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Wednesday, April 23, 2014
Rehabing after surgery when one has MG
My 72 yo mom who was dx with MG at 16yo, (on mestinon since then), recently had a triple bypass followed by surgery to correct a "leaking graft" 24 hrs later. She had to be reintubated 3 times because of difficulty weaning of the vent. and after 1 1/2 to 2 weeks was trached. The trach was removed in the rehab. hospital, but she has been there for almost 2 weeks with very little improvement. She is SOB and so week she can barely transfer from bed to chair, with assist. I`m not sure what else, if anything, we should be looking for. She is on her usual dose of mestinon - 30mg/day. Other PMH = HTN, hypothyroid, NIDDM ( X 3 years), gastric ulcers, High cholesterol/trig.
Could this failure to rehab. be connected to her MG?
First, you need to establish what is happening with her to make her so weak. Myasthenic flare with crisis is very possible a cause for inability to wean off the vent and to be this weak. But there can be other things that happen in the hospital. Critical illness neuropathy and myopathy, Guillain-Barre syndrome, diaphragmatic paralysis with severe deconditioning because of a prolonged hospitalization, etc. I would suggest having a neurologist evaluate her, especially one who works with neuromuscular diseases primarily. They can determine what pattern of weakness she has and what co-localizing features have occurred, and then can direct the investigation of what is causing the weakness, whether it is MG or another process. As a side note, Mestinon 30 mg once per day is a very low dose and would suggest that her myasthenia was probably well controlled before surgery. If her myasthenia has flared, she will need a neuromuscular doctor to help in her management. I hope this helps.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati