Oct 18, 2016

Tips and Techniques for Polio Survivorsby Dr. Richard L. Bruno


Tips and Techniques for Polio Survivors

Tips and Techniques for Polio Survivors by Dr. Richard L. Bruno

Recently I had a fever with muscle and chest pain. The only abnormal blood tests showed high C-reactive protein and high creatine kinase. My blood pressure and cholesterol are normal, I have never smoked, and I'm thin. Because of the chest pain I had an angiogram, which was normal. Could high CRP and high CK be related to PPS?

C-reactive protein is a blood marker for inflammation somewhere in the body. High CRP can be seen with type 2 diabetes, autoimmune diseases and cancers.Could inflammation somewhere in your body, as indicated by your elevated CRP, be related to PPS? Fifty consecutive patients evaluated at The Post-Polio Institute had CRP measured. The patients were on average 59 years old and 55% were women. Thirteen percent had an elevated CRP, 66% of whom were men. CRP was on average nearly three times the normal value. However, there was no significant difference between those with high and normal CRP on self-ratings of daily fatigue, difficulty with self-care or ability to perform activities inside or outside of the home. So, there is no evidence that elevated CRP or inflammation is related to PPS, either to post-polio fatigue or difficulty in functioning.

Recent studies have found that elevated CRP is related to having a heart attack or stroke. The theory is that a bacterial or viral infection (although definitely not a poliovirus infection) somehow inflames arteries and causes them to clog. Our 1985 National Survey found no more heart disease or high blood pressure in polio survivors than in the general population. But two studies found that 5% more male post-polio patients had abnormally elevated cholesterol as compared to the general population. In one of the studies, only 33% of those with high cholesterol had been given a cholesterol screening test by their doctor and not even 25% were on cholesterol-lowering medications, like the statin drugs such as Lipitor, Pravachol and Zocor. This is not good, since reducing cholesterol reduces heart attack risk. What’s more, research has shown that taking statins to reduce cholesterol can also lower CRP and may thereby increase survival even after having a first heart attack.

Statin drugs provide a connection between CRP and CK--in polio survivors. CK is an enzyme released when muscle is damaged. One half of one percent of anyone taking a statin develops muscle breakdown, which causes muscle
pain (especially in the calves), muscle weakness and an increase in CK. Even without muscle breakdown or an elevated CK, some polio survivors report muscle pain or weakness when taking a statin, usually one of the older statins like Lipitor. And polio survivors can have an elevated CK without taking a statin. Two studies found that 40% of polio survivors had abnormally elevated CK, with men having significantly higher CK than did women. In one study, CK increased with the number of steps polio survivors walked in a day. In our fifty Post-Polio Institute patients, 21% had abnormally elevated CK levels (on average about 33% higher than normal) with men also having higher CK than did women. But, as with CRP, there was no significant difference between those with high and normal CK on self-ratings
of daily fatigue, difficulty with self-care or the ability to perform activities inside or outside of the home. However, an elevated CK may mean that polio survivors are making their muscles work too hard and are causing them to break down.

So, neither CRP nor CK is related to fatigue or loss of functional abilities in polio survivors. However, all polio survivors need to have their cholesterol and CRP measured to assess heart disease risk. And since an elevated CK indicates muscle breakdown, either from taking a statin or from muscle overuse, polio survivors should have CK measured before taking a statin. If you are worried about possible muscle weakness or breakdown with the statins, or the newer cholesterol-lowering drugs like Zetia and Vytorin, ask your doctor about using older medications like slow-acting niacin or bile acid sequestrants. Besides medication, polio survivors need to eat high fiber foods, reduce saturated fat, treat high blood pressure and stop smoking to keep their tickers ticking.

Post Polio Litaff, Association A.C _APPLAC Mexico

Sleep Apnea May Boost Risk for Post-Op Problems

Certain patients should be checked for the disorder before having surgery, researchers say
sleep apnea mask
By 
HealthDay Reporter
MONDAY, Oct. 17, 2016 (HealthDay News) -- Sleep apnea may boost the odds of developing two serious health complications following surgery.
So, finding out if you have the sleep disorder beforehand -- and seeking treatment -- could boost your odds for good recovery from surgery, researchers say.
The two post-op complications are blood clots in the veins and an irregular heartbeat called atrial fibrillation, according to two new studies.
These problems occurred more often among surgical patients who had not yet been diagnosed -- and therefore weren't treated -- with sleep apnea.
Obstructive sleep apnea is characterized by repeated breathing disruptions during sleep. Symptoms include excessive daytime sleepiness, restless sleep and loud snoring -- often with periods of silence followed by gasps. 
More than half of surgery patients who have sleep apnea don't know it, the authors of one new study said. Identifying these patients ahead of time might spare them serious post-op complications, the findings suggest.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said the relationship between diagnosed obstructive sleep apnea and post-operative complications is well-documented, with the new research "confirming findings from prior studies."
Sleep apnea appears to expose the heart to "mechanical stress," while also leading to vascular inflammation and an increased risk for blood clots, he explained.
"These physiologic changes could place patients undergoing (open-heart) surgery at higher risk for complications," said Fonarow, who wasn't involved in the study.
Still, this study doesn't establish a direct cause-and-effect relationship between untreated sleep apnea and atrial fibrillation or venous blood clots. And Fonarow isn't sure that treating the sleep disorder would actually prevent these complications.
Both studies are scheduled for presentation Oct. 26 in Los Angeles, at the annual meeting of the American College of Chest Physicians (CHEST). Until the findings are peer-reviewed for publication in a medical journal, they should be considered preliminary.
One study looked at more than 200 patients having open-heart bypass surgery between 2013 and 2015 to see how a high risk for sleep apnea affected the likelihood of developing atrial fibrillation afterward.
Those at high risk of sleep apnea met three of these criteria: being older than 65; snorers; very obese; or having high blood pressure.
Almost 20 percent were considered at high risk for sleep apnea. Two-thirds were at low risk, and nearly 15 percent had already been diagnosed with the sleep disorder, according to the study.
Study senior author Dr. Samir Patel said his team found that high-risk-but-undiagnosed sleep apnea patients do have "more chances of developing [atrial fibrillation] compared to a person who already has sleep apnea, or a person who has a low risk of developing [sleep apnea]."
And when these undiagnosed/untreated sleep apnea patients developed atrial fibrillation after heart surgery, their chances for extended hospitalization and/or death increased as well, added Patel. He's an internal medicine physician with Western Reserve Health Education in Youngstown, Ohio.
Atrial fibrillation occurred among almost 70 percent of high-risk, untreated sleep apnea patients, Patel said. This compared with only about 41 percent of both the low-risk and diagnosed sleep apnea patients.
Patel said patients preparing for open-heart surgery should be tested for sleep apnea in advance, particularly if they seem to be at high risk and/or have telltale symptoms, such as excessive snoring.
The most common treatment for obstructive sleep apnea is called continuous positive airway pressure, or CPAP. CPAP requires wearing a face or nose mask during sleep. The mask is connected to a pump that provides continual airflow in order to keep the airways open. 
The second study found greater risk for other post-surgical complications among 40 patients at high risk for the sleep disorder compared to 50 already being treated for sleep apnea.
Researchers led by Dr. Mohammed Aljasmi of the Henry Ford Hospital in Detroit looked at the post-surgery risk for developing breathing complications, heart problems and medical issues that require hospitalization in an intensive care unit. Surgeries were described as elective, rather than exclusively heart-related.
Those undiagnosed but deemed at high risk of sleep apnea faced significantly greater odds for developing venous thromboembolism, a potentially life-threatening blood clot in the vein, they found.
The findings suggest high-risk sleep apnea patients will fare better after surgery if they first get a sleep apnea diagnosis and begin treatment, the researchers said.
Fonarow, however, isn't convinced that early diagnosis and treatment of sleep apnea would actually lower post-op risks.
He pointed to a large, randomized clinical trial of more than 2,700 patients that found CPAP provided no benefit in lowering cardiovascular events or heart-rhythm disorders in patients with established heart disease.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more about sleep apnea.
SOURCES: Samir Patel, M.D., MPH, internal medicine physician, Western Reserve Health Education, affiliated with Northeast Ohio Medical University, Youngstown, Ohio; Gregg Fonarow, M.D., professor, cardiology, and co-director, Preventative Cardiology Program, University of California, Los Angeles; CHEST meeting, Los Angeles, Oct. 22-26, 2016
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