NOTE: This message was originally in conference "INTERNET - E-MAIL AREA"
      and was copied here by Tom Mckeever.
From: Jane Bercier 
To: Multiple recipients of list POLIO 
Date:         Wed, 26 Jun 1996 23:22:50 -0500
Subject:      Late Effects of Polio
 
PPS/POLIO
When the paralytic form of the disease occurs, the virus attacks the
anterior horn cells n a generalize or spotty form.  Damage  to these cells
may not be severe enought to produce cellular death or degeneration
(Wallerian).  It may produce persistet metabolic disarray.  The damaged
anjterior horn cells are then subsequently stressed by the adaptive neural
responses which follow.  These include terminal sprouting in which muscle
figers, orphaned by death are adopted and reinnervated by surviving, if
damaged, anterior horn cells, thereby greatly increasing the size of the
motor units present and further taxing remaining cells. The body is then
forced to use the residual muscle fibers in the involved limbs.
This is what contributes to the increased stress on an  anterior horn cell
which likely suffered injury at the time of the acute illness.  A number of
people some thirty or more years later begin to experience of significant
and progressive functional decline.  A conservative approximation is that
about 200,000 people in the US are now affected.  Risk factors for
development of these late polio problems are a function of the severity of
the illness with the more severely involved appearing to be the most likely
to experience subsequent increasing difficulties.  The symptoms most
commonly found in these individuals include fatigue, muscle pain, joint
pain, weakness, cold intolerance, muscle atrophy, reduced mobility and
reduced self care capabilities.
The term PPS is probably a heterogeneous gourp of disorders--progressive
disability related to the paralysis but not directly to increasing anterior
hown cell dysfunction and disability related most likely to ongoing anterior
horn cell demise or dysfunction along with the normal aging process.
Unrelated disoders include-strokes, CNS neoplasms, infections, metabolic
diseases,and endocrine disorders.
Related to the paralysis-back pain, with or without spinal cord or nerve
root involvement, secondary to either progressive scoliosis or accelerated
degenerative change within the axial skeleton.
Related to the degeneration of the kanteerior horn cells are muscular
atrophy. This is related to the cell death.  This may affect muscles
significantly involved or even felt to be uninvolved by polio acutely.
In many polio survivors peak performance has been a necessity throughout
their lives and even naturally occuring changes in muscle strength, body
weight, or other physiologic processes may have far reaching implications.
 
Management of PPS depends on accurately diagnosing its cause.  Conditions
contributed to by the muscle weakness are best addressed through the use of
asssistive devices, orthotics, anti-inflammatory meds,PT,or on occasion
surgery.  In the group where there are respiratory or swallowing difficulty
the fatigue factor require special attention due to the weakness of muscles.
This is where suggestions for non-fatiguing, light conditioning exercises
with simplification of work along with energy conservation are necessary.
Weight loss is often appropriate.
Physicians have not determined what causes the syndrome or how best to treat
it. The polio survivors are now faced with returning to wheelchairs, canes,
braces,etc.  Now they thought they had overcome that initial disability and
were survivors, and now have to face it all over again.
EMOTIONAL SUPPORT is also ;an important aspect of treatment. Many who have
developed PPS are overwhelmed with the increasing realization that they
cannot function as well as they use to.  It very much feels like betrayal.
There is usually a great deal of resistance to acknowledging they are not
the physical person they once were.  That takes its toll emotionally.
People helping people find their coping skills and offering emotional
support are the things most needed not related to medical care. PPS is an
insidious thing that doesn't get better and support is necessary.  PPS
patients are resilient--they are fighters.  They have not just given up to a
disability but have lived and excelled in spite of it.  They have worked a
lifetime to maintain their function and will continue with a spirit uncommon
to most.
 
Pick A Topic-- Any Topic
THE BETTE
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