Age: 65.0
Sex: F
Vaccine: FLU4
Symptoms: CSF protein increased, Disability, Exercise tolerance decreased, Fall, Fatigue
Clinical narrative: She got her vaccine, the symptoms started on 11/20/19 when she woke up at 4:00 AM of severe pain, along with pins and needles sensation, numbness, sensory abnormality in both legs, both hands.  She went to the doctor on 11/22/19, described the symptom as a stocking glove manner.  He did blood work, and said that he would prescribe some pain killers, which he did not.  That's when it was followed by her 5 phone calls on that day, and the next few days over the next 5 days and made those calls asking for help, and they declined to help her.  They told her that her labs were normal for rheumatology problems, and that she could go to a pain program.  She did not go to a pain program as she knew that it was not pain problem material as she knew something was very wrong.  After that she gave up calling her doctor, frustrated and decided to wait until her pre-existing appointment in December.  That is about when the pain and maybe the other symptoms started to subside for about a week, which she felt she was getting better.  Then the next week came and that's when the severe weakness, the fatigue, the balance problems, the falling started.  Then that got her to 12/12/19 which was her preexisting appointment.  She went in and she asked for an urgent referral to tertiary care facility neurology.  She told them something was wrong and wanted that referral.  He told her that if she fell again that she should go to the local ER.  So on 12/13/19 she went to the local ER due to continued falls.  She was hospitalized to 12/20/19 at Hospital with a diagnosis of diagnostics and treatment due to the falls.  She was then transferred on 12/20/19 to the acute in-patient rehab unit at University with a diagnosis of probable Guillain Barre.  She was told that it was surely or almost surely Guillain Barre. They ran a bunch of exotic blood tests to rule out other things, and it was going to be potentially a couple of months until they got the results back. She left the hospital with Guillain Barre with blood work pending.  She was there at the rehab center through 12/26/19.    She came home on 12/26/19 and she had a 2 week FU appointment (fill in doctors). In late January she started PT and she continued that until mid May, stopping only because of the COVID shut downs. After several months due to the shut down she resumed therapy she did have improvement, but slow. Her healing and her physical and functional improvement has just been excruciating slow. It's been 3 1/2 years and she is not there yet, and that continues to his day.   She has never had gone back to the hospital, but she has continued PT intermittently and went a while without as she felt her healing to take a break. The last course of therapy was early January of 2023 through April of 2023. She again stopped because she had made good, but slow progress and they felt that she needed to take a break, have some more healing and then go back when she is feeling better. She has also since then started with bilateral knee arthritis worsened over the 1st several months due to the GBS. Then once she could feel them about 10-14 months into healing she realized how bad they were. She went to an Orthopedic doctor and she has started knee injections, series of 3 every 6 months months to try to preclude having knee replacements. She also saw her neurologist a couple of times and was markedly disinterested in her case.    Her primary doctor had retired, but she now has retired, but she now has a new good doctor. She is strengthening but she is still disabled. Her current physical status is continued deficits in both gross and fine motor coordination. Continued paresthesia's, sensory impairments most notably in her hands, which she wants that back. She is still ataxic in all her movements but improved. She is still high risk for falls which limits her to walking on flat level surfaces. She has limited endurance for light physical activity. In function is anywhere from independent to stand-by independence with her self cares with adaptive equipment. For those higher functions ADL's in life like housecleaning, home and property management which used to be her jobs so she is not able to participate in any higher level ADL's which makes her anywhere from dependent to moderate/maximum assistance. She cannot do big stuff. She can bath, dress, brush her teeth and so that's pretty impactful for her and her family.     She does use a walker when outside of the home, it is still a lot of effort to walk.    The lumbar puncture showed a lot of protein in her CSF.    She sustained an injury in one of her falls which was so bad that the doctor in the rehab suggested that they do an EMG and nerve conduction velocity, but decided that she did not want to have them as they could work through the problems through her PT.     Due to the GBS she stepped wrong and broke her foot so that slowed down her PT and progress. This was also slow healing.  It took 18 months for that to heal.