My name is Lauri Lowen, and I live in Redmond, Washington,
USA, a suburb of Seattle. Here is my story, which extends
from 1996 to 2002.
I had nausea, a headache and severe diarrhea in May of
1996. My neurological illness began on July 3. The interval
was between five and six weeks. After I learned that Jejuni
Campylobacter was sometimes associated with Guillain-Barré
Syndrome, I asked my internist to test my stool for the
presence of the bacterium. The results showed that it was
present in the exact amount for that infection to have occurred
at the time I had diarrhea in May.
It may be assumed, then, that I got GBS from eating undercooked
chicken in a restaurant (since I would never serve it that
way).
While driving on July 3, 1996, my limbs started aching.
I felt fine, not sick. Then my arms and legs got very heavy.
I could lift them, but it was an effort to do so. This went
on for several days. I could not fold laundry, cook or take
out the garbage. I could still walk (I shuffled) and climb
stairs slowly. I could not hold a newspaper up or use a
hairdryer.
Throughout this experience, though I have been affected
to some extent all of the time, the severity of the symptoms
varies from mild to severe. Exercise, sleep, eating or state
of mind seem to have no correlation to the severity of the
symptoms. This is not typical of Guillain-Barré Syndrome,
which made it very difficult to diagnose and prompted some
to imply that I was making it up.
When I had a friend drive me to the Emergency Room, I could
barely walk and could not lift a glass or can to drink.
I was admitted to the hospital, where I was for eight days.
My illness progressed very slowly, which also contributed
to it not being diagnosed very quickly.
My arms and legs at first got worse in the hospital. My
left leg would wiggle when I was helped to walk. (They decided
then to not allow me to walk, so that I would not
train my brain to do the wrong thing.) My food had
to be cut up. I could not lift the water bottle.
Gradually, after I was transferred to the Rehab unit, I
became able to walk with the parallel bars, then with a
walker, and then with a quad cane. Two MRIs were done,
of brain and neck. A spinal tap was done. Someone told me
that the fluid was not perfect, but not bad enough to be
considered abnormal. I was told that I did not have a brain
tumor, MS, cancer or Guillain-Barré Syndrome. I was
totally unfamiliar with what Guillain-Barré Syndrome
was. They told me it was paralysis caused by a virus. (Sometime
after my hospitalization, my neurologist, who I later learned
had never had a GBS patient before me, decided that I did
experience Guillain-Barré Syndrome).
My Guillain-Barré Syndrome had an extremely slow
progression. In retrospect, and after talking to experts
in the Guillain-Barré Syndrome Foundation, I realize
that it was too early in my illness for the spinal tap to
have shown protein. If normal GBS protocols had been followed,
a second spinal tap would have been done.
While hospitalized and beginning to doze, I experienced
sudden difficulty breathing, along with vision fading to
black at the edges and pressure (not pain) in my chest.
My blood pressure, which had normally been about 90/60,
was 200/110. Two other times I was awakened by a wave of
nausea, and learned that my blood pressure was elevated
(170/120). Other times it peaked suddenly without me feeling
much.
After I was discharged, I had periods of increased weakness,
when I was unable to stand straight or walk without help
(I had been using just the cane). I recognized this later
as a loss of muscle tone in my trunk and neck, which also
incapacitates my arms and legs. Though my arms and legs
continued to improve, the symptoms affecting my trunk and
neck continued to get worse, and during those periods when
I "lost everything," all improvement in my arms
and legs would disappear. This intermittent increased severity
of symptoms has been something I have heard of in no other
person. (My current neurologist is not concerned about it
being atypical.)
I remember watching my face melt in the mirror
when I was getting a haircut. The corners of my mouth drooped
down a little, and my eyelids closed halfway. After my hair
was shampooed, I was unable to lift my head from the shampoo
sink, and the beauty operator had to lift it for me. Improvement
in my arms and legs continued. My parents paid to outfit
my house for being slightly disabled (grab bars and shower
chair, slide-out shelves holding the heavier kitchen items,
a chair with arms to support my arms when on the kitchen
phone, a telephone headset in my den). I used my cane and
ate by sliding my forearm up and down the table edge.
Following my discharge from the hospital, I sometimes lost
muscle tone in my trunk and neck. I sometimes had trouble
breathing. My body wanted to exhale and just stop there.
I found that if I did deep breathing, very deliberately
and slowly, I could force my chest to expand. If I did not
try very hard to do deep breathing, my breaths were very
shallow and infrequent.
It was during one of these periods that I felt my face start
to do funny things. My mouth was contorting. This also is
not typical of GBS. I called the neurologist and was told
to call 911. When the aid car came, they watched my mouth
go from contortion, to normal, to another contortion, etc.
The fourth of the men there (an aid car person), took one
look at me and said, Shes got Guillain-Barré.
With my mouth contorted and my speech unclear, I said, No,
I had a spinal tap and it showed that I didnt have
that.
My blood pressure, taken twice, by two different emergency
techs in two different arms, was 190/176.
I was taken to the hospital, where my blood pressure dropped
to something over 48. The doctor unkindly said that they
had done all the tests in my recent hospitalization and
didnt have any left to do. Despite the problem I was
having breathing, she sent me away. I asked to be transferred
to University Hospital. They arranged it, though my neighbor
had to drive me, curled up like the letter C in her car,
looking at the floor, with limited ability to move my arms
and legs. I felt that University was the appropriate place
for a disease thats difficult to diagnose.
There, a doctor who thought I got sick because I should
be lonely being alone on an important American holiday like
the 4th of July, said it must be stress. (I told him
that on the 4th of July I was writing a paper on the health
effects of PCBs and making eggplant salad to take up to
my friends cabin with my potluck group.) That doctor
ordered a Psych consult.
The psychiatric social worker, though she made sure that
I intended to keep my appointment with the psychiatrist
who was a part of the original hospital's Rehab team, found
that I had a wonderful support system of friends, did not
pine over my divorce in 1985, was close to my family and
my ex-husbands family, had lovely children Im
proud of, and though I am currently interviewing for jobs
(Im between jobs now), have plenty of money in the
bank and a paid-for house. After being examined in the ER
of University Hospital, I was given an appointment for the
Neurology Chiefs Clinic. I then was sent home.
As the trunk/neck/face/breathing problems became more frequent,
friends stayed with me. My son called from his business
internship in Washington, DC and informed me that he was
coming home to care for me. I told him absolutely not to
quit his internship. He said he wasnt quitting but
was leaving early, and he had made plane reservations before
talking to me, because he knew I would try to talk him out
of it. My parents and friends convinced me to hire an agency
to provide 24 hour home health aides until my son got home
(three days). We didn't know if I would stop breathing altogether,
and the hospital had made it clear that I was not welcome.
When I had the trunk/neck/face/breathing problems, the
aides took my blood pressure and pulse. When they could
hear/feel them (sometimes they couldnt), the blood
pressure went from high down to 80/40. The changes would
take place, back and forth, as they listened/felt. I later
learned that this is because blood vessels lose tone, also.
I asked the Home Health Aide who was there one day to write
a note describing what she saw for my internist, with whom
I had an appointment.
This is the content of her note: "July 26, 1996. Dr.
Failor, I am a home health aide and I work for Providence-Marianwood
Home Care. Lauri has asked me to describe to you what I
have observed in the last two days while I have been with
her. It is difficult to describe what happens but she has
episodes that occur with varying duration, intensity and
symptoms. She has sudden changes in muscle control, during
which at times her breathing slows dramatically, her pulse
becomes weak and her B/P fluctuates and becomes very hard
to hear. Her skin color changes from flushed to slightly
cyanotic. At these times she is unable to hold her head
up and without support it will either fall forward or back.
Her arms and legs become limp. These are some of the symptoms
I personally have observed. I hope this will be of assistance.
Linda Covey, CNA, MA."
I was eventually examined at the Neurology Clinic at UW
by Dr. Eric Kraus and Dr. Bell. Their best guess was that
it was a neurological viral syndrome which would go away
eventually and not make me stop breathing. I had my appointment
with Dr. Dipple, the psychiatrist who was part of the original
hospital's Rehab Team. At the end of our discussion, he
said that he dealt with problems, and I didnt seem
to have any other than my illness. He said that he saw no
reason to see me again. His contact with me had been limited
to a conversation in the hospital, and this one appointment.
Months later, by seeing his diagnostic code on the bill,
I became aware that what he told me was not his true opinion.
The diagnostic code was for conversion disorder. Because
I was a psych/education major, I was familiar with that
term. My opinion is that my atypical Guillain-Barré
Syndrome, which looks bizarre to everybody, including me,
led him to believe that it was a physical manifestation
of a psychological condition. This note in my file followed
me, leading people to not believe me when I had relapses.
My arms and legs improved, and episodes including my trunk
and neck were much improved and decreased in number. I could
walk without my cane for several moments at a time, without
having my knees start to bend more and more after a dozen
steps. When I walked, I walked like Frankenstein. The physical
therapist said slapping is the name for what
my feet did. He says it happens when there is not enough
strength to appropriately roll from heel to toe. One day
I started to feel numb at the back of my tongue and my throat.
I had experienced tongue tingling and numbness before, but
never beyond the tip (and then middle) of my tongue. I was
able to swallow, but it felt weird when I did. I was annoyed
because I thought that the new stuff was over. I didnt
think that there was anything left to be affected, and those
that had been previously affected were improving. Eventually,
the "new" stuff stopped happening and I got better
and better, and my neurologist decided that I had GBS after
all.
After several months, I was left with some weakness in
the lifting muscles of my shoulders and thighs. I stand
with a wide stance for stability and cannot hold heavy things
in front of me, but I can live without being able to pass
a turkey. If I carry things against my body, I'm OK. If
I try to walk up more than one flight of stairs at a time,
I have to pause to let my thighs stop burning, as they get
muscle exhaustion quickly. I can't hold my arms up long
enough to change light bulbs. I use a folding cane in my
purse to walk on inclines. I can live with these things.
That was the first part of my story.
What happened next was unusual. I had a small
relapse at home during the first year after my illness. I
did not go to the hospital because I knew that they didn't
believe me and would send me home again. My family cared for
me, and thankfully it was a brief and mild relapse.
Another relapse in that first year, in 1997, was so bad that
I had to go to the hospital. I went to University Hospital,
where they kicked me out after three days because they did
not believe me after getting the other hospital's records
and reading the psychiatrist's report.
I got better slowly at home and was determined not to miss
my son's graduation from the University of Michigan. With
the help of a wheelchair, I was able to fly to Michigan and
sit in the handicapped area of the stadium. After that, my
third time for what had finally been positively diagnosed
as GBS, I did not have any more significant relapses. I thought
that it was behind me. I was wrong.
On October 3, 2001, I entered the hospital for
a routine gall bladder removal. I was supposed to be there
for one night. During the operation I began bleeding, and
the surgeon thought he solved it by cauterizing it. In the
recovery room, I awoke unable to move and having trouble breathing.
GBS didn't even enter my mind. After my blood count was found
to be dangerously low, they realized I was bleeding internally
and took me to surgery for the second time in a few hours.
They usually depend on the muscle's natural contraction after
awakening from anesthesia to help prevent bleeding. They saw
that, for some reason, my bleeding muscle had not contracted.
I needed two units of blood, in addition to the blood they
suctioned out of my abdomen and returned to me with a Cell
Saver.
When, in the post op ward, I still could not
move, I thought it was a side effect of having two surgeries
with complications and losing blood. Not until the surgeon
came in the next day and said that my GBS was back did I realize
what this familiar sensation was. Neither I, nor the people
at the hospital, thought that GBS could relapse from surgery.
It accounted for why the muscle didn't contract after surgery;
my torso was already paralyzed. I started off so weak that
people had to turn me to avoid bedsores, but made steady improvement
when they transferred me to the Rehab ward. This time, they
believed me, since I had gotten the GBS diagnosis following
my earlier hospitalizations. When I would have the periods
with breathing difficulties they would help me... a nice change
from earlier times. I never needed a vent.
When I was discharged my son stayed with me
for a few days, then a home care lady for a month. The last
relapse was as bad as the first time, except it came on strong
instantly, instead of very slowly. I saw a neurologist at
Virginia Mason Hospital, Dr. Ravits, who is an expert in GBS.
(He was in "People Magazine" the week I first saw
him!). He diagnosed me at once with Relapsing/Remitting GBS.
Everyone I had seen before thought that relapsing GBS had
to be CIDP, and tests showed I didn't have CIDP. Relapsing/Remitting
GBS, unlike regular GBS, can be turned on by surgery. So there
I was, five years later, dealing with GBS again. I had PT
in a swimming pool this time, and eventually got back to driving.
Here is where the story gets even stranger.
This wonderful doctor did all kinds of tests to learn if there
was anything else going on that could cause neuropathy. He
found that a protein in my blood was elevated. I had full
body X-rays and bone scans looking for evidence of myeloma
(cancer of the bone marrow). The hematologist/oncologist I
was sent to determined that, because the level of this protein
is not elevated enough to be cancer, I have "IgG Kappa
Gammopathy of Undetermined Significance." (Really --
that's the name.) I will need to be checked for the rest of
my life for the levels of this protein, as 25% of the cases
become cancer. I decided not to worry much about it.
Then the hematologist/oncologist found something
more serious. We now know that I have myelodysplasia, which
is bone marrow failure. My red and white cells are abnormal
and continue to reduce in number. At some point my platelets,
which control blood clotting, will also start to become fewer
and fewer. It is invariably fatal, though it may take six
or more years to get to that point. People with this disease
die of infection or bleeding. Astronomer Carl Sagan died of
this while awaiting his second bone marrow transplant.
I continue to feel healthy, though I get some
troublesome infections and am not the strongest person in
the world. But since GBS, I wasnt that strong anyway.
If it was not for this relapse and finding this wonderful
GBS expert, we would not have discovered my blood abnormalities
until the disease had progressed much more, when it was possibly
too late for a bone marrow transplant.
I knew there was a silver lining someplace.
Lauri Lowen
GBS 1996 (twice), 1997 and 2001.
Redmond, WA, USA
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