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Thursday, August 18, 2016

Brotherly Love

Posted By: Advancing Care

When his brother in Haiti was struck by unexplained paralysis, a Westchester Medical Center physician knew exactly what to do.

By Deborah Skolnik

Westchester Medical Center (WMC), the flagship of the Westchester Medical Center Health Network (WMCHealth) provides unbeatable care, and no one knows that better than Mario Nelson, MD. As Director of Rehabilitation Medicine at Westchester Medical Center, Dr. Nelson has witnessed countless families entrust their loved ones to WMC for state-of-the-art treatment. Dr. Nelson gained a new perspective this spring, however, when one of his own family members got sick.

“I was on vacation in Brazil when my brother Jean called me from Haiti, where he lives, to say he was really ill,” Dr. Nelson remembers. “He had experienced some flu-like symptoms and went to see a doctor. The physician had ordered some tests, but Jean began having paralysis before the results were even in. It started with his feet and then worked its way up his legs and throughout his body, until he could not even close his eyes and was starting to have difficulty speaking.”

Dr. Nelson immediately suspected the underlying cause: the Zika virus. Though it’s most infamous for causing devastating birth defects, in rare cases Zika can also trigger a condition called Guillain-Barré syndrome (GBS), in which a person’s immune system attacks the nerve cells. The result can be muscle weakness, and even paralysis.

Jean’s blood tests at WMC came back negative for Zika and several other possible illnesses, but that didn’t dissuade Dr. Nelson. “There’s only a short window of time when the Zika antibodies are detectable,” he explains. He was certain he’d made the correct diagnosis — and even more sure about where Jean, a 52-year-old husband and father of two, needed to be treated. He quickly made arrangements for his brother to be transported via air ambulance to WMC.

Upon arrival at the ER, he was immediately examined by neurologist Stephen Marks, MD, who confirmed the GBS diagnosis and admitted him to the Intensive Care Unit.

“Jean exhibited all of the symptoms of Guillain-Barré, including weakness, numbness and loss of reflexes; he was effectively paralyzed but completely awake and alert. He was also having trouble breathing, and we had to intubate him,” said Dr. Marks.

“This can be a terrifying state for the patient, and I constantly reassured Jean that his condition would improve and that better days were ahead,” Dr. Marks added.

Jean also suffered from pneumonia, due to his inability to respire properly. To combat this, Jean’s care team administered intravenous antibiotics and immunoglobulin, donor-derived antibodies.

“It was pretty scary,” recalls Dr. Nelson, who kept close guard over his brother. “I’m glad I was there to reassure him.”

Gradually, Jean turned a corner. “From the third day, he started getting better,” Dr. Nelson remembers. “I saw that his eyes weren’t as stiff. He started moving his hands more easily.” By the end of his first week at the hospital, he could sit up with assistance, and tests showed his pneumonia was clearing.

After 10 days, doctors were able to remove Jean’s breathing tube; he was transferred to a standard hospital unit a few days later. He was now ready to reclaim his life with the help of rehabilitation – the WMC department his brother oversees.

Assessing Jean’s weakened body, Dr. Nelson prescribed intensive physical and occupational therapy. “He needed exercise to build up his strength, endurance, balance and coordination, along with ambulation training to walk easily again,”  as well as relearn basic tasks like showering, dressing and feeding himself. After three weeks of in-hospital therapy, Jean continued as an outpatient, living in Dr. Nelson’s home for several more weeks as he continued to gain strength and agility.

Back in Haiti, “Jean is back to his regular self — he’s driving, and he is back to his job as an economist,” says Dr. Nelson. “But I expected that kind of outcome, because I know the quality of care here at Westchester Medical Center. Now, so does Jean.”

Pictured: On the road to recovery, thanks to WMC, Jean Nelson (center) is seen here with his brother, WMC’s Mario Nelson, MD, Director of Rehabilitation Medicine, and Chery Sun, DPT.