Age: 26.0
Sex: M
Vaccine: FLU4
Symptoms: Nerve conduction studies, Palpitations, Paraesthesia, Peripheral swelling, Pneumonia
Clinical narrative: At the end of August, 2018 patient got a flu shot within a few days his feet were heavily swollen with feelings of pens and needles. The swelling kept increasing and going up his legs. I called for an appointment to see primary care but couldn't get in until the day after holiday. The doctor said his heart is beating too fast and thinks its causing swelling in lower extremities and refers us to a heart specialist. The appt was a month away. I called the heart specialist and got them to move the appointment to within a few days. The heart doctor said he thinks it is the medication - Risperidone that is making his heart race, and recommends revisiting the psychiatrist. Meanwhile, patient says his legs feel like wood, he can barely walk, and is losing fine motor skills in his hands. He can't snap his fingers or tie his shoes. Its getting worse, and I take him to the ER. That doctor says the same thing - to see the psychiatrist and sends us home with patient having a resting heart rate of 172. The next day, which is Spt 10, we have an emergency apt appt with the psychiatrist. It turns out risperidone and benztropine cause the heart to beat faster and these medicines were reduced. They do not cause ascending paralyses. Patient walked into that appointment with my help, but within 30 minutes, he couldn't walk or get up from the chair. An ambulance was called. Patient went again to the ER and they transferred him. They did many him to another hospital. They did many tests. They checked his VP shunt. It was fine. They checked his heart. It was fine. The swelling and numbness was still there. He would break out in a sweat for no reason. His heart continued to race. He could walk a little ways using a walker. I had to help him to eat, bathe and go to the toilet. We stayed in Medical Center from the 10th to the 16st. They released him because there was nothing else they could do and recommended acute rehab. Rehabilitation Hospital would not accept him because beause he didn't have a diagnosis. I took him home. On the 17th of September, Patient couldn't move patient couldn't move lower extremeties at all lower extremities. I call and he couldn't urinate. I called the ambulance again. Patient is admitted into hospital. He then had a catheter to urinate and had to be lifted to the toilet. His feet were turning downward (drop-foot), and he lost his voice. The social worker looked for a rehab he could go to and he got accepted. He He fell twice the first day. The next day, 21st of Spt., I was with Patient patient in his room with the doctor doing an intake. Patient was propped up on pillows, could somewhat use his hands and was drinking a soda. He choked on that soda four times. The doctor was looking at the hospital records and asks why they didn't test for Guillain Barre? I had never heard of GBS before and I answered that I didn't know. She says she really thinks they should and sends him back to the ER. In the ER patient has trouble with his vision seeing spots and stars. Doctors are saying yes, this looks like Guillain Barre. There is this sense of panic. They have pricked his legs and arms and he can't feel anything. They say he needs need to go to the Hospital because GBS progresses fast and they don't feel equipped to deal with it. It has affected his autonomic nervous system, which is why he keeps sweating and his heart keeps racing. It progressed from his feet up to his vocal cords. Patient's hands are beginning to seize up and turn inward. He stayed in the Hospital from the 21st of Spt to the 29th. They treated him with IVIG treatments and started OT and PT and ST. Patient's symptoms plateaued about 4 weeks after they begin. He was released to Rehabilitation Hospital on 28th the 29th of September. He needed intensive speech, occupational and physical physcial therapy. His body has curled upon itself and his muscles had wasted. He couldn't speak. On the 7th of October, patient aspirated on his food. He was rushed to Medical Center. He needed a BI-PAP to breathe. He needed to be sedated to wear the BI-PAP. He didn't have any nutrition for four days. After four days, he started to breathe normal without the BI-PAP, and a feeding tube was placed. He lost 21 pounds. He also lost the ability to control his bowels. The The 15th of October - Nov 1st, Patient was back in acute rehab. By 1st. patient was back in acute rehab. by the time we left on Nov 1st, patient feet did not have drop foot, he could bend his knees, move his feet a little, and roll from side to side and urinate without a catheter. He could lift his arms, but his hands were still curled inward. He needed total care. Nov 1st - Nov 4th were at home. Nov. 4 - patient vomited and aspirated. He went back to the ER, ER then to Medical Center. Once again, he needed a BIPAP to breathe. He was in hospital four days. He went home with an oxygen machine. Patient began outpatient therapies, ST, OT, and PT and Entire Care in Medical Center. He was in a wheelchair, wheelchair with an oxygen tank and a feeding tube everywhere he went. He He stopped using oxygen and started to regain his voice in December. Also began to sit up by himself and swing his legs off the bed. He regained bowel control. His fingers started getting stronger. His muscles in his throat got strong enough to swallow - soft food without aspirating and no longer needed the feeding tube. He had one set back - with community - acquired pneumonia, but was able to be treated at home. His His legs and torso got stronger. He was able to get in and out of the wheelchair. He started to use of walker, then a roller-walker. February February 14, 2019, he took steps without assistance. assistance In March, 2019, he used a cane around the home and a roller-walker in public. As of this date, January 15, 16, 2020, patient still needs physical therapy and occupational therapy once a week. He receives IVIG infusion infusions every 6 weeks.