Posted on January 11th, 2019
Teri ORourke, wife
On February 12, 2018, my husband did not feel well. He had aches and pains, fever and was very tired. The flu was going around our town and we attributed it to that and so he stayed home from work. By February 15 he was not getting better at all. He still had a high fever, was very weak and not eating so I called our local doctor who stopped by the house. He checked his vitals and thought he was very dehydrated so he strongly suggested I take him to the hospital.
That night we went to the Emergency Room and the physician took blood, did a routine CT of the abdomen and pelvis, hooked him up to IV for fluids, took several chest X-rays. Peters neck and abdomen were very tender and painful and the doctor suggested a spinal tap to rule out meningitis. Peter was also tested for influenza A and B. The CT, spinal tap and influenza tests all came back negative, however there was “opacity” in his left lung which may reflect pneumonia. (Sepsis and Pneumonia) His BP was 122/73 (which was relatively low for him), his HR 115, RR 28 and O2 saturation 88%. He was put on a broad spectrum of antibiotics, pain medicine including morphine, oxygen and stayed overnight.
The next morning the doctor believed Peter was doing better, however, his white blood cell count was elevated as well as the bun/creatinine levels high. His BP was now 108/58 which was extremely low and his oxygen needs also increased. Looking hindsight he was trending downwards…
The blood cultures became positive with gram-positive organisms growing in anaerobic bottles. Flagyl was added to better cover anaerobes. Another chest x-ray show increased fluids in lungs. At 3:00 in the afternoon, the doctor was called in as Peter was now in acute hypoxic failure and bacteremia. He determined that Peter needed to be intubated immediately and he needed to be urgently transported by air to an ICU. While waiting for the emergency helicopter and paramedics to arrive, Peter went into respiratory failure and tachycardia. The paramedics were rushed in and were able to administer several key drugs to bring him back from the brink and stabilize him enough to fly to St. Mary’s.
Peter was admitted to the ICU on February 18 with principle diagnosis of pneumonia due to methicillin susceptible Staphylococcus aureus, acute respiratory failure with hypoxia, bacteremia due to SA, vertebral osteomyelitis acute, phlegm, acute bacterial endocarditis, septic shock and hyponatrema. He was seen by critical care doctors, infectious disease doctors, neurosurgeons, cardiologists, orthopedic surgeons.
While in ICU he was unconscious for 7 days while waiting for the correct antibiotic to work. He was on nafcillin but repeat cultures continued to be positive. They added gentamicin but he quickly developed allergic reactions to it. Additional MRI showed acute osteomyelitis from C1-C6 and (no wonder his neck hurt so bad) and a TEE now showed vegetation on his tricuspid valve. He was extubated on February 23rd and it took several days for him to be able to talk and clear his lungs.
For the next 8 days he continued to show good improvement and was moved out of ICU to start PT/OT. He was so weak that it took everything in him to stand, much less walk. He was discharged on March 3rd.
Once home, Peter slept 15-18 hours a day. He needed a walker, oxygen and had an IV with nafcillin hooked up to him 24/7. He would be on antibiotics for at least 8 weeks and a nurse would change out the IV site once a week. The once strong 230 pound 6’3″ man had lost 20 pounds and so much muscle mass. He woke up with nightmares and I was worried he would start getting depressed because he wasn’t able to walk and his body hurt.
Over the next 2 months, he slowly gained weight and became slightly stronger. However, his balance was off and he wasn’t able to bend down or walk down stairs easily. On May 3rd all of his blood test levels were almost perfectly normal and he was taken off of the antibiotics. Less than a week later he woke up in the middle of the night in extreme pain in his lower back. We both freaked out thinking the bacteria had come back. We immediately went to the emergency room and again they did a battery of tests and knowing his recent medical history advised him he must stay in the hospital overnight. The diagnosis was viral pneumonia and somehow during his recovery his immune system was still down enough for him to acquire a viral infection. He was released from the hospital and stayed another week at home.
Now here we are almost 11 months since the first emergency visit. I have learned so much about sepsis and the underlying causes and signs that one should be aware of. Low blood pressure, high heart rate, high fever, high white blood cell count, bio-markers such as C-Reactive protein. Looking hindsight the small emergency room was not able to see how seriously ill Peter was and he should have been transferred to an ICU much sooner. Peter is 95% back to normal but he does have bad days where joints hurt and I suspect he will have arthritis wherever the staph went. He has to go in every 6 months for an echocardiogram to monitor his tricuspid valve and adjacent ventricle. He still wakes up every now and then remembering some bad parts and he can’t believe how sick he was. The doctors are surprised at how well he is doing. One last note, we live in a small town and last winter there were 5 serious cases of sepsis and all very different in nature and outcomes.