Post-Polio Syndrome

A cluster of potentially disabling signs and symptoms that appear decades, an average of 30 to 40 years, after the initial polio illness is referred to as Post-polio syndrome.

In old time, Polio was one of the most feared diseases in America as it was responsible for paralysis and death which peaked in the early 1950s.

The inactivated polio vaccine was introduced and reduced polio’s spread.  Post-polio syndrome, is the condition in which people who has had polio at a young age experience certain effects of the disease many years later.

In most people, post-polio syndrome tends to progress slowly, with new signs and symptoms followed by periods of stability. Such signs and symptoms include:

• progressive muscle and joint weakness and pain,
• general fatigue and exhaustion with minimal activity,
• muscle atrophy,
• breathing or swallowing problems,
• sleep-related breathing disorders, such as sleep apnea,
• decreased tolerance to cold temperatures.

It is advisable to seek immediate medical consultation once weakness and fatigue are experienced as it is important to determine other causes of the discomfort or symptoms that may or may not be related to post-polio syndrome hence proper therapy/treatment is necessary.

At this time, the cause on why signs and symptoms of post-polio syndrome appear many years after the first episode of polio is still unknown.

The most acceptable theory at present time is the idea of degenerating nerve cells.

It offers an explanation that when poliovirus infects your body, it affects nerve cells called motor neurons — particularly those in your spinal cord — that carry messages (electrical impulses) between your brain and your muscles. Each neuron consists of three basic components:

• A cell body,
• A major branching fiber (axon),
• Numerous smaller branching fibers (dendrites).

Many of the motor neurons are left destroyed and damaged by the polio infection.

As a means to compensate for the resulting neuron shortage, the remaining neurons sprout new fibers, and the surviving motor units become enlarged.

Such cell function promotes recovery of the use of your muscles, but it also places added stress on the nerve cell body to nourish the additional fibers.

Through years’ wear and tear, neurons may have undergone more than enough stress that it can handle, leading to the slow deterioration of the fibers and eventually the neurons itself which in turn leads to the manifestation of the post-polio syndrome.

Immediately consult a doctor at the first chance of noticing signs and symptoms of post-polio syndrome to receive a diagnosis.

You will most likely be referred to a Neurologist, a doctor who specializes in disorders of the nervous system. It is best prepared before going to your doctor’s appointment since there will be a lot of things to learn, understand and discuss, this will also allow you to maximize the time spent with your neurologist which is limited only.

Always start with your list such as write down any and all symptoms that you are experiencing including those that you find unrelated but as long as the changes cause discomfort then it is best to mention it to your doctor.

Include any recent causes of stress and life changes that might have cause negative emotions may it be small or huge. Write down all questions for the doctor and be preferred to also share all the medications that you have taken in the recent years.

Here are some of the common questions to as your doctor about post-polio syndrome

• What is likely causing my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests, if any, do I need?
• What will these tests tell you?
• What's involved in the test?
• Is my condition likely temporary or chronic?
• What treatments are available?
• Which do you recommend?
• Are there alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any activity restrictions that I need to follow?
• Will I become incapacitated?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend visiting?

If you find some answers confusing then do not hesitate to ask the doctor for further explanation or to clarify it for you.

Also, prepare yourself to answer questions from the doctor which would help in diagnosing the symptoms you are experiencing.

Here are some basic questions from the doctor

• Have you ever had polio?
• If so, when?
• How severe was your polio infection?
• What areas of your body were affected by polio?
• What types of symptoms are you now experiencing?
• When did you first begin experiencing these symptoms?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve your symptoms?
• Does anything appear to worsen your symptoms?

There are three indicators that doctors consider in diagnosing post-polio syndrome: first, previous diagnosis of polio, this may require finding old medical records or getting information from older family members for acute polio primarily occurs during childhood.

The late effects of polio usually occur in people who were adolescents or older during the initial attack of polio and in those whose symptoms were severe.

Long interval after recovery. People who recover from the initial attack of polio often live for many years without further signs or symptoms. The onset of late effects varies widely but typically begins at least 15 years after the initial diagnosis.

Gradual onset

Weakness often isn't noticeable until it interferes with daily activities. You may awaken refreshed but feel exhausted by the early afternoon, tiring after activities that were once easy.

In addition, because the signs and symptoms of post-polio syndrome are similar to those commonly associated with other disorders, your doctor will attempt to exclude other possible causes, such as

• arthritis,
• fibromyalgia,
• chronic fatigue syndrome
• and scoliosis.

Due to some similarities in the signs and symptoms, some people with post-polio syndrome are worried that they may have ALS (amyotrophic lateral sclerosis), also called Lou Gehrig’s disease. Although the late effects of polio are not a form or ALS.

There is no diagnostic test to confirm post-polio syndrome hence tests to be performed are to rule out other diseases which presents the same signs and symptoms before coming up with the diagnosis of post-polio syndrome.

Such tests include:

• Electromyography (EMG)
• and nerve conduction studies.

Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle.

In a variation of EMG called nerve conduction studies, two electrodes are taped to your skin above a nerve to be studied. A small shock is passed through the nerve to measure the speed of nerve signals. These nerve conduction tests help identify and exclude abnormal condition of your nerves called neuropathy and a muscle tissue disorder called myopathy.

Another imaging diagnostic test is the magnetic resonance imaging (MRI) or computerized tomography (CT), to see images of your brain and spinal cord.

These tests can help rule out spinal disorders, such as the degenerative spine condition spondylosis or narrowing of your spinal column that puts pressure on your nerves or spinal stenosis. Muscle biopsy.

Your doctor may perform a muscle biopsy, looking for evidence of another condition that may be causing the new weakness.

Blood tests

People with post-polio syndrome usually have normal blood test results. Abnormal blood test results may indicate another underlying problem that's causing your symptoms. Once all other related conditions have been ruled out, then based on the symptoms, medical history and test results thus a diagnosis of post-polio syndrome can be made.

Post-polio syndrome does not have any specific treatment since signs and symptoms vary. Treatment goal is the management of symptoms and make sure you are comfortable and able to ensure self-sufficient while living with the condition.

Energy conservation, this allows you to have frequent period of rest in between physical activity by properly pacing self during movement to minimize fatigue. Occupational therapy is also beneficial in helping you modify your home environment to ensure safety and convenience, such as

• installation of grab bars in the shower or raised toilet seat,
• rearrange furniture,
• re-plan household or work-related tasks,
• decreasing the number of steps you must take and increasing your efficiency.

Changes in sleep patterns such as avoiding sleeping on your back or using a device that helps open up a blocked airway can help with sleeping difficulties.

Use of assistive devices, such as

• walker,
• cane,
• motor scooter or wheelchair, which would also allow you to conserve your energy.

Your doctor or therapist, can teach you proper breathing techniques to conserve energy, prescribe exercises to strengthen muscle without experiencing muscle fatigue such as swimming or water aerobics that is performed at a relaxes paced every other day.

Exercising regularly to maintain fitness is encouraged but there shouldn’t be any strenuous activity, avoid overuse of the muscle and joints and not beyond the point of pain or fatigue.

You must ensure significant rest to regain your strength.

A speech therapist can also show ways to compensate for swallowing difficulties to ensure proper nutrition.

Pain relievers such as such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others) may also prove helpful in easing muscle and joint pain.

Numerous drugs — including pyridostigmine (Mestinon, Regonol), amantadine, modafinil (Provigil) and insulin-like growth factor-I (IGF-I) — have been studied as treatments for post-polio syndrome, but no clear benefit has been found for any of them.

Part of the prevention of the development of post-polio syndrome in later life is the eradication of polio from early onset.

Hence, infants and children should be vaccinated against polio as part of a routine immunization series.

Also, before travelling to areas with increased cases of polio, travelers should ensure that they have completed the recommended age-appropriate polio vaccine series.

Alternative remedies in dealing with post-polio syndrome would involve proper dietary nutrition and planning activities that would best conserve your energy.

You have to be smart with the lifestyle choices you make as not to aggravate pain and fatigue.

You have to avoid places that your potentially expose you from developing and respiratory infection.

Always remember that conservation of energy and maintaining a healthy lifestyle are key.

Lifestyle modifications are necessary in order to cope with post-polio syndrome.

One of the hardest part in dealing with post-polio syndrome is having to accept again that the disease is back which is emotionally toiling and physically discouraging because of all the changes that you have to adopt in dealing with the illness.

Coping with this illness would need constant drive and motivation as majority of the activities that you have been used to doing will have to be changed such as your daily routine, your environment, nutrition and other possible treatment regime that would have to be followed to be able to live with the disease.

In terms of physical activities or movement, moderation is key since continuous activity is discourage as periodic moments of rest is necessary to prevent fatigue.

You have to learn to be more mindful of the environment and how it will affect you such as the need to stay in a warmer place since cold increases muscle fatigue and increasing the layer of your clothing especially when you go out as well as wearing more comfortable shoes.

Healthy lifestyle showed also be maintained by eating a balanced diet, avoid or stop smoking and decrease caffeine intake which will also help you breathe easier and sleep better.

You also have to watch out for new symptoms that might arise as it needs to be treated promptly, such as impaired breathing which may be due to respiratory infection.

Emotional and Social support from loved ones and friends is of utmost importance since dealing with fatigue and weakness due to post-polio syndrome can be physically and psychologically difficult.

Joining a support group with people who are joining through the same hardship and challenges that you are going through may prove beneficial in coping with the changes.

There are several factors which affect the risk of developing post-polio syndrome, the primary factor is the severity of the initial polio infection.

The more severe the initial infection, the more likely that you'll have signs and symptoms of post-polio syndrome.

Rate of Recovery is a risk, since the greater your recovery after acute polio, the more likely it seems that post-polio syndrome will develop. This may happen because greater recovery places additional stress on motor neurons.

Age at onset of initial illness is a risk, if you acquired polio as an adolescent or adult rather than as a young child, your chances of developing post-polio syndrome increase.

Physical activity

If you often perform physical activity to the point of exhaustion or fatigue, this may overwork already stressed-out motor neurons and increase your risk of post-polio syndrome.

Post-polio syndrome may lead to complications due to severe muscle weakness.

These are the possible complications of post-polio syndrome:

Osteoporosis

Prolonged inactivity and immobility are often accompanied by loss of bone density and osteoporosis in both men and women. If you have post-polio syndrome, you may wish to be screened for osteoporosis.

Falls

Weakness in your leg muscles makes it easier for you to lose your balance and fall. A fall may result in a broken bone, such as a hip fracture, leading to other complications.

Acute respiratory failure

Obesity, smoking, curvature of the spine, anesthesia, prolonged immobility and certain medications can further decrease breathing ability, possibly leading to acute respiratory failure. This is characterized by a sharp drop in blood oxygen levels and may require you to receive treatment to help you breathe (ventilation therapy).

Acute respiratory failure

Weakness in your diaphragm and chest muscles makes it harder to take deep breaths and cough, which can ultimately lead to accumulation of fluid and mucus in your lungs.

Malnutrition, dehydration and pneumonia

People who've had bulbar polio, which affects nerves leading to muscles involved in chewing and swallowing, often have difficulty with these activities as well as other signs of post-polio syndrome. Chewing and swallowing problems can lead to inadequate nutrition and to dehydration, as well as aspiration pneumonia, which is caused by inhaling food particles into your lungs (aspirating).  These are some serious complications that you need to watch out for and prevent from happening by following the prescribed treatment regime in managing the illness.