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Mobility aids have their own hierarchy proven 20 mg cialis super active erectile dysfunction treatment homeopathy, from low-tech wooden canes with crook handles effective cialis super active 20 mg erectile dysfunction foods to eat, to multifooted canes, to crutches, to walkers, to manual wheelchairs and scooters, to sophisticated power wheelchairs. People gen- erally start with the lowest practical option, then, if impairments progress, they move up the hierarchy, as did Walter Masterson (chapter 3). Over the last two decades the sophistication, design, and diversity of mobility aids have grown dramatically, offering consumers wide-ranging options for most tastes and requirements. Yet little systematic evidence is available about the technical pros and cons of different mobility aids and their safety and biomechanics in routine use. Research including persons with ac- 184 mbulation Aids tual mobility problems is generally conducted in laboratories, with few studies examining how people use mobility aids in daily life or whether these aids save societal costs (e. Choice of mobility aids must consider many factors beyond lower- extremity functioning, including people’s cognitive status and judgment, vision, vestibular function (which affects balance), upper-body strength, and global physical endurance, as well as home and community environ- ments. Ambulation aids fall at the low-tech, higher-functioning end of the mobility device continuum. Stuart Hartman, an orthopedic surgeon, encourages patients to use ambulation aids by emphasizing that they will still walk independently, albeit now with mechanical assistance: People don’t normally want these things—they just don’t want to be seen that way. They feel like everybody is looking at them, like they’re getting old and that’s the final chapter. But I say to people, “Look, you would walk much better, much farther, more comfort- ably, and you’d walk more places because you’d feel supported and steadier on your feet. They go farther because they’re not as exhausted, they’re not huffing and puffing. Canes augment muscle action and provide stability, especially for people with neurologic conditions. For balance, a sin- gle finger lightly touching fixed objects, like walls, actually improves stabil- ity better than canes (Maeda et al. People often “furniture surf” at home, placing objects strategically to balance themselves, but in open spaces have nothing fixed to grab. Canes can convey tactile information and en- hance balance, as fingers touching walls do (Jeka 1997; Maeda et al. Unfortunately, most people get little instruction in proper use of canes (Kuan, Tsou, and Su 1999), although, as Dr. Hartman notes, “somebody with a balance disturbance should use a cane differently from someone with a bad hip or knee who uses it for weight-bearing. Up to 70 percent of canes are the wrong length, faulty, or damaged (Joyce and Kirby 1991; Kumar, Roe, and Scremin 1995; Alexander 1996). Ambulation Aids / 185 Although canes are the least sophisticated ambulation aid, several vari- ants are available, differing at their handles and bases. Canes come with crook tops, spade tops, and straight tops; they can have a single rubber-capped tip or three or four short legs attached to little platforms at their base. Func- tional differences among these variants are unclear, and studies are limited and contradictory. Depend- ing on users’ upper-body strength, underarm crutches can bear up to 100 percent of their weight, while forearm crutches (i. Cuffs free the hands of forearm crutch users for ac- tions like opening doors. Various styles of crutches offer different benefits for people with weakness in specific arm muscles (Ragnarsson 1998). Again, choosing the most suitable crutch depends on individual circumstances. Walkers provide additional stability for people with poor balance and lower-extremity weakness and come in many styles, from standard rigid models without wheels to collapsible wheeled walkers, with handbrakes, seats, and baskets. As with canes, walkers must be the proper height, and training is essential. Wheeled walkers are dangerous if they roll forward un- expectedly, but they are easy to propel on smooth surfaces (Joyce and Kirby 1991), demand less energy (Foley et al.

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Even though you may be frustrated or experiencing anxiety in a search for answers cheap 20mg cialis super active with mastercard erectile dysfunction pills dischem, seeking opinions and treatments from other doctors while you are trying to create a proactive and productive partnership with your primary one can actually sabotage your recovery and make you both crazy generic cialis super active 20 mg impotence clinics. There are documented cases of patient deaths resulting from conflicting treatments by different doctors when one doctor did not know what the other doctor was doing. Apart from being potentially hazardous to your health, it will certainly sabotage any chance you may have of creating that productive partnership you desire. This is not to say that you must stay with one doctor if you feel you are not making any progress or your doctor is not living up to his end of the relationship. Try to resolve any difficulties you may be having with your current doctor; then and only then, move on if you cannot get what you need. Don’t stay with that doctor and then not tell him you are working with someone else. The surest way to lose the trust you have developed and commitment you have earned is to doctor-shop. Unless you are just lucky, you will not find your solutions by looking to other practitioners while you are in a rela- tionship with one specific doctor. Apart from maintaining a con- tinuing dialogue and line of communication, all interactions between doc- tor and patient must be handled with mutual respect—on both ends. While we are advocating a proactive relationship by taking action on your own and assuming responsibility for your own health care, being assertive in this way is very different from being confrontational or hostile. Oftentimes these approaches become confused when there is so much pain and frustration involved in the process of securing a diagnosis to a mystery malady. It is tempting to scapegoat someone—either for the doctor to blame the patient out of frustration for not getting well or for you to blame the doctor for your continuing sickness. If you believe that she is becoming frus- trated with you merely because she is not having success in treating you, address this with your doctor. Assure her that you are committed to staying 72 Becoming Your Own Medical Detective the course until you find the solution. Likewise, if you think you have been inappropriately angry with your doctor for not “fixing” the problem, just admit it and apologize. It can be frustrating all the way around, but main- taining honest communication can salvage any damage. While medical science may have its limits, hope does not, and that is sustained by maintaining a respectful, collaborative, and supportive rela- tionship between mystery malady patient and doctor. It is worth remem- bering that you play a major role in fostering a productive and truly healing partnership. Developing this relationship is so important that it is the last of the Eight Steps for self-diagnosis. Surgeon General Throughout our discussion of the Eight Steps to Self-Diagnosis, including how to create a partnership with your physician, we have empha- sized the need for you to assume a proactive role in sleuthing out the solu- tions to your mystery malady. In addition to observing and recording the exact nature of your symptoms, your sleuthing may involve outside inves- tigation from whatever sources of information you have available. Many people, especially seniors, use the public library to learn about topics of interest. The library is an especially good resource when there is a reference librarian to help direct your research efforts, and the libraries at many med- ical schools are open to the public. There is, however, a more convenient place to do your medical inves- tigation—your own computer. The Internet can be a gold mine of medical information if you know how to use it effectively. Many hospitals now have computer terminals available for the community to use when researching health topics. Whether you grew up in front of a keyboard or you’re a “surfin’ senior,” this chapter aims to help you do your own medical detective work on the Internet. If you’re not computer savvy, we recommend that you enlist 73 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum. Searching the Internet could turn up a unique and invaluable clue to your mystery malady. Before You Start For you library-card holders who are about to explore the Internet for the first time, understand first that there is no reason to be intimidated by the computer. Think of the Web as a library literally at your fingertips that is a little more challenging than the orderly world of library stacks. Although the Web may not be as rationally organized, it is without a doubt the biggest library you’ll ever find!