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  • Proper Shoes and Hemophilia | HemAware
    28 of Charlottesville Virginia If I do something active in the wrong shoes it hurts the next day That kind of pain and discomfort can begin a vicious cycle says Nicole Hroma PT the senior physical therapist at the Comprehensive Hemophilia and Thrombophilia Program of Children s Memorial Hospital in Chicago If you hurt your ankle and get a bleed then you will rest it so that it doesn t bear weight Hroma says But when you do that your muscles tighten That can cause you to lose range of motion and make you more susceptible to future bleeds To find the right footwear Mulvany recommends shopping at a shoe store rather than online While the Internet may be convenient you need to try on a shoe before you buy it Look for shoes with good cushioning arch support and plenty of wiggle room for your toes says Mulvany People with bleeding disorders who have foot and ankle problems do better with sturdy laced up high top shoes that support the arch and the ankle Mulvany says Those who have limited ankle motion often report that they do best if the shoe has a bit of a heel like a cowboy boot would have This puts the foot in a position that supports their limited motion When McNeil needs shoe advice he turns to his physical therapist This is a good idea for anyone with a bleeding disorder Consult with your physical therapist podiatrist or orthopedist before buying your next pair of shoes Such experts can identify problems and provide recommendations while steering you away from styles that could do your feet more harm than good Custom made inserts for people with bleeding disorders keep the foot in place and properly aligned That says Hroma helps to prevent bleeds An added advantage is that they fit inside most dress shoes which often lack support For a study that gathered data from 1999 to 2006 Hroma and her colleagues recruited 60 children who were patients at Children s Memorial Hospital s HTC Half of the children wore inserts while the other half did not Hroma and colleagues presented the study at the World Federation of Hemophilia Congress in Istanbul Turkey in June 2008 We had clear results the kids wearing the inserts averaged about seven bleeds in seven years Hroma says The other kids averaged 30 bleeds Some insurance plans cover custom made inserts and orthoses when prescribed by a certified orthopedist Check with your insurance provider before going to the orthopedist to see what your options are But don t overlook the inserts you can buy at your local shoe store say Hroma and Mulvany Sometimes inexpensive commercially available shoe inserts can make a huge difference in comfort and function Mulvany says Again check with your physical therapist or podiatrist to learn what s right for you Don t wait to determine what fits your needs best If you have problems with your feet or ankles early and aggressive intervention

    Original URL path: http://www.hemaware.org/story/focus-footwear (2016-02-18)
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  • Sensible Snacking
    grains and nuts All it takes is a little creativity and a well stocked kitchen Here are some ideas to get you started Dip carrot spears celery sticks and jicama a crunchy potatolike veggie from Mexico in low fat dressing spetnitskaya nadya Thinkstock Put Greek style yogurt skim milk and fresh berries in the blender for a tropical smoothie olvas Thinkstock Serve hummus a dip made from chickpeas with whole

    Original URL path: http://www.hemaware.org/print/1132 (2016-02-18)
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  • Shaping Up
    exercise and good nutrition but also of the scope of the problem facing young people with bleeding disorders In 2005 the CDC looked at data on the bleeding disorders community They found that it is very overweight or obese especially teens and young adults Nazzaro says In people s minds exercise is not equated with prevention but it needs to be We want to press that issue says Nazzaro A Family Affair Another program conveying that message is L I F E for Kids Based at Peyton Manning Children s Hospital at St Vincent in Indianapolis the yearlong fitness and nutrition program launched in the spring of 2007 has changed Campbell Eccles life Eight months into the program Campbell now 15 has lost nearly 40 pounds He is at the gym most days lifting weights and running on the track He has given up soda He is even eating some vegetables Before we joined the gym we walked in the neighborhood and did ab crunches on the living room floor said Zach Eccles Campbell s father and exercise partner He is also 40 pounds slimmer The program begins with weekly meetings to discuss and set nutrition and exercise goals Changes in diet and exercise habits are introduced gradually We don t do anything crazy or drastic says program founder Lori Walton RN We give out elastic stretch bands for strength training says Walton We also give them pedometers so that they can measure their daily step count If they start at 5 000 we want them up to 6 000 From there patients can pick from a lot of different activities depending on their interests and abilities One key to the program is family participation If Mom and Dad don t change their habits their kids won t either says Michele Rice executive director of Hemophilia of Indiana an NHF chapter in Indianapolis She is the mother of two sons in the program It floors me now to think that we have been drinking nothing but skim milk for six months not to mention the healthy cereals low fat cheese and whole wheat bread we are now eating Against the Current Jeff Kallberg PT runs a different kind of program at ACCUA Advanced Fitness Center near Minneapolis He has severe hemophilia A yet that did not stop him from earning a black belt in tae kwon do He uses his personal experience to inspire others As a physical therapist he likes to challenge his patients with hemophilia to achieve fitness goals they never believed they could reach or were afraid to attempt When they come here they are often not even sure how to exercise says Kallberg After administering a battery of tests to determine fitness and abilities Kallberg works with his patients individually to design a program that will be both motivating and challenging We exercise together he says With that supervision I can push them a little harder than they would push themselves at home The centerpiece of

    Original URL path: http://www.hemaware.org/print/227 (2016-02-18)
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  • Pain Management Strategies
    case of a suspected bleed healthcare providers usually recommend splinting the affected joint which limits movement and further bleeding allowing the injury to heal Applications of ice can further reduce pain and swelling They help constrict blood vessels and limit bleeding Compression or wrapping the affected area with an elastic bandage also helps reduce swelling and limits bleeding Finally it s best to keep a painful extremity elevated as much as possible to reduce swelling Although the RICE method is a mainstay for treating injuries data from the National Pain Study pilot project show that it is underused by people with bleeding disorders Pain Relievers Even when people with bleeding disorders apply the RICE method they often need pharmaceuticals to also help with pain relief According to the pain study the most commonly used drugs by respondents are acetaminophen and nonsteroidal anti inflammatory drugs NSAIDs However the use of aspirin ibuprofen naproxen and other NSAIDs are harmful for people with bleeding disorders because they can interfere with blood clotting The pain study revealed that many people with bleeding disorders are using prescription NSAIDs despite the risk Many people with bleeding disorders take a type of NSAID known as a COX 2 cyclooxygenase 2 inhibitor which is believed to have a limited impact on blood clotting COX 2 inhibitors include celecoxib Celebrex rofecoxib Vioxx and valdecoxib Bextra In 2005 The Food and Drug Administration FDA withdrew Vioxx and Bextra from the market because of an increased risk of heart attack and stroke among people who took the drugs Pfizer s Celebrex is the only COX 2 inhibitor that remains on the market In June 2005 the National Hemophilia Foundation s Medical and Scientific Advisory Council MASAC issued a recommendation Document 162 that advised caution for the use of all COX 2 inhibitors including Celebrex in people with bleeding disorders especially children The recommendation says If a COX 2 inhibitor is prescribed it should be used at the lowest effective dose for the least necessary duration 1 As with any drug acetaminophen should be taken with caution Prolonged use can result in liver injury or failure The American Liver Foundation recommends that acetaminophen use be limited to 4 000 milligrams per day for people younger than 60 years old and 3 000 milligrams per day for people 60 years old and older Other drugs commonly prescribed for short term pain relief include opioids such as oxycodone Percocet morphine methadone and codeine OxyContin is a commonly prescribed sustained release formulation of oxycodone The most common side effects of opioids include drowsiness nausea and constipation Less commonly people experience itching and breathing problems Opioids and other pain relievers can also lead to abuse dependency and addiction see Un Comfortably Numb HemAware March April 2004 p 36 Chronic Pain Although reliable statistics are not available experts suggest that chronic pain is common among people with bleeding disorders It often has a significant emotional component resulting in stress depression anxiety and anger People with hemophilia who

    Original URL path: http://www.hemaware.org/print/171 (2016-02-18)
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  • Cold Weather Safety
    Direct property loss due to house fires adds up to an estimated 7 3 billion annually With lives and such high costs at stake it s important to take steps to protect your home and your family Keep in mind Check smoke and carbon monoxide detectors to ensure they re functioning correctly Replace batteries yearly Get your gas furnace fireplace and or wood burning stove inspected and cleaned at least

    Original URL path: http://www.hemaware.org/print/1254 (2016-02-18)
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  • Flu Shot Reminder
    recommends that everyone older than 6 months old get a flu shot The flu vaccine is especially critical for the following groups People with a respiratory illness or diabetes Pregnant women Children younger than 5 years old People 65 years or older Anyone who lives or works in close proximity to someone in any of the above groups Flu vaccines now come in a variety of forms from nasal sprays

    Original URL path: http://www.hemaware.org/print/1173 (2016-02-18)
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  • Water World
    weighted leg lifts Cindy Bailey PT DPT OCS SCS director of the physical therapy program at the Hemophilia Treatment Center at Orthopaedic Hospital of Los Angeles stresses safety first for nonswimmers and pool veterans alike No one not even an Olympic swimmer should ever enter the water without a lifeguard in the area to watch assist and be there for safety she says Diving in slowly Water workouts are ideal for just about everyone from people just getting off the couch to competitive athletes If you re new to aquatic exercise start slowly says Volsen At first stick with water walking in the shallow end Then as you build strength and balance move to deeper water where you ll meet more muscle challenging resistance Walking s the perfect first step says Volsen It will take time to adapt to your new exercise Ask your PT what to expect A couple of weeks of muscle soreness for example is normal Push on and you ll be rewarded After a month or so you ll notice your muscles getting stronger Bailey says Coprid Thinkstock After you get the hang of walking in the pool add specialized equipment to your workout for a greater challenge For example Volsen likes to introduce foam ankle cuffs to her more advanced water walkers While wearing them they really have to work their legs and their core to stay stable in the water she says Read the sidebar Aquatic Exercise Equipment in HemAware s free iPad app Stationary running is another beneficial exercise even if you have ankle knee or hip problems Strap on a flotation belt or life vest and you can run in deep water without touching the bottom of the pool It will make you really really tired says Bailey Fatigue is a sign

    Original URL path: http://www.hemaware.org/print/1143 (2016-02-18)
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  • Health Benefits of the Outdoors | HemAware
    from being outside for people with bleeding disorders says James Munn RN MS program coordinator of the University of Michigan s Hemophilia and Coagulation Disorders Program in Ann Arbor Staying in shape is recommended for people with bleeding disorders a task that may seem easier while you re outside enjoying a nice day When you limit yourself by being indoors too much you re probably not getting the sort of physical activity your bones need to become healthy and strong says Munn He adds that strengthening muscles is also key to staying healthy with a bleeding disorder Being outside helps with proprioception the sense of position motion and spatial orientation To help avoid injury says Munn people with bleeding disorders should try walking on surfaces that are sandy rocky hilly or grassy If you ve never been exposed to any of that the first time you go hiking with friends you may either take it too cautiously or too aggressively and end up with an injury he says If you do get injured research suggests nature can even help you heal One classic study published in Science in 1984 found that patients with a view of a natural setting outside a window were discharged from the hospital faster Spending time outdoors provides unique benefits that can t be gained indoors says Edward J Kuebler LCSW senior social worker at the Gulf States Hemophilia and Thrombosis Center in Houston You can get the effects you need with a gym he says But when you can take the activity into the outdoor environment part of why people enjoy it so much is because of the wind on their face and the sun shining Being outdoors also positively influences your mental health studies show In one analysis published in Environmental Science and Technology in 2011 researchers found that exercising in natural environments rather than indoors was associated with increased energy and feelings of revitalization as well as decreased tension anger and depression Getting off the couch and out into nature can also provide a much needed change in perspective says Kuebler When people can t cope with what s happening they can end up shutting down and getting depressed or anxious he says When you re able to get them out and change that perspective it can allow them to see what s going on outside their head Besides exercising outside or simply having a picnic with your family can be a lot more fun than playing a video game by yourself or walking on a treadmill at the gym We live on a beautiful planet says Kuebler We should take advantage of it Heading Out Tommy W Riggs Jr 42 of Olean New York who has moderate hemophilia B used to spend his days outdoors building houses in Memphis Tennessee Then he injured his ankle and the resulting bleed eventually ate away the cartilage around the joint ending his construction career Today he runs a computer repair business Now that he s

    Original URL path: http://www.hemaware.org/story/health-benefits-outdoors (2016-02-18)
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