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No Exercise for ME Patients
No Exercise for ME Patients MADAM - As a myelgic encephalomyelitis sufferer, I was most interested to read Margaret Page's letter (July, page 329). However, I was disturbed by Professor Edwards' statement that 'the patient needs to break the vicious circle of debility . by exercise', which appears to be in direct contrast with the opinions of other leading authorities. Although symptoms vary, muscle fatigue is so universal a symptom that a diagnosis of ME is rarely made without it. Dr Melvin Ramsay states that 'muscle fatiguability is the dominant and most persistent feature of the disease'. This is borne out by personal experience. Duringthe early stages of illness, sitting up to eat a meal was en effort. Five static quadriceps contractions caused muscle pain lasting 48 hours. Now, 3 % years later, I work part-time and em gradually recovering; but specific strengthening or maintenance-exercises would still cause a
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relapse. Rather than 'breaking the vicious circle', exercise is liable to cause a downward spiral of increasing debility. Dr B Dawes, one of the few members of the medical profession achieving any degree of success in treating this disorder, believes that patients should avoid any exercise until they have been completely well for at least a year. This point is emphasised by the ME Association, which advises: 'It is possible to enjoy a long period of remission, experiencing only the occasional shadow of an ME symptom, when a brief period of extra physical or mental activity . can bring on the severest of relapses.' In the healthy person a complete lack of exercise can certainly be harmful; but with ME the sufferers must find their own balance in their daily activities - allowing themselves to approach their limit, but never to go beyond.
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ALISON ROLFE GradDipPhys MCSP Birmingham ~~
Turnbledown Treatment MADAM - In agreement with the letter
from Mrs Purves (July, page 3281, it would be ideal for the CSP to give professional advice every time physiotherapists at work were portrayed on television, but of course this advice is available to every director, if he chooses to seek it. With specific reference to the television play 'Tumbledown', the director did ask for some help from the physiotherapy department of the John Radcliffe Hospital, Oxford. However, the brief was very specific, ie:
1. To set up background action for a gymnasium scene. 2. To show one of the actors portraying a physiotherapistin the play the correct hand grip for a hemiplegic patient. We could not of course, change the words spoken by, nor influencethe attitudes shown by the 'physiotherapist' while dealing with his patient.
Ingratitude MADAM - I recently attendedtwo excellent
courses on combined movements given by Ms Kate Sheehy and Mr Chris Barratt. As we all know, a new skill learnt over a weekend is only the beginning, and it is then necessary to practiseand use it in the clinical situation to improve technique and gain a better understanding through experience. This is when the real learning occurs. With this in mind Kate offered a follow-up evening six weeks later to be held in my department to discuss our progress and any problems. I arranged for two patients to attend to participate in case presentations and demonstrations. A dozen physiotherapists said they would come. The evening involved Kate giving up her free time and travelling across London at no extra cost to course members. Everything was set up - except nobody turned up1 Kate and I had a very instructive evening but we were mystified and disappointed at the apparent lack of enthusiasm and interest. Do these physiotherapistswho have paid
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I have spoken to Robert Lawrence and he suggested that the play showed his perception at the time of how he was treated, but he came to realise afterwards that he had probably needed to be dealt with in such a fashion to gain the maximum benefit from his physiotherapy (see Therapy Weekly, July 14). In summary, on-the-spot physiotherapy advice was available from a local hospital department for a small part of this production 116 seconds of screen time) but the director was specific about the areas in which he wanted advice. As a profession, we can only hope that directors involved in future programmes involving physiotherapists at work are more enlighted and choose to accept prooer professional advice on a more open basis. I J GRANT MCSP John Radcliffe Hospital Oxford and attended these courses think they know it all now? How about sharing it? And what about common courtesy? Ionly received one apology for absence. So what is the answer? To stop offering such a service? Or maybe to charge people for it? In these days of cut-backs in the Health Service and lack of funding it is a sad state of affairs when physiotherapistscannot even be bothered to make the effort to learn free of charge, or to show appreciation of the .effort put in by others. ROSEMARY KEER MCSP St George's Hospital London SW17
Caveat for Travellers MADAM - I am writing with
regard to physiotherapistsseeking jobs overseas. Iam a British trained physiotherapist who has been working in Toronto, Canada, since August 1987. I obtained my job in Toronto by replying to an advertisement in Physiotherapy, for a position in an orthopaedic and sports medicine private practice. I obtained a one-year work permit for the job and travelled to Canada full of enthusiasm, only to be thoroughly disillusioned. In the ten months I have worked here the case-load has been primarily motor vehicle accident victims - I have seen about three sports injuries! The clinic is a private practice in that it is not attached to a hospital, but the patients' treatment is paid for by OHlP (Ontario's form of the NHS). After working only two weeks at the clinic I seriously considered leaving, but I would have had also to leave the country as my work permit allowed me to work only in my specified post. I did not want to do this for various reasons - the main one being that I had spent a lot of time and money to travel to Canada. I therefore decided to stick it out and I have been counting weeks ever since1 The main objective of this letter is to warn other enthusiastic and travel-keen physiotherapists of the possible consequences of going to a foreign country on a work permit. If I had had immigrant status, which may be applied for in the UK and takes only slightly longer to come through, I would have had the freedom to change jobs whenever I wanted. I would also like to advise applicants to check carefully as to the exact case-load of their prospective posts. I know several other British physiotherapists here who have been in the same unfortunate predicament, but also several who are perfectly happy working in Toronto hospitals. Therefore not every British physiotherapist is unhappy here, but I do advise those who are looking for work abroad to apply for immigrant status - that way they will have the option to change jobs if they wish. JUDITH GATES MCSP Don Mills, Ontario Canada
PS The following undersigned are also British trained physiotherapists who have experienced similar working conditions in Toronto and who share my feelings as expressed above. KAREN FATHARLY MCSP INGRID THORNTON MCSP The CSP advises all members to make careful inquiries from the appropriate Embassy or High Commission on visa and immigration matters before travelling Pet Allchurch, professional adviser, international affairs.
Letters to the Journal Letters for publication are always welcome. They should be original and n o t sent to any other publication. It is helpful if they are typed o n one side of the paper only.
phvswmrapy. September 1988. vd 74, rw 9
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relapse. Rather than 'breaking the vicious circle', exercise is liable to cause a downward spiral of increasing debility. Dr B Dawes, one of the few members of the medical profession achieving any degree of success in treating this disorder, believes that patients should avoid any exercise until they have been completely well for at least a year. This point is emphasised by the ME Association, which advises: 'It is possible to enjoy a long period of remission, experiencing only the occasional shadow of an ME symptom, when a brief period of extra physical or mental activity . can bring on the severest of relapses.' In the healthy person a complete lack of exercise can certainly be harmful; but with ME the sufferers must find their own balance in their daily activities - allowing themselves to approach their limit, but never to go beyond.
..
ALISON ROLFE GradDipPhys MCSP Birmingham ~~
Turnbledown Treatment MADAM - In agreement with the letter
from Mrs Purves (July, page 3281, it would be ideal for the CSP to give professional advice every time physiotherapists at work were portrayed on television, but of course this advice is available to every director, if he chooses to seek it. With specific reference to the television play 'Tumbledown', the director did ask for some help from the physiotherapy department of the John Radcliffe Hospital, Oxford. However, the brief was very specific, ie:
1. To set up background action for a gymnasium scene. 2. To show one of the actors portraying a physiotherapistin the play the correct hand grip for a hemiplegic patient. We could not of course, change the words spoken by, nor influencethe attitudes shown by the 'physiotherapist' while dealing with his patient.
Ingratitude MADAM - I recently attendedtwo excellent
courses on combined movements given by Ms Kate Sheehy and Mr Chris Barratt. As we all know, a new skill learnt over a weekend is only the beginning, and it is then necessary to practiseand use it in the clinical situation to improve technique and gain a better understanding through experience. This is when the real learning occurs. With this in mind Kate offered a follow-up evening six weeks later to be held in my department to discuss our progress and any problems. I arranged for two patients to attend to participate in case presentations and demonstrations. A dozen physiotherapists said they would come. The evening involved Kate giving up her free time and travelling across London at no extra cost to course members. Everything was set up - except nobody turned up1 Kate and I had a very instructive evening but we were mystified and disappointed at the apparent lack of enthusiasm and interest. Do these physiotherapistswho have paid
444
I have spoken to Robert Lawrence and he suggested that the play showed his perception at the time of how he was treated, but he came to realise afterwards that he had probably needed to be dealt with in such a fashion to gain the maximum benefit from his physiotherapy (see Therapy Weekly, July 14). In summary, on-the-spot physiotherapy advice was available from a local hospital department for a small part of this production 116 seconds of screen time) but the director was specific about the areas in which he wanted advice. As a profession, we can only hope that directors involved in future programmes involving physiotherapists at work are more enlighted and choose to accept prooer professional advice on a more open basis. I J GRANT MCSP John Radcliffe Hospital Oxford and attended these courses think they know it all now? How about sharing it? And what about common courtesy? Ionly received one apology for absence. So what is the answer? To stop offering such a service? Or maybe to charge people for it? In these days of cut-backs in the Health Service and lack of funding it is a sad state of affairs when physiotherapistscannot even be bothered to make the effort to learn free of charge, or to show appreciation of the .effort put in by others. ROSEMARY KEER MCSP St George's Hospital London SW17
Caveat for Travellers MADAM - I am writing with
regard to physiotherapistsseeking jobs overseas. Iam a British trained physiotherapist who has been working in Toronto, Canada, since August 1987. I obtained my job in Toronto by replying to an advertisement in Physiotherapy, for a position in an orthopaedic and sports medicine private practice. I obtained a one-year work permit for the job and travelled to Canada full of enthusiasm, only to be thoroughly disillusioned. In the ten months I have worked here the case-load has been primarily motor vehicle accident victims - I have seen about three sports injuries! The clinic is a private practice in that it is not attached to a hospital, but the patients' treatment is paid for by OHlP (Ontario's form of the NHS). After working only two weeks at the clinic I seriously considered leaving, but I would have had also to leave the country as my work permit allowed me to work only in my specified post. I did not want to do this for various reasons - the main one being that I had spent a lot of time and money to travel to Canada. I therefore decided to stick it out and I have been counting weeks ever since1 The main objective of this letter is to warn other enthusiastic and travel-keen physiotherapists of the possible consequences of going to a foreign country on a work permit. If I had had immigrant status, which may be applied for in the UK and takes only slightly longer to come through, I would have had the freedom to change jobs whenever I wanted. I would also like to advise applicants to check carefully as to the exact case-load of their prospective posts. I know several other British physiotherapists here who have been in the same unfortunate predicament, but also several who are perfectly happy working in Toronto hospitals. Therefore not every British physiotherapist is unhappy here, but I do advise those who are looking for work abroad to apply for immigrant status - that way they will have the option to change jobs if they wish. JUDITH GATES MCSP Don Mills, Ontario Canada
PS The following undersigned are also British trained physiotherapists who have experienced similar working conditions in Toronto and who share my feelings as expressed above. KAREN FATHARLY MCSP INGRID THORNTON MCSP The CSP advises all members to make careful inquiries from the appropriate Embassy or High Commission on visa and immigration matters before travelling Pet Allchurch, professional adviser, international affairs.
Letters to the Journal Letters for publication are always welcome. They should be original and n o t sent to any other publication. It is helpful if they are typed o n one side of the paper only.
phvswmrapy. September 1988. vd 74, rw 9