In May 2021, Heather was admitted to Unity Health at the St. Joseph’s Health Centre site (SJHC) suffering from pneumonia and empyema, a bacterial infection of the lungs characterized by the collection of pus in the cavity between the lungs and the membrane that surrounds them. Her empyema was treated by video-assisted thoracoscopic surgery (VATS). Shortly after her VATS procedure, Heather, who was recovering at home, began to experience an uncomfortable tingling in her fingertips. The tingling sensation spread to her arms and then her toes. Her legs became extremely weak, and she was having a difficult time walking. Heather’s condition continued to worsen, and one night her husband heard a loud bang and discovered Heather stumbling about. He immediately took her to the emergency department at SJHC.
Heather was immediately triaged in the emergency department. “Over the next few hours,” Heather recalls, “my situation worsened, and I was quickly becoming paralyzed throughout my whole body.” After an examination and blood work, the health care team at SJHC provisionally diagnosed her as suffering from Guillain Barre’ syndrome (GBS), a rare autoimmune disorder in which the body’s immune system attacks the nerves. Weakness and tingling in the extremities are usually the first symptoms. These sensations typically spread quickly. The eventual result is complete paralysis. The exact cause of GBS is unknown, but patients have reported that symptoms occur approximately six weeks preceding a respiratory or gastrointestinal infection.
After further examinations, Heather was intubated, ventilated, and heavily sedated. She was then admitted into the ICU, where she underwent a tracheostomy. Her condition deteriorated quickly, and her symptoms, including significant paralysis, became more acute.
The SJHC health care team continually monitored her condition and over the next few weeks. Heather’s recovery was slow, but she began to show improvement. Although the health care team were able to gradually wean her off the ventilator during the day, Heather continued to require full ventilation at night. Given Heather’s protracted recovery, the ICU health care team at SJHC determined that even while she was using the ventilator, she should begin rehabilitation to regain her strength and movement.
ICU patients typically need a considerable amount of time to recover from their illnesses. During that time, they can benefit from treatment in a setting that offers continued acute-level care treatment paired with low-tolerance, long-duration rehabilitation (LTLD). For Heather to recover completely, providing her with a continuum of care was of paramount importance. To ensure this, the health care team at SJHC recommended that she be transitioned to the Salvation Army Toronto Grace Health Centre (TGHC) for treatment in its RECOVER program. There, Heather could receive both acute-level care as well as rehabilitation.
The RECOVER program, designed for the treatment of patients with chronic critical illness provides care to a diverse population with respiratory and general complex health needs. RECOVER, like the TGHC’s Complex Continuing Care and Post Acute Care Rehabilitation programs, ensures optimal continuum of care for post-ICU patients in an appropriate inpatient setting, providing them with rehabilitation.
Heather was admitted to the TGHC’s RECOVER program in late July 2021. When she arrived, she was assessed by the TGHC’s interprofessional health care team to determine if any adjustments to her plan of care were required. It was decided that it was still necessary for Heather to be on a ventilator. The plan was that over the next several months she would be weaned off the ventilator, have her tracheostomy tube removed, and receive slow paced LTLD rehabilitation. It was also decided that Heather would work with a speech-language pathologist who would help her to re-establish clear speech and regain her ability to properly swallow.
In mid-October 2021, Heather’s feed tube was removed, and she was on a regular diet of solid foods. She was working hard with her rehabilitation team. “I was turning in bed and sitting up,” says Heather, “and with the assistance of a high walker and my rehab team, I was able to help myself up to a standing position.” Heather felt that her strength was slowly returning, but she adds, “My left arm was not as strong as my right arm; I thought that with more rehab it would become just has strong.”
By late October 2021, Heather had made excellent progress and was no longer benefitting from the TGHC’s LTLD program. She required more intensive, short-term therapy to advance her level of functioning and mobility. In early December 2021, she was placed in the TGHC’s Post Acute Care Rehabilitation (PACR) program. This program provides patients with high-tolerance, short-duration rehabilitation.
Heather continued to work with her original rehabilitation team. Her physiotherapist (PT) worked with Heather on mobility, focusing on walking and stair climbing. Assisted by her PT, she became able to walk with a two-wheel walker and perform several laps through the hospital hallways. She also progressed to stair climbing in the rehabilitation room. Heather’s occupational therapist (OT) continued to help Heather with self-care practices and activities of daily living. With adaptive utensils, Heather was able to feed herself, and with little assistance, she could toilet independently. Heather’s upper-arm strength and range of motion was still limited, but her OT kept working with Heather on these issues so that she would be able to dress herself before she returned home.
Heather’s goal was to return home by late January 2022. She believed that with a little more rehabilitation she would be independent enough to reach that goal.
Heather is eligible to receive care at home through the TGHC’s remote care program. The program draws on technological advancements to extend the ability of caregivers to remotely monitor patients and deliver home care to them. The program, designed to provide in-home support and care, offers an alternative to admission to an in-hospital setting for eligible patients, such as those requiring acute care, complex continuing care, and rehabilitative care. This program, part of the TGHC’s commitment to providing optimal continuum of care, assists patients in transitioning seamlessly back home and helps eliminate another health care gap.
Heather said, “The care I received at the TGHC was fantastic and the health care team was very supportive in helping me achieve my goal of getting better and regaining my independence.” She was told by the health care staff that about 60 percent of patients with an illness like GBS attain full recovery of motor strength within a year but that she had progressed a lot quicker than that. Heather believes that in part her stubbornness and determination to get better have both helped her to gain back her independence.
When Heather became ill, she had been retired for two years and enjoyed riding her horse. In her hospital room, she had placed pictures of both her horse and dog, both of which she had come to miss very much through her recovery. With the support of the TGHC’ s health care team and Heather determination she achieved her goal of returning home. Heather was discharged on January 21, 2022 and is looking forward to do the things she enjoyed the most.
By Gerry Condotta