Three weeks later when she went back to see her doctor, the patient still did not get the test. And now he had a new problem: his mouth was weak. It was difficult to talk; His voice was different. By the end of a short conversation, his words were reduced to whispering. She could not smile, and she could not swallow. Sometimes, when she drank water, it came out of her nose instead of coming down her throat. that was weird. And scary.
Chen was not there, so he had a colleague, Dr. Abhiram saw Janani Raveendran, who was also an apprentice. Ravindran had never seen MG but knew that it could affect the muscles of the mouth and throat. He urges the patient to undergo a blood test, and he sends a note to Keung, which tells of the patient’s new symptoms and possible diagnosis.
When Kyung saw the message, he became worried. He agreed that these symptoms made myasthenia gravis a possible diagnosis. And a dangerous one: Patients with MG may lose strength in the muscles of the throat and diaphragm and may be too tired to take a breath. He called the patient. His voice, he noticed, had symptoms of nasal and thin – muscular weakness. He said he had no trouble breathing, but Keung knew he could change. So they asked him to go to the hospital immediately. He frightened her. he meant.
A series of small shaking
After the patient’s immediate call to Keung, her daughter referred her to the emergency department at Yale New Haven Hospital, and she was admitted to the stage-unit. This is for patients who are not ill enough to require an ICU, but may reach that point before long. Every few hours a technician came to measure the strength of his breath. If it gets too low, it will have to go into the ICU and probably end up on a breathing machine.
Keung was not sure whether the patient had myasthenia. His eyelid was always crooked, his vision was always doubled. With MG, he would expect those symptoms to worsen after using the muscle and improve after resting. And MGs usually affect the muscles closest to the body. He would expect his shoulders to be weak, not his hands. Despite his uncertainty, he decided to start treatment for MG. He did not want to take the risk so that he would be weakened. He was given high-dose steroids and intravenous immunoglobulins to suppress parts of the immune system that attacked the connection between his veins and his muscles.
The next day Kayung performed a test, which showed whether the patient was MG. In a repeat nerve-stimulation test, a small electrode is placed above the muscle, in this case the abductor digiti minimi, the muscle that moves the pinky finger. A series of small (and uncomfortable) tremors are delivered in a rapid sequence, contracting each muscle. In someone with normal nerves and muscles, each identical jerk will produce a similar muscle contraction. In this patient, however, the first shock caused weak contractions and then they weakened further. It is characteristic of the drop-off MG that the blood test that Chen was urging to be done at the hospital. It was positive. He had myasthenia gravis.