What Having Had Polio 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 vaccines, 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 poliovirus 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 physician 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 history of polio 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 paralysis,” acute polio- The poliovirus primarily affected myelitis or acute polio encephalo- nerves leading to voluntary mus- Loss/absence of reflexes 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 polioviruses (type 1, type 2 and as, “I think I’ll point with my right with the reflex hammer and it type 3). The exact virus causing a index finger.” 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 viruses can cause a similar the face, of the trunk and abdomen 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 gastrointestinal tract. with nausea/vomiting/diarrhea, of repetitions but it “wears out” The poliovirus did not seem to a fever and perhaps a headache 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 heart (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. Atrophy (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 nerve 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 infection. The virus limb. 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 spinal cord. 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 sense (where increasing muscle weakness 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 ligaments 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 dysphagia. heel of the hand and palm from reasons such as poor arterial circu- crutches and canes or from pro- Osteoporosis/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. arteries 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 shock” 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 lungs 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.