Is "Type A" Behavior CRIPTONITE?

FROM Dr. Richard L. Bruno Chairperson, International Post-Polio Task Force Director The Post-Polio Institute and International Centre for Post-Polio Education and Research PostPolioInfo@AOL.COM
Caliper, 1997, 52: 10-15

Is "Type A" Behavior CRIPTONITE?
Painful Confessions of a SuperCrip
Dr. Richard Bruno
 Last October, I wrenched my shoulder getting my chair out of the car. Man, did it hurt! I could hardly transfer. Each time I did something strenuous the pain inched up a notch. Soon, my shoulder was too painful to do ramps or push on a rug. Ultimately, I could hardly push at all. Did I go to a doctor? No way! I didn't need no stinkin' doctor! I just kept on keeping on. I had places to go and things to do, do, do!
Then I read a magazine story about doctors with disabilities. One of the doctors interviewed struck a "cord" when she summarized her philosophy about having a disability with this statement: "It only matters what you do."
It only matters what you do? She was describing me, wasn't she? By ignoring my painful shoulder, I was acting as if "doing" is the right way-- maybe the only way--to deal with a disability. Do other people with disabilities just ignore what they feel and keep on "doing?" When you look around, it sure seems that way.
The Type "A" : Doing versus Dealing

There's a lot of information about how North America's most experienced group of crips--the 1.8 million survivors of the polio epidemics of over 40 years ago--deal with disability. Polio survivors work more hours of overtime and are more Type A--that is, hard-driven, pressured, time-conscious, perfectionistic and overachievingÑthan any other group with or without disabilities. Polio survivors, regardless of the severity of their disability are often the leaders, movers and shakers of our communities.

What's wrong with being a hard driving, Type A community leader in a wheelchair? http://www.postpolioinfo.com/vampire.php

 Dr. Nancy Frick, polio survivor and Executive Director of Harvest Center in Hackensack, New Jersey, says that Type A behavior is literally burning polio survivors out. "Our surveys show that the more Type A polio survivors are, the more likely it is they will have Post-Polio Sequelae--late-onset fatigue, weakness, muscle and joint painÑand the more severe their new symptoms will be."

What's worse, being Type A prevents polio survivors from getting treatment for their PPS.
 Even though polio survivors realize that burning the candle at both ends is causing pain and loss of function, they just can't slow down. Polio survivors will ignore even excruciating pain for years to avoid "wasting time" by going to the doctor. So for many polio survivors, pain doesn't matter. All that matters is what they "do."

But it isn't just polio survivors whose super Type A behavior gets in the way of dealing with their pain. In one study, 40 percent of patients who had. file:///C|/Users/Dean/Desktop/HarvestDOCS/library/crip.html[8/13/2010 2:15:07 AM]

Whit permission from Dr. Bruno to... APPLAC, to  publish, Dr. Richard Bruno Honorary MENBER and  medical represento f APPLAC www.postpoliolitaff.org

Despite the fact that Rolling Hills is owned by the city and leased by the housing authority, it is still considered private property, Durell said.

 Did Not Know This

So ultimately it is up to the private owner to see that things are fixed. I thought that if you were under HUD then they are the ones who 'make' it happen.


Larry Woods, the CEO of the Housing Authority of Winston-Salem, informed residents of Rolling Hills Apartments during a community forum on June 3 that their apartment complex is up for sale, and the earliest that scheduled renovations of individual units would be performed will be late this fall after the Housing Authority and the city of Winston-Salem closes the deal.

“We expect by the end of July to have identified a qualified buyer,” Woods told the group of about 40 residents. “It should be completely seamless for the residents of Rolling Hills. You’ll just be under new ownership and new management.”

Woods said the Housing Authority expected to close the deal by the end of September.

“It’s actually going to be a dual closing,” said Karen Durell, Chief Operating Officer of the Housing Authority.

Durell explained that the ownership of Rolling Hills is quite complex. The actual owner of the apartments is the city of Winston- Salem, but the Housing Authority has a lease agreement with the city. Durell said the Housing Authority has taken on the responsibility of the bond payments that funded the purchase of the property from a private owner.

“We’re100 percent liable for the bond payments and in return, we take on ownership responsibilities,” she said.

City Councilman Derwin Montgomery, who facilitated the meeting, said the new owner would be obligated under the agreement to meet inspection standards that would require renovation of a number of apartments.

Residents voiced a number of concerns and frustrations about the sale, as well as ongoing health and safety issues in the units and the complex as a whole.

“What if the new owner comes in and evicts us?” one resident asked.

Woods assured residents that the new owner would honor their current leases.

Ritchie Brooks, the city’s director of neighborhood services, said there is no way anyone could predict what the new owner might do, but said it is unlikely they would put people out of their homes.

Montgomery pointed out that residents’ housing choice vouchers, which are supplied by the US Department of Housing and Urban Development, or HUD, under a law known as Section 8, will stay with the property even after the transfer of ownership.

“It’s not financially sound for them to kick everybody out because they get that funding because of the people that are [here],” Montgomery said. “You have rights as a person who has a lease.”

One resident asked where she is supposed to live during the extensive renovations.

Brooks explained that when government money is used to acquire a property, relocation of tenants is an eligible expense for reimbursement, so it will depend on the source of the funds the new owner uses.

“If a private entity comes in to buy the apartment complex and there are no government funds involved, then it’s left up to the individual developer whether or not they want to provide any relocation assistance,” he said.

A number of residents complained that they had been waiting for more than a year for renovations and repairs promised by the housing authority. Residents also complained of substandard wiring, along with cockroaches and bed bugs that have infested dozens of units in the complex, adding that the extermination efforts of the housing authority have simply failed.

Woods said the housing authority would continue to respond to residents’ requests for pest extermination, but the major repairs and renovations would fall under the responsibility of the new owner.

“Once the substantial rehab takes place, I think all of the issues would slowly disappear as each building becomes modernized,” Woods said. “The painful part about it is there will be residents living in the existing buildings. The new management company will be taking some type of intermediate steps to try to solve some of the issues, but the real issues are going to require them to take down some walls, kitchen cabinets, all bathroom appliances, and new flooring.”

Despite Woods’ assurances, several residents declared the apartments to be unfit for human habitation and suggested the units be razed. Montgomery said tearing down the units is not economically feasible.

“We deserve the same treatment as Happy Hills Gardens,” said one resident, referring to a Winston-Salem public housing development.

“Rolling Hills is not public housing,” Woods responded. “It is private housing that is subsidized by the government.”

Despite the fact that Rolling Hills is owned by the city and leased by the housing authority, it is still considered private property, Durell said.

“Public housing and Section 8 housing are similar properties in that people who live there, their rent is based on their income,” she explained. “But they’re two different subsidized programs of the federal government.”

And the federal bureaucracy associated with performing major renovations on Section 8 housing is exactly the reason the Housing Authority and the city of Winston-Salem decided to sell Rolling Hills, Woods said.

“It could take us up to two years before we could address the first unit versus a private owner who is not under federal requirements,” Woods said. “A private owner or management company comes in they can hire an architect, an engineer and they can start the work right away. They could probably get to these units in less than nine months.”

Bug infestation and substandard wiring are only part of the problem at Rolling Hills, said one resident.

“The drug dealers own Rolling Hills,” she proclaimed.

Assistant Police Chief Barry Rountree told residents that the police department had not forgotten about Rolling Hills and the drug trafficking issues in the area, and encouraged residents to stand up for their community by working with the police.

“You are the best solution to the problem,” Rountree said.

Tabetha Bailey, a neighborhood assistance specialist, told residents that silence equals consent, and if they don’t report crime, the city cannot help them.

At one point, the exchange between city officials and residents got heated, and nearly half of the residents walked out after expressing their frustration.

Bailey told residents that walking away was not the answer; organizing at the community level is more effective.

“Let’s get together and make a list of the things we want to see accomplished so that when the new management comes in, we’ve got a plan for them,” Bailey said. “We don’t want them to have a plan for us. Let’s have a plan for them and let’s start now because we can’t go back.”

Bill McLain, site director for Weed & Seed, a US Department of Justice initiative, agreed with Bailey’s advice and reminded residents of the history of Rolling Hills.

Years ago, the housing authority performed a major renovation of the entire apartment complex and it was in excellent condition. The current state of disrepair evolved over the years, McLain said, and if residents hoped to improve their situation they would have to organize and petition city officials to listen to their grievances.

“I just don’t believe that the solution is going to happen tomorrow but there should be an effort tomorrow to change,” McLain said.

Considering the current recession, residents had to be realistic about a timetable for all the renovations and repairs on their units to be completed, McLain said.

“Asking somebody to go ahead and invest $300,000 and rehab something like this today, it ain’t going to happen,” he said. “But there’s got to be something we can do to make the conditions livable.”

McLain advised residents to keep the pressure on city officials, but to also do their part to take control of their own situation.

“They can kill all the bugs in the world, but if you don’t keep your place clean afterwards, they’re coming back,” he said.

Weed & Seed has donated $9,000 to Neighbors for a Better Neighborhood, a community organizing group composed of Rolling Hills residents. The funds are earmarked for weekly life skills classes train residents on how to properly maintain their units.

“Some of us need training how to take care of ourselves, how to take care of our children, how to take care of our food, how to take care of our utensils, and how to take care of our clothes,” McLain said. “Blaming the housing authority is not going to solve the problem. All of us working together we can get this thing done.”

Winston-Salem City Councilman Derwin Montgomery (left) and neighborhood assistance specialist Tabetha Bailey respond to questions from a group of Rolling Hills Apartments residents during a meeting on June 3. The Housing Authority of Winston-Salem announced that the apartment complex will be sold to a private owner this fall. (photo by Keith T. Barber)


Si lo que vas a decir no es más bello que el silencio: no lo digas. El odio es una tendencia a aprovechar todas las ocasiones para perjudicar a los demás. Elige mejor el camino de amor a tus semejantes tendrás experiencias muy bellas.

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




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


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



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.


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


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


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



  • tumours

  • amyloidosis

  • cysticercosis

    Link here