Editor's note: This story was originally published in Health Care Quarterly, a magazine about Southern Nevada's health care industry. Stories in Health Care Quarterly were submitted by doctors and their affiliates.
Diagnosis: Myasthenia Gravis
Patient of: Pam Hetterscheidt, R.N. manager; Paula Lane, R.N. treatment center supervisor, Southwest Medical Associates
Joseph Mosier’s symptoms had progressed to a crisis level. He saw his neurologist on Dec. 26, with symptoms that included the inability to swallow or speak and trouble breathing, all typical symptoms of myesthenia gravis.
Myasthenia gravis is characterized by weakness and rapid fatigue of any of the muscles under voluntary control and is caused by a breakdown in the normal communication between nerves and muscles. There is no cure, but treatment can help relieve signs and symptoms such as weakness of arm or leg muscles, double vision, drooping eyelids and difficulties with speech, chewing, swallowing and breathing.
It had been weeks since Mosier had eaten solid food and he could only occasionally take a sip of water. When he did, it resulted in a blocking of his windpipe and an inability to take a breath for approximately 30 to 45 seconds at a time. He was in a danger zone.
His neurologist arranged for intravenous immunoglobulin treatments to begin on Dec. 31. IVIG is a blood product and a typical treatment for myasthenia gravis. His symptoms progressed over the weekend to a point that he called for an ambulance on that same Sunday night and was transported to an area hospital. There was no neurologist on staff there and the ER staff did not seem familiar with myasthenia gravis. The ER doctor said there was no medical reason to admit him and sent him home. Mosier held out until his scheduled IVIG treatment at the Southwest Medical Rancho Urgent Care health center that week.
That is when Southwest Medical registered nurses Pam Hetterscheidt and Paula Lane encountered Mosier and his daughter Kathy Hamilton. “We recognized the seriousness of his crisis level symptoms,” said Lane.
“Since Joseph was now in a weakened and incoherent state due to his symptoms, I spoke with Kathy by phone,” said Hetterscheidt. “I explained the seriousness of her father’s condition and advised her to take him to the ER immediately after his IVIG treatment. I also insisted that a feeding tube be used, as Joseph had been unable to take nourishment in quite some time.”
“She guided me with some key phrases to use and particular points to make about his condition and what we should expect,” said Hamilton. “She obviously knew more about myasthenia gravis than any other medical professional we had dealt with so far. Everything she told me was spot on!”
Hamilton followed Hetterscheidt’s advice and got him to another area hospital with a staff neurologist who was familiar with his condition and admitted him right away.
Less than 24 hours after being admitted, his symptoms exploded and he began to suffer respiratory arrest. The hospital’s medical emergency response team transferred him to the intensive care unit where he was intubated and remained sedated and unconscious for seven days, but received proper treatment, including a feeding tube, hydration, and completion of additional finishing the IVIG as well as plasmapheresis. Plasmapheresis is a process in which the liquid in the blood, or plasma, is separated from the cells. In sick people, plasma can contain antibodies that attack the immune system.
Mosier remained in the hospital for another 9 days before being transferred to an area rehabilitation center.
“From the very first day that he got his treatment at the Rancho health center and throughout his stay in the hospital, Pam kept in contact with me to ask about my dad,” said Hamilton. “She comforted me when I was scared that he was going to die, and celebrated with me when he was extubated and began speak and swallow again! I am 100 percent certain that without the astute observation, knowledge and caring nature of Pam and her staff, my dad would have died at home from respiratory arrest rather than being in the hospital environment where they could save his life.
“I cannot express enough praise and gratitude for the quick thinking and willingness to take action on Pam’s part. My father’s life was saved because of it.”
Pam Hetterscheidt and Paula Lane work at Southwest Medical Associates, one of Nevada’s largest multi-specialty medical groups.