MY MAIDEN ENCOUNTER WITH A FATAL NEUROPATHY.

A country toddy tapper from Kottayam never felt any physical or mental unfitness in the morning of a day of September 1987, when he started climbing the tall coconut tree to do his morning tapping process to extract coconut toddy. He started his process of collecting the yielded toddy in to his container and the series of pressure massage manipulation of the spike of the coconut and final cutting of the fag end of the spike for the next yield.

The whole process was for twenty minutes. The last part of the process with his broad knife was unable to be completed by him as his wrist and fingers lost power. He sat there between two stalk of palm leaves as he was slowly losing power in his hands, trunk, and lower limbs. He shouted for help for one hour but nobody heard his call for help as it was a desolate area. His hand grip became weak and fell down, fortunately, with his trunk between two strong stalks of palm leaves, head and legs hanging down, and so did not drop to the ground below. You can imagine the result of a drop from forty feet height.

One good samaritan came that way and saw him hanging from the coconut tree. He gathered people and the toddy tapper was brought down in a big basket tied with long ropes. He was immediately taken to the neurologist in Kottayam medical college. The expert neurologist could immediately diagnose it as GUILLAIN BARE SYNDROME, despite GBS was not a popularly known disease at that time. He said that he was unable to manage in that condition as there was no ventilator anywhere. He advised to rush up to Sree Chitra medical center, the only place he could be managed in that condition. It was not less than three and a half hours journey from Kottayam to Trivandrum. They started immediately and after two and a half hours, when they reached Kollam, he started gasping as his diaphragm, the major respiratory muscle, was getting paralysed. They took him to the nearest Holy cross hospital where he was put in oxygen, which was difficult for him to inhale, still continued the journey to Sree Chitra medical center, where there were sixteen ventilators, all connected to sick patients. As prior information was given to the hospital, they removed one ventilator from a somewhat better patient, put him in an oxygen Ambu bag, and kept one machine ready for toddy tapper, whose oxygen saturation was 60 percent when he was connected to a life-saving machine. He had lost his capacity to inhale oxygen taken from the Holy cross and was about to die before reaching Sree Chitra. God extended his date of expiry. He was survived by pushing oxygen mixed air to his lungs by the machine as per requirement, acertained by computer. His blood oxygen control was transferred to the machine, which exposed all values on the monitor. Forty-five years ago, Sree Chitra medical center was the only hospital in Kerala, which could manage Peripheral neuropathies like GBS, CIDP, etc. in that condition. Certainly, now many hospitals are super specialty hospitals with sufficient ventilators and can tackle any serious health problems. The present pandemic situation has equipped India with innumerable ventilators in hospitals.

The toddy tapper underwent tracheostomy(surgically making a hole in the throat to intubate by ventilator) and was on the ventilator for five months, meanwhile, plasma exchange treatment was given. The progressing disease was arrested. He was totally paralysed, but was able to breathe freely as his diaphragm could pick up strength.

Now the next herculean task was rehabilitation, mainly by physiotherapy. I took the responsibility of that, although I was with him in ICU all throughout five months for respiratory therapy and preservation of his joint range. He underwent physiotherapy for nine months staying in a Christian charity care center in Trivandrum and started independent walking. He went to Kottayam and came for review after six months. He was perfectly normal in strength so that he climbed all steps of one floor to come and see me in my department on the first floor for thanksgiving. I blissfully asked him, " Gopalan, Have you started your traditional toddy tapping job ? ". He said, " Oh No, I tried, but my legs started shivering when I touched coconut trees and looked up. I was fully conscious when I was hanging from the coconut tree and that scene dreadfully reflects in my mind and make me feeble ". In fact, he had no physical lack of power, but the fear psychosis made him abandon his traditional job. Then I asked him, "How do you live with your family"? He replied, "I started a lottery ticket business, which is ok for my livelihood".

I did not encourage him for his traditional job, although he was physically fit as he adapted himself to a different safe occupation. Our motto of rehabilitation is to attain the fullest possible functional ability. He was in contact with me for some years. I advised him to slowly be in touch with your traditional job within the protection of his group of workers, who are a strong group in Kerala. At some point of time, the lottery business declined in Kerala and the poor man was in trouble. He tried his traditional job, which he brushed up with his fellow workers and slowly he became independent. Necessity is the mother of invention. He did again his traditional job successfully for thirty years.

Thank you