Team of specialists at Ruby Hall Clinic Hinjawadi come to his rescue after severe respiratory distress.
Pune, 11 September 2020: For the last 10 years, 52-year-old Atul Javdekar* regularly
visited a multitude of neurologists at various hospitals. In his early forties, he had begun
experiencing trouble walking, lifting objects or even chewing and swallowing. “I had learnt
to live with this condition where bouts of helplessness hampered my daily activities. I was on
medication for a long time for episodes of muscle weakness which occurred anytime or
anywhere. In the last couple of years though, my condition had improved and I was not
required to take medication,” says Mr. Javdekar. He was suffering from a lifelong medical
condition known as Myasthenia Gravis or MG.
In medical terms, MG is an autoimmune neuromuscular disorder characterised by physical
weakness and fatigue in the voluntary muscles group which is caused due to a breakdown in
the normal communication between nerves and muscles. It is a relatively rare condition that
affects about 16 out of every 1,00,000 people. The disorder can cause drooping eyelids,
blurred or double vision, slurred speech, difficulties with chewing and swallowing, chronic
muscle fatigue and weakness in the arms and legs where one is unable to walk even a few
steps. While there is no cure for myasthenia gravis, the symptoms need to be controlled.
To add to this existing condition, COVID-19 soon struck Mr. Javdekar in late July 2020. Dr.
Sudha Desai, Consultant – Intensive Care Specialist, Ruby Hall Clinic Hinjawadi
says,“When the patient suffered from high grade fever and cough for 4 to 5 days, he was
tested for COVID-19 and resulted positive. On being wheeled into our hospital, he was
admitted with COVID-19 related pneumonia including bi-lateral lung involvement. He was
already in severe respiratory distress due to oxygen deprivation and had to be put on the
ventilator. Initially, we tried non-invasive ventilation for a few hours, but his body was not
reacting well to it. We administered intravenous immunoglobulin and an increased dose of
steroids since his condition of myasthenia gravis precipitated due to COVID-19.
He had to be intubated owing to low blood pressure. After 48 hours when he showed signs of
improvement, we put him in prone position on the ventilator. This meant the patient was made
to lie on his stomach, for a certain amount of time every day owing to significant respiratory
distress. After 50 hours of prone positioning, we were happy to notice that he was doing much
better. The patient was in the ICU for 12 days, out of which 9 days he spent on invasive
ventilation,” explains Dr. Desai.
Owing to the fact that the patient was COVID-19 positive, doctors at Ruby Hall Clinic
Hinjawadi were required to use bedside respiratory mechanics to evaluate for neuromuscular
respiratory weakness with caution because of the potential risk of aerosolisation of viral
particles and viral transmission. After 21 days in the hospital, Atul Javdekar’s condition
drastically improved and he was discharged. He has been advised by the team of neurologists
to continue his medication for myasthenia gravis.
Dr. Sudheer Rai, COO, Ruby Hall Clinic Hinjawadi concluded, “In the modern medical
era of randomised controlled trials, we are habituated to making decisions supported by an
evidence base. While COVID‐19 has rapidly become a global pandemic, little is known about
its potential impact on patients with pre-existing myasthenia gravis (MG) which made this
case all the more challenging. Our team of doctors stayed at the forefront of this condition
while ensuring the patient did not develop any bacterial infections or sepsis. We also ensured
that our current best practice standard of care was maintained.”