SALK, SABIN, AND THE RACE AGAINST POLIO

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Today is Jonas Salk’s birthday. If he were alive, he would be 100 today. But conquering polio was not only about Dr. Salk.

9a6c4875-d872-44f1-a031-df088f1930adAs polio ravaged patients worldwide, two gifted American researchers developed distinct vaccines against it. Then the question was: Which one to use?

By Gilbert King
Smithsonian.com
April 3, 2012

They were two young Jewish men who grew up just a few years apart in the New York area during the Great Depression. Though both were both drawn to the study of medicine and did not know each other at the time, their names would be linked in a heroic struggle that played out on the front pages of newspapers around the world.

In the end, both Albert Sabin and Jonas Salk could rightfully claim credit for one of humanity’s greatest accomplishments—the near-eradication of polio in the 20th century. And yet debate still echoes  over whose method is best suited for the mass vaccination needed to finish the job: Salk’s injected, dead-virus vaccine or Sabin’s oral, live-virus version

In the first half of the 20th century, Americans lived in fear of the incurable paralytic poliomyelitis (polio) disease, which they barely understood and knew not how to contain. That the disease led to some kind of infection in the central nervous system that crippled so many children, and even a president (Franklin D. Roosevelt) was alarming enough.

But the psychological trauma that followed a neighborhood outbreak resonated. Under the mistaken belief that poor sanitary conditions during the “polio season” of summer increased exposure to the virus, people resorted to measures that had been used to combat the spread of influenza or the plague. Areas were quarantined, schools and movie theaters were closed, windows were sealed shut in the heat of summer, public swimming pools were abandoned, and draft inductions were suspended.

Worse, many hospitals refused to admit patients who were believed to have contracted polio, and the afflicted were forced to rely on home care by doctors and nurses who could do little more than fit children for braces and crutches. In its early stages, polio paralyzed some patients’ chest muscles; if they were fortunate, they would be placed in an “iron lung,” a tank respirator with vacuum pumps pressurized to pull air in and out of the lungs. The iron lungs saved lives, but became an intimidating visual reminder of polio’s often devastating effects.

Source: www.smithsonianmag.com

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LIFE HAS SIDE EFFECTS

We say the same thing in a variety of ways:

  • There’s no such thing as a free lunch.
  • Everything has consequences.
  • For every action, there is an equal and opposite reaction — Newton’s third law with a philosophically relevant twist.

It’s certainly true of medication. Whatever is bothering you, if you take something for it, it will do something bad while doing what you want. You may not be aware of the side effects, but that little yellow pill could be taking out your liver, kidneys or heart while getting rid of your headache.

Cracker jacks single boxMy migraine medicine makes me groggy and stoned. Time changes ones perspective. Dopiness was — in my wild and crazy youth — the prize in the Cracker Jack box. Remember Cracker Jacks? Stonedness has morphed into just another annoying side effect. I’m muzzy-headed enough without chemical assistance.

I’ve got a lot of physical issues. If I took something for each thing that bothers me, the side effects would be worse than the conditions for which I take the meds.

At a more innocent stage in my battle to continue living, I took whatever any doctor prescribed, to a point where no one could separate the cure from the side effects.

Ultimately, I became a medication minimalist, striving to take the least amount of whatever to achieve the desired result.

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Pain relief, controlling blood pressure and sleep are the things I take medication for — the big three in my world. I’ve got plenty of other problems, but I don’t take stuff for them — either because the side effects are worse than the problem or I can’t afford the prescription.

Allergies. Weird gastric stuff. Asthma. High cholesterol. Arthritis, rheumatoid and osteo. Tendonitis. Bursitis. Non-focusing eyes. And the potential for the return of breast cancer but in some new and terrifying permutation. There’s more, but honestly I can’t remember it all.

I was sitting here pondering what, if anything, is bothering me enough to take something for it. The headache? The dry, burning eyes? The itching dermatitis? The pain in my hips? Chest? The light and sound sensitivity that warns me my headache is heading into migraine territory?

Maybe I should just have a cup of tea. It seems to work for the British.

Don’t you just hate when that happens?

Diagram of the human heart 1. Superior Vena Ca...

I have to decide whether or not to have open heart surgery. It’s a clear-cut decision. I can choose to not have surgery. Eventually — but probably sooner rather than later — my heart will be unable to deliver oxygen to my lungs and I’ll die. It’s not doing too good a job right now and it isn’t going to get better.

Or, I can have The Surgery. Get my mitral value replaced or repaired. Get the blockage of my aortic valve removed. The whole left ventricle is a sorry mess.  It’s not a simple valve repair or replacement, so the minimally invasive option is unavailable.

The odds are good the surgery won’t kill me, but how well I’ll recover from it is anyone’s guess.

I’m falling apart. Worse, all my similarly aged friends are falling apart too. We are suffering progressive decrepitude. I got a note from a friend telling me he goes to the same “heart guy.” Swell.

This whole getting old thing is getting old.

Digression: Conversation with friend.

Her: So if I get to the Bridge first, I’ll say hi to all our dogs.

Me: Oh puleeze. I have to see the heart surgeon tomorrow. 

Her: Fine. I’ll just sit here and wait for the results of my biopsies.

End digression.

I’m unhappy with my choices. I can choose A or B, but I want  C. Do or die. Which is to say do it. Or die of not doing it. This sucks. I don’t want the surgery. Nor do I want to give up on life. I’m so screwed.

Don’t you just hate when that happens?

 

Watch Out for the Pod People!

Everything and everybody changes. Most of my family and friends have changed relatively gradually over the years. Recently a couple of people I’ve known for a long time have changed suddenly and dramatically. Overnight, they became dry and humorless.

It appears they had a humorectomy. While they slept, their sense of humor was removed. I don’t know exactly how it happened, but it’s deeply disturbing. I think it’s possible they have been replaced by pods, like the  “Invasion of the Body Snatchers.”

I could not survive if I did not see how ridiculous my life is. If the absurdity of it didn’t make me laugh, I would do nothing buy cry and bewail my state. Laughter heals me. It’s better than sex. Better than yoga, meditation, medication, or street drugs. It’s free, unrestricted by laws, available to anyone who is not yet dead and is acceptable behavior under almost all religious systems.

Many friends are going through rough times. Their problems vary, but the results are the same. Stress, anguish, fear, worry, insomnia. You worry, try to keep it together until you’re ready to explode.

What can you do? If the light at the end of the tunnel is indeed the headlight of an oncoming train, I say: “Buckle up and let your hair blow in the wind. It’s going to be a Hell of a ride.”

Laughing at the craziness, insanity, ludicrousness, the utter absurdity of my life — and the demented world in which I live it — is my first line of defense against despair. Take away laughter, strip away my sense of humor and I’m a goner.

At our wedding — 22 years ago — my cousin and I danced the hora. What makes the dance so memorable  — other than discovering that she was in great shape and I wasn’t — was feeling like I was going to spin out of control.  That feeling of being grabbed by something stronger than me and being twirled and spun with no ability to control what happens has become an allegory for life.

I laugh any time I can, at anything that strikes me as even a little bit funny. It helps me remember why I bother to keep living.

My friends make me laugh. I make then laugh. When our lives are in tatters and everything around us is collapsing, we laugh. Then, we take a deep breath, and laugh some more. The more awful the situation, the more dreadful and intractable the problems, the funnier it is. We are not laughing at tragedy … we are laughing at life.

The difference between tragedy and comedy is how you look at it. Laugher is the universal cure for griefs of life.

Ouch!

I don’t want this to sound as if I think I’m special because I deal with pain. I realize I’ve got plenty of company. It’s just that sometimes, I feel like I’m in an over-crowded lifeboat. Sinking.

There a central irony to this story, so I’ll start with the irony and go from there.

Parents, school advisors, well-meaning friends and family are forever urging kids to get out and get physical. Join a team. Take up a sport. Get some fresh air. Exercise. It’s good for you, right?

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It is good for you. Mostly. But. Youthful athletic activity is often the start of a lifetime of pain. How many young men destroy their knees playing football? How many girls dislocate their spines in gymnastics? How many head injuries happen during little league baseball games? How many broken backs are the result of falling off horses? It’s not rare or unusual.

These days, everyone knows about the dangers, but it doesn’t stop kids from playing or parents from encouraging their involvement. Safety equipment is available, but injuries happen anyhow. Active sports are dangerous. It’s a fact. I’m not suggesting anyone stop playing sports. Life is meant to be lived, risks and all.

The irony is that sports are good for you if you don’t get hurt. If the helmet keeps the baseball from braining you. If getting tackled doesn’t tear the ligaments and tendons in your knees. If you don’t break your ankle coming down from a jump shot. If you ride well, don’t fall and land on your butt … or head.

For me, it was horses. I love horses. I love riding. I didn’t take lessons. I just got on and rode. I fell a few times. It looks funny when you land on your butt. Everyone laughs as you get up and limp back to your mount. You’re young. You suck it up.

Ignoring pain isn’t necessarily good. Pain can mean something is wrong. I dislocated my spine. Repeatedly. Each fall worsened the problem. One day after riding, I noticed my back didn’t hurt. I couldn’t feel much of anything. My back was numb and aside from tingling, so was my right leg. That scared me. I was used to pain. I figured it was part of athletics. No pain, no gain, isn’t that what everyone says? But numbness was new and I figured maybe I should see a doctor.

My spine was 50% displaced and was pressing on my spinal cord. Which accounted for the lack of sensation. If something wasn’t done about it, I was going to be in a wheel chair before I was old enough to vote — 21 back then.

At 19, it hadn’t occurred to me I might have a real problem. In those days, we didn’t run to the doctor for every bang, bruise or pain not because we were tougher, but because we were ignorant. We’re more sophisticated these days but in the early 1960s, no one thought much about sports injures. Kids played hockey, rode bikes and horses, played sandlot baseball. Nobody owned safety equipment. If we had, we’d have been embarrassed to use it. Only a total weenie would wear a helmet on a bicycle. Has that changed or do kids remove their helmets the moment they are out of mom’s sight?

I went to the doctor. He told me to do absolutely nothing until he got me into surgery. I got a second identical opinion. Don’t bend. Don’t lift. Don’t fall. Don’t do anything. I asked if that meant I couldn’t ride. The surgeon looked at me like I had two heads, both stupid. I figured he meant “No.”

My surgeon didn’t enumerate the risks. I doubt it would have made any difference if he had. I wasn’t going through life unable to do anything active. Whatever the risks, I wanted to be repaired. I wanted to ride. At 19, I had a spinal fusion and laminectomy.

The doctor mentioned I might develop some arthritis at the site of the surgery later in life.

“Uh huh,” I said. Later in life was a million years away. After I healed — a two-year process — I went back to riding. I never fell again. I took lessons, a wise move that might have prevented youthful injuries, but my parents were unwilling to pay for lessons. Too frivolous.

Fast forward 47 years, arthritis began to make inroads. I had to stop riding. My doctor explained if I fell, I might not get up. Ever. The fusion had disintegrated. I was glued together by arthritis, nature’s way of keeping my spine intact. When the pain got worse, I went back to my doctor.

“Surely,” I said to him, “you can do something for me.”

“No,” he said. “Pain management. Cortisone shots will help. For a while.”

I’ve been down cortisone road. The shots do help for a few weeks, after which the pain returns. The human spine isn’t engineered for bipeds. Many of us have spinal weaknesses we don’t know about until after we get hurt. When I was young, a bad back was not so common. With the passing of decades, almost everyone I know has some kind of back problem. Unless you are very lucky, the chances you’ve had a back injury are high. So I live with pain and quite possibly, so do you.

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There are a lot of members of the back pain club. After you join the club, you usually get a lifetime membership. I finally discovered I have a problem I can’t fix. No amount of persistence, research, medical attention or cleverness is going to make it go away. So I’ve designed the world to make my back happy. We have a back-friendly home. From our adjustable bed, to the reclining sofa, our place is kind to spines.

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There’s no moral to this story. It’s just life. If you don’t die young and live an active life, you hurt. The years roll on, pain gets worse.

I yearn for a scooter, but the one I want doesn’t exist. I want a scooter that’s an ATV, but weighs like a bicycle and folds up. There is no such thing. I probably couldn’t afford it if it did, but I can dream.

I have had to accept reality but I do not have to like it. Sooner or later we all face an intractable problem or several. It’s a nasty shock if you’ve always believed you are unstoppable. When you hit that wall, I recommend you get some very comfortable furniture.

If the moccasins pinch, wear them

I just read another post on the power of positive thinking. I was glad to hear again how I can conquer pain and make my problems go away by believing they will.  Does God really reserve his blessing for those with a positive attitude?

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I don’t think there’s a malevolent deity or evil destiny stalking me or anyone else. Life just is. It’s not omens and portents: it’s stuff that happens.

Positive thinking is not bad.  It’s just that positive thinkers have a way of forgetting how suffering people don’t necessarily want a pep talk. They want to be in less, preferably no, pain. They want love, comfort and sympathy. My suggestion? Listen to them, find out what they want and do your best to give it to them. Your positivity may cure your problems and you are welcome to use it to make yourself feel better. Just don’t impose it on me or anyone else. Don’t force people to smile when they want to cry so you can feel okay.

I’ve got more than a few physical problems that are difficult to manage. There are bad days. I want to avoid dragging others down, but I have given up trying to make everyone else feel better by internalizing everything.

It’s unfair to tell people to relax, be happy, smile and that will make everything fine. It’s not true. Internalizing pain and sadness increases stress and makes problems worse. Don’t stop believing, but quit imposing. If you can make your own pain go away by force of will, good for you. In the meantime, remember: only you are you. The rest of us are different. A single solution, attitude or way of thinking does not fit everyone.

It is said you cannot know anyone until you’ve walked in their moccasins. Be careful: those moccasins can pinch something fierce.

Pain isn’t always a warning … sometimes, it’s just pain

It’s remarkable how much pain a non-lethal medical problem — like a bad disc in your back or an intestinal spasm — can cause …. while you can be incubating a heart attack, stroke, or cancer without pain or any other symptoms.

My back is never going to kill me. It’s a disaster and hurts like bloody hell. It makes life difficult, but that’s all it will do. The pain may be worse or better, but that’s it. Misery without end, but not life-threatening. I get esophageal and intestinal spasms that mimic a heart attack so well I’ve been hospitalized because of them until they were diagnosed and are now controlled by, ironically, nitroglycerin tabs. They are considered “medically insignificant,” but the pain they cause is breathtaking to the point where I can’t speak and am almost paralyzed by pain. My husband recognizes the symptoms and can flawlessly find my pills in under a minute, including running down the hallway to the bedroom, coming back, and depositing two of them under my tongue.

Meanwhile, I had cancer in both breasts, but no symptoms.

Go figure.