Tuesday, September 25, 2007

Mysterious infection blamed on tongue piercing

By Sharon Salyer, THE ASSOCIATED PRESS, September 24, 2007

EVERETT, Wash. -- Cindi Reedes heard doctors tell her the same frightening words three times in eight days: Her teenage daughter's chances of survival were slim. It would take a near-miracle to save her from the aggressive infection ravaging her body.
The only cause doctors could guess at was the tongue piercing 18-year-old Lacey Filosa got without her mother knowing about it.

For weeks, Lacey wavered at the edge of death, kept in a drug-induced coma to give her struggling body every chance to heal. A tube kept her breathing. Operations to cut out the infection were needed nearly every day.

At her daughter's bedside, Reedes did everything a mother could to let Lacey know she was there. Doctors told her to talk to Lacey as if she were awake.

"My son and I would rub lotion on her feet," Reedes said. "I'd take her hand and say, 'We're here. Come on! Pull through this!'" Sometimes, in response, her daughter would squeeze her mother's hand.
No one can say with certainty what triggered the infection.

Doctors suspect it was linked to a tongue piercing Filosa had gotten in Everett, a type of piercing popular with young adults. Their theory: Bacteria commonly found in the mouth and saliva possibly entered Lacey's bloodstream through the hole punched through the girl's tongue. Once inside, they flourished, triggering a firestorm of infection.

"I kept looking for other causes, but could not find any," said Dr. James Erhardt, the Everett physician who first treated Lacey at Providence Everett Medical Center. "The only thing we could trace it to was the tongue piercing."
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Reedes' phone rang about 7 o'clock on a Thursday evening, March 30, 2006. It was someone from Providence Everett Medical Center. "You need to get here as soon as you can," they told her.
Her daughter was at the emergency room. Doctors had already put a tube down her throat so she could breathe.
Reedes drove to Everett from her Camano Island home in 20 minutes. She was escorted to a treatment room, where she was shocked by what she saw. Her daughter's neck had swollen to "the size of a man's thigh."

All she could think was: "Oh my God, what happened?"

The pieces began to fall into place when she talked to another family member who also was at the hospital that night.
Lacey already had ear and belly button piercings. She'd been working on her mother to let her get one more a tongue ring.
Reedes was dead-set against it.

"I had heard horror stories," she said.
That night at the hospital, Lacey's mom learned that about two weeks earlier, her daughter had gone to a local shop and gotten her tongue pierced.

Lacey, who had graduated from Stanwood High School in 2005, had been living temporarily with a girlfriend, so her mom didn't know.
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At the hospital, swelling in Lacey's throat was so bad it had blocked her airway. She stopped breathing on the way to get a CAT scan.

Erhardt, a specialist in head and neck surgery, was urgently paged to the emergency room to treat her.
The infection was spreading rapidly. She was going into septic shock, a dangerous blood infection. They gave her an emergency tracheotomy so she could breathe.

Then, she was rushed into the operating room where Erhardt cut into her neck and chest. All he could see was infection.
"Way far away in her chest there was pus pouring out everywhere," he said. Pockets of infection kept popping up.

At one point, Lacey had 16 tubes in her upper body to help drain away the infection. Tests showed the bacteria ravaging her body were types commonly found in the mouth.
Yet the extent of the infection and how quickly it spread, Erhardt said, was "the worst I've ever seen" in his 28-year career. "This was an unbelievably horrendous infection." It had the power to shut down all the girl's vital organs.

The surgery took about two hours. When it was finished, Reedes remembers being told: "You guys need a miracle for her to make it the next 12 to 24 hours."
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It took a while for Lacey to work up the nerve to get the tongue piercing. "I didn't think I was going to be brave enough to do it," she said.
She worried it would hurt. But when they stuck the needle through her tongue, she said that she instead felt an adrenaline rush. "It wasn't bad at all," she said.
Lacey did have trouble eating with the barbell-shaped jewelry stuck through her tongue. But she didn't notice any other problems for about a week.

Then, she began to feel unusually tired, as if she was getting a cold or the flu. Her throat started hurting.
She made a dental appointment to recheck an abscessed tooth. X-rays were taken of her mouth. The dentist took one look at the results and said, "You need to get to the hospital right now."
Two friends drove her to the Everett hospital. She later was told that if she had arrived just 30 minutes later, she would have died.

Lacey filled out the paperwork to be treated at the hospital and remembers going through the double doors to the emergency room. A friend held her hand as they hooked an intravenous tube to her arm.
"Then they wheeled me to the CAT scan," she said. "That's when I stopped breathing."
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For two days following her surgery, Lacey seemed to improve. She regained some of her color and even gestured to a nurse to ask her mom to bring her glasses. She wanted to watch TV.
On the third day, though, she took a turn for the worse. She was taken back into surgery to clean out more infection.

By the fourth day of her hospital stay, Monday, April 3, her blood count was dropping. Doctors performed yet another surgery. That evening, they put her into the drug-induced coma so her body would have a better chance of fighting the infection.

Erhardt, her surgeon, couldn't fathom what was happening. He would operate to drain her infection. But it would rebound back as strong as ever.

"We had her on the biggest-gun antibiotics and she still wasn't doing well," Erhardt said. "She kept forming abscesses." And her condition continued to worsen.

Finally, on a hunch and maybe even a sense of last-chance desperation, he called Virginia Mason Medical Center with a hypothesis.

Its hyperbaric chamber had been used to treat cases of flesh-eating bacteria. He wondered: Could its oxygen-saturated environment help Lacey's body smother this infection?

On Friday, April 7, she was taken by ambulance to the Seattle hospital. On Saturday morning, three doctors pulled Lacey's mom aside. For the third time, she was told that Lacey's chances for survival were slim.
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For seven straight days, Lacey underwent the same grueling treatments: First she was wheeled into the hospital's hyperbaric chamber for 90 minutes of oxygen treatments. Then she was taken, on life support, to surgery, where doctors cut away some of her infection from her neck and chest.

Little by little, her mom saw improvements. Lacey would sometimes use her hands to signal to the nurses, asking for a piece of paper and a pen. Her breathing tube prevented her from speaking.

"I have about seven to eight pages of her notes and half of them I can't even make out," her mom said. But a few of Lacey's messages cut through the mental fog caused by her medications and treatments. "Where's my mom?" one asked. Another said simply "I love you."

There was no one point where she seemed to turn the corner, her mom said. One day, after three weeks in the intensive care unit, "she just snapped out of it."

One hospital worker told Lacey's mom that Virginia Mason had treated five people in the previous four weeks with similar types of out-of-control infections. Only two survived. Lacey was one of them.
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Although Lacey's life was saved, the combination of the infection, surgeries and other treatments had ravaged her body. Slim even before her illness, she had shed 32 pounds, leaving just 110 pounds on her 5-foot-9 frame.

"It's like her muscles were just not there," her mom said. Physical therapists worked with her to help her regain balance. She learned to walk with a cane.

And after weeks of having a tube in her throat, she even needed help from a speech therapist to regain her ability to talk.

But Lacey had a goal, and in her mother's words, she was bound and determined to meet it: She would celebrate Mother's Day, on May 14, at home, not in the hospital.

"She was still weak when she came home, but she was alive," her mom said. "That's all that mattered."
The potent medications she was given and the seriousness of her illness erased most of Lacey's memories of her hospitalizations. She didn't really know the full extent of her problems or how close she was to death until she began flipping through her medical records. "She broke down," her mom said.
"I still do," Lacey said. "It's hard to look at it."

Lacey continued to recuperate at her mom's home, subject to what she jokingly calls "medical house arrest."

At first, she said, she wasn't allowed to leave. But then she paused, saying what was even harder to say: "I didn't want to leave."

Doctors and friends told her how lucky she was to be alive. She knew it and agreed. But once she was home, she battled bouts of depression and periodic anxiety attacks.

"I had really good people around me when I got out of the hospital to help me get my strength back and everything back to normal," Lacey said. "Like my mom. That's who I give my biggest thanks to."
When friends who hadn't been allowed into the hospital's intensive care unit finally were able to visit her at home, they would greet her with outstretched arms. "Don't hug me too hard," she would tell them. "It still hurts."
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For weeks after she left the hospital, Lacey couldn't bring herself to look in a mirror. Her neck has two big scars, and another runs under her chin. There's a scar left by the breathing tube placed in her throat. A long scar starts under her bust and continues to her right shoulder blade. On her left side left is a scar healing over a bullet-like hole from where her chest tube had been inserted. People often ask if she's been in a car accident.

"No," she tells them. "I got my tongue pierced."

The bills for her medical care hit nearly $525,000, her mother said. Luckily, insurance paid all but $1,000.
In July, attorneys filed a lawsuit in Snohomish County Superior Court on Lacey's behalf. It alleges the Everett business where she got the tongue piercing was negligent. The business denies the charge.
No one knows how many times piercings have caused dangerous infections. That's one of the reasons Lacey's mom said she's urged her daughter to talk about what happened.

"She's so quiet and modest. I keep telling her you might save another family from going through the hell we went through."

Time heals. There's only a small dent left in her tongue from the piercing.
The barbell was given to a friend who helped drive her to the Everett hospital. He wore it as an earring for a while.

Her confidence has so increased that the young woman who once avoided looking in mirrors and didn't want her picture taken for a year after leaving the hospital has asked photographers to take model-like photos of her three times since July. "It makes me feel better about myself," she said.

Lacey celebrated her 20th birthday in August and now lives in Des Moines. She works part-time at a wholesale jewelry business and is going to a nearby technical school taking multimedia classes.
Her mom, who has since moved to a Chicago suburb, hopes that Lacey will someday turn her medical ordeal into a cause by speaking to parents, middle school and high school students.

They need to hear that a tongue piercing, what may seem like a decision made on a whim, can sometimes have life-threatening consequences.
"It's not something I want any other family to go through," she said. "As a mother, I relive it about every day: How could I get her through 18 years of life and all of a sudden they're telling me she could be gone in 12 to 24 hours?"

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