Membership in these health clubs and spas involves more than 16 million persons. Of these 16 million persons, more than 9 million engage in aerobics and/or body-conditioning classes at least three times per week.

These numbers do not include hospital- or corporate-based health clubs and spas, or other private clubs.

The latter clubs bring an additional 4 million persons to the total.

Indeed, the sheer number of persons engaging in aerobics and body-conditioning classes is staggering.

And, the potential number of persons who may experience permanent damage to their residual hearing as a result of exposure to high-intensity levels of music is likewise significant.

“Arthritic joints take more effort to move than normal joints,” said Ginny Keely, P.T., M.S., of Southwest Texas State University’s Department of Physical Therapy in San Marcos, Texas. “Learning to protect joints reduces pain and saves energy. Adaptive devices and techniques can improve the mechanics of a task, allowing it to be accomplished with less strength or movement,” Keely explained.

The Benefits of Assistive Devices
The benefits of assistive devices are many, says Dr. Thao Tran, of The Institute for Rehabilitation and Research (TIRR) and the University of Texas-Houston Medical School. Safety should be the No. 1 factor, but quality of life also is very important. Many easy-to-use medical aids are available to help with function and independence, but individuals should receive instructions on how to use them from their physician or therapist, Tran cautions.

Many assistive devices are available at your nearest drugstore or medical supply store. According to Tran, there are three categories:
Mobility aids — Canes, crutches and walkers help your balance, compensate for weakness on one side and prevent falls while taking the weight off sore joints. They can also prevent additional stress to other areas of your body. For example, overcompensating for a sore left knee, in the long run, could cause deterioration in your right knee.

Daily living items — These include bath bars, jar grippers and other household gadgets. Hundreds of adaptive devices are available that can help with personal care and household tasks.

High-tech help — This can range from voice recognition systems for computers to inexpensive timers for clocks, alarms, lights and heating/air conditioning systems.

Home Sweet Home
Discovering helpful tools and making some simple changes to your home can make a big difference. Home health occupational therapists can help you identify ways to make your home safer and easier to navigate. Or try these small changes, recommended by a number of sources, including Tran and Keely:
Use adaptive devices, such as jar openers, that will help you function with less pain.

Ask your pharmacist for easy-open caps rather than childproof lids for your medications without prescriptions if there are no children in your house.

Place a waterproof chair or stool in the tub or shower to help you get in and out more easily.

Adjust the height of the toilet seat with risers.

Use electric can openers and knives.

Invest in large-handled eating and cooking utensils. Many have special easy-to-hold grips.

Use long-handled reaching devices or tongs for grasping hard-to-get items.

Count on shoehorns and use Velcro instead of shoelaces.

With just a few accommodations like these, arthritis patients can protect their fragile joints from further injury.

You talk about quality of life. Are there cases where, even if the surgeon says to have surgery, I can look at my life and say, “I don’t need to do this?”
Sure. Let’s say you’re someone whose major enjoyments in life come from a rather sedentary existence. You enjoy reading, puttering around the garden. And you do not particularly enjoy activities like tennis or running. You may have a knee condition and when you do engage in vigorous activities, you have pain, and that pain would best be relieved by surgery, a ligament repair in your knee. If in your lifestyle, that pain is infrequent and it keeps you from the activities that are unimportant to you, then by no means should you even consider having an operation. Conversely, if you play singles tennis three times a week and the pain is keeping you from doing what is a very important part of your life, by all means do it. The question is: how important is the pain in your knee in the context of what’s important to you?

What if it’s not me who’s considering surgery, but a close family member or friend, is there a role for me, or should I stay out of the way?
I think you can be an enormous help. First and foremost you can help them focus on the fundamental questions. You can be a sounding board for their concerns. If it’s someone to whom you’re very close, I think it can be helpful to you to join them at the time of the surgical consultation so that they have essentially a second set of ears, or second antenna, to recall the enormous amount of information that’s usually being exchanged in such an encounter.

I hear a lot of stories about surgeries done in the past from older people. Is surgery a lot different these days?
It’s a completely transformed world compared to 20 or 30 years ago. It is a much safer world. Many of the operations we did then have become obsolete. And the things we do now weren’t even considered then.

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What happens if I hear my surgeon’s very good, but when I try to talk to him, he’s rushing me and is on to the next patient before I’ve finished my sheet of questions? Should I go elsewhere?
Hopefully, even before you ask, he will have volunteered additional resources in his office or institution to help answer your questions. If that’s not available, I think it is right to feel uncomfortable, and you ought to seek more information elsewhere.

It’s OK then to expect that your surgeon may not be the source of all the information you need?
In fact, the surgeon should not be the only source of information because there are many aspects of the process of having an operation that I think are better communicated by nurses, physicians assistants, anesthesiologists, and others that will be involved in your care.

You mentioned the surgeon does the calculating and I take the risk. What about the risk, especially with anesthesia?
There’s an enormous spectrum of risk that’s associated with surgery. For patients who are otherwise healthy, the risks of anesthesia are extremely low. And they should be weighed against the benefit that you anticipate getting from the operation. If it’s an operation that’s designed to make your life longer, with convincing statistical evidence that the operation will do that, the risk of anesthesia is generally trivial in comparison. And with regard to issues of quality of life, we take chances all the time to improve our quality of life. We travel in airplanes, cars, boats…we walk around on streets crowded with traffic…we eat in restaurants…all have risk and, obviously, a quality of life benefit. I think anesthesia ought to be considered in the same context.

What about pain? I’m concerned that being cut into is going to cause a lot of pain, especially after the operation.
Post-operative pain now is generally very well controlled with medication, and with some relaxation therapies. Some people would argue that hypnosis can be helpful here as well. But the mainstay of post-operative pain management is certainly the use of medication. It’s most important that you be given adequate doses. The medications themselves are well-established and quite safe.

You mentioned relaxation and hypnosis. Is it realistic to expect that some kinds of alternative or complementary medicine could be part of the surgical experience?
It’s very variable. There are some patients who are very receptive to these techniques, which are most valuable in my opinion for the subjective benefit they provide. They simply make you feel better. That’s just not true of everybody. If it works for you, by all means do it, provided that what’s being proposed is safe and compatible with the surgery or the medicines that you’re taking.

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Are there certain questions I should always ask if I’m trying to decide whether or not to have surgery?
Absolutely. First and foremost, does the proposed operation have explainable, definable benefits to you, both with regard to survival and to quality of life? And unless you feel that it is going to benefit you in at least one of those areas — namely, to increase your likelihood of survival, or increase the quality of your life in a way that’s meaningful to you — you shouldn’t do it.

How can I tell if I’ve gotten a good surgeon?
I believe reputation is important. You should ask your surgeon how often he or she has done the operation that’s proposed for you, and what the results have been. You should expect a level of comfort in the explanations you get from the surgeon, in both the reasons for having the operation and in the experience and knowledge that he has in doing that procedure.

Should I always get a second opinion?
Most often, I don’t think you need a second opinion if the answers you’ve been getting to the fundamental questions provide you with comfort. If you feel you need an operation, based either on its ability to prolong your life or make it better, then I think you should feel very comfortable in the decision. If you have any discomfort in that regard, then you should seek more information through a second opinion.

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To set the record straight, Dr. Eric A. Rose, a heart surgeon and chairman of the department of surgery at Columbia Presbyterian Medical Center in New York City, wrote “Second Opinion: The Columbia Presbyterian Guide to Surgery,” (St. Martin’s Press, 2000, $27.95) Rose tracks how to proceed from the first inklings that an operation is an option, through the decision-making process, and finally what to expect in the course of the surgical experience itself, if you choose to have it.

As a patient, “your role should be a very active one,” said Rose. “You’re basically a customer making a decision. Not in the sense that you’re shopping around for the best price or looking for a bargain, but that in the sense that you have many choices. And before you make that decision, you want to be informed.”

(During the preparation of Rose’s book, Kabak worked with Rose on its content. She recently interviewed him to revisit the issues that lead to being in charge of your own health in the face of surgery.)

The following are answers to questions that could be posed by a person who is considering surgery.

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M.P.

A.First, let me provide some background on Creutzfeldt-Jakob disease (CJD), a rare disorder of the central nervous system that causes a rapidly progressive dementia (decline in intellectual function). Unlike Alzheimer’s disease, which progresses over years, CJD progresses over months, with most patients dying less than one year after the onset of illness. In addition to mental deterioration, most patients have spasticity, rigidity, abnormalities in eye movement and visual disturbances. There is no known treatment for this invariably fatal disease.

A.The cause of CJD is the accumulation of abnormal proteins called prions (proteinaceous infectious particles) in the brain. In 10-15 percent of cases, people develop the disease because they have inherited a mutated gene that results in the production of prion protein, an abnormal version of a protein normally present in the brain. In other cases, CJD disease symptoms are caused by an infectious process. Prions are thought to infect previously healthy people and replicate in some way in the host, causing an accumulation of more prions. One theory is that prions introduced into the brain somehow trigger a change in the normal counterpart of prion protein, making it abnormal.

CJD is not contagious in the usual sense. For example, it is not transmitted through casual contact, sexual contact or by insect bites. However, people who have CJD, even by inheritance, can pass it on in certain circumstances. It can be transmitted by directly introducing infected material into the body, as occurs with organ or cornea transplantation or injections of human growth hormone derived from cadavers. (Today, genetically engineered human growth hormone is available, which eliminates the risk of CJD from cadaver-derived hormone.) Also, researchers have linked cases of a new variant of CJD, most of which have occurred in Britain, to the consumption of meat from animals stricken with mad-cow disease. Because of this link, British authorities ordered the destruction of more than 100,000 cows.

H.U.

A.The spine is divided into several regions. The cervical region is the neck and comprises seven vertebrae. The thoracic area is what the ribs attach to, and there are 12 thoracic vertebrae. The lumbar spine comprises five vertebrae between the thoracic spine and the sacrum, which is the bottom part of the spine.

A.When the spine is viewed from the front or back, it should look like a straight line. If there is any curvature, this is known as scoliosis. When viewed from the side, the spine has several normal curves at various regions. The cervical spine and the lumbar spine both curve toward the front.

You can feel these curves at the back of your neck and the small of your back. This sort of curve is called lordosis. The thoracic spine curves toward the back, which is called kyphosis. An extreme degree of lordosis in the lumbar vertebrae is commonly called swayback. A person with increased kyphosis is said to have a humpback.

There is clearly a variation in the normal amount of lordosis and kyphosis of the spine. If a patient has pain, then other causes need to be evaluated. However, mild or moderate increases in lordosis and kyphosis typically do not result in pain.

Nursing our children in front of other people can be intimidating mainly because we worry we’ll receive comments from rude individuals. I am NOT going to tell you that you will hear only nice things when you nurse your little one in front of others. Many of us have relatives who criticize us, and strangers can be equally as unthinking and rude.

My best advice is to practice in front of a mirror or a caring friend (or your husband), and once you are more comfortable you will gain confidence. If anyone makes a comment to you, reply with humor or information or whatever YOU personally think suits the situation.

Another concern for some moms is the worry that breastfeeding in public is illegal in some states. In her terrific webpage LLLI: A Brief Summary of Breastfeeding and the Law, attorney Elizabeth N. Baldwin (La Leche League’s legal advisor) says: “Mothers have a right to breastfeed, and there is no law anywhere that we know of that prohibits breastfeeding, or tells a mother how long she can nurse. To the contrary mothers have a constitutional right to breastfeed … ”

This is very reassuring. So if someone confronts you when you are nursing, tell them that they seem to be unaware of your constitutional right to breastfeed, and that you would like to contact the local media. That should do the trick.

I do feel that our world would be a better place if nursing were considered natural and normal instead of indecent exposure. I see more breast on the cover of a Cosmo at the grocery store than I do when I see a mom nursing in public.

Be assured that if I noticed you nursing at the mall, in church, on a park bench or anywhere, I would smile and tell you what a beautiful breastfed baby you have. And perhaps you would make a new and supportive friend. Reach out to other moms that you see nursing in public. You may very well be the friendly face that they remember amid the sea of frowns.

Diarrhea is defined as watery or very loose stool, sometimes associated with foul odor. It may occur as the result of an infectious illness like stomach flu or it may be caused by some intestinal disorder if it is chronic. Even sudden changes in diet, particularly in infants may result in temporary diarrhea.
Normal course of illness

The course of diarrhea depends on the cause and how it is managed. Usually diarrhea caused by infection with common childhood viruses is short lived, 3-7 days in duration, 3-6 times per day. In cases where there is prolonged or excessive quantities of stool, minimizing the risks of dehydration is key to recovery. Diet management and fluid replacement is vital. In diarrhea of chronic inflammatory bowel disease, the course will depend on the dietary and medication management followed.
How it is spread

Infectious diarrhea is spread through contact with the stool of another infected person or in the more uncommon cases of food borne infection, by ingesting the tainted food. Day-care workers have a special challenge in preventing the spread of diarrhea illness since child to child transmission tends to be highest in this environment.
Prevention

Strict handwashing after any contact with stool, including washing the hands of the child being assisted since hand to hand transmission is likely during the clean up process. Careful avoidance of foods likely to carry bacteria such as under-cooked meat and mayonnaise is also imperative. The younger the child the greater the need for vigilance.
When to call the doctor

When signs of dehydration such as diminished urine output or lethargy exist, there may be a need for emergency fluid replacement, sometimes by intravenous route. When vomiting and fever coexist with diarrhea or if the stool is blood tinged, it is essential to contact your doctor. Since most cases of diarrhea are mild and last only a few days, it is vital to consult with your doctor when your child’s condition is outside this framework.

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