Shortest list- Reduce/eliminate neck stress in daily activities to include sleeping.

Short list

1. Wear highly cushioned, support shoes to reduce neck, cerebellum pounding. Commercial cross-trainer sneakers are recommended - New Balance, Nike, Reebok etc.- test before buying.

2. Avoid neck-stressing activities (football, soccer, basketball, wave pools, diving, tennis, roller coasters, other amusement park rides of high G forces, lifting in excess of 15 lb, backpacking, falling asleep in chairs, extended reading with head bent etc.)

3. Get plenty of rest and sleep (eight hr minimum). Pillows and sleep position are very important. Soft, small pillows with fiberfill are very good for this i.e. little or no"push" back. (see expanded list below for other comments about pillows). Most Chiarians are side-sensitive. Use a large pillow(s) etc. to prevent rollover onto affected side. Elevate your bed at the head 4-6 inches by inserting old telephone books, bricks, boards or blocks under the front frame legs.  Have a strong relative or friend assist you.  If possible, do the same when staying at a hotel/motel or at the home of relatives."  Stop eating and drinking three to four hours before bedtime to reduce the need to get up at night.

4. Avoid caffeine, alcohol, aspirin and/or high salt diet if tinnitus is a major symptom or any of these dietary items increase other symptoms.

5. Stay in excellent physical condition via walking, exercise bikes and other non-neck stressing activities - STAY LEAN

6. Sit in soft recliners with high backs and foot rests.

7. Support reading material with elbows on your knees/thighs or chair arms. Read "straight" ahead. Use book holders or music stands. Look at computer monitors straight ahead.

8. Drive if you have to but use wide vision mirrors and get seats with high backs. -Take your time and limit your driving to short distances at slow speed preferably during the day. Some Chiarians find orthopedic collars help reduce neck stress when riding in a car etc. Some do not.

9. Relax and avoid stress and noise. Don't tighten the neck muscles. Stay "cool".

10. Put soft cold compresses on the neck/ brain joint area or on the top of your head for about an hour while lying down (these are soft compresses). Some Chiarians prefer warm compresses.

11. Straining during bowel movements should be avoided. Eat plenty of roughage and eat at regular times. Drinking herbal tea containing senna may help give pain-free relief from constipation.

12. Heavy jewelry, scarves, ties, tight collars, bras, rings, bracelets and watches might feel uncomfortable. Adopt a casual life style and don't wear them.

13. Try to avoid waiting in lines where stutter stepping is involved. Uneven surfaces or checkered designs in floors maybe difficult to walk on. Focusing on an object in front of your or closing one eye may help when dizziness hits.

14. Do crossword puzzles to assist short- term memory retention. Ditto for playing cards.

15. Take calcium supplements to assist in bone enhancement especially after surgery. Be very cautious using vitamins and supplements- most have not been thoroughly tested for primary and side effects. As always, check with your doctor first.

16. TENS machines may help ACM/SM patients, especially those with spasticity (cervical, thoracic, lumbar muscles) and spinal pain. TENS units also can help with headaches. You can buy one for use at home. As always, check with your doctor first.

17. Avoid cervical traction.

18. Lumbar punctures, spinal taps or epidurals can be dangerous for Chiarians. Always ask your doctor and insist they review the literature on these procedures with respect to increasing herniation.

19. Brushing teeth or gargling can result in sneezing. Minimize head motion during brushing and not bending the neck when gargling.

20. Avoid chiropractor adjustment. Most chiropractors have no experience in treating ACM's. One member's herniation significantly increased after cervical adjustment. "That is because I herniated from 3-4 mm to 15-20 mm in 8 months with this treatment (documented on MRIs)".

21. Review daily movements to include cooking and cleaning. Eliminate as much neck stress as possible. See the items on the expanded list below for some helpful hints.

22. Use the special tray that most beauty shops have for washing hair for people who cannot lean back on blunt sink rims. Chiarians should never lean back on the edges of sinks.

23. Methods to reduce neck stress during house cleaning/cooking are listed at http://www.pressenter.com/~wacma/pamshints.htm  

Expanded list (use Find on the Edit Menu to quickly go to key words)

1. Increase foot/ankle support by wearing Nike, Reebok or New Balance Air-crosstrainers or similar highly cushioned/ supported shoes (i.e. cushion the cerebellum). Running or walking shoes typically do not have the proper support. The crosstrainers are sold in most sneaker stores. Since each brand is a little different, it is recommended that you test the different models before purchasing. All come in different colors to include black. New Balance crosstrainers get my personal nod as Nike has changed their style resulting is less support and cushioning. (from Sarah- Use gel pads as inserts in your shoes , ...... put em in before you choose the shoes , 'cause they take up more room . They add more shock absorption. Berkinstock makes a similar insert pad that's good too. These help when fashion dictates something other than athletic shoes.

2. Avoid neck "jerking"/stressing activities such as football, basketball, tennis, weight/furniture lifting, wave pools, roller coasters, backpacking, extended reading or sleeping with the head bent down or up, etc.

Notes from Jim Foutty:

When you think of Chiari malformations, picture in your mind an orange with a cord through its middle sitting on top of a soda bottle. If you get hold of the cord and pull downward, this is in a simple way, what is happening to our brain. It is trying to make its way down through a very small opening so what we must do is to stop and reason carefully what we do and the affect it will have. Lifting heavy objects, squatting down, bending a lot, working overhead and using our upper body are some of the things that will cause a downward pull or a swelling of muscles in the neck and therefore cause increase in symptoms. Be careful of anything that puts you in jeopardy of falling and creating trauma of any type.

3. Get plenty of rest and sleep- use a small soft pillow, fiber better than foam, and extra side pillows/rolled towels to prevent rolling to a neck-pinch position,- sleep with your head higher than your feet,- a head down position can cause significant pressure on the neck. Dr. Milhorat recommends sleeping on a bed that is elevated to some degree at the head board. Some Chiarians use a water-base pillow. (http://www.mediflow.com). Other types, a sobakowa pillow, a feather pillow. When staying at a motel/hotel/guest quarters, roll up two or three large towels and insert them between the mattress and the box springs near the head board. Sneakers will also work. Don't forget to remove the "risers" before you leave.

Eight plus hours of sleep are recommended by most Chiarians. If possible get a nap during the day. It helps to refresh and get through the rest of it. Stop eating and drinking three to four hours before bedtime to reduce the need to get up during the night.

Notes from Sue Marsigli:

Not finding a pillow that is comfortable enough post operatively is an issue many of us face. Before anyone has surgery the issue is much easier to face as you are only dealing with finding the position in which you can put your head and neck that will not increase any of the symptoms.

After surgery you are still dealing with this issue, but in addition, you are dealing with scar tissue, sore incision sites, bony pain or pain from the hardware and never mind if you have to wear some type of brace to sleep in.

Sleep is usually interrupted for many of us and yet this is probably the only time that we are able to unload our spine for any length of time and this is needed to aid in the healing process. I wish there were a magic answer of a pillow or bed that would work for everyone. What is important is to try various amounts of different things and constantly reevaluate what you are doing. Is my head and neck in a neutral position-how long does it stay there before I have to move, what position causes increase in pain, how long at a stretch am I really sleeping? The list of questions goes on and on.

Get your spouse or even a child to look at you when you are sleeping and the next day (don't need to wake you up after you finally got to sleep) let you know what position you were in. You may need to brace yourself with some pillows or towel rolls. I do know that with scar tissue a hard surface is probably not going to be your best bet but then also you don't want to go with something too soft. I think that when you get some type of material that has some play with it you have a better chance in succeeding to achieve the correct amount of support.

I also think that we tend to forget about using some terry cloth towels rolled to the correct height to wear around your neck to sleep with. The material is soft enough to not irritated the scar tissue and yet strong enough to give the bony alignment that you need.

Sleep patterns take 6 weeks to change so don't expect to change things overnight. If you are able to comfortably sleep for two hours then I bet you are on the right track and that with time your pattern will increase. You will constantly need to change things as you heal and some things get stronger-muscles and scar tissue so be ready to make adaptations.

I bought a pillow from Brookstones and have found that is the only pillow that I can use to sleep with. It is called Tempur-pedic and it is a little bit pricey standard size $99 ($130 queen size), but it is amazing and I highly recommend. I know that when I bought it I thought here goes another one that will not work. The salesman told me to keep the plastic on it and if it did not work to return it for a full refund. They couldn't buy it back from me now. It works on the theory of the heat of your own body allows it to conform to your head and neck. I think that this is great, especially if you have had surgery. When you have had surgery there is scar tissue that has formed and when you use an orthopedic pillow that is supposed to put you in so called normal alignment, the scar tissue is stretched and therefore it is uncomfortable. This pillow molds to you and gives you support instead. Hope this helps. I know that my breathing and swallowing and hear difficulties are better with this.

Instructions for a Postoperative Pillow (from Patrick's Mom)

· Purchase an inexpensive down pillow (king-size is best). · Remove any protective zip-on liners that may have come with it. · Equally "divide" pillow in half by pushing all the down out to the sides. · Pin the center of the flat pillow ticking with straight pins from the edge to about half-way through to prevent the down from moving back into the center · Either by hand, or by machine, baste-stitch in the center from the edge of the pillow up almost to the middle, across 3/4" and back down the other side returning to the edge of the pillow. · Return pillow to any liner and give it to your favorite Chiari patient!

This pillow keeps direct pressure away from the surgical incision when the patient is lying on his/her back, yet allows them to turn from side to side without needing to reposition the pillow. A king-size pillow works best because it provides cushioning across the entire length of a hospital bed and allows extra room for turning from side-to-side. (A king-size pillow is difficult to push through the arm of your sewing machine, but it is possible!) But if you take this pillow with you to the hospital, be sure to put a vinyl liner around it to protect it from post-surgery nausea!

4. Avoid caffeine, alcohol and aspirin. Salt typically increases blood pressure which is not good for a lot of reasons to include an increase in ear ringing and possible influence on ACM's Note: abstinence from caffeine and alcohol is also recommended for individuals suffering from Meniere's disease) (note: let your symptoms be your guide. If a glass of wine or beer does not affect your symptoms and you are not on any medication, enjoy. Your doctor/pharmacist also should be your first authority on diet).

Notes from Suzanne Chisum:

Dr. Milhorat told me something interesting.... he called it Meniere's Syndrome... it is when a person with Chiari has a build up of fluid pushing on the semi-circular canals in the inner ear and it produces Meniere's like symptoms.

He told me that he operated on 70 people with these symptoms, having them go through a thorough exam by an ENT and then he has them go through it again after the operation and has seen great improvement

5.Stay in excellent physical shape with walking, exercise bikes and other non-neck stress activities- stay lean,

6. Sit in soft recliners with high backs and foot rests,

7. Drive if you have to but use wide vision mirrors and get seats with high backs. -Take your time and limit your driving to short distances at slow speed preferably during the day.

From Sarah - Wearing a soft cervical collar when in a car is found to be helpful by many Chiarians before and after surgery .

I also use a cloth sleeve filled with the plant potting granules that hold water , just sew it to fit my neck , soak in water a few hours , and it holds the water turning into a firm gel .....this then evaporates in the heat over several hours ,....makes a huge difference when its 90 or 100 degrees outside :) I like using old silk ties from the thrift shop for this ....great fabrics and colors etc. for pennies ! and non toxic :)

8. Relax and avoid stress and noise. Don't tighten the neck muscles, stay "cool".

9. Put soft cold compresses on the neck/ brain joint area or on the top of your head for about an hour while lying down-these are soft compresses. As per Darlene, Arab Chiarians use cold compresses/ cloths wrapped around their heads to alleviate some of their symptoms. Darlene also notes that a lot of Arabs have mild ACMs. Hot showers help some Chiarians with bad headaches. Some Chiarians use hot/warm moist sandbags on the back of their necks.

Note from Donna Corman:

Last fall at a craft sale I bought this thing that could be put in the freezer or in the microwave. It works great. And is so simple to make. It's just flannel material sewed in a square and filled with rice. Make them any size you want. The one I have is about 8" x 8" and is filled with three lbs of rice. They just look like those bean bags we use to play with as kids. Be careful the first time you put them in the microwave. Each oven is different. Please start out on the lowest setting first. These things work wonderful and just the light pressure feels good when I must use them on my head. I used the frozen vegetable bags the other night because I needed so many for my legs.

Other ideas for ice packs:

We found ACE manufactures an ice pack that is reusable and soft (conforms to the body). Its order number is 207516. Hope this helps someone. Faith

Also, here is a recipe for an ice pak. gallon zip lock bag 1 cup water 1 cup alcohol

Mix water and alcohol. Put in freezer and freeze, it will be mushy and comfortable. And can be reused and reused. Cheap. Martha P.

10. Straining during bowel movements should be avoided. Eat plenty of roughage and eat at regular times. Drinking herbal tea containing senna may help give pain-free relief from constipation. Notes from Darlene: Straining for difficult bowel movements increases intercranial pressure...and we all know what that can lead to. At the '97 CSN conference, Dr. Tator was quite outspoken about maintaining bowel routines so that ACM and syringo patients do not have to strain during bowel movements. This can cause problems and is a leading cause of complications. Those in a post operative condition have to be really careful as the use of the narcotic pain meds predispose you to the old concrete bowel syndrome.

Use a stool softener, or speak to your doc about it...but don't let it happen to YOU!

From Peg: A healthy vegetarian diet really helps with the constipation. It is much higher in fiber and beans/lentils ferment and breakdown faster then meat. When I start having increased constipation which is often I decrease meat and increase beans with much success.

There is the "gas" problem but if fiber is added gradually and beans/lentils are used as the source of protein daily the body adjusts and the gas problem resolves. This also can often alleviate the need for bowel medications which can interfere with nutrient absorption. For anyone with a history of coronary problems a well balanced vegetarian diet can also be very beneficial. Adequate water intake is also very important, I stress water not soda or coffee. I am a registered dietitian who has treated many people with constipation and have post surgery symptoms from ACM, I know how bad straining for any purpose is to our well being.

Another benefit to the vegetarian diet is for those of us who have difficulty chewing, I fatigue with chewing, beans are much softer then meat.

11. Support reading material with elbows on your knees/thighs or chair arms. Read "straight" ahead. Use book holders or music stands. Look at computer monitors straight ahead.

Notes from Andrea Traugott:

Using a 'puter is probably one of the worst ACM symptom exacerbators there is... sitting and staring and using the keyboard can mess up even the healthiest body let alone ours. Have the screen (or monitor) at eye level and if at all possible get an ergonomic chair for the back. BUT remember to sit in the new chair correctly (butt to the back of the chair, not on the edge... feet flat (no leg crossing) and keep your back as straight as you can in the back of the chair. You can also get an ergonomic keyboard to help the strain on your hands, wrists, arms and cervical area of the neck. The keyboard is slanted/sloped and you'll need to get used to using it.. my hubby bought me one for my birthday and I love it!

Also remember to BLINK!! It lubricates the eyes and prevents dry eye.

Notes from Sarah in Paradise:

I also found 2 other things that help. I use a rocking chair in the mornings while at this desk ......don't have the faintest clue why but the motion of moving helps some ............and I set a timer to go off about every half hour and do 5 mins of stair step or stretching . if I sit to long stationary (as I have a tendency to do when engrossed on the puter ) I get stiff and achy ....makes the rest of the discomfort harder to ignore !!

12. Heavy jewelry, scarfs, ties, tight collars, bras, rings, bracelets and watches might feel uncomfortable. Adopt a casual life style.

13. Try to avoid waiting in lines where stutter stepping is involved. Uneven surfaces or checkered surfaces may be difficult to walk on. Focusing on an object in front of you or closing one eye may help when dizziness hits.

14. Do crossword puzzles to assist short term memory retention. Ditto for playing cards.

15. Take calcium supplements to assist in bone enhancement especially after surgery. As always check with your doctor first.

16 Be very cautious using vitamins and supplements- Most have not been thoroughly tested for primary and side effects-

17. TENS machines maybe useful for ACM/SM patients, especially those with spasticity (cervical, thoracic, lumbar muscles) and spinal (cervical, thoracic, lumbar) pain. TENS units are also useful with headaches. You can buy one and use it at home, but first check with your doctors.

18. Avoid cervical traction! it's good for your cervical vertebras, but a time-bomb for your herniated cerebellar tonsils.

19. Acupuncture might help. But find a Japanese/Chinese expert.

20. Lumbar punctures (aka spinal taps) can be dangerous for ACM patients... always ask your doctor: "what about lumbar punctures and ACQUIRED ACM? Herniation increase?" and expect "yes..., er... but we need spinal fluid to test,..." improperly performed lumbar punctures = ACM trigger. Ask Allison Rutan RN, neuro nurse about this, her email is: ABUSHRN@aol.com

21. Brushing your teeth can cause problems.  During the over-active phase, I switched from a toothbrush to a water pik or other circular motion tooth cleanser. It is the in and out motion of the brush as it strikes the soft tissue in the mouth (plus the act of watching it in the mirror) which is likely stimulating the gag reflex or sneezing.

Try closing your eyes when you brush you teeth, then try to clean the teeth without touching the tongue and roof of the mouth...use a mouthwash type dental cleaner for this.

Also you may want to try the mouth rinses that have a numbing effect...chloraseptic etc...and rinse with that first to numb or decrease your gag reflex a little. There are also prescription oral rinses that have a numbing effect, Tantum oral rinse comes to mind.

I found switching to the water pic and forgetting about vigorous brushing motion was the best for me. When I tried to close my eyes I fell over and that presented a whole other set of problems : )

22. For sleep apnea which is a symptom of some Chiarians, consider using a device called "Silent Night" or another one called "Thorasnore". they both work basically the same way by moving your bottom jaw forward to help keep the airway open when you are sleeping. These devices are contraindicated if you have TMJ.

  This list can be given to anyone, anytime, anywhere. It is a compilation of suggestions made by WACMA members over the past five years.

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