Aug 10, 2019

Respiratory problems in PPS are an important cause of symptoms and complications, including sleep disorders.




Post-polio syndrome  [13][14]

Importance

  • Respiratory problems in PPS are an important cause of symptoms and complications, including sleep disorders.
  • They may be under-diagnosed or inadequately assessed.
  • Treatment can improve both quality of life and prognosis.

Aetiology[14]

Respiratory problems in PPS may be due

to one or more of:
  • Respiratory muscle weakness.
  • Bulbar impairment - this may affect control of the upper airway or the respiratory cycle. If the upper airway is affected, there may be obstructive sleep apnoea.
  • Skeletal deformity - scoliosis or chest wall stiffness.
  • Other pathology - eg, chronic obstructive pulmonary disease (COPD), asthma, obesity.
  • Aspiration - if swallowing is affected.
All these are likely to worsen during sleep. The pattern of respiratory impairment may be hypoventilation, obstructive sleep apnoea, or both.

Symptoms

Respiratory failure can develop insidiously - symptoms may be subtle or unnoticed. Breathlessness may not be a symptom in patients with limited mobility. Possible symptoms are:
  • Sleep disruption, eventually leading to insomnia, daytime sleepiness or fatigue.
  • Morning headaches, irritability, poor concentration, anxiety or depression.
  • Abnormal sleep movements, nocturnal confusion, vivid dreams.
  • Breathlessness which may be positional.
  • Weak cough, and chest infections.

Signs

These may be subtle - possible signs are:
  • Unexplained tachypnoea.
  • Use of accessory muscles.
  • Abdominal paradox - this is inward movement of the abdomen on inspiration while the upper chest expands.
    • May be best seen with the patient supine during a sniff manoeuvre. When upright, it can be missed, as the diaphragm passively descends at the beginning of inspiration.
  • Severe, untreated nocturnal hypoxaemia can cause pulmonary hypertension, giving signs such as raised JVP and ankle oedema.

Assessment of respiratory problems

  • Listen to the patient's story and preferences.
  • Assess:
    • Voice and cough.
    • Chest deformity.
    • Observe patients in realistic situations - eg, doing repeated tests or actions, and doing everyday actions in which they may be using the necessary breathing muscles to achieve another task.
  • Investigations:
    • Peak flow and cough peak flow.
    • Spirometry:
      • Both seated AND supine spirometry are needed.
      • A sensitive indicator of respiratory muscle weakness is reduction in maximal inspiratory pressure.
    • Oximetry (and possibly capnography).
    • Sleep study (polysomnogram).
    • ECG and CXR if appropriate.
    Full sets of lung function tests and arterial blood gases may not be helpful in this scenario, unless intrinsic lung disease is suspected.

Management of respiratory problems

There are various options - choice will depend on the patient's individual situation and preferences.
Night-time mechanical ventilation is often used. This helps by resting the respiratory muscles at night, and preventing deterioration of respiratory function during sleep. It also treats the secondary sleep disorder.

Supportive measures include:
  • Not smoking.
  • Avoiding sedatives and alcohol.
  • Optimal weight and nutrition.
  • Pneumococcal and influenza vaccination.
  • Postural support if needed.
  • Prompt treatment of chest infections.
  • Techniques such as assisted cough or glossopharyngeal breathing ('frog breathing').
  • Chest expansion exercises.
Assisted breathing options are:
  • Non-invasive ventilation (NIV), also called non-invasive intermittent positive pressure ventilation (NIPPV), is often useful - see box below.
  • Rocking bed:
    • This helps breathing by rocking a patient consecutively head up and head down. It is surprisingly effective, especially where muscle weakness is mainly diaphragmatic.
  • Pneumobelt:
    • This gives intermittent abdominal pressure ventilation and is useful for daytime assistance.
  • Negative pressure ventilation:
    • Examples are tank ventilators (iron lung), jacket ventilators (Tunnicliffe), and cuirass ventilators. The devices are cumbersome, and mainly used where NIV is not tolerated, or to provide 'respite' from NIV
  • Tracheostomy ventilation.

Non-invasive ventilation and 'bi-levels' explained[13][14]

NIV increases alveolar ventilation. It is provided by a portable ventilator and a tightly-fitting nasal or facial mask or nasal 'pillow'.
  • NB: NIV is NOT the same as continuous positive airway pressure (CPAP). CPAP is useful for obstructive sleep apnoea because it maintains the upper airway. It is not normally indicated for hypoventilation from respiratory muscle weakness.
People with neuromuscular disease may have difficulty breathing in, so require NIV with higher inspiratory than expiratory pressures. This can be provided using a 'bi-level' ventilator:
  • Bi-level ventilators were developed by modifying CPAP. The inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) settings are adjusted separately.
  • The difference between IPAP and EPAP is called the span.
  • For example, a patient may require an IPAP of 14 and an EPAP of 3.
  • Sensitive flow triggers enable normal breathing to be supported. There may be a back-up control to provide ventilation if respiratory effort fails to trigger a breath.
The symptoms of post-polio syndrome are slowly progressive, with periods of stability lasting 3-10 years.
Prevention of acute polio infection is discussed elsewhere (see separate article onPoliomyelitis).

Prevention of PPS is not much discussed in the literature. Given the various known contributing factors, it seems possible that PPS problems might be reduced by:
  • Careful management of exercise and daily living activities to optimise muscle and joint use, and prevent overuse or disuse.
  • Correct maintenance of aids and prostheses.
  • Monitoring and early treatment of associated/contributing problems such as:

Further reading & references

  1. Trojan DA, Cashman NR; Post-poliomyelitis syndrome. Muscle Nerve. 2005 Jan;31(1):6-19. [abstract]
  2. EFNS guideline on diagnosis and management of post-polio syndrome; Report of an EFNS task force, European Federation of Neurological Societies (2006)
  3. Halstead LS, Silver JK; Nonparalytic polio and postpolio syndrome. Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):13-8. [abstract]
  4. Howard RS; Poliomyelitis and the postpolio syndrome. BMJ. 2005 Jun 4;330(7503):1314-8.
  5. Khan F; Rehabilitation for postpolio sequelae. Aust Fam Physician. 2004 Aug;33(8):621-4. [abstract]
  6. Boone H; Problems experienced by polio survivors and suggested solutions. Presentation for occupational therapists, given at the Neurological Occupation Therapy Conference, October 2008.
  7. My Polio Life; A patient questionnaire providing baseline information and comparison charts, for use by polio survivors and their health professionals, Polio Survivors Network, 2007
  8. Boone H; When test results do not match important symptoms. Conference presentation, Post Polio Association of South Florida, Miami, 2007.
  9. Hildegunn L, Jones K, Grenstad T, et al; Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post-polio symptoms. Physiother Res Int. 2007 Mar;12(1):39-49. [abstract]
  10. Davidson AC, Auyeung V, Luff R, et al; Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study. Disabil Rehabil. 2009;31(4):309-17. [abstract]
  11. Polio Outreach of Washington
  12. Lambert DA, Giannouli E, Schmidt BJ; Postpolio syndrome and anesthesia. Anesthesiology. 2005 Sep;103(3):638-44. [abstract]
  13. Howard RS, Davidson C; Long term ventilation in neurogenic respiratory failure. J Neurol Neurosurg Psychiatry. 2003 Sep;74 Suppl 3:iii24-30.
  14. Lincolnshire Post-Polio Information Newsletter. Volume 5, issue 9, June 2006. Issue covering respiratory problems.
Original Author: Dr Colin TidyCurrent Version: Dr Colin TidyPeer Reviewer: Dr John Cox

Post Polio Litaff, Association A.C _APPLAC Mexico


Aug 9, 2019

The polio virus, and its reign of terror in the American psyche, is faded history now.




SALT LAKE CITY — The polio virus, and its reign of terror in the American psyche, is faded history now. After a vaccine was introduced in the mid-1950s, millions of people sighed, turned the page and moved on. Many polio victims, often struck in childhood, tried to leave the story behind and forget, too.

Tom Smart for The New York Times
Virginia Lewis Hall, 63, retired as a teacher after post-polio syndrome made breathing hard. A 1949 newspaper article pictured her in an iron lung at 3 years old.


Tom Smart for The New York Times
After polio stunted his right leg as a child, Ronald S. Hanson's left knee gave out from overuse.

Tom Smart for The New York Times
Becky Lloyd of the University of Utah started the project.

Tom Smart for The New York Times
Fran Broadhead, 78, attributes the fatigue she has felt for a decade to getting polio when she was 6.
“I worked alongside people who didn’t even notice my limp,” said Ronald S. Hanson, 78, a retired banker here who got polio at age 6, stunting his right leg but leaving him, he said, determined to live a normal life. “I didn’t want them to notice.”
So when Becky Lloyd, a researcher at the American West Center of the University of Utah, started an oral history project on polio last fall, she imagined weaving a tapestry of memory — a filling in of details about quarantines and rehabilitation units and hospital wards, with their rows of iron-lung breathing machines that became the most chilling symbols of the disease’s attack. Polio cases peaked in the United States in 1952.

But Ms. Lloyd soon found that polio’s past was not dead and gone. It was not even past. In all the early interviews, people talked about an after-echo legacy of the disease called post-polio syndrome that had come back to hit them in their 60s and 70s. Survivors who had battled through braces and operations decades ago wanted to talk about the present, Ms. Lloyd said, and the new battlefield they faced.

“Thirty, 40 or 50 years later, it’s like they’re getting the disease again,” Ms. Lloyd said.
Post-polio syndrome, first recognized by science in the 1980s, is not technically a disease — no bacteria or virus causes it, for example, like polio itself. 

Rather it is more like a car’s transmission breaking down after too many years of wear and tear on the gears: battered muscles and nerves that are pushed through a lifetime of strain to overcome and compensate for polio’s debilitating effects simply wear out sooner, doctors say. 
And now the advancing age of the polio generation — an estimated 750,000 people in the United States — is compounding post-polio’s reach. 

About two-thirds of polio survivors are over the age of 64, according to Lawrence C. Becker, the author of a study by Post-Polio Health International, an advocacy group. As many as 60 percent, by some estimates, will experience a post-polio aftershock, moving into an old age that few had prepared for.

Some polios, as survivors call themselves, say that post-polio has refocused their minds on how the virus shaped their lives — and sharpened their bittersweet memories.
“For years, I wouldn’t allow myself to think of polio,” said Virginia Lewis Hall, a retired teacher who grew up in a small town south of Salt Lake City and caught the disease at age 3, in 1949. “I always said, ‘I’ll just tough it out.’ ”

Ms. Hall, 63, said the effects of post-polio, particularly a deterioration of the breathing muscles, which forced her to take an early retirement and requires her to be on oxygen most of the time, have deepened her understanding of the mantra her parents taught her growing up: that she could choose any road she wanted in life, but that her journey would be different because of the disease. 

In an interview over her kitchen table, Ms. Hall held up a photograph, taken when she was 5 and recovering from bone surgery, encased in a white plaster body cast from neck to toe, legs stiffened and splayed by a rod between her ankles. In the picture, her older brother, John, in a chest-cast himself from a polio operation (he died of respiratory complications at age 52) holds her up from behind. Huge grins illuminate their faces.
“My dad built a stand so I could stand up — it could hold me, and I could draw, and I could paint,” Ms. Hall said, describing her nine months in the cast. A love of art took root as she stood, otherwise immobilized but free to let her imagination roam. Today, water-color landscapes painted in retirement line the walls of her home. 

Part of the problem for aging polio survivors is that, like World War II veterans or Holocaust survivors, their numbers are shrinking every year, which means that money for scientific research into post-polio is drying up, too. 

Doctors with hands-on polio experience, like Jacquelin Perry — 91 and still practicing at a rehabilitation center in California — are disappearing even faster.

Dr. Perry began working with polio during World War II, when she was a physical therapist for the Army, and she has seen some patients continually for 50 years or more, creating lifelong charts of their progress, and in many cases, she said, their decline.
Her conclusion about polio and age is that the people who worked hardest to overcome disability have in many cases been hit hardest by its second-wave attack, as over-used muscles and nerves gave out after decades of strain. Her observation is backed up by numerous studies.
“It’s overuse,” Dr. Perry said in a telephone interview. “The people who tried hardest to be normal, and pushed hardest, have been hit more with post-polio.”

Some polio survivors call that the “Type A” problem. Overcoming polio, they say, required immense work, if not obsession, to adapt undamaged muscles and nerves to carry the load. Mr. Hanson, for example, the retired banker, said his left knee, unaffected by polio but burdened for years from carrying most of his body weight, gave out about 11 years ago and had to be replaced. The polio-damaged right leg, meanwhile, became even weaker.
“We’ve followed a lifetime of saying, ‘Push hard, keep going forward,’ ” said Prof. Fernando Torres-Gil, a polio survivor and director of the Center for Policy Research on Aging at the University of California, Los Angeles. “But now that’s an impediment to successful aging.”

Some people who have participated in the Utah project say that rethinking polio’s path — and accepting that post-polio could shape the rest of their days — has given them strength.
“I feel more in control,” said Fran Broadhead, 78, who got polio at age 6, in Alberta, before moving to Montana and later Utah.

Ms. Broadhead, whose childhood illness was relatively mild — she was up and playing with friends a year later — said she thought the weakness and fatigue that began hitting her in the last decade were mostly from polio. It is not a question her doctors can help answer, she said, since post-polio is rarely a formal diagnosis.
“It makes it easier for me to accept what I’m going through,” she said, “and to teach myself to adapt.”




Post Polio Litaff, Association A.C _APPLAC Mexico

Post-polio syndrome .By Mayo Clinic

Reprints. A single copy of this article may be reprinted for personal, noncommercial use only.
Post-polio syndrome By Mayo Clinic staff


Original Article:  http://www.mayoclinic.com/health/post-polio-syndrome/DS00494

Definition

Post-polio syndrome (PPS) refers to a cluster of potentially disabling signs and symptoms that appear decades — an average of 30 to 40 years — after the initial polio illness.
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.
According to some studies, however, up to half the people who had polio at a young age may experience certain effects of the disease many years later — post-polio syndrome.

Symptoms

Common signs and symptoms of post-polio syndrome 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
In most people, post-polio syndrome tends to progress slowly, with new signs and symptoms followed by periods of stability.
When to see a doctorIf you're experiencing weakness or fatigue that seems to be 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

Nobody knows exactly what causes the signs and symptoms of post-polio syndrome to appear so many years after the first episode of polio. Currently, the most accepted theory regarding the cause of post-polio syndrome rests on the idea of degenerating nerve cells.
When poliovirus infects your body, it affects nerve cells called motor neurons — particularly those in your spinal cord — that carry messages (electrical impulses) between your brain and your muscles.
Each neuron consists of three basic components:
  • A cell body
  • A major branching fiber (axon)
  • Numerous smaller branching fibers (dendrites)
A polio infection often leaves many of these motor neurons destroyed or damaged. To compensate for the resulting neuron shortage, the remaining neurons sprout new fibers, and the surviving motor units become enlarged. This promotes recovery of the use of your muscles, but it also places added stress on the nerve cell body to nourish the additional fibers. Over the years, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers and, eventually, of the neuron itself.
Another theory is that the initial illness may have created an autoimmune reaction, causing the body's immune system to attack normal cells as if they were foreign substances.

Risk factors

Factors that may increase your risk of developing post-polio syndrome include:
  • 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.
  • Gender. Females are more likely to develop post-polio syndrome.

Complications

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, smoking, 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

You're likely to start by seeing your family doctor or a general practitioner when you first notice your symptoms. However, you'll probably be referred to a doctor who specializes in nervous system disorders (neurologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
  • 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.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For post-polio syndrome, some basic questions to ask your doctor include:
  • 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 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 websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctorYour 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

Indicators of post-polio syndromeTo 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.
In addition, because the signs and symptoms of post-polio syndrome are similar to those commonly associated with other disorders, your doctor will attempt to exclude other possible causes, such as arthritis, fibromyalgia, chronic fatigue syndrome and scoliosis.
Some people with post-polio syndrome worry that they may be getting amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. But the late effects of polio are not a form of ALS.
Tests to rule out other conditionsSome of the tests your doctor may use to rule out alternative diagnoses include:
  • 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.
  • Muscle biopsy. Your doctor may perform a muscle biopsy, looking for evidence of typical nerve abnormalities caused by the polio virus.
  • Blood tests. People with post-polio syndrome usually have normal blood test results. Abnormal blood test results may indicate another underlying problem that's causing your symptoms.

Treatments and drugs

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. Pain relievers, such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others), may ease muscle and joint pain. Numerous drugs — including pyridostigmine (Mestinon, Regonol), amantadine, 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.

Lifestyle and home remedies

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 difficult. 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.

Coping and support

Dealing with the fatigue and weakness of post-polio syndrome can be difficult, physically and psychologically. You may need to lean on your friends and
 family for support. In most cases, they're probably already looking for ways to help you, and you can help them by telling them how.
You may even consider joining a support group for people with post-polio syndrome. Sometimes, just talking things over with people who have similar problems
 enables you to better cope with the challenges at hand. You can contact Post-Polio Health International to find out about support groups in your area.
DS00494March 3, 2011
© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these 
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