PSN Library Files

Dr. Henry writes about antidepressant medications

I am a little surprised at the concern about the use of antidepressant medications in the treatment of PPS. It rings of the ongoing stigma against individuals who suffer from so called mental illlness. I have spent 31 years studying, researching, and treating mental illness. I have a significant family member who spent 20 years in a state mental hospital. When I first began my psychiatric training 31 years ago, schizophrenia was considered a mental illness with probable psychogenic causes. There was even a term used then, namely the schizophrenigenic mother. Today, we know clearly that schizophrenia is a biological brain disease involving disturbances of certain brain biochemicals affecting cognitive and perceptive function. There are changes on MRIs and probable genetic factors or predispositions. The same can be said of bipolar disorder (manic depressive illness) and major depression. Some studies indicate that over one third of PPSers before being diagnosed or shortly thereafter meet the criteria for the diagnosis of major depression.

The “boundary” between so called mental illness and physical illness is quite vague and may not exist. The very fact that many medications such as the various types of antidepressant drugs help us and many other individuals with chronic or reocurring disorders should tell us logically that so called mental illness has definite biological factors and vice versa, that is, a condition such as PPS has definite emotional factors. I know what I have experienced. I have experienced loss of functional status, having to accept disability at a time that I would be at the zenith of my career, fear of what is happening to me and not knowing what really helps except rest, the logical anxiety that this PPS is progressive, and to hear or read that we are all going through this again (deja vu) and the whole experience seems unfair and makes me angry. That anger can get projected when we have our feuds, bash our doctors, and assail various agencies. Don’t get me wrong, most of the time our complaints have some merit, and we mostly support each other, but we have been individualists and in control so long that these life style adjustments are tough and can be depressing.

Everyone who has ever lost someone precious or lost a part of their self-esteem or been ill with a chronic disorder knows what depression is like. We take antidepressants and other psychotropic or brain directed drugs because they help some of us. True, the doses are usually lower than for treating most biological depression in people without PPS. But we do not tolerate most any drug or stress very well. We require less pain meds and even less anesthesia than most. Maybe the antidepressant drugs do help our “depression” in lower doses. I simply do not know, but it would not bother me in the least if they do work that way on us. I feel better and when you feel better, you are usually less depressed.

So if you take Prozac, Paxil, Zoloft, Elavil, Pamelor, Effexor, Klonopin, Ativan, Valium, Xanax, Ambien, Desyrel, Wellbutrin, and on and on, and you feel better, I say be grateful because I am.

I have said enough.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

25th February 1997

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 27th February 1997

Last modification: 22nd January 2010.

Dr. Henry writes about Bulbar and spinal polio

Bulbar polio involved the brain stem where the centers for the cranial nerves are located. The cranial nerves involve smell (olfactory), vision (optic), three cranial nerves control the various muscles that control eyeball movements, the trigeminal nerve and facial nerve which innervate cheeks, tears, gums, and muscles of the face,etc, the auditory nerve which provides hearing, the glossopharyngeal nerve which controls in part swallowing, and functions in the throat, another cranial nerve which controls tongue movement and taste and one that actually sends signals to the heart, intestines, respiratory (lungs) and the accessory nerve that controls upper neck movement. Thus bulbar polio could affect any or all of these functions. Death from bulbar usually occurred from damage to the cranial nerve sending the signal to breathe to the lungs. This nerve stimuilates our breathing during sleep. An iron lung, invented around 1926 could keep victims alive with negative pressure breathing. Today, ventilators mostly utilize positive pressure breathing because it is more efficient. Bulbar victims could also die from damage to the swallowing function because a victim could drown in their own secretions unless adequately suctioned or given a tracheostomy to suction secretions before the secretions entered the lungs. It was difficult to have a tracheostomy and still be able to tolerate the air tight collar of an iron lung. Death also occurred from the overwhelming invasion of the virus into other parts of the brain causing coma and death. This was found on autopsy in some deceased victims.

Spinal polio involved damage to the anterior horn cells which run up and down the spinal cord. These cells control motor function only. Sensory cells in the spinal cord were spared, thus we all feel pain and touch. Paraplegics and quadraplegics do not have motor or sensory function below the level of their injury. Spinal polio could damage the muscles of breathing in the chest wall and thus spinal polio victims could also need the assistance of a ventilator or iron lung. Many people had both, spinal and bulbar combined. Actually, many victims that had bulbar alone and had good recoveries had good muscular function because their spinal cord was not involved. With PPS, many of these people are having swallowing and central fatigue problems or problems with any functions related to the cranial nerves (double vision for example).

I hope I am explaining this adequately. Statistically, most of us had spinal polio, and most that had bulbar had it combined with spinal. But now we seem to be learning that many of us had brain involvement during the acute infection that did not do any recognizeable damage then, but may be giving us problems now with the total body fatigue or central fatigue of PPS.

People who had only the GI form of polio which we had initially when we became ill (flu like) had the non-paralytic type of polio. The mystery now is whether these people may have had silent CNS involvement and are subject to PPS.

This disease, back before Salk and Sabin, and now with PPS, is amazing and fascinating to any one who studies the natural course of infectious diseases that do not always kill you quickly. Syphilis was this way

before antibiotics and Aids is similarly tragic and fascinating in its specificity for the cells of the immune system. Viruses are wonders of nature. I wished I had missed this one in 1950.

Take care all and I love this service to each other.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

21st February 1997

Addendum

Yesterday, I posted from memory my thoughts on bulbar and spinal polio as well as spinal/bulbar polio. What is posted is generally correct. However, I got out my neurology text and will give some specifics since the readers on this list are learned folks and like accuracy.

The twelve cranial nerves and their functions are:

Many of these nerves have branches, especially the trigeminal and vagus. The “bulb” or medulla part of the brain contains the ascending corticospinal tracts of the spinal cord, the descending sensory tracts of the spinal cord and the nuclei of the 9th thru the 12th cranial nerves. Thus, bulbar polio would most commonly affect the 9th thru 12th cranial nerve and could also affect the anterior horn cells in the spinal cord causing motor paralysis or damage to the muscles being supplied by those spinal nerves. Usually the damage was assymetical and could even be upside down (a person left with the ability to walk, but

possibly in need of a ventilator). Thus more often bulbar polio involved problems with swallowing, breathing and speech. Add the spinal component and there would be motor paralysis, as severe as quadraplegia of motor function, not sensory.

Most people had nonparalytic polio, followed by spinal, followed by spinal-bulbar. Now I think since other areas of the brain were also involved even in spinal alone, there is some rational as to why so many of us are now experiencing central fatigue as a symptom of PPS. So much of the central nervous system may have been involved unknown to us and our doctors at the time. The doctors, nurses, and physical therapists could only record and measure the observable losses during the time periods of the polio epidemics, not the unobservable damage. I think this explains in part at least part of the mystery of why we are experiencing such a variety of signs and symptoms with PPS. At least it makes a little bit of sense to me. I hope I communicated this in a readable manner.

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 22nd February 1997

Last modification: 22nd January 2010.

Dr. Henry writes about Medication and Psychotherapy

In my experience, any disease process may require a combination of talk therapy and medication or other treatments (surgery, rehab, Pt etc). Most so called mental illnesses are more clearly involving a biological component. The brain is an organ just like the heart, the liver, the intestines, etc. Every disease that affects

the human emotions needs more than medication or procedures. PPSers have a double problem emotionally. We have all the deja vu memories of the acute polio episode mixed in with the current reality of PPS. We have repressed memories being rekindled by the current problem, hence many emotional factors complicated by the the CNS physiological and psychological effects of PPS. That seems to be the reason we need to talk about our problems and take medication also or whatever treatment works for us.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

17th February 1997

Dr. Henry writes about Depression

Manic depression (bipolar disorder) is primarily a genetic (predisposition) biochemical disorder that occurs separately from post polio syndrome. At least there are a lot more people with bipolar disorder than PPS and more people with PPS that do not have bipolar disorder. If you have both, it is like having PPS and another disorder such as diabetes. It is very true that many PPSers get depressed perhaps secondary to psychological factors such as loss of self esteem and a sense of usefulness, and possibly to biological factors such as a depletion of serotonin or dopamine. Whatever the connection, the various groups of antidepressant drugs seem to help many PPSer deal with pain, sleep disturbance, anxiety and mood changes, but usually in lower dosages than normally used in treating biological depression alone. Other CNS drugs are also frequently used such as analgesics, antiparkinsonian drugs, benzodiazapines (minor tranquilizers), antiviral agents, and sleep hynotics. The doctors do not know what is going on except something is happening to almost the entire CNS system, but not exactly the same way in all of us. For some it is motor, some sensory (pain), some involuntary functions such as GI changes, some special senses (tinnitus in the ears), and some seems to be more brain fatigue (central fatigue). I think it is all related to the damage done at the time of the original viral infection and now we are having delayed post viral sequalae and the wearing out phenomenon we all know about. Research done by Dr. David Bodian (I may not have his name exactly correct) in the late 40’s and early 50’s on autopsies of fatal polio cases revealed considerable brain involvement in the original infection and not just limited to bulbar, but spinal as well.

Enough on this, but it is interesting to revisit the research done on the disease before Salk and Sabin. Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

14th February 1997

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 17th February 1997

Last modification: 22nd January 2010.

Dr. Henry writes about Science and Us

I have observed that considerable discussion has resulted from some postings by scientific minds. I have known many scientific minds and have been involved in clinical research in the past. As a group, most scientific researchers that I have met and known are imaginative, creative, inquistive, bright people who usually have an appreciation for the arts, nature and even religion. One has to have some investigative imagination to develop a theory or postulate. Yes, much of scientific discovery is trial and error. When antibiotics, steroids, and antihypertensives were discovered, many doctors overused them in an effort to help many people who wanted relief from their maladies. From this experience, we learned of the harmful effects of overusing steroids and other drugs. Even today, if a young mother takes her child with a viral sinus infection to the pediatrician, the pediatrician will often prescribe an antibiotic because it will comfort the mother, even though the infection is probably viral and the antibiotic will not be effective. But if that same child has bacterial meningitis, you better believe that same pediatrician will depend on antibiotics to save that same child’s life.

The interesting insight to me is that many PPSers are just as inquisitive, imaginative, religious, and bright as most scientists. We really have a lot in common. Many of us are willing to try various treatments, some help some of us, some do not. But, I believe that if a researcher found that drug X improved the PPS symptoms in over 50% of a clinical sample of 100 patients with significant PPS, I believe most of us would want to try that drug immediately.

Galileo was one of the first to believe that human beings might better understand the world we live in by making objective observations about the world we live in. This got him in conflict with the Catholic Church. Issac Newton was often involved in heated disputes with his academic colleagues and was also in conflict with the Church in his time, but he made objective observations and proved his conclusions. Albert Einstein is well known to this century. He was a genius with equations, but was pulled into politics and was fortunately living in the free world during the critical phases of WWII. He was offered the presidency of Israel in 1952, but refused, stating “equations are more important to me, because politics is for present, but an equation is something for eternity.”

One of my personal heroes is Dr. Stephen Hawking, the ventilator dependent English physicist with ALS. I close this post with a quote from the end of the conclusion of his book “A Brief History of Time.”

“Even if there is only one possible unified theory, it is just a set of rules and equations. What is it that breathes fire into the equations and makes a universe for them to describe? The usual approach of science of constructiong a mathematical model cannot answer the questions of why there should be a universe for the model to describe. Why does the universe go to all the bother of existing? Is the unified theory so compelling that it brings about its own existence? Or does it need a creator, and, if so, does he have any other effect on the universe? And who created him?

Up to now, most scientists have been too occupied with the development of new theories that describe

what the universe is to ask the question why. On the other hand, the people whose business it is to ask why, the philosophers, have not been able to keep up with the advance of scientific theories. In the eighteenth century, philosophers considered the whole of human knowledge, including science, to be their field and discussed questions such as: Did the universe have a beginning? However, in the nineteenth and twentieth centuries, science became too techical and mathematical for the philosophers, or anyone else except a few specialists. Philosophers reduced the scope of their inquiries to much that Wittgenstein, the most famous philosopher of this century, said, ‘ The sole remaining task for philosophy is the analysis of language.’ What a comedown from the great tradition of philosophy from Aristotle to Kant!

However, if we do discover a complete theory, it should in time be understandable in broad principle by everyone, not just a few scientists. Then we shall all, philosophers, scientists, and the ordinary people, be able to take part in the discussion of the question of why it is that we and the universe exist. If we find the answer to that, it would be the ultimate triumph of human reason— for then we would know the mind of God.”

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

12th February 1997

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome

and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 17th February 1997

Last modification: 24th January 2010.

Dr. Henry writes about pain and temperature perception

The perception of pain, temperature, touch, and propriaception (or one’s position in space like standing still with your arms outstretched, eyes closed and still have ability to touch your nose with your forefinger, one of the tests for drunkeness) are all functions of the central nervous system (brain and spinal cord). The polio virus attacked the central nervous system and may have done more damage to this system than originally thought because of the great recoveries. For example, some polio victims in the acute phase had incontinence or had urinary retention and required temporary catheterization. President Roosevelt was catheterized for about two weeks by wife Eleanor with a glass catheter and amazingly did not get a bladder infection. The virus attacked the gastrointestinal system. Post mortem exams of victims prior to Salk often revealed brain involvement (basal ganglia and reticular activating system) beyond the brain stem (where swallowing and breathing centers are located), and thus I believe we PPSers are vulnerable to a variety of CNS symptoms as is daily expressed on the various postings here. Circulation only effects temp when there is an impairment of circulation as occurs when one has a vessel occlusion or even after death. External coldness can gradually slow circulation and lead to eventual circulatory problems and death as being frozen.

I have noticed on this list service that some have various sensitivity problems such as reduced perpheral [sic] sensation of the skin and the opposite such as burning sensation of the skin. Some complain of blurred vision, tinnitus (ringing in the ears), reduced taste, swallowing problems, breathing problems, all kinds of motor and pain problems and some spasms or twitching of various muscles. I believe we are vulnerable to any symptom that is stimulated by the CNS. I believe that Salk and Sabin put an end to the natural history of polio or the study of polio’s complete pathogenesis. Some reseachers such as Richard Bruno are developing theories about these many symptoms and their relatedness to the original infection.

Enough said for now.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

5th February 1997

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 6th February 1997

Last modification: 24th January 2010.

Dr. Henry writes about Medical Records

There has been much discussion regarding the saving and destroying of medical records. I believe the regulations vary from state to state. In Virginia, when a doctor retires or dies, he or she is required to maintain the records of patients for at least five years. Most doctors and hospitals keep them much longer for their own protection. There are some exceptions. With the assessibility of records to so many outsiders (insurance companies, gatekeepers, lawyers, etc, I would suspect that many doctors do thin their records after five or seven years for old patients that have not been seen in that time. Those doctors may feel that destroying records somehow protects them. In VA, the statute of limitations is two years for malpractice suits. A claim for malpractice needs to filed within two years of the event, but there are always legal loopholes to some of this.

Another issue is storage space for records. Medical records now are volumnous because of the extensive copying and sharing of records with so many health care workers. Doctors now organize in large groups to survive and prosper financially and the records multiply in large groups as you can imagine. I had lithotrypsy for a kidney stone five years ago. My urologist (whom I like and he helped me immensely) is in a group of 20+ doctors. This group has four office locations in Richmond. I have seen him in two of these locations, one time in one location for my convenience and another time in a different location for his convenience, but it allowed me to get an earlier appointment. This group has several employees to just deal with the management and transport of medical records. My file consists of multiple x-ray films, lab reports, office notes and insurance data. It is a fairly thick chart and I only saw him a total of six times in five years. In contrast, I was able to see my polio records on microfilm at the medical records library at the Medical College of VA. Hospital where I was hospitalized for three months with polio in 1950. The ENTIRE record consisted of about 20-25 pages and included my hospital bill which was $1058.00

Overall, I think most doctors and hospitals perfer to retain records for their own protection and also in case the patient returns for care after many years. In my practice, I had many patients who would return after absences of ten or more years because their problems were episodic or they had moved away years ago and returned to the community later. I was delighted to have their old record available.

In general, teaching or university hospitals are much more likely to microfilm old records because of the value of clinical research that may be relevant at a later date. This is particularly true for our polio population.

Actually now that I am retired from private practice, I have my patient records stored at home and I would not part from them. These records are a testament to my years of patient care. I can pull any old chart out at any time, and recall the story of a life that I hopefully affected in some positive way. In a way, these records are a part of my life. I would not destroy them for that reason. I believe most solo practitioners (a dying breed) feel that way about their records. This is less likely the case in large corporate group practice because the records belong to the group or corporation.

Persistance does help in dealing with hospitals. I was successful in seeing my polio record of 1950 only after speaking to the Director of medical records at MCV.

Enough said by me on this topic.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

2nd February 1997

The Lincolnshire Post-Polio Network

Registered Charity No. 1064177

An Information Service for Polio Survivors and Medical Professionals

All enquiries, book requests, medical article requests, membership fees, items for newsletters and donations to

The Secretary, Lincolnshire Post-Polio Network

PO Box 954, Lincoln, Lincolnshire, LN5 5ER United Kingdom

Telephone: +44 (0)1522 888601

Facsimile: +44 (0)870 1600840

Email: info@lincolnshirepostpolio.org.uk

Web Site: www.lincolnshirepostpolio.org.uk

The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

© The Lincolnshire Post-Polio Network 1997 – 2010.

© Copyright Henry Holland 1997 1998 1999 2000.

Copyright is retained by The Lincolnshire Post-Polio Network and/or original author(s). Permission is granted to print copies of individual articles for personal use provided they are printed in their entirety. Links from other Internet WWW sites are welcome and encouraged. We only ask that you let us know so that we can in future notify you of critical changes. Reproduction and redistribution of any articles via any media, with the exception of the aforementioned, requires permission from The Lincolnshire Post-Polio Network and where applicable, the original author(s).

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.

Created: 3rd February 1997

Last modification: 24th January 2010.

Dr. Henry writes about Doctors

I have read the recent postings by Nancy, Sara, and Tony and I will attempt to respond with some thoughts. I still have opportunity to teach interviewing skills to second year medical students at the School of Medicine of the Medical College of VA. This school prides itself on educating and producing clinicians as opposed to research oriented doctors. This school built on hills and certainly not barrier free in 1962 accepted me and I was fortuate to win a National Foundation Health Scholarship to pay my way. My MCV class had its 30th reunion last April and everyone present was involved in patient care, either primary care or speciality care. When I see the 2nd year students, they are usually likeable, caring, genuine, and somewhat niave (and yes, unspoiled). They come from diverse economic, ethic, and racial backgrounds. Currently, close to 40% are women. They seem motivated to enter a medical career for admirable and what I would call the right reasons. What happens to them during the next seven or eight years (completing medical school and a four to six year residency) can change many of them, sometimes unfortuately for the worse. There is only one word for it—-PRESSURE…. that is hard to describe. There is the pressure simply to get into medical school somewhere, the pressure of essentially studying seven days a week year round for most of four years. One survives because as a class, one knows that one is not alone. One’s peers in other fields are getting on with their lives and earning money and seem to be enjoying the good life. One finally graduates, yes—takes the Hippocratic Oath as a class and feels proud, only to discover that the whole grind starts over again when one starts the first year of residency (formerly called an internship) and one is at the bottom of the pyramid again. The advances in medical science that have occurred in the twentieth century (even the last twenty years) are awesome and to try to learn this volume of material is at times overwhelming. It is not that one has to be a genuius to learn, it really takes more steady perservering dedication to the task day to day as a priority over everything else. This is depicted fairly well on the TV show “ER”. The toll in my opinion on the educated residency trained doctor is the development of some psychological defenses that are not always healthy (such as the loss of real empathy that may have been present as a 2nd year medical student), a fear of losing it all because of an unintentional mistake, the powers of outside forces such as boards of medicine, medicare and medicaide audits, continuing medical education pressures, the cost of malpractice insurance, having to battle HMOs and other managed care powers, and the business competition that has been created by the huge hospital corporations and insurance companies. To survive in practice one has to join them or sink financially. I really believe Albert Schweitzer would be appalled by modern medical practice and run happily back to the rain forests of Africa. Don’t get me wrong. I know many doctors have abused insurance systems and probably still do, have done harm and should have their licenses revoked by medical boards, and there should be safeguards to protect us all. Many doctors have huge debts after finishing training and are too intent on making money. Also, many medical marriages fail because of the physical and emotionally absent medical member. “He or she is not the same is not the same person I married.”

I was 35 years old when I passed my board certification examination because at that time, I had to have two years of clinical experience beyond residency before I would be eligible for the exam. My written

exam was in Wash. D.C. and my oral exam was in New York the following year. My wife went with me and I carried my portable ventilator to survive. One of my oral exams was at Bellevue Hospital in N.Y. The cab ride to the exam created more anxiety than the exam, and had actually relaxed me because I was so thankful to get there in one piece. When I learned that I had passed that exam, I thought now I can relax. But no, now many specialities require recertification, with emphasis on facts and knowledge with little emphasis placed on experience in my opinion. I know that I would have difficulty passing a board exam now (not that I wouldn’t try), but I know that I have immense experience now that can not be accurately measured on an exam.

To make matters worse, primary care physicians are in demand and with monetary rewards for doing less referring, I think many patients are being delayed in seeing the right specialist soon enough. There is no way that a primary care physician can know everything. I believe PPSers need to see a physical medicine and rehab specialist sooner than they usually do. These doctors usually know more about PPS.

The key to me as a doctor was to survive all this adversity over the educational and training years, and come out of it with my empathy intact. I think it was easy for me because I was educated and trained at MCV where I had been hospitalized with paralytic polio at age eleven, and I walked those same halls daily while in med school and psychiatric training. I have never forgotten how it felt to be a terrified, motionless child, totally dependent on the care of EMPATHIC doctors, nurses, P.T.s, aids, volunteers, and housekeeping and food service staff. Most of these people cared then and could bring a smile to my face.

There will always be disease and many diseases over the years do have recurrences such as malaria, TB, MS, Crohn’s, and even untreated syphylis to name a few. Now, we, and I mean WE are learning more about the natural history of the the disease brought on by the wild polio virus before the discovery of Salk and Sabin. Our generation, if nothing else, should help solve this puzzle because there are many of us who have lived long enough after the original polio event that we will hopefully bear witness to the reality of PPS and maybe somebody will uncover what is really going on with us. Is it neurological, metabolic, sytemic in the CNS, biochemical, harmonal, etc? In my opinion, one thing that it is not….It is NOT in our heads (psychogenic), it is REAL day to day. As I think about it, many of us probably have similar defenses and personalities as the BAD doctors we complain about, except hopefully, we have retained our empathy for each other as is often revealed on this list service.

Even Sister Kenny concluded that the American doctor believes in the conservative scientific method (that brought Salk and Sabin), but is curious enough to listen and examine a new idea which usually keeps the American doctor ahead of the rest of the world. Remember, America was the only country that accepted her ideas at all. I hope we maintain the strict adherance to the scientific method but also keep our curiosity and sense of adventure.

I have said enough. If you have found a knowledgeable, listening, and empathic doctor, you are fortunate, and treat him or her as a friend. When I was in practice, I received the most thoughtful notes and holiday gifts from some of my more difficult and troublesome patients, but I somehow knew that they did not really enjoy their plight and they apparently perceived that.

I do not intend to create controversy, but I welcome thoughtful comments.

Henry Holland, Richmond., Virginia, USA. Henry4FDR@aol.com

28th January 1997

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