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By H. Yokian. Hebrew College. 2018.

You can get physical therapy at hospitals 130 mg malegra dxt amex erectile dysfunction 27, at medical centers discount 130 mg malegra dxt with mastercard impotence merriam webster, or through the local visiting nurse service (check your telephone book). A less expensive exercise package—a three-ring notebook con- taining thirty-eight illustrated exercises and two accompanying audio tapes—is available from the United Parkinson Foundation, 833 West Washington Boulevard, Chicago, IL 60607. Several useful publications are available through the American Parkinson Disease Association at 800-223-APDA. They include Parkinson’s Disease Handbook; PD ’N’ Me: Coping with Parkinson’s Disease; Be Active: A Suggested Exercise Program for People with Par- kinson’s Disease; Be Independent: Equipment and Suggestions for Daily Living Activities; and Speaking Effectively, which focuses on speech and swallowing problems. The Parkinson’s Disease Foundation offers a free introductory packet, as well as other materials. Call PDF at 212-923-4700, or write PDF, William Black Medical Research Building, 710 West 168th Street, New York, NY 10032. The foundation provides The PDF Exercise Program, a three-ring binder with two cassette tapes, at a cost of $15, or the Motivating Moves for People with Parkinson’s DVD for $14. Begin helping yourself with moderate range-of-motion and stretching exercises today, during your "on" time, working up from ten-minute sessions to twenty-minute sessions, morning and eve- ning. Nurse Linda Perry, of the Boston University Hospital Par- kinson’s Day Program, recommends a series of exercises in which you move and stretch your neck, shoulders, elbows, wrists, fin- gers, hips, knees, ankles, toes, waist, mouth, eyes, and all of the muscles of your face. For example, when exercising your neck, move your head from side to side, touching each 54 living well with parkinson’s shoulder with it; move your head forward and down to your chest, then back as far as you can, and rotate your head as far as it will go in each direction. Now the arms: stretch them out to the sides and move them in small circles; move them in and out from the elbow and up and down from the elbow; stretch one arm up, then the other arm up (the whole arm), then both arms up over your head; touch the backs of your hands over your head, exhal- ing as your arms come down. Now the knees and the ankles: hold onto a counter or a firm grab-bar, keep your back straight, bend from the knees, and go up and down. Stand, hold onto a counter or a chair back, go up on your toes, then down, several times, then do the same with each foot alternately. If you "freeze," break your freeze by imagining a line in front of you and stepping over that line; or imagine that you are marching, and go! Holding onto the back of a chair, bend forward and then back upright several times. If you have a tendency to retropulse (that is, to step backward), then always keep one foot back when stand- ing in place; this will provide a better base of support. Always exercise, the means to an active life 55 walk with your legs about eight inches apart for a better base of support. For people with Parkinson’s, exercising is a must, and it is not that difficult if we exercise only during our "on" time. I know that it takes a great deal of patience to stand by and watch someone who has Parkin- son’s trying to complete a job, whether the job is dressing, folding clothes, or feeding the dog. It is also the worst thing you can do, because it deprives the person of the movement he or she needs to maintain flexibility. If after several attempts, I can’t hook the necklace, fasten the button, or whatever, I ask Blaine for help. There are also times when Blaine sees that I am unusually tired, and he asks if he can help. Encourage people with Parkinson’s to be very patient with themselves, to give themselves plenty of time, and to keep on trying. In addition to the exercise they get in doing things for themselves, there is also value in the feeling of independence they maintain. A sense of independence is very important in building a positive attitude toward life with Parkinson’s. And attitude, as we shall discuss in the next chapter, is the key to living well with Parkinson’s disease. For people with Parkinson’s, attitude is as important as nutri- tion and exercise. It determines whether our day will be productive and happy or unproductive and depressing. For example, many times I’ve found myself feeling weak and unable, until some pick-me-up comes along and propels me. I scuffle along 56 attitude makes all the difference 57 and feel incredibly weak and helpless, looking at the housework to be done. Then the telephone rings, and one of my friends asks me to join her on an outing—a movie, an exhibit, a meeting, a shopping mall, a friend’s home, or just a drive. Once I’m involved in something that is interesting, challeng- ing, or just fun, I observe that I can go much longer without med- ication and still feel good.

Several of them found the courage to talk to me about their own family members who were handicapped in some way discount malegra dxt 130mg visa erectile dysfunction pump amazon. Sometimes when I fumbled for money at a checkout counter or held up some other line purchase malegra dxt 130mg without prescription erectile dysfunction drugs and medicare, I apologized for being so slow and explained that my Parkinson’s was responsible. Many times, someone who overheard me would mention an acquaintance or a family member with Parkinson’s and would ask questions. I found 12 living well with parkinson’s that talking about it helped me to accept it as a reality I could cope with. In that early period, one of the things I found most difficult to deal with was waking up during the night and in the morning, having to face the fact that my Parkinson’s was indeed a reality. Sometimes I planned one specific activity that I could look forward to on the following day; then I promised myself that I’d substitute the thought of that activity whenever my Parkin- son’s came to mind. Or I made up mental lists of things that I could still do that I could be thankful for. Try as I might, there seemed to be no way to prevent my mind from returning to my Parkinson’s. When he imitated me, all of his body language and tone of voice showed anger, but he was forcing a wide smile and saying, "I’m not angry! What worked for me won’t necessarily work for you, but the important thing is for you to admit that you have normal emotions, look at how you deal with them, and allow yourself not to feel guilty about having them. I bring up the subject of guilt because you may have grown up hearing the same homespun wisdom that I heard: "Well, your problem could be a lot worse" and "What if you had what Jane Smith has? Each person has a right to his or her share of sympathy and understanding, according to need. We don’t have to feel guilty because we become angry or need a shoulder to cry on. Problems arise only when we prolong the complaints, which prevents us from ultimately picking ourselves up and getting on with life. Fortunately, in my set of mixed feelings, the balance is more positive than negative. I fear what is ahead, but I immediately think of the current, ongoing research that will provide me with more protection. I resent all the limitations, but at the same time, I’m so thankful for all the things I can still do. Although I still grumble when I get up at night and find myself shuffling along, I have other things to think about when I 14 living well with parkinson’s wake up in the morning. Does this mean that I have totally accepted and adjusted to the fact that I have Parkinson’s? I don’t like Parkinson’s, but I’ve got it, and I’ve proved to myself that I can handle it and still lead a productive life. As time has gone by, my frustrations have changed as my Par- kinson’s has changed. Now when I have a "freezing" or a dizzy spell, I know that in a few minutes it will pass. I still try to do as many things as I did in the past, but I have to make allowances. As with most things, it seems that with Parkinson’s, what goes around comes around. Even when I felt somewhat energetic and capable, I still noticed little, sneaky symptoms cropping up, like the incident with the plate of cookies. Then when I lost hope and was almost ready to give up, things improved and I started the cycle all over again. I haven’t given up yet, and I con- sider myself fortunate that I’ve had very little tremor. CHAPTER 3 Coping with Frustration: Practical Suggestions for Everyday Living If my brain can conceive it, And my mind can believe it, Then I can achieve it. The most ordinary tasks and activities become difficult and taxing, especially toward the end of a dose of medication. This interference in everyday activi- ties produces deep feelings of frustration in the person with Par- kinson’s—feelings that I, for one, have never been able to over- come entirely. However, I have found ways to minimize the problems that cause these feelings, and they are worth sharing with you. At the outset, you should know that current medications and therapies enable people with Parkinson’s to have a normal life and 15 16 living well with parkinson’s live it more comfortably than ever before.

Print was the medium of choice for communications throughout the 1960s cheap 130mg malegra dxt with mastercard erectile dysfunction 47 years old, in spite of the increasingly influential role the electronic media were playing for marketers in other industries purchase malegra dxt 130 mg amex erectile dysfunction doctors in orlando. This was the era of polished annual reports, informational brochures, and publications targeted to the com- munity. Health communications became a well-developed function, and hospitals continued to expand their PR function. Some segments of the healthcare industry entered the sales stage during this decade. Sales forces were established to solicit physicians on the part of pharmaceutical companies and individuals on the part of insur- ance plans. Sales forces in the employ of healthcare providers, however, were still a development for the future. The 1970s During the 1970s, hospitals felt a growing urgency to take their case to the community. This was coupled with the growing conviction that, in the future, healthcare organizations were going to have to be able to attract patients. Legal restrictions on marketing were loosened, and many organizations The History of M arketing in Healthcare 11 extended their PR functions to include a broader marketing mandate. Such activity appeared to be particularly strong in parts of the country where health maintenance organizations (HMOs) were emerging. With few limits on reimbursement, both not-for-profit and for- profit hospitals expanded services. Continued high demand for health services and the stable payment system created by Medicare made health- care attractive to investor-owned companies. Numerous national for-profit hospital and nursing home chains emerged during this period. Much of the early interest in healthcare marketing was generated from outside the industry, principally by academic marketers who saw an opportunity to expand marketing’s scope into industries where it was rare. Philip Kotler was an early proponent of healthcare marketing from this perspective. Some early attempts at advertising health services were made, and interest in market research was beginning to emerge. Official recog- nition of marketing came with a conference on the topic sponsored by the American Hospital Association in 1977, and the movement was given impe- tus by rulings that allowed healthcare providers to advertise. For hospitals, the sales era began in the mid-1970s with the changes that occurred in reimbursement. Under cost-based reimbursement (a la Medicare), competition with other hospitals was not a major concern. Hospitals had ample patients, lengths of stay were not a concern, and occu- pancy rates were high. Hospitals treated patients and passed along the actual costs, along with an appropriate profit margin, to third-party payers for reimbursement. Traditionally, this goal was accomplished by attracting as many physicians as possible to admit patients to the hospital. The hospital wanted to maximize the number of patients that were admitted into the facility when directed by their doctors. Hospitals tried to entice doctors to admit to a particular facility, developed physician-relations programs to bond with the providers, and offered other enticements to encourage physician loy- alty (Berkowitz 1996). When hospitals recognized that patients might play a role in the hospital-selection decision, a second strategy for selling to the public emerged. In the mid-1970s many hospitals adopted mass-advertising strate- gies to promote their programs, including the use of billboard displays and television and radio commercials touting a particular service. The adver- tising goal was to encourage patients to use the hospital facilities when the doctor presented a choice or to self-refer if necessary (Berkowitz 1996). Marketing as we know it today still had not taken root in hospitals by the decade’s end.