Book review by Tessa Jupp.        Dr Richard Bruno, in his book “The Polio Paradox”, explains his research into the “blue feet” common to many polios.

We all know that the polio affected foot/leg/arm/hand etc is usually colder than the rest of the body and seems to take forever to heat up.

Dr Bruno explains how he actually measured the temperatures with a thermometer and was surprised to find that whilst a normal foot will have normal body temperature measurements, the cold polio foot may actually be several degrees lower than the room temperature, not the just lower than the other foot!

Even with a hot pack on it, the foot took 30-60 minutes to start to warm up and when it did, the skin went from being a reddish purple calf and a deep purple foot - to a foot that was as red as a lobster!

Rehab pioneer Fred Kottke had found that polios could also have burning in their cold limbs, which became supersensitive to pain.  He and others thought that  these colour changes were due to muscle spasm in the muscles surrounding blood vessels, causing narrowing and reduction of the flow of warm blood to the skin causing the skin to become cold.

However to Bruno this didn’t make sense as if the skin is starved of blood the skin would be white.  So spasm in the muscles surrounding blood vessels was not the cause.

Pooling of venous blood though, would cause this blue colouring.  That is - blood not being able to get back to the heart and collecting in a lower body part, like the feet and legs.

Normally the  blood vessels respond to changes in temperature, becoming more closed to conserve body heat or open in hot weather to cool us down.  This is controlled by the sympathetic nervous system and this can be damaged by the polio virus too.

Dr Bruno’s team did a Lab study with polio and non polio people in a walk-in fridge measuring a number of factors.  They found that compared to 30°C function, at 25°C the ability of the motor nerves to function in polio survivors’ polio affected areas was less, and at 20°C there was a 70% loss in manual dexterity and strength.  In fact the nerves were functioning as if the room temperature was 10°C lower than it actually was!

So the fact that polio affected limbs can still feel cold even on a hot day is right.  It is like the ‘doors and windows’ of the blood vessels are left permanently open and as the weather gets colder we can’t shut them so the ‘inside rooms’ in our feet just keep getting colder and colder.

As the skin and veins get colder, the arteries and muscles around them get cold causing them to contract, reducing blood flow in and so the area gets even colder  The feet get purple and even dark blue as non oxygenated blood pools in big open veins, arterial flow slows and doesn’t push the blood back to the heart.

The coldness of the skin moves inside the leg the nerves get cold so muscles don’t get the message thru’ from the spine and get weaker.  The muscles become chilled, as do the tendons and ligaments and we become literally “chilled to the bone”.

The process of heat loss and deep cooling isn’t easy to reverse and there is danger in getting too warm too.  Polio feet and legs become lobster red as the arteries and veins open wide and blood rushes to the skin.  When we stand up in this condition, gravity pulls blood into the feet and blood pressure can drop causing light-headedness and even fainting.  This is why polios are more prone top swollen feet when they hang down and when there is less muscle to help to pump the blood flow back to the heart.

It is important to try to keep cold polio areas warmer as constantly being cold can cause further loss of nerves and increased permanent weakness.

TO KEEP WARM

Dress to preserve the heat in polio affected areas.  Put on layers of clothes that can be removed or added as you need.  Elevate your feet.  As winter approaches, get out the long-johns and leg warmers.  Get socks and gloves that help to conserve the heat.  Get insulating polypropylene clothing.  Keep as warm as when in bed.  Don’t let yourself get cold.

Make sure your doctor is aware of this when undertaking tests and surgery.  The examination room needs to be warmed and you will need more blankets after surgery.  Many polios report shivering in recovery.  Cold can affect muscle strength & may even affect your blood pressure.