Jun 20 2012

Polio Perspecvtive

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Polio Perspective – October, 2017

Millie Malone Lill, Editor        Wilma Hood, Publisher

In This Issue

Diagnosing Post-Polio Syndrome in the Elderly, a Case Report

by Morolake Amole 1,* and Nadine Khouzam-Skelton  

PIVOTAL MOMENTS:  FLORENCE KENDALL AND THE FACTS ABOUT “SISTER” KENNY.

By Elizabeth Kendall McCreary

Post-Polio Sequelae Monograph Series

NY: random harvest, 2017 

Cirque de Soleil

by Millie Malone Lill 

Web Corner 

Other Polio Newsletters 

A Little Bit of Humor

******************************************************

Diagnosing Post-Polio Syndrome in the Elderly, a Case Report

by Morolake Amole 1,* and Nadine Khouzam-Skelton

Abstract: Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome.  Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.  

Keywords: neurology; ambulatory care; comorbidity; primary care; geriatrics

  1. Case Presentation

A 78-year-old male with a past medical history of hypertension, coronary artery disease status post myocardial infarction requiring stent placement, asthma, gastroesophageal reflux disease, and bulbar poliomyelitis presented to our Primary Care clinic for evaluation of worsening fatigue, exertional shortness of breath, dysphagia, chest tightness and generalized weakness.

The patient reported a diagnosis of poliomyelitis in 1956 after noticing flu-like symptoms and weakness. His course was complicated by dysphagia requiring tracheostomy placement, but noiron lung therapy was required. He reported appropriate recovery from his condition with few noticeable sequelae.

Vitals signs were within normal limits. Physical exam revealed an elderly male, alert, oriented, in no acute distress and with non-labored respirations. Neurological exam revealed mild bilateral upper extremity weakness. Sensation and reflexes were intact; positional and balance testing were normal and there were no cranial nerve abnormalities. Remaining cardiopulmonary, abdominal, musculoskeletal and skin exams were within normal limits. Routine blood testing revealed no abnormalities.    

More extensive outpatient workup was initiated to elucidate possible etiologies of the patient’s symptoms. High Resolution CT Scan showed eventration and elevation of the right hemidiaphragm

but no evidence of honeycombing, ground-glass opacification, suspicious lung nodules, bronchiectasis or bronchial wall thickening. Pulmonary Function testing was performed and results showed very mild restriction with a total lung capacity of 79%. A sleep study was also ordered and revealed mild obstructive sleep apnea.  

Electrocardiogram revealed sinus rhythm and no ST-T wave abnormalities. Stress Echocardiogram showed an ejection fraction of 70%, no signs of ischemia and a non-reversible infarction in the basal Geriatrics 2017, 2, 14; doi:10.3390/geriatrics2020014 www.mdpi.com/journal/geriatrics Geriatrics 2017, 2, 14 2 of 4           

inferolateral region that appeared unchanged from prior stress testing. Esophagogastroduodenoscopy (EGD) was also performed to further investigate the patient’s complaints of dysphagia. EGD showed a hiatal hernia in the esophagus as well as an esophageal schatzki’s ring requiring balloon dilation. A diagnosis of post-polio syndrome was made given the patient’s distant history of poliomyelitis, mostly negative multi-system workup and presenting signs. Auto-pap was issued to the patient for the treatment of sleep apnea. Physical therapy was recommended with an emphasis on the avoidance of overexertion.          

  1. Discussion

2.1. Poliomyelitis

Poliomyelitis is caused by an enterovirus transmitted fecal-orally. Once inside the body, the virus can cross into the central nervous system (CNS) and affect the motor neurons of the spinal cord,

brainstem and motor cortex, leading to paralytic poliomyelitis. Polio infection initially presents with malaise, fatigue, fever, sore throat, nausea and vomiting. Symptoms can then progress over the course of several days to include myalgias and muscle stiffness/spasms. In some patients, symptoms progress even further to paralysis.     

The type of paralysis produced depends upon the portion of the CNS affected. For instance, spinal polio is caused by viral infiltration of the anterior horn of the spinal cord, and bulbar polio is caused by viral damage of the bulbar portion of the brainstem. Spinal poliomyelitis leads to asymmetric paralysis of the limbs due to spinal cord motor neuron damage. Bulbar polio, a significantly more rare form of poliomyelitis, affects the cranial nerves and thus the muscles they supply leading to respiratory difficulty as well as trouble with chewing, swallowing, and controlling facial movements [1].             

2.2. Post-Polio Syndrome

Post-polio syndrome is a phenomenon that is characterized by muscle weakness and fatigue in patients with a history of poliomyelitis with complete recovery and who have had a long symptom-free period. In such patients, the key to diagnosis involves the history of polio, the presence of classic symptoms of motor neuron disease and the exclusion of other diagnoses [2]. The exact prevalence of post-polio syndrome is not known. According to the National Institute of Neurological Disorders and Stroke (NINDS), researchers have estimated that post-polio syndrome affects approximately 25%–40% of polio survivors.              

The exact pathophysiology of post-polio syndrome is unknown, however, there are several theories that have been proposed. One theory is that during the acute infection, excess damage of motorneurons leads to the development of collateral motor neurons. Over time, it is impossible to maintaininnervation and capillarisation of these compensatory motor neuron sprouts. The result is muscle weakness, muscle pain and easy fatigability. Another theory is persistence of polio infection. Several studies have reported the presence of poliovirus genome fragments in the cerebrospinal fluid (CSF) of patients with post-polio syndrome. A third theory is that there is a delayed immune response to the poliovirus, leading to chronic inflammation and thus persistent symptoms of poliomyelitis. This theory proposes treatment with immune modulators as means of combating the chronic inflammation [3]. Another proposed theory is that muscle weakness and fatigability may be the result of the normal ageing process causing symptoms in patients with post-polio syndrome [1]. It is possible that most of the symptoms experienced by this cohort of patients (elderly patients with a history of poliomyelitis infection) may be, mostly or in part, due to senescence.            

Several proposed diagnostic criteria exist for post-polio syndrome, but most are based upon the criteria proposed by Halstead in the 1991 paper Assessment and differential Diagnosis for Post-Polio Syndrome. Criteria for the diagnosis of post-polio syndrome are as follows: (1) Prior diagnosis of polio must be confirmed; (2) There must be a period of functional and neurological stability; (3) There must Geriatrics 2017, 2, 14 3 of 4 be the onset of new neurological symptoms like weakness or fatigue; and (4) There must be an attempt to exclude of other medical diagnoses that may cause similar symptoms [4]. No specific mode of treatment exists. Treatment is mainly supportive, focusing on physical therapy and palliation. Physical therapy is used to build endurance but also focuses on avoiding overuse. Other therapies are aimed at improving quality of life by adding aids such as walkers. There is little in the way of pharmacologic treatment for this condition. Psychotherapy may also be beneficial given the significant psychological impact that poliovirus as well as its sequalae have on patients [1]. 2.3. Primary Care Management of Post-Polio Syndrome in the Geriatric Population with Comorbidities Post-polio syndrome is a fascinating disorder for the geriatric population. Its prevalence now in the United States can be correlated with 1950s epidemics. However, it is a difficult diagnosis in the ageing population because many of the classic symptoms of the disorder overlap with other disease processes affecting older populations, thus necessitating the need for extensive outpatient testing to exclude other plausible diagnoses. In patients with a history of heart disease, cardiac testing may be necessary to exclude acute coronary syndrome as the etiology of exertional shortness of breath and fatigue. This is even more important if the patient is female or has a history of diabetes mellitus, because these groups often present atypically. Electrocardiogram, echocardiogram, exercise or nuclear stress testing and possibly even heart catheterization may be necessary to further evaluatethe condition [5].  

Pulmonary etiologies must also be explored, even more so if the patient has a prior history of lung disease. In these instances, shortness of breath could be more attributable to decreased lung capacity as opposed to residual diaphragmatic paralysis from post-polio syndrome. Therefore, pulmonary function testing, chest imaging (high resolution CT imaging) or polysomnography may be necessaryto evaluate complaints of breathing difficulty, fatigue and generalized weakness.             

If the patient reports swallowing difficulty, it may be important to rule out gastroesophageal pathologies such as stricture or reflux prior to equating these symptoms to the prior history  of bulbar polio. Consider esophagogastroduodenoscopy to further evaluate for anatomic abnormalities. It is also important to exclude other neurologic pathologies such as Parkinson’s disease, Amyotrophic lateral sclerosis or multiple sclerosis, as these symptoms also cause neuromuscular deficits similar to post-polio syndrome. Electromyography, lumbar puncture and MRI may benecessary. Electromyography is particularly helpful because findings can suggest where certain prior disease-affected muscle groups are located.              

Excluding age as a cause of symptoms is very difficult, as there is much symptom overlap. If decline appears to be age-appropriate, then some symptoms may be related to ageing. There is littleharm in attributing part of the disease process to age, as treatment of age-related decline in function is akin to treatment of post-polio syndrome.         

Post-polio syndrome is an important primary care topic because its diagnosis requires extensive testing that is often prompted by the primary care specialist. Recognizing the signs and symptoms of the syndrome as well as a remote history of poliomyelitis is necessary [6].         

  1. Conclusions

Post-polio syndrome is an interesting disorder characterized by new neuromuscular deficits that present years after the resolution of a polio infection. There are several diagnostic criteria, but one of the most important is the exclusion of other possible diagnoses. Post-polio syndrome diagnosis is even more difficult in the elderly population due to the presence of multiple comorbid conditions. Extensive testing may be necessary for an appropriate diagnosis in this population.                  

Acknowledgments: The authors would like to thank the University of South Florida College of Medicine Department of Internal Medicine for its contribution to the preparation of this manuscript.

Author Contributions: All authors contributed to the assembly of the information for the preparation of this manuscript. M.A wrote the paper and N.K.S revised the manuscript.          634–642.

 

PIVOTAL MOMENTS:  FLORENCE KENDALL AND THE FACTS ABOUT “SISTER” KENNY.

By Elizabeth Kendall McCreary

Post-Polio Sequelae Monograph Series

NY: random harvest, 2017

As early as 1931, Henry Kendall of Baltimore’s Children’s Hospital School recognized that immobilization of polio survivors with splints and casts was preventing muscle contractions and jointdeformities but was not allowing muscles that still had functioning motor neurons to move again. With his wife, physical therapist Florence Kendall, the Kendalls recommended that initial splinting be followed by gentle massage of muscle spasms, stretching and careful muscle training.

But in 1940 a self-taught “nurse,” Australian Elizabeth Kenny,came to America with a “new concept” for the cause and treatment of polio that she said was “diametrically opposed to those accepted throughout the medical world.” Thus Kenny was welcomed to America wielding misinformation about polio the disease and unnecessary boiling, blistering hot packs.  Elizabeth Kendall McCreary, the Kendall’s daughter, recounts the battle between the Kendall’s scientific studies and clinical expertise versus the media’s extolling Kenny’s “alternative facts” about polio.                 Dr. Richard L. Bruno, Editor

Florence Kendall and Elizabeth Kendall McCreary

I want to share with you some stories of pivotal moments in Florence Kendall’s professional career. You may know her as “The Physical Therapist of the Century,” the #3 orthopedic physical therapist in the world (#1 in America, #1 woman), the recipient of numerous honorary doctorates and of all the top awards in her profession.  But all the accolades, fame, celebrity, celebrations and applause that are associated with Florence Kendall weren’t always there for Florence or for her husband, Henry.  People often ask what made Florence so strong? Part of her strength was gained by climbing mountains of adversity – especially during the decade of the 1940’s. And that’s where I’m going to take you.

A War Within a War

The ‘40s was a decade of discouragement, disappointment and even despair for the Kendalls, but it was also the decade of their greatest challenges and growth, and that’s why it’s important for you to know about it.  This decade (and even longer) was when the Kendalls were probably two of  the most politically incorrect people in America. They went against a tidal wave of public opinion that included the press, the A.M.A., their own PT associates, prestigious journals, Congress, the FBI, the White House, Hollywood and, most of all, the Diva of the Decade – the second most admired woman in America – “Sister” Kenny. It was an extraordinary time.

What I want to do is share those stories that will not only give you greaterinsight into and appreciation of Florence, but also stories that may empower you – and give you strength to persevere against all of the challenges you may face. Hopefully, your own problems will pale and seem much more surmountable when put into the perspective of what Florence and her husband, Henry (a.k.a. Bob), went through to reach the pinnacle of their profession. That summit was not easily reached.  First, a little background, the setting and cast of characters of about 70 years ago:

  • A president who had had polio and was confined to a wheelchair and who had established what was to be the pre-eminent polio treatment center in the US in Warm Springs, Georgia.

  • A partially blind physical therapist in Baltimore, Henry O. Kendall, who, in over 15 years at the Children’s Hospital, had established an excellent reputation for his care and diagnosis through muscle testing of polio patients, who was called a “master clinician” and who, in 1935, married Florence.  Together, they wrote a U.S. Public Health Bulletin (#242) published in early 1938 on the after-care of polio. It was well received. Florence says that was her first taste of the politics of polio (another good story that won’t be told her

  • A “nurse” from Australia – who had never even graduated from a nursing school – Sister Elizabeth Kenny came to the US in 1940 saying she had a “revolutionary treatment for polio” that she said was completely opposed to the so-called orthodox treatment, her treatment resulting in an 80% recovery rate compared to 13% for the orthodox methods. In the Kenny “system,” muscle testing, braces, splints, casts and even massage were not used (“Massage is altogether forbidden,” said Kenny in February 1942) and especially there was to be no muscle testing. Kenny also said that polio was a disease of the skin, in spite of a decade of overwhelming neuropathological and neurophysiological evidence that polio was a viral disease of the neurons that made muscles move.

  • A public, desperate to find answers, desperate for hope when it came to the scourge of polio that devastated lives and families. No one knew what caused polio or how it was spread. At times of epidemics whole communities were known to put up signs saying “Children Under 16 Not Allowed To Enter This Town.” Quarantine signs were put on homes. Affected persons were immediately isolated in hospitals often against the will of parents or family. It was a time of individual rights versus public health mandates. This was also a public dealing with World War II and all the fears, separations, deaths and injuries of war, a public desperate for someone bearing good news and hope. Fear defined the mood of the early 1940’s. Hope is an antidote to fear and hope is what Sister Kenny brought. She could not have arrived in America at a more auspicious time for herself.

A Pivotal Day, A Pivotal Hour

I would like to take you back over 70 years to what I believe to be the most pivotal day, perhaps the most pivotal hour, in the professional lives of the Kendalls.

It’s Tuesday January 21, 1941 at a Minneapolis hospital where the Kendalls had been invited, along with others, to observe Sister Kenny’s methods for three days.  It’s 9:00 AM on the morning of the third day and the Kendalls had been told that Sister Kenny wanted to meet with them. They arrived to find Sister Kenny alone with the Public Health Bulletin they had written. She wanted to discuss it.

It was evident over the previous two days that there were disagreements, and Sister Kenny did not take well to disagreement. In fact, Alice Lou Plastridge, a physical therapist from Warm Springs, described Sister Kenny during those three days:“She had an antagonistic attitude towards everyone” and “She

seemed to feel every question was a criticism rather than a sincere query.” “She sincerely believes that her method is not only the best, but the only effective one.” Plastridge also referred to her “stubbornness and belligerence.”

So Florence Kendall started out trying to be conciliatory and said to Sister Kenny (and I am quoting from Florence’s handwritten notes): “You know there are many things we could get together on by being open-minded and discussing some of the problems, and we’re ready to give you credit for a

contribution in the form of heat for acute cases. There are not as many points of difference as it seems.”

But Sister Kenny was not receptive to conciliatory comments. Kenny misquoted Florence’s remarks, whereupon Florence said to Kenny, “We do not wish to sit here and be so completely misquoted unless we can be in the presence of the doctor in charge.” They placed a call for the doctor at 9:15 AM.

They waited. Things began to deteriorate further. The Kendalls said they had been promised they would see a treatment. Sister Kenny said, “Too bad.”

Henry Kendall replied, “When you ask me questions, as you did yesterday, I have given you sensible answers. But when I ask you for scientific facts, you’ve answered by saying, ‘You’re talking about a disease that doesn’t exist, or further cover up by referring to mental alienation’.”

Kenny was angry that the Kendalls were going to write about her after only a few days, and she asked them how long they planned to stay in Minneapolis.  Henry Kendal responded, “AS LONG AS IT TAKES TO EXPOSE YOU FOR THE FRAUD THAT YOU ARE!”  Henry O. Kendall had just called the woman who was to become the second most admired woman in the United States (after Eleanor Roosevelt) a fraud.

The Kendalls then told Sister Kenny they would wait in another office in the hospital until a doctor could come. While waiting they got a phone call, about 45 minutes later, saying Kenny had left the hospital, called for her associate to leave, and that she was going to return to Australia. And she left, 10 days later, but not before she wrote the following on January 28 to the Medical Director at Children’s Hospital about the Kendalls:

“It was impossible for me to demonstrate my work to these visitors, owing principally to the fact that they were absolutely non-receptive.” She also said “Mr. and Mrs. Kendall could not understand what I was talking about [&] I have definitively proved the symptomology of the disease to be exactly opposite to that accepted by Mr. and Mrs. Kendall. Therefore a treatment based on the wrong symptomology cannot be satisfactory.”

Although the Kendalls would have liked a cooperative search for the truth, this was not to be. The battle lines had been drawn.  Kenny’s departure generated a great deal of press, and the public was led to believe that a recalcitrant orthodox medical establishment was blocking her innovative approach to the dreaded disease. When she returned a few months later, the press, public, politicians and even the medical community received her as a heroine returning to wage and win a war.

Two Pivotal Years

That pivotal day was followed by two pivotal years, 1941 and 1942, when the Kendalls were clearly on the losing side of the political and propaganda war against polio. Sister Kenny used the press and public opinion to try to coerce the medical profession into adopting her methods. And, for a time she succeeded.

In probably one of her lowest moments, Florence wrote the following:

“An animal in the heart of a stampede commits suicide if he stops running with the herd. Sometimes propaganda has the power of a stampede, and to resist the force is suicidal, too. Be that as it may – if the herd is being led to slaughter, one does not risk too much in risking suicide.”

The Kendalls knew that by not going along with the herd, by not being politically correct, they were risking professional suicide.  Some of the lowlights of 1941 included Kenny’s return after several months.  Her return was welcomed by the National Foundation for Infantile Paralysis that, in June 1941, jumped on the Kenny bandwagon and endorsed her methods (they jumped off the bandwagon a couple of years later). Toward the end of 1941, the A.M.A. also endorsed Sister Kenny’s methods.

In October 1941 a flawed study by two St. Louis physicians appeared in a prestigious orthopedic journal. It mistakenly portrayed prolonged immobilization (up to 18 months) and prolonged rest and protection as being the “Kendall Method.” It was not. The article concluded that the “Kendall Method” was not effective in the treatment of polio. Imagine how you would feel if your life’s work were totally misrepresented and dismissed as ineffective in a prestigious medical journal! And how would you feel about the veracity, validity and reliability of any “professional” journal articles?

About five months later in the Spring of 1942, the Kendalls learned something shocking about the published study from a Dr. Irwin from Warm Springs. Florence wrote:

“One evening he invited Mr. Kendall and I to join him in the cocktail lounge. He said he wanted to tell us how we had been‘set up’ for the so-called study in St. Louis. It had all been planned…in order to discredit Mr. Kendall’s polio treatment.”

The damage had already been done. In January 1942, an article appeared in the Physiotherapy Review by a Dr. Hansson based on that flawed study. He wrote, “McCarrol and Crego, by their critical study of this long immobilization have destroyed the Kendall myth.” He also said that hopefully this method “will be discontinued forever to the relief of patients and parents.”

Now those are discouraging words! Florence started calling her husband “Myth Kendall.” Still, they responded by writing an article called “Let’s Immobilize False Impressions.” But there were darker days ahead.  The Medical Director at Children’s Hospital was under intense pressure to adopt some of Sister Kenny’s methods, and he was about to capitulate.  [The Kendalls did not see any need for the constant application of blistering hot packs when they had documented the ability to relieve spasm with gentle massage and stretching. Said Florence, “Seldom discussed were the adverse reactions to the hot packs. An adult who was treated at age 8 for polio says the heat treatments were the worst aspect of his illness, and to this day he cannot tolerate a hot bath. One boy was reported to have been hot-packed until his temperature reached 108 degrees F and he succumbed.” R.L.B.]

Florence wrote:

“We were not about to be seduced into doing something we felt was wrong” and Mr. Kendall “threatened to resign rather than succumb to the dictates of (what he called) ‘Hearst Newspaper

Therapy’.”

Unfortunately, freedom of the press can very easily and quickly become tyranny of the press – and that’s exactly what happened.  Even the Maryland chapter of the American Physical Therapy  Association jumped on the Kenny bandwagon. The Kendalls had helped found the Maryland APTA and Florence served as its first President in 1939. So, imagine how they felt when, in 1944, the Board of Directors concluded that the Sister Kenny concept of polio treatment was the only logical, sensible manner to treat this dreaded disease. Then again, in 1946, the Maryland chapter announced unqualified endorsement of Sister Kenny’s theories, and members offered lifetime membership to Sister Kenny, which was promptly accepted.

The A.M.A. had tried to jump off the Kenny bandwagon in 1944 but, by 1945, Sister Kenny’s popularity had become so phenomenal that there was no stopping the tidal wave of public opinion. In fact, in early 1941, congressional and FBI investigations of opposition to Sister Kenny were proposed and received front page newspaper coverage. Kenny said, “The only thing which will make me alter my plans for leaving will be an immediate congressional investigation of the situation.”  To be against Sister Kenny at that time was like being against the flag, apple pie and motherhood. It just wasn’t tolerated. Fortunately, when Roosevelt died in early Spring 1945, these proposed investigations also died.

I think it is worth nothing that, while in 1945 America, congressional investigations of people opposed to Sister Kenny were planned, there was quite a different perspective on Kenny in England. The August 1945 British medical journal The Lancet stated:

“The ‘Kenny concept’ had been built up to a fictitious importance largely by salesmanship and wishful thinking.” “…it is the duty of honest physicians to oppose and expose false prophets irrespective of their sincerity. Fidelity to sound science is not a glamorous pursuit, not a financially lucrative one, but it does enhance ones self-respect, and, in the long run brings the respect of the world.”

Then, in 1946, Hollywood made a movie about Sister Kenny starring Rosalind Russell. It’s a real tearjerker. Once again, the British perspective was a good one. A report in the journal British Association of Physical Medicine describes the movie as “…an exaggerated sentimentality and also

offensive sensationalism which should find no place in a film professing to be of scientific value.” And, regarding the film’s attack on the Kendall’s “orthodox method,” it stated, “This portion deserves condemnation for sheer bad taste.” That was especially true because the little boy shown in the film

with two leg braces representing the orthodox treatment of polio was not even a polio patient. He had spina bifida. That was a well-kept Hollywood secret.

Pivotal Exemption

Jumping ahead to the year 1950, you’d think by then that “The Diva Kenny” would no longer be front and center stage. But, in that year, the U.S. House of Representatives passed a resolution allowing Sister Kenny permanent access to the United States without visa or passport, allowing her to stay indefinitely. Congress exempted Kenny from all existing immigration and alien laws. This for the woman Henry Kendall had called a “fraud” nine years before.

So what did the Kendalls do in the late 40’s and early 50’s? They did not let common sense become a casualty of political correctness. They did the hard and tedious work of science, helping thousands of patients and, unlike Sister Kenny, keeping meticulous records for comparative studies.  In 1947 they did a flexibility study of almost 5,000 Baltimore school children to determine normal forward bending in different age groups because Sister Kenny was requiring all patients to touch their foreheads to the knees before they would be released from her care. This is not the kind of work that gets any press. But the Kendall’s study is now in every edition of their text Muscles: Testing and Function, the first edition published in 1948.  [The Kendalls found that only about 1% of boys and 4% of girls 6 to 18 years old who had not had polio were able to touch their foreheads to their knees.  R.L.B.]

Polio’s Pivotal Year

1952 was another very pivotal year in the professional life of the Kendalls. Not only was their second book, Posture and Pain, published and called twenty years ahead of its time, 1952 was the year of America’s worst polio epidemic (over 57,000 cases).  The Kendalls left Children’s Hospital and opened a private practice, a pretty wrenching experience that took a lot of courage. The Kendalls had used up all of their meager resources to write two books and, unlike Sister Kenny who had received massive amounts of money, they had received no funding for their treatment or research. And they had 3 young daughters to take care of.

At that time, the Kendalls weren’t even sure that doctors would refer patients to them privately. It took a great leap of faith and courage to start a private practice. Their own professional organization threatened to expel them. At one point the Kendalls actually tendered their resignation from the national physical therapy organization rather than be condemned by it.  But remember Dr. Hansson who wrote about dispelling the “Kendall Myth” in 1942? Well, in 1956, fourteen long years later, he reviewed Posture and Pain in an orthopedic journal and wrote the following:

“The authors’ integrity was well-established when they, almost alone among the country’s physical therapists, stood by their convictions and opposed Sister Kenny’s questionable idea of the pathology and the therapeutics of poliomyelitis. They have again shown the courage of their convictions by publishing a book on posture and pain in these days of antibiotics and steroids, which seem to dominate our therapeutics.”

And something else happened in 1952. Sister Kenny died in Australia.  [The Australian and British medical communities had rejected Kenny in the late 1930’s for exactly the same notions about polio – “diametrically opposed to those accepted throughout the medical world” – that caused her to be

welcomed in America. Despite the Congressional kudos of 1950, the American medical community and National Foundation for Infantile Paralysis feared that Kenny’s dogged pursuit of publicity and her angry public disagreements with the scientific findings that polio was in fact a disease of the central nervous system would cause Americans to reject the polio vaccine that in development. By 1951, it was time for Kenny to go.   R.L.B.]

Pivotal Courage

It took an unbelievable amount of courage on the part of the Kendalls to stand up against the most powerful forces in the country, but that’s what made Florence strong. If she were here today she would be telling you not to get your exercise by jumping on and off the latest bandwagons, but by swimming against the tide of public opinion when necessary. And, don’t be afraid to be politically incorrect!

Cervantes said, “He who loses wealth loses much; he who loses a friend loses more; but he that loses courage loses all.”

The Kendalls did not lose the courage of their convictions. That’s the message I’d like to leave you with. Despite so many stories of continued professional setbacks, the Kendalls left a legacy of courage, perseverance and a dogged determination to find and implement the facts. I hope their story will empower you in your own lives, and that you will persevere and try to make the changes and improvements that you know are needed in health care today.

 

Cirque de Soleil

by Millie Malone Lill

Our bodies are wonderfully made when you think about it.  Imagine, for instance, that a virus sneaks up on a 4 year old child.  It strikes the spinal cord and squirts poison on half or more of the child’s motor neurons.  Those neurons had been doing a great job of handling this little body as it went from tiny little collection of cells, to infant, to toddler, to preschooler.  They were juggling messages to her little brain, saying Bend, Lift, Move all her life.  Now half or more of their staff are dying off.  I imagine them as little performers, doing a serious job of keeping that body going for an expected 80 or more years.

They send out distress signals, calling for more workers.  No can do, comes the message.  Figure it out on your own.  A committee meeting ensues.  They form teams of sorts.  Neuron #5, you send out as many tendrils as you can.  Yes, you have to supply your own muscle cells, the ones already assigned to you, but now you have to help out with this other muscle as well.  Same for all the rest of you.  Send out those tendrils!  Juggle that load.  Swing from that trapeze, upside down if necessary.

Oh, look, she wants to walk!  Great, good for her, but the leg muscle is orphaned.  OK, Neurons #6-10, you know the drill.  Get this kid walking.  There ya go.  Knew you could do it.  Keep up the good work.  Oh, man, thought maybe this kid just loved to read and you guys wouldn’t have to do quite so much work, but no.  Look, the little brat wants to read sitting on the branch of that apple tree!

Oh, you think that’s bad?  Now she wants to take dance lessons, go swimming and learn to roller skate.  Divide and multiply, Neurons.  Do what you can.  This job will not get easier, I can tell you that much.

Juggle those messages, swing on that trapeze, stretch further than anyone should have to stretch.

Oh, no.  She is getting married.  She will want kids, you know she will.  Well, at least the fetus will have its own neurons, but you will still have to keep this ungainly body moving.  She’s marrying a farmer, of course.  You guys really have your work cut out for you.  She will be walking miles to get the cows in from the pasture, milk them, turn them back out, feed the calves, slop the hogs, separate the cream from the milk…and she has housework to do, bread to bake, meals to fix.  Laundry, cleaning, taking care of those kids, the list goes on and on.

As time goes on, those little circus performers start to get tired.  The tendrils they have sent out begin to shrink and wither and age.  They valiantly try to keep things going, but  the juggling and the aerial acts are starting to be a bit wobbly.  The ones keeping her legs going quit.  She struggles to walk but it is exhausting for her and for the poor over extended neurons.  A wheelchair helps.  It helps a lot, actually, as some of those neuron need a rest or they will die.

Life slows down.  Some of the neurons die, but some struggle on.  She finally understands that she must slow down.  Cut down on her activities a little, use what assistive aids she needs.  She’s had a good life but she is tired.  The neurons breathe a sigh of relief as she gently glides to a slower life style.  More reading, fewer apple tree branches.  Asking for help, letting people do for her some of the things she has always done for herself.  Crying, sometimes, in mourning for all she used to do and can no longer do, but mostly enjoying a simpler life.  Time to smell the roses.  Let her Magic Chair take her where her legs can no longer go.  Life is still good.  And the neurons thank her.

 

Web Corner

There’s no moaning and groaning with these active adults

http://www.blufftontoday.com/sun-city/2012-05-23/theres-no-moaning-and-groaning-these-active-adults

From Country Doctor to International Epidemiologist?

https://www.endpolio.org/from-country-doctor-to-international-epidemiologist?adbsc=wpd171882751&adbid=10155836847824837&adbpl=fb&adbpr=78976274836

Save a bundle on meds?

https://www.blinkhealth.com/ (I have used this myself and got my medication for 1/3 of  my copay with my Medicare Advantage plan)

Sultan of Sokoto advises Nigerians to ensure compliance on eradication of poliomyelitis

http://aitonline.tv/post-sultan_of_sokoto_advise_nigerians_to_ensure_compliance_on_eradication_of_polio

Seven signs you probably had anxiety as a child.

https://themighty.com/2017/10/signs-i-had-anxiety-as-a-child/?utm_source=The+Mighty+Newsletter&utm_campaign=a57448ae69-EMAIL_CAMPAIGN_2017_10_19&utm_medium=email&utm_term=0_083492ca1a-a57448ae69-201491717

Live every moment

https://www.facebook.com/goalcast/videos/1601308876612963/

9 signs that adrenal fatigue is behind your joint pain. Etc.

http://theheartysoul.com/9-signs-of-adrenal-fatigue/

About the director of the movie Breathe

https://beta.theglobeandmail.com/arts/film/motion-capture-whiz-andy-serkis-makes-a-double-debut-as-director/article36645120/?ref=http://www.theglobeandmail.com&

A light hearted look at polio

http://mpnews.com.au/2017/10/17/light-hearted-look-at-polio/

A couple confronts polio in the movie Breathe

http://nprillinois.org/post/couple-confronts-polio-breathe#stream/0

 

Other Polio Newsletters

http://www.papolionetwork.org/

https://www.polioaustralia.org.au/

http://poliosurvivorsnetwork.org.uk/

http://www.post-polio.org/

 

A Little Bit of Humor

Farmer John lived on a quiet rural highway. But, as time went by, the traffic slowly built up at an alarming rate. The traffic was so heavy and so fast that his chickens were being run over at a rate of three to six a day.

So one day Farmer John called the sheriff’s office and said, “You’ve got to do something about all of these people driving so fast and killing all of my chickens.”

“What do you want me to do?” asked the sheriff.

“I don’t care, just do something about those crazy drivers!” So the next day he had the county workers go out and erected a sign that said:  SLOW–SCHOOL CROSSING
Three days later Farmer John called the sheriff and said, “You’ve got to do something about these drivers. The ‘school crossing’ sign seems to make them go even faster.”

So, again, the sheriff sends out the county workers and they put up a new sign: SLOW: CHILDREN AT PLAY

That really sped them up. So Farmer John called and called and called every day for three weeks. Finally, he asked the sheriff, “Your signs are doing no good. Can I put up my own sign?”

The sheriff told him, “Sure thing, put up your own sign.” He was going to let the Farmer John do just about anything in order to get him to stop calling every day to complain.

The sheriff got no more calls from Farmer John. Three weeks later, curiosity got the best of the sheriff and he decided to give Farmer John a call. “How’s the problem with those drivers. Did you put up your sign?” 

“Oh, I sure did. And not one chicken has been killed since then. I’ve got to go. I’m very busy.” He hung up the phone.

The sheriff was really curious now and he thought to himself, “I’d better go out there and take a look at that sign… it might be something that WE could use to slow down drivers…” So the sheriff drove out to Farmer John’s house, and his jaw dropped the moment he saw the sign. It was spray-painted on a sheet of wood:

‘NUDIST COLONY – GO SLOW AND WATCH OUT FOR THE CHICKS’

 

7 Responses to “Polio Perspecvtive”

  1. Thomas Christian says:

    Ole better git a hearing ade?

  2. ruth says:

    thanks for this news letter. My sister is having the same feeling of when she had polio at 6. I am helping her learn what could be happening. thanks for this as the doctor is not talking about it.

  3. Millie Lill says:

    Ruth, read all you can online and I also suggest that you join one of the Facebook polio sites. You can learn a lot from those of us who have been there and done that.

  4. Hilary Boone says:

    Why do we still have so much hassle trying to get decent medical care. Sharing experiences really does help us realise ‘It’s not just me’ which slightly lessens the frustration and stress. Millie as usual you have done a great job.

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