A

Publication of the Boca Area Post Polio Group March 2020 “Sharing and Caring Together” Volume 23 Issue 3

Thursday, March 12 @ 11:30 AM

10 Minutes with . . . Joel Sinkule

Let’s Do Lunch . . .

March 17 @ 11:30 AM

Prime Catch

700 E. Woolbright Road, Boynton Beach

561-737-8822 for directions [I-95 North, exit Woolbright Road East, turn right

before Intracoastal bridge to white-roofed building]

Next Meeting – Thursday, April 9, 2020

Lunching Around – Tuesday, April 14, 2020

FEBRUARY ’20 MINUTES

On a warm, breezy day, twenty members

gathered to hear our speaker.

We welcomed all members, especially

Walter/Susan Bieber we hadn’t seen recently.

Lunching Around – 12 hands went up!

Member Update – Keep members in prayer.

Library – Check books out and return timely.

Cruise 2021 – Exciting new itinerary! Pg.5.

Reneé Nadel was born 1943 Bronx, NY;

fled to Rockaway to escape polio epidemic,

yet contracted it in summer 1946, at age 3. She

remembers being shy; feeling sick with fever;

spinal tap; hospitalized; had Sister Kenny

treatments & only short parent visits. Received

home PT yet didn’t cooperate; eventually

walked with a limp; proved to principal she

could climb stairs enabling public school &

wore a brace for drop-foot until age 7.

Moved to Long Island; 1950 mom took

brace away; still walked w/dropped foot/limp;

2½ size shoe difference w/lift; tennis player

dad taught her to play despite disability. In HS

she told a friend about Polio, which freed her

& changed her personality to become a leader.

After HS, was counselor at Camp Ranger

(same camp as Professor Mike); met Joel;

Queens College; married him 1963 & lived in

Dixs Hills, NY; has Master’s & taught 7 yrs.

pre/elementary school. Moved to FL 1980 w/3

children; had left ankle fusion in ‘90s. Joel

passed 2006; met Harry 2007 & has a nice life.

Reneé was past President, South County

Tennis Association & now teaches adult

literacy & ESL. She enjoys her 7

grandchildren; aquacising; bridge; reading;

book clubs & BAPPG meetings.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 2

Unfortunately, due to illness, Professor

Mike was unable to travel from NY to speak.

Thanks to Reneé Nadel who ‘pinch-hit’ her

10-minutes in his absence.

The meeting was opened asking for

questions or comments from the members,

which covered many subjects. We conversed

about health care providers using too

technical of terms when presenting to our

group. Advised approximate fall date when

Professor Mike will speak. Several pros &

cons of walk-in tubs were offered.

Need for medical alert systems, ie.

pendants, ‘Alexa’, & GreatCall products,

especially for those living alone.

Polio Paradox was an eye-opener/life-

changer for a new ‘passer’ member and her

husband, who both now understand the need

to conserve to preserve by recently obtaining

a brace for drop foot & purchasing a scooter.

We talked about pain, fatigue, overdoing,

staying up late/getting enough sleep, eating

more protein, cutting down on carbs/sugar.

Oftentimes medications, lack of hormones,

stress & inability to nap can cause fatigue.

Some have found asking and accepting

help from strangers is getting easier when out

and about shopping. Using assistive devices

is liberating & energy conserving.

All in all, it was a good ‘sharing & caring’

meeting in spite of the program change.

After the meeting,

11 hungry members

gathered at Olive

Garden enjoying a

2½ hour lunch with

good conversation

and fellowship.

Submitted by Jane & Maureen

BAPPG appreciates the generosity of the

people who enable the printing of this

newsletter.

Earl Feick

Ellen Pedersen

Freeman & Lizzie Yoder

*Names remain for 1 year.

WITH MANY THANKS

We wish to thank the many

benefactors* who have given so generously

to the Boca Area Post Polio Group.

Sandy Katz & Stan Rose

Dr. Leo & Maureen Quinn

Daniel & Sonia Yates

Betty Thompson

Barbara Rogers In memory of husband Lee, members lost & In honor of Jo Hayden & BAPPG committee

Wilbur & Hansa May

Joe Virant (In memory of wife Millie)

Eddie & Harriet Rice

Bruce & Dianne Sachs

Reneé Nadel

Teresa Russell (In memory of father, Thomas Iovino)

Henry & Nancy Chajet

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 3

A DECLARATION OF

INTERDEPENDENCE

By Sunny, August 24, 2019

“Need help with that ladder, Grandma?

No? Splat! OMG! Grandma fell from the

ladder! She’s grimacing in pain and can’t get

up! Call the ambulance! There goes Grandma

off to the hospital.

Sigh. I wish

Grandma knew that

asking for help

isn’t a cop out. It

takes courage at

first, but after that,

it would make life a lot easier for all of us.”

It seems that many people who are

living into later life resist asking others for

help in the name of independence and “not

wanting to burden anyone.” But what might

life really teach us about managing its never-

ending onslaught of challenges? Maybe

sharing my experience will be useful. As a

polio survivor for 67 years who has used

crutches, leg braces, and now an electric

scooter to get around, I was taught searing

lessons early on about the difference between

dependence and independence.

Dependence was a bad word. It

conjured up images of being shut away in a

medical institution or in a back bedroom

somewhere, sick and infantile, totally reliant

on others. I was also taught as a child not to

be a burden on others and was chastised

when I was moving in that direction. Now I

wonder about that. A burden? What does that

mean? I guess it means being emotionally

and physically needy, being a taker,

childishly weak, unable or unwilling to

participate in reciprocal relationships with

those around us. When we are too dependent,

do we become a thorn in the side of those

near us, an affliction imposed upon others?

Independence, on the other hand, was

a good word. A very good word. As children

of the polio epidemics of the 1950s, we were

indoctrinated with the goal of becoming

fiercely independent as we went through our

initial rehabilitation from acute polio. “Do it

yourself! You fell? Well, figure out how to

get up on your own! It’s a cold, cruel world

out there! You will always have to prove

yourself to others,” were messages I often

heard from my parents and therapists. And

those lessons worked well for me for a long

time.

Now, as a mature adult who continues

to live with a physical disability, I

contemplate: could it be that dependence

versus independence are two unreasonable

extremes? Too much dependence can lead to

dysfunction and low self-esteem. Conversely,

too much independence can lead to burnout–

always giving, always super-achieving.

What, then, is the most sensible way to

manage our daily lives now? Our greatest

American document, other than the

Constitution, is our Declaration of

Independence. For people who are growing

older with the late effects of polio or simply

growing older with the late effects of life, I

say we need to draw up a more evolved

document: our own Declaration of

Interdependence! Not wilting dependence.

Not blazing independence. But inter-

dependence.

Interdependence. It’s “the

quality of being mutually reliant on

each other.” Trying to be that timeworn kind of

independent doesn’t work as we grow into

our later life years. Trying to do everything

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 4

without help is not only isolating; it can be

dangerous. Climbing a ladder to hang

curtains? A broken hip is no fun.

Traipsing in the snow

and ice to my roadside

mailbox instead of arranging

for front door mail delivery

with the post office? Let’s

think outside the box (or in

this case, the mailbox) about that issue!

Asking for convenient mail delivery

wouldn’t be viewed as a cop out by anyone.

It’s a smart thing to do. For me, front door

delivery has become an opportunity to share

a smile and good words with my mail carrier.

And I know by her friendly tidings that she

appreciates our positive rapport. Our new

arrangement may also have spared her the

horror of finding me stranded and struggling

in a snowbank trying to retrieve my mail the

old way.

These days painting the fence or

planting a garden could easily result in a fall,

and then a popped

bicep when trying

to push up from the

ground. My

Declaration of

Interdependence advises me to find a few

twenty-year-old’s who love outdoor work.

Then give them some of my best home baked

cookies, some money and my full attention

as they do the work, share their interests and

tell me all about their life plans. This way,

everyone gains from the experience.

At first it might feel humiliating or

distasteful to ask for new assistance, but it

can be done. In fact, in my own medical

situation, I discovered the hard way that it

must be done. When I unexpectedly faced

new debilitating pain, weakness and fatigue,

known as polio’s late effects, I had to ditch

my uninformed ways of managing medical

and lifestyle challenges. Now I pace myself

and metaphorically, “take the elevator

instead of the stairs.” I also make sure to tap

into the advice of physical and occupational

therapists regularly.

Since the early 1980s, polio survivors

numbering in the hundreds of thousands

around the world have, in the spirit of

interdependence, created and participated in

our networking organization, Post-Polio

Health International (PHI). Through PHI,

post-polio medical professionals and

survivors have learned from each other about

the late effects of polio. They have become

healthcare-interdependent. Banding together,

they have supported cutting-edge medical

research, built an extensive library of

scientific and historical information

(https://www.polioplace.org/) and continue to

advocate for resources. It’s powerful to

witness medical professionals and their

patients become each other’s experts as they

come together in conferencing, publishing

newsletters, and linking up on a variety of

web-based platforms.

Interdependence. It’s “the quality of

being mutually reliant on each other.” Under

the guidance of this new Declaration, my

neighborhood buddies and I now have added

opportunity to enjoy each other’s company

because we are more open about expressing

our changing needs. As we talk, we agree to

show up for each other in new ways. In the

process, we have identified one key to

success. I make sure that what I ask

others to help with is something they

genuinely like to do. Some enjoy running

errands. Others treasure their cooking skills.

Still others love to help with craft or sewing

projects. And they, in turn, know what I

would do best for them. Drawing upon our

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 5

specific talents almost always guarantees that

our exchange will be mutually rewarding.

My Declaration of Interdependence

also extends to willing strangers whom I

encounter in public places. Often, I ask

unsuspecting shoppers at the grocery store

for assistance in reaching items on high

shelves. My reciprocal gift to them can be

sizeable or simple. A warm hearted thank

you and recognition that their kind assistance

is truly valued may be the only boost they

have had all day.

Adopting a renewed level of mutual

exchange makes sense because we have

always needed

others and they

have needed us.

Surprisingly, I

have found that

life can be even

more deeply

gratifying as I

risk receiving and giving in unexpected new

ways.

Living out my new Declaration of

Interdependence has been different. It’s also

been delightful.

Thanks for reading,

Sunny

Have Good Ideas for this Blog? Feel free to email me at

sunnyrollerblog@gmail.com if

you have any questions, tips,

suggestions, guest post ideas,

requests and so on. All are

appreciated!

Source: http://www.sunnyrollerblog.com/a-declaration-of-

interdependence/

Posted on Facebook, 8/24/19.

BACK BY ‘POPULAR’

DEMAND!

BAPPG CRUISE 2021!!

Royal Caribbean Cruise Line

Allure of the Seas

February 21 – February 28, 2021

Cozumel, Mexico Roatán, Honduras

Puerto Costa Maya, Mexico

& CocoCay, Bahamas All Docked Ports-of-Call

Doesn’t a week in February, enjoying

the warm Caribbean sun, sound enticing?

Now is the time to book that cruise

you’ve always wanted to experience. Why

not join our 18th

annual trip leaving from Port

of Miami.

A variety of accessible staterooms

have been reserved for our group; and rates

begin at $941 per person, which includes all

taxes & port charges.

A $250 deposit per person is 100%

refundable until October 1, 2020.

PPS is not a pre-requisite – family &

friends are always welcome! Travel

insurance is strongly suggested.

Contact Maureen at 561-617-4450 or

bappg@aol.com for questions, accessibility,

roommates, scooter rentals & onshore tours.

Contact Judith at 561-447-0750 x102,

or judith@travelgroupint.com for booking,

perks, transfers, hotels & air.

More details – www.postpolio.wordpress.com

4½ minute Allure of the Seas video -

https://www.youtube.com/watch?v=FaCiGAymtYc

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 6

THIS IS FOR YOU . . .

WHEN IN YOUR SCOOTER

OR POWERCHAIR

PRIDE XLR USB CHARGER

Have you ever been out in your

scooter/powerchair and realized that your smart

phone is almost out of

power and there isn’t a plug in sight?

The Pride XLR

USB Charger is

compatible with most

iPhone, Android and

mobile devices. Simply

plug your USB cord into

this charger & plug the

other end into the charger port on your

chair. Your device will charge whether your chair

is moving or off. No need to be tethered to a

wall!! Charger will switch off automatically when

device is charged & will not discharge [drain]

chair battery. Specs: 5V DC; 1-Amp charger;

compatible with 24V/36V systems; 2” x 1” with

lanyard.

The charger is offered at $22.00. Internet has some for almost twice as much!

Just provide name, address, phone #, &

mail check payable to BAPPG, 11660 Timbers

Way, Boca Raton, FL 33428.

Courtesy of one of our BAPPG members!

MEN BRAGGING

Three men were sitting together

bragging about how they had given their new

wives duties.

The first man had married a woman

from Alabama, & bragged that he had told

his wife she was going to do all the dishes &

house cleaning that needed done at their

house. He said that it took a couple days –

on the third day he came home to a clean

house, dishes were all washed & put away.

The second man had married a woman

from Florida. He bragged that he had given

his wife orders that she was to do all the

cleaning, dishes and the cooking. He told

them that the first day he didn't see any

results, but the next day it was better. By the

third day, his house was clean, dishes were

done, & he had a huge dinner on the table.

The third man had married a Michigan

girl. He boasted that he told her that her

duties were to keep the house cleaned, dishes

washed, lawn mowed, laundry washed and

hot meals on the table for every meal. He

said the first day he didn't see anything, the

second day he didn't see any, but by the third

day most of the swelling had gone down and

he could see a little out of his left eye,

enough to fix himself a bite to eat, load the

dishwasher and telephone a landscaper.

Got to love those Michigan girls.

Source: Unknown

Contributed by Jane McMillen, member, 5/27/04.

Please provide your new

street/email address to be sure not to

miss an issue of Second Time Around.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 7

EXERCISE GUIDELINES FOR

POLIO SURVIVORS By Carol Vandennaker, MD

UC Davis Post-Polio Clinic, October 19, 2013

Exercise is defined as planned, structured,

and repetitive body movement. Physical activity

is movement occurring during daily activities. A

therapeutic exercise program is designed for

health benefit – generally to reduce pain,

increase strength, increase endurance and

increase the ability to do daily activities. Not all

polio weakness is due to overuse; often lack of

exercise and physical activity leads to muscle

wasting and cardiovascular deconditioning.

Research supports a carefully designed

therapeutic exercise program for most polio

survivors to enhance optimal health and

function. The program should be individualized

and modified if problems arise.

Important principles to follow are:

1. Start very slowly. Often 3-5 minutes is all that

can be tolerated initially if muscles have not

been exercised for a period of time.

2. Interval exercise, short bouts of exercise

alternating with rest periods, can be very

effective.

3. Progression should be slow, especially in

polio-affected muscles.

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4. Intensity should be low to moderate.

5. The plan should include a rotation of different

types of exercise such as stretching,

cardiovascular (aerobic) conditioning,

strengthening, and range of motion exercises.

6. Pacing should be incorporated into the

program with at least one day of rest between

strengthening exercise sessions.

7. Aquatic exercise is often ideal as the

buoyancy of the water helps to support weak

muscles and unweight joints while providing

mild resistance to muscles. Remember it is easy

to overdo in the pool because it is so much easier

to move!!

8. Be aware that signs of overuse can occur 24-

48 hours after too strenuous exercise or an

overly active day. Symptoms of overuse indicate

a need to decrease the amount of exercise or

decrease the frequency of activity. The

symptoms to watch for are: muscle cramps and

spasms, muscle twitching, muscle pain and

extreme fatigue.

Remember that you can exercise safely &

improve your condition if you approach it with

patience and consistency! Revised 11/2018

Source: https://polioepic.org/wp-content/uploads/12-

exercise-guidelines-for-Polio-survivors.pdf

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 8

GABAPENTIN (Brand names – Neurontin, Horizant,

and Gralise)

A Lengthy Conversation from

Marny Eulberg, MD July, 2019

Question:

I started Gabapentin for help with my “polio”

leg jerking and sleeping at night. I take one at

bedtime (low dose 100 mg.) and two if I have

been very active throughout the day. It has

definitely seemed to help with me for sleep,

but I feel as though I’m definitely getting

weaker.

Answer:

This is a good question and I’m not aware of

any scientific research addressing this

question. Gabapentin (and its cousin –

Pregabalin – brand name = Lyrica) do their

work at the site of neurons—peripherally and

at the brain level. So they might “Mask”

symptoms that could be a warning about

overdoing since they don’t really fix the

problem causing the symptoms.

I’m sorry to hear that your leg has

become weaker, but there is no way to know

if that would have happened (or how much

weakness might have happened) if you had

been aware of the symptoms and been able to

curtail your activities. The natural history of

PPS is increasing weakness over time so it is

difficult to say how much weakness would

have occurred just as a result of a year going

by.

Also getting poor sleep from

symptoms is not very good for muscle

recovery overnight – so I think this might be

another of those “chicken or egg” kind of

questions.

That being said – I’d like to talk more

about this medication.

Originally, Gabapentin was developed

as a medicine to treat seizures, particularly

“partial” seizures, but it was also found to be

helpful for neuropathic pain (as a result of

shingles or peripheral neuropathy and

sometimes nerve pain from a “pinched

nerve”), and possibly also for some

menopausal symptoms. It also has been used

for acute pain after certain surgeries, “restless

legs” symptoms, and essential tremor.

How does Gabapentin work?

Gabapentin treats seizures by decreasing

abnormal excitement in the brain.

Gabapentin relieves the pain of post herpetic

neuralgia (PHN) by changing the way the

body senses pain. It is not known exactly

how Gabapentin works to treat restless legs

syndrome.

•Side Effects. Drowsiness, dizziness, loss of

coordination, tiredness, blurred/double

vision, unusual eye movements, or shaking

(tremor) may occur. Other possible side

effects include swelling in hands or feet {this

is more likely with Lyrica – a cousin of

Gabapentin} or changes in mood or anxiety.

•Interaction with other medications or

supplements. Any medicine, including

alcohol that can on its own cause drowsiness

or brain fogginess may increase the nervous

system side effects of Gabapentin.

•Antacids (containing aluminum or

magnesium) may interfere with the

absorption of this medication. Therefore, if

you are also taking an antacid, it is best to

take Gabapentin at least two hours after

taking the antacid.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 9

•Use of Gabapentin in a person who has had

polio. There are anecdotal reports about the

use of Gabapentin for post-polio pain, but no

controlled, double blind research supporting

the use of Gabapentin for symptoms of PPS.

Although polio survivors may be prescribed

Gabapentin for other co-existing conditions

such as post herpetic neuralgia or diabetic

neuropathy.

Gabapentin, in some instances, has

decreased pain in polio survivors but may

have also possibly led to increased weakness

(because the person now was able to

“overdo” and without pain as an indicator

that they should stop or cut down on

activities). Please see the side effects listed

above. The ones that may be of particular

concern to polio survivors are the dizziness,

loss of coordination and vision difficulties,

especially as this relates to increased fall risk.

Dr. Eulberg, a family

medicine physician, is a

polio survivor herself,

located in Wheat Ridge,

CO. “I am retired from

family medicine. The only

patients I currently see are

people who have had polio and have polio-related

issues.” Source: www.papolionetwork.org, August 2019.

A SENIOR MOMENT

Don't laugh! This could be any of us in a

few years.

There were two elderly people living in

a Florida mobile home park. He was a

widower and she a widow. They had known

one another for a number of years. Now, one

evening there was a community supper in the

big activity center. These two were at the

same table across from one another. As the

meal went on, he made a few admiring

glances at her and finally gathered up his

courage to ask her, "Will you marry me?"

After a dramatic pause and precisely six

seconds of 'careful consideration,' she

answered. "Yes, Yes, I will."

The meal ended with a few more

pleasant exchanges and they went to their

respective places. Next morning, he was

troubled. "Did she say 'yes' or did she say

'no'?" He couldn't remember. Try as he

would, he just could not recall. Not even a

faint memory. With trepidation, he went to

the telephone and called her. First, he

explained to her that he didn't remember as

well as he used to. Then he reviewed the

lovely evening past. As he gained a little

more courage, he then inquired of her,

"When I asked if you would marry me, did

you say 'Yes' or did you say 'No'?"

He was delighted to hear her say,

"Why, I said, 'Yes, yes I will' and I meant it

with all my heart."

Then she continued, "And I am so glad

that you called, because I couldn't remember

who had asked me.

Contributed by Jane McMillen, member.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 10

PREVENTING COMPLICATIONS

IN POLIO SURVIVORS

UNDERGOING SURGERY (OR)

RECEIVING ANESTHESIA Post-Polio Sequelae Monograph Series.

Volume 15 (1). NY: random harvest, 2015.

Richard L. Bruno, PhD, Chairperson International

Post-Polio Task Force and Director, International

Centre for Polio Education

www.postpolioinfo.com

Unfortunately, only a handful of specialists

treat Post-Polio Sequelae (PPS) - the unexpected

and often disabling fatigue, muscle weakness,

joint pain, cold intolerance, swallowing, sleep

and breathing problems - occurring in America's

1.63 million polio survivors (40 years after their

acute polio).1,2

However, all medical

professionals need to be familiar with the

neurological damage done by the original

poliovirus infection that today causes

unnecessary discomfort, excessive physical pain

and occasionally serious complications after

surgery. This is a brief overview to inform

patients and professionals about the cause and

prevention of complications in polio survivors

undergoing surgery.

PRE-OPERATIVE PREPARATION

The pre-operative period is the most important,

since it is when polio survivors must establish

communication with the surgical team. After the

second opinion and a polio survivor's decision to

have surgery, the patient needs to ask the

surgeon to read this article and the references

cited. Then, surgical candidates must meet with

the surgeon and anesthesiologist to discuss in

detail patients' complete polio and general

medical histories and the problems that will

likely arise before and during surgery, in the

recovery room and on the nursing floor. It is also

recommended that the polio survivor meet with

the Supervisor of Nursing on the floor where

they will be transferred after surgery to discuss

likely problems during the post-op and recovery

period.

Lungs. We recommend that all polio survivors

have pulmonary function studies as part of their

pre-operative. This is vital for those who had

bulbar polio acutely, whether or not they used a

respirator or an iron lung. But, polio survivors

who have (or had) neck, arm or chest muscle

weakness or have swallowing problems should

also have their lung function tested 3 so there

will be no unpleasant surprises coming off the

respirator at the end of the operation. Polio

survivors with a lung capacity below 70% may

need a respirator or respiratory therapy after

surgery.1 Of course, polio survivors who use a

respirator during the day or at night must discuss

their respirator use and maintenance in detail

with their surgeon, anesthesiologist, the nursing

staff, and with their own pulmonologist, before

admission to the hospital.

Physical Assistance. X-rays are a normal part of

pre-op testing. Because of workers

compensation concerns, many hospital staff are

not eager to move or lift patients. Unfortunately,

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 onto a high table, or even pull

themselves over onto a table from a stretcher.

Thus, polio survivors must ask for help in

transferring. Since most polio survivors have no

experience asking for help under any

circumstances, they need to find a phrase with

which they are comfortable that will

communicate whatever their needs are. Long

explanations about having had polio or PPS or

the specifics of which muscles are weak or

paralyzed are not necessary. (For example, a

simple "My legs (arms) are paralyzed and I can't

get onto that table” or “I will need help" should

suffice). This phrase may have to be repeated

before the polio survivor will be assisted. If the

professional replies, "Oh, I bet you can move by

yourself if you try!" or "Don't expect me to lift

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 11

you," an appropriate response is "I cannot get

onto the table. Please ask someone else to help

me or let me speak to your supervisor." A

pleasant but steadfast refusal to do difficult or

dangerous transfers is the polio survivor's best

defense against injury before or after surgery.

ANESTHETICS General Anesthetics. Polio survivors are

exquisitely sensitive to anesthetic. It has been

known for 50 years that the poliovirus damaged

the area of the brain stem – called the reticular

activating system (RAS) – rresponsible for

keeping the brain awake.4, 5

Because the RAS

was damaged in those who had paralytic and

non-paralytic polio, a little anesthetic goes a

long way and lasts a long time. For example, the

pre-operative medication used to "calm" surgical

patients - sometimes Valium or Vistaril – may

by itself put polio survivors to sleep for 8 hours.

(Such excessive and prolonged sedation does

occur when low-dose Propofol is used alone in

patients undergoing invasive but nonsurgical

procedures, like endoscopy.) Add to a pre-

operative "calming cocktail" an intravenous

anesthetic (like sodium pentothal) or a gaseous

anesthetic, and polio survivors have been known

to sleep for days. Propofol is the drug of choice

for polio survivors. In addition, polio survivors

with respiratory problems may have trouble

clearing the gaseous anesthetics. A number of

our patients have awakened from anesthetic on a

respirator in I.C.U. to the frightened faces of

their family, surgeon and anesthesiologist

several days after surgery.

Here is the first of rule of thumb - we call

"Rules of 2" – for polio survivors having

surgery:

Anesthetic Rule of 2:

Polio survivors need the typical dose of

anesthetic divided by 2.

This first "Rule of 2" is certainly NOT

intended to dictate the dose of anesthetic, but

merely to remind anesthesiologists that polio

survivors need much less anesthetic than do

other patients. This does not mean that a given

polio survivor might require less than 1/2 the

typical anesthetic dose, or that another won't

need more anesthetic. As always, the dose of

anesthetic must be individually adjusted (for

body weight, lipid space, etc) and be adequate to

keep patients under during surgery but not cause

them to sleep for a week. We have found

Desflurane to be the best tolerated anesthetic

when used with BIZ brain wave monitoring.

Even applying the "Anesthetic Rule of 2"

polio survivors may be very sedated, if not

asleep, for many hours after the surgery. This is

one of the reasons why same-day surgery - even

for complicated dental procedures – is not

advisable for polio survivors. Sleeping or

excessively sedated polio survivors cannot be

expected to return home and take care of

themselves after same-day surgery, since

surgical complications may go unnoticed and

sedation-impaired coordination makes falling

likely. In spite of insurance company pressure,

NO POLIO SURVIVOR SHOULD HAVE

SAME-DAY SURGERY except for the simplest

procedures that require only a local anesthetic.

Nerve Blocks. However, there are also problems

with local anesthetics that numb only one area of

the body. Spinal anesthetics, like epidural or

saddle blocks used for childbirth and lower body

procedures, often allow surgery without the

patient being asleep and are therefore more

desirable for polio survivors. However, the

injection of a local anesthetic near the spine

results in both pain-conducting nerves and motor

neurons being anesthetized. Polio survivors are

very sensitive to anything that further impairs

their poliovirus-damaged motor neurons; and a

spinal anesthetic may cause polio survivors to be

paralyzed for many hours. If a spinal anesthetic

is used, polio survivors cannot be expected to get

up and walk after surgery. Curare-like drugs that

are intended to paralyze muscles (e.g.,

succinylcholine) are typically used during major

surgery to relax muscles that are going to be cut

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 12

and make it easier for the ventilator to fill the

lungs while patients are on the table. Again, any

drug that interferes with muscle functioning will

prevent polio survivors from walking or even

moving for hours longer than it would for

patients who didn't have polio.

Regardless of whether a local, spinal or

general anesthetic is used, the following applies:

Post-Anesthetic Rule of 2: Polio survivors require 2 times as long to

recover from the effects of any anesthetics.

Blood and Guts. There are yet additional

concerns. Polio survivors with muscle atrophy,

especially in the thigh muscles, will have a

smaller blood volume than would be expected

for their height or weight. Therefore, bleeding

during surgery may be more of a problem. Polio

survivors may want to bank their own blood

slowly over the course of weeks, even for

procedures where excessive blood loss is not

typically expected. However, since polio

survivors may be significantly more fatigued and

prone to faint after giving blood, relative's blood

may need to be banked instead. Also, polio

survivors can be sensitive to atropine-like drugs

used to dry secretions during surgery.6 Atropine-

like drugs also slow the gut, and polio survivors

may be excessively constipated after surgery or,

in some cases, actually have their stomachs and

intestines stop moving (gastroparesis; paralytic

ileus) for a period of time. These problems can

be treated symptomatically as they would in

someone who did not have polio.

Positioning. One overlooked problem is the

positioning of the post-polio patient on the

operating table. Muscle atrophy, scoliosis and

spinal fusions may make certain positions

problematic, especially those involving

extension of the spine. Since the polio survivor

is usually unconscious during positioning, there

will be no report of pain that would normally

warn of potential damage. A number of polio

survivors have experienced severe back pain for

months post-op, and even permanent traction

injuries of nerves, after being placed for hours in

damaging positions. It would be advisable for

the patient to be awake during positioning on the

table to prevent such post-op complications.

POST-OPERATIVE CARE Cold. If the dose of anesthetic is carefully

regulated, a polio survivor's first post-op

experience will be waking in the recovery room.

Often, polio survivors awaken from anesthetic

shivering violently. Research has shown that

polio survivors are extremely sensitive to cold

because they have difficulty regulating their

body temperature. Polio survivors' automatic

(autonomic) nervous systems were damage by

the poliovirus from the brain (hypothalamus)

through the brain stem (reticular formation and

vagal nuclei) to the spinal cord

(intermediolateral columns).4-8

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 the poliovirus. Therefore, polio

survivors' blood vessels open under anesthetic

and dump the heat of their warm blood into the

cold recovery room. Recovery room nurses need

to know about this problem and help polio

survivors stay warm. Additional blankets will

help, and the surgeon can even write an order for

a heated water blanket to be used in recovery.

Vomiting. Another post-op problem related to

brain stem damage is vomiting. As in anyone

who receives a general anesthetic, polio

survivors can develop nausea and vomit.

However, polio survivors are more apt to faint

(have vasovagal syncope and even brief

asystole’s) when they attempt to vomit.6 It is

very important that post-operative emetic control

be discussed with the anesthesiologist and

administered before polio survivors go to the

recovery room and that additional medication is

written as needed in the post-op orders.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 13

Choking. Yet another concern is difficulty

swallowing as the patient is awakening.9 Polio

survivors who are aware of having swallowing

problems, and sometimes in those without

apparent swallowing difficulty, cannot clear

secretions and may choke (or feel like they are

choking) when they are lying on their backs, still

half asleep, as the anesthetic is clearing. 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. A number of studies

have shown that many surgical patients are

under medicated for pain. 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.8

Increased pain

sensitivity is apparently related to poliovirus

damage to endogenous opiate-secreting cells in

the brain (Para ventricular hypothalamus and

periaquiductal gray) and spinal cord (Lamina II

of the dorsal cord). 4,8

Rule of 2 for Pain: Polio survivors need 2 times the dose of pain

medication for 2 times as long, since polio

survivors are known to be extremely stoic and

very unlikely to abuse or become dependent

upon narcotics.

RECOVERY In keeping with the "get 'em up, move 'em out"

trend in medicine, there will be the tendency to

get polio survivors up and walking almost

immediately after surgery. This is not advisable

for a number of reasons. When polio survivors

reach the nursing unit, they may still be twice as

sedated from the anesthetic as are other patients.

Since polio survivors need a very clear head to

be able to control their weakened, polio-affected

muscles to stand and walk, a fuzzyheaded polio

survivor is at serious risk for falling. Even if a

polio survivor's head is clear, the anesthetic or

other drugs may have temporarily weakened or

even paralyzed the muscles needed to stand and

walk. What's worse, the surgery may have cut

muscles (especially abdominal muscles) that

substitute for muscles paralyzed by polio (it is

often muscle substitution that actually allows

polio survivors to stand and walk, even though

the muscles that are typically needed to walk

were permanently paralyzed). Not only will

post-polio patients be unable to stand or walk,

they may also be unable to even move to

position themselves in bed. Polio survivors may

also have low blood pressure after surgery that

could itself cause lightheadedness, fainting and

falls.

Rule of 2 for Recovery: Polio survivors should stay in bed 2 times longer

than other patients.

Under any circumstances, polio survivors

should get up slowly, first sitting up in bed, then

sitting with feet dangling, then getting into a

bedside chair with assistance, then standing with

assistance and finally walking with assistance

and appropriate assistive devices. With the

necessity of additional bed rest, anti-embolism

stockings and medication to prevent blood clots

may be a prudent precaution. Gentle physical

therapy in bed may be advisable to maintain

range of motion and for stretching, since polio

survivors are prone to developing painful muscle

spasms if they are not up and moving.

Rule of 2 for Length of Stay. Polio survivors

need to stay in the hospital 2 times longer than

other patients. While polio survivors may

become deconditioned with bed rest somewhat

faster than others patients, because of autonomic

nervous system damage, the dangers of getting

them up and walking too quickly far outweigh

those of moving too slowly. Polio survivors have

learned to be very aware of what their bodies can

and can't do. They are the best judges of when

they can move, stand and walk safely.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 14

Nursing Care and Nurse Caring. Polio

survivors often have difficulty merely being in

the hospital. They may have insomnia, anxiety,

and even have panic attacks. These symptoms

are easy to understand when it is remembered

that as young children, polio survivors were

ripped away from their families and admitted to

rehab hospitals for months or even years.2,10,11

Post-polio children underwent multiple surgeries

and painful physical therapy, procedures

administered often without explanation and

certainly without their consent.

Many post-polio patients have had

multiple experiences of psychological, physical

and even sexual abuse at the hands of hospital

staff. Questions or complaints about painful and

frightening therapies were not infrequently met

by staff anger or punishment. Patients report

having been locked in dark closets overnight

when they asked questions, spoke out or cried.

Necessary nursing care could be withheld for no

apparent reason. Many post-polio children were

slapped and some were actually beaten with

rubber truncheons by physical therapists to

"motivate" them to stand up and walk. 10

It is not surprising that polio survivors

can be terrified of again becoming powerless

patients at the mercy of hospital staff. Nursing

staff's appreciation of the childhood trauma polio

survivors experienced at the hands of medical

professionals, and taking a moment to actually

listen and respond to the real needs of the adult

post-polio patient, will go far toward making the

patient feel safer and more comfortable during

their stay.

RETURNING HOME

There is another "Rule of 2" when surgical

patients return home:

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.

For all of the reasons described above, the

entire recovery process takes longer for polio

survivors. It is not uncommon for typically

overachieving, hyperactive Type A polio

survivors, who were taught as children to "use it

or lose it," to return to work or household duties

the day after they return home from the

hospital.10,11

Polio survivors must be encouraged

to rest and to return to activities slowly,

especially if they are somewhat deconditioned

and feel weaker or more fatigued post-op. Polio

survivors should ask their surgeon for a note that

allows them to stay home from work twice as

long as the typical patient.

POST-OP PPS? The 1985 National Survey of

Polio Survivors has shown that emotional stress

is the second most frequent cause of PPS (after

physical overexertion).11

Certainly, there are few

emotional or physical stressors more potent than

surgery. So, polio survivors should expect some

increase in fatigue and muscle weakness

resulting from the combination of the physical

and emotional effects of the surgery, anesthesia,

other medications, and bed rest.

However, only a handful of post-polio

patients permanently lose function after surgery.

Strength or endurance lost after surgery is

typically recovered. To aid recovery, gentle

physical therapy may be advisable. Passive

stretching, range of motion exercises and slowly

increasing endurance are more valuable than

muscle strengthening exercise, which can

actually cause muscle weakness. Especially if a

polio-affected part of the body has been operated

on (stomach, back, arms or legs), a physiatrist

who is thoroughly knowledgeable and

experienced about the care of polio survivors

and PPS should be consulted before surgery so

that a post-op rehabilitation plan can be in place.

A short stay in a rehabilitation hospital after surgery (especially after back or leg surgery) may

make polio survivors recovery safer, faster and

more complete.

Polio survivors need to remember the: Rule

of 2 for Feeling Better: Polio survivors need 2

times longer to feel "back to normal" again.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 15

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. All polio survivors must be evaluated and

managed according to their individual needs.

Please take the time to read the following

references so that you will be fully knowledgeable

about and be able to help meet polio survivors'

special needs.

REFERENCES 1) Bruno RL. Ultimate burnout: Post-polio sequelae basics.

New Mobility, 1996; 7: 50-59.

2) Frick NM, Bruno RL. Post-Polio Sequelae: Physiological and psychological overview. Rehabilitation Literature, 1986;

47: 106-111.

3) Bach JR, Alba AS. Pulmonary dysfunction and sleep

disorder breathing as post-polio sequelae: Evaluation and

management. Orthopedics, 1991; 14: 1329-1337.

4) Bodian D. Histopathological basis of clinical findings in

poliomyelitis. Am J Med. 1949; 6: 563-578.

5) Bruno RL, Frick NM, Cohen J. Polioencephalitis, stress and

the etiology of Post-Polio Sequelae. Orthopedics, 1991;

14: 1269-1276.

6) Bruno RL, Frick NM. Parasympathetic abnormalities as post-polio sequelae. Archives of Physical Medicine and

Rehabilitation, 1995; 76: 594.

7) Bruno RL, Johnson JC, Berman WS. Vasomotor

abnormalities as Post-Polio Sequelae. Orthopedics, 1985;

8:865-869.

8) Bruno RL, Johnson JC, Berman WS. Motor and Sensory

Functioning with Changing Ambient Temperature in Post-Polio

Subjects. In LS Halstead and DO Wiechers (Eds.): Late Effects

of Poliomyelitis. Miami: Symposia Foundation, 1985.

9) Bucholtz DW, Jones B. Post-Polio dysphagia: Alarm or

caution. Orthopedics, 1991; 14: 1303-1305.

10) Bruno RL, Frick NM. The psychology of polio as prelude to Post-Polio Sequelae: Behavior modification and

psychotherapy. Orthopedics, 1991; 14: 1185-1193.

11) Bruno RL, Frick NM. Stress and "Type A" behavior as

precipitants of Post-Polio Sequelae. In LS Halstead and DO

Wiechers

(Eds.): Research and Clinical Aspects of the Late Effects of

Poliomyelitis. White Plains: March of Dimes Research

Foundation, 1987.

International Centre for Polio Education

POLIO SURVIVORS' PRE-OP CHECKLIST Give above article to surgeon and discuss:

1. Pre-op lung tests with measuring of carbon

dioxide.

2. Possibly having lower blood volume and blood

banking or bloodless surgery?

3. Authorization for a longer stay in the hospital if

needed.

4. Orders for post-op anti-vomiting medication. 5. Positioning and cushioning on the table during

surgery.

6. Orders for staying warm in the recovery room.

7. Difficulty clearing secretions in the recovery

room and on the nursing unit.

8. Orders for increased dose of pain medication. 9. Physical therapy for stretching and range of

motion in hospital.

10. Placing polio articles in the medical chart.

Give/discuss above article to anesthesiologist &

anesthetist:

1. Lung problems & THAT POLIO SURVIVORS CAN RETAIN CARBON DIOXIDE.

2. Lower dose of pre-op calming medication.

3. Using lower dose of anesthetic.

4. Longer-term paralysis of muscles with spinal

anesthetic and curare-like drugs.

5. Orders for post-op anti-vomiting medication.

6. Difficulty clearing secretions in recovery room.

Give this article to nursing supervisor and discuss:

1. Longer-term sedation with anesthetic.

2. Difficulty clearing secretions on nursing unit.

3. Orders for increased dose of pain medication. 4. Needing help in moving in bed and in the room. 5. Not standing or walking until you are fully

awake and able.

6. Anti-embolism stockings and anti-clotting

medication.

Meet/discuss with PPS physiatrist before surgery:

1. Post-op rehabilitation plan.

2. Physical therapy for stretching and range of

motion in hospital.

3. Possible admission to a rehab hospital before

going home.

4. Physical therapy for walking and increasing

endurance at home.

Source: http://www.postpolioinfo.com/library/surg.pdf

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 16

HOW DAYLIGHT SAVINGS TIME

CAN DAMAGE YOUR HEALTH

As clocks ticked toward the end of

daylight savings time, many sleep scientists &

circadian biologists pushed for a ban because of

potential ill effects on human health.

Losing an hour of afternoon daylight

sounds like a gloomy preview for the dark

winter months, and at least one study found an

increase in people seeking help for depression

after turning the clocks back to standard time in

November – in Scandinavia. Here's what science

has to say about a bi-yearly ritual affecting

nearly 2 billion people worldwide.

Sleep Effects: Time changes mess with

sleep schedules, a potential problem when so

many people are already sleep deprived, says Dr.

Phyllis Zee, a sleep researcher at Northwestern

Medicine in Chicago. About 1 in 3 U.S adults

sleep less than the recommended seven-plus

hours nightly, & more than half of the U.S. teens

don't get the recommended eight-plus hours on

weeknights. One U.S. study found that in the

week following the spring switch to daylight

saving time, teens slept about 2 1/2 hours less

than the previous week. Many people never

catch up during the subsequent six months.

Research suggests that chronic sleep

deprivation can increase stress hormone levels

that boost heart rate and blood pressure, and

chemicals that trigger inflammation.

Heart Problems: It has also been shown

that blood tends to clot more quickly in the

morning. These changes underlie evidence that

heart attacks are more common in general in the

morning, & may explain studies showing that

rates increase on Mondays after clocks are

moved forward in the spring, when people

typically rise an hour earlier than normal.

That increased risk associated with the

time change is mainly in people already

vulnerable because of existing heart disease, said

Barry Franklin, director of preventive cardiology

and cardiac rehabilitation at Beaumont Health

hospital in Royal Oak, MI.

Studies suggest that these people return to

their baseline risk after the autumn time change.

Car Crashes: Numerous studies have

linked the start of daylight saving time in the

spring with a brief spike in car accidents, with

poor performance on tests of alertness, both

likely due to sleep loss. The research includes a

German study published this year that found an

increase in traffic fatalities in the week after the

start of daylight saving time, but no such

increase in the fall.

Internal Clocks: Circadian biologists believe ill health effects from daylight saving time

result from a mismatch among the sun "clock," our

social clock – work & school schedules & the

body's internal 24-hour clock.

Ticking away at the molecular level, the

biological clock is set by exposure to sunlight. It

regulates, i.e. metabolism, blood pressure &

hormones promoting sleep & alertness.

Disruptions to the body clock have been linked with obesity, depression, diabetes, heart

problems and other conditions. Circadian

biologists say these disruptions include tinkering

with standard time by moving the clock ahead one

hour in the spring.

Pressure to change: In the U.S., daylight

saving time runs from the second Sunday in March

to the first Sunday in November. It was first

established 100 years ago to save energy. Modern-day research has found little or no such

cost savings. Federal law allows states to remain

on standard time year round but only Hawaii and

most of Arizona have chosen to. Roenneberg and

Northwestern's Zee are co-authors of a recent

position statement advocating returning to

standard time for good, written for the Society for

Research on Biological Rhythms.

"If we want to improve human health, we

should not fight against our body clock, and

therefore we should abandon daylight saving

time," the statement says.

Reprinted from Sun Sentinel, 11/3/19.

Contributed by Jane McMillen, member.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 17

AUTOPSY OF A POLIO

SURVIVOR WITH

MUSCLE WEAKNESS

This isn't the first autopsy of a polio survivor

with PPS. But it does remind us that:

1) Progressive muscle weakness means

motor neurons are dying;

2) The original

poliovirus attack

killed motor neu-

rons not only in the

spinal cord area

that controlled this

man's left leg but

also caused "silent

damage" through-

out the spinal cord,

silent in that the

patient had no

muscle weakness in

the right leg or his arms after polio but did

have arm and leg muscle weakness beginning

at age 58;

3) Neuron death caused glial scars in the

spinal cord, the same type of scar our MRI

studies found in fatigued polio survivors'

brain activating systems;

4) NONE of the markers for ALS was found.

Conserve to preserve. The neurons you save

will be your own!

An autopsy case of progressive generalized

muscle atrophy over 14 years due to post-

polio syndrome.

Oki R, et al. Rinsho Shinkeigaku. 2015 Nov.

We report the case of a 72-year-old

man who had contracted acute paralytic

poliomyelitis in his childhood. Thereafter, he

had suffered from paresis involving the left

lower limb with no

relapse or pro-

gression of the

disease.

In his 60s he

began noticing

slowly progressive

muscle weakness

and atrophy in the

upper and lower

extremities. At 72,

muscle weakness

developed rapidly,

and he demon-

strated shortness of breath on exertion and

difficulty swallowing. He died after about 14

years from the onset of muscle weakness

symptoms.

Autopsy findings demonstrated

MOTOR NEURON LOSS and GLIAL

SCARS not only in the motor neurons in the

anterior horns, which were result of his old

poliomyelitis, BUT ALSO THROUGHOUT

THE SPINE. NO Bunina bodies, TDP-43 or

ubiquitin inclusions, which are seen in ALS,

were found.

The pathological findings in the

patient are considered to be related to the

development of muscle weakness.

Posted in The Post-Polio Coffee House on Facebook by Richard Bruno,

PhD, August 2019.

SECOND TIME AROUND, MARCH 2020 – PUBLICATION OF BOCA AREA POST POLIO GROUP, BOCA RATON, FL 18

COMMENTS

Ellen Pedersen, Harpelunde, Denmark:

Thank you so much for the calendar and the

pen. Denmark has great holidays without

Christmas snow.

Earl Feick, Vero Beach, FL & Plymouth,

WI: Received the news letter today. I have

been reading it via email. Would love to

attend one of your meetings. Enjoyed the

article from Warren Peascoe – I’m in the

same boat only worse because I drive my

van from my wheel chair. Looking into my

local paratransit as a back-up plan like he

suggests. Thanks for your note, Maureen.

Freeman & Lizzie Yoder, Middlebury, IN:

Enclosed is a donation and thanks for the

newsletters.

FOR SALE Pride GoGo portable scooter – separates into

five pieces; fits in most

trunks; new lock

cylinder & batteries. In

very good shape.

Asking $200 or best

offer. Call Marion at

201-681-6290, Boca Raton, FL.

MARK YOUR CALENDAR

Polio Network of NJ is hosting PPS in NJ –

Past, Present & Future presented by Richard

L. Bruno, PhD, Sunday, April 26, 2020,

Bridgewater Manor, Bridgewater, NJ.

www.pnnj.org or info@pnnj.org.

Colorado Post-Polio will host a Rocky

Mountain Getaway PPS educational

conference, Rocky Mountain Village Camp, Empire, CO, August 16-20, 2020. Contact Mitzi

720-940-9291 / mtolman@eastersealscolorado.org

Ohio Polio Network will host its semi-

annual Post-Polio Conference on Saturday,

September 19, 2020, Tuscora Park, New

Philadelphia, OH. Contact Brenda Ferguson

(330) 671-7103.

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MISSION STATEMENT

To help polio survivors become aware

that they are not alone and forgotten.

To share our thoughts and feelings with

others like ourselves.

To network with other support groups.

To share information and encourage each

other to carry on.

To educate the medical profession in

diagnosing and treating Post Polio

Syndrome.

To always maintain a positive attitude.

Boca Area Post Polio Group collects no

dues and relies on your donations. If you

would like to make a contribution, please

make your check payable to BAPPG.

Thank you for your support!

Maureen Sinkule Carolyn DeMasi

11660 Timbers Way 15720 SE 27 Avenue

Boca Raton, FL 33428 Summerfield, FL 34491

561-617-4450 352-454-6383

Jane McMillen, Sunshine Lady - 561-391-6850

Flattery will get you everywhere!

Just give us credit:

Second Time Around, Date

Boca Area Post Polio Group, FL

Disclaimer: The thoughts, ideas, and suggestions presented in this publication are for your

information only. Please consult your health care provider before beginning any new

medications, nutritional plans, or any other health related programs. Boca Area Post Polio

Group does not assume any responsibility for individual member’s actions.

BOCA AREA POST POLIO GROUP

11660 Timbers Way

Boca Raton, FL 33428

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Second Thursday of each month

Except June, July, August & September

Spanish River Church

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Entrance and parking on west side

E-mail: bappg@aol.com

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BOCA AREA POST POLIO GROUP A Ministry of Spanish River Church

FOUNDERS

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COMMITTEE MEMBERS

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