Date: Sat, 1 Mar 2003 14:54:40 -0500
From: "Eddie Bollenbach"
Subject: Re: [PPM] ppm exhaustion

I don't think exhaustion is a _primary_ symptom of PPS but rather is secondary to muscle fiber loss from motor nerve malfunction. The motor units are too big (one neuron enervating 100 muscle fibers, for example, and they are getting bigger as muscle fibers lose connections and functioning large motor units compensate by putting out even more connections to enervate orphaned muscle fibers) so muscles have inadequate enervation. This muscle inadequacy, or weakness, is primary whether you feel it and realize it or not. I never realized this and testing my muscles by manual muscle testing can leave the doctor thinking I am at a maximum of 5 in strength for all my muscles even though I must use a power chair to get around without feeling exhausted. That's because gigantic motor units contract all my muscles at once giving great instant strength. But contract a polio affected muscle for a while, say by holding a leg or arm up, and the limb often starts to move rhythmically. Do you know why the limb muscles seem to contract, relax, contract, relax, as a tremor all in synch? Its because all your muscles are contracting at the same time and relaxing at the same time because the motor units are too big and there are too few enervated fibers.

The exhaustion is secondary to the weakness, which is what you feel and perceive. With the exception of breathing problems, that is, if you do not have bulbar involvement, the best way to avoid exhaustion is to avoid overusing, or using, muscles that are failing, and to improve, if possible, cardiopulmonary fitness along with the fitness of unaffected muscles. This involves enormous and difficult changes which mean accepting adaptive durable medical equipment and lifestyle changes. This is very hard for most of us. But that is the way, otherwise we're dancing around the problem.

Eddie Eddie
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