I am extremely disappointed.

There have been a number of reactions from readers in regard to last month's issue of the IPPSO magazine in which I published some "polio" and other stories submitted by members (see "Letters to the Editor below) but, very sadly, not one of you has sent me (or even promised to send me) your own story - on polio or any other subject. Last month's issue was, I think, sufficient to show that personal stories make for very good reading.

So I have some questions for all of you........ what is the matter with you guys and gals? Apart from a few notable exceptions, most of you never submit anything at all! Am I wasting my time asking you to do so? Maybe the answer is that you never read this magazine.

Do you??                                                                                                                                            Mike Isaacson

Letters to the Editor

From Claude H. Hess

In the May 2009 issue of IPPSO news letter, the picture with the paragraph talking about my getting married in 1950 is that of my second wife that I married in 2004.  I am attaching an image of Irene and I, whom I married in 1950. Would you please correct this error.  Thank you.

Sorry about that Claude, and thank you for pointing out the mistake.

Here is the correct picture, and a very nice one it is too!

                                                                                                     Mike Isaacson Ed.

From Shari Fiksdal

I was so pleased, amazed and sometimes saddened to read the wonderful articles from our members in the last Magazine. Thank you all for sharing your stories with us. They were all so well written and so full of the pain, yet the positive attitudes of each of you made it uplifting. You make it all so real and personal, and I must say interesting, to know what each of you went through in your life with Polio and now PPS. Thank all of you who participated and opened your hearts to your IPPSO family.

Hehehe Corner

Behold the hippopotamus!
We laugh at how he looks to us.
And yet, in moments dark and grim
I wonder how we look to him.

Women With PPS Experience Menopause Differently Than the Non-disabled

Women with PPS experience menopause differently than their non-disabled peers - physiologically, physically and psychologically - according to a study in 2004 funded by Post Polio Health International.

A team of researchers from the University of Michigan Health System conducted a nationwide study to explore the experience of menopause for 500,000 women in the U.S. with a history of polio. To highlight the unique contribution of menopause, men with a history of polio also participated and served as a control group.

In their final report "Women with Polio: Menopause, Late Effects, Life Satisfaction and Emotional Distress," the researchers present significant findings:

Satellite Cells in skeletal muscle are a heterogeneous population of stem cells and committed progenitors. We found that quiescent satellite stem cells expressed the Wnt receptor Fzd7 and that its
candidate ligand Wnt7a was unregulated during regeneration.

Wnt7a markedly stimulated the symmetric expansion of satellite stem cells but did not affect the growth or differentiation of myoblasts. Silencing of Fzd7 abrogated Wnt7a binding and stimulation of stem cell expansion. Wnt7a signaling induced the polarized distribution of the planar cell polarity effector Vangl2. Silencing of Vangl2 inhibited Wnt7a action on satellite stem cell expansion.

Wnt7a overexpression enhanced muscle regeneration and increased both satellite cell numbers and the proportion of satellite stem cells. Muscle lacking Wnt7a exhibited a marked decrease in satellite cell
number following regeneration.

Therefore, Wnt7a signaling through the planar cell polarity pathway controls the homeostatic level of satellite stem cells and hence regulates the regenerative potential of muscle.

Hehehe Corner

If you throw a hand grenade into a kitchen in France , does it result in Linoleum Blownapart?

Itzhak Perlman - Violinist Extraordinaire

He is regarded as one of the greatest violinists of the late 20th century, and is certainly among the most famous.

Early days

Like I said, Perlman contracted polio at the age of four. He made a good recovery, learning to walk with the use of braces and crutches. Despite his handicap, young Itzhak began showing talent on the violin, and his father Chaim, a barber, quickly recognized his son’s unusual abilities and arranged for lessons for him at the Music Academy of Tel Aviv. Soon Itzhak began giving concerts and attracting attention throughout Israel. American television talent agent Ed Sullivan learned of Perlman’s abilities and brought the 13-year-old to New York for a 1959 appearance on his Caravan of Stars show, where the young virtuoso continued to attract attention. He enrolled at the Juilliard School of Music, studying with Ivan Galamian and Dorothy DeLay.

Short Summary about Itzhak Perlman

He made his official debut in 1963 at Carnegie Hall with a performance of the F sharp minor Wieniawski Concerto and went on to win the Leventritt Competition, one of whose prizes was an appearance with the New York Philharmonic, then led by Leonard Bernstein.

After these triumphs Perlman was taken on by impresario Sol Hurok and given a heavy schedule of concerts in the United States, Europe, Asia, and Israel over the coming years. He also began making recordings with RCA and would eventually sign contracts with EMI, Sony, Teldec, and others. Over the next three decades, his recordings would include the concertos of Beethoven, Brahms, Sibelius, Mendelssohn, Berg, the two by Prokofiev, Tchaikovsky’s Piano Trio, Dvorak’s Sonatina, Paganini’s Caprices, and many others.

He returned to Israel in 1965 for a season of concerts, making his British debut the same year at the Festival Hall with the London Symphony Orchestra. Perlman’s fame grew rapidly in the 1970s and he began appearing regularly on television programs, like the children’s show Sesame Street, the Tonight Show, David Letterman, and various specials on the PBS network.

Never forgetting his early encouragement, from his teachers as well as from Isaac Stern, Perlman from the beginning of his career made a habit of encouraging young talent and has over the years held a variety of teaching posts, including master classes at London’s South Bank Summer Music Series beginning in 1968, the Meadowbrooks Music Festival in 1970, and close involvement, alongside his wife Toby, in Perlman Music program for young people, beginning in 1998.

He also became a frequent performer at White House events, especially during the Reagan administration. In 1986, President Reagan awarded him a Medal of Liberty, an award recognizing the contributions of foreign-born Americans. By 1990 Perlman had performed with virtually every major orchestra in the world and with almost every important conductor. He also signed a new contract that year with EMI, the label for whom he has made the most recordings.

Achievements

On the Fourth of July, 1986, Perlman was one of twelve first-generation Americans to be honored with the Medal of Liberty in recognition and appreciation of his contributions to the United States. In December 2000, President Bill Clinton awarded Perlman the National Medal of Arts.

It’s Itzhak Perlman’s passion for music that recommends him to the world. The joy of making music has seldom been translated so well and it is this combination of talent and personal charm which makes him such an outstanding violinist and the greatest violin virtuoso of our time.

Hehehe Corner

The short fortune-teller who escaped from prison was a small medium at large

Did You Know?

About the Handicapped Travel Club, Inc? It was formed in 1973 to encourage  traveling for people with a wide range of disabilities. The Club encourages people with disabilities to travel, to meet and to share information on making vehicles accessible for the disabled. The Club has many members, they publish a newsletter, have local get-togethers and sponsor an annual rally as well as an occasional regional rally which is held in various states in the USA.

Who Can join? Originally. at least one family member had to be handicapped, but a lot of able\bodied folk wanted to join because they approved of the idea, so membership was opened to everyone. There are no limitations as to color, race, religion, age, disability or political beliefs. It is just one big happy family.

In addition, the club has developed resource information that includes RV dealers, manufacturers, rental agencies and conversion facilities that will provide vehicles for the disabled. Interested? Go to Google and search for "Handicapped Travel Club".

Normal Sized People Get No Respect

Normal sized people, stand up and be counted!
Obese people (and all of us PPS'ers are obese, aren't we?) are the subject of ridicule, derision and seen by the health community as health risks. Extremely thin people are the subject of ridicule, derision and seen by the health community as health risks. Blah. Blah. Blah.

Boy, talk about two groups whining and getting all the attention!

What about normal sized people? You know them. Many are probably part of your family, a friend or hey, they might even be you. Normal sized people don't eat too much and they don't eat too little. They can buy off the rack with no problem and they're not the subject of stand-up monologues,  South Park episodes or health programs hosted by Dr. Sanjay Gupta of CNN.

Normal sized people do exist America!! No matter how much you'd like to pretend they don't, they're all around us. They smile at you as they walk the supermarket aisles with carts full of just enough food to maintain their textbook physiques. They share the waiting room at your doctor's office with you as you wait for your yearly physical results. Your physical may come out too fat or too thin, while theirs will be perfect.

Frankly, I hate our current societal mindset of ignoring normal sized people. Where do we get off putting the normal sized of our country into little dark boxes and hiding them away?

There are all sorts of support groups for the extremely big and the extremely thin. Fat people have chubby chasing groups to alleviate the pressure and ostracism of being overly pleasantly plump. Extremely thin people have the fashion industry to pay them ridiculously large amounts of money to make a living as human coat hangers.

So as the obsessively obese and the terrifically thin get to party with each other and their admirers, work for the fashion industry as large plus sized models or super elite fashion plates, once again the normal sized man or woman gets lost in the shuffle.

Where does it end America? What does the normal guy or gal have to do to be noticed? What is it going to take to make normal sized people accepted?

2009 Euro Health Consumer Index

The objective is to compare the extent to which the national healthcare systems of Europe take the patient and consumer into consideration in 2009.

For the fifth year running, Health Consumer Powerhouse (HCP) is asking health campaigners across Europe to help it compile the annual Euro Health Consumer Index. This will measure the user-friendliness of national healthcare systems across 33 countries in Europe.

If you would like to contribute your views on the condition of your country's healthcare system in 2009, you will find a link below to the survey's online questionnaire. This year's questionnaire is short, only 15 questions, and should take no more than about 10 minutes of your time to complete. The closing date is Tuesday, August 25th, 2009

If you are interested in the questionnare, go to Google and type in:-2009 Euro Health online questionnaire.

Hehehe Corner

When cannibals eat a missionary, do they get a taste of religion?

Eradication of Polio

Fears about vaccination, political unrest and global financial crisis threaten 20 years of progress.

Since the world’s top health and humanitarian organizations first joined forces in 1988 to eradicate polio by the year 2000, the number of polio endemic countries has shrunk from 125 to four and the number of cases per year equals what was once a daily average. And yet, polio continues to threaten the health of children around the world.

  The current polio resurgence can be traced back to 2003 when rumors circulated in Nigeria that the oral polio vaccine used to immunize children would spread HIV and sterilize young girls. After political leaders endorsed the rumors, vaccination programs in the country came to a halt for 11 months.
By 2006 polio strains originating from Nigeria had spread to 20 previously polio-free countries in both Africa and Asia, resulting in more than 5,000 cases of paralytic polio. At the end of 2007, vaccination campaigns contained polio transmission caused by importations in all of the affected African countries except Angola, Chad, the Democratic Republic of Congo, Niger and Sudan. During the past year, however, an additional 32 wild poliovirus importations originating from these countries resulted in the current outbreaks in three regions of Africa.

Uninterrupted wild poliovirus (WPV) transmission continues in northern India due to reduced oral poliovirus vaccine (OPV) effectiveness and also in Pakistan and Afghanistan, where conflict prevents children from receiving vaccine.
Health officials agree that as long as virus transmission continues, Western nations are at risk. “WPV is only a plane ride away from the United States,” said Walter A. Orenstein, MD, deputy director of vaccine-preventable diseases at the Bill & Melinda Gates Foundation and Infectious Diseases in Children Editorial Board member.

“If we let down our guard, if our immunization coverage drops, there is certainly the possibility of a polio outbreak,” Orenstein said.

In an interview, Steven L. Cochi, MD, MPH, senior advisor in the CDC’s Global Immunization Division, said, “Every country is vulnerable as long as any country is not adequately implementing the proven strategies that will eradicate polio.”

Risk for U.S. importation

Although the United States has not had any domestically acquired paralytic WPV cases since 1979, officials emphasize that health care providers and the public must remain alert. Assuring high levels of immunization coverage and considering polio in the differential diagnosis of any patient who presents with acute flaccid paralysis are a physician’s two duties to protect patients against the risk of imported poliovirus, according to Orenstein.
“We know today that nothing is far away. Diseases cross borders so easily,” Aloudat said. “In 2003, severe acute respiratory syndrome jumped from East Asia to Canada in a matter of days. Just a few years ago polio jumped from the Port of Sudan across the Red Sea and into Gulf countries such as Saudi Arabia and Yemen.”

Current vaccine recommendations in the United States state that children should receive four doses of inactivated poliovirus vaccine (IPV) — with the first dose administered at age 2 months, the second at 4 months, a third at 6 to 18 months and the last at 4 to 6 years.

U.S. polio vaccine coverage levels were high in 2007 with 92.6% of children aged 19 to 35 months having received at least three doses. More than 95% of children were covered in time for school entry, data from the last complete National Immunization Survey indicated.

However, health officials warn that the public can become complacent, particularly about diseases they may have never seen.

“Pediatricians must be ever vigilant about the possibility of polio and be clear to parents and families that vaccination must continue to provide a barrier of protection against the possibility of being exposed to an importation of polio from parts of the world where it still exists,” Cochi said.

The other half of prevention is recognition of cases should they occur. Physicians a century ago were more adept at diagnosing polio without help from modern technology. “Today it would be much harder for us to even suspect the disease in the West,” Aloudat said.

Pediatricians should consider polio in any child with acute flaccid paralysis who has traveled to an area where wild polio viruses are being transmitted, Orenstein said. Because only one in 200 cases of polio result in paralysis, it is important to recognize that children can still contract the disease from a person with an asymptomatic infection. If a physician suspects polio, they should contact their state health department immediately to ensure that the proper specimens are collected. The clinical diagnosis of polio is usually confirmed through detection of polio viruses in stool samples.

Easing vaccine anxiety

In Western nations, vaccine anxiety poses the biggest threat to polio eradication efforts as more parents opt out of vaccinating their children. Aloudat called these decisions “extremely unwise and dangerous.”
“This is not a unique phenomenon. In many Western countries with better education and more resources, people wrongly believe that vaccines can endanger their children,” Aloudat said. “Eradicating a disease isn’t only about delivering vaccine. … It’s about delivering a message and helping communities become more aware and better informed.”

At the global level, fostering trust between medical and indigenous communities is one of the Red Cross and Red Crescent Society’s main aims during emergency and routine polio vaccination rounds. Community volunteers play a vital role in the emergency vaccine campaigns ongoing in Africa, where volunteers travel door to door sharing life stories and telling families about the polio vaccine. The goal is to reach 25 million of the most remote, hard-to-reach children who remain unvaccinated in outbreak- affected countries.

“Our volunteers carry global fundamental principles, approaches and tools, and they take them and adapt them to how their communities think,” Kate Elder, MPH, senior officer for polio and measles at the International Federation of Red Cross, said. “They deliver simple messages and show by example how global programs can be translated into local activity.”

What’s next in endemic countries?

Although polio vaccine coverage rates remain high in the United States and other Western nations, many areas of the world lag significantly behind WHO’s 2010 goal of 90% global vaccine coverage. Increasing cooperation between health officials and political leaders, and improving vaccine implementation strategies in the remaining endemic countries are major goals.

Nigeria’s polio vaccine coverage remains the lowest of the endemic countries at 61%. “The main problem in Nigeria is shortcoming in the delivery of the vaccine,” Cochi said. “If we could adequately immunize children with good implementation of strategies, polio would already be gone.”

In 2008, 799 cases of WPV occurred in Nigeria, almost half of the 1,652 cases worldwide last year.
Nigeria’s failure to achieve adequate vaccination rates hinges on issues that go beyond public trust and into the realms of inadequate organization, supervision and accountability at the government level.

“Nigeria has a very decentralized form of government and health care delivery. Getting ownership, particularly in northern states, by political leadership and health officials has been a very slow process,” Cochi said. “But there are signs that that is now moving strongly in the right direction.”

In March of 2006, Eyitayo Lambo, Nigeria’s federal minister of health, signed the Communiqué of Abuja along with representatives of 10 other African nations, renewing their commitment to meet international health targets including polio eradication.

“Nigerian leadership is taking polio extremely seriously,” Orenstein said. “We are very impressed with the kinds of efforts they’re making now.”

Vaccination rates in Afghanistan and Pakistan are slightly higher than those in Nigeria, at 83% in each country. Lack of security in Taliban-controlled areas — particularly in Kandahar and the southern region of Afghanistan and along the eastern border where Afghanistan meets the northwest frontier province of Pakistan — has resulted in whole groups of children not being vaccinated.

These groups of children can trigger small outbreaks, Cochi explained. Like Nigeria, inadequate vaccine implementation is another factor behind poor coverage in districts where conflicts are not occurring.
But political commitment from Pakistani leaders has improved during the past nine months, with the president and prime minister creating a polio eradication task force to achieve better vaccine delivery in the few districts still sustaining poliovirus spread, Cochi said.

“The government has committed to work with the World Bank to have a sustained way of financing OPV over the next three years so there won’t be interruptions or shortages in vaccine supply, and there’s more effort to improve supervision and accountability in poor performing districts,” he said. Suboptimal vaccine efficacy

The vaccine situation in India — the last of the four countries that has never interrupted transmission of wild polio viruses — is unique. For unknown reasons, the effectiveness of OPV is reduced, particularly in two northern states, Uttar Pradesh and Bihar, compared with other areas of the world. In addition, polio transmission is facilitated in these areas because of crowded living conditions, poor sanitation and frequent migration. Eradication efforts in this part of the world have required a tailored approach.

“We don’t really understand it, but these are the two most populous, poor and crowded states of northern India where the poliovirus continues to hang out,” Cochi said. High incidence of diarrheal illness among children due to poor sanitation also contributes to reduced vaccine efficacy, he explained. Achieving adequate immunity has required administering many more doses of OPV in Indian children than those in other areas of the world.
“Attempts have been made to overcome these shortcomings by using a monovalent OPV as opposed to the trivalent vaccine,” Cochi said. “Then you remove the competition from the vaccine itself for those three different vaccine viruses to successfully infect the intestinal tract and cause a good immune response.” A recent case-control study in Uttar Pradesh concluded that trivalent OPV had an effectiveness of 11% per dose against type 1 polio. In contrast, monovalent OPV type 1 had an effectiveness of 30% per dose.

Health officials have been using monovalent OPV to vaccinate against the two WPV strains still circulating in India, WPV type 1 and WPV type 3. However, officials are stepping up efforts to wipe out WPV1 because of the higher association between this strain and paralysis, as well as its propensity to spread further faster.
“The focus has been on getting rid of the type 1 virus as the priority because that will disproportionately reduce the number and size of polio outbreaks and reduce the risk of spread to other countries and regions of the world,” Cochi said.

Additionally, health officials are discussing the possibility of adding IPV to OPV during mass vaccination campaigns in some of the highest-risk districts of northern India to improve immune responses by taking advantage of both vaccines. At the moment, there are no current plans to implement widespread IPV administration during this pre-eradication phase.

“In northern India, the issue is sustaining good quality immunization rounds with the monovalent vaccines,” Cochi said. “We’re going to be looking very closely to see whether WPV1 survives the low season, and we should know by June or July whether or not we’re successful at snuffing out WPV1 in India.”

Postpolio paradigm shift

The potential for wild polio viruses to reseed the population post-eradication and the potential for vaccine polio viruses to mutate and rarely take on the transmissibility and virulence characteristics of wild polio viruses (circulating vaccine-derived poliovirus, cVDPV) and the fact that some immunocompromised people can be chronic shedders of virus have caused many in the health care community to reconsider the Eradication Initiative’s initial goal to cease all vaccination after the last documented case of polio. Continued use of OPV, particularly in populations with low immunization coverage, can lead to circulation of the vaccine viruses, which over time can accumulate the critical mutations to become cVDPVs. Since 2000, at least 11 outbreaks of cVDPV have been detected. Nigeria has had ongoing cVDPV type 2 since 2005 with at least 193 cases.

“Because of the combination of those rare circumstances, I think we’ve altered our thinking about a post-eradication world,” Cochi said. “It seems necessary to be using IPV for at least some period of time following eradication of naturally occurring poliovirus.” This would assure population immunity to prevent spread of both wild viruses, if introduced, or of vaccine viruses.

In March, health officials in Minnesota implicated vaccine-derived poliovirus in the paralysis and death of a woman there. The patient had an inherited immunodeficiency disease, and, based on genetic sequencing, CDC officials believe the infection was latent for more than 10 years.

“It’s not known why it manifested itself at this point and time, but she most likely got the virus from someone who had received the live-attenuated OPV vaccine before its use in the United States was discontinued, possibly from exposure to one of her children,” Cochi said.

Only about 45 cases of chronic infection with a vaccine-derived poliovirus have been documented since the inception of live-attenuated OPV in the United States in the 1960s, and all were people with inherited immunodeficiency diseases.

Vaccine-derived polio from immune deficient people is extremely rare, Cochi emphasized, and depends on people with already-vulnerable immune systems coming in contact with someone who has received oral polio vaccine and is still shedding the virus.

Cochi projects that after at least three years of intensive surveillance, efforts to replace OPV with IPV will commence.

The global economy

Slumping economies in many Western nations raise questions about the future of donation-dependent eradication programs, but commitments by several governments and nonprofit organizations suggest that polio programs may weather the economic downturn.

In early 2009 the Gates Foundation awarded Rotary International a $255 million grant, and Rotary pledged to raise another $100 million in donations over the next three years. Combined with a joint commitment of $280 million from the governments of the United Kingdom and Germany, funds so far this year total $630 million.

Elder said that pleas from the International Federation of Red Cross and Red Crescent Societies for emergency vaccine campaign funds are slow to be answered, despite the modesty of recent proposals compared with those in the past. In April the Federation launched an appeal for $2.1 million in emergency funds to help with the African outbreaks.

“Maybe in better economic times we would have fulfilled the money we are requesting within 48 hours because people would be eager to give, but people now are less eager because of internal problems,” Elder said.
Many have called for renewed commitment to eradicating the disease. “It would be a terrible tragedy to let polio out of the bag now,” Orenstein said. “We’re so close. We just need to finish the job.

“If we could demonstrate as we did with smallpox that the world can come together against a common enemy and fight that enemy and be successful, we set the stage for solving all sorts of other problems in global health. Polio eradication is a win-win effort for the United States and the world. In the world we prevent this terrible crippling disease, and in the United States we reduce the threat of importation,” Orenstein said.

Hehehe Corner

A chicken crossing the road is poultry in motion

Changes in ability, perceived difficulty and use of assistive devices in everyday life: a 4-year follow-up study in people with late effects of polio.

Thorén-Jönsson AL, Willén C, Sunnerhagen KS.
The Institute of Neuroscience and Physiology - Section for Clinical Neuroscience and Rehabilitation Gothenburg University, Göteborg, Sweden.

Submitted by Barb Oniszczak, IPPSO Recording Secretary

Background
There are numbers of persons living in the community with late effects of polio, of which many develop new symptoms, but the course of progression is unclear.

Objectives 
To assess changes after 4 years in ability and perceived difficulty in persons with late effects of polio.

Material and methods -
Community dwelling persons from a polio clinic. Information was gathered by questionnaire and interview on demographics, age at polio onset, affected body parts, health problems, the use of assistive devices, housing condition and activities of daily living (ADL) function as well as perceived difficulties.

Results 

There were no significant increase in frequency of ADL dependency but perceived difficulties increased significantly and more used mobility devices.

Conclusions

Over 4 years, more persons perceived difficulties and the use of assistive devices increased. This  might reflect adaptation and acknowledgement of problems previously ignored. Time is a factor in integrating knowledge and adaptation. 

Hehehe Corner

Once upon a time there was a woman selling pretzels on a street corner. She had a big sign reading "PRETZELS 50c" Every Thursday, a man used to pass by and put 50c into her tin, but he never took a Pretzel. This carried on for about six months - he would put the 50c into her tin and walk on.... never once did he take a pretzel.

One day, he walked past and put the 50c in her tin as usual, and she said to him "Excuse me mister... the price of pretzels has gone up. It's 75c now!"

SPECIALLY FOR YOU

Handi-Robe™

The unique design allows the user to put on the HandiRobe™ without standing up! This enables the wearer a more independent life-style and caregivers more ease! The front zipper opening allows access to the inside of the robe or storage pouch (great for a colostomy bag). It also has a deep scoop neck opening and wide arm openings, allows for easy transfer of I.V. bags. The large outside pocket is ideal for many items. Made of thick absorbent velour terry cloth in white or dark royal blue.
Unisex: Unable to modify.

#600
Price: $65.00

A great gift idea for your helper! This is a hooded, poncho style changing robe made of thick quality velour terry cloth. This unisex robe features a full hood, deep scoop neck opening to  look inside robe while changing, large inside pouch to store clothing before and after changing, two large outside pockets, zippered front opening over inside pouch with a flap. The inside pouch can be accessed from inside or outside of robe. This robe is everything in one! Use it to change under, dry off, stay warm with, or use as a blanket. Ideal for changing anywhere!
Comes in dark royal blue.
Unable to modify.

#610
Price: $65.00

Cozy adult blanket sleeper zips down the front or the back. 100% polyester fleece or 100% cotton knit. This perfect, cuddly garment can have the option of having long or short legs and sleeves.
 The neck, sleeves, and legs are finished with knit cuffs.
 Can be made with feet with non-skid bottoms for an additional $5. It also can have snaps in the crotch for an additional $10. A long zipper to the ankle is also available for an extra $10.
 Very Washable.

FLEECE COLORS: Baby Blue, Royal Blue, Hunter Green, Yellow, Navy, Pink, Red, Jade, various prints. Please ask for micro-fleece (a light weight fleece that is less bulky but equally as warm as the standard weight fleece) availability if preferred.
KNIT COLORS: Baby Blue, Royal Blue, Hunter Green, Yellow, Navy, Fuchsia, Aqua, cardinal, various prints. Thermal knits are also available in Grey, Sage Green, and Navy.
SIZES: Chest sizes, Small (30-32"), Medium (34-36"), Large (38-40"), Extra Large (42-44"), 2XL (46-48")

ITEM#:
#200 Fleece Blanket Sleeper w/no extras (S-L) $75.00
#200 Fleece Blanket Sleeper w/no extras (XL-2XL) $80.00
#201 Knit  Blanket Sleeper w/no extras (S-L) $70.00
#201 Knit  Blanket Sleeper w/no extras (XL-2XL) $75.00

 
Perfect pajama for the undresser and the Alzheimer person! The garment has a back zipper and an elastic waist.

 Elbow length or long sleeves (additional $5), long or short pants.

 Cut full for ease of dressing and movement.

 This pajama can be made into a 2-piece set if required.

FABRICS:
Ladies & men's cotton prints
Double napped flannel in print and solid colors - please call for availability.

SIZES:
Chest measurements: Small(32-34); Med(36-38); L(40-42) XL(44-46); XXL(48-50); XXXL(52-54)

ITEM #:
# 205 - - Pajamas...S-L..........$53.00
# 205 - - Pajamas...XL-3XL...$59.00

A must have for easy dressing! This comfortable gown snaps down the front for fingers that may not be so nimble anymore.
 Sleeves are elbow length but can be made long (an additional $5).
 Snaps or buttons down the front for easy dressing.

FABRICS:
Ladies & men's cotton prints
Double napped flannel in print and solid colors - please call for availability.

SIZES:
Chest Measurements: Small (32-34), Med. (36-38), Large (40-42), X-Large (44-46), XX-Large (48-50), and XXX-Large (52-54)

ITEM #:
#215 Night Gown...Sizes S-L..........$39.00
#215 Night Gown...Sizes XL-3XL...$43.00

Hehehe Corner

The only job where you start at the top is when you are digging a hole