Dr Daria Trojan – Post Polio Clinic, Montreal Neurological Institute and Hospital
- Friday 30 May

I was very pleased to have the opportunity to meet with Dr Daria Trojan, Physiatrist, whom I videotaped and with the assistance of Danielle Lafleur, the clinic Administrator, I was treated to a morning tea and information exchange with other members of the team. This was followed by one-to-one interviews with Dr Diane Diorio, Neurologist, as well as Marie-France Lanoie, the Physiotherapist, and Tatiana Ogourtsova, Occupational Therapist. People requiring other treatments are referred out to PPS-aware health professionals in the community. The OT on the team is responsible for the swallowing and cognitive difficulties that other PPS clinics may refer to a Speech Therapist.

I was also granted permission to observe two follow up assessments with Dr Trojan. These patients had been attending the clinic for many years and had nothing but praise for Dr Trojan and the other clinic staff. One woman had rejected an orthotic because it was grey instead of white and Dr Trojan made a point of saying that Montreal woman were generally very conscious of their appearance, often wrapping scarves around their mobility aids to coordinate with their outfits. Very French!

The best way to describe the clinic is to quote directly from the web page for the Post Polio Clinic at Montreal Neurological Institute and Hospital (http://apps.mni.mcgill.ca/mnhpolio.html):

“The post-polio clinic was started by Dr. Neil Cashman, Neurologist, in 1986. Dr. Daria Trojan, Physiatrist, joined the clinic in 1989 first as a research fellow, and then as a clinic physician. The clinic is currently coordinated by Dr. Trojan. Dr. Diane Diorio, Neurologist, joined the clinic in 2001. The work of the post-polio clinic encompasses three areas: 1) clinical care of patients, 2) education of health care professionals and lay groups, and 3) clinical research on post-polio syndrome.”

“To this time, more than 1000 post-polio patients have been evaluated. The referral base is primarily the province of Quebec, secondarily eastern Canada. A first appointment in the clinic involves evaluation by Dr. Diane Diorio or Dr. Daria Trojan. Many patients are followed regularly in the clinic, approximately every 6 to 12 months. Some patients are referred for electromyography (EMG) studies to Dr. Daniel Gendron. Many patients are referred to a pulmonary specialist with a special interest in neuromuscular disease at the Royal Victoria Hospital, and to other specialists, as necessary. Most patients are also referred to the physiotherapists and occupational therapists of the Montreal Neurological Hospital.”

“The post-polio clinic patient population provides volunteers for several ongoing clinical studies including studies on the relationship of fatigue with brainstem neuronal injury and other factors, and studies on determinants of adherence to treatment recommendations in patients with post-polio syndrome.”

Unfortunately, due to the fact that this is the only post polio clinic in Canada’s Eastern provinces, they are overwhelmed with patients and, consequently, experience the same up to six month waiting list that we have with Polio Services Victoria.

What is really outstanding about this post polio clinic is the clinical research it has generated over the years. Dr Trojan’s reputation precedes her as the result of a number of clinical research projects she has instigated and subsequently published articles on post polio syndrome-related issues, such as:

Osteoporosis in a Postpolio Clinic Population (quoted from the Aug 2007 article, “Conclusions: In this retrospective, cross-sectional study, we found that osteoporosis and osteopenia at the hip occur commonly in postpolio clinic patients referred for bone densitometry in men, premenopausal women, and postmenopausal women compared with the general population.);

Sleep-Disordered Breathing in Fatigued Postpoliomyelitis Clinic Patients (quoted from the Oct 2006 article, “Conclusions: In our retrospective, cross-sectional study, we found that SDB, especially obstructive hypopnea, was very prevalent among postpolio clinic patients referred for sleep evaluation.”);

Predictive Factors and Correlates for Pain in Postpoliomyelitis Syndrome Patients (quoted from the Aug 2002 article, “Conclusion: Our study provides insights on the pathophysiology and possible management of muscle and joint pain in PPS . . . Because pain is associated with significant reduction in Quality Of Life in PPS, further study of this important symptom is indicated.);

A multicenter, randomised, double-blinded trial of pyridostigmine in postppolio syndrome (unfortunately, the 1999 article concluded that “This trial did not show a clear benefit of pyridostigmine.);

Fibromyalgia Is Common in a Postpoliomyelitis Clinic (quoting from the June 1995 article, “Conclusions: (1) Fibromyalgia occurs frequently in a postpolio clinic. (2) Fibromyalgia can mimic some symptoms of postpoliomyelitis syndrome. (3) Fibromyalgia in postpolio patients can respond to specific treatment.”)

Dr Trojan has also just completed another study to compare inflammatory markers in PPS patients to normal controls. The study also included MS patients with PPS patients, and normal controls. They have presented the MS inflammatory marker results (with the PPS and normal control results) in abstract form but not in the published paper.

Dr Trojan believes this study needs to be further developed by other scientific researchers. However, referring to discussions with Dr Marcia Falconer (see Ottawa), if proven, this could be significant in supporting the theory of inflammation playing a part in postpolio syndrome. As a respected and measured researcher, Dr Trojan is careful not to draw any such conclusions from her own study. But as an enthusiastic Community Development Worker, I’m quite happy to speculate . . .

For anyone wanting to read more about the research mentioned above, Dr Trojan has provided me with the articles, which can be accessed through the Polio Network Victoria’s library. Of course, they are all subject to Copyright. Some of these studies may be available to read on-line through Post-Polio Health International (PHI – see St Louis).

I found my visit to the Post Polio Clinic at Montreal Neurological Institute and Hospital very informative and valuable in adding yet another perspective to the range of services that can assist polio survivors. If only we could blend the best aspects of these post polio clinics for the benefit of all. Ah, well – it can’t hurt to dream.