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Post-Polio Health (ISSN 1066-5331)

Vol. 6, No. 3, Summer 1990

Read selected articles from this issue ...

Let's Talk about Oxygen and Polio
Roberta Simon, RN

Prescription for Weakness
From Fifth International Polio & Independent Living Conference
Marny Eulberg, MD, moderator
Presenters: James C. Agre, MD, PhD, Daria A. Trojan, MD, and Jacquelin Perry, MD

The Diagnosis of Underventilation following Polio
G.T. Spencer, FFARCS, Consultant in Charge, Phipps Respiratory Unit, St. Thomas' Hospital, London, England

Treatment of Underventilation by Day and Night
G.T. Spencer, FFARCS, Consultant in Charge, Phipps Respiratory Unit, St. Thomas' Hospital, London, England

Response to "Prescription for Fatigue," Polio Network News (Vol. 6, No. 2)

Americans with Disabilities Act Becomes Law

A Tenting, Lobbying and Celebration Experience!
Leah Welch, Minneapolis, Minnesota

Information on New book on polio and the Salk Vaccine; Brain Tissue Bank; New Study on the Effects of Aging on Early Life Disabilities

Leaders Write ... from New Zealand and from Australia

Readers Write

Let's Talk about Oxygen and Polio

Roberta Simon, RN

Many myths and truths are circulating in polio circles about oxygen use in medical crises. This is causing great apprehension for many, especially those that had bulbar polio. I think it is time to clarify some of these misunderstandings.

Let's start with a quote from the Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors (first edition) published by Gazette International Networking Institute in St. Louis. (As far as I'm concerned this is must reading for all polios whether they have the late effects or not!) Under "Oxygen" it states, "oxygen should be used with caution. in the face of hypercapnia, oxygen therapy may eliminate the final mechanism for maintenance of respiratory effort and thus result in apnea. Maintenance of adequate alveolar ventilation is of primary importance. In case of severe hypoxia and respiratory failure, mechanical ventilation and oxygen may be necessary." Now that we have all of that technical information lets dissect it so we can digest and understand it!

First, we must understand hypercapnia. Hypercapnia is excessive (more than necessary) carbon dioxide in the blood. This value can be determined by taking blood from your artery (not your vein as is usually done) when you are admitted to the hospital or when .your physician sees a necessity to determine this value, such as prior to surgery.

When the carbon dioxide level in your blood is increased, it causes many symptoms including morning headache, fatigue and confusion of thought. Unfortunately in polios that have fatigue as part of their post-polio problem, fatigue due to hypercapnia is at times difficult to sort out without testing.

Our second problem is to understand why hypercapnia may eliminate the mechanism that maintains respiratory effort. Respiratory effort is regulated by the chest muscles and by the medulla, which is part of brain stem. (Located at the base of your brain. The brain stem may have been affected earlier by polio.) The depth and frequency of breathing is established here.

Now here is the tricky part. If this part of your brain has been functioning at top capacity to assist your breathing since you had polio and it is suddenly assisted by outside oxygen, it gets the message that everything is in order - it says, "Great! I need a rest." And then it goes on vacation! Later, when oxygen is discontinued, there may be a problem getting the respiratory center to function again. Hence, the potential danger of oxygen.

Fortunately, this is not a problem with all polios! A daytime study of hypercapnia/hypoxic drive may be diagnostic for individuals at risk. The test may be done in a pulmonary function laboratory. If the test is negative, the problem may also be diagnosed by doing a sleep study to determine if you have central (brain-centered) sleep apnea (cessation of breathing while sleeping).

Sleep apnea occurs in polios if the respiratory center of the brain is weak and shuts down for brief periods during the night when the individual has lost control of his/her respirations. One difficulty that results from this is an increase of carbon dioxide in the blood. Increased carbon dioxide may also occur in polios who have chest muscle weakness and may be controlled quite adequately by resting the chest muscles at night. Chest muscles can be rested by using some type of mechanical assistance such as nasal or mouth positive airway pressure.

Because of possible chest muscle weakness, it is imperative that all sleep studies be conducted in a sleep laboratory. Their equipment monitors the movement of your chest muscles while you are sleeping.

(It should be noted that sleep apnea does occur in people that did not have polio or do not have another neurological condition. This type of apnea is called obstructive apnea and is due to airway obstruction or malformation of the jaw.) Obstructive apnea may also be caused by pharyngeal weakness or lack of coordination of muscle function in people that have had polio. These problems cause obstruction of the airway with subsequent cessation of breathing for short intervals of time several times throughout the night. Obstructive events (or apnea) may also have a central origin.

The Handbook goes on to say, "in case of severe hypoxia (decreased oxygen in the tissues) or respiratory failure (failure to breath properly to maintain oxygen in your tissues which is essential to life) mechanical ventilation or oxygen may be necessary. Maintenance of adequate alveolar ventilation is of primary importance." This is an absolutely true statement and should not be taken lightly. When you reach this period of crises, you must depend on your physician to help you make decisions.

I think it is important to note that individuals with hypercapnia (excessive carbon dioxide) and apnea (cessation of breathing caused by obstruction, weak chest muscles or the brain center shutting down) have done quite well following surgical procedures and medical emergencies by being placed in iron lungs or on some other type of ventilation assistance for a short period of time.

All of the above can be evaluated by a knowledgeable pulmonologist and properly equipped sleep study laboratory prior to an emergency situation and should be done if warranted. This is why every polio with respiratory or suspected respiratory weakness should have a complete pulmonary evaluation.

if you did not have bulbar polio and if you do not have chest muscle weakness, you are not at risk for this problem! Should you need oxygen, it is not a problem. You may be treated and supported through a crisis just as any other individual. However, many people are unaware that they did have mild bulbar polio. It is possible you were never tested for it at the time of your original polio, because only the most obvious cases were diagnosed. Therefore, it is suggested that all polios should undergo pulmonary function screen. These tests should include spirometry, lung volume measurements, and a measure of respiratory muscle strength, such as negative inspiratory force.

Acknowledgements: The author wishes to thank Ann Romaker, MD, for editing the article and for all her efforts in the past to assist polios. She has been extremely generous with her time both in the Chicago, Illinois, and the Kansas City, Missouri, where she now resides. Dr. Romaker has a pulmonary medicine practice and is also responsible for the sleep and pulmonary laboratories at St. Luke's Hospital in Kansas City, Missouri.

*This article, or any segment, may not be copied or reprinted without the written permission of the author.