West Nile Virus, The Sting Lingers…

by Stanley Rosen, DDS

It is so very difficult to convey to you, to commit to words, my thoughts, my concerns and my hopes. How can a relatively fit, very active, outdoors-type person, a sports junkie, “wannabe” golfer suddenly have his whole world shattered-by a mosquito?

Friday, September 6, 2002 for me began with a 7:30 a.m. appointment for my general physical examination. While undressing for the examination, my physician and I noticed an extensive but asymptomatic rash on my legs. We assumed that it was innocuous.

After leaving my GPs office, I went to play golf-not well and customarily. I was walking and carrying my clubs. I felt a little weak and lethargic but I attributed these symptoms to my lousy golf. I walked off the course after ten holes.

That evening while undressing for bed, my wife and I noticed that the rash now covered my entire torso and limbs, however, still no symptoms. Saturday and Sunday, I seemed to be somewhat lacking in energy.

Following a full day of work on Monday I returned home. After dinner I began to experience a nasty headache and my head felt very hot. I normally don’t have headaches. I decided to retire (go to bed) early, which was very unusual for me.

Tuesday, September 7, 2002 (my 9/11) I arose as usual and prepared to go to my office. As I was about to leave, my wife asked where I was going and I replied to my office–especially since I had a patient from out of town scheduled for surgery. Mavis advised me that I was very unsteady and seemed to be swaying, etc. She would not allow me to drive and instead wanted me to call my MD. I insisted that these symptoms would soon pass and I had to get to my office. Mavis countered that with–if I insisted on going to the office, we would go by bus and she would accompany me. Done! When we arrived at my office, my staff agreed with Mavis that I was unwell and asked my colleague Lloyd to come down the hall to see me. He insisted that Mavis and I take a taxi to my MD’s office.

Following Bernie’s examination and a phone call, I was dispatched to the Emergency department at Toronto General. Following my admission to hospital, my condition began to deteriorate very rapidly. My temperature became very elevated. I was placed on IV antibiotics and fluids until some days later it was determined that the etiology was viral, not bacterial. I was semi-conscious and hallucinating. I became paralyzed i.e. arms, legs and lower torso, however, I was able to breathe and did not require a ventilator.

After several MRIs, two lumbar punctures and countless blood studies, I was diagnosed with viral encephalitis and a traverse myelitis. I was unable to leave my bed and hospital room until three weeks after admission when my wife, Mavis, took me downstairs in a wheelchair to an outdoor patio. That was a very emotional moment. The impact was enormous. How important it seemed to be able to be outdoors again. I suddenly realized how close I had come to not making it.

Waves of doubt passed over me. Would I ever be able to walk again? To feed myself? To dress myself? Would I ever be able to work again? And many more unanswered questions. Moreover, I still didn’t know the etiology of my problems. In fact, it wasn’t until ten weeks past my admission to hospital that West Nile Virus (WNV) antibodies were confirmed. Finally, after six weeks of acute care followed by six weeks of in-patient rehab at T.R.I., I was discharged. I was able to ambulate with a rolator (walker).

In January 2003, I began receiving outpatient physiotherapy at T.R.I. (Rumsey) and I learned to walk with the use of walking sticks.

About five months after I became infected, I returned to work– very slowly at first and I have gradually increased my workload to three days per week, about twenty-one hours per week. I am still severely handicapped in my mobility, ambulating very slowly and somewhat unsteadily for short distances. I cling to the hope that with physiotherapy, hard work and exercise, my mobility will improve. It is however, proving to be a very slow process and very discouraging and frustrating not to improve faster.

I am very thankful that I have my profession. Knowing that I am still able to provide a useful service for my patients has displaced doubt and self-pity. I have been very fortunate as well, to have the love and support of my wife and family, my dedicated staff and so many wonderful patients and colleagues in my effort to overcome this infection.

In summary, I must say that I am very angry at times–who or what to blame. I certainly was not aware of the possible impact of WNV infection until it was too late. I doubt that many, if anyone in our province took protective measures until after the outbreak on WNV infection in 2002. Virtually everyone I have met since I became disabled has been shocked and totally unaware of the harm that can be inflicted by this virus.

The impact here can be devastating. The WNV is far less potent in Europe and Africa than in North America, probably because it has been there for a longer period and people have greater immunity. Shouldn’t the government have embarked on a preventative program preemptively? They knew this infection would reach us after the initial outbreak in 1999 in New York State.

Mosquito season approaches. Take precautions, take care and don’t forget the DEET!