COVID-19: A Survivor's Case Study

The COVID-19 pandemic presented a global medical challenge. At the onset, acute care hospitals were often overwhelmed as they addressed the needs of patients diagnosed with this new virus that had no widely accepted treatment. In those frantic first months, each patient was a case study, especially as the virus’ symptoms and severity grew increasingly complex.

By April 2020, COVID-19 survivors began to emerge, with many of the more involved cases requiring stays at inpatient rehabilitation hospitals. Many, like Baylor Scott & White Institute for Rehabilitation (BSWIR) – Fort Worth patient Benjamin Cromwell, displayed extreme muscle loss, weakness and fatigue on top of life-altering complications.

An unlikely COVID journey

 

Benjamin, 41-year-old financial advisor from Burleson, Texas, enjoyed traveling, cooking, and attending concerts and other events around Dallas-Fort Worth. In July 2020, he was diagnosed with COVID-19 and began quarantining at home. At first, his symptoms appeared mild, though doctors were concerned about the virus’ impact on his pre-existing conditions, including diabetes and high blood pressure. About two weeks later, however, Benjamin noticed steadily worsening leg pain and numbness. When it became unbearable, his wife drove him to Texas Health Huguley Hospital in Fort Worth. Scans revealed bilateral blood clots: a complete occlusion of his left leg and partial in his right.  He was transferred to Texas Health Harris Methodist Hospital, where Benjamin’s condition worsened. His legs, cold to the touch, showed decreased pulse activity. Doctors ordered further testing, performed clot-removal surgery and began intravenous blood thinners. Four days later, Benjamin received convalescent plasma to aid in the viral fight. On the fifth, he underwent the below-the-knee amputation of his left leg.

 

Doctors tried to save Benjamin’s right limb, ordering additional plasma therapy, clot removal surgeries and a catheter of the clot-busting drug tPA and heparin directly to the site. Unfortunately, his leg was removed a short time later. Then, several days after the second surgery, more bad news. Benjamin was presenting symptoms of stroke and additional scans confirmed the diagnosis. After a month in the hospital, Benjamin tested negative for COVID-19. He was removed from isolation, but his fight to recover had only just begun. A long road to recovery lay ahead, and his doctors recommended inpatient rehabilitation.

 

Time to get better

Benjamin struggled to adjust. In a matter of weeks, he’d gone from being relatively healthy to a double amputee and stroke survivor. “I lost both of my legs. I was in excruciating pain and had to relearn how to do everything -- to care for myself, maneuver,” Benjamin said. “My goal was to get back to normal, or as normal as I could.”


Upon admission to BSWIR- Fort Worth, Benjamin received a comprehensive medical and multidisciplinary therapeutic evaluation. He demonstrated mild cognitive linguistic impairments, which limited information recall and detailed task performance. Decreased strength, endurance and balance, limited mobility and pain made even simple tasks challenging.


“We saw Mr. Cromwell in the middle of the pandemic when everyone was still coming to terms with what COVID was, how to treat it, and things were still changing on an almost daily basis on how to treat it in various settings, said Dr. Asher Light, Mr. Cromwell’s attending physician at BSWIR – Fort Worth.


Mr. Cromwell had one of the more severe and memorable complications from COVID. He was also taking hormone replacement at home, which we think coupled with the COVID created a severe hyper-coagulative state causing arterial clotting in the bilateral lower extremities as well as a DVT in the Upper Extremity. He came to us after the amputations in the legs, which had happened pretty suddenly in the other hospital, so he hadn’t had a chance to even process what had happened or what his future would look like. He worked really hard while he was here. He was obviously upset, frustrated, and sad, but had a great disposition, and had a great attitude and worked really hard. Neuropsych did a lot to manage his mood, his therapists worked really hard with him and always encouraged him, and he enjoyed all disciplines of therapy. He had a good outcome because he had good surgeons prior to coming to us, he had a great team here, and he and his wife had a good outlook and did everything to create a smooth transition home. It was great to follow up with him months later and see him walking with his prosthetics and doing so well.”


During his more than three hours of therapy a day, Benjamin worked with his physical and occupational therapists, focusing on increasing his upper body strength to improve his ability to transfer and his balance and endurance to be able to tolerate sitting and eventually standing. Speech-language pathologists led exercises to enhance critical thinking and attention span. He also benefitted from recreation therapy that helped to reinforce the skills he gained. Benjamin was also seen by the hospital’s neuropsychology team who helped with the emotional and physical adjustments of limb loss and stroke. As his strength, skills and understanding improved, so did Benjamin’s confidence. Physicians provided daily medical oversight, while nurses provided residual limb care and pain management. As the surgical sites healed, Benjamin donned shrinkers to prepare his limbs for prostheses. Finally, on August 31st, he was discharged from inpatient rehabilitation to home, using a wheelchair with a sliding board for transfers.

 

Owning his future

 

Four months later, Benjamin was fitted for his prostheses. He returned to BSWIR – Fort Worth to participate in its Day Neuro Program, receiving five hours of intense therapy each weekday for a little over nine weeks. His sessions concentrated on helping him overcome anxiety, improve balance and mobility and increase his confidence and independence. At the program’s end, he was able to return to driving and work. Benjamin was also eager to participate in modified CrossFit classes and join the Adaptive Training Foundation, a local non-profit organization that advances post-rehabilitation fitness.

Benjamin remains optimistic about the future. Having survived incredible odds, he knows there’s no limit to what he can accomplish.

 

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Message from Dr. Hamilton

Dr. Hamilton, our Chief Medical Officer gives an updated on BSWIR news, our continued efforts to provide care during the pandemic and our recent ranking on the U.S. News & World Report's best hospitals list. Read now.

 

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