A number of clients with Polio have undergone surgery to various joints.  It is timely to remind the Network members to make sure that they are well prepared with information to give to their GP, surgeon, therapists etc. More important is to ask the right questions and have all the information you need, before the operation.
 
For those who are Internet savvy please look up these sites:
http://www.azstarnet.com/~rspear/surgery.htm
You are looking for a PPS Monograph Series. 1996, Volume 6(2)
"Preventing Complications in Polio Survivors Undergoing Surgery " by Richard L Bruno, PhD, of  Kessler Institute for Rehabilitation.
 
The Lincolnshire Post Polio Library will also have some relevant information-
http://www.ott.zynet.co.uk/polio/lincolnshire/library/gawne/ppspandcm-s11.html.
 
Questions that will give you information on how to prepare yourself for the operation:
 
Before the operation:
 
1. Ask the doctor about the length of bed stay required. Inform the doctor/surgeon that,   "in-activity will only weaken your muscles"
If bed rest is required, you, the patient, must be given a list of bed exercises to keep your muscles ticking over.
Who will do this? (can you arrange with physio before-hand)
 
2. It is often not obvious to others, how clients with polio have adapted to:
· self care tasks like getting out of bed, getting on and off the toilet, personal toileting, showering, dressing .
· activities of daily living like cooking, house cleaning, shopping etc
 
3. Ask the doctor/surgeon:
· About the length of bed stay that will be required?
· The period of time you may require a walking aid?
· How much weight you can put on the joint or the limb?
· What angle of movement are you allowed?
 eg - Must you use a walking stick or frame?
· How are you now going to manage in the toilet, getting out of bed, carrying cups and plates if  your hands are otherwise occupied?
 
4. Discuss whether your spouse is strong enough   to help you, if you need help with moving in bed, in and out of bed, walking and with self care activities.
 
5. Tell your doctor about the activities that you are involved in, and ask how the operation will impact on these activities.

6. If the operation is to an arm joint:
 · How long before you are allowed to move the joint? How will this affect your self care ability and activities of daily living?
· What sort of splint will you be wearing?
· Will you be able to remove and put  the splint on by yourself, especially if the operation is to the stronger arm?
· If the operated hand is the stronger hand, are you strong enough to use a stick in the other hand, what will it do to your shoulder joint if you put extra stress on the joint?
· When can you start carrying objects in the hand , what weight can you carry?
 
7. If the operation is to the leg:
 · Will you need a walking aid?
· Are your arms and joints strong enough to take the stress?
· Do you have enough space in the house to use a walking aid?  Do you have carpets that might make it difficult?
· When can you put full weight on the limb?
· How much joint bend are you allowed?  This will affect chair and toilet seat height.  If you have steps in your house you may have difficulties.  The height of your bed may need to be looked at.
· You may need a shower chair to be able to shower safely.
· If you rely on the momentum of the lower part of your body to swing out of bed, you might need a bed rail to help you sit up or move in bed, as you might need to rely on arm strength for a while.
· Your return to driving will be affected - ask the question.

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Ø You might want to ask about Silver Chain assistance for self care activities. You might need
assistance with house work and with shopping.
 
Ø You might want to ask for an OT assessment of your home, to look at assistive devices to help
in the post-op period till you are fully functional.
 
Ø You might want to ask about post-operative physiotherapy, to regain strength, to ensure that
you are able to maintain independence.
 
Ø Always go to the doctor with written questions.    We all have performance anxieties.
 
Ø Sharing experiences and solutions via your newsletter is a useful way of problem solving.
 
 written by G.Jegasothy, Senior Physiotherapist
 Late Effects of Disability Clinic. RPH-SPC