Post Polio Syndrome: Not Just For Breakfast Anymore

According to the family legend, my mother was having morning coffee and cigarettes with our slightly older neighbors, Annette and Louie Friedman, near the end of the school year, in 1954, when I was eight, when Louie, an internist with the Cleveland Clinic, interrupted the kaffee-klatsch, and demanded my mother bring me to him. I had been playing outside with other kids. I was brought into the house, examined, an peremptorily sent to bed, where I stayed for large parts of the next two-and-a-half years. Louie, our gruff, cigar-smoking, T-bird-driving next door neighbor, had spotted anomalies in my movements that he diagnosed, at a distance of at least 50 feet, as symptomatic of poliomyletis.

The NEXT year the Salk vaccine was released. The year I was diagnosed (with what turned out to be the "non-paralytic" variety), there were 66 THOUSAND new cases reported in the USofA, alone. The year after the release of the vaccine, there were fewer than three thousand, and the numbers have fallen ever since. It hasn't been eliminated, but polio now is very rare. And it is kept that way by vaccinations.

One unexpected consequence of the disease has emerged and endured:  a neuromuscular disorder called post-polio syndrome (PPS), marked by the recurrence of motor symptoms some 10 – 40 years after recovery from a polio infection.

Y'all may know I've been experiencing considerable pain and discomfort in the mere and simple acts of standing and walking. My mobility has been increasingly--and in retrospect, significantly--impaired. I have been attributing it to sciatica, and I do have that condition. But that, I think, oughtn't account for the really generalized physical discomfort in my lower limbs--below my waist--which I experience upon returning home from a barely one-mile excursion walking Budreaux, the Pink-nosed Pit Bull; with, I should say, momentary pauses where a seat o f some kind is available. The pauses or no more than a minute, and they help, but I cannot forego them.

So, as a "survivor"--dear fucking hell, how I loathe what that word has come to betoken--of polio, I am wondering if I'm not experiencing the recrudescence of the malady late in life. (Sh)It happens. Specifically, shit like this:

Pain. The patient experiences burning, cramping, aching, or a "tired" feeling in the neck, back, legs, and arms and may develop spasms from the overuse of muscles.6 Having fought a debilitating disease, polio survivors are used to pushing themselves. For instance, a patient who can't lift her arm will use her shoulder instead; contracting the shoulder muscles on a regular basis can lead to pain and spasms.

Weakness and fatigue. About 75% of PPS patients report mental and physical fatigue and new muscle weakness.8 While the pathophysiology of the fatigue isn't clear, weakness is associated with atrophy of the muscles that were involved during the polio infection. This may contribute to fatigue when functions such as breathing, walking, and swallowing are compromised. Sometimes, muscles that appeared to be unaffected by the poliovirus may also develop this new progressive weakness. These muscles had subclinical involvement at the time of the acute poliomyelitis.9

Memory problems. Difficulty with word-finding is a common symptom of post-polio fatigue. The memory lapse is thought to be caused by a decreased level of dopamine that's been found in polio survivors' brains and affected by physical and emotional stress.10

Breathing problems. Difficulty breathing, hypoventilation, and hypercapnia are common. Early signs of respiratory dysfunction include headaches, fatigue, nightmares, restless sleep, difficulty sleeping while supine, poor concentration, anxiety, inability to speak loudly, breathlessness, and frequent respiratory infections.6

Sleep disturbances. Sleep apnea is common in PPS patients and may be caused by weakened musculature or brain dysfunction.  Patients may be kept up at night by such movement disorders as generalized random myoclonus—twitching and contraction of various muscles—or restless legs syndrome. The movement interrupts the REM cycle of sleep, causing poor sleep patterns and daytime fatigue. Many patients aren't aware of such movement until it's documented during a sleep study.

Impaired swallowing. Swallowing difficulty, or dysphagia, is common in polio survivors who had bulbar involvement—weakening of muscles innervated by cranial nerves—when first infected. Dysphagia puts patients at risk for aspiration. Early signs of swallowing difficulty are coughing, choking, and frequent clearing of the throat.

Cold intolerance. Polio survivors may find that their limbs become more sensitive to pain when it's cold. Many have reported that their feet have always been cold to the touch, with the problem worsening as they age.

During infection, the poliovirus may have attacked the sympathetic motor nerves in the spinal cord, as well as other areas of the brain that regulate peripheral vasoconstriction. Because the capillaries do not contract, warm blood flows to the surface of the skin, resulting in excessive loss of heat and cooling of the limbs, sometimes causing severe shivering. The skin may become pale and cyanotic. Impaired vasoconstriction increases the risk of postural hypotension, especially if the patient takes vasodilators.

Urinary problems. These include retention, incomplete emptying of the bladder, incontinence, nocturia, and hesitancy. They may occur because the pelvic floor and bladder detrusor muscles have been paralyzed by the poliovirus.2,9

Emotional stress. When polio survivors realize they're losing muscle strength and function, they understandably become fearful and even depressed. The resurfacing of symptoms can cause painful memories, and patients are likely to have difficulty accepting and adjusting to this unexpected recurrence.2,9

Of the nine classes of symptoms, I believe I exhibit at least six: Pain, weakness/fatigue, breathing problems, sleep disturbances, impaired swallowing, and emotional stress. I almost never pass a night without awakening to urinate.

Actually, if the truth were known, I feel almost foolishly helpless. I couldn't run 100 feet. I used to sprint the 100-yard dash (around 12 sec, circa 1964). I used to surf, but I doubt now I could tread water very long. I know the old saying: The older I get, the better I used to be... but this is fucking ridiculous. I can barely STAND for more than half-an-hour without pretty severe discomfort, approaching pain, afflicting my legs and hips. I can walk about a quarter of a mile, and then I have to rest. I have to walk much more slowly when I do proceed, than even a couple of years ago.

I had stents put in an artery in the heart in '06. I take statins (a pretty high dose) to control cholesterol, and I know that statins are linked to increased incidences of myalgia. So there is ambiguation. It may be there is a not-so-subtle interplay of the two pathologies. Nobody lives forever; but I'd just as soon not be THIS hobbled for the rest of what's left. So I am going to ask my Primary guy about it when I see 'em next month.