Polio was once one of the most feared diseases in America, responsible for paralysis and death. Shortly after polio reached its peak in the early 1950s, the inactivated polio vaccine was introduced and greatly reduced polio's spread. Today, few people in developed countries get paralytic polio, thanks to the polio vaccine.
Symptoms By Mayo Clinic staff
Post-polio syndrome refers to a cluster of disabling signs and symptoms that appear decades — an average of 30 to 40 years — after the initial illness. Common 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 of cold temperatures
If you're experiencing weakness or fatigue that seems to be slowly getting worse, see your doctor. It's important to rule out other causes of your signs and symptoms that may require different therapy from what's currently advised for post-polio syndrome.
Causes By Mayo Clinic staff
Risk factors By Mayo Clinic staff
- Severity of initial polio infection. The more severe the initial infection, the more likely that you'll have signs and symptoms of post-polio syndrome.
- Age at onset of initial illness. If you acquired polio as an adolescent or adult, rather than as a young child, your chances of developing post-polio syndrome increase.
- Recovery. The greater your recovery after acute polio, the more likely it seems that post-polio syndrome will develop. This may be because greater recovery places additional stress on motor neurons.
- 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.
- A major branching fiber (axon)
- Numerous smaller branching fibers (dendrites)
Complications By Mayo Clinic staff
Generally, post-polio syndrome is rarely life-threatening, but severe muscle weakness can lead to complications:
- 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.
- Malnutrition, dehydration, 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 (aspirating) food particles into your lungs.
- 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. Obesity, 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).
- 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
Preparing for your appointment By Mayo Clinic staff
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're taking.
- Write down questions to ask your doctor.
- 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 these 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 Web sites do you recommend visiting?
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- 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?
- Tests and diagnosis By Mayo Clinic staff
- To arrive at a diagnosis of post-polio syndrome, doctors look for three indicators:Previous diagnosis of polio. This may require finding old medical records or getting information from older family members, because 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 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.
- 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 tests help identify and exclude conditions such as neuropathy, an abnormal condition of your nerves, and myopathy, a muscle tissue disorder.
- Imaging. You may undergo tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT), to produce images of your brain and spinal cord. These tests can help exclude spinal disorders, such as spondylosis, a degenerative spine condition, or spinal stenosis, a narrowing of your spinal column that puts pressure on your nerves.
- Blood tests. People with post-polio syndrome usually have normal blood samples. Abnormal blood test results may indicate another underlying problem that's causing your symptoms.
- Treatments and drugs By Mayo Clinic staff
- Because the signs and symptoms often vary, there's no one specific treatment for post-polio syndrome. The goal of treatment is to manage your symptoms and help make you as comfortable and independent as possible:
- Energy conservation. This involves pacing your physical activity and combining it with frequent rest periods to reduce fatigue. Assistive devices, such as a cane, walker, wheelchair or motor scooter, also can help you conserve energy. A therapist can even show you ways to breathe that help conserve energy.
- Physical therapy. Your doctor or therapist may prescribe exercises for you that strengthen your muscles without you experiencing muscle fatigue. These usually include less strenuous activities, such as swimming or water aerobics, that you perform every other day at a relaxed pace. Exercising to maintain fitness is important, but be cautious in your exercise routine and daily activities. Avoid overusing your muscles and joints and attempting to exercise beyond the point of pain or fatigue. Otherwise, you may need significant rest to regain your strength.
- Occupational therapy. A physical therapist or occupational therapist can help you modify your home environment so that it's safe and convenient for you. This may include installation of grab bars in the shower or a raised toilet seat. Your therapist may also help you rearrange furniture or rethink certain household or work-related tasks, decreasing the number of steps you must take and increasing your efficiency.
- Speech therapy. A speech therapist can show you ways to compensate for swallowing difficulties.
- Sleep apnea treatment. Treatment for sleep apnea, which is common among people with post-polio syndrome, may involve changing your sleeping patterns, such as avoiding sleeping on your back, or using a device that helps open up a blocked airway.
- Medications. Medications, including aspirin and other nonsteroidal anti-inflammatory drugs, may ease muscle and joint pain. Numerous drugs — including pyridostigmine (Mestinon), amantadine (Symmetrel), modafinil (Provigil), insulin-like growth factor-I (IGF-I) and alpha-2 recombinant interferon — have been studied as treatments for post-polio syndrome, but no clear benefit has been found for any of them. Early studies of intravenous immunoglobulin suggest that it may reduce pain, boost strength and improve quality of life for people with post-polio syndrome.
- Lifestyle and home remedies By Mayo Clinic staff
- Having to deal again with an illness you thought was in the past can be discouraging, even overwhelming at times. Recovering from the initial illness required drive and determination on your part, but now the late effects of polio require you to rest and conserve your energy. Moving from one frame of mind to another can be a difficult switch. Here are some suggestions that may help:
- Limit activities that cause pain or fatigue. Moderation is key. Overdoing it on a good day can lead to several subsequent bad days.
- Be smart. Conserving your energy through lifestyle modifications and assistive devices doesn't mean you're giving in to the illness. It just means you've found a smarter way to deal with it.
- Stay warm. Cold increases muscle fatigue. Keep your home at a comfortable temperature and dress in layers, especially when you go out.
- Avoid falls. Get rid of throw rugs and loose clutter on the floor, wear good shoes, and avoid slippery or icy surfaces.
- Maintain a healthy lifestyle. Eat a balanced diet, stop smoking and decrease caffeine intake to keep fit, breathe easier and sleep better.
- Protect your lungs. If your breathing is impaired, watch for signs of a developing respiratory infection, which can make breathing problems worse, and have it treated promptly. Also, avoid smoking and stay current with your flu and pneumonia vaccines
Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures.
- Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.
- Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.
- Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the FDA recommends restricting therapy to two years or less.
- Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women older than 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.
- Exercise. Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life. Combine strength training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — mainly affect the bones in your legs, hips and lower spine. Swimming, cycling and machines such as elliptical trainers can provide a good cardiovascular workout, but because they're low impact, they're not as helpful for improving bone health as weight-bearing exercises are.
- Add soy to your diet. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures.
- Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine. The effects on bone of secondhand smoke aren't yet known.
- Consider hormone therapy. Hormone therapy can reduce a woman's risk of osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you. Testosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. Taking it when you have normal testosterone levels won't increase bone mass.
- Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. There's no clear link between moderate alcohol intake and osteoporosis.
- Limit caffeine. Moderate caffeine consumption — about two to three cups of coffee a day — won't harm you as long as your diet contains adequate calcium.
- Maintain good posture. Good posture — which involves keeping your head held high, chin in, shoulders back, upper back flat and lower spine arched — helps you avoid stress on your spine. When you sit or drive, place a rolled towel in the small of your back. Don't lean over while reading or doing handwork. When lifting, bend at your knees, not your waist, and lift with your legs, keeping your upper back straight.
- Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get in and out of your bed easily.
- Manage pain. Discuss pain management strategies with your doctor. Don't ignore chronic pain. Left untreated, it can limit your mobility and cause even more pain.