BluElf Polio Treatment

040599 Treatment

To avoid boring dialogue I have broken out descriptions and placed
them at the end. You can click on name and read the description then jump
back to the same place or wait and read all at the end. Since I could not
possibly describe all forms of treatment or equipment used by Polio survivors
I limit my essay to my personal experience.

Not all Polio patients survived the acute attack. Too many of them died. Fevers that high are dangerous but probably the chief cause of death was the loss of chest wall flexibility. The chest wall muscle became paralyzed and the patient just could not breath. The iron lung was introduced in the early 1900's and saved many lives. I was in an iron lung for a week or so.

The treatments received by survivors varied greatly. A conciseness was never reached on methods in the medical profession. Practice ranged from the Kenny method to the rigidity method.

The Kenny method was developed by Sister Kenny, not a nun but rather ex-army nurse from Australia. This method began with hot wrappings to ease the muscle pain. No braces or supports were used. Exercise was focused on one limb at a time, which did involve pain for the patient. The method proved successful many times in reducing paralysis and restoring function. Many parts of the method were generally adopted. However it does not seem that the Kenny method was any more successful than others when long term functionality was examined. (my interpretation)

The rigidity method focused on limiting movement of limbs. The body was restricted by all forms of metal and plaster. This kept the patient's pain low and provided support for movement. It did little to reduce paralysis or strengthen muscles. (my interpretation)

By 1954 when I had Polio a combination of the two was being used at Warm Springs. I bathed in the warm mineral waters. A physical therapist exercised my limbs every day. To help with support I was given a corset, braces and crutches. It may not have been the best way to treat a recent victim but it was OK by me.

When I left Warm Springs after that initial visit the muscles that were to come back alive had been defined for the rest of my life. A major loss were muscles in my trunk, stomach and back. Over the years this lead to severe scoliosis of the spine. A second major loss were quadriceps in my left leg which kicks the leg forward and provides stability when you walk. Later this would lead to hyper-extention of the left knee. Another loss were muscles in my feet which hold the foot straight. Later I began to walk on the inside of my feet leading to the need for corrective surgery.

There were a couple of other changes that were noticed. I am right handed but my left arm is stronger. For some reason the growth of the right side of my body was stunted. My right arm, leg, foot and chest were all physically smaller than the left. Determined compensation kept this form being obvious until many years later. All testing continues to show that I am very much left side dominate.

I attribute any physical ability I may have had to my home exercise program. My parents did them with me EVERY DAY for twelve years. Only now as a parent can I understand the intense determination required from my parents and the value of the gift given me.

The exercise routine varied a little over the years but the two basics were always included. These were stretching my heel cords and stretching my back. These were physically difficult for the caretaker. For all twelve years my father participated. As I grew larger my mother was replaced by one uncle and later a second uncle.

On a regular basis, every three months or so until I was eighteen, we would drive to Warm Springs for a check-up. This involved getting x-rays of my back and legs then a visit with Dr. Haag. He was a delight to visit, always chewing on a cigar and telling fun stories. I was always apprehensive because often we discussed my next visit to the hospital and what would be done. However every check-up trip was a maturing event because Dr. Haag always discussed hospital stays and new procedures directly with me before he talked with my parents. By the time I was in my early teens the type of suggested surgery and when it might be done became my decision and I vetoed some suggestions.

Each check-up required the rest of the day to visit the corset shop and the brace shop. These were required because I was a growing boy. I would get new and altered corsets. I would get new braces, new crutches, a head traction, a plastic jacket , a Milwaukee Frame, a head sling, altered shoes and other types of equipment. As I became an adult the most amazing fact about these check-ups was that everything was done on the same day. It is impossible to get the same quality and quantity of work done today in the same time period.

There were two type of hospital visits which I experienced. The first was full body cast back wedging and the second for corrective bone and muscle transplant surgery.

I had body wedging during four separate summers while school was out. These summers were during my most rapid physical growth periods, i.e. when I was young. The medical thought was that by having the spine forced straight and allowing it to grow even for a short period held in position would slow the scoliosis. Now I believe most people see it as a waste of time.

The process was simple but not very pleasant. My body was wrapped in plaster from just above the knees to just below my arm pits. Each week for six weeks my back would be x-rayed to see the spinal curve. Twice each week the cast would be cut and a larger block of wood inserted forcing my body against the spinal curve. After the 6th week my spine would appear in the x-ray to be as straight as possible, not to mention that my body in the cast would be shifted at unbelievable angles. For the last 10 days to two weeks the spine would grow? straight.

Eight weeks in a body cast for a kid who is really not ill is an experience. You are either on your back or your stomach and rolling over by yourself is an art form. Pooping is a real challenge. A metal bedpan is slid under your, raising your bottom about eight inches off the bed, then you do it up hill. At that time the hospital was not air-conditioned. I can not describe living in a body cast during a south Georgia summer. It lead to a lot of exposed body parts seeking ventilation. I lost all physical modesty at a very young age.

I was more fortunate than most patients in that my parents lived close enough to visit often. Every Wednesday they would make the four hour round trip to spent a couple of hours with me in the evening. Every Saturday afternoon they would drive down to visit, stay the night at a local motel (Fowler's) then spend all day Sunday with me. I can not imagine the toll this took on their lives. Even now I can not find the words to describe what they gave to me.

I made two additional visits to the Warm Springs resort. Both of these visits were to have corrective orthopedic surgery. The first involved two separate surgeries. Operation one was ankle stabilization on my right foot followed a week later with a hamstring reversal on my left leg. Then there was three months of healing and therapy. This visit took place when I was fourteen.

The second visit, and my last stay at Warm Springs, happened when I was seventeen. This was for ankle stabilization on my left foot.

Unlike body cast wedging I believe this treatment was beneficial. As a young person grows without the use of all muscles, limb deformities occur which impair mobility. Also, it is sometimes possible to attach healthy muscles at new locations to compensate for weak muscles and thus improve mobility. The description of my surgeries at the end will better explain their benefit to me.

The one other major surgery which people pushed me to have was spinal fusion. However I elected not to have that surgery during my youth for a number of sound and logical reasons. The deciding factor was a non-logical reason; the interruption of my social life. So for the following twenty years I built a career and family and tried to compensate for not having the fusion.

By the time I hit forty the scoliosis had become too much. The curve was so great that vertebras were pinching the nerve cells leading to my lower extremities. At times my right leg would become numb and my back seemed to always hurt. I had pain killers as strong as morphine (prescribed, not black market). Therefore I was left little choice beyond surgery or move into a wheelchair.

Spinal fusion for an adult is not an easy surgery. It involved two operations separated by a month. In total I was on medical leave from work for seven months. The surgery was a success because first I survived and second because my back is pain free.

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These were the major treatments I had for Polio. Since I am not in the high risk group for Post-Polio, I hope these will be the end and I can concentrate on MS.

Polio Main

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Treatments

iron lung
The iron lung saved a lot of lives. It's design has not changed in the last fifty years and some Polio survivors still depend on them to live. It is a huge metal tube laying horizontal. The patient slides into it feet first at an open end. A metal cap swings closed to cap the tube with the patient's head sticking through a small opening in the cap. The space between the opening's edges and the patient's neck is filled with air tight foam rubber. The patient lays on his back with only the head outside of the tube. Then the machine decreases air pressure within the tube at a breathing rhythm. This decreased pressure allows the patient's lungs to expand and thus breathe with less difficulty.
iron lung

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heel cord
Both of my heel cords would become tight. This may have been due to weak counter muscles but I also believe the decreased flexibility from braces was a cause. Stretching them was done with me on my back. Each foot was done separately. The adult held my leg down with one hand pressing down on my leg below the knee and the other hand would hold my heel as my foot rested on their forearm. The adult would lean toward my upper body with much of their weight pushing the foot up. This stretched the cord. The foot was held for a count of five and the process repeated twelve times.

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back
As I indicated one big muscle hit was to my trunk muscles, both abdomen and back. This lead to scoliosis of the spine. The larger curve shot out to my right. The stretching was for the tighter muscles on my left side.

I would sit on the edge of a narrow table. One adult stood in front of me and another would lean over the table behind me. The one behind would grip my body on both sides just above my hips, pressing down to keep my bottom on the table. The standing adult would grip my upper body just below my arm pits. Then I would be stretched up and over as far as possible to my right. I was held that way for five seconds and the process was repeated twelve times.

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corset shop
The corset shop was staffed with older ladies who knew their stuff and had rather be doing this than knitting at home. When you walk in you hear the hum of industrial strength sewing machines. I sat on a table as a lady took a few measurements but most of the fitting was done by sight, experience and the touch of gifted hands. After a few minutes you are sent on your way to return in a couple of hours. A good corset is a second skin even with plastic and metal flat rods sewn in to give vertical support. When you return you receive 2-3 custom made corsets that fit like a glove. It was always amazing and just part of the ladies' daily job.

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Brace Shop
This place was a wonder, where real live elves crafted braces and other equipment with speed, quality and magic comparable to Santa's Workshop. For example, if you needed a new leg brace you came in and stretched your leg out on a long piece of brown paper. They would trace your leg with a ball point pen. The circumference of the leg was measured where straps would go and pressure points were noted on the brown paper. In a couple of hours you would get a custom made brace which withstood the punishment of a active little boy.

These craftsmen could do the same for almost any support device and this included specialty braces that might be just a sketch from a doctor. They forged their own metal and custom sewed the straps and padding. The quality and uniqueness of their work is no longer done anywhere. It was an art lost when the brace shop finally closed and the last of the craftsmen retired.

For example, I still use the last set of crutches made for me at Warm Springs nearly thirty years ago. When I take them in to a shop for new leather I am always asked if they were made at Warm Springs. Once I tried to have a spare set made as exact duplicates. The manaer of the local brace shop told me, We can not do this kind of work. It was only done at Warm Springs where they made the metal and no one knows how to do it any more.

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Head Sling

The head sling was a torture device designed by Dr. Doom because his mother was the wicked witch in the Wizard of Oz. Its stated purpose was to stretch the spine in growing children. It was thought this would help the spine to grow straight. (Yea, sure.)

It was designed on the same principle as used to punish horse thieves in the old West. Cloth straps ran under the chin and the base of the back of your head. These straps were attached to a metal bar above the head. A rope was connected to the metal bar, ran through pulleys and connected to free hanging weights of 30-40 pounds. The victim would sit in a chair with the weight pulling the head upward for 20 to 30 minutes a day. (as treatment, sure)

The first time my uncle placed me in this device, he thought the weight was suppose to sit on the floor. So he proceeded to PUSH the weights DOWN to the floor. Luckily my parents noted his mistake quickly and made corrections, since I could not say anything with my jaws clamped shut hanging two feet above my chair.

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Plastic Jacket

A plastic jacket is just that, a plastic - jacket. It was used to support the trunk better than a corset. They were made by creating a mold of the body then conforming hot plastic around the mold. Thus it fit perfectly, when it was new. It was split right down the front. To get in, one would spread it open, slip in and lace it up.

The jacket was more appropriate for broken backs than for spinal curves. The support provided probably did more harm than good since the trunk muscles did not have to work as much and got weaker rather than stronger.

The plastic jacket did have one great benefit. Since it was solid and never lost its shape, a growing youth's body could only spread out below or above the jacket. This gave girls a great figure early in life and gave boys the Cheyenne Bode look.

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Ankle Stabilization
This surgical procedure is also call a triple arthrodesis. It is used to stabilize the foot at the ankle, allowing the foot to only move up and down. A normal foot also has lateral movement at the ankle. This lateral movement outward caused problems. With a lack of muscle control I began to walk on the inside of my foot, on the arch. This affected my balance and increased the possibility of additional damage to my legs and knees.

The procedure is complicated orthopedic surgery. Bones are broken around the ankle then repositioned to allow limited motions, just up and down. Two long steel pins, about ten inches each, are inserted into the foot to hold things in alignment as the healing process begins. One pin enters through the heel and runs through the ankle reconstruction and up along the leg bone. The second pin enters between the toes running through the middle of the foot and into the ankle reconstruction.

These pins remain for only two weeks. Without any pain medication (we polio'ers are tough) the pins are pulled out. The doctor grips the pin with clamping pliers, twists it around to loosen, then pulls out all ten inches of steel (as the patient watches with terror in his eyes). The foot is wrapped in plaster and allowed to mend for three months.

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Hamstring Reversal
In some cases the quadricep muscles in the front of the leg are affected by paralysis. The long ham strings in the back remain strong. The imbalance of muscle control causes instability while walking. The knee will buckle if the leg is not supported. Fortunately the leg can be made more stable by using surgery to move around the stronger hamstring muscles.

The procedure begins with a long incision, about 18 inches, along the outside of the leg, another incision across the knee cap, and a third behind the knee. In the back of the leg you have 2 groups of 3 hamstring muscles. Two of each group are rerouted under the knee cap. Then steel wires are used to hold these muscles in place as you heal. The leg is wrapped in plaster and allowed to bake for six weeks. When the cast is removed the wires are pulled. The doctor holds down the knee cap, firmly, wraps the wire around his finger and pulls. (Yep, you feel it.)

Therapy to retrain the leg is interesting. A hot whirlpool is used to loosen muscles so that you can bend the knee again. The first time I was ever able to kick my left leg forward was a surprise. The physical therapist told me to pull my leg under. When I did, the leg went forward. Over a short time the brain was able to tell four hamstrings to act independently, or in reverse, to the other two hamstrings still in the back of my legs. Net result, I was more stable and was able to eliminate the long brace on my left leg.

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Spinal Fusion

This one was not cool but was necessary. It was a surgery I put off as long as possible but finally had to be done. My scoliosis was severe. As I aged my bones began to settle. The vertebra at the worst part of my curve began to pinch the nerve cells that lead to my right leg and also strain what muscle tissue I had in my back.
spine 1

For five years leading up to the surgery I struggled with mobility and pain. If I was on my feet for any length of time I would loose sensation in my right leg to a point where I could no longer control the leg. Any quick movement or sharp jarring, such as sitting down quickly or driving over a speed breaker, would send intense pain into multiple areas of my body. No matter what my activity the pain was always with me and at times so intense that I could not even sit up in bed. When forced, I took pain medication including morphine. The best treatment was swimming but even that was painful. The majority of the time it was just a matter of living with it.

For anyone, especially an adult, this surgery is dangerous. The procedure is long, blood loss can be massive and there is always the possibility of cutting a nerve causing permanent paralysis. Also for an adult, the recovery time is long.

The procedure involves two operations. For me each operation lasted over six hours. The first requires a Thoracotomy incision. It is made from midback under the armpit down the side and into the lower abdomen. The surgeon moves aside all the organs and works on the inside of the spine. He removes all the cartilage between vertebra and packs with bone shavings from the bone bank. This operation is the most painful requiring constant pain medication.

After 2-4 weeks the second operation is performed. An incision is made all the way down the back. Again the surgeon removes cartilage and packs bone into the holes. The steel rods are placed in the back on either side of the spine. In my case they were bent and anchored into my pelvic. Wires are tied between the back bone and rods and tightened until the spine is straightened as much as possible.

Recover took me six months and a full year to totally readjust. However, immediately following the second operation, THERE WAS NO BACK PAIN for the first time in fifteen years. My muscles still get tight and used but the intense pain has not occurred. Pain medication now is nothing more than ibuprofen. Until it was gone, I had no idea how much pain I was tolerating.

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Polio Main

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