Late Effects of Polio

As we age, common symptoms may be experienced by people who have had polio at an early age. The symptoms include fatigue, muscle weakness and muscle and joint pain, shortening of tendons in polio-affected limbs, difficulty sleeping, difficulty breathing, and psychological stress. These symptoms can be quite debilitating and may compromise health and independence.

People tend to notice these changes from 20 to 45 years after recovering from polio.

Although New Zealand is now polio free, with no cases of wild polio infection since 1970, the late effects of polio continue to affect thousands of New Zealanders. Those who are affected require a management regime to deal with the effects of the symptoms. Polio NZ is dedicated to ensuring that those who had polio are able to access appropriate services to enable them to manage their condition. Such a management plan needs to be based on information about each individual as polio affected us all in many different ways.

Polio

Poliomyelitis, or polio, is a highly contagious viral disease. It was responsible for killing and maiming large numbers of people in the early 20th century. It is transmitted orally and initially infects the small intestine. Most people who contract the disease do so when they are very young, between three and five years old.

The initial symptoms of polio are flu-like. In a small minority of cases, the infection spreads beyond the intestine, into the blood stream and invades the central nervous system. In this case, called paralytic polio, the disease is far more serious and can cause floppy limbs or paralysis, which can be permanent. It is this form of polio that may later lead to post polio syndrome.

A vaccine for polio was developed in 1955 and intensive immunisation campaigns worldwide have successfully eradicated the disease from much of the world. Immunisation in New Zealand began in 1957 and the last reported case due to wild poliovirus was in 1962. There have been nine vaccine-related cases since 1962. However, in 2002, immunisation was switched to the inactivated polio vaccine, which is not associated with vaccine related infections.

Follow this link for more information about polio. Follow this link for data on polio incidences in New Zealand in the 20th century.

Life after polio

While an attack of polio only lasts a short time, recovery can take about two to eighteen months. During this time, movement in affected limbs gradually returns, unless permanently affected, though the limbs may be weak. Physiotherapy can further help recovery and surgery may be required for serious cases to repair damaged muscles or straighten bones.

Polio survivors have shown a great capacity to recover and to cope with the long term effects of polio. For years after recovery, a normal life can be lived, with perhaps some adjustment for residual paralysis or weak limbs.

Paralytic polio damages the nerves of the body, which may result in too few healthy nerves working the body’s muscles. The body has a great capacity to adapt, so it can cope with this in the short term. However, over time the overworked nerves begin to break down. It is this weakening of the nervous system that is believed to give rise to post polio syndrome. (Follow this link for other theories on the cause of post polio syndrome.)

Onset of post polio symptoms

About 20 to 45 years after the initial attack, the recovered polio victim may begin to deteriorate, showing some of the symptoms listed below. This is the onset of the late effects of polio.

It is important to note that post polio symptoms are not caused by old age, but age does worsen the symptoms. Its onset is related to the length of time since the original polio attack. However, the onset may be triggered by trauma, such as emotional upheaval, an accident or undergoing surgery.

Symptoms of the late effects of polio:

The symptoms of post polio syndrome include

  • General fatigue, not related to activity
  • Muscles weakness or pain and tenderness
  • Muscle cramps and spasms
  • Joint pain
  • Episodes of pain, exhaustion or weakness that vary in duration and occur spontaneously and unpredictably
  • Respiratory difficulties
  • Depression or anxiety

These symptoms are not specific to post polio and can also be due to the natural effects of aging, diabetes, heart disease or other enervating diseases. Because of this, a complete diagnoses that can account for all other possible causes is required. If you feel you may be affected by the late effects of polio, but are unsure, you should consult a neurologist.

The late effects of polio may give rise to other consequences:

  • Easily fractured bones due to polio-induced osteoporosis, and slow healing of fractures
  • Joint problems
  • Use of crutches and wheelchairs can cause carpel tunnel syndrome and other repetitive strain injuries, as well as arthritis
  • Loss of independence and the disappointment that goes with that loss

Treatment

Treatment necessarily concentrates on managing the symptoms, as detailed in the next section below. Your current age has a lot to do with whether your symptoms can be reversed or eliminated, or whether you can just maintain the degree of health and mobility that you currently have so that your condition is not made worse.

Several medications are being researched for the treatment of the late effects of polio:

  • Pyridostigmine, used for muscle fatigue, has many side effects
  • Human growth factor, very expensive
  • Magnesium supplements to help with cramp
  • Carnitine, used in Australia and Switzerland, but very expensive and not fully proven
  • CoEnzyme Q10, may reverse muscle pain, but expensive

Managing post polio symptoms

Managing your life with the late effects of polio involves coping with the weakness and pain that arises, avoiding becoming overly fatigued and remaining positive. On another page we deal with these management approaches in detail, but below we give some general coping strategies:

  • Do not get overtired, learn how to pace yourself
  • Exercise only under the supervision of a person who is fully informed about the late effects of polio.
  • Swimming in warm water is best
  • Do not let yourself get chilled; make it a habit to carry a sweater with you whenever you go out
  • Keep a normal weight
  • Have periodic muscle strength evaluations
  • Get adequate nutrition, including enough bulk producing fibre
  • Maintain a positive attitude towards your health
  • Join the Post Polio Support Group in your area

Drugs to avoid

  • Sleeping pills, tranquilisers and too much alcohol may lead to falls
  • Muscle relaxants such as benzodiazepines and orphenedrine may further weaken muscles
  • High-dose steroids can cause muscle weakness and osteoporosis
  • Lipid-lowering drugs, especially statins, can cause muscle pain and inflammation

     

    ANAESTHETIC WARNING

  • There are specific dangers of anaesthetics for people affected by polio due to the loss of muscle mass and pre-existing weaknesses.  If you are scheduled for an anaesthetic by your dentist or doctor, please ensure that they are fully informed about the specific considerations relative to anaesthetics and those who have had polio.
  • Muscle relaxants such as benzodiazepines and orphenedrine may further weaken muscles