Post‐Polio Syndrome: A Perspective from Three Countries

A 55-year-old woman with a history of polio at the age of 2 years presents with complaints of increasing fatigue and pain in her legs with moderate activity, including performing general household tasks and ambulating distances greater than a few city blocks. She reports that she had residual weakness in her legs that limited her participation in school athletics as a child and teenager, but no fatigue or pain. She has mild scoliosis but this is not accompanied by any symptoms and does not affect her activity or social participation. The symptoms of fatigue and pain began to emerge about 10 years ago and have steadily worsened to the point that she is having difficulty maintaining her previous level of function. Her parents told her that she did not require ventilatory support during the acute illness and never needed bracing during childhood. She describes her pain as primarily achy but sometimes more intense, sharp and radiating from the back. Rest usually helps to relieve pain and fatigue. She experiences the fatigue as both muscular and more generalized, gradually increasing with walking or other physical activity. These symptoms disturb her sleep intermittently during the week. She reports some mild depressive symptoms but does not believe that she suffers from depression. She is employed full-time as a paralegal, as she has been for many years. She used to be an avid golfer but has been unable to play the sport in recent years. What additional evaluation, including history and physical examination, laboratory, or other studies, would you recommend for this patient? What do you think are the possible etiologies of her symptoms? How would you advise her concerning treatment of her condition including medications, lifestyle modifications, or exercise? Guest Discussants: