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Up First Do No Harm PPS Intro PPS Reference By Date By Symptoms

constr1.gif (3604 bytes) The Upcreek PPS By Symptoms page presents medical articles categorized based on the symptom with which they are associated. Source of information is included.

This page needs a lot of work.  Please be patient.  Send suggestions.

  *SYMPTOM: BRAIN Information related to problems related to damage the polio virus did in the brain. PPS problems with memory, attention, cognition, concentration are sometimes referred to as "Brain Fatigue." There also appears to be some evidence of depression of the forebrain control of respiration during sleep in survivors of bulbar polio.  
Polioencephalitis: Explaining Post Polio Fatigue 1 page Summary of Dr. Richard Bruno's look at the results of 1940's autopsy results updated with MRI scans, and the relationship of brain lesions on PPS.
The Pathophysiology Of Post-Polio Fatigue:
A Role for the Basal Ganglia in the Generation of Fatigue
Post-polio fatigue is characterized by subjective reports of problems with attention, cognition and maintaining wakefulness, symptoms reminiscent of nearly two dozen outbreaks during this century of post-viral fatigue syndromes that are related clinically, historically or anatomically to poliovirus infections. These relationships, and recent studies that associate post-polio fatigue with clinically significant deficits on neuropsychologic tests of attention, histopathologic and neuroradiologic evidence of brain lesions and impaired activation of the hypothalamic-pituitary-adrenal axis, will be reviewed to described a role for the reticular activating system and basal ganglia in the pathophysiology of post-polio fatigue. The possibility of pharmacologic therapy for PPS is also discussed.
  *SYMPTOM: BREATHING Issues here have to do with difficulty breathing using ventilators, sleep apnea, etc.  
  *SYMPTOM: CLEARING PHLEGM, SWALLOWING Issues here have to do with difficulty swallowing, clearing phlegm, hoarseness, and other laryngal symptoms  
Peter Ellis Story: Post Polio Personal story published on this web site is to help other bulbar polio survivors who are experiencing difficulties in swallowing. It is also intended to encourage and guide others to seek out the proper medical disciplines because medical help is out there. You just have to know who to see.
  *SYMPTOM: COLD Issues here have to do with cold intolerance, circulation, "polio feet", etc.  
Polio Feet- There's a Reason You have Cold Feet - but you can keep warm and stay cool The process that cause "Polio Feet" to turn blue and cold and become difficult to move when it's only cool is the same process that caused paralysis after the original polio.
  *SYMPTOM: FATIGUE The most commonly reported symptom of PPS is exhaustive fatigue, resulting in hitting the polio wall, where further activity is impossible.  
Bromocriptine in the Treatment of Post-Polio Fatigue: A Pilot Study with implications for the pathophysiology of fatigue 1997 (in press) Bruno, Richard L., PhD. Jerald R. Zimmerman, M.D., Susan Creange, M.A., Todd Lewis, Ph.D., Terry Molzen, M.A., and Nancy M. Frick, M.Div, Lh.D. American Journal of Physical Medicine and Rehabilitation. Objective: Determine the effectiveness of Bromocriptine in the treatment of severe and disabling post-polio fatigue. …

These very preliminary findings suggest that Bromocriptine may be helpful in treating polio survivors whose fatigue is more central in origin (i.e., associated with impaired attention and cognition) while pyridostigmine may be helpful in treating patients whose fatigue is more peripheral (i.e., associated with muscle weakness, fatigability or decreased physical endurance). …

Taken together, these data suggest that any medication for post-polio fatigue will benefit only the most fatigued, neuropsychologically impaired or neurophysiologically abnormal patients who have not responded to conservative therapies. …

medication is not a substitute for self-care and no medication to treat post-polio fatigue should be prescribed until all conservative therapies have been consistently applied by the patient and found inadequate to reduce fatigue sufficiently to allow a satisfactory level of personal, vocational and recreational functioning.

Energy Saving Techniques Mayo Clinic Paper.
Grace Young's Energy Conservation Site
Post-Poliomyelitis Fatigue Where is the Lesion? The Controversy - Three Points of Views Sep 1997 Cashman, Neil MD. Original Publication: A Report of a Special Neurology Rounds At The Montreal Neurological Institute And Hospital. Also in Nov 1997 LINK-PIN. A lightly edited resume delivered by Dr. Cashman at Polio Quebec's Annual General Meeting the following day appears below for those who were unable to be with us or who would like to "hear" it again.
"Post-polio fatigue is probably the most common and certainly one of the most disabling symptoms that occur after polio. There is a great deal of controversy in the field as to what is causing the fatigue. The stakes are very high, because if we were to understand what is causing the fatigue then we could design a treatment or therapy that would help counter it.
The Cause and Treatment of Post Polio Fatigue 1995. Bruno, Richard L., PhD. Nancy M. Frick, Lh.D., Susan J. Creange, M.A., Todd Lewis, Ph.D., and Terry Molzen, M.S.
Healthy Partnerships. Ontario: March of Dimes Fatigue is the most commonly reported, most debilitating and least studied Post-Polio Sequelae (PPS) affecting the nearly 2 million North American polio survivors. Among polio survivors, 91% reported new or in creased fatigue, 41% reported fatigue significantly interfering with performing or completing work and 25% reported fatigue interfering with self-care activities . Fatigue was reported to be triggered or increased by physical overexertion in 92% and by emotional stress in 61%. Importantly, polio survivors distinguish between the physical tiredness and decreased endurance they associate with new muscles weakness, and a 'brain fatigue' that is characterized by problems with attention and thinking. Between 70% and 96% of polio survivors reporting fatigue complained of problems with concentration, memory, attention, word-finding, maintaining wakefulness and thinking clearly, with 77% percent reporting moderate to severe difficulty with these functions.
  *SYMPTOM: PAIN A common symptom in PPS is pain of muscles, joints, etc.  
Pain Relief - Some Tips from the Collected Wisdom of the Internet Polio Mail List Walter, Tom assembled these items. Assuming the person has been thoroughly checked for any other conditions that could mimic PPS symptoms and be treated -- and that any orthopedic anomalies that could be causing pain have been treated -- here's a partial list of some tips that PPSers have reported seem to work for them, alone or in combination:
  *SYMPTOM: PSYCHOLOGICAL Topics include depression, post-traumatic stress, second time around, managing stress, etc.  
Bouncing Back Without Guilt Wendy Clyne, Psy.D article that discusses the impact of psychological issues on polio survivors dealing with PPS. She relates it to Post Traumatic Stress syndrome and highlights the psychological issues that arise for a polio survivor who has not fully "talked out" the original experience when new symptoms cause flashbacks to childhood trauma.
The Contribution of Childhood Physical and Emotional Trauma to the Development of the Post-Polio Personality 1995. Frick, Nancy M., M.Div, Lh.D Proceedings of the Ontario March of Dimes Conference on Post-Polio Sequelae. Toronto: Ontario March of Dimes.
What Post-Polio Survivors and their Families Want Each Other to Know Jan/Feb 1997 issue of Pen & Ink. A good discussion of the things that are hard to talk about.
  SYMPTOM: SLEEP Insomnia, Sleep apnea, depressed forebrain control of breathing in post-bulbar patients, etc.  
  *SYMPTOM: TWITCHING, SPASMS, RESTLESS LEG Twitching, spasms and night-time restless leg are commonly reported PPS symptoms that add to fatigue and cause sleep problems.  
  *SYMPTOM: WEAKNESS    
Exercise: What is Right For You 1997/01. Matheson, Mavis J., MD.
Many people with a history of polio can improve muscle strength and cardiovascular conditioning with an exercise program. One of the problems that people with Post-Polio Syndrome face is how much exercise they should be doing. We have all been told to conserve our energy. We know that too much exercise will further damage already weak muscles. We also know that if a muscle is not exercised it will loose strength. So what should we be doing.