September 2, 2003
Virginia's first West Nile virus victim of the year seeks treatment in Mississippi
By Susan Christensen
Health and Research News Service
JACKSON, Miss.—As a fourth generation farmer, Ned Jeter of Virginia figured he knew all the risks of his profession. “I thought I might get hurt on some type of machinery or a bull might run over me,” he said.
He never imagined a little mosquito might do him in, until a debilitating case of West Nile virus infection left him unable to stand on his own two feet. “I never thought something as small as a mosquito would do this much harm,” he said.
Jeter is Virginia’s first West Nile Virus victim of 2003, and since Aug. 21 he has been working hard to learn to walk again at Methodist Rehabilitation Center in Jackson.
Why Jeter traveled some 800 miles to a Mississippi hospital for treatment says a lot about his family’s determination to find an expert on the link between West Nile virus and paralysis.
Jeter said as his brother-in-law and niece called big-name hospitals and scoured the Internet for information, one name kept popping up—Dr. Art Leis, a neurologist and senior scientist at the Center for Neuroscience and Neurological Recovery (CNNR) at Methodist Rehab.
Leis and a team of researchers at Methodist were the first in the world to report that the West Nile virus can attack the spinal cord, causing paralysis, muscle weakness and fatigue, and the first to confirm that observation through autopsy findings. This July, they received an $82,000 federal grant to do follow-up studies on patients with West Nile virus infection.
“My brother-in-law B. Painter talked to people at Johns Hopkins, Duke University Medical Center, the Mayo Clinic and the Cleveland Clinic, and it seemed like Dr. Art Leis was the man to see,” Jeter said.
“This paralysis is like a modern-day polio and the lack of information about it is unbelievable,” Painter said. “When we learned that Dr. Leis is a pivotal player in the national scope of things, we wanted to take advantage of his experience and the ongoing flow of information that will pass through here because of his high profile.”
Leis said the center has evaluated about 50 cases of West Nile virus infection, and that clinical experience naturally translates to better patient care. “One of the prerequisites for expertise is you have to have a passion for the clinical research and the treatment of the condition. And we’ve organized a team that has a passion for treating patients with West Nile virus infection.”
Leis said patients also benefit from having access to a physician who has experience treating patients with polio symptoms. “There are very few physicians still practicing who treated acute polio virus infection,” explained Leis. “But Dr. Michael Winkelmann, one of our rehabilitation medicine physicians, has extensive experience with patients who have residual effects from having had polio in the 40s and the 50s.”
Jeter believes his problems began on July 12, the day he stepped onto his deck wearing shorts and no T-shirt and wound up with several mosquito bites. In the next two weeks, he came down with flu-like symptoms that only seemed to get worse.
“I was real weak. I had diarrhea and was throwing up and in a lot of pain. I called my fiance to take me to the doctor. I knew I had something.”
Trouble was, no one seem to know what that something was. “Early Saturday morning, July 26, I went to the emergency room. They did an EKG, gave me some pain medication and sent me home. That weekend I thought I was going to die. The pain was terrible. I waited until Monday and went to my family practitioner and she admitted me to the hospital. They ran a lot of tests and drew blood two different times. Then my legs started hurting and went numb.”
Jeter said his doctors finally decided he had Guillan-Barre syndrome, a peripheral nerve condition that also can cause paralysis. They stuck with the diagnosis even after health department tests revealed Jeter had West Nile virus.
“Mr. Jeter’s hospital course illustrates that there is still a lot of clinical confusion regarding the manifestations of West Nile virus infection,” Leis said.
To definitively diagnose West Nile virus infection in patients who exhibit polio-like symptoms, Leis said he performs a battery of comprehensive electro-diagnostic tests. “He worked with me four or five hours,” Jeter said. “I’ve never seen a doctor spend as much time with me as he did. He really does a thorough check.”
Leis said the workup evaluates a patient’s muscles, peripheral nerves and spinal cord function to ensure there are no alternative causes for the paralysis or muscle weakness. “That’s important because once we know the spinal cord has been a target of the virus, we can avoid unnecessary and inappropriate treatments which can be associated with bad side effects and even death,” he said.
Leis said Jeter’s examination turned up some good news. “Our studies indicate there are some preserved connections from his spinal cord to the skeletal muscles in each of his limbs. That means he has a more favorable prognosis than a lot of the patients that had polio-like presentations a year ago. Some of those patients are still paralyzed.”
To regain function in his legs, Jeter has been working three hours a day with Methodist Rehab physical and occupational therapists. While Jeters’ peripheral nerves are healing, the therapists are using electro-stimulation to motivate his muscles.
“The electrodes stimulate the muscles just like nerves do,” said Lisa Barnes, therapy manager for Methodist’s spinal cord injury program. “We’re targeting specific muscle groups combined with functional activities to increase his strength and mobility. He is also undergoing gait re-training.”
Jeter has been giving it his all in therapy because he’s eager to get back home. Besides the usual demands of running a 500-acre farm, he has some other unfinished business. “I was supposed to get married on Sept. 13,” he said.
Those plans are on hold until he recovers, but Jeter has hopes he’ll soon be walking down the aisle on his own power.
Jeter said he has been told to think of his recovery in terms of months not weeks, but he’s already encouraged by the progress he has made. “Our experience here at Methodist has been everything we hoped it would be,” he said. “I’m very thankful that family found out about Dr. Leis.”
Physical therapist Cathy Henderson assists West Nile virus patient Ned Jeter as he walks.
Jeter is Virginia's first West Nile Virus victim of 2003, and since Aug. 21 he has been working hard to learn to walk again at Methodist Rehabilitation Center.