Parkwest provides answers after patient’s eight-year medical journey
Mercer Granade was in a dramatic state of decline that was sudden and completely unexpected. “It was absolutely terrifying,” says Granade, 71. When he spoke, no one understood him. When he tried to eat, he couldn’t. His muscles were failing him and he was desperately weak when he arrived in the emergency department at Parkwest Medical Center in March 2022.
A Long Journey
Granade was first diagnosed with Parkinson’s disease in 2013, and that diagnosis was affirmed with a second opinion at a hospital in the state where he lived at the time. But right from the start, the traditional treatments for Parkinson’s didn’t seem to be very effective. Working hard at physical therapy and doing his best to follow doctors’ orders, he and his wife began to question whether his diagnosis was accurate. In August and September of 2021, Granade began to notice he was having some trouble swallowing. When Thanksgiving came, he began to have trouble speaking, too. “We had company over and all of a sudden, I could not be understood,” Granade says.
Granade spent the next three months in a tornado of uncontrollable decline. He tried to get help from specialists, but his condition deteriorated to a point where he was unable to even eat or drink for weeks. He ultimately lost 40 pounds. An alert ear, nose and throat specialist sent Granade to the emergency department at Parkwest Medical Center. The emergency team was waiting for him when he arrived.
Solving the Mystery
When Parkwest neurologist Robert Malka, MD, walked into the hospital room, he thought that he would be examining a Parkinson’s patient who needed to be approved for a feeding tube. “It was immediately clear that this was not Parkinson’s disease,” Dr. Malka says. He explains that Granade didn’t exhibit the lack of movement, the quiet speech pattern or the stiff facial muscles of a typical patient struggling with advanced symptoms of Parkinson’s. “His speech was coming out incredibly slurred and almost unintelligible, but he was emoting and moving his hands, and his face was expressing everything he was trying to say,” Dr. Malka says.
After an examination, Dr. Malka stood at the edge of the hospital bed and confidently delivered the news. Granade and his wife were shocked. “I looked at my wife and she looked at me and I could literally see the relief come over her face.” Granade says. After ordering tests, Dr. Malka delivered a diagnosis of myasthenia gravis. “It’s an autoimmune disease where the immune system attacks the junction between nerve and muscle, so the nerves don’t talk to the muscles appropriately,” Dr. Malka explains. “That leads to weakness and fatigue in the muscles.” In addition to medication, a key element of the treatment that followed was plasmapheresis (plasma exchange) in which the plasma compartment of the blood is exchanged with substitute plasma to keep the immune system from attacking the body. In about a day, Granade was talking again. “We had felt isolated and alone for a long time… but Dr. Malka figured it out in 24 hours,” Granade says. “That says a lot – that when I was in that condition, a caring, competent doctor figured it out.”
Dr. Malka quickly shares credit with the Parkwest team. Beginning with a Parkwest ear, nose and throat specialist who recognized a patient needed help, the team eventually included
Parkwest neurology; internal medicine; critical care; physical, occupational and speech therapy; nursing and other medical staff, and even a kidney specialist who carried out the plasma exchange. “Neurologic problems are extremely common,” Dr. Malka says, “and having that close team makes it easier to do a good job.”
The result for Granade has been a renewed quality of life. His speech is clear and he’s well enough to enjoy his children and grandchildren, more holidays and birthdays, and the day-to-day blessings of ordinary life. “I can’t change the past, but what I can do is put all my positive attitude and energy and effort into everything this team tells me to do to get to the best possible place I can,” Granade says. “I’m just so grateful I ended up at Parkwest and with this wonderful, incredible team of people that took care of me.”
Getting It Right: Parkwest physicians are committed to accurate diagnoses.
After eight years of treatment for an illness he didn’t have, Mercer Granade, 71, is finally on the right track. His myasthenia gravis was misdiagnosed as Parkinson’s disease in 2013 before he and his wife moved to Knoxville, but the further he progressed in his illness, the more doubtful he became about the diagnosis. It took a visit to the emergency department at Parkwest Medical Center and an examination by board-certified neurologist Robert Malka, MD, to find out what was really wrong.
“I’m just so grateful for my entire team that continues to take care of me,” Granade says. “I just can’t put it into words — I get emotional about it.” Dr. Malka says diagnosing an illness can be challenging, and any time a patient has a very sudden spike in symptoms, a reevaluation is in order. “That’s where you have to step back and start over – ground zero, square one,” Dr. Malka says.
In Granade’s case, the patient had described being “stiff” when he went upstairs, got up from a seated position or got in and out of a car. The stiffness he was describing wasn’t caused by nerve damage from Parkinson’s disease, but muscle weakness from myasthenia gravis. “I think that’s what threw everyone off for so long,” Dr. Malka says. “Patients describe their
symptoms in their own language. They’re not going to read you the textbook.” Dr. Malka says the only way to deliver the right treatment is to get an accurate diagnosis, and the only way to get an accurate diagnosis is by listening to the patient. The answers don’t always come quickly, and physicians must be persistent in their commitment to put the patient first and interpret what the patient is trying to express.
“My (neurology) partner at Parkwest has the same mindset, and we’re going to listen and we’re going to pull out all the stops we can to get an accurate diagnosis,” Dr. Malka says. “My partners at Fort Sanders Regional Medical Center are also of that mindset. Between our facilities, I think we have the top two facilities for neurologic care in the region. I don’t say that lightly. I truly mean it.”
Myasthenia gravis is a serious illness in its own right, and Granade’s condition is impacted by his delay in treatment. But having the right diagnosis and the right treatment today has restored his quality of life and gives him more hope for a full life ahead. “It’s a situation like his that keeps us inspired, honestly, to keep doing what we’re doing,” Dr. Malka says. “That’s a thrill for me and it makes me proud to work at Parkwest.” To learn more about care and services available at Parkwest Medical Center, visit TreatedWell.com or call 865-374-PARK (7275).