The "Rest" of the Story

Dr. Shari Emails:

THE REST OF THE STORY...
I've been hesitant to ask before and give you more to write about, but now that TJ is improving, I wonder if you could tell us how this all began, I.e. Events before hospitalization and intubation.

Stay with me as I throw out some seemingly random facts.

Through November, TJ had spent approximately 150 nights away from home. In late November (I believe the week of the 18th, but don't hold me to it) TJ got a slipped disk in his upper back. On November 29th TJ went into the dentist with a sore tooth, they found it was infected and pulled it.

All of us have bacteria sitting and growing in our mouths, not a big deal. About a third of us in the US have staph bacteria on or in us, and 0.84% carry MRSA. (Mary Ann probably has a greater chance of contracting and spreading MRSA due to her job as a school nurse.) Still not a real big deal -- until you throw all of these together.

For TJ to come down with MRSA he first needed some sort of opportune entry point into his body, we believe that he actually contracted MRSA when he had his tooth pulled. The wound left from the tooth was an open door.

Next, his immune system had to be running at less than 100%, traveling half of the time (literally, half) will do that to you.

For those of you counting, there is a four day break between when TJ is thought to have contracted MRSA and when he entered the hospital. Due to the slipped disk TJ was on a fair amount of pain meds, which would have masked initial symptoms of an infection. He might have been running a fever over the weekend between the dentist and the hospital (or should have been) but we wouldn't know. Also, pain in the chest or sides would have been masked to a certain degree.
By Monday TJ was feeling ill enough that he agreed to go see a doctor the next day (this is a big deal, it means he really wasn't feeling well). By Tuesday morning, Mary Ann took a look at him, suggest the ER and TJ agreed.

The initial diagnosis was congestive heart failure, and then pneumonia after an MRI. By Thursday we lacked a working a cause for the pneumonia but thought we were turning a corner. Friday things didn't look as rosy, on Saturday he was intubated.

Also on Saturday the doctor of infectious diseases was confident that TJ had a fungal infection causing the pneumonia so they did a bronc wash. Initial results were negative, but he was put on an anti-fungal antibiotic just in case. By Monday, however, we had the cultures back and it was obviously not fungal.

Finally, Monday (12/10) afternoon he was officially diagnosed with (CA)MRSA.

From there it has been a wild ride, with at least one near-death scare (at least it was at the time), heart rates of 235 combined with a fever of 103.2, a torn then miraculously better mitral valve, and more.


Addendum
MRSA is already something of a "superbug" in and of itself. This case has been weird enough that some of the doctors are wondering if this isn't a new mutation of MRSA. E.g., an überbug (über means "super super"). Doctors have been waiting for the überbug, but have yet to find it.

Time and labs will tell.