Can you imagine?

Guillian Barre. If you watch House you've probably heard this term thrown around at least a couple of times. Well tonight I have a patient who is suffering from Guillian Barre Syndrom (GBS). The patient's own immune system attacks their peripheral nerves (the nerves outside of the brain and spinal cord). The cause is unknown, but appears to be triggered by a viral or bacterial infection in most patients. Long story short, the process is characterized by motor weakness that may progress to paralysis in an ascending nature (feet to face). GBS is a unique disorder. It attacks for a few weeks as the symptoms increase in severity, it plateau's, and then the patient starts to recover and regain motor function. During the progressive phase deterioration can be rapid. Up to 10% patients experience respiratory failure and must be intubated (as my patient is). The plateau phase varies in length. Although the paralysis is not getting worse, the pain can be excruciating from the inflamed nerves, and stiff muscles/joints. The recovery phase starts spontaneously when the body's immune system decides to stop producing the antibodies that destroys myelin. The symptoms gradually disappear and nerve healing begins. Pain is still an issue as the neve cells start to regenerate. The degree of recovery depends on the severity of the nerve damage in the first phase.

Can you imagine? I can't. What would it be like to be a normal teenager (or any age range for that matter), and have complete motor function one day, and then the next you start to loose control of your body, starting from the bottom. My patient (17 years old) came into the hospital saying "my arms and legs stopped working." Just think about that for a minute. You can walk, run, exercise... and then all the sudden you're tripping, loosing balance. And then, your legs don't work at all. You are in a wheelchair or a bed as the GBS moves up your body, looking for the next ability it can take away from you.

My patient is in the plateau phase; she has some movement still in her neck and can shrug her shoulders, but that's pretty much it. Instead of the normal call light (since she can't use her fingers) she turns her head to the left where a big red button is hooked up to a radio. When she hits it, Kool105 comes on, and that lets me know that she needs assistence. That assistence may be repositioning her completely, putting a blanket on, taking a blanket off, turning the fan on, suctioning her mouth, nose or trach, etc. etc. etc. (and I mean ETC!). Another common request is that I merely straighten out her fingers, or bend her elbow a little bit more. Seriously, can you imagine being able to feel your fingers being uncomfortable, but not being able to straighten them out on your own? Although she can barely move, she can feel everything, to a painful extreme. She is constantly complaining of foot pain. They are EXTRA sensitive, but I try my best to make her feet (and her whole body) comfortable. Sometimes this means I'm in there every 5 minutes, or for 30-45 minutes at a time, constantly making tiny adjustments.

I wish I had a magic potion that could put this poor suffering girl into the recovery phase. What a treat it will be for her when she can start to adjust her own arms again, or scratch where she itches, or pull a warm blanket on. I hope I'm around on the day(s) she starts making improvements. And I hope she has complete recovery. Of course she will need therpies to help her regain motor function, but I'll be rooting her on the whole way.