The Polio Paradox
Uncover the hidden history of polio to understand and treat post-polio syndrome and chronic fatigue syndrome
Englewood Hospital and
Undiagnosed childhood polio causes Chronic Fatigue Syndrome in women baby boomers
The "Bush-Pretzel Syndrome": A new late-onset problem in polio survivors
June 4, 2002. Englewood, NJ. A new late-onset problem in polio survivors -- the "Bush - Pretzel Syndrome" -- is revealed in today's publication by Warner Books of "The Polio Paradox: Uncovering the Hidden History of Polio to Understand and Treat Post-Polio Syndrome and Chronic Fatigue" by Dr. Richard L. Bruno. Dr. Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at New Jersey's Englewood Hospital and Medical Center.
While watching a football game President George W. Bush swallowed a pretzel, causing his pulse and blood pressure to plummet and causing a faint. An unusual experience? Not for some of the world's 20 million polio survivors with Post-Polio Sequelae. PPS are the unexpected and often disabling symptoms -- overwhelming fatigue, muscle weakness, muscle and joint pain, sleep disorders, heightened sensitivity to anesthesia, cold and pain, as well as difficulty swallowing and breathing -- that occur about 35 years after the poliovirus attack in 70% of paralytic and 40% of "non-paralytic" polio survivors.
"A new problem in polio survivors called 'vaso-BAGEL-syncope,' a play on the name vaso-vagal syncope, has come to light only in the past few years," says Bruno. "The President's problem likely had to do with a pretzel irritating the esophagus and stimulating the vagus nerve." Vagus nerve stimulation causes heart rate and blood pressure to drop and is the most common cause of fainting, called vaso-vagal syncope. "Anything that irritates the esophagus -- like swallowing a large piece of bagel or even a pretzel -- can stimulate the vagus nerve enough to slow the heart and drop blood pressure, which likely happened to the President," says Bruno.
The vagus nerve normally carries information about how much food is inside your throat, esophagus, stomach and intestines back to the vagus nerve neurons in your brain stem that regulate heart rate and blood pressure. "The more food in your stomach, the lower your heart rate and blood pressure and the more fatigue you feel," explains Bruno. "A too-full stomach causes the well known post-Thanksgiving Dinner nap."
For Mr. Bush, his "vaso-bagel" faint is likely a one-time thing. But for polio survivors low blood pressure, lightheadedness, severe fatigue and sometimes a faint can be frequent occurrences. Bruno has been following a growing number of post-polio patients from around the world who come to The Post-Polio Institute for treatment. Although polio survivors don't usually faint they do feel exhausted after eating even a normal-sized meal, says Bruno. He has found that when these polio survivors' stomachs' fill with food, the vagus nerve is apparently over stimulated, triggers a drop in blood pressure and causes severe fatigue.
Why do polio survivors have more problems with the vagus nerve, heart rate and blood pressure than do those who didn't have polio? "We know that the poliovirus damaged brain stem neurons that control the vagus nerve, and possibly the nerve itself," says Bruno. What's more the vagus nerve is a two-way street. It also carries commands from brain stem neurons to activate the muscles in the throat, esophagus, stomach and intestines that make swallowing, digestion and elimination possible. "So it's no surprise that polio survivors report a related problem that was the trigger for President Bush's problem: food sticking in the upper esophagus," says Bruno. "We think food sticking a polio survivor's esophagus is due to the vagus nerve not being able to stimulate esophagus muscles to move food downward. Food sticking triggers a painful esophagus muscle spasm that can also stimulate the vagus nerve, causing blood pressure and heart rate to drop. Vagus nerve damage disrupting the normal functioning of the gut may explain Bruno's 1985 National Post-Polio Survey findings that swallowing difficulty, diarrhea, colitis, ulcers and constipation -- even the complete stoppage of the movement of the stomach and intestines -- are as much as fifteen times more common in polio survivors than in those who didn't have polio.
The relationship between fatigue, brain stem neuron damage and low blood pressure links polio survivors to another group: those with chronic fatigue syndrome. About one quarter of patients with CFS have fatigue that is associated with low blood pressure or changes in heart rate. Some CFS patients report fatigue when a hot shower or hot room causes blood vessels to open and blood pressure to drop, as do nearly 40% of polio survivors. "Some CFS patients have blue feet just as polio survivors do," says Bruno," suggesting that blood pooling in the legs can also contribute to low blood pressure."
"All polio survivors and CFS patients should have their heart rate and blood pressure taken lying, sitting and standing, " says Bruno. "If a drop in blood pressure is associated with fatigue elevating the legs and using compression stockings are often helpful to stop blood from pooling in the legs." Medications that increase the amount of fluid in the blood or reduce the size of veins to stop blood from pooling in the legs can also be helpful.
"If fatigue is associated with meals eating small bites and washing them down with liquid -- as well as eating frequent, small, higher protein meals -- can stop food from sticking in the esophagus and stop the stomach from getting too full, prevent over stimulating the vagus nerve and prevent fatigue or even a faint," says Bruno.
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