The Knife Is Not So Rough If.....

This is an excerpt from an article by Dr. Richard L. Bruno. Dr. Bruno put this article on the Internet and asked that it be shared with polio survivors.
If you have to go under the knife, we suggest that you give a copy of this article to each member of the surgical team and to the nurses on the hospital floor where you will be staying. Discuss the article with your doctor and ask that a copy be put in your medical chart.

PRE-OPERATIVE PREPARATION - This is the most important period, since this is the period when you must establish communication with the surgical team. After a second opinion, meet with the surgeon and the anesthesiologist to discuss in detail your complete polio and general medical histories and any problems that might arise before and during surgery, in the recovery room and on the nursing floor.

LUNGS - It is recommended that all polio survivors have pulmonary function studies as part of your preoperative testing. This will help the surgical team evaluate the proper type of anesthesia for you and will help eliminate any unpleasant surprises coming off a respirator at the end of surgery.

PHYSICAL ASSISTANCE - X-ray and examining tables are built at heights that are convenient for the professional, not the patient. Many polio survivors cannot step on a stool to get on a high table. Polio survivors must ask for help in transferring. Since most polio survivors are not good at asking for help, they need to find a phrase with which they are comfortable that will communicate their needs. If you run into someone that does not want to help or work with you, ask for someone else to help or ask to speak to their supervisor.

GENERAL ANESTHETICS - Polio survivors are exquisitely sensitive to anesthetic. A little anesthetic goes a long way and lasts a long time due to the damage of the brain stem - called the reticular activating system. Polio survivors have been known to sleep for days after surgery.
For polio survivors we use the RULES OF 2 for surgery.

ANESTHETIC RULE OF 2 Polio survivors need the typical dose of anesthetic divided by 2. This is merely to remind anesthesiologists that polio survivors need much less anesthetic than do other patients. Also, polio survivors can be sensitive to atropine-like drugs used during surgery.

POSITIONING - One overlooked problem is the positioning of the post-polio patient on the operating table. Muscle atrophy, scoliosis and spinal fusion may make certain positions problematic. It would be advisable for the patient to be awake during positioning on the table to prevent post-op complications.

POST-OPERATIVE CARE:

COLD - Polio survivors are extremely sensitive to cold because they have difficulty regulating their body temperature.
No polio survivor should have same-day surgery for any reason except for the most simple procedure that requires a local anesthetic

POST-ANESTHETIC RULE OF 2 - Polio survivors require 2 times as long to recover from the effects of any anesthetics.

BLOOD AND GUTS - Polio survivors with muscle atrophy will have a smaller blood volume that would be expected for their weight and height. Therefore bleeding during surgery may be more of a problem. Polio survivors cannot control the size of their blood vessels, since the nerves that make the smooth muscle around veins and capillaries contract were paralyzed by poliovirus. Therefore, polio survivors blood vessels open under anesthetic and dump the heat of their warm blood into the cold recovery room. Polio survivors must be kept warm.

VOMITING - Another post-op problem related to brain stem damage is vomiting. Polio survivors are more apt to faint (have vasovagal syncope and even brief asystoles) when they attempt to vomit. It is important that post-op emetic control be discussed with the anesthesiologist and administered before going to the recovery room.

CHOKING - Polio survivors who are aware of having swallowing problems, and sometimes in those without apparent swallowing difficulty, cannot clear secretions and may choke when they are lying on their backs. Polio survivors secretions need to be monitored in the recovery room and they should be positioned on their side if possible so that secretions can drain.

PAIN - The single most troublesome problem after surgery is pain control. Under-medication is a serious problem for the post-polio patient since two research studies have shown that polio survivors are twice as sensitive to pain as those who didn't have polio.

RULE OF 2 FOR PAIN - Polio survivors need 2 times the dose of pain medication for 2 times as long.

RECOVERY - Polio survivors need more bed rest than most patients, because of autonomic nervous system damage. Polio survivors are the best judges of when they can move, stand and walk safely.

RULE OF 2 FOR RECOVERY - Polio survivors should stay in bed 2 times longer than other patients.
RULE OF 2 FOR LENGTH OF STAY - Polio survivors need to stay in the hospital 2 times longer than other patients.

RULE OF 2 FOR WORK - Polio survivors need 2 times the number of days of rest at home before they return to work or household duties.

RULE OF 2 FOR FEELING BETTER - Polio survivors need 2 times longer to feel back to normal again.

CONCLUSION:
All of the Rules of 2 are suggestions for polio survivors and the surgical team; they are not a substitute for specific information about the individual patient and communication among all members of the treatment team, including the patient.

We are in the Phoenix, AZ area and you can get in touch with us:

Polio Echo, Inc.

%Webmaster, 4202 E. Karen Drive,<br>

Phoenix, AZ 85032<br>