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Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.
Q: A few months ago I had a fever every evening for a week. When the fever stopped, I lost my appetite and woke mornings with pain in the front and back of both legs below the knees. The pain then moved above my knees. My doctor said I had the flu with unusual leg muscle pain he called "myalgia." Two days later I felt very sick--the pain reached all the way to my hip and was so severe that I went to the hospital. I was diagnosed with pancreatitis, a gallstone and my intestines had stopped working. My gall bladder was removed, the leg pain stopped and my intestines really moved with some castor oil. But not one doctor understands why I had leg pain. I do have scoliosis and a severe "sway back." Was my leg pain due to my curved back, the gallstone or was it a polio thing?
I think your problems were gallstone, back and polio-related. Gallstones squeezing through the bile duct irritate the pancreas--which lies next to the duct--and causes inflammation. Gallstones also irritate the intestine, cause it to stop moving and create "paralytic ileus"--gas trapped in a non-moving intestine. But polio survivors don't need even that much provocation to have paralytic ileus. The poliovirus damaged brain stem neurons that are responsible for controlling the vagus nerve, which gets your entire digestive system moving--from throat to stomach to intestines--making polio survivors prone to gut stoppage. Polio survivors can also develop gastroparesis--their stomachs stop moving for no apparent reason. Damage to the vagus nerve likely explains our Post-Polio Survey finding that bowel problems, like constipation and paralytic ileus, are more common in polio survivors.
What's to be done about stopped-up guts? Be wary of "anticholinergic" drugs (usually pills that make your mouth dry) since they may slow or even stop your intestines. And if your gut does stop, your doctor may try a small dose of castor oil, as in your case, or the drug Reglan to get things going.
I must say, leg pain related to a gallstone is a new one on me. You apparently had referred pain--that is, pain due to your gallstone, pancreatitis and stopped intestine--being felt in your legs. In a study of patients who didn't have polio but who reported leg pain without an identifiable cause, more than 85 percent had scoliosis or an abnormal curvature of the low back, suggesting that pain that should have been felt in their backs was being referred to their legs. In your case, the gas and inflammation in your belly--combined with the twists and curves of your low back--may have irritated the pain nerves coming up through your pelvis from your legs, and made it feel as if you had leg pain.
Polio survivors having pain without an obvious cause--especially those with twisty backs--should be assertive with their doctors and ask for tests to find out if they have referred pain from a treatable condition. A simple blood test when you visited your doctor would have diagnosed the pancreatitis and likely saved you from such a serious illness. I'd appreciate hearing from polio survivors who have had referred pain whose cause was ultimately diagnosed.
Fall Is Coming!
For the past few years, polio survivors have been reporting even more than their usual problems with the change of seasons. Not only are they feeling colder as the temperature drops, they are reporting more neck muscle pain, spasm and headaches. Our 1983 study found that polio survivors' nerves function as if it's 20 degrees colder than the temperature outside. So, come winter, polio survivors should dress as if it's 20 degrees colder than the outside temperature. But polio survivors can have even more problems during the change of seasons--when the thermometer goes up and down from day to night and from day to day--than they do in winter, as polio survivors' temperature-challenged bodies can't decide if they should sweat to stay cool or shiver to stay warm. Since your body can't regulate its own temperature, you have to do it. Layering of clothing is the way to stay comfortable when the weather is thermally confused--as are polio survivors' bodies--and unable to decide what temperature it wants to be.