Polio and Post-Polio Syndrome

What is polio?

Polio, or poliomyelitis, is a disease that spreads from person to person. It is caused by the poliovirus. The virus attacks the nervous system. In serious cases, it can cause paralysis (where you can't move parts of the body). The paralysis may be lifelong and can sometimes be life-threatening.

Because of vaccines, polio is rare in the United States. But polio does occur in some parts of the world, and travelers can spread the virus.

The poliovirus is very contagious. It spreads through contact with:

• The stool (poop) of person who has the infection
• Droplets from a sneeze or cough of someone who has the infection

This contact can happen if:

• You get contaminated stool or droplets on your hands and then touch your mouth
• A child puts contaminated toys or other objects into their mouth
• You share food or utensils with someone who has the infection

People who have the infection can spread it to others just before and up to several weeks after the symptoms appear. People who don't have symptoms can still spread the virus to others and make them sick.

Polio mainly affects children under age 5. But people of any age (including adults) who are unvaccinated are at risk of developing polio. People who live in or travel to areas where there is polio are more likely to get polio.

Most people who get infected with poliovirus do not have any symptoms. But one out of four people who get polio will have flu-like symptoms. These symptoms usually last 2 to 5 days, and they include:

• Sore throat
• Fever
• Fatigue
• Nausea
• Headache
• Stomach pain

In rare cases, polio can be very serious. It can lead to:

• Meningitis, an infection of the covering of your spinal cord and/or brain.
• Weakness or paralysis in your arms, legs, or both. This paralysis or weakness can last a lifetime. It is possible for the paralysis to become life-threatening if it affects the muscles that you use to breathe.
• Post-polio syndrome (PPS), which happens later in life.

Post-polio syndrome (PPS) is a condition that affects polio survivors many years after they recovered from polio. It usually happens 15-40 years later. It is not contagious.

People who get PPS start having new weakening in muscles that were previously affected by the polio infection. Symptoms may range from mild to serious. The symptoms of PPS include:

• Muscle weakness
• Muscle atrophy (wasting away of muscles)
• Loss of muscle function
• Mental and physical fatigue
• Joint pain
• Curving of the spine (scoliosis)

PPS is rarely life-threatening, but the symptoms can interfere with your daily life.

If you think you or someone in your family has symptoms of polio, call your healthcare provider right away or go to an emergency room.

To find out if you or your child has polio, the provider:

• Will do a physical exam.
• Will take a detailed medical history, including your vaccination history and history of any recent travel.
• Will collect samples of body fluids, such as stool, saliva, blood, urine, and spinal fluid. Poliovirus is most likely to be detected in stool specimens.
• May do an MRI to look at pictures of the spinal cord.

There is no cure or specific treatment for polio. For a mild case, getting rest and drinking plenty of liquids may help with some of the symptoms.

If the polio is more serious, you or your child may need:

• Physical or occupational therapy to help with arm or leg weakness. The earlier therapy is started, the better.
• Pain relievers to help with pain and treat fever. If your child is sick, do not give them aspirin unless their provider tells you to.
• A ventilator to help with breathing if the breathing muscles are weak or paralyzed.

There is no cure for PPS. Treatments may help you manage your symptoms. They include:

• Non-fatiguing exercises (exercises that do not cause pain or fatigue that lasts more than 10 minutes). These exercises may improve muscle strength and reduce tiredness. Your provider can help you figure out which exercises are best for you.
• Mobility aids.
• Ventilation equipment.
• Lifestyle changes, such as eating a healthy diet, getting enough sleep, and not smoking.

There are two types of vaccine that can prevent polio:

• Inactivated poliovirus vaccine (IPV) given as an injection in the leg or arm, depending on how old you are. Since 2000, this has been the only polio vaccine used in the United States.
• Oral poliovirus vaccine (OPV) is given as drops in the mouth. It is still used throughout much of the world.

Children in the United States get four doses of PV as part of their routine childhood immunizations. Most adults in the United States were vaccinated against polio as children.

There is a one-time IPV booster. It may be given to adults who have completed their polio vaccinations but are at higher risk of contact with poliovirus. You may be at higher risk if you are:

• Traveling to a country where the risk of getting polio is greater
• Working in a laboratory or healthcare setting and handling samples that might contain polioviruses
• A healthcare worker who has contact with patients who could have polio

Another way to help prevent the spread of polio is to wash your hands often with soap and water. Alcohol-based hand sanitizers will not kill poliovirus.

Centers for Disease Control and Prevention

Progressive Supranuclear Palsy

What is progressive supranuclear palsy (PSP)?

Progressive supranuclear palsy (PSP) is a rare brain disease. It happens because of damage to nerve cells in the brain. PSP affects your movement, including control of your walking and balance. It also affects your thinking and eye movement.

PSP is progressive, which means that it gets worse over time.

The cause of PSP is unknown. In rare cases, the cause is a mutation in a certain gene.

One sign of PSP is abnormal clumps of tau in nerve cells in the brain. Tau is a protein in your nervous system, including in nerve cells. Some other diseases also cause a buildup of tau in the brain, including Alzheimer's disease.

PSP usually affects people over 60, but in some cases it can start earlier. It is more common in men.

Symptoms are very different in each person, but they may include:

• A loss of balance while walking. This is often the first symptom.
• Speech problems
• Trouble swallowing
• A blurring of vision and problems controlling eye movement
• Changes in mood and behavior, including depression and apathy (a loss of interest and enthusiasm)
• Mild dementia

There is no specific test for PSP. It can be difficult to diagnose, because the symptoms are similar to other diseases such as Parkinson's disease and Alzheimer's disease.

To make a diagnosis, your health care provider will take your medical history and do physical and neurological exams. You may have an MRI or other imaging tests.

There is currently no effective treatment for PSP. Medicines may reduce some symptoms. Some non-drug treatments, such as walking aids and special glasses, may also help. People with severe swallowing problems may need gastrostomy. This is a surgery to insert a feeding tube into the stomach.

PSP gets worse over time. Many people become severely disabled within three to five years after getting it. PSP isn't life-threatening on its own. It can still be dangerous because it increases your risk of pneumonia, choking from swallowing problems, and injuries from falling. But with good attention to medical and nutritional needs, many people with PSP can live 10 or more years after the first symptoms of the disease.

NIH: National Institute of Neurological Disorders and Stroke

Psychotic Disorders

Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.

Schizophrenia is one type of psychotic disorder. People with bipolar disorder may also have psychotic symptoms. Other problems that can cause psychosis include alcohol and some drugs, brain tumors, brain infections, and stroke.

Treatment depends on the cause of the psychosis. It might involve drugs to control symptoms and talk therapy. Hospitalization is an option for serious cases where a person might be dangerous to himself or others.

Respiratory Failure

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include:

• Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19
• Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
• Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
• Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
• Drug or alcohol overdose
• Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

Your health care provider will diagnose respiratory failure based on:

• Your medical history
• A physical exam, which often includes
• Listening to your lungs to check for abnormal sounds
• Listening to your heart to check for arrhythmia
• Looking for a bluish color on your skin, lips, and fingernails
• Diagnostic tests, such as
• Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
• Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

Treatment for respiratory failure depends on:

• Whether it is acute (short-term) or chronic (ongoing)
• How severe it is
• What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include:

• Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
• Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
• Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
• Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
• Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
• Medicines for discomfort
• Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

NIH: National Heart, Lung, and Blood Institute

Restless Legs

Restless legs syndrome (RLS) causes a powerful urge to move your legs. Your legs become uncomfortable when you are lying down or sitting. Some people describe it as a creeping, crawling, tingling, or burning sensation. Moving makes your legs feel better, but not for long. RLS can make it hard to fall asleep and stay asleep.

In most cases, there is no known cause for RLS. In other cases, RLS is caused by a disease or condition, such as anemia or pregnancy. Some medicines can also cause temporary RLS. Caffeine, tobacco, and alcohol may make symptoms worse.

Lifestyle changes, such as regular sleep habits, relaxation techniques, and moderate exercise during the day can help. If those don't work, medicines may reduce the symptoms of RLS.

Most people with RLS also have a condition called periodic limb movement disorder (PLMD). PLMD is a condition in which a person's legs twitch or jerk uncontrollably, usually during sleep. PLMD and RLS can also affect the arms.

NIH: National Heart, Lung, and Blood Institute