Tryst with Corona Part 1: The doctor who defeated Covid-19
My Covid Story
By Dr. Nizamuddin Kotwal
I am Dr. Nizamuddin Kotwal, DNB Medicine practising in Solapur (Maharashtra).
I was running my regular medicine clinic at Dr. Kotwal’s Clinic and IPD at Narmada Multi-speciality Hospital and ICU, Solapur during COVID. My wife Dr. Nisha Kotwal, a Gynaecologist was also performing her routine duties.
On night of 5 June 2020 my wife had mild flu like symptoms with bodyache. In view of current scenario, we both isolated ourselves on the first floor of our residence and kept parents and kids on ground floor. I started giving her medication for same. She had high grade fever on 6th and 7th June which gradually reduced by 8th June.
I only had body ache since 5th June which on 8th June turned into full blown myalgia and raging fever with chills and rigors. Temperature swung from 101-103.4 degree F on 9th,10th and 11th June. On 11th June I began having nausea & vomiting. I was unable to even tolerate water orally; that is when we decided to get admitted. Throughout these days my oxygen saturation never dropped below 95%.
On 11th June 2020 I got admitted in CNS Hospital, Solapur (owned by my beloved teacher and mentor Dr Prasanna Kasegaonkar); under Dr Vishal Gore, an excellent Physician and Intensivist as well as a great friend of mine, I was given supportive therapy as befits a moderately symptomatic COVID infection.
On 12th June 2020, my family decided to shift me to Pune for further treatment with my best friend Dr. Kapil Patwardhan, Physician and Intensivist at Sahyadri Hospital, Nagar Road, Pune.
We reached Pune at 7:30PM, gave throat swab but somehow felt more tense there, so we returned to Solapur the same night at 3 AM(13-6-20).
On 13th June 2020, I was feeling much better with no fever or chills or rigors. However, I got readmitted in CNS Hospital as a prophylactic measure if at all our tests come out positive. As expected both my wife and I turned out COVID Positive.
13th, 14th, 15th, 16th June 2020 were absolutely uneventful and I felt relieved. I was put on Injection Enclex 0.4 OD(LMWH) as my D-Dimer was on higher side(800) and injection MPSS (Steroid) 40mg BD as my baseline Ferritin & CRP was on higher side. My wife and I were admitted together and our discharge was due on 20th (according to protocol COVID positive should stay in hospital for 7 days and then home quarantine for next 7 days).
During this stay of ours Dr. Vishal Gore treated me really well and kept my moral high.
Dr Seena and Dr Prasanna Kasegaonkar came to meet us and motivated us.
On 17th June 2020 I had mild fever(100F) which came down with only single dose of Tablet Paracetamol 650mg (I assumed it was due to thrombophlebitis) The rest of the day went by uneventfully with saturation maintained at 94% & PR (pulse rate) 100bpm off O2. Yet, at night I could not sleep in supine position(flat on back); with lots of adjustments I finally fell asleep at 90 degree propped up position.
On 18th morning I developed a high grade fever again (101-102 F). Injection Paracetamol 1gm was given.
This is when Dr. Vishal Gore took decision to repeat my inflammatory markers (IL-6,CRP, Ferritin, LDH & D-Dimer). The report came by 5 PM and all the markers were in thousands. To my horror, it was the dreaded CYTOKINE STORM.
My chest X-Ray was done which was nearly normal and I was maintaining 96% saturation on 4 litres Oxygen and started feeling comfortable. My wife kept monitoring my saturation throughout the day off Oxygen and realised that slowly the baseline was shifting from 94% to 92% then 90% and finally at 2AM it was 88% ! She called Dr. Vishal who sat by my side till 4 AM to monitor me personally. Suddenly at 4 AM I experienced severe Chest Pain and was shifted to the Intensive Care Unit where my ECG was normal. By now I was uncomfortable and breathless in all positions. At this point, Dr. Vishal Gore decided to give me Injection Toclizumab which brought my saturation upto 90% with 4 litres O2 but my discomfort still persisted.
On 19th June 2020, my Inflammatory Parameters started falling but my HRCT showed more than 70% lung involvement with ground glass opacities et al and that was the reason I had what is known as asynchronous breathing ( which means my lungs and diaphragm were contracting and relaxing at separate rates).
This was the most terrifying experience of my life. I could not breathe, I could not think and all I could see was my family, all alone without me. With the little strength I could muster, I took my wife’s hand and shared my Term Insurance Policy, email ID and Password, told her to look after our lovely children (Son Hussain 9 years & Daughter Mariya 7 years) and my elderly parents, I asked her to stay strong in life and take all further decisions on how and where to proceed with treatment.
Nisha called all our dear friends – Dr. Archana and Dr. Pravin Khare, Dr. Prajakta and Dr. Praveen Narote, Dr. Shankar Patil, Dr. Deepa and Dr. Guddu Babladi, Dr. Sampada and Dr. Balaji Anvekar, Dr. Poonam Deshmukh, Dr. Prashant Dond and Dr. Sumit More. All these wonderful people stood as a rock solid support system with Nisha and decided to shift me to Pune Sahyadri Hospital.
A Cardiac Ambulance was arranged in no time by Dr. Manik Gurram (Chairman, Shree Markandey Rugnalaya) by the tireless efforts of Dr Pravin Khare. The only fear here was what if some problem occurs in transit and everyone started rethinking the possible complications during shifting.
At 12 PM while my friends and my wife were deciding the best course of action, my treating physician called my other Intensivist friends Dr. Yogesh Rathod, Dr. Nilrohit Paike, Nephrologist (Yashodhara Hospital, Solapur) who came to CNS and evaluated me. At this time, HFNO ( High flow nasal oxygenation machine ) was not available in Yashodhara Hospital but Dr. Yogesh Rathod assured me that he had already ordered HFNO from Bangalore and it would reach by 20th June 2020 (the next day) and I would be the first person he would use it on.
Their counselling and confidence helped us decide to stay back at Solapur and I was shifted to Yashodhara Hospital ICU at 6PM. At Yashodhara my saturation went down to 85% off Oxygen, so was put on BiPap ( Non invasive ventilator) With BiPap I could finally breathe as the movement of my lungs and diaphragm got synchronised. I still couldn’t sleep, Dr Navin kindly stayed by my side all night reassuring and motivating me; thank you so much Navin!
On 20th June 2020, I was on BiPap till 5 PM and at 5PM I was put on newly arrived HFNO machine @ 20 litres with humidifier, with this I was maintaining 97% saturation and PR of 80-90 bpm and finally got a restful sleep after 4 sleepless nights. My off O2 saturation improved marginally to 88%.
On 21st June 2020, I was quite comfortable so Dr Yogesh reduced my HFNO to 15 litres & shifted me to a room at 5PM. I was started with CARP ( Covid awake repositioning Prone ) Protocol; initially I could not lay down in <60 degree, with some I started prone ventilation by nightfall. I could eat semi-solid food after 4 days as now I could control respiration and swallowing simultaneously.
On 22nd June 2020, HFNO was tapered down to 10 litres. I could perform CARP effortlessly, eat solid food, use washroom without assistance and breathe freely.
On 23rd June 2020, Oxygen was completely stopped and I was put only on 10 litres high flow (on HFNO machine) with atmospheric oxygen level (21% PaO2), I was now maintaining 92-93% saturation and had no breathlessness.
On 24th June 2020, the HFNO Machine was disconnected and finally after 7 long days I was breathing on my own maintaining 93% saturation.
On 25th June 2020, I was suppose to do my “6 minutes walk test”, but by God’s Grace I managed to walk for 30 minutes without fall in saturation or tachycardia!
On 26th June 2020,I got discharged from hospital with 95% saturation, Improving Chest X-Ray, falling Inflammatory markers and most importantly, A New Me…
In this life changing journey of mine I would like to take a moment to remember everyone who stood by me
1. I must thank God for giving me this second life so that I can share my experience. I have more faith in God now than ever before.
2. As our patients always say “Doctor you are God for us”. I can’t thank you enough Dr. Vishal Gore for treating me, making the right calls at the right time & always motivating me. You really are great ‘Vishal’.
3. Dr. Yogesh Rathod, you are a lifesaver man. Thanks so much for all the efforts you made to get that essential HFNO. You instilled confidence in me .
4. Dr. Nilrohit Paike, thank you so much for doing your job to perfection and being there throughout. You people are warriors fighting in these hard times.
5. Dr. Sheroz Bombaywala
6. Dr. Bhaskar Patil
7. Dr. Sunil Shewale
8. Dr. Amjad Sayyed
9. Dr. Poonam Deshmukh
10. Dr. Navin
11. Dr. Harshwardhan Joshi
12. Dr. Nitin Toshniwal
13. Dr. Dinesh Kshirsagar
14. Dr. Amol Achlelkar
15. Dr. Anjali Shivpuje
16.Dr. Mukteshwar Shete
17.Dr. Hafiz Junaidi
18. Dr. Seena and Dr. Prasanna Kasegaonkar, thank you for making me feel at home at CNS with all the comfort & luxury. You came to meet me in spite of the fact that you yourself were down with fever. You have amazingly caring staff Mr. Sandeep Patil (AO) and all the hardworking Nursing Staff.
19. Dr. B S Kolur Sir ( Chairman Yashodhara Hospital ) Thank you Sir for making everything available for me at Yashodhara Hospital. Everyone in the hospital were so ready to help it made me feel proud that once I was a part of this prestigious institute.
20. My Yashodhara Friends -Paresh, Dhananjay, MICU Staff and everyone who helped me.
21. Krishnamai Nursing Home Family – Thank you Dr. Madhuri & Rajiv Dabade, Dr. B Doshi, Dr .Supriya and Vinit Birajdar, Dr .Yojana, Dr. Mukta and all staff for supporting Nisha and praying for me.
22. Dr Kapil Patwardhan, thanks a bunch for holding me up at every step, guiding me, supporting me, motivating me like a brother.
23. My Army – Dr. Archana and Pravin Khare, Dr. Prajaktaand Praveen Narote, Dr. Deepa and Guddu Babladi, Dr. Shankar Patil, Dr Prashant Dond, Dr Sampada and Balaji Anvekar. What can I say about you all? You know you are not just my friends, you are my Family by choice. A million Thanks for standing by Nisha and me in all the ups and downs of life (not just this COVID episode). I’m grateful to you guys for taking care of my parents & kids back home in our absence and I value our friendship deeply.
24.Dr Sumit More, Dr Sheetal and Sandeep Holkar, Dr Trupti Deshpande.
25.My Best Friends Forever – Dr. Uday Mirje, Dr. Kapil Patwardhan, Dr Shankar Patil, Dr Umesh Salunkhe, Dr Sumit Shah, Dr Makrand Dombale for having my back through it all.
26.My Adorable Family – Ammi, Abba , Zeba & Riyaz,my brave Hussain & Mariya (my reasons for happiness) ,Aunty-Uncle,my cousins, my Nieces for praying for me & standing strong despite being scared. I know this wasn’t easy.
27. My fantastic extended family – My In Laws for constantly praying and being a source of inspiration and support.
28.Last but not the least my lovely wife Nisha, my pillar of strength for never losing hope and having the courage to fight back and for loving me so much. I cherish you.
Things to remember
1. If you have any symptom get yourself tested ASAP!! The treatment protocol is changing everyday, newer medicines are coming into practice. It will be fair if these medicines be given only to COVID positive patients and not just anybody. Once you are tested positive, it will also be easy to keep close watch on potential complications.
2. DON’T PANIC!! – Maximum mistakes are made when we panic and it can lead to depression.
3. First and foremost, ISOLATE yourself from rest of the family members and get everyone in the family tested.
4. See your Covid Physician immediately-No self treatment please (Even if u are a doctor)(Especially if you are a doctor!)
5. Do a research and check today itself as who is doing COVID OPD in your city and keep their numbers stored on your phone.
6. A good quality Thermometer and Pulse Oximeter is a must in every house now to keep record of fever as well as Oxygen saturation.
7. In the most dreaded complication i.e Cytokine Storm it was seen that Hypoxia (Low Oxygen level in body) is the first sign which appears much before breathlessness occurs and with pretty low oxygen patients are comfortable, it is called “Happy Hypoxia”. Hence, It is always a good practice to know your baseline O2 saturation and Pulse Rate so that you can diagnose the fall early.
8. Hydration is extremely important – WATER, lemon, juice, coconut water, ORS must all be kept handy to avoid dehydration. Also make sure you are passing good amount of colourless urine.
9. Never stop eating! – Taste and Smell is lost in a large group of patients causing loss of appetite but keep eating soft food with good nutritional value like eggs, khichdi, sheera, soups etc. (I lost 9 kgs in 10-15 days)
10. Sense the Danger – There are 2 dangerous times – the first 7 days if you are having very high grade fever (>101-102) elderly people and people with co-morbid conditions (Hypertension,Diabetes,Heart Disease,Kidney Diseases,Cancer) are at higher risk and Secondly 7-14th day if fever reappears. Hypoxia, Breathlessness or any abnormal event if encountered can be a sign of Cytokine Storm, see ur physician immediately and GET ADMITTED!
11. Call for help – In these difficult times and times of danger you need all the help you can get from any direction; you never know who may turn into an angel for you. Do not hesitate to seek assistance.
12. Physiotherapy – CARP Protocol, Yoga (Pranayam & Anulom-Vilom), Spirometry is all you need to regain your respiratory health. Do It religiously.
13. TRUST YOUR DOCTOR!! Please remember the doctors on COVID duties are doing their BEST with all the energy they have to save your life. You all know the work is a lot and the manpower is way too less, so have faith. The doctor can only treat you, not teach you. I myself being a physician without asking a single question, surrendered myself to Dr. Vishal, Dr. Yogesh and Dr. Nilrohit and here I am – Happy and Healthy.
14. INSURANCE – This is high time each and every person SHOULD have an insurance plan in place, as all these high tech machines, treatment modalities, medicines, expert consultation and well qualified doctor, inflated staff payments, PPE’s, hospital sanitisation, etc requires money. You cannot possibly expect a miniscule amount.
15. Mental Health – COVID-19 is an illness that not only takes a toll on our physical health but also our mental health. Stay connected with your loved ones and never hesitate to take professional help if required.
16. Keep Praying – Belief and rituals keep you grounded keeps you strong & also helps ward away negativity.
17. Positive Mindset – My wife Dr. Nisha was also COVID positive so she could always be with me throughout my treatment but everyone is not that lucky. It may just be a matter of 15 days but these will be the most lonely and difficult 15 days of your life when you have to stay in hospital room or travel alone with no familiar company physically present. It’s only a positive mindset which can get you through. Always remember this too shall pass.
18. PTSD(Post Traumatic Stress Disorder) – It is mostly seen in healthcare professionals. Try to identify it, admit it, accept it, take professional help and get it treated.
19. Prevention is better than cure – Stay home, stay safe. I wouldn’t wish COVID19 on my worst enemy. Trust me you are better off indoors and bored than fighting for your life or watching a loved one struggle.
A last and extremely valuable piece of advice for my doctor friends. According to my experience, the OPD is the main point of contracting highest viral load from patients. Patients come within 2-3 days of symptoms (fever, cough, etc). Or worse, they are ASYMPTOMATIC. They are most infectious at this stage. By the time SARI develops, the viral load is remarkably reduced plus when treating IPD patients all are using PPE.
OPD is the point where we are likely to be more casual. That’s where we go wrong and are most susceptible. I also did same mistake. I was just using OT gown in OPD and not PPE.
I request to all of you please use PPE in OPD also. Don’t be complacent or entertain the false impression that your immunity is good and nothing will happen to you.
Believe me, I am fairly young – 37 year old and a fitness freak. I spend 1.5 hrs in gym daily and run 7 km every alternate day.
Still I suffered.
While I am sending this unfortunately my Intensivist friend Dr. Yogesh Rathod who treated me is admitted in ICU in Yashodhara with Covid symptoms and B/L ground glass haziness on Chest x ray.
I pray to God for his speedy and complete recovery.