Remember our study where we measured blood sugar levels in post-polio survivors and gave them tests of attention? We found that the lower polio survivors' blood sugar, the worse they did on the most difficult attention tests. Attention was about 20 percent below normal for those whose blood sugars were around 80, which is exactly at the bottom of the normal range -- that is, between 80 and 110. In fact, polio survivors' ability to pay attention with a blood sugar of 80 was actually worse than in diabetics who had blood sugars of 65, which is way below normal!

So, in terms of focusing attention, polio survivors' brains act as if they were hypoglycemic and function as if blood sugars were about 15 points lower than the actual blood sugar level. We found that when polio survivors eat the amount of protein at each meal -- especially at breakfast -- that is appropriate for the weight they want to be (body weight times 0.46, e.g., 16 grams per meal for a 150 pound person), fatigue decreases remarkably and quickly.

These findings illustrate one of our Post-Polio Precepts: "Little things mean a lot" -- in this case a borderline low but still normal blood sugar, and especially a blood test result that's "a little" low, should be considered abnormal in polio survivors and should be addressed.

The same precept applies to polio survivors with a thyroid that's "a little" slow. Polio survivors can have a surprising decrease in fatigue when given a drug like Synthroid, a hormone that stimulates the thyroid, even if their thyroid functioning is not so low that a doctor would usually give the drug.

The precept also applies to treating "a little" anemia. I'm not talking about being given an injection of Procrit, a drug that stimulates red blood cell production, if your hemoglobin is one point below normal. But you should talk to your doctor about taking iron and -- here it comes again -- eating more protein if you're "a little" anemic.

"Little things mean a lot" applies not only to what's already in your blood but what you put into it. Polio survivors are very sensitive to even small doses of drugs that are sedating: sleeping pills, antihistamines, narcotics, and medications for high blood pressure, like beta blockers (see "PPS Forum," October 2004). And of course, drugs intended to sedate you can knock polio survivors for a loop.

Anesthetics used for "twilight sleep" during a colonoscopy, gastroscopy or to induce anesthesia before major surgery (such as Propofol), gaseous anesthetics that keep you under during major surgery (like desflurane), and drugs such as succinylcholine and mivacurium used to paralyze muscles during surgery, can make polio survivors sleep and keep muscles -- especially breathing muscles -- paralyzed for hours longer than in non-polio survivors. Even local anesthetics used for minor surgery, dental procedures or spinal anesthesia (as in an epidural block) can last longer and have effects beyond the area where they're injected (See the "Preventing Surgical and Dental Complications" articles in The Post-Polio Library at postpolio info.com/postpolio.)

Over the years we've found the "rule of two" works well for polio survivors having anesthesia: "Polio survivors need the usual dose of anesthetic divided by two and need at least two times as long to recover." Recently, we've found that anesthesiologists need to be reminded to apply the "rule of two" during surgery. If a second dose of anesthesia is needed during a long procedure, it should also be lower than the first dose, and b. Brain waves always should be monitored to determine the level of sedation so that polio survivors don't get "Rip Van Winkled" and wake up in ICU on a vent three days after surgery.