Hole in his neck

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Hole in his neck  

Mr Tamang, 35 yr old hailing from sindhupalchowk was in a good shape of health till he found his legs shaky. He had a good physique and had immense strength in his limbs. He never had any hospital visits in his life. His family was a sweet  family with a wife and two children living happily together. 

To his greatest surprise of his life, he suddenly couldn't feel his feet standing on the ground. He had some unusual tingling sensation in his legs. He barely could stand up on his own and had his feet dragging on the floor. This was a huge shock for him and his family. 

The problem didn't seem to stop progressing. The weakness of his legs became more prominent and gradually ascended up to involve his upper limbs as well. On next day,  he was taken to a hospital. The rapidity of symptoms was an alarming sign for treating doctor. He couldn't scratch his nose when it had an itch. He couldn't catch a glass for drinking water. It seemed as if walking was just a dream.  What was the cause behind this nuisance in his life ? 

 The prayers didn't work and deterioration wouldn't stop for anyone. He couldn't count up to 20 in a single breath. He was far too weak to elevate his head. He lost his beautiful smile that would spread on his lips and the corners of eyes.  His face lost his cheerfulness and was a constant expressionless face unless he tried smiling. 

The doctor found that the weakness of his limbs was preceded by a few loose bowel motions a few weeks earlier. He didn't remember eating any street foods that would upset his bowels. He had low oxygen levels in his blood as shown by the the probe. He was putting on extra effort for the breathing. His sternocleidomastoid muscles were struggling hard to make him comfortable. However, he could comprehend well with people. Seeing the desperate scenario, the doctor decided to put endotracheal  tube in his trachea so that his respiratory muscles would rest and  the organs wouldn't cry for oxygen. What would be the next deciding step ? 

His scenario would mandate an expensive treatment. It would cost no less than 5 lakhs. The medicine, immunoglobulin was only hope at the time. His family arranged cash in very short time and the treatment begun. However, doctors could notice mild improvement which wouldn't be improvement at all for him and his family. The immunoglobulin might take months to show recovery. There was just a hope that would keep him alive. 

He stayed in the hospital beds for 7  months He had wasting in his limbs and face. He had a metallic tube on his neck that would eject secretions. His wife spent these months clearing the secretions, feeding him, and moving his limbs. He couldn't even drive away the fly that sat on his nose. Sometimes his belly had such an irritating itch that he couldn't wake his wife for easing the itch. Can you imagine his plight ? In addition, he had an opening on his neck for the ease of breathing and coughing out the sputum. 

 He would sometimes  be very desperate that he wished an instant death. Sometimes he would try desperately to move his limbs. He would dream his body walking out of hospital bed, and wander in his hometown. When he was awake, he would be at the same place in a bed with heavy legs and hands. His body probably  witnessed all antibiotics to fight against infection in his chest. He felt he was like a living  corpse with wandering soul. He lived with hope of walking again. He hoped that he needn't depend on others for living a day. Was it a false hope ? 

Fortunately, he could move his limbs slightly after 6 months. He moved his arms  earlier than the fingers, thighs earlier than feet. Though he couldn't grasp an object, he could ask with whispering voice closing the tracheostomy opening by his hand.  He could communicate appreciably resonating voice by occluding the hole in his neck. The thickest secretions would often plug the opening and suffocate him for air. With a hole in his neck and tube in his stomach, he constantly strived for standing up again.His neurons got defeated with his will power. It felt as if the nerves were awake from hibernation. Its a general fact that neuronal networks recover slow and brain is plastic enough to take over the lost action of the affected area. Though he had altered perception of sensations , doctor didn't find any objective sensory deficit. He could feel hot and cold, pain and touch. He could urinate well in a container. 

Mr Tamang had normal brain imaging and his organs were functioning quite good. The problem was on the nerves that innervated his limbs and his pharynx. The spinal fluid examination showed no infections. Though the defense cells, white blood didn't home his cerebrospinal fluid, the protein was elevated. After 14 months , he visited OPD and surprised the doctors. He was able to walk on a crutch. Now,he can scratch an itch himself and drive away the fly. What was the disease that put his life into an ordeal ? 

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