Flu vaccination suspected in emergency director's illness
By TIM UNRUH
The Salina Journal
Posted at 10:29 AM on Sunday, January 19, 2003
Gail Aills is walking with a cane these days and reminiscing about a holiday season he'd have rather skipped.
Excruciating leg and hip pain marked the end of 2002 for the director of Saline County Emergency Management. Neurologist Trent Davis diagnosed it as Guillian-Barre Syndrome, which may have have been a reaction to the flu vaccination Aills received Nov. 15.
"You want to cry and scream and yell," said Aills, 62, describing the agony that invaded his lower body. "I thought I had a pretty high threshold of pain. That, I couldn't handle."
He spent 23 days in Salina Regional Health Center and is faced with a long recovery, including physical therapy, and isn't expected to return to work until sometime next month. Until then, Bryan Armstrong, deputy director, is running Saline County Emergency Management.
"I'll never top him with childbirth again," quipped Jo Ann Aills, his wife, referring to the pain.
A former Salina firefighter who has headed Emergency Management since 1990, Aills said he received a flu shot when it was offered to all city and county employees at the Saline County Health Clinic, 125 W. Elm. He's been vaccinated every year for two decades.
Aills came down with a cold afterward and jokingly blamed it on the vaccination. It lasted a couple of days. But on Dec. 2, he started experiencing discomfort after a Thanksgiving trip to Enid, Okla.
"I'd had a little pain in my hip and attributed it to the long ride," he said.
But it became worse Dec. 2 and continued when he went to work in the basement of the Law Enforcement Center. A heating pad provided some relief, but it persisted, so he left work at noon, thinking he might find a comfortable sitting position in a recliner at home.
Next he moved to lying on his back in a sort of fetal position on the living room floor.
"It was hurting bad enough that we called the doctor, which is enough to know," Jo Ann Aills said. "He never calls the doctor."
Their family physician, Dr. Mark Krehbiel, prescribed muscle relaxers, but they weren't adequate. Aills still was sleeping on the floor and groaning. He attended the Saline County Commission meeting Dec. 3 to deliver the monthly Emergency Management report and then returned home.
"That's when we started real serious pain," Jo Ann Aills said.
It continued Dec. 4, spreading from Aills' left hip down his leg and to his toes. At 10 that night, they headed to the emergency room at Salina Regional. He asked for an ambulance, but eventually opted to try the back seat of their family car.
Once at the hospital, however, Jo Ann, requested a gurney.
"There was no way he could get out of the car and stand," she said.
Addressing the pain
In the hospital, Aills was put on morphine, but the powerful drug had no effect on him.
"I told them to find something else for pain relief," Gail Aills said.
Davis kept him on morphine, but he also prescribed three anti-seizure medications, which he said have proved to decrease nerve injury pain.
"I'm sure it was a miserable month for him," Davis said.
After a full round of tests, including two painful spinal taps, Aills was diagnosed with Guillian-Barre Syndrome.
Davis started Aills on two treatments, first an intravenous infusion of gamma globulin, or antibodies that are pooled from thousands of blood donors.
"We hope these will attack the antibodies in his system which are attacking his nerves," the neurologist said.
But that didn't work for Aills, so Davis tried plasma pheresis -- commonly known as blood cleansing or plasma exchange -- on a device similar to a kidney dialysis machine.
"It's filtering of the blood where the protein and fluid in the blood are drawn off and discarded, leaving only red cells," he said. Other fluid and blood protein are added.
"That worked," Davis said.
Aills received six treatments -- lasting three hours each -- during 12 days.
Not rare, but not common
Guillian-Barre Syndrome is not exactly rare, occurring in one in 100,000 people, the neurologist said, and a flu shot reaction is one cause.
"As diseases go, it's nowhere near as common as stroke or (multiple sclerosis)," he said, "but we see cases of it every year."
Guillian-Barre usually surfaces during the viral seasons in the spring and fall, he said. Symptoms include varying combinations of muscle weakness and numbness, tingling, and/or pain.
"It tends to progress from nothing to full strength over a few days to a week," Davis said.
Weakness can be severe enough to hinder respiration and swallowing, he said.
"Sometimes people have to be on a ventilator for awhile," Davis said. "It's rarely fatal. In fact, excellent recovery is more the rule than the exception, but it may take anywhere from a few weeks to 18 months."
Aills' symptoms included numbness and sharp burning pain.
"We were afraid it would creep up into my vital organs," Aills said, but it didn't.
He developed a staph infection from the blood cleansing and spent Christmas in the hospital. With low blood pressure and a 103.2-degree fever, it set Aills' recovery back three days. Also a Type II diabetic, his blood sugar levels shot up from the various drugs he was taking.
The couple celebrated Christmas on the following Saturday with their four children, eight grandchildren and two stepgrandchildren.
Aills left the hospital Dec. 27 and began physical therapy about 10 days ago at Salina Regional to regain leg strength, knowing he faces weeks to months of recovery.
"This week has been a little bit rough," Jo Ann Aills said, so her husband has taken a break from therapy. "He has to get a little better before he tries it again."
Aills' physical strength has diminished, cutting short daily walks that are essential in controlling diabetes.
"My left leg is still so weak," Aills said, adding that he's fallen several times. "Taking a shower can be exhausting."
No reason not to get flu shot
While Aills won't likely take another flu shot, Davis said the yearly inoculations are worth the risk, even for other members of the Aills family.
"It was just a particular sensitivity he has to the shots," Davis said, pointing to 1977 when swine flu vaccines brought about a number of Guillian-Barre Syndrome cases across the nation. He speculated that the particular viruses targeted by this year's flu shot may have triggered a reaction in Aills.
"It's an uncomfortable condition to have. It disrupts life and work, but it rarely kills," Davis said, adding that he's been flu-free for the 10 years he's taken the annual shot. "When you look at the figures of people dying from influenza, it's well worth it."
The neurologist can't be totally sure the flu shot had anything to do with Aills' condition, but given that symptoms began within 10 to 15 days, it's a "typical interval" between the shot and the onset of pain
"It would, at this point, be my best guess," Davis said. "There's no way to prove it."
A report of Aills' experience has been sent to the federal Centers for Disease Control and Prevention in Atlanta.
"It's not in the administration of the vaccine or the vaccine itself," said Yvonne Gibbons, interim director of the Saline County Health Department. "The percentages of this happening are low, but it's not uncommon with immunization programs."
The reaction can occur after a viral infection or from other immunizations, and some women have the symptoms after childbirth, she said.
"It's your own immune system attacking the body," Gibbons said. "People should not be discouraged. We would not encourage (Aills) to get a shot again."
Jo Ann Aills said she is planning to get a flu shot this coming fall.
"I don't want people not to get their shots," she said. "Some people really need them."
* Reporter Tim Unruh can be reached at 823-6464, Ext. 137, or by e-mail at firstname.lastname@example.org.