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Tuesday, November 24, 2020

‘GBS with Covid rare, muscle weakness indicator of symptom’

A month after recovery, noted paediatric surgeon Dr Dasmit Singh speaks to The Indian Express about the consuming loneliness of his hospitalisation and says that, till a vaccine is finalised, the only way to prevent the infection is social distancing and masking.

Written by Anuradha Mascarenhas | Pune | October 25, 2020 10:36:44 am
‘GBS with Covid rare, muscle weakness indicator of symptom’Dr Dasmit Singh had contracted Covid but, worse, it brought on Guillain-Barre Syndrome (GBS), a rare and life-threatening neurological complication.

At the very hospital where the rush of patients daily would afford him no breathing space, Dr Dasmit Singh lay in a room with only the clock for company. He would watch the seconds hand, deriving constant reassurance that time was indeed ticking by and the present would soon be an unpleasant memory of the past.

The 58-year-old noted paediatric surgeon with Jehangir Hospital in Pune had contracted Covid but, worse, it brought on Guillain-Barre Syndrome (GBS), a rare and life-threatening neurological complication. A month after recovery, he speaks to The Indian Express about the consuming loneliness of his hospitalisation and says that, till a vaccine is finalised, the only way to prevent the infection is social distancing and masking.

How rare is GBS in Covid-19 patients?

Only about 40-50 such cases have been reported around the world in the last few months. Symptoms of GBS usually manifest in the third week of the infection. GBS can vary from mild to severe, depending on how much of the body gets paralysed. It progresses, affecting nerve after nerve, causing loss of muscle function. Severe cases can result in paralysis of all four limbs, the neck and respiratory muscles. This may then require ventilator support for months to years. Early diagnosis and treatment is very important. Symptoms should be picked up as soon as there is muscle weakness.

What symptoms led you to suspect you had GBS?

Two days with a sore throat, from September 16, were followed by difficulty in even putting on a slipper on the left foot. The weakness in the foot spread to the knee and left hip. The next day, the right lower limb also became weak. Such was my condition that I had to pick up my leg with my hands to move it. Soon, I lost control over the movement of the lower limbs. My Covid test returned positive on September 18. An MRI of the spine and hip was normal. But I had to be admitted to the hospital as limb weakness had increased. Blood inflammatory markers, cerebrospinal fluid examination, brain MRI, chest CT scan, nerve conduction velocity and other tests conclusively proved that GBS had set in.

What was the treatment protocol and how long did it take to recover?

I was started on Remdesivir, followed by intravenous immunoglobulins (IV Ig) and methylprednisolone. The IV Ig was magical, halting the progression of the weakness and limiting it to the lower limbs. From the third day, I began regaining movement in the limbs and was put on mild physiotherapy. It was now possible to stand and walk with support.

Regaining full muscle strength is expected to happen over the next few months. Physiotherapy and good nutrition is key to success here. I was discharged on September 27. I was able to perform daily chores independently within 15 days. After a month, I have begun seeing patients in my OPD. Note here that quick diagnosis, proper treatment and assistance from the healthcare staff greatly aided my recovery.

And despite the care, it was you and your condition at the end of the day…

Yes, the loneliness due to the isolation was the toughest part of my hospitalisation. Besides, the fatigue was so overwhelming that I wanted to sleep most of the time. I would pick up my legs, one at a time, and position them with my hands before sleeping. I would get up and the ungracious clock would indicate that only an hour had gone by.

The realisation that a large part of the day was still remaining was an excruciatingly painful thought. Sitting up, even with support, was a distressing chore. It would lead to a severe throbbing headache.

Positioning the limbs was not without its own set of problems. It was important to keep moving the legs to prevent pooling of blood as intravascular clotting is known to cause many of the complications of Covid. But positivity helps with boosting immunity and early recovery. Friends offered to send books to read, but I refused as it would stress my Covid-fatigued eyes. The TV was a distraction but I found the content loathsome. I needed content to pacify the agitated neurotransmitters of the brain. Patient-friendly channels need to be started for hospitals.

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