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NO MEETINGS IN JULY AND AUGUST
September 19th, 2004 -- Speaker:- Dave Clark – a polio survivor who played minor
league baseball while wearing braces on both legs and
using crutches. A motivational speaker worth listening to.
November 21st, 2004 --
January 16th, 2005 -- NEW YEAR’S LUNCHEON
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CONTENTS
Polio Word Search 1
Eat Smart –
10 Nutrition Moves 3
Eat Smart –
D, definitely 4
To My Friends 5
Post-Polio Update – May 2003 6
Anesthesia – Considerations for
Patients with Post-Polio Syndrome 11
Issues to Discuss With Your
Anesthesiologist 13
Stem Cell Therapy for
Post-Polio Syndrome 14
Strokes 17
Salonpas 18
Upcoming Conferences 19
Dues 19
African Polio Groups Brace
To fight Menace 20
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Reprinted from the Post Polio Awareness & Support Society of British Columbia, PPASS News, May/June 2004; reprinted from GLEANINGS, January/February 2003, Nebraska Polio Survivors Association.
POLIO WORD SEARCH
by Millie Malone
If you are expecting a grid to appear and a list of words, I am truly sorry. The polio word search is a totally different game. A polio survivor can be rattling along (chatterboxitis is a well-known polio residual) when all of a sudden… what was the word I was going to use? This leads to a fun game played by all polio survivors. Sometimes we play via e-mail, sometimes in person.
Polio survivor 1: “…and then I saw this really remarkable… ummmmm, you know, that thing. I think it starts with an “r.” Maybe not.”
Polio survivor 2: “Is it bigger than a… oh, shoot… you know, you keep that sliced stuff in it so it won’t get all dried out?”
Polio survivor 1: “Breadbox? Is what bigger than a breadbox?”
Polio survivor 2: The really remarkable thing you saw… remember? Is bigger than a breadbox?”
Polio survivor 1: I have no idea. I can’t even remember what it was I saw now!”
This scenario is played out over and over. Polio Survivor 1 will, in all likelihood wake up at 3 a.m. shouting “Rifle! It was a rifle!” At which point his/her spouse will jump out of bed and have 911 dialed before Polio Survivor 1 can explain that it was a lost word that just found its way home.
I talk to many polio survivors via the Internet every day. None of us can remember anything. I am thinking of inventing one of those, you know… they suck stuff up… no, not a straw… a vacuum, yes that’s the word.
What was I saying? Oh, yes, I am thinking of inventing a vacuum that will suck up all the words we lose in our everyday conversations and restore them to our heads where they belong.
I can see it now… a group of polio survivors are sitting around a table, each holding some playing cards in his/her hands. No-one can remember if they were playing Hearts or Euchre, so they lapse into a conversation instead. One woman is telling her friend about a new place to shop, the men are swapping fishing stories. The conversations peppered with “oh, you know what I mean” and “I’ll think of it in a minute, just hang on.” Words are wandering off, some of them not just leaving but taking hostages as well.
TADA! In I come with my new invention, the thingie… you know what I mean. I plug it in and start vacuuming up the words that have drifted into a pile in the corner of the kitchen. Then I get a large box and dump the bag. “Hey! Who was talkng about fishing? I found “flycasting” in here. Did someone say something about hot flashes? This word is sort of bent and scuffed, but I think it’s “menopause.” Anybody need a perfectly good “repercussion”? Ooooops… I think I have to adjust the settings here… all that is left is a pile of odd vowels, four exclamation marks and several hundred commas. They could be semi-colons… maybe this one is an apostrophe. Anyone want any of these before I dump them in the wastebasket?”
I am thinking of perhaps opening a used-word store. I could vacuum up all those lost words, dust them off, polish them up a bit and sort them alphabetically. I could put up some shelves and line them all up. Then when a polio survivor calls me and asks for a word, I could help him/her find it. “You were talking about your mother-in-law, you say, and totally lost the word you were searching for. Does it start with a B? I have an entire shelf of B words. Bountiful? Good, I will sent it right over.”
I might need to hire a… hmmmmm… they take letters… no, not Vanna White. She turns letters, but she doesn’t actually take any. No, I mean those people with the pads… not bachelors… damn it, I know the word. Secretary, yes, I might need to hire a secretary to help me keep track of the uh… you know… those things on the shelves in my new store. Words, that’s what I was going to say. Words. In an on-going effort to thwart spammers, I have added a little something to my reply to address. When replying to my posts, please remove “clothes.”
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EATSMART
By Jean Carper
10 BEST
NUTRITION MOVES
Every meal can easily include several points on this no-nonsense list.
Details about specific nutrients are fascinating. But in tracking down the fine points, don’t lose sight of the big picture. Here are 10 solid, sweeping actions that will get you the best nutrition bank in 2004.
Ø Eat seven to nine servings of fruits and vegetables a day. Antioxidant-packed, they can cut your risk of heart disease up to 70%, diabetesf40%, lung cancer 30% and breast cancer 20%, studies show. Tops in antioxidants: prunes, raisins, blueberries, blackberries, garlic, kale, cranberries, raspberries, strawberries, spinach.
Ø Eat fatty fish two or three times a week. That provides enough omega-3 fat to help prevent heart disease, arthritis and brain dysfunction. Fish oil protects brain cells, and suppresses inflammation and irregular heartbeats. In a new study, eating fish just once a week cut the risk of Alzheimer’s disease 60%. Best: salmon, sardines (fresh and canned), mackerel, herring.
Ø Restrict red meat to once or twice a week. Recent evidence ties red meat (beef, pork, veal, lamb) to increased cancer of the colon, pancreas, breast, prostate and kidney. Reason: Carcinogens form in meat during cooking. Worst methods: frying, barbecuing. Best: baking, stewing, boiling, microwaving.
Ø Eat 25 grams of fiber a day. Most adults eat less than half that. Fiber lowers cholesterol and blood pressure; cuts the risk of heart disease, diabetes and cancer; and helps control weight. Super sources: All-Bran, Fiber One, oat-bran cereals (check labels), dried beans, barley.
Ø Use olive oil primarily; avoid trans fats. Olive oil is the main choice of people who live the longest and have the least heart disease, cancer and other chronic diseases. Deadliest: trans fats in some margarines and baked goods, such as doughnuts – they clog arteries more than saturated animal fats do.
Ø Eat “good” carbs. Slash “whites” – bread, sugar, potatoes – that cause rapid spikes in blood sugar. Such foods can double your odds of heart attack, diabetes and certain cancers, and make you fat. Eat carbs that produce a slow rise in blood sugar. Best: legumes (including peanuts); whole-grain, high-fiber breads and cereals; fruits and vegetables.
Ø Drink three or more cups of tea a day. “Real” tea (not herbal) helps save you from heart disease, cancer, osteoporosis, infection, age-related mental decline, dental cavities and weight gain. In one study, three cups a day cut the risk of heart attack 11%. Brewed caffeinated green tea has the most antioxidants; bottled and instant teas have the least.
Ø Eat nuts every day. A mere 3/4 ounce of nuts (almonds, walnuts, pecans, peanuts) daily slashed the risk of heart dieseas and diabetes 30% and Parkinson’s disease 43% in Harvard studies. Daily consumption of nuts and peanuts, including peanut butter, helped control weight in other research.
Ø Shave portions by one-third to half. Gigantic portions are a major cause of weight gain and obesity. In studies, adults given a large serving ate 30% more calories than when given a small one. Kids, too, devoured 25% more calories when served oversized portions. If it isn’t on the plate, you aren’t tempted.
Ø Take a daily multivitamin/mineral pill. It can erase subtle deficiencies that make you more prone to infections and chronic diseases, including cardiovascular disease, cancer and bone fractures. Many leading authorities now urge all adults to take a daily supplement.
Contributing Editor Jean Carper is a nutrition authority. Contact her or sign up for a free e-mail newsletter at JeanCarper.com.
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EATSMART
By Jean Carper
D, definitely
Millions of Americans deficient in Vitamin D are on the fast track to chronic illness, says expert Michael F. Holick, M.D., of Boston University Medical Center. Here are seven risks:
¨ Bone/muscle pain. In one study, 93% of people with chronic musculoskeletal pain were low in D. New research shows vitamin D cuts the risk of rheumatoid arthritis by a third.
¨ Heart disease. Vitamin D lowers blood pressure as much as drugs, cuts the risk of congestive heart failure and keeps arteries elastic.
¨ Osteoporosis. Vitamin D outranked calcium in preventing bone fractures in a Harvard study.
¨ Cancer. Daily D results in 40% fewer colon polyps. In test tubes, it also inhibits lung, breast, colon, prostate and pancreatic cancer cells.
¨ Multiple sclerosis. In D-rich women, risk dropped 50%.
¨ Schizophrenia. When babies were given vitamin D, their risk of this disease sank 90%.
¨ Type 1 diabetes. Eight in 10 cases might be prevented if infants were given extra D daily.
Most apt to be deficient: breast-fed babies, the elderly, the obese, dark-skinned people and those who get little sun. (Sunlight spurs vitamin D production; 30% of healthy young adults lacked D after a Boston winter.)
The minimum you should get: 200 IU daily from birth to age 50, 400 for ages 51 to 70, then 600. The official safe limit is 1,000 IU in infancy, then 2,000. But five times that can be safe if you are deficient, Holick says. To see if you are, have your doctor test for 25-hydroxy-vitamin D. (Note: 1,25-dihydroxy-vitamin D is the wrong test.)
Sources: Fatty fish (salmon, mackerel, halibut, sardines); fortified foods (orange juice, breakfast cereals).
Jean Carper is a nutrition authority. Contact her or sign up for a free e-mail newsletter at JeanCarper.com. Scientific sources are at usaweekend.com
FECPPSG Editor’s Note:- This is one vitamin we really don’t hear that much about. Next time I’m at the doctors will ask for that particular test (25-hydroxy-vitamin D).
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Further FECPPSG Editor’s Note:- The preceding two articles are reprinted from two issues of USA Weekend, the first one from the Jan. 16-18, 2004 issue and the second one from the May 7-9, 2004 issue. They are put into this newsletter as your editor feels they will be of interest to you.
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This came to us from an e-mail friend and it just felt right to share with all our friends.
To My
Friends
If you live to be a hundred,
I want to live to be
a hundred minus one day,
so I never have to live
without you.
-- Winnie the Pooh
True friendship is
like sound health;
the value of it is
seldom known
until it is lost.
-- Charles Caleb Colton
A real friend
is one who walks in
when the rest
of the world walks out.
Don't walk in front of me,
I may not follow.
Don't walk behind me,
I may not lead.
Walk beside me and
be my friend.
-- Albert Camus
Strangers are
just friends waiting to
happen.
Friends are the Bacon
Bits in the Salad
Bowl of Life.
Friendship is one mind
in two bodies.
-- Mencius
Friends are God's way of taking care of us.
I'll lean on you and
you lean on me and
we'll be okay
-- Dave Matthews
If all my friends were
to jump off a bridge,
I wouldn't jump with them,
I'd be at the bottom to
catch them.
Everyone hears what you say.
Friends listen to what you say.
Best friends listen to what you don't say.
We all take different
paths in life,
but no matter where we go,
we take a little of each
other everywhere.;
-- Tim McGraw
My father always used
to say that when you die,
if you've got five real friends,
then you've had a great life.;
-- Lee Iacocca
Hold a true
friend with both your hands.;
-- Nigerian Proverb
A friend is someone who knows
the song in your heart
and can sing it back to you
when you have forgotten
the words.;
-- Unknown
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Post-Polio Update, May 2003
With Susan L. Perlman, M.D.
Associate Clinical Professor of Neurology
UCLA Medical Center, Los Angeles, California
Revised February 2004
Reported by Mary Clarke Atwood
Editorial assistance by V. Duboucheron and S. L. Perlman, M.D.
Dr. Perlman is Clinical Professor of Neurology at the University of California - Los Angeles (UCLA) and Director of the Neurogenetics Clinic. She has a consultation clinic for post-polio syndrome.
This report is based upon Dr. Perlman’s presentation in Newport Beach, California to the Post-Polio Support Group of Orange County, on May 18, 2003. It includes Drugs to Use with Caution, Evidence-Based Medicine, PPS Facts, Research Highlights, and Practical Management Strategies including information on pulmonary dysfunction and use of oxygen.
Or, why is it so hard to find a doctor who knows about post-polio syndrome and is willing to treat it? Because one of the first things physicians are taught is, do no harm. A physician might tell a PPS patient, “I’m not the right kind of specialist.” Or if the physician fears there is something particular about this disease that he doesn’t know and he might recommend something wrong. Or he might say that there is no evidence-based treatment that he can justify recommending. With the abundance of information currently available on the Internet, a physician can quickly educate himself about PPS.
1. Post-Polio Muscle Atrophy (PPMA), often referred to as PPS, weakens nerve muscle communication and performance. Therefore drugs that affect those areas should be used with caution.
3. Appropriate adaptive equipment and bracing will not cause more weakness when used properly. Do not be afraid to use adaptive equipment with muscles that are already weak. This equipment will actually make a person stronger by relieving stress on the muscles.
4. Don’t blame everything on polio; polio survivors are not immune to other conditions and/or diseases.
These central nervous system depress-ants can increase feelings of fatigue:
· Narcotics
· Sedatives
· Tranquilizers
· Sleeping pills
· General anesthetics, e.g. ether
· Alcohol
Muscle relaxants:
· Valium--diazepam
· Soma--carisoprodal
· Robaxin--methocarbamol
· Parafon Forte--chlorzoxazone
· Norgesic, Norflex--orphenadrine
· Flexeril--cyclobenzaprine
If a person already has muscle fatigability and weakness, he may feel weaker if he begins a muscle relaxant similar to those listed above for pain relief.
Depolarizing drugs (used in surgery) may cause some prolonged weakness when first waking up in the recovery room. Discuss this with the anesthesiologist in advance.
· Quinine (anti-cramp medicine)
· Quinidine
· Procainamide
The preceding two muscle relaxants are heart medications that do relax muscles. If you need these drugs for a medical condition, be an alert consumer and monitor your condition.
· Beta-blockers, e.g. propranolol, are known to cause fatigue and tiredness, but people do tolerate them.
· Calcium channel blockers, e.g. verapamil or Calan, may be associated with muscle fatigue.
· Diuretics (water pills) can deplete the body of potassium and cause the muscles to feel more tired.
· Laxatives can also deplete the body of potassium if used frequently.
· Cholesterol-lowering drugs – statins, e.g. Lipitor, Mevacor, etc.
In healthy individuals taking a statin there is a 10 – 20% chance that person will have muscle pain, cramping, or feelings of weakness. Someone who has a neuromuscular problem can take these drugs, but needs to be aware and alert to possible side effects.
Evidence-Based Medicine and PPS
There is an enormous body of literature that shows that rehabilitation is able to stop the progression of symptoms and improve function and quality of life in patients with PPMA. Rehabilitation strategies include therapeutic exercise, conditioning exercise, energy conservation, adaptive devices, and bracing. Improvement in more general areas (pain management, pulmonary or sleep interventions, weight and nutrition concerns, stress, or depression) can result in overall improvement for the individual’s specific post-polio symptoms.
On the downside, aging and motor unit losses are important contributing factors in PPMA - with no treatments proven to block their effects. New drug trials have not yet shown statistically significant benefits. Possible restorative therapies such as growth factors or stem cells are in the very early stages of development. Since the exact causative mechanisms of PPS are not yet fully known, curative therapies are delayed.
Research Highlights of 2002-2003
1. At the April 2003 American Association of Neurologists meeting, Trojan et al. confirmed other studies that showed only very slow changes in PPMA. They reported no change in isometric strength, subjective fatigue, or quality of life over a one-year period. However, during a period of five to ten-years, some things do get worse. This reinforces the validity of studies that show some improvement with various post-polio management strategies.
When a person begins a new strategy, Dr. Perlman suggests monitoring his/her own performance by the day or week and then reporting back to the physician after six weeks.
2. Last year Jubelt et al. reported that a mouse could be given acute polio and be allowed to recover; the EMG measurements that followed were consistent with recovered polio. At the April 2003 meeting it was reported that 1/3 of those recovered mice developed new weakness after a year. This correlated with progressive motor neuron degeneration.
The good news is that now a good animal model for PPS is available; it can be used for testing new drugs.
3. The long-awaited study of nervous system inflammation as a cause of PPMA was reported by Gonzalez H, Khademi M, Andersson M, Wallstrom E, Borg K, and Olsson T. at the Karolinska Hospital in Sweden, in J Neurol Sci 2002, 205:
9-13. It was reported that there are cells in spinal fluid of patients with PPS that are producing inflammatory chemicals (“cytokines”) similar to those seen in multiple sclerosis spinal fluid and blood. These may be generated by reactions with old poliovirus debris that is still there.
In an editorial response to the Gonzalez report, Marinos Dalakas, MD, a premier researcher in post-polio and other neuromuscular diseases, agrees that these cytokines may cause progressive toxicity to nerve cells and some of them can directly cause fatigue and excessive sleepiness. But before drugs for MS are tried in PPS, studies must first show that cytokines are not increased in polio survivors without PPS, that they persist or increase in those with PPS, and that they correlate with new PPS symptoms.
Nothing new has been reported relating to Bruno’s studies of the role of poliovirus-induced lesions of the Reticular Activating System in the genesis of “brain fatigue” and cognitive problems in PPS.
One wonders how the hyperintense spots seen on MRI in patients reporting severe fatigue (as opposed to none in patients with mild fatigue) might relate to brain inflammation from the cytokines – and what would happen to those spots after treatment with MS drugs. The stage is set for new drug trials on brain inflammation.
1. Exercise
People are still confused and worried about the proper use of exercise. Any therapeutic exercise can be used (strengthening, conditioning, aerobic, aquatic) as long as it doesn’t cause pain or fatigue that persists for more than 1 or 2 hours. Exercise programs should be custom-designed with respect to each person’s strengths and weaknesses while minimizing the number of repetitions. Too much exercise is not good; overdoing can increase PPS symptoms. Aggressive physical therapy could cause harm.
It is important to educate your doctors and therapists. The March of Dimes PPS brochures are accurate, easy to read, and available at http://www.marchofdimes. com/files/PPSreport.pdf.
Post-Polio Health International, 4207 Lindell Boulevard, #110, Saint Louis, MO 63108, formerly GINI, is also distributing print copies of the brochures. One free copy is available and bulk quantities are available for a minimal shipping and handling fee.
The Spring 2003 issue of "Post-Polio Health" (Vol. 19, No. 2), formerly known as "Polio Network News”, includes “A Statement about Exercise for Survivors of Polio”. This position paper was developed and endorsed by the twenty-nine physicians on the Medical Advisory Committee of Post-Polio Health International. http://www.post-polio.org/ ipn/pnn19-2.html
2. Progress
What is the best way to follow a patient’s progress? Annual doctor visits review the level of symptoms and benefits of symptomatic treatment, as well as strength testing to look for areas of improvement or worsening. Tests used to make the diagnosis of PPS (e.g. EMG) do not need to be repeated unless something is getting worse or something new is happening. EMG is not a good way to follow a person’s progress.
3. Oxygen
Should PPS patients use oxygen? There are conflicting opinions on this.
In a recent article Dr. Julie Silver stated that pulmonary specialists might order pulmonary function tests, sleep studies, or blood oxygen tests to help determine the best treatments for weak breathing muscles – ventilator, CPAP, BiPAP, or pulmonary rehab. Oxygen might be ordered.
Dr. Perlman said that the good thing about supplemental oxygen, for a PPS patient complaining about fatigability of breathing and shortness of breath, is that the breathing muscles wouldn’t have to work as hard to get oxygen. Oxygen could be considered an “anti-fatigue device” for someone who has a weak diaphragm on one side or scoliosis that restricts some chest movement, and might be overusing his neck muscles to help with breathing. A small amount of oxygen at appropriate times (not all day, but just at certain times of the day) would let the person breathe with a little less effort, yet still get the oxygen he needs. It is like giving the neck muscles a brace, so they do not have to work as hard. So in certain individuals, oxygen can be a good energy conservation device for breathing muscles.
However, if a person’s breathing is weak and his oxygen level is low, but in addition he is not breathing out enough carbon dioxide, then supplemental oxygen could cause more problems. It would slow his breathing for the purposes of getting oxygen in, but the slower breathing would result in less carbon dioxide being removed. The carbon dioxide would build up further in his bloodstream and could cause decreased alertness, even coma.
Oxygen is a double-edged sword. Not that it can never be used, but when it is used, the physician needs to know how the person’s breathing is functioning—whether or not his carbon dioxide levels are building up. Not everybody who has increased carbon dioxide has shortness of breath, so testing for carbon dioxide levels in blood may be the only way to determine if oxygen can be used safely.
· Sometimes it is just an oxygen problem, so then oxygen can be used periodically through-out the day very safely.
· Some people who have had increased carbon dioxide in their blood for years, might stop breathing altogether with only a small amount of supplemental oxygen.
A patient needs to have a pulmonologist provide guidelines for this – not a neurologist, not a general physician; this is in the area of pulmonary medicine.
1. Pulmonary Dysfunction in PPS
Late-onset pulmonary dysfunction of 2% per year, from a compensated baseline (the stable forced vital capacity the patient has had since his recovery from acute polio), is associated with a decline in Forced Vital Capacity (maximal amount of air a person can inhale in one breath).
Ventilatory failure occurs because of neuromuscular decline or increasing spine deformity, but secretion build-up, aspiration, and obstructive sleep apnea can also contribute, leading to fatigue, excessive daytime sleepiness, and pulmonary complaints.
There is a greater risk of progressive loss of lung compliance (flexibility of the lung tissue to expand when a person breathes) due to reduced ability to take deep breaths and the effects of secretions. Small changes (mucous plugs, infection, dehydration, excessive fatigue) can lead to acute respiratory failure. Chronic alveolar hypoventilation (“underbreathing”) may be worse at night even without obstructive sleep apnea.
Management goals are to:
· Maintain normal alveolar ventil-ation (getting enough oxygen and carbon dioxide in and out of the lungs) around the clock
· Provide clearance of airway secretions
· Improve pulmonary compliance (more flexible lung tissue moves more air)
· Address the factors causing sleep disordered breathing (central or obstructive)
· Establish an individualized pulmon-ary rehabilitation program
Overall improvement of an individual’s specific post-polio symptoms will occur with progress in the more general areas of pain management, pulmonary or sleep interventions, weight and nutrition concerns, stress, or depression. Therapeutic exercise, conditioning exercise, energy conservation, adaptive devices, and bracing are able to stop the progression of symptoms and improve function and quality of life in patients with PPS. It is important for polio survivors to educate their doctors and therapists. Aggressive physical therapy could cause harm. Too much exercise is not good; overdoing can increase PPS symptoms.
Medications that weaken nerve muscle communication and performance should be used with caution; examples are found in this report.
© Copyright 2003
Mary Clarke Atwood
Reprint permission must be obtained directly from:- Rancho Los Amigos Post-Polio Support Group
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Reprinted from Polio Survivor News, CO, February 2004; reprinted from Polio Deja View, Richmond, VA,
April – May 2003.
ANESTHESIA CONSIDERATIONS
FOR PATIENTS WITH
POST POLIO SYNDROME
General
Functional capacity diminished due to fatigue and/or muscle weakness 15 to 40 years after initial infection, and after stabilization of s
ymptoms for many years – “unstable polio”.
Theories-most practical is the giant motor neuron dysfunction – Collateralization of muscle fibers during recovery from motor neuron loss produced giant motor neuron units, which with time, aging, overuse, or decreased remodeling have broken down. Exertion brings on fatigue and weakness. Wide range of functionality, and most at risk are original muscles. Compensated deficits will decompensate with anesthesia.
Symptoms and involvement to be discovered in thorough pre-operative evaluation: These include Chronic Pain, Fatigue, progression of weakness, dysphagia, respiratory insufficiency, urinary retention, GI motility changes, emotional reaction to change in functional capacity and to recrudescence of polio.
Anesthesia consideration highlight include the following:
Pain
Type I Polio muscular pain; nerve entrapment, muscular-myofascial fatigue pain; joint pain from unstable joints, previous procedures; arthritic changes. Patients generally avoid narcotics:
a. fear of addiction
b. fear of pulmonary compromise, and
c. avoidance of functional compromise.
Hyper-aesthesia otherwise not the norm. Chronic Pain med’s otherwise utilized.
Aspiration Risk
Patients who have had bulbar symptoms likely have dysphagia, esophageal dysmotility, pharyngeal pooling, delayed swallowing, LES dysfunction and should be considered to be a risk for aspiration.
Pulmonary
History of iron lung during childhood places patients at increased risk for post-operative ventilation, or requirement for post-op vent support. Psychiatry evaluation of value pre-op. Pulmonary function tests. 3 Rules of 50% quite germane in this population.
CAH – chronic alveolar hypoventilation due to restrictive disease, assessed by VC, MIF, ABG’s; pre and post-op; Incentive spirometry.
Support CPAP/BiPAP – if required during day or night, might require titration of support and O2 immediately post-op. Patient’s own masks most comfortable, and will require recovery room coordination with respiratory therapy and nursing.
IPPV – Intermittent positive pressure ventilation – requires pre-operative training. Might use chronically. If post-operative ventilation expected, this is the optimal weaning modality, preferable to endotracheal ventilation with CPAP wean. Mucous plugging decompensatory in severe cases. Effective cough maintenance.
Ventilatory Fatigue may appear precipitously and post-operative monitoring crucial.
Neuromuscular
Few studies to support exquisite sensitivity to no-depolarizing NMB. However NO Residual Blockade by double burst, and full reversal. Avoid Edrophonium for short half-life. Muscle relaxant effect of anesthesia gas to be minimized by ventilating off prior to extubation.
Cold susceptibility – Patients often with baseline vasomotor dysfunction. Neuromuscular dysfunction amplified with temperature drops as little as .5 degrees Centigrade.
Neuroendocrine
Theoretical hypoadrenal state link to fatigue. May consider pre-operative cortisol dose. Not et in literature. Blood pressure support medications helps many patients with fatigue.
Regional
No specific contraindication to regional barring:
High spinal in those with respiratory muscle weakness.
Avoid neurotoxicity of 5% lidocaine.
Avoid spinals with epinephrine wash.
Patient comfort is paramount (sensitization to lumbar puncture, sensation of paralysis).
Renal
Urinary dysfunction/retention exacerbated by anticholinergics, gas, opioids.
Cardiovascular
Older patient population with the usual considerations. In addition:-
- exercise programs conditioning pre-op as delineated by physiatry would stabilize hemodynamics, lower resting HR.
- muscle conservation of non-stress exercise with avoidance of overuse may mask coronary artery insufficiency. Stress testing pre-operatively for mod and high-risk procedures recommended.
Geriatric Considerations
Standard for this population.
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Reprinted from Polio Survivor News, CO, February 2004; reprinted from Second Time Around, January 2004 – publication of Boca Area Post Polio Group, Boca Raton, FL
ISSUES TO DISCUSS WITH
YOUR ANESTHESIOLOGIST
BY HELEN O’KEEFE, MD, ANESTHESIOLOGIST
Handout at SFBABS, September 21, 2002 meeting listing questions a polio survivor should ask the medical provider before taking anesthetics.
Information from you to the anesthesiologist.
Questions, issues for the anesthesiologist.
ARM/LEG MUSCLE INVOLVMENT FROM POLIO
1. The actual extent of your muscle involvement.
2. Whether this is stable over years, or in a changing phase.
3. Will muscle relaxants be necessary? (lowest possible dose, often ½ usual, monitored with nerve stimulator)
CENTRAL NERVOUS SYSTEM
1. Any history of excessive fatigue.
2. Prior experience with sedatives, pain medications or anesthetics.
3. RAS (reticular activating system) damage from original polio infection may cause sensitivity to sedatives, prolonged wake-up.
RESPIRATORY SYSTEM
1. Chest muscle involvement, lung capacity, pulmonary function tests.
2. Prior or current ventilator use.
3. Sleep apnea, serious snoring, CPAP use.
4. Smoking. . . PLEASE STOP any-how, please!!!!!
5. Plan for respiratory support during & after surgery.
GASTRO-INTESTINAL SYSTEM
1. Any reflux or heartburn, antacid use.
2. Any swallowing difficulties… including using pills.
3. Request for maximal antiemetic treatment intraop.
POSITIONING
1. Any particular positions that are painful for you?
2. What position will be used during surgery? (Check out whether there are problems for you in that position.)
TEMPERATURE
1. Any problems with sensitivity to cold or chilling.
2. Are forced-air warming blankets available.