37-year-old ICICI Bank manager from Pune, Maharashtra, comes to show me symptoms of pain in the abdomen, weakness, and shivering.
Whenever a new patient enters our cabin, we need to read body language carefully…
Seeing this patient, everything seemed normal, but suddenly, he collapses on the wheelchair!! And that too in the OPD!!
A lot of anxiety on the top means light mood to reduce anxiety, I jokingly said, “You’re a young man; will it be windy on the wheelchair?”
Patient: “Sir, let me go… what to say? First, I had pain in the stomach, shivering, fever came.. I’ve never felt so weak in my entire life! Because of that weakness, I stumbled and ended up here on the wheelchair!”
Me: “Is it so severe that you had to come here again?”
And what do we worry about?
If there is viral fever and shivering, a little weakness can be resolved in two-three days…
Patient: “But, sir, in Pune, two MD doctors told me the same and prescribed medicines, but even after taking them, there was no improvement.”
It doesn’t matter; I went to Nandurbar, and there, they said it’s due to dehydration and lack of vitamin. I stayed there for three days, took vitamin injections, but my condition worsened.
I told them that you are a specialist in stomach issues, so I came here urgently… that’s why the wheelchair.
Now, my condition is a bit serious, so I have stopped joking and started studying his old files carefully.
Me: “How many times have you had shivering in these three days?”
Patient: “5-6 times.”
Me: “Wow… how many times in total in these three days? I didn’t ask about one day.”
Patient: “Oh, sir, only 3 times in these three days.”
Me: “Area… how many times in total in three days? Don’t just say three times.”
Patient: “Yes, sir, only three times in these three days.”
Me: “If it’s more than 5 times in 24 hours, you should be worried about this weakness and dehydration! How many points was the fever?”
Patient: “98-99 points.”
Me: “That’s normal to say, is this fever a little low?”
Patient: “That means, sir, I should feel like I’m burning up all over my body… check it on the thermometer, it should be that high.”
Me: “What happens to you in weakness, tell me in detail.”
Patient: “Sir, both my hands and feet get numb and start vibrating.”
Me: “Do you work in a bank?”
Patient: “Yes.”
Me: “Did you do office work or sign checks even after falling sick?”
Patient: “Yes, but sir, what to do about my weakness?”
Me: “Have you made any other changes?”
I got into thinking and gave a stern answer… “Yes, sir, I have… I hold my finger and shake it!”
I pulled my hand away and told him not to let go of my finger…
The patient burst into laughter. 😃
I told him seriously that I haven’t made any jokes, just hold my finger tightly.
I pulled my hand away, and he still clung to my finger!!!
I checked his reflexes on his feet – absent.
The patient seemed a little confused… “Sir, check my stomach… check everything – the nerves, fingers’ strength, legs – what are you checking in all these?”
Me: “This is not dehydration, weakness due to lack of vitamin, fever, or pain. This is a neurological problem, whether it’s related to the brain, spinal cord, nerves, or muscles. We need to consult a neurologist immediately, Dr. Ravi Vatiani.”
Patient: “Sir, first admit me; I’m very weak. Please call the neurologist here in the hospital for an evening visit.”
Me: “No, it’s not like we’re running out of time. First, go there immediately, I will call him and let you know. We will perform NCV (nerve) tests at his clinic, send you for a blood test at the lab – blood and urine, NCV test, MRI of the brain and spinal cord, and CSF analysis. I will call you in 2 hours, admit you and start appropriate treatment.”
In just 3 hours, all the patient’s reports (blood, urine, NCV test, brain, and spinal cord MRI and CSF) arrived, and we reached the diagnosis immediately!!
Diagnosis:
GBS (Guillain-Barré Syndrome) following viral/bacterial enteritis (a rare condition caused by a virus that leads to symptoms like weakness, paralysis, and body vibrations)
Treatment:
IVIG injections (this injection costs 2 lakhs)!! And it has to be given immediately.
Result:
In 5 days, the patient was walking, eating, and talking again! 🙂
Medical facts:
This disease can be very challenging. (1 in a lakh chance!!)
If diagnosed early, paralysis can be prevented throughout the body.
If weakness reaches the chest muscles, the patient may need to be on a ventilator for a long time (1-3 months).
Even after coming off the ventilator, many GBS patients remain bedridden for months.
Even if the patient consults me in the evening and I send him to the neurologist, it might be 5 days or more before they are admitted to the hospital!!
The patient came in complaining of abdominal pain and left with a neurological diagnosis!!
Quick diagnosis and treatment changed the scenario. Thanks a lot to Dr. Ravi Vatiani, SIDS Hospital’s ICU team, and above all, the Almighty 🙏🏻🙏🏻.
