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Monday, October 22, 2007

Here's the "short" version of my story:

TENS is a severe adverse reaction to medication (a more severe version of Steven Johnson Syndrome - SJS), which causes the epidermis to blister, die and come off over 30% of the body, internally and externally. In my case it was over 80%.

I live in Decatur, GA where I was misdiagnosed twice by one hospital and then correctly diagnosed at another hospital and then sent for treatment at a third hospital where I stayed for over a month in the trauma burn unit. I wish to be on your program because I appreciated to way you have handled peoples stories in the past and because I am alive because that little voice in my head simply would not stop telling me that something was REALLY wrong.

Here's the long version of the story - please excuse any repeat of information - this is the same version of the story that I have shard with people in my online support group. I apologize for the length.

I am a 30 year old caucasian female and the short version of my story is that I developed TENS over 80% of my body and spent over a month in the trauma burn unit at Grady Memorial Hospital as a result of taking Piroxicam (Feldene).
Here's the long story - I am going to try to be as specific as I can, so that people may contrast and compare thoroughly. I feel that this is the best way for us to better understand the what and why of SJS/TENS. If I seem to state the obvious for some things, please keep in mind that not all cases are the same and some other people may need explanation. Also, please excuse any misspellings.

As of June this year (2007) I was in fairly good health prior to this incident, with the exception of having severe pollen allergies with asthma and mildly bad joints. I am also moderately allergic to many fresh fruits and vegetables and tree nuts. Latex has also caused minor irritation to my skin (i.e. I cannot use traditional condoms). Last, I had a reaction to the antibiotic Augmentin a couple years ago in the form of a rash on my stomach and legs as well as feeling hot - not like a fever but internally hot - a feeling I am sure most of you are familiar with. Looking back and knowing what I know now, it is my personal belief that I experienced Erythema multiforme from the Augmentin. At the time I was treated with a shot of steroids and discontinued the medication and the symptoms went away.

Then, on June 2nd of this year (2007), I noticed that what I thought was a vaginal yeast infection was not improving but getting worse, even though I had used a over-the-counter yeast infection treatment that I had used with success in the past. In addition, my eyes were irritated and had some mucus in them (not from an outside source - I was not using any kind of eyedrops and I did not have contacts or glasses).

I was concerned that instead of a yeast infection I might have a urinary tract or bladder infection, so I decided to go to the hospital emergency room (because it was a Saturday). After waiting many hours I finally was seen by a doctor. By this time my external vaginal area was inflamed and somewhat painful to the touch. My eyes also continued to be affected with mucus. In addition, I could feel that my mouth was beginning to get sores - I could feel my gums swell in places and I had that distinct metallic taste of blood.

It was faint and the doctor claimed she couldn't see anything when I asked her to look in my mouth. I was struck by and mentioned the oddity that all of my mucus membrane areas were reacting at the same time. The doctor brushed it off as mere coincidence, saying that I just had a bad yeast infection and just needed regular eyedrops for my eyes, completely disregarding my mouth. I left the hospital, got my yeast infection prescription filled and went home. I applied the medication as prescribed but over an hour later I still was continuing to feel worse and not better.

I called the hospital and somehow managed to speak to the doctor I had seen. I asked her if I should have at least some relief from the vaginal cream and she said yes. I told her my situation and she advised me to come back to the hospital. It was around 11:00 p.m. at this time, but I went anyway because of my increasingly inflamed and painful state. I was taken to a room fairly quickly, but once I was there I had to wait a long time again.

By now I was unable to sit because of the pain. My eyes were worse and my mouth felt very raw. My fiance noticed small red pimple-like spots on my back. A different doctor saw me and told him about my previous visit. He did pay closer attention to my eyes - he put some sort of florescent dye in them and looked closely with a blacklight flashlight. This was his diagnosis: a really bad yeast infection and a viral infection in my right eye.

The connection of all mucus membrane areas and the red spots were brushed off as nothing and I was told that these are not issues that are important enough to come to the emergency room for and I should not come back. By now it was around 2 a.m. and I went to the pharmacy to get my prescription eye drops. I went home, took the medication and went to bed.

I woke earlier than usual the next day (June 3rd) in a state of anxiety - I KNEW something was not right. Over the course of a couple hours, the red spots spread, my lips began to swell, my skin looked grey and I felt hot. (As with the Augmentin reaction - this heat is different from a regular fever. I felt hot in my body, like my insides were boiling) I decided to go back to the emergency room - a different one this time.

When we pulled up to the ER my breathing was becoming labored and I was processed fairly quickly. At this time I asked my fiance to document how I looked with his camera. (He continued to take pictures throughout the whole experience. I am debating whether or not to post them) The first photo shows me with red spots all over my body, red inflamed eyes and huge, swollen lips.

The ER staff quickly realized that I was having some sort of reaction and, because they are a teaching University hospital, called in a group of various specialists to look at me. At first it was a toss up between adult chicken pox (shingles) and SJS. They put me in a private room, put me on IVIG and took a skin biopsy. I was kept there overnight for observation. The diagnosis of SJS from the NSAID Piroxicam came in the morning after I was moved to their ICU because my breathing had become difficult again.

By now the red spots were getting bigger in size and it was clear that this was not going to pass quickly or easily because I had been on the Piroxicam at the strongest dose for over a month and this particular medication has one of the longest half-lives of any medication on the market. In other words, it builds up in your system and it takes a very long time for it get back out. I was put in an ambulance and taken to Grady's trauma burn unit in Atlanta, Georgia. I stayed there until July 6th.

Over the course of my stay the SJS became TENS when over 80% of my top layer of skin (the epidermis) blistered, died and came off. I was treated the same as someone who had 2nd degree chemical burns - only mine came from the inside out. My internal organs also sloughed, causing my throat to get filled up with dead tissue. I was given a catheter - a very painful event because by then my vagina was so severely inflamed that even regular urination felt like razor blades (please know I am not exaggerating). I was given Hydrotherapy every day - an intensive bath in which dead skin is actively removed. After a week I was put into a medically-induced coma with the drugs Versed and Phentonyl, given a tracheotomy and put on a ventilator.

I stayed like that for over 3 weeks, including 10 days when my lower layer of skin (the dermis) was almost completely exposed and my epidermis (top layer of skin) was failing to grow back. With each day that passed my chances of survival decreased greatly. Amazingly, my skin finally began to grow back and my recovery thereafter was actually fairly and comparatively fast. Over time I began to breathe on my own and learned to walk again. On the second to last day the feeding tube that had stretched all the way from my nose down to my lower intestine and the life-saving yet annoying tracheotomy in my neck were finally removed.

Since coming home this has been my life:
-Moisturizing my dry, scarred skin, including the patches on my left arm where I had a secondary infection and on my neck from the tracheotomy
-Dealing with my severe dry eye by using preservative-free eye drops, Restasis eye drops and nightly ointment (I don't believe the Restasis is working)
-Not being able to drive, work or do any other eye-focus oriented activity
-Going to physical therapy twice a week for strengthening, stretching and conditioning
-Trying to find a general physician who will be my doctor. I was turned away by 7 so far
-Going to appointments to see Dermatologists, Opthamologists, Rhuematologists, Gastroenterologists. etc.
-Having to stay out of the sun
-Struggling with chronic fatigue
-My pre-existing allergies and joints continue to be problematic and now I am advised not to use any medication unless I absolutely must, so treatment is tricky at best
-Last but not least, I had to postpone my wedding. It's hard to be bride when your fingernails are falling off, you have a bald spot right on top of your head and your skin is unpleasant to look at. I would say the emotional toll is nearly as great as the physical.

Thank you for taking the time to read my story. I hope the information herein is helpful to others. Feel free to contact me if you have any questions.

1 comment:

Gris said...

Hey Kate! For some reason I hadn't read your blog, but reading it I totally understand what it was like for you. (The razor blades... I couldn't have said it better). It is so painful!!! I just need to tell you, we are very blessed to be alive and fairly normal.
I just hate the fact that we were both misdiagnosed, I went to the ER 3 times!!! Thankfully we were stuborn enough to insist and keep coming back until they helped us. Yey for that little voice inside!!
Hugs!!
Griselda :D