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Monday, December 22, 2014

Dr. Pegs Prescription

Washing hands and developing clean habits can ward off life-altering infections

It was the summer of Joseph Paz’s sixteenth year. As a high school junior in Las Cruces, his days were filled with basketball and track. He and his friends dreamed of becoming world-class athletes. Joseph was a good runner — good enough that a college scholarship was a distinct possibility. Life was good, the future bright.

One morning he woke up with pain in his right leg. Initially he shrugged it off, but it steadily got worse, until by the end of the day he could hardly walk. He started to feel sick. He developed a fever. He went home and called his aunt, who happened to also be his doctor. She evaluated him and sent him for an ultrasound of his leg, on the off chance he could have a blood clot, a rare finding in a young man. In the middle of the scan, the tech left the room to call Joseph’s aunt with the bad news that he indeed had a clot all the way down his leg.

Things quickly went from bad to worse. Joseph was admitted to the hospital, where doctors determined that he had a blood infection which had caused the clot. The infection had already settled in the aortic valve in his heart. Initially unable to isolate the infecting organism from his blood, they finally found it by aspirating fluid from his knee joint. It was Methicillin-resistant Staphylococcus aureus, or MRSA.

Staphylococcus aureus means “golden cluster of seeds” in Greek, because that’s what it looks like under a microscope. Staphylococcus, or “staph,” is a common sort of bacterium. One in three of us carries some kind of staph in our noses, unbeknownst to us; a benign ride-along. Some kinds of staph cause food poisoning, others cause skin infections. Most kinds of staph are readily killed by common antibiotics.

MRSA is named for its ability to resist antibiotics: first penicillin, then a derivative, methicillin. MRSA got its power from merging with a virus, which helped it produce a chemical weapon that deactivates some antibiotics. The Centers for Disease Control estimates that 2 percent of Americans carry MRSA all the time, without knowing it or being bothered by it. But when it decides to cause trouble, it can be serious. The CDC estimated that more than 94,000 people suffered a serious MRSA infection in 2005, and more than 18,000 died.

Fortunately, the incidence of invasive MRSA infections is declining. Most MRSA infections we see at SHAC are local skin abscesses, which we treat with drainage and antibiotics. Experiences like Joseph’s are mercifully rare, but deadly serious.

Where did Joseph contract MRSA? He will never know exactly. He had been troubled by an infected ingrown toenail. It could have been that. One of his teammates had recurrent skin boils. It could have been that. “We were constantly sharing things — towels, socks, clothes. I never thought twice about it.” He thinks differently now, as you will see. MRSA can be spread through shared items, and a cut or break in the skin makes it easy for it to take hold.

An infected heart valve will disintegrate, and you can’t live with a disintegrated heart. Joseph was taken to the operating room and his infected valve was replaced with an artificial valve. But the infection was too entrenched. It spread to two other valves in his heart, and into the bones of his leg. The antibiotics he was getting in his IV couldn’t reach deep enough. He needed more surgery.

Joseph was transferred to Texas Children’s hospital in Houston, and his family gathered around him. He underwent operations to remove infected bone from his leg. The doctors took him back for a second open heart surgery. The aortic valve was replaced again, and two other valves were cleared of infection and reconstructed. He spent weeks in intensive care. It was touch-and-go. Twice the priest was called to give him Last Rites.

Joseph survived. He lay in his hospital bed for weeks, too feeble to sit up. He had lost 30 pounds, and he was a slim runner to begin with. His rebuilt heart slowly recovered. The doctors told him his leg wouldn’t tolerate competitive running. He felt fragile and depressed. There were some very dark days.

Thankfully, Joseph is made of strong stuff. His family values perseverance and is filled with living examples. One of his doctors shared her own story of battling cancer at his age, and how she came through it. All of this helped, but it was his own inner fortitude that made the difference. Joseph reached a point of determination. He realized he could either stay down or rise up. He decided to rise up.

“I didn’t want that experience to define me,” Joseph told me. He got out of the hospital, went home and finished high school. Not only did he finish, he did it on time with his peers and with a 4.0 average. He was accepted at UNM and came north.

Having gone through what he did, it would be understandable if Joseph chose to live in a bubble, or at least alone. But no — he wanted the whole college experience. He lives in a dorm with three roommates. He did make it clear that he would not be sharing towels or anything else, and who could blame him? “I’m not a germophobe,” he told me, “but I do take precautions.”

In the first years after his brush with death, he didn’t want to even think about MRSA, much less talk about it. But time and distance have brought perspective, and now he wants to educate others. His basic message is simple, but powerful:

“Be conscious of decisions you make on a daily basis. Don’t share clothes, towels, razors or anything else that gets close to your skin. Take care of your skin; it’s your number-one defense. Wash and sanitize your hands and stay clean.” It’s good advice, and will help protect you from MRSA and other germs.

Joseph has arthritis in the knee from his surgery. He doesn’t run competitively anymore, but he does swim and ride a bicycle. The recipient of the 2013 Raymond E. Plotkin scholarship, he is majoring in chemical engineering and hopes to eventually work in a biomedical field. His rebuilt heart is working great. He only sees doctors about once a year now.

“I can’t say that most days I don’t wish it hadn’t happened, but it has changed my outlook on how I live. I appreciate each day now,” Joseph told me.

Thank you, Joseph Paz, for sharing your important message and your inspiring story. I know your experience will help others. I wish you well.

Dr. Peggy Spencer is a physician at Student Health and Counseling. She is also co-author of the book “50 Ways to Leave Your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous.