Platelet rich plasma treatment

By Lynda Shaw

I am a 65-year-old lady originally from Ghana, West Africa, but I have been living in Australia since 1980. I contracted polio at one year of age. The polio severely damaged muscles on the right side of my body, especially my leg. As a consequence, I have a pronounced limp and since 2000, walk with the aid of a walking stick.

I have suffered pain in my left, unaffected, hip for the last seven years resulting from the increased stress placed on that hip through having to perform most of the weight bearing requirements when standing and walking.

I was receiving cortisone injections annually as part of accepted medical treatment to relieve hip pain stemming from wear and tear caused by overuse. However, as advised by my doctor, the cortisone was only a medium term solution being as it only masked the pain and tended to lead to continued overuse of the affected area and ultimately further damage.

The eventual requirement would be for a hip replacement.

A couple of years ago a friend told me about an innovative treatment known as Platelet Rich

Plasma (PRP) and suggested that I should try it for my hip pain. After making an appointment at the Wakefield Sports Clinic I waited eight months to meet with Dr Ramona Chryssidis, one of very few doctors specialising in this treatment in South Australia.

The PRP is derived by centrifuging a sample of the patient’s own blood to concentrate

platelets. The PRP is then injected, with the aid of an ultrasound to the identified areas of

tissue damage. It is believed that the platelets secrete substances called growth factors and

other proteins that regulate cell division and stimulate tissue regeneration to promote healing and accelerate the healing of injured (affected) tendon, ligaments, muscles, joints etc.

I had my first treatment in April 2019 and within a matter of days I noticed that I could get up from a sitting position easily and without pain. Prior to the PRP treatment I took Meloxicam (Mobic), a prescription anti-inflammatory medication, almost daily and paracetamol in between. However, since the treatment I rarely take any medication at all.

I have since had a second series of injections of PRP (at my insistence) prior to a road trip to

Queensland in December 2019 to be sure I would be ok for the long trip.

In May this year (2020) I had a top up of Medical Glucose injections (via ultrasound) as recommended by Dr Chryssidis because I was experiencing mild ache in the hip. The glucose is understood to re-activate the previous injection and stimulate the body’s natural healing process, and it did just that.

I can honestly say this treatment worked for me and would highly recommend that others with similar issues consider trying it.

 Nik tells a similar story   

A recent conversation with my physio, suggested that the reason PRP works is that it helps in joints, rather than muscle or tendons, with osteo-arthritis.

Ergo, knees and shoulders!

I have mine done at Symons and Fowler in Hutt Street. Shaun Fowler is the man.

Smart Health and Training, on Richmond Road [82931100] offer it as well. …. the practitioner is Ramona Chryssidis.

Readers probably should also go to the internet and look for “platelet rich plasma treatment.” There is information there, some very scientific.

When people talk to their doctor, they should not be put off by a negative response. Some doctors are just unaware of this treatment and don’t know better.

The beauty of the treatment is that there is nothing foreign or chemical being pumped in….it is all from one’s own blood.

Having said all of the above, there is a caveat……. PRP is not a 100% panacea for all.

The only way to find out if it is suitable, is to try it  !

An old Russian saying says: “if one doesn’t jump in the water, one doesn’t get wet!”

Hope this helps.   

Cheers, Nik Surikov

Community Information Videos Fatigue part 3 Task Scheduling

Presented by Steph Cantrill Polio Australia Community Programs Manager

Continuing our series on managing fatigue, we look at planning and scheduling tasks to incorporate pacing. Remember - everyone's capacity is different. It's about finding your own balance, so that you're alternating activity and rest and not pushing up to (or beyond!) your limit.

An open letter to the Prime Minister, Scott Morrison, in the wake of the US decision to cease support for the WHO.

Gillian Thomas OAM President of Polio Australia as written an open letter to Prime Minister Scott Morrison. In the wake of the US decision to cease support to the World Health Organisation

Community Information videos - Fatigue Part 1 Pacing

Steph Cantrill Community Programs Manager at Polio Australia.

Has kindly provided some information while we are isolated due to coronavirus the first in the series is

Fatigue Part 1 Pacing.

There will be more videos and we will update to the website when they are available

Fatigue is something that many polio survivors struggle with. Pacing is a strategy for self-management of fatigue. It's easy to talk about but not so easy to put into practice - and some people just hate the very word! What's your experience of pacing? What others ways have you found to manage your fatigue?
More information at www.poliohealth.org.au/research-fatigue/

Polio survivors see in coronavirus era levels of fear not seen since poliomyelitis epidemics

Polio survivors have noted striking similarities between the series of 20th-century epidemics and today's coronavirus — two very infectious diseases that changed the world.

During the height of the polio epidemic in parts of Australia, state borders, schools, pools, and theatres closed, and travel restrictions and quarantine measures were introduced.

Newspapers published daily case numbers and deaths.

Sound familiar?

Gillian Thomas, president of Polio Australia, said the coronavirus crisis brought back memories for many survivors of poliomyelitis.

Known as 'the silent epidemic', the highly infectious viral disease struck people out of nowhere and moved silently throughout the community.

Paralympics New Zealand: The powerful story of Reuben Ngata

Polio & chronic fatigue syndrome

Q. I had polio with weakness in my left leg. I recovered and carried on a normal life until the early 1990’s when I started to have fatigue, heart palpitations, skipped beats, low blood pressure (especially after I eat) plus constipation. Should my doctor be considering a tie-in with polio?

A. Oh, yes! Fifty years ago polio pioneer Dr. David Bodian discovered that every polio survivor had some poliovirus-damage to neurons in the brain stem, the so-called “bulb”; of the brain.  

When brainstem damage was severe “bulbar” polio was diagnosed whose icon, the iron lung, was needed when brain stem breathing-control neurons stopped working. But the most common symptom of “bulbar” polio was trouble swallowing, not trouble breathing. And some had severe difficulty controlling their blood pressure and heart rate, which was the leading cause of death in “bulbar” polio patients.

The brain stem neurons damaged by the poliovirus that are responsible for the above symptoms control the vagus nerve, which carries commands from the brain stem to activate muscles in your throat, esophagus, stomach and intestines and also controls your heart rate and blood pressure. But the vagus nerve is a two-way street, since it also “listens” to activity in the gut, heart rate and also your blood pressure (through stretch receptors called “baroreceptors” in your aorta and carotid arteries) and sends that information back up to the brain. Vagus damage disrupting the normal functioning of the gut may explain our 1985 Post-Polio Survey findings that swallowing difficulty, diarrhea, colitis, ulcers and constipation are as much as six times more common in polio survivors than in non-polio survivors. And the other symptoms you describe may result from poliovirus-damage to the activity of brain stem vagus neurons controlling blood pressure and heart rate. For example post-polio patients can feel exhausted after a meal. When their stomachs fill with food, the vagus is apparently over-stimulated and triggers a drop in blood pressure and heart rate, causing feelings of fatigue and sometimes palpitations. Polio survivors also have been reporting another problem: food sticking in the upper esophagus behind the breastbone. We think this is due to the vagus not stimulating esophagus muscles to move the food downward. When food gets stuck, irritation triggers a painful esophagus muscle spasm that also stimulates the vagus nerve, causing blood pressure to drop and the heart to rate to slow.

Although blood pressure drops most polio survivors don’t faint, which is consistent with our 1995 Post-Polio Survey finding that polio survivors do not faint any more frequently than those who didn’t have polio. But the 1995 Survey did find that anyone who had fainted even once in their lifetime reported significantly more daily fatigue than those who never had fainted. This suggests that damage to brain stem blood pressure control and vagus nerve neurons may be coupled to poliovirus damage to bulbar “brain activating system” neurons, which our laboratory research suggests are responsible for post-polio brain fatigue.

The relationship between fatigue, brain stem damage and low blood pressure links polio survivors to another bunch of very tired folk: those with Chronic Fatigue Syndrome. About one quarter of CFS patients have fatigue that is associated with low blood pressure or increased heart rate. Some CFS patients report fatigue when a hot shower or hot room causes blood pressure to drop, as do about one third of polio survivors. Other CFS patients have blue feet, just like our polio survivors “polio Feet” suggesting that blood pooling in the leg veins contributes to low blood pressure.

Polio survivors should have a doctor take their blood pressure and heart rate lying, sitting and -- if possible -- standing. Polio survivors who have fatigue associated with a drop in blood pressure or a slowed or racing heart need to see a cardiologist who treats low blood pressure. Compression stockings, which push blood back toward the heart, and medications that increase your blood volume or stop blood from pooling in the legs, can be helpful. If fatigue follows eating, frequent, small, higher protein meals can prevent the stomach from getting too full, stimulating the vagus nerve and dropping your blood pressure...and you.

The Encyclopedia of Polio and Post-Polio Sequelae

contains all of Dr. Richard Bruno’s articles, monographs, commentaries, videos and “Bruno Bytes”

Pelvic muscles & bladder problems

Dr. DeMayo, I have PPS. In the last few years I have experienced bladder issues. I have urine retention. On a recent CT Scan, It showed pelvic muscle atrophy. Is there a connection with Bladder problems and Polio? Were Pelvic muscles effected by the virus?

 Great Question! Unfortunately, there is not a great, short answer. Nevertheless, like most good questions, there is an opportunity to use this as a learning opportunity.

 First a few basics… 

1) The first Basic Bladder issue is that bladder issues in men are far different then in women. I will discuss both men and women.

By far, the most common source of urine retention (inability to empty the bladder) is obstruction of outflow caused by the prostate in men.

PPS itself does not cause urine retention in the bladder. Having said that, one needs to be sure that retention is in fact the problem. This is usually done with an ultrasound of the bladder after a void to see if to much urine still remains. Of note, frequent urine incontinence (inability to control urine / wetting one’s self) can be either due to urine retention with “overflow” leakage OR due to a lack of resistance to flow. The latter is far more common in PPS due to weakening of the pelvic floor as discussed below. Also, incontinence is for more common in women compared to men due to multiple factors including a shorter urethra (the tube connecting the bladder to the outside), the urethra having less of a bend (especially when the pelvic floor drops), and lack of resistance of the prostate. Additionally, the bladder storage capacity in women tends to be smaller (partly due to presence of the uterus).

 2) The second Basic Bladder issue is that neurological issues can have a major impact on urologic function. The bladder can become either over active or one can loose the awareness of bladder filling. Coordinated control of the bladder storage and emptying requires the interaction of muscles in the bladder wall, nerves from the bladder to the spinal cord, reflexes coordinated within the spinal cord and control from the brain (both with conscious awareness and without). Stroke, Brain Injury, Spinal Cord Injury, Multiple Sclerosis and many other neurological conditions can result in incontinence due to what is termed an “upper motor neuron bladder” William DeMayo, MD. www.papolionetwork.org March, 2019 1. Since Polio is a lower motor neuron problem, we won’t discuss these more other than to say that Polio patients are not immune from any of the above conditions so they should always be considered. Also, the normal aging process can create a “hyper reflexive bladder” that can mimic an upper motor neuron problem.

3) The Bladder Basic that is most pertinent to Polio survivors is that the pelvic floor muscles play a profound role in bladder function. Any older individual is subject to this issue but those who have restricted mobility or a prior reason to have pelvic floor weakness are certainly more at risk. “Stress Incontinence” results when a cough, a laugh or a sneeze increases the pressure in the abdomen and thereby increases pressure on the bladder. It occurs when the resistance to outflow is low and this is especially the case in women. Polio can certainly cause weakness in the pelvic floor muscles and this weakness can progress in cases of PPS. Additionally, a history of child birth, recent sedentary lifestyle and weight gain can all add to relative weakness of the pelvic floor. Weak pelvic floor muscles are directly associated with less resistance to outflow. They play an important role in supporting the bladder, directly tightening the area around the urethra as well as creating a “kinking” effect with cough, sneeze or other activity which further increases resistance.

4) The last Bladder Basic is that many times bladder management is NOT Basic. Urine infection, bladder / kidney stones, stress, physical activities, behavioral concerns and many other issues can significantly impact bladder function. As such, all significant symptoms that do not resolve, should be evaluated. Referral to a urologist should always be considered if symptoms fail to resolve with treatment by a PCP.

Additionally, some Physical Therapists specialize in Pelvic Floor therapy. They can often be found through your urologist, PM&R physician or GYN. Like any muscle, the pelvic floor can be over fatigued and so treatment of a patient with PPS should be individualized and not focused on just intensive pelvic floor strengthening. A good PT specializing in this area can often provide lots of tips to improve symptoms. An example would be an older person who repeatedly has incontinence on the way to the bathroom. By the time they realize the bladder is full they risk an accident because the act of moving from sit to stand causes a reflex spasm of the bladder and the pelvic floor is not strong enough to resist this. Thankfully, there is an opposing reflex that inhibits the bladder (briefly) after 3 strong but quick contractions of the pelvic floor (Kegel type contraction). Thus, if this person takes 10 seconds to do these 3 contractions prior to standing, they can sometimes counteract the reflex bladder activity just long enough to get to the toilet.

 A full explanation of bladder management is obviously well beyond the scope of this brief article. At the same time, I hope I have provided some insight into the way some bladder issues arise and provided hope that there are solutions.

William DeMayo, MD

DeMayo’s Q&A Clinic

Identifying and Managing the Impacts of a Post-Polio History Full lecture from Dr Stephen de Graaff (25 mins)

Dr Stephen de Graaff is the Director of Pain Services and a Senior Rehabilitation Physician at Epworth Healthcare. He is a Fellow of the Australasian Faculty of Rehabilitation Medicine, and his areas of research interest include stroke rehabilitation, spasticity management, pain management, post-polio sequelae, and Continuing Professional Development. Dr de Graaff is a Past-President of the Australasian Faculty of Rehabilitation Medicine, a faculty of the Royal Australasian College of Physicians (RACP).

Dr Stephen de Graaff, The General Practice Education Day Melbourne, 2018

Meet the Expert - Brief interviews with leading clinicians Polio Infection This Week's Expert: Dr Stephen de Graaff (Interview from 2018)

Polio Infection
This Week's Expert: Dr Stephen de Graaff (7 mins)