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Man survives bout with flesh-eating disease

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MARCIA A. NELESEN
November 12, 2007
— Dennis Cormier woke at 6 a.m. Wednesday, Aug. 15, and noticed his elbow was a bit sore.

That benign moment was the beginning of a horrific nightmare.


The next night, Cormier would be in the burn unit at UW-Madison.


Cormier had necrotizing fasciitis.


He has said the words about a thousand times now, so he says them easily. People otherwise know it as flesh-eating disease.


The underside of Cormier’s left forearm is the only physical reminder of his brush with death. Shiny, pink skin from a graft covers the area, with a thinning line of pink heading toward his armpit. A small, innocent-looking hole is at the tip of his elbow.


Cormier will wear a compression sleeve for a year to minimize disfigurement.


But really, he’s one of the lucky ones.


Forty percent of the people who have necrotizing fasciitis die, his surgeon said. Many lose limbs and other parts of their bodies as doctors desperately cut out the sickness to halt the spread.


“When you do see it, it is very life-threatening,” said Dr. Pat Garner, the Mercy Hospital surgeon who treated Cormier. “There are not a whole lot of surgical emergencies, but that’s when you bump everyone else in the OR and say, ‘I’m coming in. I’m coming now.’”


Cormier, 37, still is assimilating the enormity of what happened to him—and what could have happened. He is married with three little boys, and every day he is grateful that he will be here for them as they grow.


Cormier agreed to talk about his experience so others become aware of the disease and its symptoms. Early detection is crucial, but the disease often is misdiagnosed because it is uncommon.


That Wednesday—“the longest day ever”—Cormier noticed his elbow was a little bit swollen, a little bit hot.


He and a group of co-workers left that morning for a business meeting in Lake Forest, Ill. Cormier works for Lab Safety Supply.


By noon, Cormier knew he was sick. He was nauseous and had chills, cold sweats and a fever. He couldn’t concentrate.


He remembers thinking, “‘Wow, this is weird.’ As we’re sitting there, talking about financial reporting, I’m sitting there thinking ‘My arm is hurting more and more.’”


He was sick enough that he and his co-workers ended up by early afternoon in the emergency room in Lake Forest. “I had gotten so much worse in that short of time, I didn’t know if I could wait several more hours more before getting back home,” he said.


There, staff diagnosed cellulitis, a potentially serious bacterial infection. He received an IV of antibiotics and an ACE bandage.


What I’ve learned about this infection is, ‘It’s almost always misdiagnosed the very first time,” Cormier said.


Once home, Cormier got sicker and sicker.


“It was the worst I ever felt in my life,” he said. He would learn that is how everybody describes the symptoms.


Later that night, Cormier’s wife, Michelle, read the cellulitis information and realized her husband already should already have improved with the initial dose of antibiotics. But his swelling was worse, puffing past his ACE bandage.


At 10:30 p.m., they went to the Mercy Hospital emergency room, and Cormier was admitted.


Garner recalls seeing Cormier the next morning. His skin was red, warm, swollen and painful, but didn’t look impressive at that point, she recalled.


But necrotizing fasciitis was always at the back of her mind. She did her training in the Navy in San Diego, where the SEALs trained, and had treated five cases.


“They punish their bodies so much, it (necrotizing fasciitis) was pretty common for them,” she said. She also treated three cases when she was stationed in Guam.


Time was not linear that Thursday for Cormier, who was in terrible pain.


He remembers a progression of doctors and tests—ultra sounds, an MRI, X rays—and taking every antibiotic that staff could throw at him. Personnel drew lines at the outer edges of the swelling to track the disease’s spread. Then, they drew new lines.


The raging infection marched in a relentless line toward his wrist and armpit.


“The hallmark is its progression,” Garner said of the disease.


“He (Cormier) just progressed that whole day. (It was) increasing in front of our eyes. People start to look pretty sick overall.”


The only thing that stops it is surgery.


“I know I’m saving a life,” Garner said. But she also knows the results will be disfiguring.


“Every time I’ve taken a patient to the OR, I hate it. It’s a debilitating surgery … We’re skinning these people. We’re taking skin and subcutaneous tissue off. You make an incision, and you keep taking the tissue until you’re down to normal tissue.”


Otherwise, the disease will spread to the muscle, which leads to amputations, and to the bloodstream, when the body shuts down.


At about 6 p.m. Thursday, Cormier was prepped for surgery. The infection had spread to his wrist and his armpit. His arm was more than twice its normal size.


He recalls the doctor warning him that the surgery could be devastating.


“Are they going to cut this thing off, or what?” he remembers thinking.


Garner cut the diseased flesh from the underside of his arm—“a significant amount”—to halt the infection’s spread.


The surgery left him with exposed muscle, kind of like what you’d see in an anatomy book, Garner said. The wound was wrapped but left open.


The next thing Cormier knew, he was wheeled to a helicopter and flown by Med Flight to Madison.


“I knew I had surgery; I knew I still had my arm—which was a good thing,” Cormier recalled. “I was just kind of along for the ride.”


Cormier had another surgery Friday at University Hospital, where surgeons made sure all the diseased flesh was removed. He had a skin graft on Tuesday.


“Oh yeah, let’s not forget that part,” Cormier said in recounting his ordeal, describing the two large strips of skin cut from his leg, up to a foot wide and six to eight inches long.


“That was delightful,” he said dryly.


Cormier returned home from the hospital Aug. 24. A month later, he returned to work.


Cormier’s skin is still tight and painful, but he eventually should regain full mobility.


He didn’t realize until later, when he did research, exactly what he went through and survived.


He urges everyone to learn the signs of the infection and listen to their bodies.


His chances of getting it again are about the same as the rest of population, which is rare.


Garner pointed out that nobody close to Cormier got the disease.


“I think he unfortunately got into contact with this (bacteria) and touched his elbow,” Garner said.


Her advice? Practice good hygiene and keep wounds clean. If you have a red area that is swollen and hot, get to a doctor and get it treated early. If it doesn’t get better, come right back in. Don’t wait four or five days, she said.


“I will tell you one thing,” Cormier said.


“I am a lot more conscious of washing my hands than I ever was before. I’m not creeped out about it, but every once in a while, I’ll say, ‘Alright, everybody, wash your hands, get out the antibacterial soap and clean.’”


Cormier said he never asks, “Why me?”


“I don’t’ need to know,” he said. “There’s no answer to that. I don’t feel like I’m a victim.


“It did happen, and I can’t change that. I do feel a lot more grateful now, just for the little things.


“I know there are people who have had this who have suffered a lot more than I did.”


“Lucky is the word,” he said.


Talking about necrotizing fasciitis

Questions on nectrotizing fasciitis answered via the National Necrotizing Fasciitis Web site:


Q: What is necrotizing fasciitis?


A: Necrotizing fasciitis is a bacterial infection caused commonly by group Strep A bacteria, the same bacteria that causes strep throat. An especially strong variant causes life-threatening cases known as “flesh-eating bacteria.” The bacteria releases toxins and destroys skin and muscle.


Necrotizing fasciitis is different than the staph infections recently in the news. That is MRSA, Methicillin-resistant staphylococcus aureus, a severe skin infection caused by bacteria resistant to common antibiotics.


Q: How do you get necrotizing fasciitis?


A: The bacteria enters through an opening or even a weakened part of the skin, such as a bruise. An infection also can occur after major trauma or surgery. In some cases, the point of entry is never found.


Q: Who gets it?


A: The disease is rare. But the mortality rate is as high as 40 percent, depending on the source.


The bacteria is transferred by respiratory droplets or direct contact with secretions of someone carrying Strep A. Those people are often just carriers and not even sick. They cough or sneeze, and another person picks up the bacteria on their hands or directly at the point of the wound.


NF patients are not likely to be contagious, and inanimate objects also are unlikely points of transmission.


Q: Can I prevent it?


A: You can protect yourself by practicing good hygiene, especially washing your hands often with anti-bacterial soap. Avoid contact with people with sore-throat symptoms. Clean and care for even the smallest wounds, using antibiotic ointments and sterile coverings. Frequently change the coverings.


Also, cover your mouth when you cough or sneeze and throw away tissues. You could be a carrier and not know it. Fifteen percent to 30 percent of the population carries Strep A at any given time, usually with no symptoms.


Q: What are the symptoms of nectrotizing fasciitis?


A: They are:


-- Pain in the general area of an injury that gets more and more severe.


-- Flulike symptoms, including diarrhea, vomiting, naseau, fever, confusion, dizziness, weakness.


-- Dehydration.


-- The most telling symptom of all is if you have all the symptoms combined. In general, you probably will feel worse than you’ve ever felt and not know why. Any time all of the early symptoms are present, go the doctor and insist that nectrotizing fasciitis be ruled out.


The majority of cases are misdiagnosed because the disease is uncommon. Most emergency room personnel have never seen it.


Prompt diagnosis is the best treatment.


Advanced symptoms include:


-- Swelling.


-- Large, dark marks that become blisters filled with a blackish fluid. The wound may be bluish-white or have a dark, mottled, flaky appearance.


The critical symptoms include:


-- A severe drop in blood pressure. The body begins to go into toxic shock from the toxins given off by the bacteria.


Q: How is the disease treated?


A: Patients are treated with antibiotics, and the diseased flesh must be removed. Minimal scarring is the best you can hope for.



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