PPS: Physiatrist or Neurologist?
Eddie Bollenbach

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Eddie Bollenbach Bio & Picture

Date: Tue, 26 Jan 1999 18:59:01 -0500
From: "Eddie Bollenbach"
Subject: Confronting Fatigue!

Physiatrists are medical doctors and can prescribe medicines, order tests, and can utilize medicine in the ways other MD's do. However, they are oriented toward working with Physical Medicine, which means their approach to a problem would generally begin by prescribing bracing, encouraging lifestyle changes (which may be very difficult for many of us), and mostly looking at the problems of PPS as mechanical and physical and which can only get better by ameliorating strain.

Physiatrists: American Academy of Physical Medicine & Rehabilitation

Neurologists, on the other hand, are interested in the neurological (central nervous system) aspect of PPS. They are more likely (in my opinion) to try drugs, do EMG's, and try to get the nervous system to function better.

At this time we can only palliate PPS, and not cure it. I believe the muscle pain and spasms we feel are from overuse and that many of the people who are having the most difficult pain are the most mobile and push on wanting to stay that way. I think that muscle pain and muscle fatigue are a great strain on us and rob us of a quality of life that could be possible with change and adaptation to the problems presented by PPS. And I think the best course is to rest polio affected muscles while, at the same time, optimizing our strength and stamina.

For example, even though this is extremely difficult, many of us need to use a wheelchair. Some of us who use a wheelchair need a power chair. Even if we make the leap and swallow our pride and begin to use these devices the benefits are not without hidden consequences. We lose stamina and conditioning because we are no longer walking. And we may still have a lot of discomfort from sitting. I have found that when polio affected muscles get weak they get really weak and it takes a lot of backing off to get relief from the pain. At least that was the case in my situation.

This may seem contradictory, but after you take the strain off of polio affected muscles you must exercise in some way. Of course, the exercise should be tailored to using muscles that were not affected or minimally affected. Even if the exercise is treading water in a pool for 15 minutes three times a week, or some other sustained activity that you can tolerate without pain. Unfortunately, some of us cannot do this. Without some degree of conditioning we will be subject to some fatigue and pain.

I believe that the course I have described above for PPS management is the best course and is more likely to be recommended and managed by Physiatry rather than Neurology. But I am sure there are exceptions and exceptional Neurologists who manage their PPS patients very well.

Eddie
Contact Professor Edward P. Bollenbach
Bollenbach AT commnet.edu
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