help to regenerate skeletal muscle fibers, and a decrease in sensitivity to or the availability of critical secreted growth factors which are necessary to maintain muscle mass and satellite cell survival. Sarcopenia is a normal aspect of aging, and is not actually a disease, but it can be linked to many injuries in the elderly, as well as decreasing quality of life.

Physical inactivity and atrophy

Inactivity and starvation in mammals leads to atrophy of skeletal muscle, accompanied by a smaller number and size of the muscle cells as well as lower protein content. In humans, prolonged periods of immobilization, like bed rest or astronauts flying in space, are known to result in muscle weakening and atrophy. But there is always an exception to prove the rule, isn't there? Bears are famous for their ability to survive unfavorable environmental conditions of low temperatures and limited nutrition availability during winter by means of hibernation. During that time they go through a series of physiological, morphological and behavioral changes. Their ability to maintain skeletal muscle number and size at time of disuse is of a significant importance. During hibernation bears spend four to seven months of inactivity and anorexia without undergoing muscle atrophy and protein loss. There are a few known factors that contribute to the sustaining of muscle tissue. During the summer period, bears take advantage of the nutrition availability and accumulate muscle protein. The protein balance of bears at time of dormancy is also maintained by lower levels of protein breakdown during the winter. At times of immobility, muscle wasting in bears is also suppressed by a proteolytic inhibitor that is released in circulation. Another factor that contributes to the sustaining of muscle strength in hibernating bears is the occurrence of periodic voluntary contractions and involuntary contractions from shivering during torpor. The three to four daily episodes of muscle activity are responsible for the maintenance of muscle strength and responsiveness in bears during hibernation.

Hehehe Corner

How long is a minute? Well, it depeds upon which side of the bathroom door you are.

More on Sleep Apnea

One of the most common sleep problems that us PPS'ers experience is sleep apnea (or apneoa - take your pick - I've often seen it spelled both ways.) What happens in sleep apnea is that we 'forget' to breathe whilst we are asleep. We have already seen from the article on muscles, that these are divided - very broadly speaking - into three categories. Those which are voluntary, like moving your arm (or leg - if you don't have polio!), those which are involuntary and life sustaining like the heart, and those which are semi-voluntary, like breathing. You can hold your breath for a while, but eventually you have just got to start breathing again, haven't you?

So the question arises... If sleep apnea results in your forgetting to breathe whilst you are asleep, can you die from it?

Well, bearing in mind that medicine is not an exact science (like mathematics, where two and two added together can only equal four - never three point nine!) there is of course no guarantee that death cannot occur from sleep apnea, but the chances of that happening are so remote that the very thought can be discounted completely unless there are other pre-existing contributory factors like heart problems etc. What does happen in sleep apnea is that, because of the difficulty in breathing, the level of sleep is interrupted from time to time, and the benefit of a refreshing rest is lost, so you are still very tired when you wake up in the morning. Since we are asleep at the time, we don't realise what is happening as far as our level of sleep is concerned. However, a sleep study where knowledgeable people are monitoring what is happening in our brain whilst we are sleeping, and printing out all sorts of data on all sorts of strange looking machines - will show up the problems of, shall we call it "shallow" sleep. Let's assume that the result - the diagnosis - is sleep apnea....... what exactly is sleep apnea all about?

I am indebted to Cilla Webster for the following explanation of sleep apnea. Those of you know Cilla will also know that she experiences sleep apnea as a result of PPS.

The primary functions of the respiratory system are to bring oxygen into the lungs, transfer the oxygen to the blood, to expel the waste product called carbon dioxide, and to help regulate acid-base balance. Oxygenated blood travels from the lungs through the pulmonary veins and into the left side of the heart, which pumps the blood to the rest of the body. Oxygen-depleted, carbon dioxide-rich blood returns to the right side of the heart and is pumped through the pulmonary artery to the lungs, where it picks up oxygen and releases carbon dioxide.

Because the lungs have no muscles of their own, the work of breathing is done primarily by the diaphragm and, to a lesser extent, by the intercostal muscles (between the ribs). During forced or laboured breathing, other muscles in the neck, chest wall, and abdomen also participate.

As the diaphragm contracts, it moves down, enlarging the chest cavity. This reduces pressure in the chest and air rushes into the lungs to equalize the pressure. The diaphragm then relaxes and moves up; the chest cavity contracts and raises the air pressure. Air is pushed out of the lungs because of their elasticity. The intercostal muscles participate in this process, especially if breathing is deep or rapid. When everything is working well a person hardly notices that he is breathing.

Symptoms
Breathing problems can sneak up on polio survivors because they may not be easily identified. Is your answer “Yes” to any of these questions?

Are you experiencing increased fatigue?
Do you frequently awaken with a headache?
Are you having problems sleeping?
Do you need to use additional pillows when sleeping?
Do you sleep better in a recliner or chair than in your bed?
Do you have a poor cough or difficulty clearing secretions?
Did you ever use assistive breathing devices (such as an iron lung) during or following the acute stage of polio?

If your answer was “Yes” to any of these questions, then it is probably time for a breathing evaluation. If your answer to all of the questions was “No”, it is still important to educate yourself about possible breathing difficulties in Post-Polio Syndrome (PPS) so that you will be able to recognize a problem if it does occur.

We need a Positive Air Pressure (PAP) machine to treat sleep apnea, but do we need continuous pressure (CPAP) or Bi-lateral pressure (BiPAP). We need to know if we are having trouble breathing in, or trouble breathing out. Also. In either case, what level of pressure do we need - and would a humidifier help at all?

A lot of these questions will have been answered by our initial sleep study, but we may need a second sleep study to find the right answers. One question that won't have been answered though is, accepting that we need, at the very least, to wear a mask over the nose through which the machine can help us to breathe - what kind of mask is the most comfortable for us? One that covers just the nose? The nose and the mouth? A full face mask? And how the h*ll do we manage to sleep whilst wearing the mask?

Whereas the sleep study may have already answered some of these questions, it won't have given us any idea at all as to which mask will be the most comfortable. It also won't have told us which of the myriad of machines available to assist our breathing will be the most comfortable for us. Most people have a lot of trouble using the mask because they might find it more of a hindrance than a help, but it is amazing what the human body can get used to. For instance, before we moved to Capetown, we lived in a house that was very close indeed to a railway line. The locomotive, either steam or diesel driven, would always arrive at around 3.30 a.m. And the noise that it made would invariably awaken us. Eventually though, we became so used to the noise that we didn't hear it any more. But any of our friends or relatives who spent the night with us, remarked the next morning on how badly they had slept the previous night because of the noise the locomotive had made. The moral of the story is that, like the railway locomotive, the mask that you wear to help you to breathe will eventually become so much a part of you that you won't be able to sleep without it. So, if at first you don't succeed, persevere!! The benefit you will derive from it is immeasurable.

Choosing a Mask and Headgear

Once you have been prescribed Continuous Positive Airway Pressure (CPAP) therapy, you will need to be fitted for a connection to your nose and/or mouth, tubing and headgear - "an interface". The mask is attached to tubing that, connected to the CPAP machine, delivers the pressurized air that prevents apneas from occurring. It is very important that the mask is comfortable and provides a proper seal for the airflow; the proper air pressure level cannot be established unless the fit is correct. Moreover, a comfortable mask that fits well will make using CPAP easier. In seeking a comfortable mask, keep in mind the fit (does the mask seal over your nose and/or mouth and/or are the straps too tight or too loose?), the size (do you have a small when you need a medium?), and the style, which is a personal preference that only you can determine.

Most masks are triangular in shape and are worn over your nose (or the nose and mouth, with a full-face mask for mouth breathers) while the adjustable straps of the headgear hold the mask in place. Straps that are too loose permit air to leak. Straps that are too tight can break the seal and create leaks; any strap pulled too tightly can cause discomfort. Headgear straps must be snug enough for a good fit in all sleeping positions (back, side, and front) but not tight. "Quick-release" clips attach to the straps at the front of the mask or the strap hooks to one part of the mask; both allow for quick, easy removal of the mask. They also keep the straps in place so you do not have to adjust them each time you use the mask. Headgear comes in a variety of colors, sizes, and materials, but some masks can be used only with specific headgear (many masks are sold prepackaged with headgear). If you breathe through your mouth, you may also want to consider using a chin strap to help keep your mouth closed or a mask designed for mouth breathers. (If you regularly breathe through your mouth during the day because of nasal obstruction, a consultation with an ear-nose-and throat physician may be in order.) A chin strap is not recommended in that case.

CPAP machines compensate for a "built-in leak" in the system usually near the exhalation port of the mask that is necessary to keep the air supply fresh. One mask includes over its exhalation port a small plastic piece filled with sound-absorbing material that muffles the sound and dissipates or spreads the exhalation flow that may bother a bed-partner. Too much leaking, though, may occur if the mask does not fit properly; excessive leaking reduces the set pressure and must be corrected (not to mention that leaks can irritate your eyes). Masks that are too large tend to leak more easily than snug ones, so as a rule of thumb, if in doubt, select the smaller. If you extend your tubing, keep in mind that hoses longer than twelve feet generally will not maintain the proper pressure and may require increased pressure. (Discuss using longer hoses with a health care professional.) If the tubing gets in your way during sleep, try draping it over your headboard or an object designed specifically for this purpose.

Many masks have a hard plastic body and softer silicone seal that touches the face and may have varying features. For example, a mask may include an adjustable pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be as tight. If the mask has a lower profile and does not sit too high at the nose's bridge, it can typically accommodate eyeglasses better. Some masks, particularly accommodates glasses. Another new mask that works only with a specific headgear has inside the silicone seal a soft, foam-like type material with memory for facial contours. This mask also includes a thin plastic piece that glides from side to side across the mask as the person moves in sleep: this is to allow the headgear, but not the mask, to move with the user and alleviates mask leaks. Some triangular masks have two openings or connection ports so, when necessary, oxygen can be used with the CPAP machine. If allergic to silicone, try a mask made from materials like synthetic rubber or vinyl. Several masks on the market now are made out of gel-like material. They are intended to mold to each person's face in order to alleviate pressure points and to be more comfortable. However, because some of these masks are larger and heavier than traditional types, some people find them less comfortable. Another mask now has an inflatable cushion that lets the wearer adjust the fit and prevent leaks.

A more recent variation of the gel-type masks, marketed as one-size-fits-all, has a soft, flexible shell and gel cushion with a pliable wire molded into the shell that allows the mask to be shaped to adjust for individual differences.

In addition to the masks described above-the standard mode of CPAP delivery- an oral mask, designed for mouth breathers, is now available. This delivers the pressurized air through the mouth, and while it uses no headgear, it requires heated humidification. Because the mask touches only the skin around the mouth, it can also accommodate eyeglasses. Not all patients can use this mask, for example, people who grind their teeth and some people who have had surgery for sleep apnea.

Nasal pillows are another option. Instead of wearing a triangular mask, the user inserts into the nostrils two small flexible pieces (shaped somewhat like mushroom caps) that are attached to a plastic adapter that is in turn attached to the tubing. However, people with higher pressures sometimes experience discomfort with the pillows. The pillows can also be inserted into headgear made of pliable metal and plastic which curves over your head and can be adjusted at four points. The pillows do not rest on the nose, upper lip, or cheeks, may solve the problem of allergies to mask material as well as complaints of claustrophobia. Some people, especially people with a beard or moustache, simply prefer nasal pillows to a mask. (While some masks are made with moustaches and beards in mind, facial hair can compromise the effectiveness of CPAP masks.) This headgear can now be used with a triangular-shaped mask.

In addition, there is a new interface that is not a mask but has two tubes that fit snugly inside the nostrils. It looks like a large nasal cannula. While a nasal cannula has two smaller tubes that are used to deliver oxygen, the tubes with this interface must be big enough to prevent the pressurized air from escaping. No headgear is necessary-and hence this interface can also accommodate eyeglasses-as the tubing loops from the nose around the ears. The two tubes join together near the chest and then, as one tube, attach to the CPAP. There is also a strap that goes behind the head to keep the tubing around the ears in place.

There is also is another device that combines two therapies: oral appliances and pressurized air. Oral appliances, which in these cases are to open the airway by moving the lower jaw forward, are connected to CPAP tubing so that the pressurized air is delivered either through the nose (via nasal pillows) or the mouth (through the appliance). The oral appliance attachment requires fitting and adjustment by an appropriate dental practitioner. The oral appliance may also be used alone.

Dry skin can also reduce a mask seal. Skin moisturizers can help with this problem. Although they slightly reduce the mask's life, an improved facial seal may very well be worth it. Some moisturizers are manufactured specifically for CPAP users and can be used inside the nose as well, but avoid petroleum-based products. Conversely, excess skin oil may also reduce the ability to maintain a seal between the mask and face. This may be addressed with improved skin care. Some of these and other products to help the CPAP users are available via the Internet.

Just as there are several CPAP manufacturers that offer different types of machines with different features, there are different masks and headgear styles within manufacturers' lines. Your mask may be manufactured by one company and the CPAP machine by another. Virtually any mask will fit the standard air hose (or can be adapted easily), but, as mentioned, some masks work only with specific headgear, and auto-titrating machines are typically designed to work only with specific masks. It is also possible to have masks custom-made, so ask your doctor, home care company's representative, or dentist about all options. Varying the style or type of mask can reduce chronic nose, lip, or facial discomfort caused by repeated nightly use of the same mask. However, some insurance carriers resist paying for more than one CPAP mask in a specific time period (such as six months or a year), so additional masks may be an out-of-pocket expense for you. Before selecting a mask, try using it with the CPAP on and under realistic conditions (for example, lying down moving from side to side). You, the wearer, should be happy with it. If you have discomfort with any mask, try other ones; though keep in mind any restrictions on cost and/or provider your insurance company may impose.

A guy went to a psychiatrist. "Doc," he said, "I've got trouble. Every time I get into bed, I think there's somebody under it. So I get under the bed, but then I think there's somebody on top of it. Top, under, top, under. "you gotta help me, I'm going crazy!"
"Just put yourself in my hands," said the shrink. "come to me three times a week, and I'll cure your fears."
"How much do you charge?"
"A hundred dollars per visit."
"I'll think about it," said the guy.
Six months later the psychiatrist met the guy on the street. "Why didn't you ever come to see me again?" asked the psychiatrist.
"For a hundred buck's a visit? A bartender cured me for ten dollars."
"Is that so! How?"
"He told me to cut the legs off the bed!"

Meet Cilla Webster

Open the Internet and type in "Cilla Webster" then hit Enter. You will be amazed at the wealth of information that comes up in respect of this remarkable lady and what she has done for Polio Survivors. Here is her story.......

I was only 3 years old when I got polio. When I read the stories of polio survivors who can remember almost every detail of their polio experience (says Cilla) it is unbelievable to me. I am definitely one of those who was so traumatized by my polio experience that I blocked it out. There are bits and pieces I can remember, like when I was lying in the Iron Lung and could see myself in the mirror.

One thing I remember vividly was the day I started school at the Open Air School. My mom had a black eye because my dad had hit her so she was wearing sunglasses. When we went up to the boarding school to find my bed and when the other girls asked why my mother was wearing sunglasses I brazenly told them that it was because my father gave her a black eye. My cousin, also a boarder there, shot me the dirtiest looks ever and that was to be the story of my life. Fighting for my own rights and putting up with unkindness because I was the kid whose parents never collected her for holidays and long weekends so I had to be farmed out to other families.

At Open Air School

I was very grateful for Dr. Fred Hedden, orthopaedic surgeon, who performed so many miracles on my legs. I walked very well for years, right up until the age of 35-years-old. He did the first Grice operation on me in the southern hemisphere. It entailed a great deal of time in hospital watching the mail ships come in and out of Durban harbour and doing school work in the hospital school. After six months I was ready to go back to boarding school to enjoy my new Achilles tendon.

When I went to live at home I was shocked to see that my father was an alcoholic and that we lived in abject poverty. I studied hard and married at the age of eighteen. Those were the days when you could make a wedding dress for the cost of R10 for the material. What a foolish thing that was to do. It was probably a subconscious move to get out of the house.

My first husband wasn’t a very faithful man and divorced me within four years so that he could marry his affair. It was to be a very long time before I ever trusted a man again.

Although I only had one daughter I gave her all the love I had because that is what I wanted from my mother when I went to live at home at the age of thirteen but with eleven children to raise my mother just couldn’t find the time. I also had to help her raise the young children.

At the age of thirty-five I starting experiencing post-polio syndrome symptoms and eventually could hardly breathe. It was to be nearly twenty years before I was finally diagnosed with post-polio syndrome.

Cilla (16) & Lyn Shopping

In the meantime I was abused by doctors and they treated my like a hypochondriac, over drugging me or not helping me at all because they thought everything was in my mind.

My marriage to Len was a wonderful and happy move in my life; very unexpected because I wasn’t looking to marry again but nonetheless a time when I could at last start building a happy life. It was hard to be happily married because no one had ever shown me true happiness, how to enjoy it and what to do when we hit a hiccup but after sixteen years I’m doing pretty well.

Forming the Post-Polio Network RSA was a great achievement for me because it gave me great insight into what I and thousands of other South Africans and Africans are suffering from. So far it has been a long hard journey but has been worth every second.

Since my psoriatic arthritis has worsened I have been forced to exercise and although I am doing it slowly I am finally becoming more mobile and losing weight. The fact that I am still reliant on a wheelchair is not a problem… losing weight and being fit has become very important to me.

Since Len’s diagnosis of dementia last year life has become very different but we continue to be very happy and trust in God to heal both of us through the stripes of His son Jesus Christ so that we can both live a longer life together sharing a life and a love that is truly a blessing.

Cilla, March 2008

Shake and shake the ketchup bottle. First, none will come and then a lotlle.

Fatigue in Post-poliomyelitis Syndrome

Association With Disease-Related, Behavioral, and Psychosocial Factors.
Trojan DA, Arnold DL, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, Narayanan S, Tartaglia MC, Caramanos Z, Da Costa D.
Submitted by Barb O
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, 3801 University St., Montreal, Quebec, H3A 2B4, Canada(dagger).

OBJECTIVE: To determine the biopsychosocial correlates of general, physical, and mental fatigue in patients with post poliomyelitis syndrome (PPS) by assessing the additional contribution of potentially modifiable factors after accounting for important nonmodifiable disease-related factors.

It was hypothesized that disease-related, behavioral, and psychosocial factors would contribute in different ways to general, physical, and mental fatigue in PPS and that a portion of fatigue would be determined by potentially modifiable factors.

DESIGN: Cross-sectional study.

SETTING: A tertiary university-affiliated hospital post-polio clinic.

PATIENTS: Fifty-two ambulatory patients with PPS who were not severely depressed were included.

ASSESSMENT OF RISK FACTORS: Potential correlates for fatigue included disease-related factors (acute polio weakness, time since acute polio, PPS duration, muscle strength, pain, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, body mass index, disability, fibromyalgia, behavioral factors (physical activity, sleep quality), and psychosocial factors (depression, stress, self-efficacy).

MAIN OUTCOME MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI; assesses fatigue on 5 subscales) and the Fatigue Severity Scale (FSS).

RESULTS: Multivariate models were computed for MFI General, Physical, and Mental Fatigue.

Age-adjusted multivariate models with nonmodifiable factors included the following predictors of (1) MFI General Fatigue: maximum inspiratory pressure, fibromyalgia, muscle strength; (2) MFI Physical Fatigue: maximum expiratory pressure, muscle strength, age, time since acute polio; and (3) MFI Mental Fatigue: none.

The following potentially modifiable predictors made an additional contribution to the models:

(1) MFI General Fatigue: stress, depression;

(2) MFI Physical Fatigue: physical activity, pain; and
(3) MFI Mental Fatigue: stress.

CONCLUSIONS: PPS fatigue is multidimensional. Different types of fatigue are determined by different variables. Potentially modifiable factors account for a portion of fatigue in PPS.

The early bird might get the worm, but the second mouse gets the cheese.

Clinical Depression

What is Clinical Depression?

When we refer to depression in this article, we are talking about "Clinical Depression". It is a serious medical illness that negatively affects how you feel, the way you think and how you act. People with clinical depression are unable to function as they used to. Often they have lost interest in activities that they once enjoyed and they feel hopelessly sad for long periods of time. Clinical depression isn't the same as feeling sad for a few days and then feeling better. It can affect your body, you thoughts, your mood and your behavior too. It can change your eating habits, your ability to work, to study, and also how you interact with people. Those who have clinical depression often remark that they "don't feel like themselves any more." It isn't a sign of personal weakness. People who are clinically depressed just cannot "pull themselves together" It is a serious illness that can last for weeks or months, sometimes even for years. In fact, it may even lead to suicide. But, like Pandora's box, there is always hope. With the right treatment, most people who seek help get better within several months. Many people begin to feel better in just a few weeks.

Types of Depression:
Clinical depression can come in different forms. It may start suddenly or build up over a period of weeks, months, or years. Here are descriptions of the three most prevalent forms, though for an individual, the number, severity and duration of the symptoms may vary.

Major Depression: a combination of symptoms that interfere with one's ability to work, sleep, eat and enjoy once pleasurable activities. These episodes can occur once, twice or several times in a lifetime.
Dysthymia: a less intense type of depression that involves long-term, chronic symptoms that are less severe, but keep one from functioning at full ability and from feeling good.
Bipolar Disorder (also known as manic-depressive illness): periods of depression alternate with periods of elation and increased activity, known as mania.

How Is Clinical Depression Different From Normal Stress and Sadness?
Feeling sad and depressed is often a normal reaction to a stressful life situation. For example, it is normal to feel down after a major disappointment, or to have trouble sleeping or eating after a difficult relationship break-up. Usually, within a few days, perhaps after talking to a friend, we start to feel like ourselves again.

Clinical depression is very different. It involves a noticeable change in functioning that persists for two weeks or longer. Imagine that for the last three months you've slept more than 10 hours a day and still feel tired, you have stomach problems, you're unable to cope with life, and you wonder if dying would solve all your problems. Or, imagine not being able to sleep more than four hours a night, not wanting to spend time with family or friends, and constantly feeling irritable. And when friends try to reach out to you, you get even more upset and bothered. You lose perspective, and you don't realize that what you're experiencing is abnormal. You want to just "wait it out," and you don't get help because you think it's weak to ask for help or you don't want to burden your friends.

These are some of the experiences that people can have when they suffer from clinical depression. Unlike normal stress and sadness, the symptoms of clinical depression persist and do not go away no matter how much the individual wants.

What Causes Depression?
You may feel you know exactly why you're depressed. Other times, however, the reasons for depression are not as clear. The causes of depression are quite complex. Very often it is a combination of genetic, psychological, and environmental factors. Regardless of the cause, depression is almost always treatable. You do not need to determine the cause of your depression to get help.

Biological factors: You may have heard about chemical imbalances in the brain that occur in depression, suggesting that depression is a medical illness. Depression does seem to have a biological component. Research suggests that depression may be linked to changes in the functioning of brain chemicals called neurotransmitters. Current research focuses on the serotonin, norepinephrine and dopamine systems. The usefulness of antidepressant medications suggests that brain chemistry is involved in depression. However, it is also possible that biological changes happen as a result of being depressed.

Some kinds of depression seem to run in families, suggesting a biological vulnerability. This seems to be the case with bipolar depression and, to a lesser extent, severe major depression. However, having a biological vulnerability does not mean you are destined to become depressed. Not everyone in a family develops depression, suggesting that other factors are involved. In addition, depression can occur in individuals who have no family history of depression.

Stress: Psychological and environmental stressors can contribute to a depressive episode. Common stressors among college students include:

academic demands
transitions-re-entry to school.
balancing school, work, family, social life
financial responsibilities or worries
family concerns
social isolation
difficulties in relationships with friends and romantic partners
being on one's own in a new environment
exposure to new ideas, new people, and temptations
awareness of sexual identity and orientation
preparing for life after graduation, career decision-making

A major loss, chronic illness, relationship problems, work stress, family crisis, or unwelcome life changes can often trigger a depressive episode, even in individuals without a family history or genetic predisposition.

Psychological Tendencies: Psychological make-up can play a role in vulnerability to depression. People with low self-esteem, who consistently view themselves and the world with pessimism, or are readily overwhelmed by stress, may be especially prone to depression.

Alcohol or Other Drug Use: A lot of depressed people, especially young adults and men, have problems with alcohol or other drugs. Sometimes the depression comes first and people try alcohol or other drugs as a way to escape it. Other times, the alcohol/drug use comes first, and the drug itself, or withdrawal from it, or the problems caused by substance use, may lead to depression. Sometimes you can't tell which came first. The important point is that when you have both of these problems, the sooner you get treatment, the better. If you are taking medication for depression and abusing alcohol or other drugs, your medication will not work effectively. Medication should never be discontinued without talking to your doctor.

Men and depression
Depression can strike anyone regardless of age, background, socioeconomic status or gender. However, in any given year, 12% of women (nearly 12 million women) in the United States are diagnosed with depression compared to 7% of men (over 6 million men). Important questions remain about the causes underlying this gender difference and whether depression truly is less common among men, or whether men are less likely than women to recognize, acknowledge and seek treatment for depression.

Research at the National Institute of Mental Health (NIMH) on depression awareness has shown that many men are unaware that physical symptoms such as headaches, digestive disorders, and chronic pain can be associated with depression. Depression in men can present itself differently than in women. Men are more likely to acknowledge fatigue, irritability, loss of interest in hobbies, sleep disturbances, and discouragement, rather than feelings of worthlessness or guilt. Men's depression is more often masked by alcohol or other drugs, or by the socially acceptable habit of working excessively long hours.

Even if a man realizes he is depressed, he may be less likely to seek help. Men express concern about seeing a mental health professional, thinking that people would find out and it might have a negative impact on their job security, promotion potential, or health insurance benefits. Men may fear that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends. On campus, male students may be more concerned about their standing in their academic department, or being labeled as weak, if they seek help. Encouragement and support from concerned family members and friends can make a difference. Significant others play an important role in helping men recognize their symptoms and getting treatment.

More About Bipolar Disorder
Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and severe lows (depression). Sometimes the mood switches are dramatic and rapid, but most often are gradual. When in the depressed cycle, an individual can have any of the symptoms of a depressive disorder. When in the manic cycle, an individual is overly "up" or irritable. Someone in a manic state may appear excessively talkative and energetic, with little need for rest or sleep. This can affect thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, an individual in a manic phase may feel elated, full of grand schemes, or engage in reckless spending sprees or increased sexual activity. Individuals who are in a manic state may feel in possession of special powers or abilities that others can't understand. Bipolar Disorder is treatable.

So.... considering all the above...... aren't you pleased that your own depression is transitory - not clinical - and that it will disappear in a couple of days!!

Do not argue with an idiot. He will drag you down to his level and beat you with experience.

The three best Physicians are Dr. Diet, Dr. Quiet and Dr. Merryman