|1.||Have you ever
considered what the chiropractor can do to help the pains and the
general condition of the spinal cord?
now feel that chiropractic manipulation may be good for some especially
if they have acute lower back pain. A chiropractor may even give
quicker relief than a traditional doctor in certain cases. But I am
very worried when people get their necks manipulated. I've seen too
many accidents in this context - nerve roots being pinched or torn -
actual damage to the spinal cord or brain stem. I still cringe when
there is talk about neck manipulation.
|2.||(a) When do you
decide to prescribe Mestinon to a patient?
think that Mestinon helps with severe generalized fatigue and also with
muscle fatigability. Exert yourself, walk the length of a mall, and you
may have increased weakness and have to sit down to recover your
strength. These kind of symptoms seem to be helped by Mestinon. We
think Mestinon improves the communication between the nerve and the
muscle. First of all we advise non-medical ways of treating fatigue:
activity planning, changes in life-style. If those don't work, we
consider trying Mestinon. Even if we prescribe Mestinon, we find only
about 60% respond to it well, so we don't have a predictive test as to
whether a person will respond well or not. When we have exhausted
non-medical ways of treating fatigue, we try Mestinon.
|2.||(b) Is general
fatigue a criteria for the use of Mestinon, or is it more for
weaknesses to legs, arms or for pain?
There's no physiological explanation for it to be effective for pain.
Mestinon might have other uses than just for fatigue, but at present,
we're not smart enough to know how it works, or whether it can work for
|3.||Has there been
any research/invest into alternative medicine techniques either using
herbal remedies or other healing techniques (Qi-gong)?
use of alternative medicines is a matter of choice for the individual.
Although we can't cure post-polio syndrome, we believe we can treat
some of the symptoms. Be sure you have good advice before taking them
so that you avoid hurting yourself physically or financially. Remember
that nobody has the cure for post-polio syndrome.
recommend taking extra Calcium or Vitamin E for PPS?
trouble in the muscle is inside the muscle. It's not due to not enough
calcium. It's due to the muscle cell physiology, so extra calcium
wouldn't help there. However, there are reasons to take extra calcium,
i.e., for osteoporosis and health in general, but not for post-polio
syndrome specifically. As for Vitamin E., it is a different story. It
is a very potent anti-oxidant, and there is apparently no toxic dose of
this vitamin. So it is safe to take several hundred units a few times a
day. It won't hurt you. Perhaps it will help. At least there won't be a
|5.||Should a PPS
person do conditioning exercises, sub maximal exercises or maximal
fatiguing exercises, or all three?
role of exercise in PPS is hotly debated at present and is being
researched actively. We used to say that any exercise to the point of
pain, muscle cramps or weakness in the muscle was too much and that it
might actually accelerate weakness in PPS. At this point there are
people under carefully controlled research conditions (e.g. Dr. Agre in
Wisconsin) who have been able to show that even fatiguing exercise can
result in an increase in strength with time. The conventional wisdom is
"don't push, it may make things worse." But there are some cracks
beginning to appear in the conventional wisdom. As for specific advice,
do NOT exercise to the point of cramps or pain or weakness unless you
are under some carefully controlled research environment. There has to
be a happy medium between some form of activity and over-exertion. And
for the time being, I think it is best to stay in that happy medium.
Don't just sit and do nothing!
|6.||What are your
thoughts about CPAP?
is a non-invasive machine to assist breathing, especially at night. It
can be used if there is a profound weakness of the respiratory muscles
or if the patient has sleep apnea.
the role of free radicals in PPS?
Tough question which would take pages to explain and my answer is based
more on an idea than on very specific knowledge. Motor neurons appear
to be very sensitive to the effects of free radicals. A free radical is
a molecule that can oxidize things in the cell, e.g., lipids, DNA and
proteins and make them not function properly. We found that the motor
neuron generates a pulse of free radicals when it is about to die. If
one can block the action of free radicals then you can prevent or slow
down motor neuron cell death. I have wondered whether there is a
similar effect at the nerve terminal which is where we think the action
is in PPS. What we think is happening in PPS is that the hugely
enlarged nerve "tree" with 10 times more branches than it was supposed
to have undergoes a loss - a sort of breakdown or PPS pruning. This
loss of terminal axons over time after polio, and why these degenerate
is not known at present. A possible mechanism for degeneration.
involves free radicals that they be oxidizing the lipids and proteins
in the nerve terminal. It opens the possibility that some anti-oxidant
medicines may prevent or slow down the loss of terminal axons in PPS.
Something as simple as Vitamin E, for instance, might slow down the
loss of nerve terminals in PPS and other related diseases. More work
needs to be done.
[Canadian] government recognize PPS? Has any progress been made towards
getting compensation for PPS?
We have been able to have people declared disabled with post-polio
syndrome. But applications for compensation seem to be automatically
rejected, requiring the appellant to go to appeal. If you decide to opt
for disability with your doctor, expect a battle of between 6 - 12
months, if indeed you succeed.
weight control is a problem when mobility is reduced, what advice would
you give given that weight loss is a twofold formula of fewer calories
combined with increased physical activity?
Polio Clinic, through Dr. Trojan at the Montreal Neurological Institute
and Hospital, can refer you to a dietician, a physiotherapist and an
occupational therapist. Together they can recommend an appropriate diet
and exercise program.
anything new to relieve the feeling of coldness due to polio?
as there are many reasons for post-polio fatigue, there are dozens of
reasons why people who have polio may experience cold in their
extremities, e.g., poor circulation, loss of muscle mass in a leg. Some
reasons may be related to polio, but not necessarily so. I have been
doing some work which is not yet published showing that when one gets
nervous or tired or something similar, there can be prominent
constriction of the blood vessels which causes a sensation of cold.
and bursitis a sign of PPS? Are there short-term or long-term remedies?
Is exercising recommended to regain strength?
These conditions are often the result of people overexerting for a long
period of time. If arms are bearing weight or being used to get around
in a wheelchair, they begin to complain.
will Mestinon have on the heart?
Mestinon increases acetylcholine everywhere in the body; part of the
rhythm control of the heart is due to levels of acetylcholine at a
synapse of the heart. Too much acetylcholine in the heart causes a
slowing down of the heart. This isn't dangerous; in fact it is barely
noticeable. But people who have had heart disease, either myocardial
infarction or a rhythm a abnormality should consult their doctor before
embarking upon Mestinon therapy.
|13.||How old is your
youngest post-polio patient?
|A. Fourteen years old.|
Audio Cassette (English Only) and Video Tape (English Only) of the above which includes Dr. Cashman's Annual Report and his resumé of the Grand Rounds on the three possible causes of Post Polio Fatigue are available by calling Canada 514 932 6092. In UK contact the Lincolnshire Post-Polio Network. Cost of audio-cassette - $ ; cost of video-cassette (thanks to Mansour Jabbari) - $ are unknown at the date of going to press. If you would like a copy of the Annual Report, please contact the Association. Sally Aitken email@example.com.
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Document preparation: Chris
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Created: 24th January 1998
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