4/06/2015

Polio Survivor And Doctor Chooses New Path


Dr. Lauro Halstead retired in June after a 50-year career in medicine. He served at the Medstar Health National Rehabilitation Hospital for 26 years, where he specialized in spinal cord injury and post polio syndrome. He will be opening a small private practice focusing on helping older adults cope with physical disablities, he can be reached atlauroshalstead@gmail.com.
By: Sabri Ben-Achour November 2, 2012 Ben-Achour
Dr. Lauro Halstead retired in June after a 50-year career in medicine. He served at the Medstar Health National Rehabilitation Hospital for 26 years, where he specialized in spinal cord injury and post polio syndrome. He will be opening a small private practice focusing on helping older adults cope with physical disablities, he can be reached atlauroshalstead@gmail.com.
We have no control over some of the most important events that shape our lives, but we do have a choice in how we respond to them. Dr. Lauro Halstead contracted polio in 1954, and survived on a plywood ventilator in the basement of a children's hospital run by nuns. He went on to become a renowned physician, and treated polio patients and people with spinal cord injuries. He just retired from his position with the MedStar National Rehabilitation Hospital. He talks to Metro Connection's Sabri Ben-Achour about his work and about how a combination of serendipity and resilience dictate how our lives unfold. Following are highlights of their conversation. 
Dr. Halstead on contracting polio as a teenager: "I was 18. I had just completed my first year of college. I was going to Europe as many students did in those days, and still do, and I passed through Madrid. And as it happens when I got to Madrid, I was quite ill initially — GI upset, mostly lower intestinal tract with diarrhea and cramps, low grade fever, not feeling generally well. Of course initially thought this was a minor setback and I'll be finished with this shortly. But this persisted and within about 48 hours my right arm was totally paralyzed. My legs were so weak I could not climb a set of stairs, and I had reduced use of my left arm. Eventually I ended up in a Spanish hospital, and within another week my breathing started to go out, and they transferred me to another facility where I was placed in a respirator."
On handling the disease while he was in Spain: "I was essentially alone. And what made it worse was in those days, the dictator of Spain, Franco, in an effort to conserve electricity, turned off all power in the city of Madrid from 2 a.m. to 6 a.m. And so the respirator went dead at 2 a.m. And just by the grace of God, I managed to survive and eventually get back to the United States."
On his decision to study medicine: "Well you're right in some respects. I didn't fully recover. My right arm has remained totally paralyzed since. My legs did get stronger; in fact, they were very strong for a number of years. And my left arm was reasonably strong — wasn't normal strength. I realized that with my physical limitation, I needed a profession where there was a fair amount of intellectual involvement."
On handling medical school: "Well, I was right-handed originally, so I did have to learn to write with my left hand. It was not very graceful script, but you manage, and that's one of the messages I learned with my polio, is that you learn to compensate in ways that the average person can't even conceive of. When I was in training, for example, I had to draw blood often, and one might say that is almost impossible with one hand. Well, I devised techniques for doing and in fact got so skillful that I was I was teaching other people how to do it with one hand, if you can believe it."
His advice to young people: "I think an important element for any young person is the whole concept of resilience and perseverance. I mean, no one's life is free of problems, of challenges, of confrontations. And I think it’s absolutely critical that everybody learn how to deal with misfortune, with events that are out of their control, with challenges,
whether it's physical, emotional, financial." http://wamu.org/programs/























































Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here