Three weeks after he returned to see his doctor, the patient had not yet passed the test. And now he had a new problem. His mouth felt weak. It was difficult to speak; his voice was different. Even at the end of a short conversation, his words turned into whispers. He could not smile, he could not swallow. Sometimes, when he drank water, it came out of his nose rather than down his throat. It was weird and terrible.
Chen was not there, so he saw his colleague, Dr. Abhiram Ani Anini Ravendran, who was also a practitioner. Ravendran had also never seen MG, but he knew it could affect the muscles of the mouth and throat. He urged the patient to have a blood test, and he sent Keung a note updating the patient with new symptoms of anxiety.
When Keung saw the message, he was alarmed. He agreed that these symptoms make myasthenia gravis a serious diagnosis. And dangerous. Patients with MS may lose strength in the throat, diaphragm muscles, or become too tired to breathe. He called the patient. He noticed that his voice was nasal, a sign of muscle weakness. He said he had no breathing problems, but Keung knew it could change. So he told her to go to the hospital immediately. He scared her. He meant.
A series of small shocks
After the patient received Keung’s emergency call, his daughter drove him to the Yale New Haven Hospital Ambulance Department, where he was admitted to the ward. This is the section for patients who are not so ill that they need CMD but can get to that point very quickly. Within a few hours, a technician came to measure his breathing. If it was too low, he would have to go to the IUD և maybe he would find himself on a respirator.
Keung was not sure if the patient had myasthenia gravis. His eyelid was always drooping, his eyesight was always double. With MG, he expects these symptoms to worsen after muscle use և and improve after rest. And MG usually affected the muscles closest to the body. He would expect his shoulders to be weak, not his arms. Despite his uncertainty, he decided to start treatment for MG. He did not want to risk the latter becoming even weaker. He was given high-dose steroids – intravenous immunoglobulins – to suppress the parts of the immune system that attack the nerve-muscle connections.
The next day, Keung performed a test to see if the patient had MG. In a repetitive nerve stimulation test, a small electrode is placed on the muscle, in this case the primary digiti minimi, the pink finger moving muscle. A series of small (: awkward) concussions occur in rapid sequence, each causing muscle contraction. For someone with normal nerves and muscles, each identical concussion will produce the same muscle contraction. In this patient, however, the first concussions caused a slight contraction, and then they weakened even more. This release describes MG. The blood test, which Chen urged him to do, was performed in a hospital. It was positive. He had myasthenia gravis.