January 22, 2007
Mosquitoes no small threat
By Susan Christensen
Health and Research News Service
FLOWOOD, Miss.—After winter’s first freeze, most people quit worrying about mosquitoes bearing West Nile virus. Not Melanie Smith. “I see something flying around and I freak out,” says the 42-year-old Jackson resident.
Smith has just cause to be jittery. West Nile virus put her in a wheelchair. “See what a mosquito can do,” she says, as therapists at Methodist Outpatient Rehabilitation in Flowood help her struggle to her feet. “You can go to bed fine, then wake up and you can’t walk.”
The Mississippi State Department of Health reported 183 human cases of West Nile virus in 2006, and Smith was almost among the year’s record 14 deaths.
“Melanie was very ill,” said her mother Carole Moore of Byram. “They said we almost lost her. You can’t imagine how hard she has worked to get this far.”
Smith’s troubles started in late July when she came down with a bad backache, a high fever and “legs that felt like concrete.” A doctor at a local clinic thought she had a severe kidney infection. But when a sudden paralysis put her in the hospital, physicians there immediately suspected West Nile virus poliomyelitis.
Credit for the quick diagnosis is partly due to the work of researchers at Methodist Rehab’s Center for Neuroscience and Neurological Recovery. In 2002, Dr. Art Leis and Dr. Dobrivoje Stokic, both of Madison, were the first to report that West Nile virus can attack the motor cells of the spinal cord, causing fatigue, muscle weakness and a polio-like paralysis. In the years since, the Methodist Rehab neurologists have become sought-after experts on the disease, drawing patients from as far away as Oregon and Pennsylvania.
Smith arrived at Methodist Rehab in August, and one of the first orders of business was a nerve conduction study in Dr. Leis’ electromyography (EMG) lab. “It’s an important diagnostic tool because it gives you an accurate estimate of the number of motor neuron cells destroyed by the virus,” Dr. Leis said.
Found in the gray matter of the spinal cord, motor neuron cells communicate brain signals to the muscles via a network of nerve fibers. When illness or injury destroys these cells, it’s as if the fibers are plugged into a dead phone jack. The brain can no longer “talk” to the muscles. “As a consequence of this loss, muscles literally waste away and eventually disappear,” Dr. Leis said.
Dr. Leis said early physical therapy may mitigate these disabling effects by sparking new nerve fiber growth and strengthening muscles adjacent to those weakened by poliomyelitis. Therapy also can help prevent complications associated with paralysis – such as blood clots and bone deterioration.
After her bout with the virus, Smith could barely move her arms and her legs were useless. Yet there was reason to be optimistic. The electromyography revealed viable nerve connections in her limbs. “That was the first time I had hope,” she said.
When she first began therapy, Smith couldn’t even roll over in bed without help – a disturbing state of affairs for someone who had always prized her autonomy. “I was so independent I didn’t even get married until I was 39,” said the office manager for Higginbotham Mercedes in Jackson. “I never imagined I would be 42 years old and happy to take a step.”
Methodist Rehab physical therapist Rhonda Fetcko of Flowood said Smith’s therapy is designed to improve her strength, balance, coordination and endurance.
“Her quads aren’t quite able to support her body weight yet,” Fetcko said. But with the help of some specially designed leg braces and a rolling walker, Smith manages several laps around the therapy gym.
“Melanie’s primary goal is to walk, so we do a lot of gait training with the help of Andre’ Hardy of Brandon, our physical therapy technician,” Fetcko said. “Initially, it took four people to help Melanie stand in the parallel bars. Now she can walk using her braces and rolling walker with only one person assisting her.”
Smith says her faith in God and the support of family, friends and the staff at Methodist Rehab have helped her stay hopeful about her chances of walking again. “I try very hard not to have a pity party,” she said. “This is going to take time and I know it’s going to take patience – but I wanted it yesterday.
“It’s the little things I miss most – like being able to stand up and unload the dishwasher or to take my dogs outside without assistance. I have to have someone with me all the time.”
Smith said she was encouraged by a visit from a West Nile virus survivor who shared tales of his recovery. And she hopes to some day encourage others who fall victim to the debilitating disease. Meanwhile, she and her mom will both be sounding the alarm about the harm West Nile virus can do.
“People need to take it seriously and take precautions,” Moore said. “Unless you’ve seen it, you can’t imagine the havoc West Nile virus wreaks. It changes lives.”