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What Having Had Polio Causes, Might Cause and Does Not Cause Marny K

What Having Had Polio Causes, Might Cause and Does Not Cause Marny K

What Having Had Causes, Might Cause and Does Not Cause Marny K. Eulberg, MD, Family Practice, Denver, Colorado

Introduction: As time has elapsed since the major poliomyelitis epi- demics ended, following the widespread introduction of the polio , persons affected by polio, their families and their health- care providers seem to have less and less clear understanding about what symptoms are caused by polio, which are associated with polio and which are not. Many healthcare providers in practice today have had little experience or training in the care of polio survivors, and they studied the basic pathology that the causes years ago. Organizations, such as Post-Polio Health International, which exist to provide information to polio survivors, are frequently asked questions Marny K. Eulberg, MD about various symptoms and the relationship to the acute polio. Post-polio groups and expert professionals have indicated that many individuals have been given incorrect or confusing information.

Attributing symptoms or changes in symptoms and try to understand them. functioning to one’s previous polio Often a symptom can be caused by when the symptom is, in fact, due to many different mechanisms and a disease or condition that should be sometimes even by a combination treated by an entirely different medi- of factors. cal regime than polio/post-polio is not This article is not meant to be all- only not helpful but may be danger- inclusive and list every possible cause/ ous. Polio clinics can help with symp- disease but to discuss the most com- toms that are polio related and can mon and most frequent conditions. help a person sort out what is and As polio survivors age, especially as is not related to polio. The primary they approach the second half of care can treat the non-polio their lives, other medical issues can related symptoms, and can also man- emerge that may make it difficult to age polio-related symptoms with determine exactly what is causing guidance from knowledgeable post- what. Polio survivors should inform polio professionals. their healthcare providers about their The intent of this article is to provide prior because it can basic information about what the directly or indirectly affect their cur- poliovirus does to the human body rent medical condition. and to provide a general framework to guide patients, families and health- care providers as they encounter new continued, page 3

INFORMATION FROM POST-POLIO HEALTH INTERNATIONAL, SAINT LOUIS, MISSOURI, USA What Having Had Polio Causes, Might Cause and Does Not Cause continued from page 1

What does the poliovirus my foot on the floor or in midair? new weakness in muscles that do (pathology)? Or is my foot on a flat surface or were thought not to have been a slanted surface?”) affected is one of the defining The diseases that were called features of the condition. “infantile ,” acute polio- The poliovirus primarily affected or acute polio encephalo- leading to voluntary mus-  Loss/absence of at myelitis, or simply “polio” were cles. Those are muscles that you a joint. For example, when the all caused by one of the three can control with thought, such healthcare provider hits your knee (type 1, type 2 and as, “I think I’ll point with my right with the hammer and it type 3). The exact causing a index .” This may include does not “kick” out. But rarely, person’s disease can now be iden- the muscles involved in taking a polio survivor may have an tified in the laboratory but each a deep breath, in swallowing, of exaggerated response or hyper- of the can cause a similar the face, of the trunk and active reflex. pattern of disease when they and the limbs. There is lack of  Muscle fatigue/decreased infect an individual. As used here, consensus among medical profes- endurance. When a muscle does poliovirus or virus refers to one sionals about how much the polio- not have a full supply of “motor or more of the three polioviruses. virus affected non-voluntary units” it may still be able to muscles such as those in the The virus causes a “flu-like” illness function for a limited number bladder or . with nausea/vomiting/diarrhea, of repetitions but it “wears out” The poliovirus did not seem to a fever and perhaps a sooner. The person may be able cause permanent damage to the and muscle aches, and, in a small to “sprint” but could not run a (cardiac) muscle. percentage of individuals, varying mile and certainly not a marathon. degrees of paralysis. The majority What symptoms/signs  Muscular pain. Polio survivors of persons infected with the virus are likely related to polio generally describe this as an had only the flu-like illness, did (primary effects)? “achy, burning or sore feeling.” not develop any paralysis and were It is thought to be due to overuse thereafter immune to that virus.  (muscle wasting). The of the muscle(s) in the area. Less than 5 percent of all individ- “skinny arm” or “skinny leg” is a Individuals who had acute polio uals that were infected with the result of the muscle or part of the when they were old enough to virus developed paralysis of mus- muscle not getting the message remember the event say it feels cles ranging from a few muscles from the that it should con- similar to the muscle pain that to nearly all the muscles of their tract or move. Related to this is occurred with the acute polio. body; some people died as a the possible shortening of the Others describe it differently, but result of the . The virus . In a growing child, bone polio-related muscular pain is circulates in the cerebrospinal grows as a result of the muscle rarely sharp and stabbing. fluid all around the brain and up pull on it and/or weight bearing. Therefore, many who contracted  Biomechanical problems. These and down the . In the are problems related to abnormal spinal cord, the virus attacked the polio as a growing child may have one arm or leg or foot that positions of a limb around a anterior horn cells (the nerve cells joint, e.g., one leg being shorter that go out to the muscle and tell is shorter and smaller than the non-affected/less affected limb. than the other or abnormal cur- the muscle what to do) but did vature(s) of the spine. This can not affect the nerves that go back  New weakness. In the more cause mechanical low back pain, to the spinal cord with messages than 40 percent of polio survivors increase the likelihood of “wear about touch, pain, temperature who develop post-polio syndrome, and tear” arthritis in a joint or a sensation or position (where increasing in the body part is in space, i.e., “is muscles previously affected or continued, page 4 www.post-polio.org POST-POLIO HEALTH B Spring 2012 B Vol. 28, No. 2 3 What Having Had Polio Causes, Might Cause and Does Not Cause continued from page 3

chronic tendonitis/bursitis or even down into the stomach causing manual wheelchair users) put nerve compression problems. a pneumonia known as aspiration more stress on the joints of the  “Polio cold” leg or arm. There pneumonia. Some people lose upper extremities than someone are several theories about what weight and have difficulty main- who has normal use of their legs, causes it, but it is real! Generally taining adequate nutrition be- and this can result in damage to the person doesn’t perceive the cause eating is so time consuming cartilage, tendons and limb as feeling as cold as it feels or difficult. in the wrists, elbows and shoulders. when it is touched. It occurs when Note: Many people over age 50 have  Nerve compression. Carpal tun- other problems unrelated to polio that the environment is cold – such as can cause problems swallowing. Various nel syndrome can be caused/ in winter or in an air-conditioned tests can determine the exact cause of aggravated by pressure on the room. Unless the person has other the . heel of the hand and palm from reasons such as poor arterial circu- crutches and canes or from pro-  /osteopenia. Weight lation from diabetic vascular dis- pelling a manual wheelchair. bearing exercise is necessary for ease or severe hardening of the Other nerves may also be com- bone to become and remain strong. that causes poor blood pressed by abnormal positions of In persons who had paralytic polio flow in the arteries, “polio cold” joints and of the vertebrae in the the affected limb(s) may have leg or arm will not cause delayed spine. Symptoms of nerve com- bone that has less than the normal healing of fractures or injuries. It pression are usually a numbness mineral (calcium) content. The is mostly an inconvenience to the or tingling, an “electric ” terms osteoporosis and osteopenia individual and his/her bed partner. sensation and sometimes progres- refer to decreased amount of sive weakness in the area of the  Some problems with breathing. normal bone tissue; osteoporosis body supplied by the particular These include decreased ability to is more severe than osteopenia. nerve that is being pinched. move enough air in and out to get These conditions can mean the ample oxygen into the or bone is more “brittle” and may  Increased respiratory problems to exhale enough carbon dioxide break more easily than normal from increasing curvature of the due to new respiratory muscle bone. (Generalized osteoporosis/ spine resulting in less room for weakness or from residual muscle osteopenia can also occur in the lungs and internal organs. weakness from the initial polio. certain medical conditions and  Fatigue from increased energy Medically this is called “restrictive with increasing age and is usually expenditure. Walking with an disease.” Problems include not related to polio.) abnormal gait, use of crutches “remembering” to take a breath and propelling a manual wheel- or to take enough breaths per What symptoms/signs chair all require more energy minute. This is broadly called may be related to polio than unimpeded walking. For sleep (central apnea). (secondary effects)? example, walking with a locked Paralysis of some muscles of the Increased wear and tear on joints knee can use up 20 percent more throat can also cause intermittent  including osteoarthritis, tendonitis, energy than walking with an blockage of the air passages in the tendon tears, bursitis. When a unlocked knee, and walking with throat, which may also be termed two crutches can burn up to twice sleep apnea (obstructive). person has a weak limb, the un- affected or lesser affected leg or as much energy as an nondis-  Certain problems with swallowing. arm does more work to compen- abled person would use walking These can cause choking while sate, and weakness from polio can the same distance. swallowing, especially thin liquids lead to arthritis problems in the  . These can be “mus- such as water, and sometimes good limb as well. People who use cle contraction” headaches that some of the swallowed material their arms in place of their legs may be caused by chronic overuse will go into the lungs instead of (crutch walkers, users of canes, of muscles, unusual use of Z

4 POST-POLIO HEALTH B Spring 2012 B Vol. 28, No. 2 www.post-polio.org Marny K. Eulberg, MD, is a polio survivor who has worn a brace for more than 30 years. She is a family physician who founded a post-polio clinic in 1985 and has seen more than 1,500 polio survivors. Eulberg was named “Colorado Family Physician of the Year” by the Colorado Academy of Family in 2005. She is a member of the PHI Board of Directors and serves as Secretary. Eulberg can be reached at Post-Polio Clinic, St. Anthony North Family Medicine Center, 8510 Bryant St., Westminster, Colorado 80031, 720-321-8180. Z neck muscles when doing daily tasks or related to abnormal posi- tions of the neck from muscle imbalance or . Headaches, difficulty turning in bed or from  Inability to know the position especially upon awakening, can poorly fitting supportive devices of a part of the body or where it be from inadequate ventilation (corsets, braces). is in space (decreased proprio- (breathing) overnight that may  Situational depression associat- ception). be due to respiratory muscle ed with decreased functioning  Food getting stuck in the lower weakness and/or sleep apnea that and independence. (in the midchest may or may not be connected to or lower). prior polio. More important than establishing the relationship between a condi-  or diarrhea.  Emotional issues. These can in- tion and prior polio is finding a  Cancer of any kind. clude post traumatic stress disorder treatment or solution for the medi- associated with hospitalizations cal problem. Post-polio experts  Liver disease. and medical procedures and/or agree that in most instances the  disease. teasing by childhood peers or dys- management or treatment plan Most infectious diseases, functional family interactions with for the secondary and/or tertiary  except the person who contracted polio. problems are the same as for perhaps pneumonia in a person people who did not have polio. with a weak cough or who has What symptoms may be swallowing problems and is compounded by having What symptoms/signs “aspirating” food into their lungs. had polio (tertiary effects)? are NOT related to polio?  Skin rashes, but unrelieved pressure on areas of the skin can  High blood pressure and/or  of arm, leg or head skin breakdown and redness. coronary heart disease aggravated especially when that body part by weight gain and decreased is at rest.  Diabetes, but weight gain and exercise that were related to decreased activity often worsen limitations imposed by polio.  Problems with “sense organs” – vision, hearing, taste, smell. blood sugar control in persons  Weight gain (including over- with other risk factors for diabetes.  . weight and obesity) linked to  Hardening of the arteries decreased exercise/activity.  Allergies to medicines or to (atherosclerosis) in the heart, Significant obesity, can, of itself, things in the environment. legs, neck, brain, although life- lead to obstructive sleep apnea  Dizziness or vertigo (“the room style changes induced by polio and restrictive lung disease plus spinning”). may increase the likelihood of other problems including dia- developing this when added to betes, osteoarthritis of hips and  Sharp, shooting pains or severe other risk factors. s knees, etc. burning pain with numbness. Generally, polio does not cause  Diabetes, in susceptible individ- numbness, but nerve compression uals, related to decreased activity can result from abnormal positions and/or weight gain. around a joint or from crutch/  Skin breakdown, or pressure cane walking or propelling a sores, from prolonged sitting manual wheelchair and cause without shifting position, from these symptoms. sleeping in one position due to

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