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Richard L. Bruno, HD, PhD Director, International Centre for Polio Education and author of The Polio Paradox Hosts The Post-Polio Coffee House on Facebook. Bruno Bytes are his Q&A's of PPS information. |
NOTE: We collaborate with Dr. Bruno to publish Bruno Bytes Quarterly.
- Every issue of Bruno "Bytes" is available in PDF format at the bottom of this page.
- Feel free to download and share them.
Bruno Bytes - Third Quarter, 2022
Topics Include: Disabled Caregivers, Eye Muscle Weakness, Medications, Polio Anti-body testing, Steroids, Types of Polio and Undiagnosed Polio
Topics Include: Disabled Caregivers, Eye Muscle Weakness, Medications, Polio Anti-body testing, Steroids, Types of Polio and Undiagnosed Polio
On the topic of Caregivers with Disabilities Needing Support
Dr. Bruno’s Original Post: From the University of Pittsburgh, July 22, 2022.
“Caregivers with their own disabilities face significant problems while trying to care for aging or ailing partners, including physical and mental health issues and financial and healthcare strains according to a University of Pittsburgh study.
The study found that spousal caregivers were more likely to report a disability and were generally older, with close to half over the age of 65. Older spousal caregivers also had higher rates of chronic disease and often reported worse physical health.
Researchers found that spouse caregivers had the highest rates of:
The majority of caregivers with a disability said they received training following the hospitalization of their partner and were more likely to use assistance such as paid care, respite services and support groups. Still, use of such support services was relatively low – less than 10% of caregivers with or without disabilities.”
On the topic of Medications for Muscle Weakness
Question: My physician has recommended mestinon (Pyridostigmine) for my muscle weakness. Does it help?
Dr. Bruno’s Response: There have been a number of limited quality studies of pyridostigmine's effect on North American and European polio survivors. The title of this 2003 study says it all:
“Pyridostigmine in Post-Polio Syndrome: No decline in fatigue and limited functional improvement.”
There wasn’t a decrease in fatigue nor any significant increase in muscle strength on drug.
On the topic of “Minor” Illness being Undiagnosed Polio
Dr. Bruno’s Original Post: Symptoms of a "minor" illness that could be polio but possibly not be diagnosed. "The CDC states most people infected with polio will not have weakness or paralysis. One in four infected people will have flu-like symptoms that include:
• Sore throat;
• Headache;
• Fever;
• Nausea;
• Fatigue;
• Stomach pain.
Symptoms typically last two to five days and then go away without treatment and are not followed by neuron damage, muscle weakness or paralysis."
Question: Is having these flu-like symptoms the same as “non-paralytic” polio?
Dr. Bruno’s Response: No. Flu-like symptoms would be considered "abortive polio" where the virus doesn't enter the central nervous system or cause any damage. "Non-paralytic polio," is where the virus can enter the central nervous system, causes neuron damage and measurable muscle weakness in about 40% of patients.
On the topic of Muscle Weakness Affecting the Eyes
Question 1: I have paralysis of the 7th cranial nerve causing the left side of my face, neck, and shoulder to be paralyzed. Bulbar Polio was the cause. Could this be affecting the vision in my left eye?
Question 2: I also have eye problems from polio when I was one. My left eye has always had a problem, I call it a "wandering eye". My eye muscles are weak. Now, my right eye is getting weak as well and my vision has changed.
Dr. Bruno’s Response: Polio can affect the muscles that move the eyes and eyelids. This article may help you and your ophthalmologist: Abnormal Eye Movements and PPS. You can find it in the Encyclopedia of Polio and PPS under the topic of Muscle Weakness.
On the topic of Poliovirus Antibody Testing to Determine Immunity
Dr Bruno’s Original Post: Testing for Types 1 and 3 Antibodies
The case of paralytic polio in lower New York State, caused by the mutated Type 2 vaccine, has prompted survivors to ask whether they had been fully vaccinated and have antibodies to all three types of poliovirus. Commercial laboratories will test for the presence of poliovirus antibodies but only for Type 1 and Type 3, since wild Type 2 poliovirus is no longer circulating. Unfortunately, it is the mutated Type 2 oral vaccine strain that currently is circulating and being found in wastewater.
The CDC states, "Demonstrating antibodies to poliovirus types 1 and 3 does not reliably indicate protection against poliovirus type 2. In the absence of the availability of testing for antibodies to all 3 serotypes, serologic testing is no longer recommended to assess immunity."
Source: www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6601a6.pdf
What's more, infectious disease specialist Dr. Paul Offit stated that laboratories can "find" poliovirus antibodies that are in fact antibodies against “cousin” non-polio enteroviruses, making antibody testing worthless.
On the topic of Polioviruses – Types vs Strains
Dr. Bruno’s Original Post:
You often hear doctors on television news make a simple mistake: confusing the “types” of virus with “strains” of virus.
It's really simple. Each TYPE of virus requires its own specific antibody to subdue it. But within each TYPE of virus there can be many STRAINS that are genetically different (because of mutations) but still succumb to an attack by its TYPE’s antibody.
Dr. David Bodian discovered that there were 3 TYPES of poliovirus. A committee of scientists was formed and collected samples of poliovirus from North America and around the world to be certain that there were only 3 TYPES and therefore only 3 individual formulations of polio vaccines would be needed.
The findings confirming that there were just 3 TYPES of poliovirus were presented in 1952 at the Second International Poliomyelitis Conference. But also presented was the finding that there were 255 STRAINS of TYPE 1 poliovirus, 36 STRAINS of TYPE 2 and 9 STRAINS of TYPE 3.
TYPE 1 STRAINS were by far the most numerous and virulent; so it's not surprising that they were responsible for the majority of polio epidemics.
On the topic of Steroids.
Question: In the Polio Paradox, you advise against polio survivors being given steroids. Does this include steroid injections for pain? I fell and have a torn shoulder ligament. Despite physio and osteo treatments, the pain is still there. I am considering asking my doctor for a steroid injection next week.
Dr. Bruno’s Response: The problems reported by our Post-Polio Institute patients - weakness, fatigue - when they were given oral steroids for the long-term treatment of arthritic pain, which is not an appropriate use of steroids.
Steroid injections do not cause the same problems. But steroid injections should be limited in number because they damage the bone. Ask for the injection to be the steroid combined with a local anesthetic.
Additional Comment: I have a lot of neck pain and regularly use physical therapy and at home traction. Two years ago, my rehabilitative physician (aware of the side effects) felt I should take a single dose pack of oral steroids (lasting only 1 week) to reduce the increased pain and inflammation in my neck. You’ve written previously about oral steroids for pain. Your article “Steroids – the Good and the Bad” helped me a lot, as did the week of steroids. Just being aware that fatigue could be a side effect, I wasn’t afraid of it nor was I surprised on the 3rd day when I felt like a rag doll. I used it as an opportunity to rest, which was probably what I needed anyway. (You can find the article mentioned above and more information on steroids under the topic of Muscle Weakness in the Encyclopedia of Polio and PPS.)
On the topics of the “Summer Grippe”, “Mild Case of Polio” and Type Two Poliovirus
Question: What’s happening in New York is raising awareness of children who have the poliovirus but only have flu-like symptoms, are not being diagnosed and thus can spread it. The more I learn about Polio and PPS the more interested I get. I was sick in 1954 with the Summer Grippe. Recovered on my own, no doctors. My drop foot gradually appeared over the years.
How many of us were not diagnosed (initially) with polio, but with the Summer Grippe? Albert Sabin described it in 1946.
(Pages: 277 – 283 in The Polio Paradox.)
Additional Post: Polio hit me like a ton of bricks and I've always been puzzled by people in these groups who don't know when they got it and were never in a hospital. I have run into people who never had to wear special shoes or like you said never went to the hospital but yet they say they had polio. I know polio affected us all differently, but the fact that my foot dropped, toes curled, and noticeable limp and size of leg, makes it hard to imagine not knowing!
Additional Post: I can see why someone might not ever know they had polio at the time. I had a girlfriend who had gotten it in one of her legs. Her leg never was shorter, she never had to wear a brace or different size shoes. When she was reaching age 50, then she needed a brace because her foot on that leg was staring to drop. We are all so different, yet the same.
Additional Post: My whole family came down with "Summer Grippe" in 1948. Seven kids, I was the youngest at 1 year. No doctor was called till I started walking again and dragging one foot. We were some of the lucky ones; no iron lungs or long hospital stays. Dealing with PPS now is tough, having all sorts of problems with pain in the back and legs. My siblings have also had PPS problems. I'll always wonder how many Summer Grippe children have developed muscle weakness issues that have never been attributed to polio.
Dr. Bruno’s Response: All three types of poliovirus caused paralysis. The Type I poliovirus is the epidemic virus that paralyzed(es) most people. Albert Sabin discovered that it was the Type II poliovirus that apparently caused "the Summer Grippe” (and it was also the cause of the polio epidemic in Iceland the next year).
Unfortunately, we will never know how many Summer Grippe children there were nor how many children went undiagnosed with "non-paralytic" polio. (There are numerous articles about "non-paralytic" polio under the topic of “poliovirus” in the Encyclopedia of Polio and PPS.)
Dr. Bruno’s Original Post: From the University of Pittsburgh, July 22, 2022.
“Caregivers with their own disabilities face significant problems while trying to care for aging or ailing partners, including physical and mental health issues and financial and healthcare strains according to a University of Pittsburgh study.
The study found that spousal caregivers were more likely to report a disability and were generally older, with close to half over the age of 65. Older spousal caregivers also had higher rates of chronic disease and often reported worse physical health.
Researchers found that spouse caregivers had the highest rates of:
- obesity/overweight (71%),
- high blood pressure (51%),
- high cholesterol (50%),
- arthritis/gout/lupus/fibromyalgia (48%),
- diabetes (19%),
- skin cancer (13%) or other type of cancer (14%).
The majority of caregivers with a disability said they received training following the hospitalization of their partner and were more likely to use assistance such as paid care, respite services and support groups. Still, use of such support services was relatively low – less than 10% of caregivers with or without disabilities.”
On the topic of Medications for Muscle Weakness
Question: My physician has recommended mestinon (Pyridostigmine) for my muscle weakness. Does it help?
Dr. Bruno’s Response: There have been a number of limited quality studies of pyridostigmine's effect on North American and European polio survivors. The title of this 2003 study says it all:
“Pyridostigmine in Post-Polio Syndrome: No decline in fatigue and limited functional improvement.”
There wasn’t a decrease in fatigue nor any significant increase in muscle strength on drug.
On the topic of “Minor” Illness being Undiagnosed Polio
Dr. Bruno’s Original Post: Symptoms of a "minor" illness that could be polio but possibly not be diagnosed. "The CDC states most people infected with polio will not have weakness or paralysis. One in four infected people will have flu-like symptoms that include:
• Sore throat;
• Headache;
• Fever;
• Nausea;
• Fatigue;
• Stomach pain.
Symptoms typically last two to five days and then go away without treatment and are not followed by neuron damage, muscle weakness or paralysis."
Question: Is having these flu-like symptoms the same as “non-paralytic” polio?
Dr. Bruno’s Response: No. Flu-like symptoms would be considered "abortive polio" where the virus doesn't enter the central nervous system or cause any damage. "Non-paralytic polio," is where the virus can enter the central nervous system, causes neuron damage and measurable muscle weakness in about 40% of patients.
On the topic of Muscle Weakness Affecting the Eyes
Question 1: I have paralysis of the 7th cranial nerve causing the left side of my face, neck, and shoulder to be paralyzed. Bulbar Polio was the cause. Could this be affecting the vision in my left eye?
Question 2: I also have eye problems from polio when I was one. My left eye has always had a problem, I call it a "wandering eye". My eye muscles are weak. Now, my right eye is getting weak as well and my vision has changed.
Dr. Bruno’s Response: Polio can affect the muscles that move the eyes and eyelids. This article may help you and your ophthalmologist: Abnormal Eye Movements and PPS. You can find it in the Encyclopedia of Polio and PPS under the topic of Muscle Weakness.
On the topic of Poliovirus Antibody Testing to Determine Immunity
Dr Bruno’s Original Post: Testing for Types 1 and 3 Antibodies
The case of paralytic polio in lower New York State, caused by the mutated Type 2 vaccine, has prompted survivors to ask whether they had been fully vaccinated and have antibodies to all three types of poliovirus. Commercial laboratories will test for the presence of poliovirus antibodies but only for Type 1 and Type 3, since wild Type 2 poliovirus is no longer circulating. Unfortunately, it is the mutated Type 2 oral vaccine strain that currently is circulating and being found in wastewater.
The CDC states, "Demonstrating antibodies to poliovirus types 1 and 3 does not reliably indicate protection against poliovirus type 2. In the absence of the availability of testing for antibodies to all 3 serotypes, serologic testing is no longer recommended to assess immunity."
Source: www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6601a6.pdf
What's more, infectious disease specialist Dr. Paul Offit stated that laboratories can "find" poliovirus antibodies that are in fact antibodies against “cousin” non-polio enteroviruses, making antibody testing worthless.
On the topic of Polioviruses – Types vs Strains
Dr. Bruno’s Original Post:
You often hear doctors on television news make a simple mistake: confusing the “types” of virus with “strains” of virus.
It's really simple. Each TYPE of virus requires its own specific antibody to subdue it. But within each TYPE of virus there can be many STRAINS that are genetically different (because of mutations) but still succumb to an attack by its TYPE’s antibody.
Dr. David Bodian discovered that there were 3 TYPES of poliovirus. A committee of scientists was formed and collected samples of poliovirus from North America and around the world to be certain that there were only 3 TYPES and therefore only 3 individual formulations of polio vaccines would be needed.
The findings confirming that there were just 3 TYPES of poliovirus were presented in 1952 at the Second International Poliomyelitis Conference. But also presented was the finding that there were 255 STRAINS of TYPE 1 poliovirus, 36 STRAINS of TYPE 2 and 9 STRAINS of TYPE 3.
TYPE 1 STRAINS were by far the most numerous and virulent; so it's not surprising that they were responsible for the majority of polio epidemics.
On the topic of Steroids.
Question: In the Polio Paradox, you advise against polio survivors being given steroids. Does this include steroid injections for pain? I fell and have a torn shoulder ligament. Despite physio and osteo treatments, the pain is still there. I am considering asking my doctor for a steroid injection next week.
Dr. Bruno’s Response: The problems reported by our Post-Polio Institute patients - weakness, fatigue - when they were given oral steroids for the long-term treatment of arthritic pain, which is not an appropriate use of steroids.
Steroid injections do not cause the same problems. But steroid injections should be limited in number because they damage the bone. Ask for the injection to be the steroid combined with a local anesthetic.
Additional Comment: I have a lot of neck pain and regularly use physical therapy and at home traction. Two years ago, my rehabilitative physician (aware of the side effects) felt I should take a single dose pack of oral steroids (lasting only 1 week) to reduce the increased pain and inflammation in my neck. You’ve written previously about oral steroids for pain. Your article “Steroids – the Good and the Bad” helped me a lot, as did the week of steroids. Just being aware that fatigue could be a side effect, I wasn’t afraid of it nor was I surprised on the 3rd day when I felt like a rag doll. I used it as an opportunity to rest, which was probably what I needed anyway. (You can find the article mentioned above and more information on steroids under the topic of Muscle Weakness in the Encyclopedia of Polio and PPS.)
On the topics of the “Summer Grippe”, “Mild Case of Polio” and Type Two Poliovirus
Question: What’s happening in New York is raising awareness of children who have the poliovirus but only have flu-like symptoms, are not being diagnosed and thus can spread it. The more I learn about Polio and PPS the more interested I get. I was sick in 1954 with the Summer Grippe. Recovered on my own, no doctors. My drop foot gradually appeared over the years.
How many of us were not diagnosed (initially) with polio, but with the Summer Grippe? Albert Sabin described it in 1946.
(Pages: 277 – 283 in The Polio Paradox.)
Additional Post: Polio hit me like a ton of bricks and I've always been puzzled by people in these groups who don't know when they got it and were never in a hospital. I have run into people who never had to wear special shoes or like you said never went to the hospital but yet they say they had polio. I know polio affected us all differently, but the fact that my foot dropped, toes curled, and noticeable limp and size of leg, makes it hard to imagine not knowing!
Additional Post: I can see why someone might not ever know they had polio at the time. I had a girlfriend who had gotten it in one of her legs. Her leg never was shorter, she never had to wear a brace or different size shoes. When she was reaching age 50, then she needed a brace because her foot on that leg was staring to drop. We are all so different, yet the same.
Additional Post: My whole family came down with "Summer Grippe" in 1948. Seven kids, I was the youngest at 1 year. No doctor was called till I started walking again and dragging one foot. We were some of the lucky ones; no iron lungs or long hospital stays. Dealing with PPS now is tough, having all sorts of problems with pain in the back and legs. My siblings have also had PPS problems. I'll always wonder how many Summer Grippe children have developed muscle weakness issues that have never been attributed to polio.
Dr. Bruno’s Response: All three types of poliovirus caused paralysis. The Type I poliovirus is the epidemic virus that paralyzed(es) most people. Albert Sabin discovered that it was the Type II poliovirus that apparently caused "the Summer Grippe” (and it was also the cause of the polio epidemic in Iceland the next year).
Unfortunately, we will never know how many Summer Grippe children there were nor how many children went undiagnosed with "non-paralytic" polio. (There are numerous articles about "non-paralytic" polio under the topic of “poliovirus” in the Encyclopedia of Polio and PPS.)
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“Bruno Bytes” – How it all began
Bruno Bytes are published quarterly, through a collaborative effort between Dr. Richard L. Bruno, HD, PhD (biography above) and the PA Polio Survivor’s Network. They are answers to questions posted in the “Post-Polio Coffee House” (on Facebook).
This partnership began in November, 2014.
Bruno Bytes help to teach polio survivors, spouses, caregivers and health care professionals about the many and varied topics related to the physical and emotional issues associated with having had polio and about the importance of managing PPS.
Note: Bruno Bytes are for education only. Any personal treatment plan must be determined in association with a PPS knowledgeable health care professional.
Bruno Bytes are published quarterly, through a collaborative effort between Dr. Richard L. Bruno, HD, PhD (biography above) and the PA Polio Survivor’s Network. They are answers to questions posted in the “Post-Polio Coffee House” (on Facebook).
This partnership began in November, 2014.
Bruno Bytes help to teach polio survivors, spouses, caregivers and health care professionals about the many and varied topics related to the physical and emotional issues associated with having had polio and about the importance of managing PPS.
Note: Bruno Bytes are for education only. Any personal treatment plan must be determined in association with a PPS knowledgeable health care professional.