I wasn't sure where else to go, I know I'm pretty much a stranger here now.
My cousin is in bad shape, possibly dying and no one is certain why - I know you have access to research resources I don't I was hoping you might have some advice for us.
He appears to have necrotizing fascitis. The strange thing is, he was was just injured on Saturday. Usually this bacteria takes time to develop into a problem like this.
Here's the deal - he was skiing on Saturday in the lake, he fell, and struck his arm on something. He described it as feeling a shock and instant pain, and thought he'd broken his arm. He was bleeding, when they pulled him in the boat. He began throwing up from the pain almost immediately and couldn't walk to the car. They drove him straight to an emergency room (at a small regional medical center in Gadsden), where the arm was x-rayed and found to not be broken. There was a puncture wound in the arm about the size of a nail hole.
They sent him home, with some antibiotics and told him to call his doctor in Birmingham on Monday if it was no better. That night, he woke up vomiting and crying out in pain. His wife rushed him back to the hospital where he had a 103 degree fever, the arm was red and swollen and his pain was severe enough to require morphine.
A CAT scan this morning revealed a gaseous pocket inside the arm and he was taken to surgery. The doctor says the puncture wound was almost through and through - within an eigth of an inch of coming out the other side of his arm. There was a peach-sized pocket of gas and pus from the bacterial toxins. They debrided the arm, and have him on high doses of pain meds and antibiotics, still waiting for a culture to see what it is he has. The infection has spread from the forearm to the shoulder, very quckly and aggressively. The doctors admitted not ever seeing anything that moved that fast.
Sara, have you ever heard of something like this developing so fast? Is there anything else that could possibly be going on? He's at a local hospital, a good hospital, I've had surgery there and all four kids were delivered there, but should he be transferred to UAB?
Anything you might offer that could help us, or reassure us, would be great. Those of you that have met cherie, my aunt (Fael on this board) - this is her oldest son. She is very scared, as are we all.
Please help if you can.
And, I'm panicking now, because I examined my kids and they have lots of minor cuts and abrasions, and now I'm paranoid. Does the fact that I'm most likely a silent carrier of strep put them at risk?
[ August 02, 2004, 06:07 PM: Message edited by: Belle ]
Posted by TMedina (Member # 6649) on :
Belle, I am so sorry.
I'm not a medical mind, but given the nature of the injury and the fact it happened in the lake leads me to believe the wound was at greater risk of becoming infected, moreso than any casual cut or scrape.
I'm hoping for the best.
-Trevor
Posted by Storm Saxon (Member # 3101) on :
I hope everything turns out o.k., Belle.
You are in my thoughts. Posted by Azile (Member # 2312) on :
The only comfort I can offer you now is that your children are very unlikely to have gotten the infection. When I looked necrotizing fascitis up, I found:
quote:This disease rarely occurs in children. Pediatric cases have been reported from countries where poor hygiene is prevalent.
My heart goes to you and your family, Belle. I will be sure to send all my prayers to your cousin as well as to Fael. Hang in there. Posted by mackillian (Member # 586) on :
I can only hope for comfort for you and cherie and your cousin. What a devastatingly frightening thing for all of you and I hope the doctors will be able to soon allay those fears.
Posted by Theca (Member # 1629) on :
OK, here is some stuff from my UpToDate Doctor program.
Early recognition of necrotizing fasciitis is very important since there may be a remarkably rapid progression from an inapparent process to one associated with extensive destruction of tissue, systemic toxicity, loss of limb or death...features to look for include unexplained pain, blister and bullae formation, and signs of systemic toxicity.
Erythema may be present diffusely or locally but, in some patients, excruciating pain in the absence of any cutaneous findings is the only clue of infection. Within 24 to 48 hours, erythema may develop or darken to a reddish-purple color, frequently with associated blisters and bullae; bullae can also develop in normal appearing skin. The bullae are initially filled with clear fluid but rapidly take on a blue or maroon appearance. Once the bullous stage is reached, there is already extensive deep soft tissue destruction such as necrotizing fasciitis or myonecrosis; such patients usually exhibit fever and systemic toxicity.
In addition to pain and skin findings, fever, malaise, myalgias, diarrhea, and anorexia may also be present during the first 24 hours. Hypotension may be present initially or develop over time.
TREATMENT — Treatment consists of early and aggressive surgical exploration and debridement of necrotic tissue, antibiotic therapy, and hemodynamic support as needed. In addition, the various types of infection require some specific modalities. The best indication for surgical intervention is severe pain, toxicity, fever and elevated CPK with or without radiographic findings.
Surgery — A delay in surgical diagnosis and debridement probably increases mortality although, for obvious reasons, a controlled trial to address this question cannot be performed. The goals of initial surgery are to establish a diagnosis and, if necrotizing fasciitis is present, to perform aggressive surgical debridement of the involved fascia. Reexploration should be performed in 24 hours; repeat explorations and debridement may be necessary on a daily basis until all necrotic tissue has been removed
So, he needs prompt surgery (I know he already did) and probably repeat trips to the OR to keep that thing under control. They do not want it to get into the neck tissues; from there it can go into the head. He ought to have an infectious disease doctor on the case as well as a good surgeon. I cannot tell you whether the care he is getting is good enough; you guys will have to ask a lot of questions and be on top of things. Cutting it out and sacrificing the arm and shoulder, if necessary, should be strongly considered if it truly is necrotizing fasciitis. There is a possibility he won't make it, even if they do everything 100% correct. Finding out the name of the organism will help.
As for you and your kids' risk factors? Don't worry. Your cousin got a puncture wound and something bad got trapped in there and spread like wildfire. Your strep strain is a different strain, and probably NOT virulent the way his is. And your strain and his strain have nothing to do with each other, as far as I would guess. Now, anyone could catch his strain, but since he got his from a specific portal of entry, then I doubt your family has had exposure to it. And even if you guys DO get colonized, your individual risks of devoping this sort of infection is very very low.
[ July 27, 2004, 03:12 AM: Message edited by: Theca ]
Posted by Shigosei (Member # 3831) on :
I have nothing to offer but my prayers for your cousin, for you, and for your family. I hope everything turns out all right.
Posted by Theca (Member # 1629) on :
I'm still wondering if it truly is necrotizing fasciitis or if it is a related infection. The presence of gas in the wound makes me less likely to blame strep; I don't think strep causes gas formation. There are other bacteria that DO cause gas formation in necrotizing fasciitis. Also, claustridial or nonclaustridial gas gangrene of a puncture wound would look similar. And Claustridium histolyticum specifically is found in water.
Theca, thanks for weighing in, I really appreciate it.
I've been reading all night, and finding case histories where this type of rapid progression happened, so I suppose it isn't all that abnormal with this stuff.
When I first heard his symptoms, I thought snakebite. I just didn't think a few hours was enough time for there to be a massive infection.
When they went in for the first surgery, the doctor was thinking possibly snakebite as well.
They did tell Cherie that future surgeries were pretty much a given, and that they could expect him to be in the hospital for a while. He is still in enormous pain, which from what I've read is pretty common with this type infection.
They do have an infectious disease specialist on board. They are baffled as to what caused the puncture, the surgeon said there was no debris or anything in the wound to give a clue.
I guess it's good he did progress so quickly, and was hospitalized less than 24 hours after the incident.
I know I'm overreacting. But, I found myself going over the kids legs looking for any mosquito bites they might have scratched open, or any scrapes or bruises. My kids play outside every day, riding their bikes and scooters and running through the trees, they are covered with tiny nicks and scrapes. I always clean any open sores, and treat the mosquito bites to keep them from scratching if possible (and use bug and sun screen, but they get bitten anyway) but this has got me spooked, bad. I don't usually react to stuff this way. I'm kind of worried about my reaction, honestly. It's 2:42 and I'm still up, can't sleep.
Posted by Noemon (Member # 1115) on :
Belle, I can completely understand your reaction to this--it seems fairly normal, honestly, given the circumstances. I do think that Theca and Trevor are right, though, and that your family is at pretty low risk. I'm so glad that Theca was here to give you a good, detailed response. I'll be thinking of your cousin. Keep us posted on how he's doing (and how Fael and the rest of you are holding up emotionally).
((Belle))
Posted by Rakeesh (Member # 2001) on :
(Adrian & Family)
You're in my thoughts, all of you. I'm sorry for the ordeal Posted by pooka (Member # 5003) on :
(((Belle))) never a stranger here. I've missed you.
There was a case like this on TV once. Young hiker comes in with a painful red spot under skin and they have to amputate. I don't know which show it was.
I don't know if it will help your anxiety to remember that riding in a car is still the most hazardous undertaking most of us engage in.
What is odd is the sudden pain he felt when it happened. I pray he'll make it. Again it's good to see you, even though this isn't necessarily a good time for you.
Posted by Troubadour (Member # 83) on :
Hey Sara,
Just thought I'd weigh in on the Hyperbaric treatment issue. Although you're well aware I have no medical background I do have some personal experience with this treatment.
My mother had breast cancer several years ago and had a portion of her breast removed. Sor quite some time she made no progess in the healing of the wound - it just sat open, apparently.
Eventually she was slated for a combination of kelp being packed in the wound and hyperbarid treatment.
Her recovery was nothing short of sensational, the wound rapidly healing, and as an odd side-effect, her terrible eyesight going to near 20/20 for a few weeks before returning to normal.
Just thought you might like to hear a completely unimportant non-medical POV...
Belle - I hope your brother recovers, I'm sure he's getting great treatment.
Posted by Jim-Me (Member # 6426) on :
((Belle))
have missed you, too, lady, and you are never a stranger.
Prayers underway for the young man.
[ July 27, 2004, 10:24 AM: Message edited by: Jim-Me ]
Posted by dkw (Member # 3264) on :
((Belle))
I have also missed you, and will be praying for your cousin and for Fael and the rest of your family. This must be terribly frightening for all of you.
Posted by Belle (Member # 2314) on :
Thanks for the support, everyone.
cultures were taken and haven't heard results yet.
Only other piece of information that i didn't have yesterday is that at the site of the injury, when the boat swung around and picked him up out of the water, there was a dead catfish floating nearby, one of the guys in the boat remembers remarking they needed to get the wound cleaned up since he was in the area of the dead fish.
Don't know if that is significant or not.
I'm better today, I realize this is a very rare thing, (even rarer in kids) and there's nothing you can really do to prevent it except practice normal hygiene and wound care as I would to prevent any type of infection. I was just freaked last night, spent too much time reading case histories and survivor stories.
Posted by BannaOj (Member # 3206) on :
*hugs*
AJ
Posted by TMedina (Member # 6649) on :
Ugh.
Lakes are a hotbed of possible infections and the dead fish in such close proximity only heightens the possibility of infection.
Given the nature of his wound, it again amplifies any possible infection - whereas a relatively simple cut or scrape doesn't give the same instant access to the body.
Your kids will be fine - although I realize this may be cold comfort the next time someone skins their knee and your heart stops.
-Trevor
Posted by Belle (Member # 2314) on :
I have no clue on the tetanus, I will ask.
I had a severe allergic reaction when I got a tetanus shot last, no more tetanus shots for me. Posted by Belle (Member # 2314) on :
Swelling and hives, starting from the injection site and spreading rapidly. I worked for a phamaceutical company, and one of our registered pharmacist employees stopped me in the hall, when he saw me scratching my arm, and asked what was wrong. he looked at it, dosed me with benadryl and drove me back to the doctor's office.
Posted by Olivetta (Member # 6456) on :
I'm so sorry. I hope he continues to improve.
Posted by beverly (Member # 6246) on :
Belle, it is good to see you here again. I have been wondering about you, how you are, if/when you would return to Hatrack.
I am so sorry about the scary circumstances of your cousin. I don't have much in the way of medical knowledge, all I can say is that I am sorry and that I hope things work OK for him and all of you. It is so hard not knowing what is going to happen. Posted by Kwea (Member # 2199) on :
Belle, it's good to see you again, but I am sorry it's because of this.
I hope everything works out for you and your family.
Kwea and JenniK
Posted by Troubadour (Member # 83) on :
Indeed. Thought I might give it a try myself. Posted by Belle (Member # 2314) on :
They are officially calling it necrotizing fasciitis now, but still no result on the culture to find out exactly what strain of nasty we're talking about.
The doctor did say it was a gangrenous bacteria though, I suppose because of the pocket of gas they found?
His fever is down, but still not normal. His white count looks better than yesterday's. They are still planning on going back in for more surgery.
Posted by pooka (Member # 5003) on :
Thanks for the update. (((Belle)))
Posted by Derrell (Member # 6062) on :
(((Belle))) I hope his condition continues to improve.
Posted by Belle (Member # 2314) on :
Well...so much for improvement. White count is back up and fever is back over 100. Surgery again 1st thing in the morning.
If anything drastic happens, I'll let you know, I think this may be a long drawn out affair.
Posted by dkw (Member # 3264) on :
Belle, I just read this thread to Bob (he's offline this week) and he asked me to tell you and Fael that you all will be in his thoughts and prayers.
Posted by rivka (Member # 4859) on :
(((((Belle&family))))) What an ordeal, for you cousin and your whole family! You are all in my prayers.
I hope to hear good updates soon.
Posted by Shan (Member # 4550) on :
(((Belle and family))) Prayers your way -
Question to medical types: apart from the fictional representation of this treatment, what are the possible benefits? Natural practice medico's talk about the use of maggots to debride - a certain type that only eat the dead flesh. Would that be possible, helpful? Or totally out of the realm of okay-ness? (Late night thinking)
Posted by Jaiden (Member # 2099) on :
Posted by Kwea (Member # 2199) on :
Best of luck for him (and you too) Belle!
Kwea
Posted by rivka (Member # 4859) on :
Shan, I was thinking about maggots too (I've been reading a lot about their medical use recently). But I think they would be too slow for something like this. It takes days for maggots to clean a wound thoroughly, I believe.
Posted by Shan (Member # 4550) on :
I think you're right about that, rivka . . .
Posted by Olivetta (Member # 6456) on :
I thought the same thing (What about maggots? Hmm...probably too slow for this situation). Plus, doesn't that bacterium produce a toxin that kills surrounding tissue? Wouldn't it kill the maggots, too?
[/weird rabbit-trails of thought]
I'm sorry to hear about his condition worsening. You'll all be in my prayers. (and yeah, I mean it, even though I'm a professed heathen).
Posted by Belle (Member # 2314) on :
Hey guys, nothing new but on the maggot thing - they say this stuff progresses at a rate of about 2cm an hour, probably too fast for maggots.
Don't they use maggots for flesh that has died for lack of proper circulation? (Or am I thinking they use leeches to remove blood that isnt' circulating.)
Anyway, it seems like this stuff may not leave the flesh in any condition the maggots want to eat. isnt' that a lovely thought?
Posted by Belle (Member # 2314) on :
Oh, I forgot to add. he can no longer feel his toes or fingers. From my understanding, that is from drugs used to help his blood pressure, which shunts blood away from the outer extremities.
Theca, CT, is that right?
Apparently, this is not an uncommon thing with NF and it's very common for patients to even lose some of their extremities because of the lack of circulation. Which means, amputations may happen of fingers and toes not affected by the bacteria, but which die because of the treatment.
If he survivies this, I wonder what bodes for his future? he's an IT guy, I found myself wondering if he'd be able to type.
I know, however, that prayers right now need to be mainly for survival and fingers, toes, and even his arm are expendable when compared to his life.
Posted by pooka (Member # 5003) on :
Belle, you don't have an address up, or I would email you. I normally only mention in joking that we use health magnets, but they might help the peripherals. It's a fact that magnets increase the flow rate of saline through tubules in laboratory conditions, and a lot of folks claim they seem to have a similar effect in capillaries.
Ironically, the magnet/maggot confusion is joked about frequently in the health magnet scene. Anyway, they sell them pretty much everywhere now so I don't feel like it's violating the terms of use to mention them.
P.S. I assume the are trying to starve the afflicted arm on purpose? So if they did wind up using any magnets, of course don't use them on the wounded arm. Not only would it be defeating the drug action, they could worsen bleeding. That's one thing I sincerely believe about natural alternatives- if they work at all there is logically some what they could hurt someone.
[ July 28, 2004, 11:27 AM: Message edited by: pooka ]
Posted by PSI Teleport (Member # 5545) on :
Belle, I know what you're saying. My husband is working in masonry while he gets his cartooning business up and running, and our greatest fear is that something will happen to his right hand before he gets the business to a point where it can support us.
Posted by beverly (Member # 6246) on :
Amputation is an irrational fear of mine. I know of a gal who has cancer spreading in her upper arm, and if other treatments fail, they are going to amputate.
The irrational part of my feelings is that there is a part of me that would rather die than lose a body-part. Isn't that silly of me? I'm sure that you and your cousin would prefer that he survive no matter the outcome.
I am remembering you and your family in my prayers.
Posted by Theca (Member # 1629) on :
Sorry, I'm a little busy right now. The medications Belle is talking about are probably drugs used to raise blood pressure to a healthier level. He probably has low blood pressure from being so ill and infected. Side effect of pressor drugs is that the arteries become narrow, so that the extremities get less blood, appear pale and cool to the touch. The blood is being shunted centrally to preserve the brain and central organs, you see.
So anything that reverses that (like magnets, if they work like you said they do) will counteract the pressors. Not a good idea. Hopefully they can get the infection under control soon, then the blood pressure will improve, then he can get off the pressors before any permanent damage to his extremities. Permanent damage is pretty rare, in my experience, though.
Posted by pooka (Member # 5003) on :
Thanks, Theca. Like I said, none of these panaceas can also be totally harmless.
Posted by TMedina (Member # 6649) on :
As a would-be IT guy, he can function quite well without having all his original fingers.
Depending on what he does within the broad field of IT, all he really needs to do is be able to manipulate a mouse and hunt-and-peck.
Worst case scenario and they do have to amputate, he'll need to learn new skills but it won't impede his ability to function effectively.
-Trevor
Posted by Belle (Member # 2314) on :
Well, we have the information from the cultures finally. The doctor said the predominant bacteria was gram negative Proteus bacteria.
I did some quick reading and found it is more common in urinary tract infections. Maybe Theca or CT can shed some light on it?
Anyway, the doctor told Cherie several times "He's lucky he got to the hospital so fast." Apparently this is not a good thing to have.
I did read this, which didn't exactly fill me with encouragment:
quote:Because Proteus and Pseudomonas organisms are gram-negative bacilli, they can cause gram-negative endotoxin-induced sepsis, resulting in systemic inflammatory response syndrome (SIRS). SIRS has a mortality rate of 20-50%.
The surgery yesterday went well, they didn't find as much stuff as they thought and were encouraged. However, he had a very bad night last night, with them unable to control his fever and his pain.
Another surgery is scheduled for tomorrow and they have changed his antibiotic. He's still running a fever and they upped his morphine dosage so now he is pretty much out of it all the time.
Posted by TMedina (Member # 6649) on :
Ouch - at least they know what they're dealing with now.
Good luck Belle.
-Trevor
Posted by Vána (Member # 6593) on :
Belle - I just found this thread. I was hoping you'd be back soon...but...this is not what I had in mind.
We'll be praying for him, and your family. Posted by Olivetta (Member # 6456) on :
(((Belle)))
(((Fael)))
Posted by Bob_Scopatz (Member # 1227) on :
Belle, Fael, & family:
I'm still keeping you in my thoughts and prayers. Identifying the bacteria responsible is a huge step. I hope they are really getting out "ahead" of this infection and that they can make him more comfortable while doing so.
Posted by Dagonee (Member # 5818) on :
Belle, I hope in a month you can all look back on this as the turning point. I'm praying for you and your cousin.
Dagonee
Posted by Belle (Member # 2314) on :
Well, things are looking up!
His fever has broken. The last surgery, the surgeon was encouraged to find that there was very little necrotic tissue, so it seems the spread has slowed.
My husband had a transport to the hospital so he went to see him, and said he was alert and looking much more coherent. Cherie/Fael said he is 100% improved.
The doctors are very encouraged, and the surgery that is scheduled for today (I should hear in about an hour or so) will tell them if it is indeed slowing down.
The infectious disease specialist said that the way things are heading now, he may not be in for as long a stay as originally thought. He also stressed that getting to the hospital and getting IV antibiotic therapy within 15 hours of the incident is the reason things are going so well now.
Posted by Telperion the Silver (Member # 6074) on :
Just goes to show you pain is our friend... if you hurt like death...go to the hospital. Posted by PSI Teleport (Member # 5545) on :
That's really good news! It's great when things go better than hoped, especially in situations like this.
Posted by Belle (Member # 2314) on :
Oh, and I finally got the full story of the catfish.
It was a filetted catfish, someone had apparently caught it, cleaned it, and thrown the remains overboard.
They are almost positive he impaled his arm on the dorsal fin spine of the dead catfish. The size of the puncture corresponds to the size, and it just makes sense, since there was nothing else in the area, ya know?
So...the doctor said "This is a one in a million freak happening."
What are the odds skiing in a lake the size of Logan Martin, and hitting a filetted catfish corpse in the right way as to force the spine into your arm?
Ick.
And yes, it was the pain that drove him back to the hospital that night. The first hospital told him it wasn't broken and to go see his doctor in town if it didn't feel better by Monday.
If he had followed that advice, it could have turned out much differently, because delaying the start of antibiotics apparently can make a huge difference in these cases.
Not only that, the admitting physician called in the surgeon and infectious disease specialists on Sunday. She was convinced it was serious enough to warrant their attention right away.
It appears that everything worked right - he did the right thing by coming back in, the doctors did all the right things.
Now, I am just praying we don't have any setbacks and he continues to improve at this rate.
Posted by BannaOj (Member # 3206) on :
wow, what a story. He will have the end all be all of "fish" stories now!
AJ
Posted by Derrell (Member # 6062) on :
I hope he continues to improve. (((Belle)))
Posted by PSI Teleport (Member # 5545) on :
Belle! *waves* Do you have a moment to email me about something pretty unrelated?
*points to profile*
Posted by Ryuko (Member # 5125) on :
O_o WTF. Wow, Belle. That's insane. I'm really glad to hear that he's better. I pray that he makes a complete recovery.
Posted by Belle (Member # 2314) on :
Well, in surgery today, everything looked so good, they closed the arm up!
They will keep him a bit longer, to make certain he's okay, but unless something unexpected happens he will be going home if a few days.
They had a plastic surgeon close the wound, and he was able to stretch the skin enough to not even need any grafts. He's off all meds except antibiotics and pain meds.
All in all, it was amazing, that he has done so well, a true testament to the wonderful doctors there on staff, and definitely a good cautionary tale - if you're in pain, seek help immediately. Getting treatment so fast helped keep this from being a much worse outcome.
Thanks everyone for the prayers and well wishes, I truely believe in my heart they helped.
Posted by Shigosei (Member # 3831) on :
Hooray! That's great news.
Posted by TMedina (Member # 6649) on :
I'm glad it worked out for the best Belle.
-Trevor
Posted by Kwea (Member # 2199) on :
Glad to hear it Belle. I am glad that everything has worked out so well for him.
Posted by pooka (Member # 5003) on :
Catfish. Blehhhhhhh. Glad to hear things are going well ~~~~Gratitude~~~~~
Posted by beverly (Member # 6246) on :
Hallelujah! I am so glad! It could've been sooooo much worse....
Posted by rivka (Member # 4859) on :
I'm so glad to hear such good news about your cousin, Belle. Posted by Eduardo_Sauron (Member # 5827) on :
Posted by Farmgirl (Member # 5567) on :
This is definately wonderful to hear, Belle! What a blessing!
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Ick. ![[Razz]](tongue.gif)
Glad to hear things are going well ~~~~Gratitude~~~~~