To Home Page of PHI website to PHI's Secure Shopping Cart
PHI's Education
About PHI Education Advocacy Research Networking to How to Donate to Membership Application

Post-Polio Health (ISSN 1066-5331)

Vol. 11, No. 4, Fall 1995
Presented at Sixth International Post-Polio and Independent Living Conference, Fall 1994

Facing Surgery When Breathing Is a Problem: Considerations Before Surgery

Oscar A. Schwartz, MD, FCCP, Saint Louis, Missouri

Certain polio survivors may be at increased risk for surgical procedures, and the benefits must be weighed with the risks for determining candidacy. Prior to surgery, a good evaluation of the respiratory system is necessary. Polio survivors can develop breathing problems due to weakness of muscles originally (and obviously) involved with polio as well as those partially compromised but continuing to function. The effects of scoliosis also need to be considered, as Dr. Alba has discussed.

The evaluation should focus on the individual's reason for going into surgery as well as the complications that may result from anesthesia. Anesthetic complications can include those that are secondary to the general anesthetic, as well as those which may be complications of use of the anesthetic. The program that is developed should have the goals of supporting the respiratory system if it is impaired, or decreasing the amount of risk associated with the surgical procedure.

Patient-focused care involves a team. Team members are determined by the type of surgery, whether it involves surgery of the spine or abdominal surgery such as gallbladder, colon surgery or hysterectomy. The team is established so that the surgeon, anesthesiologist, as well as the professional following the polio survivor, communicate with each other.

With healthy individuals, surgical procedures may have limited risk. In polio survivors, even minor surgical procedures that involve general anesthetics or nerve blocks that may paralyze the only functioning respiratory muscles may have disastrous effects.

Individuals who are diaphragm breathers may have response to inhaled anesthetic totally different from those who use the diaphragm as well as the intercostal muscles to breathe. Swallowing difficulties are of concern because of the potential risk of aspiration associated with the general anesthetic. Anesthesia can further compromise muscles in the head and neck area that may be involved with swallowing or breathing. Polio survivors should understand what the anesthesiologist will do and feel at ease with the procedure used.

After surgery, respiratory support may involve facilitation of cough. Support with a ventilator may be necessary, especially if the individual had a preexisting need for one. The post-operative period may be longer for polio survivors.

Presented at Sixth International Post-Polio and Independent Living Conference, Fall 1994

Facing Surgery When Breathing Is a Problem: Preparing for Surgery

Kathleen Navarre, PhD, Essexville, Michigan

When I was six years old, I had bulbar polio as well as paralysis in my upper and lower body. In 1991 through the network, I connected with Oscar A. Schwartz, MD, in Saint Louis. Since that time I have used LIFECARE's PLV-100 ventilator with a Respironics face mask for night-time ventilation. I am back to driving and teaching full time. I feel quite alive, and delighted to be so.

My experience with surgery, in 1993, was not a polio issue; it was a hysterectomy. I came to Saint Louis to have the support of Dr. Schwartz and the team at St. Mary's Health Center which paid off, for I was back in the classroom five weeks after the surgery.

My greatest fear as a polio survivor with breathing problems was the thought of abandoning myself to an anesthetic and letting something take over my breathing for me. I am a sensitizer (a person with internal locus of control), so to face this traumatic experience, I gathered all the details, even the gory ones. I suspect that most of us attending this conference want all of the information we can get.

Others come under the label of repressors (individuals who have an external locus of control). They say in essence to a physician, "Do whatever you need to do and wake me up when it is over." That is fine, too.

Having an internal or external locus of control or being a repressor or sensitizer is neither good nor bad. Recognize which you are and make it very clear to your physician.

When my sister and I walked into St. Mary's Health Center for my surgery, there was an iron lung in the hallway Being a sensitizer, I said, "Oh, my goodness, Mary, that's for me." Being a repressor, she said, "Oh no, that's always there." I responded, "There's about four inches of dust on it. Obviously it's been in a closet since 1954." I was iron lung phobic but I wanted to touch it, to feel it. After I did touch it and put my hands in it, and sort of kicked a tire or two, I felt better about it. Because it was Halloween, the nurses discussed putting a pumpkin at the head and that humorous idea made me feel more comfortable. (The iron lung was there for me in case I required it after surgery, but it was not needed.)

They tried to do a spinal for my surgery which did not work because of my scoliosis. It was impossible to provide the necessary regional anesthesia. I did receive a general anesthesia with appropriate incubation. My recovery was normal in terms of time.

Kathleen offers these suggestions for adjusting to using a face mask:

At first the vent feels like a smothering enemy, but it will become a life-affirming friend. Give it a chance.

Continued ...