5/06/2017

Polio survivor group talks of legacy and a new battle



At six-years-old, Bobby Doherty from Belfast wasn't playing or riding his bike - he was lying entombed in plaster from head-to-foot in Musgrave Park Hospital after contracting polio. 
More than half a century after the infection first struck, he and a group of fellow polio survivors still meet up each week in the Short Strand Recreation Centre. 
They play games, reminisce over a cup of tea and support each other in coping with the effects of a disease, which many people think doesn't exist anymore. 
Now in his 70s, Mr Doherty still vividly recalls falling ill. 

Bobby Doherty
Image captionMr Doherty still uses leg braces to get about

"It was September 1949, a lovely sunny Friday evening and I remember my father taking me to the GP but when we got there the surgery was closed," he said. 
"The doctor turned up at my house on Monday morning, tickled my left foot and said 'I'll be back in an hour with an ambulance or a consultant.'
"An hour later I was in an ambulance heading to the Purdysburn Fever Hospital."

'Fear of wasps'

Mr Doherty was to remain in hospital for more than a year with the serious viral infection, which causes muscles to shrink, paralysis and in some cases, death. 
When he was discharged, polio had left a permanent mark. He was paralysed in both legs and was fitted with leg braces, known then as calipers, which he still uses to get about. 
Another long-standing member of the NI Polio Fellowship is Eddie McCrory, who contracted the disease in 1957, aged five, during its largest outbreak in Northern Ireland. 

Eddie McCrory
Image captionMr McCrory was completely paralysed at first

For him too, the memories are sharp. 
"My father said I would only be in hospital for the night - and I remember falling out with him when I had to stay much longer than that," he said.
"I was in an isolation ward with three others, and my mother and father would come to the window and look in. She would cry and run away. 
"I was completely paralysed at first and I remember a wasp coming into the ward. The other children could cover themselves with their sheets but I couldn't. 
"It was terrible and I've had a fear of wasps ever since."
Mr McCrory, who is originally from Belfast's Short Strand but now lives in Carryduff, was left with a severe curvature of the spine. 

A young Eddie McCrory

Polio is now all but eradicated in the UK thanks to a highly-effective vaccine introduced in the 1960s. 
Polio does still exist worldwide, although polio cases have decreased by more than 99% since 1988, from an estimated more than 350,000 cases to 74 reported cases in 2015. 
Only two countries in the world have never stopped transmission of polio - Pakistan and Afghanistan.

Polio Fellowship Group meeting
Image captionThe NI Polio Fellowship playing some sport

But for the friends who still gather in east Belfast, the legacy of the disease lives on, not only in their disabilities but in a new battle with what's known as post-polio syndrome. 
Mr McCrory explains that while polio was once considered a static disease, it is now thought fresh symptoms can emerge up to 60 years later. 
"I have a diagnosis of post-polio syndrome - I can feel tired, really fatigued and then there are aches," he said.
"Not awful aches but in the parts where I didn't ever have polio. I'm very sensitive to cold. My feet and legs are like blocks of ice because the body doesn't respond quickly enough to changes in body temperature."

'Contented life'

He says there's a lack of awareness of the condition - not helped by the fact many polio experts are retired or deceased.
"Young doctors would have no idea," he said. "When I go to see the neurologist and he sends me to the physiotherapist, she'll often bring in her students and say - this is someone who had polio."
Dr Ultan Power, a molecular virology specialist from Queen's University Belfast, says post-polio syndrome is a neurological disease evident in people who had polio.

Dr Ultan Power
Image captionDr Ultan Power says no treatments are currently available for post-polio syndrome

"I've asked a few of my colleagues had they heard about post-polio syndrome and they all said no," he said. 
"My understanding is it is not well-known because of the virtual eradication of polio in society."
There are no treatments available but some clinical trials are ongoing, he added.
"One involves using antibodies from people who have the polio virus, which is pretty much everybody as we are all vaccinated," he said.
"They take them from healthy individuals and transfuse them into people who are suffering from post-polio syndrome. 
"The hope is that it will have an impact on the residual virus, help eliminate it and improve function for individuals - i.e. their ability to walk - and live a generally contented life."
From

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

video

movie

movie2

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