| POLIO TIPS ‘N’ TECHNIQUES
by Dr. Richard L. Bruno
Polio survivors’ most troublesome problem after surgery is pain control. Studies have shown that surgical patients are often under medicated for pain.
Under medication is a serious problem for a postpolio patient since two studies have shown that polio survivors are twice as sensitive to pain as those who didn’t have polio, increased pain sensitivity apparently being caused by poliovirus killing the body’s own morphine-producing cells.
So, while for Anesthesia the “Rule of 2” is that polio survivors need the usual dose of anesthetic divided by two, the “Rule of 2” for Pain is just the opposite: Polio survivors need two times the dose of pain medication for twice as long.
This rule applies to dental procedures, too, since polio survivors may need two or more times the dose of Novocain. After surgery, polio survivors should have a PCA pump that delivers pain medication on demand when the patient pushes a button. And, doctors need not worry that polio survivors will become addicted to pain medication. Polio survivors are known to be extremely stoic and are not likely to abuse or become dependent upon pain meds, even narcotics.
There is also a “Rule of 2” for recovery after surgery: Polio survivors need at least twice as long to recover as other patients. In keeping with insurance companies’ and HMO’s wanting to get ‘em up and move ‘em out, there is the tendency to get polio survivors up and walking almost immediately after surgery. This is not a good idea. When polio survivors reach the nursing floor, they may still be very sedated. Since polio survivors need a very clear head to be able to control their polio-affected muscles to stand and walk, a fuzzyheaded polio survivor is at serious risk for falling.
Even with a clear head, anesthetics or other drugs may have temporarily weakened or even paralyzed the muscles needed to stand and walk, especially if a spinal anesthetic was used. What’s worse, the surgery may have cut muscles (like abdominal muscles) that substitute for muscles paralyzed by polio and that allow polio survivors to stand and walk. Polio survivors may also have low blood pressure after surgery that could itself cause lightheadedness, fainting and falls.
Polio survivors should get up slowly, first sitting up in bed, then sitting with feet dangling, then getting into a bedside chair with assistance, then standing with assistance and finally walking with assistance and appropriate assistive devices. Gentle physical therapy is helpful to maintain range of motion and for stretching, since polio survivors are prone to developing painful muscle spasms if they are not moving. Physical and occupational therapists need to know that polio survivors have learned to be very aware of what their bodies can and can’t do. They are the best judges of when they can safely move, stand and walk.
All hospital staff need be aware that many polio survivors have emotional difficulty merely being in the hospital, having insomnia, anxiety and even have panic attacks. These symptoms are easy to understand when it is remembered that as young children, polio survivors were ripped away from their families and admitted to rehabilitation hospitals for months or even years. Post-polio children underwent multiple surgeries and painful physical therapy, procedures administered often without explanation and certainly without their consent.
Many post-polio patients have had multiple experiences of psychological, physical and even sexual abuse at the hands of hospital staff. Questions or complaints about painful and frightening therapies were not infrequently met by staff anger or punishment. Necessary nursing care could be withheld for no apparent reason. Patients report having been locked in dark closets overnight when they asked questions, spoke out or cried. Many postpolio children were slapped and some were actually beaten with rubber truncheons by physical therapists to “motivate” them to stand up and walk.
It is not surprising that polio survivors can be terrified of again becoming powerless “patients” who are at the mercy of hospital staff. Nursing staff’s appreciation of the childhood trauma polio survivors experienced at the hands of medical professionals, and taking a moment to actually listen and respond to the real needs—both physical and emotional—of the adult post-polio patient, will go a long way toward making the polio survivors feel safer and more comfortable during their hospital stay.
Dr. Richard L. Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. E-mail PostPolioInfo@aol.com.
