This is the time of goodwill to all mankind. A time to be treasured, a time of peace and goodwill to all mankind; a time for family gatherings. A time to give and to receive. A time to wish each other a Merry Christmas, if you are a Christian, or Happy Hanukah to those of us who are Jewish. It is the message behind the greeting that is important............ serenity and harmony.

Continuing from where we ended in last month's issue, Mary-Anne visits..........

Greg Schmieg, the Executive Director of Roosevelt Warm Springs Institute for Rehabilitation met us to discuss our orientation of the complex. This began with a guided tour by Linda Creekbaum and Mike Shadix, the Librarian and historian for Warm Springs. Between the two of them, we heard many stories about the people who passed through and the history of the buildings. For example, a number of years ago, all the old wooden columns needed to be replaced with hardier concrete at a cost of $1,000 each. Through a bit of creative promotion, they received money from a variety of sources including numerous previous polio patients. Each column that was funded bares a plaque with a short inscription, i.e. Donated by Better Carter-Wright “Where life began, again.” and John A. Swearingen – August, 1962 June, 1966 – “Here I learned to love.”

“The Polio Hall of Fame” consists of 17 bronze busts depicting 15 scientists and 2 laymen who were instrumental in the fight against polio – sculpted by Edmond R Amateis. We were also told that funding had been received from Rotary International’s Polio Plus Program for these 17 to be joined by a number of other prominent, more contemporary people involved in the ongoing eradication of polio, and that plaques would be mounted to explain each person’s endeavours.

We viewed the “Smithsonian at Roosevelt Warm Springs: Whatever Happened to Polio?” exhibition with a sign above the door reading “Contagious Entrance”. Apparently, many school children coming along to see the exhibition refused to pass though because they thought they would catch polio. The static display depicted the nature of the virus, the various treatments, vaccine development, and Franklin D Roosevelt’s (FDR) part in it all.

In the afternoon, Greg became our tour guide for a look at the facilities Warm Springs is now involved with. In 1974, the State of Georgia took over the operation of what had previously been run by the Georgia Warms Springs Foundation. It became a medical rehabilitation facility specialising in brain injury, spinal cord injury, orthopedic and stroke rehabilitation, as well as other general rehabilitation services.

Warm Springs also has an extensive Vocational Rehabilitation Unit, Therapeutic Recreation & Fitness, the totally accessible Camp Dream, and Conference Services. Warm Springs will be the location of a major, international post-polio conference in April 2009 being put together by Joan Headley at Post-Polio Health International. They are expecting around 400 participants.

Today Medical Services include: Long Term Acute Care; Inpatient Rehabilitation; and Outpatient Services such as Post-Polio Services, Acupuncture, Aquatic Programs, Diabetic Foot Center, Rehabilitation Technology, Seating and Wheeled Mobility Clinic, and Wound Care.

Greg took us to the rehabilitation services area where we were met by Rene James, Physical Therapist, and Sonal Nakrani, Occupational Therapist. Rene explained the very ‘hands on’ approach Warm Springs has to physical therapy and that, although they may not have the range of high-tech equipment that private hospitals can afford, their time tested “Roosevelt Way”, together with interdisciplinary teamwork, yielded very effective results.

The newly opened “Blanchard Hall” is where all the outpatient services are provided. After Rancho Los Amigos, Jill was very keen to see the Warm Springs Seating and Wheeled Mobility Clinic where we were shown yet another two seating pressure ‘mappers’. Carlyle McConnell, the Administrator of Out Patient Services, told us that they rarely use these anymore because the actual cushions being used on the wheelchairs have now become so sophisticated.

This facility was also home to the orthotic and prosthetic technicians. They make all their braces on site and polio survivors come from across the USA and Canada to have their old braces repaired because they can’t find anyone else to do it. Of course, newer, lighter materials such as carbon fibre could be used for bracing, but people seem to want to stick to what they know works for them. On an annual basis, there are approximately only 100 polio survivors seen at Warm Springs these days, many for orthotics.

I spent time with Mike Shadix as we swapped historical photos and watched a couple of incredible educational videos that he is keen to get digitized before the images are lost to antiquity. I recorded him talking about the history of the Roosevelt Warm Springs Institute for Rehabilitation, which is clearly his passion after 17 years of diligent archiving. He presented me with 3 books, 2 were bound papers presented at consecutive “Research Symposiums on the Late Effects of Poliomyelitis” held at Warm Springs, and the other was “The Squire of Warm Springs: FDR in Georgia, 1924-1945” by Theo Lippman, Jr.

Greg later took us to McCarthy Cottage, which was built by FDR in 1927 and where he lived when he was in Warm Springs until 1932 when “The Little Whitehouse” was built. McCarthy Cottage was actually used on the set for the “Warm Springs” movie. We were able to look around the inside and it was quite awesome to be walking through the same rooms as one of the most significant polio survivors and adored American Presidents in history.

After that, we were taken to one of FDR’s favourite picnic spots called “Dowdell’s Knob” which he often visited to look over the view and contemplate life. He was once reported as saying that anyone who felt down and could not be uplifted by the majesty of the view, was beyond rehabilitation.

The Little Whitehouse certainly lived up to its name. With the trend for huge, impressive buildings these days, it was interesting to see just how modestly a President could live.

The historic hydrotherapy pools was where FDR first went for rehabilitation. These pools sit on top of the warm springs after which the town gets its name. The flow is up to 914 gallons per minute and the water averages 88 degrees (Fahrenheit) throughout the year. This water also supplies all the needs of “The Little Whitehouse” and the Warm Springs Rehabilitation complex.

According to the Georgia State Parks & Historic Sites brochure, “When FDR found swimming in the warm buoyant waters helped his paralyzed legs, he bought the once prosperous resort area and converted it into a health spa for treating other polio patients. In 1927, the facility was incorporated as the Warm Springs Foundation. . . Once the new indoor pool was built on the Institute grounds in 1942, the outdoor pool was seldom used for therapy and over the years fell into disrepair. In the1990’s, utilizing both public and private funds the Georgia Department of Natural Resources restored the facility.”

This site was also used in the making of the movie “Warm Springs”. Unfortunately, these days, the pools are only filled on special occasions as the spring underneath is severely undermining the integrity of the structure. As well as that, the warm water produces an algae bloom that would require daily cleaning, and the cost of resourcing this type of operation is clearly prohibitive.

Washington DC, USA

We met with Wendy Wilmer (President) and Elver Ariza (Board Member) from The Polio Society. Wendy was very interested in finding out all about how we work things in Australia and shared some of what was going on for The Polio Society. Their Board of Directors, made up of 9 members, meets on a quarterly basis and operates on a similar basis to our Australian ‘Networks’ except they do not oversee support groups. According to their Mission statement, The Polio Society aim “To make a difference in the lives of people who have Post-Polio Syndrome and other polio-related problems. We provide education and resources to polio survivors, their families and caregivers along with health care providers, policy makers, and others who affect the well-being of people who had polio.”

Wendy contracted polio in 1952 as an infant. She was in her mid-30’s when post-polio syndrome (PPS) was first mentioned and she has since taken to wearing a leg brace and using a walking stick, as well as a wheelchair from time to time. Wendy got involved with The Polio Society because she is a keen advocate for disability rights and became the President in 2007.

Elver Ariza who, at only 38 years old, is one of the younger polio survivors on the Board. Elver was born in Colombia and contracted polio in 1969 at the age of 6 months. He was lucky to survive the illness due to the lack of medical resources available to his farming parents. Through sheer determination, they got him diagnosed and stabilized at Columbia’s “Roosevelt Institute”. He went on to obtain a Master’s Degree in Food Engineering from the University of Bogota. However, Colombia proved to be a difficult place to live with a disability. This, together with development of PPS, made Elver seek further opportunities in USA. He is still on a student visa but continuing to apply for a change in status so he can find permanent, paid employment and qualify for medical insurance. At this stage, Elver has to pay for every service and piece of equipment he needs.

Discussions led to the problems that many ageing polio survivors and related groups are facing and that is about how to keep on keeping on. The Polio Society is challenged by the need to fundraise, find new members and keep ‘old’ ones, delegating work amongst the members who are all experiencing some form of PPS symptoms, and trying to remain relevant and informative for their members. Of course, there are no easy solutions but success does tend to rely on being able to access a number of dedicated, multi-skilled people to work together. As the old saying goes, “Many hands make light work.” Although there seems to be a belief that polio survivors are a “dying breed”, there are still many younger people like Elver, and even those who are experiencing symptoms but are unaware that PPS even exists, who will need to access information and resources in years to come.

Dr Lauro S Halstead is the Director of NRH’s Post-Polio Program. In 2006, he printed the 2^nd edition of “Managing Post-Polio: A Guide to Living and Aging Well with Post-Polio Syndrome” – one of many publications produced throughout his career. Dr Halstead contracted polio at the age of 18 and, as he writes in Chapter 15 of his book under “The Lessons and Legacies of Polio”, he “. . . made the trip from iron lung to wheelchair and then to no assistive device within six months. This experience taught me a number of things, including denial. I had recovered and, although my right arm remained largely paralyzed, I did not think of myself as disabled – just inconvenienced.” Dr Halstead went on to graduate from medical school and specialize in the area of Internal and Neuro/Rehab Medicine, working primarily with people who had spinal cord injury. In the early 1980’s, Dr Halstead started experiencing extreme fatigue – something he had never felt before. A little while later, he noticed he couldn’t walk as far as he used to and his legs felt ‘heavy’ and painful.

Dr Halstead underwent numerous tests with a number of specialists, none of which resulted in any conclusive diagnosis. He then started to research various medical publications and chanced upon one focussing on a sample of polio survivors that seemed to describe his symptoms. Quoting from his book again under “The Legacy of Emotional Isolation”, Dr Halstead writes, “Speaking for myself, the detachment I learned made it difficult to express emotions and share deeply in relationships. The physical losses sensitized me to other kinds of losses. I contracted polio in 1954 but did not experience being disabled until 1983, almost 30 years later, when I was 46. Not until I joined a support group and began talking with other polios about my new weakness and pain did I begin to grieve for the body I had lost 30 years earlier.”

With his medical background and personal experience, Dr Halstead was clearly an ideal physician to head the Post-Polio Clinic at the National Rehabilitation Hospital in Washington DC. We met with Dr Halstead for an overview of the work he does at NRH (now part-time) before being introduced to one of his team member’s Ginger Stewart Walls, a PT and Clinic Director specialising in Neuro Rehabilitation with the Outpatient mobility clinic.

Ginger offered to show us around her area including the hydrotherapy pool (94 F / 34 C), the physical therapy exercise and assessment room, the seating centre, and a brilliant facility called “Independence Square” which is a large area set up with the same services and related obstacles that need to be negotiated within the general community – all in the safety of a controlled environment. There was a supermarket with a turnstile, a bank and cafe, steps, ramps, a bedroom, bathroom and kitchen, and an excellent adaptive driving simulation. We were really impressed with this set up.

The Post-Polio Clinic which includes consultations with Dr Halstead, a Physiotherapist, Occupational Therapist, Nurse Evaluation, Orthotist (if required), Electromyogram (EMG/muscle test) (if needed), and a Social Worker is conducted over 1½ days, the theory being that the overnight period is a good time for people to discuss the day’s events with their ‘significant others’ and to generally come to terms with what has been discussed during the day.

They can then ask specific questions during the next day’s activities. ‘Significant others’ are also encouraged to attend he ‘Wrap Up’ meeting, which is important to enable all the relevant specialists to ensure suggested management strategies have been fully explained and understood, referrals to local community practitioners can be made, and any last questions addressed.

This extraordinary service is paid for through private health insurance. If you were to pay for it yourself, it would cost around $2,000 - $2,500 USD. Dr Halstead sees approximately 2 new polios for assessment each week and up to 250 – including reviews – per year. I can only assume people comply with the suggestions made and actually improve somewhat after such a thorough going-over.

Later, Dr Halstead and I discussed numerous aspects of the workings of NRH’s Post-Polio Clinic, including the subject of who will be his successor? Unfortunately, a well regarded colleague who had operated a second ‘team’ of post-polio health professionals recently left. Unfortunately, there is no guarantee that a suitable replacement will be found, i.e. a physician interested in working with and learning from the polio community.

§ ‘Significant others’ are encouraged to attend the final clinic assessment meeting

§ Currently there is no successor to take on the role when Dr Halstead retires

One last sight I had to see in Washington was the FDR Memorial. Jill and I shuttled over to the somewhat out of the way location and were impressed with the thought put into the display. It also has the only sculpture of Franklin Roosevelt obviously sitting in a wheelchair. This was a late addition as earlier sculpture shows a more common image of him sitting with a cape draped around the chair.

Following on from our Warm Springs experience, we felt that visiting this Memorial rounded off our experience of FDR’s contribution to the polio cause.

Dr William DeMayo, the Medical Director, provided an overview of the Specialty Clinics he manages including the Post-Polio Program. Other Neuroscience Specialty Programs include:

§ Blending Traditional Medicine with Complementary Healing Methods to Treat PPS

§ Arts for Healing: Giving Patients New Hope for Relief from Chronic Pain and Neurological Conditions

There are also a number of interesting research projects that have been undertaken and others that are still works in progress. Two of particular interest are: Cognitive Function Status in Polio Survivors with and without PPS (not completed), which I know will be of extreme interest to many; and Hatha Yoga and Meditation in Patients with PPS (completed). The Yoga research study enrolled 23 patients who all participated in a 5 day retreat in Johnstown. According to an article which appeared in “Alternative Therapies”, Mar/Apr 2004, Vol 10,No 2, “These results showed significant improvements in a patient population where a lack of deterioration is often viewed as success. These patients improved and at the end of 12 weeks they were actively involved in self-care.”

A monthly teleconference called the “Post-Polio Clinics Directors Network” is hosted by Dr DeMayo, which anyone with an interest in the subject can join (6.00 pm USA eastern standard time, third Tuesday of each month / 8.00am Australian eastern standard time, third Wednesday of each month). Many international organisations participate and I believe it to be a great initiative to promote in Australia.

It became evident that JPMNPI is not purely ‘clinical’ in its approach to treating patients. When Dr DeMayo was recruited as the Medical Director 6 years earlier, it was largely due to his philosophy on addressing the total mind, body and spirit to achieve wellness.

Other members of the team we met as part of our program were: Sharon Lehman, Research Nurse; Kerri Golden, the Occupational Therapist - contracted from Saint Francis University; Lori Murphy, Physical Therapist; Tim Golden, Orthotist; Jan Goodard, Research Nurse; and Lisa Pasierb, PhD, who gave us a demonstration of the Post Polio Registry Kiosk. This Registry is designed to track polio survivors and their health issues and can be done on-line. We were interested to learn that as part of the PPS assessment process, polio patients were also given an “Osteoporosis Evaluation Score Sheet” to determine if follow-up was required in this area.

Jan Goodard discussed her work in the area of Therapeutic Uses of Essential Oils. She provided precautionary information such as which oils not to use under various conditions as well as recipes for relaxation, fatigue, insomnia, and pain. She also gave both Jill and me a few samples to try and assured us that it’s not the smell that makes the oils work. Although skeptical, Jill later tried one of these oil blends for pain and was surprised and relieved by its efficacy.

All members of the team echoed each other in their support of the mind, body, spirit philosophy espoused by Dr DeMayo and believed that their success was reflected in the fact that they see approx 200 polio survivors per year who make their way to Johnstown from all over the US, and other countries such as Canada, UK and Mexico.

Barbara Duryea, Director of Research and Development, was my main contact at JPMNPI. She put together an entertaining and informative presentation which took us through the JPMNPI experience before opening up to a general information exchange around the table. It was also an opportunity for the other staff members present to learn more about/refresh their knowledge of what’s going on in their own workplace.

We were given a ‘gift pack’ containing information about the Institute, two PPS DVD’s, one on Yoga for PP patients, and 3 books which will be a great addition to our library - two I already have but one I haven’t, called “Living with Polio: The Epidemic and its Survivors” by Daniel J Wilson.

In summary, John P Murtha Neuroscience and Pain Institute has been an absolute treat to visit. I was really impressed by their whole-health philosophy and willingness to look at the range of traditional and complementary options to treat and manage patients with chronic illnesses. I think we could learn much from the concept of exploring the ‘spiritual’ side of healing which, of course, will mean different things to different people. I suppose the key message is not to overlook the less obvious strategies for wellbeing.

§ Key Services/Points:

~ Cognitive Function Status in Polio Survivors with and without PPS (not completed); and

In next months issue, Mary-Anne Liftoff visits Dr. Bruno............................

Most of us have already been living with PPS for more years than we care to remember, but some of us are very new to the syndrome. Be that as it may, it is useful to remind ourselves from time to time what PPS is all about..........Ed

Nobody knows exactly what causes the signs and symptoms of post-polio syndrome to appear so many years after the first episode of polio. Currently, the most accepted theory regarding the cause of post-polio syndrome rests on the idea of degenerating nerve cells. When poliovirus infects your body, it affects nerve cells called motor neurons — particularly those in your spinal cord — that carry messages (electrical impulses) between your brain and your muscles.

Nerve cells communicate with adjacent nerve cells at contact points called synapses. Electrical impulses run along extended chains of these neurons until they reach their desired destination, as when your brain sends a message to the muscles of your legs and feet to step forward.

How polio affects nerve cells
A polio infection often leaves many of these motor neurons destroyed or damaged. To compensate for the resulting neuron shortage, the remaining neurons sprout new fibers, and the surviving motor units become enlarged. This promotes recovery of the use of your muscles, but it also places added stress on the nerve cell body to nourish the additional fibers. Over the years, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers and, eventually, the neuron itself.

Normally, everyone loses some neurons through the aging process. But people who've had polio may have lost so many due to the infection that they end up with fewer total neurons than people who've never had polio. This may lead to the progressive weakness characteristic of post-polio syndrome. On the other hand, little evidence suggests that people who've recovered from polio lose remaining healthy neurons at a faster rate than normal.

Some scientists theorize that the initial illness may have created an autoimmune reaction, causing the body's immune system to attack normal cells as if they were foreign substances. But the evidence surrounding this theory is limited, compared with the studies supporting the more generally accepted motor neuron degeneration theory.

It's possible that some of the signs and symptoms of post-polio syndrome, especially joint pain, may be due to chronic overuse of muscles that apparently were undamaged by the initial phase of polio. For example, if your left leg was disabled by polio, it may be that your right leg develops complications later in life because its muscles and joints have had to overcompensate for the disabled leg.

Bruce is a C 5/6 quadriplegic and we have set up a wheelchair accessible condo in a Hawaiian paradise. Our 2 bedroom/2 bathroom condo is in the Makani A Kai complex which has 24 units and is located on the beach at Ma’alaea Bay, Maui. Additional features are free high-speed internet and free long-distance calling to North America.

Makani A Kai offers privacy as it is the last condominium in Ma'alaea and its neighbor to the south is 4 miles of white sand beach.

Bathroom aids (shower chair, transfer benches, etc.) are available for rent on Maui from Gammie Home Care.

This 5 bedroom/4 bathroom villa comfortable accommodates up to 12 guests and is located in the beautiful surroundings of 'Hampton Lakes' two miles south of the US192. It is ideally situated to enjoy all that Florida has to offer. The magical and enchanting World of Disney is only 15 minutes away. MGM Studios, Epcot Centre, Typhoon lagoon, Sea World, Universal Studios are all within easy reach of the villa.

There are shopping malls and numerous restaurants nearby. Interstate 4 provides easy access to either the Gulf Coast and its stunning beaches or the East Coast where you can enjoy the Kennedy Centre, Coco Beach etc..

This is a disabled accessible villa with a bedroom and bathroom on the ground floor level that can accommodate disabled guests. The bathroom has a wheel/roll in shower. The ground floor is open plan and the front door and back patio door are ramped.

“Walking Isn’t Everything” which is Jean Denecke’s account of her experience with having polio (edited by Kristin Gruenawald and Shari Fiksdal) is now available. The book was written in 1952 but was unpublished at that time. This book discusses what it was like to get polio, her experiences with various hospitals and doctors, and her experience in Warm Springs. The book is a straight chronicle of her experiences. The book describes the service delivery system at the time and the book touches upon gender roles (what it was like to be a woman with a disability at that time). See www.mmpubs.com/catalog for further information. On the web site you can choose the paperback version of Walking Isn't Everything and there is a "Coupon/Discount Voucher" box you can fill in during the checkout process. Fill in the code "POLIO" (without the quotes, in all uppers) and you will get a $2.00 discount on your order. This discount code works only one time per customer, and expires March 31st, 2009.

Also, the second edition of the book, "The Road Ahead: Transition to Adult Life for Persons with Disabilities" is now available

Here are ten questions for you - all about previous First Ladies. How many can you answer? Answers are given later in this issue.

What is Chronic Pain?

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

Is there any treatment?

Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.

What is the prognosis?

Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.

What research is being done?

Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers believe activates endorphin systems. Other experiments with acupuncture have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.

Lucky

Mary and her husband Jim had a dog named 'Lucky.' Lucky was a real character. Whenever Mary and Jim had company come for a weekend visit they would warn their friends to not leave their luggage open because Lucky would help himself to whatever struck his fancy. Inevitably, someone would forget and something would come up missing.

Mary or Jim would go to Lucky's toy box in the basement and there the treasure would be, amid all of Lucky's other favorite toys. Lucky always stashed his finds in his toy box and he was very particular that his toys stay in the box.

It happened that Mary found out she had breast cancer. Something told her she was going to die of this disease....in fact, she was just sure it was fatal. She scheduled the double mastectomy, fear riding her shoulders.

The night before she was to go to the hospital she cuddled with Lucky. A thought struck her...what would happen to Lucky? Although the three-year-old dog liked Jim, he was Mary's dog through and through. If I die, Lucky will be abandoned, Mary thought. He won't understand that I didn't want to leave him. The thought made her sadder than thinking of her own death.

The double mastectomy was harder on Mary than her doctors had anticipated and Mary was hospitalized for over two weeks. Jim took Lucky for his evening walk faithfully, but the little dog just drooped, whining and miserable. Finally the day came for Mary to leave the hospital. When she arrived home, Mary was so exhausted she couldn't even make it up the steps to her bedroom. Jim made his wife comfortable on the couch and left her to nap. Lucky stood watching Mary but he didn't come to her when she called. It made Mary sad but sleep soon overcame her and she dozed.

When Mary woke for a second she couldn't understand what was wrong. She couldn't move her head and her body felt heavy and hot. But panic soon gave way to laughter when Mary realized the problem. She was covered, literally blanketed, with every treasure Lucky owned! While she had slept, the sorrowing dog had made trip after trip to the basement bringing his beloved mistress all his favorite things in life. He had covered her with his love.

Mary forgot about dying. Instead she and Lucky began living again, walking further and further together every day.

It's been 12 years now and Mary is still cancer-free. Lucky? He still steals treasures and stashes them in his toy box but Mary remains his greatest treasure. Remember....live every day to the fullest. Each minute is a blessing. And never forget....the people who make a difference in our lives are not the ones with the most credentials, the most money, or the most awards. They are the ones that care for us.

Since many people are alone when they suffer a heart attack, this article seems to be in order. Without help, the person whose heart is beating improperly and who begins to feel faint has only about 10 seconds before losing consciousness. However, these people can help themselves by vigorously coughing repeatedly. Take a deep breath before each cough. The cough must be deep and prolonged as when producing sputum from deep inside the chest. and cough deeply and prolonged. Cough and breathe repeatedly every two seconds until help arrives, or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing squeezes the heart and keeps the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. That will give you time to get to a hospital. It could save your life!

When you get to the end of your rope, tie a knot and hang on." ~ Franklin Roosevelt