www.state.ar.us/ascc

New Commission Member

R. Doug Foster, M.D. of Fayetteville, AR has been appointed to the
Arkansas Spinal Cord Commission by Governor Mike Huckabee.

Governor Mike Huckabee appointed R. Doug Foster, M.D. to the Arkansas Spinal Cord Commission (ASCC) on April 5, 2003. Dr. Foster will serve a ten-year term, through January 2013.

An orthopedic surgeon, Dr. Foster’s specialty is in spine treatment. He practices in Northwest Arkansas with offices in Fayetteville, Rogers and Mountain Home. A graduate of the Medical School of Georgia, he completed his medical residency at Louisiana State University, followed by a spine surgery fellowship at Rancho Los Amigos National Spine Center/University of Southern California, where he had significant opportunity to work with spinal cord injuries.

He is Board certified with the American Board of Orthopedic Surgery and the American Board of Spine Surgery. In addition to his private practice, Dr. Foster was previously the Medical Director for the Rehabilitation Unit at the Baxter County Regional Medical Center. Dr. Foster certainly brings a unique perspective and strong background to his new position.

He and his wife Rhonda and their children live in Fayetteville. In his little free time he enjoys scuba diving, as well as spending time on his farm near Mountain Home.

Dr. Foster replaces Sheila Galbraith Bronfman on the Commission. Ms. Bronfman has been involved with the Commission since its inception. Many will remember her as one of the first ASCC Case Managers and a long-time disability advocate. She was appointed to the Commission by Governor Bill Clinton in 1991 and later reappointed by Governor Tucker in 1993. Her knowledge and experience have been great assets to the Commission and we appreciate her long commitment to the Arkansas Spinal Cord Commission and to the citizens of Arkansas with spinal cord disabilities.

David Hill Joins ASCC

David Hill is ASCC’s new Case Manager in the Batesville office.

David Hill joined the staff of the Arkansas Spinal Cord Commission in March. He has assumed the Case Management duties in the Batesville office covering a ten county area in North Central Arkansas. “Since becoming a part of ASCC, I have learned that there are so many people who can keep a good attitude, no matter what type of adversity they may be facing. I think this has made me appreciate living my life one day at a time.”

David graduated from Harding University in 1999 with a degree in Psychology and Public Relations. Prior to joining ASCC, he was employed as an Employment Specialist for the Association of Rehabilitation in Industry and Businness (ARIB). David also has a background in designing Web pages and brings a wealth of computer experience to the Commission.

After four months on the job, David has made great progress in visiting the 169 individuals on his caseload. He reflected that, “The hardest part of my job is realizing that I can’t help everyone who needs it, and I find myself worrying about that quite a bit. But I know that I will continue to try.”

In his free time David loves camping and walking outdoors with his two dogs, Chaucer and Keats. He also finds time for photography and oil painting. As soon as David gets settled in his new position, he plans to complete his Masters degree, which should take up the rest of his free time.

The Commission feels very fortunate in having found someone with such diverse skills. Please join the Commission members and ASCC staff in welcoming David!

From the Director
By Cheryl L. Vines, ASCC Executive Director

Thirty years ago, Mrs. Jane Smith, the moving force behind the establishment of the Arkansas Spinal Cord Commission, thought big when she began crafting the plans for the Commission. She wanted Arkansans with spinal cord disabilities to get the quality of care that folks in other states received.

Her plan included a comprehensive treatment program, from emergency medical treatment to long-term follow-up, access to state-of-the-art care and treatment, and assistance in obtaining these services. In addition, she envisioned a “bricks and mortar” building, “an Arkansas spinal cord treatment center and system to serve the entire state” (Act 330 of 1975).

Fast forward to 2003. Dr. T. Glen Pait and Little Rock philanthropist Jackson T. Stephens have a similar vision. Though the scope is broader, to treat a plethora of spine related diseases and disabilities, the concept is the same, comprehensive state-of-the-art treatment for Arkansans with spinal injuries and diseases.

The Jackson T. Stephens Spine and Neuroscience Center is the newest addition to the UAMS campus. It is an imposing 12-story building on the east side of the campus. Looking at its four strong columns, one is reminded of a tall spine.

What’s inside is even more imposing. From the ground level state-of-the-art outpatient rehabilitation program through the clinics, the Center for the Athletic and Aging Spine and the floors of spinal cord research to the 360-degree view from the top floor, the Stephens Center is truly a center of excellence.

So, will the dreams of Mrs. Smith, Mr. Stephens and Dr. Pait become one? Not yet! While the Center will provide a variety of spine related services useful to folks with spinal cord disabilities, it does not presently include acute spinal cord rehabilitation. Future plans do include prospective outpatient clinics, including one to serve adults with spina bifida.

Presently in the planning phase is a functional electrical stimulation “parastep” ambulation research program for folks with spinal cord injuries. That program should be operational by the end of the year. Dr. Tom Kiser, ASCC Medical Director, and I are working with the folks at the Stephens Center to keep spinal cord injury treatment on the agenda. As new programs evolve, we will keep you informed.

Maybe Mrs. Smith’s dream will come true after all!

With Thanks

Donations this quarter from:

Jimmy Ashley
Louise Craig
Jimmy Richardson

In Memory of Monie Kirchner:
Donna and John Wyrick

In Honor of Donald Hughes:
Jewell D. Hughes

ASCC accepts tax deductible donations. The generosity of the many individuals and families, who over the years have made memorial donations, is greatly appreciated. Contributions are used to assist our clients through purchases of equipment and educational resources.

If you would like to make a contribution, please contact the Commission at 501-296-1788 / 800-459-1517 (voice) / 501-296-1794 (TDD), or send your donation to:

AR Spinal Cord Commission
1501 N. University, Suite 470
Little Rock, AR 72207

Support Groups

The White County SCI Support Group held their annual picnic on Tuesday, June 3rd at Riverside Park in Searcy. Approximately 60 people of all ages were in attendance. Everyone enjoyed catfish and a wide variety of other food items. The weather was perfect for an outdoor picnic gathering. New friends were made and old friendships were made stronger.

This group meets regularly the first Tuesday of each month and has been meeting for over 10 years. The meeting begins at 10:30 a.m. at the White County Medical Hospital in the rehabilitation area. Contact Larry Wilson at 501-724-3504 for more information.

The St. Vincent Rehabilitation SCI Support Group meets on the third Thursday of each month at 11:30 a.m. An indoor picnic was enjoyed on May 15th. Barry Vuletich from Arkansas Rehabilitation Services spoke on, “New Laws Affecting the Disabled.”

The Baptist Rehabilitation Institute in West Little Rock holds quarterly SCI Support Group meetings in the Educational Room located on the ground floor. The next meeting will take place on August 8th beginning at 11:30 a.m. Mike Fangue, who serves as congressional liaison for Senator Mark Pryor, spoke at the May 9th meeting on the topic, “How to Be Your Own Best Advocate!”

Contact Judith at 501-683-1124 for more information about these support groups. All of these groups have an emphasis on the opportunity to socialize and meet new friends.

Call and tell us about your SCI Support Group!

A child’s chance of developing leukemia can be significantly reduced if he or she is exposed to high levels of folic acid while in the womb, researchers suggest. Folic acid is already known to reduce the risk of brain damage and spina bifida, and it was recently suggested it could also cut the risk of a baby being affected by Down’s Syndrome.

A deficiency in folate levels has been linked to damage in DNA, and to an increased risk of developing some adult cancers, including breast and colon. Scientists also know that many cases of childhood cancer are influenced by chromosomal damage before birth.

Genetic Differences
Researchers from the Institute of Cancer Research looked at whether the folic acid levels children were exposed to in the womb influenced their chance of developing leukemia. They focused on an enzyme called MTHFR which breaks down folic acid and reduces its levels. But some people inherit a variant of the MTHFR gene which makes the enzyme inactive, so they have high levels of folic acid because their bodies cannot break it down.

Scientists studied 253 British children who were diagnosed with leukemia from 1992 to 1998 and compared them with healthy children. It was found that those who inherited the inactive enzyme had a significantly lower risk of leukemia compared to those with a normal MTHFR gene.

DNA Damage
Dr. David Grant, science director of the Leukemia Research Fund which funded the research, said it showed some children who developed leukemia were “almost certainly born with defective blood cells which go on to become leukemic cells.” He added, “The realization that damage to the DNA in these cells can be reduced with folate supplements in pregnancy is extremely exciting and could help to reduce the number of cases of this terrible disease in children.” The study was carried out as part of the U.K. Childhood Cancer Study.

A second study from Australia found if mothers took folic acid during pregnancy, it almost halved the risk of their children developing leukemia.

Reprinted from the BBC NEWS website: http://newsvote.bbc.co.uk on May 7, 2003, Health /Folic acid cuts child cancer risk.

Alcohol and Your Health
after Spinal Cord Injury

By Charles H. Bombardier, Ph.D.

Although most of us know that overuse of alcohol can have severe health consequences, people with SCI may not be aware of the unique health problems associated with alcohol use—even in small amounts—after SCI.

People drink for many reasons, perhaps most commonly because alcohol in low doses produces pleasant relaxing effects and reduces inhibition. These positive effects are reversed, however, after more than two to three drinks. And although people may think they need alcohol to be relaxed and sociable, researchers have found that given the right social situation, such as a party, people experience the same enjoyable effects even if their drinks contain nothing more than the taste of alcohol.

According to the Surgeon General, “normal” drinking is not more than one drink per day for women or two drinks per day for men. (One drink equals about 12 ounces of beer, five ounces of wine or one ounce of hard liquor.) Normal drinking can be a healthy choice for some people: it seems to reduce the risk of coronary heart disease (including heart attack) and stroke by about 20-40% in the non-spinal-injured population.

Drinking more than the Surgeon General recommends increases the risk for stroke and for developing cancer of the liver, mouth, throat, larynx and esophagus. Heavy drinking can damage the liver and pancreas. Alcohol irritates the lining of the esophagus and stomach, increasing the risk of inflammation, tearing (ulceration) and bleeding of the stomach lining. Over time, heavy drinking can damage the brain and impair memory and thinking. “Binge” drinking—defined as more than four drinks at a time—drastically increases the risk of falls, car crashes and other injuries. Many people believe that because they no longer feel drunk after more than three to four drinks, alcohol is not harming them. This is not true: even when the awareness of drinking too much becomes dim, the damage to organ systems continues unabated.

In addition to the general alcohol-related risks, people with SCI need to be aware of several unique concerns. To begin with, weight loss after SCI may cause people to become more intoxicated if they drink the same amount as they did before injury. Alcohol lowers the body’s ability to fight infections. Even one drink temporarily lowers immune function; regular drinking lowers immune function more and the lowered immunity can last up to two months after drinking stops. Compromised immune function can reduce your body’s ability to fight urinary tract, bladder and skin infections.

Alcohol causes the body to produce more urine and fill the bladder more quickly. While drinking, people sometimes become careless with bladder care and wait too long to empty the bladder, which can overstretch the bladder wall and weaken the muscle lining. Overstretching the bladder causes backflow of urine into the kidneys, kidney infection and progressive damage over time. Alcohol also causes dehydration, increasing the risk for developing pressure sores. Overfilling the bladder can also cause autonomic dysreflexia, a dangerous increase in blood pressure that can lead to stroke, convulsions or even death.

Alcohol can interact dangerously with other medications, especially those used for pain, spasticity and infection. Using alcohol along with pain relievers such as aspirin or ibuprofen can cause stomach and intestinal bleeding. Repeated use of alcohol at the same time as acetaminophen can cause liver damage. If used with narcotic pain medications (Oxycodone, Oxycontin), antidepressants (fluoxetine, paroxitine, citalopram, sertraline, nortriptyline, trazodone) or antispasticity medications such as diazepam (Valium), alcohol can cause confusion, greater drowsiness and motor incoordination. Alcohol can also change or reduce the effectiveness of other medications and cause them to build up in your bloodstream. Drinking while taking blood thinners (warfarin/Coumadin) can cause excessive bleeding or blood clots. Drinking while on antibiotics can cause facial flushing, nausea and vomiting.

Alcohol reduces male sex hormone (testosterone) production in males, inhibiting sexual performance (erection and ejaculation). Alcohol reduces sexual desire and sexual satisfaction in both men and women. Abstinence from alcohol improves sexual function in men and women.

Even though alcohol may help people fall asleep, it causes them to sleep fitfully or awaken easily later in the sleep cycle. Alcohol consumed even six hours before bedtime can disrupt sleep in the middle ofthe night.

People who drink or have a history of alcohol-related difficulties often develop skin problems because they forget to do weight shifting and pressures releases. In some people alcohol can cause bladder or bowel incontinence, which also irritates the skin. Impaired judgment or coordination from alcohol use can lead to accidents, falls or burns.

Although people who sustain SCI often have a prior history of heavy drinking and/or alcohol-related life problems, many of them stop or reduce their drinking after injury, according to a study conducted at Harborview Medical Center. For many, spinal injury appears to be a wake-up call regarding unhealthy lifestyles and habits. On the other hand, about 30% of those with a history of problem drinking are still drinking heavily and experiencing significant alcohol-related life problems one year after SCI.

If you sometimes wonder whether you are drinking in a healthy way, you can take a confidential “drinker’s checkup” at your doctor’s office or online at www.alcoholscreening.org. The website compares your drinking pattern, genetic history, and the effects of drinking on your life to what is average or normal for Americans.

There are many different strategies for changing drinking behavior, including developing a plan with your health provider, enlisting the help of family or friends, or using support groups such as Alcoholics Anonymous, Rational Recovery, or Moderation Management. Thinking about your life goals can help motivate you to develop strategies that fit your situation. Change can be an extended process and often involves relapses, but each time you try again you improve your chances of success.

This article was reprinted with permission from the Spring 2003 issue of Spinal Cord Injury Update (Vol. 12, No. 1), published by the Northwest Regional Spinal Cord Injury System, University of Washington, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195-6490 (http://depts. washington.edu/rehab/sci). For subscription information, call 206-685-3999 or e-mail: scirehab@u.washington.edu

Accessible Transportation

Accessible transportation has always been a challenge for individuals with special needs wanting to use public transportation. In an effort to assist our clients, the staff here at the Arkansas Spinal Cord Commission are compiling a directory of transportation vendors. These are “transportation brokers” with Medicaid, as well as public transportation, and some private sector vendors.

This list is not conclusive. We encourage the input of everyone to make this list a comprehensive one. The phone numbers included in this list have been verified to be the numbers to use in contacting these agencies for transportation. Please feel free to contact Judith at 296-1792 / 1-800-459-1517, or e-mail her at jakridge@arspinalcord.org with your input/comments and new contacts to be added to this list.

The numbers in this directory of transportation vendors will be on our web page at www.state.ar.us/ascc and will be updated as the office receives and records them. If you do not have access to the Internet, then please feel free to contact Judith to request a printed list to be mailed to you.

Web-based Training
Module on Folic Acid

Folic Acid: A Guide for Health Professionals—a free, web-based training module—provides information on the benefits of folic acid and offers strategies for counseling individuals on folic acid intake. The module includes detailed information specifically geared toward allied health professionals, dentists, dietitians, physicians, nurses, optometrists, pharmacists and public health professionals. The module is available at http://www.folicacid.net/login.asp.

Shunt Card . . . Can It Help?

By Becky Watkins-Bregy, R.N., C.IV
Spina Bifida Program Coordinator, Arkansas Children’s Hospital

Shunt malfunctions can happen anywhere and at anytime. Recently, a call came into our office from a rural emergency room doctor. He was seeing a patient followed by the Arkansas Children’s Hospital (ACH) Spina Bifida Program. He was concerned the child “might have a possible shunt malfunction.”

The symptoms were not clear, as they often can be similar to other types of illness (ear infection, stomach virus, flu, etc.). He had obtained a CT scan but had nothing to compare it with for a clear diagnosis of shunt malfunction. So, it was agreed that the family would be told to drive two hours to ACH with the scans for an emergency room (ER) evaluation for shunt malfunction. The family did not want to waste a trip, but as I always say, “better safe than sorry.” The comparison did show a shunt malfunction and the child went to surgery the next morning.

The same day, I received a call from another family who happened to be on vacation in California. The mother stated, “I am so glad I asked if I needed to take any x-rays or information with us on our vacation.” As it turned out, they had spent the night before in an emergency room, ruling out shunt malfunction. They did not have to send for CT scans all the way from Arkansas. In fact, the doctor had all the information he needed to compare the CT scan done in the ER, with a shunt card the parents had made to take on the trip. The mother reported it was only a virus and the sibling was starting to show signs of the virus as well. The mother stated that the peace of mind to know it was not a malfunction, which would have required emergency surgery, “was well worth the effort and cost to get the card.”

What is a shunt card? It is a heavily laminated, wallet size card that includes six views of you/your child’s CT or MRI. The scans show what the ventricles should look like when the shunt is working well, as well as other important clinical information about you/your child’s shunt. Your/your child’s neurosurgeon must select the appropriate CT/MRI scans to be used for the shunt card. Once this has been done, you can mail the films and the request form to the company for production. It usually takes about 4-6 weeks for the delivery of the card. Average cost for one card and shipping is around $40. This is ideal for families who travel or live a significant distance from your/your child’s neurosurgeon.

For more information on the Hydrocephalus/Shunt Card, please call Bel Med, Inc. at 1-800-531-9614 or write to them at:

Bel Med, Inc.
2810 Gleneagles Pointe
Alpharetta, GA 30005

They also offer a Spinal Implant I.D. Card for patients who have had rod placement at the same cost.

Bojak Cates Represented AR

Photo courtesy of Children’s Miracle Network website
http://www.cmn.org/capitolhillarkansas.html

Bojak Cates (above) visited with U.S. Rep. Mike Ross at a national Children’s Miracle Network event on Capitol Hill in March 2003. Bojak (age 13 from El Dorado, AR) was born with spina bifida and underwent his first surgery at Arkansas Children’s Hospital (ACH) at two days old.

He was chosen to represent Arkansas in the Foresters Champions Across America program as an ambassador for ACH and traveled to Washington, DC and Orlando, FL.

Volunteers Needed

Researchers at the University of Nevada, Reno (UNR) are looking for adult volunteers for a study to help improve the support for adults with paralysis. To do this, they need to hear from you about the support you receive. If you would like to participate, you would be asked to complete a 20-minute survey. All the information you provide is completely confidential.

If you: (1) are 18 years of age or older, (2) can understand or read English, (3) are experiencing some form of paralysis and would like to learn more about becoming a study participant, please call Brenda Gosser, Project Manager at (toll free) 1-866-317-8431 and leave your name and a phone number where you may be reached, or visit their website at www.supportand paralysis.org

This study is sponsored by the Centers for Disease Control and Prevention.

Congratulations! Doug Moore

Congratulations to Doug Moore of Van Buren, AR, the Open Division winner at the PVA Bass Trail Texas Round Up Bass Tournament on March 31, 2003. The tournament, one of six on the PVA Bass Trail this year, was held at Cedar Creek, TX. Doug brought in 16 lbs. 11 oz. of bass to win his division, over some of the best fishermen on the tour. His prize (shown above) was a Ranger Bass Boat. He ought to be getting plenty of fishing in this summer in that new boat!

If you are interested in competing in the PVA Bass tournaments (not limited to veterans), check out the website at www.pva.org or contact Geoff Hopkins in the Sports and Recreation Department of PVA at 1-800-424-8200.

New Items in the Resource Center

The McCluer Education and Resource Center on Spinal Cord Injury has added a number of new items to its collection. If you are interested in checking out any of these resources, please call 296-1792 or 1-800-459-15187.

Reproductive Health for Women with Spinal Cord Injury, Part 2 – Pregnancy and Delivery, University of Alabama (video) - Addresses how women with SCI and their health care providers can manage the pregnancy and any problems that they may experience, such as bowel and bladder management, respiratory complications, weight gain and mobility, medications or autonomic dysreflexia.

Black Bird Fly Away: Disabled in an Able-bodied World, by Hugh Gregory Gallagher (book) - A look at disability in America, this powerful, insightful, and occasionally irreverent collection of writings deals with the author’s personal struggle with disability and with society’s difficulty in addressing the subject. Mr. Gallagher is one of the world’s most highly respected writers and lecturers on disability.

Negotiating the Special Education Maze: A Guide for Parents and Teachers (book) - One of the best resources available to parents, teachers and school administrators for understanding the special education system and learning how to make it work for individual families. It presents an effective approach for obtaining appropriate instruction and therapy designed to meet the unique needs of every child with special needs.

SPINAL COURIER

Published quarterly by Arkansas Spinal Cord Commission

Cheryl L. Vines, Executive Director

Thomas L. Farley and Dee Ledbetter, Coeditors

Commission Members: Jimmy Ashley, Chair, R. Doug Foster, M.D., James Miller, Joe McNiel and Sandra Turner

The Arkansas Spinal Cord Commission does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

Visit our website at: www.state.ar.us/ascc or e-mail us at: courier@arspinalcord.org