NOTE: This message was originally in conference "INTERNET - E-MAIL AREA"
      and was copied here by Tom Mckeever.
From: Alan Mitchell 
To: Multiple recipients of list POLIO 
Date:         Mon, 16 Sep 1996 09:49:54 GMT
Subject:      APPA News 13 Special Report from the Internet (*)
Organization: MindSpring Enterprises, Inc.
 
The following is an excerpt from an article by Dr. Richard L. Bruno,
called  The Knife Is Not So Rough If..... .
 
Dr. Bruno put this article on the Internet and asked that it be shared
with polio survivors
 
If you have to  go under the knife,  the innocent ignorance of your
surgeon  can lead to unnecessary emotional discomfort, excessive
physical pain and, occasionally, serious complications.
        So read the article and give a copy to each member of the surgical
team and the nurses on the hospital floor where you will be staying.
Discuss the article with your doctor and ask that a copy be put in you
 
medical chart.
        Medical professionals need to be familiar with the neurological 
amage
done by the original polio infection.
        POST-OPERATIVE PREPARATION This is the most important period, since
this is their period when you must establish communication with the
surgical tea.  After a second opinion, meet with the surgeon and the
anesthesiologist to discuss in detail your complete polio and general
medical histories and any problems that might arise before and during
surgery, in the recovery room and on the nursing floor.
        LUNGS.  It is recommended that all polio survivors have pulmonary
function studies as part of your preoperative testing..  This will
help the surgical team evaluate the proper type of anesthesia for you
and will help eliminate any unpleasant surprises coming off  a
respirator at the end of surgery.
        PHYSICAL ASSISTANCE X-ray and examining tables are built at heights
that are convenient for the professional, not the patient.  Many polio
survivors cannot step on a stool to get on a high table.  Polio
survivors must ask for help in transferring.
        Since most polio survivors are not good at asking for help , they 
eed
to find a phrase with which they are comfortable that will communicate
their needs.  If you run into someone that does not want to help or
work with you, ask for someone else to help or ask to speak to their
supervisor.
        GENERAL ANESTHETICS Polio survivors are exquisitely sensitive to
anesthetic.  A little anesthetic goes a long way and lasts a long time
due to the damage of the brain stem - called the reticular activating
system. Polio survivors have been known to sleep for days after
surgery.
 
For polio survivors we use the   RULES OF 2  - for surgery.
 
ANESTHETIC RULE OF 2 Polio survivors need the typical dose of
anesthetic divided by 2.  This is merely to remind anesthesiologists
that polio survivors need much less anesthetic than do other patients.
 
        Also, polio survivors can be sensitive to atropine-like drugs used
during surgery.
 
POSITIONING One overlooked problem is the positioning of the
post-polio patient on the operating table. Muscle atrophy, scoliosis
and spinal fusion  may make certain positions problematic.  It would
be advisable for the patient to be awake during positioning on the
table to prevent post-op complications..
POST-OPERATIVE CARE Cold. Polio survivors are extremely sensitive to
cold because they have difficulty regulating their body temperature.
        No polio survivor should have same-day surgery for any reason except
for the most simple procedure that requires a local anesthetic.
POST-ANESTHETIC RULE OF 2 Polio survivors require 2 times as long to
recover from the effects of any anesthetics.
BLOOD AND GUTS   Polio survivors with muscle atrophy, will have a
smaller blood volume that would be expected for their weight and
height.  Therefore bleeding during surgery may be more of a problem
        Polio survivors cannot control the size of their blood vessels, since
the nerves that make the smooth muscle around veins and capillaries
contract were paralyzed by poliovirus. Therefore, polio survivors
blood vessels open under anesthetic and dump the heat of their warm
blood into the cold recovery room.  Polio survivors must be kept warm.
 
VOMITING   Another post-op problem related to brain stem damage is
vomiting.  Polio survivors are more apt to faint (have vasovagal
syncope and even brief asystoles) when they attempt to vomit.  It is
important that post-op emetic control be discussed with the
anesthesiologist and administered before going to the recovery room.
CHOKING   Polio survivors who are aware of having swallowing problems,
and sometimes in those  without apparent swallowing difficulty, cannot
clear secretions and may choke  when they are lying on their
backs.  Polio survivors secretions need to be monitored in the
recovery room and they should be positioned on their side if possible
so that secretions can  drain.
PAIN   The single most  troublesome problem after surgery is pain
control. Under-medication is a serious problem for the post-polio
patient since two research studies have shown that polio survivors are
twice as sensitive to pain as those who didn t have polio.
RULE OF 2 FOR PAIN   Polio survivors need 2 times the dose of pain
medication for 2 times as long.
RECOVERY Polio survivors need more bed rest than most patients,
because of autonomic nervous system damage. Polio survivors are the
best judges of when they can move, stand and walk safely.
RULE OF 2 FOR RECOVERY   Polio survivors should stay in  bed 2 times
longer than other patients.
RULE OF 2 FOR LENGTH OF STAY   Polio survivors need to stay in the
hospital 2 times longer than other patients.
RULE OF 2 FOR WORK   Polio survivors need 2 times the number of days
of rest at home before they return to work or household duties.
RULE OF 2 FOR FEELING BETTER   Polio survivors need 2 times longer to
feel  back to normal  again.
CONCLUSION   All of the  Rules of 2  are suggestions for polio
survivors and the surgical team; they are not a substitute for
specific  information about the individual patient and communication
among all members of the treatment team, including the patient.
 
Linda Sutherland
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