Sepsis Kills More Than 375,000 Americans Each Year

Sepsis was the most-expensive reason for people being taken to the hospital in 2009 in the U.S.


 
 

Suzanne Hoholik, The Columbus Dispatch | | Monday, December 12, 2011


COLUMBUS, Ohio -- Gripping a metal rail with his left hand, Tim Wykle takes a few wobbly steps in a medical office before letting go.

At the end of the rail, he turns around and walks back unaided. Then he does it again.

After a few minutes, Wykle slows down to concentrate on balance, something he will have to work hard to regain.

He doesn't mind the work. After nearly six months of sitting in hospital beds, wheelchairs, couches and chairs, Wykle is walkingagain.

It wasn't a stroke that robbed the 53-year-old Logan man of his mobility. Or a car crash or gunshot wound. ·

But it is just as scary.

It was sepsis, a disease caused by a bacterial infection that federal estimates say kills more than 375,000 Americans each year -- more than the number of deaths from prostate cancer, breast cancer and AIDS combined, according to the National Institutes of Health.

The number of sepsis cases has increased by an average of 6 percent a year -- up 153 percent from 1993 to 2009. Medicare is the biggest payer for this disease, covering 58 percent of the patients.

And the cost is staggering: Sepsis was the most-expensive reason for people being hospitalized in 2009 in the United States. Treatments that year totaled almost $15.4 billion and accounted for 1.7 million hospital stays, according to an October report from federal health officials.

Sepsis has cost Wykle his right hand, his left foot, parts of the fingers on his left hand and the toes on his right foot.

Despite the year he has had, Wykle is adjusting. He is being fitted for a prosthetic leg and arm, and he said he doesn't dwell on "Why me?"

"I try to concentrate on what I have to do instead of what I could have done," he said. "I want to get up every day and get back into what I used to do, but it ain't going to happen.

"When I get up and go now, it's going to be all new. I got to put my leg on."

When sepsis occurs, the body releases chemicals into the blood to fight the infection, triggering widespread inflammation.

This inflammation causes the blood vessels to dilate and the cells that make up their walls to separate. The vessels become leaky, and tiny blood clots form in the vessels, blocking nutrients and oxygen from reaching organs.

That causes the organs to shut down.

Something as innocuous as a urinary tract infection, the flu or pneumonia can spur sepsis. In about 10 percent of cases, doctors can't identify the infection that led to sepsis.

Treatment with antibiotics needs to begin immediately for patients with suspected sepsis, said Dr. James O'Brien, a critical-care specialist at Ohio State University Medical Center. "Not giving a guy antibiotics is like not giving a guy in cardiac arrest CPR."

Sepsis symptoms include fever, chills, confusion and rapid breathing and heart rate.

There is no single test for sepsis, but a blood test that shows elevated white-cell counts can help with the diagnosis.

"Sepsis is like a torpedo to a boat," O'Brien said. "This is an epidemic that kills us all the time. If this was a new disease that killed this many, we'd be getting attention."

The night before Easter, Wykle awoke in a cold sweat. By the next morning, he was dizzy, feverish and sick to his stomach.

He lay in bed while his family ate the Easter ham his wife, Debbie, had spent the day cooking.

The next day, he started vomiting. He called his wife at work, and she took him to Hocking Valley Hospital in Logan.

"We were in the emergency room just a short while and the doctor told me he was really, really sick," Mrs. Wykle said. "They asked me why I'd waited so long to bring him in, and I said, 'I thought he had the flu.' "

By 2 p.m. that day, he was on his way to OSU Medical Center by ambulance. He was taken directly to the medical intensive-care unit, where doctors gave him antibiotics intravenously.

O'Brien told Mrs. Wykle her husband had sepsis. She had never heard of the disease.

Mr. Wykle developed breathing troubles that day. The next morning, doctors hooked him up to a ventilator. Then his kidneys failed, and he was put on dialysis.

His blood pressure began to drop.

"The bottom fell out very quickly," O'Brien said. "We still didn't have a great idea of where his septic shock was coming from."

Doctors tested Mr. Wykle's urine, feces and mucus in an attempt to pinpoint the infection. They couldn't.

They continued pumping in antibiotics and fluids. In less than a week, his weight increased from 269 pounds to 350 pounds.

The damage to blood vessels causes fluids to leak out into a patient's tissues, and the vessels become dehydrated. To counteract this, doctors increase the amount of fluids in the bloodstream, but much of it leaks out, causing swelling.

Surgeons desperate to find the infection performed a bedside operation -- Mr. Wykle was too weak to be taken to an operating room -- to peek inside his gut and intestines. Still, they found nothing.

Being able to locate infection in the body helps physicians create a plan of attack, including which antibiotics to use, what doses and for how long.

Meanwhile, drugs that kept blood and oxygen flowing to his brain, heart and other core organs had cut off the same supply to Mr. Wykle's hands and feet, which were turning black in response.

O'Brien told Mr. Wykle's wife, parents, brothers and children that he wasn't sure whether he would survive the day.

But Mr. Wykle did, and over the next day or so, he showed improvement. He was taken off the ventilator, and his kidneys started to work on their own. He finally awoke in a haze.

"What happened to my hands?" he asked his stepson, Coy. "Is my face like this? Is this the end of me?"

The year leading up to Mr. Wykle's sepsis hadn't been easy.

He fell off a ladder in early 2010, cracked a vertebra and was hospitalized for five days.

Then he developed kidney stones and later was told he had prostate cancer. He underwent surgery for both and recovered.

His business, Wykle Construction, already slowed by the bad economy, was drying up. The year's worth of savings he had set aside for a rainy day was nearly gone.

He and his wife were living on Mrs. Wykle's salary from her job at Smead Manufacturing in Logan, but it wasn't enough.

They lost their house this past spring to foreclosure and moved into a mobile home that Mr. Wykle's mother owned.

Mrs. Wykle's health insurance has covered the majority of her husband's medical expenses, but the couple's debt was mounting.

They filed for bankruptcy in June.

In the intensive-care unit at OSU Medical Center, doctors explained to Mr. Wykle what they did to save him and why he was losing his extremities.

But they still couldn't tell him how he had contracted sepsis in the first place.

"When you go in with flu symptoms and wake up with this, it's a little overwhelming," Mr. Wykle said. "You wonder what's next."

He was discharged from the hospital in May and was told he would need several amputations -- his right hand, left foot, parts of the fingers on his left hand and the toes on his right foot.

Just like that, a man who had spent his life taking care of others -- family members, friends and neighbors in need -- would need a wheelchair and the help of others to eat, bathe and dress.

Still, he smiled, laughed and waved goodbye to the staff as he left the hospital. That doesn't surprise the people who know him. He's quick with a joke, often bursts out in song and pokes fun at himself all the time.

For example, he suggested to family members that once doctors amputated his right hand and left foot, they could be used as a paperweight and doorstop, respectively.

"You've got to joke about it, or else you'd be depressed all the time," Mr. Wykle said.

Mr. Wykle's hands were the tools of his trade as a carpenter and builder. And they were dying before his eyes.

His right hand turned hard and black. Mr. Wykle said it felt cold and heavy, as if it were trapped in concrete. By June, he could no longer move his fingers.

His left foot also had turned black. So had the toes on his right foot. Both smelled of decay.

"Sometimes, you just think it's a nightmare that never goes away," he said. "I dream that I go out and my hands are fine, and then I wake up and it's still there."

Before the surgery to remove his hand and fingers in June, his family and pastor gathered around his hospital bed, held hands and prayed.

"If it weren't for God, I wouldn't be here today," Mr. Wykle said. "I'm a firm believer that God has a plan for me."

In the operating room, Dr. Brian Janz, an OSU hand surgeon, sat on a stool and hunched over Mr. Wykle's left hand. He tried to save as much of each finger as he could.

Mr. Wykle played bass guitar with a band made up of family members. He wants to play again.

Janz spent several minutes removing the blackened tissue from Mr. Wykle's fingers and hours connecting veins and tendons to let blood flow to them.

Then he cut a piece of skin with a vein still attached from near the left index finger and folded it over the thumb to save it as well.

When those procedures were completed, Janz amputated Mr. Wykle's right hand.

While Mr. Wykle is getting used to the amputations, the pain is something else.

At first, he got by on mild pain relievers. But a few days after his hand surgeries, he said his left thumb felt as if it "was in a vise and I couldn't get it out."

Today, he relies on morphine for relief.

The hand surgeries were followed by two others to remove his left leg just below the knee and the toes on his right foot.

The pain, he said, varies, depending on the body part.

He suffers phantom pain where his right hand and left foot used to be. His right foot feels like "someone stuck a knife in it," he said, and his right arm throbs with a steady pain that morphine doesn't seem to curb.

It was so bad that Janz went back into the arm to "bury some nerves" near the stub.

A week before Thanksgiving, the last of the blackened toes were removed. (One had fallen off on its own at home.)

Mr. Wykle expected to go home the same day.

But he didn't. Doctors told him after the surgery that he has a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus, or MRSA. It had formed in the bone of his big toe.

He'd have to stay in the hospital a few days and take two intravenous antibiotics at home for more than eight weeks. He and Mrs. Wykle cried when the doctor told them the news.

"I'm a crier, but I haven't really cried through all this," she said. "But the word infection, I don't like it."

After her husband's toes were removed, Mrs. Wykle learned a new skill -- how to administer intravenous antibiotics at home. It's one of many she has learned since Easter.

For more than seven months, she has been his nurse and caregiver. She attends almost every doctor's appointment and sleeps in his hospital room during every stay at OSU Medical Center.

At home, her day starts around 4:30 a.m. when she gets ready for work and gets her husband ready for his day. She changes his bandages, helps him bathe and shave, prepares his breakfast and doles out his medications.

She also vacuums their mobile home every day.

While she's at work, one of Mr. Wykle's brothers, parents or friends comes by to help him or keep him company.

Jack Price, an old family friend, has taken on the job of physical therapist. The 74-year-old makes sure all of Mr. Wykle's exercises are performed.

After work, Mrs. Wykle takes over again.

The couple has been married for 32 years. When they met, she worked with Mr. Wykle's brother Audie. Before he asked her out, he told his brother he was "going to marry her one day."

They went to the Great Southern Hotel in Downtown Columbus (now the Westin) on their first date. Mr. Wykle sat in with the band.

They took her son, Coy, on their second date.

She said she liked his sense of humor, his close-knit family and his love of children. He thought she was pretty and said she had a kind heart.

They married six months later. A few years after that, they had a daughter, Kyla.

Today, they have three grandchildren.

Mr. Wykle said his ordeal has made him appreciate the people in his life even more.

"It threw a switch on in my mind of how precious everyone is -- my wife, my family, my friends," he said. "I realize life can be taken away from you."

Adversity tends to turn small towns into big families.

Mr. Wykle's brothers, Audie and Dan, led a fundraiser in August to help with medical expenses. The 13-hour event at a Logan school gymnasium drew a steady crowd of people who bought lunch, bid on hundreds of donated auction items, cheered for the bands that played and gave Mr. Wykle countless hugs.

Judy Powers made 24 pounds of macaroni salad for the fundraiser. Her son went to school with Mrs. Wykle. Mr. Wykle had done some work at her house.

"He's so special, we love him to pieces," Powers said. "I know if it was me in his situation, he'd be the first person to help."

Carol and Bill Drake hadn't met Mr. Wykle until that day. But they knew his dad and stepmother and drove 90 minutes from Morgan County to attend the party.

"It's a good cause, and being such a young person, it's tragic," Mrs. Drake said.

The highlight of the day was when Mr. Wykle was wheeled onto the gymnasium stage with a bass guitar on his lap. His brothers had crafted a device from melted plastic and dog collars that strapped onto Mr. Wykle's right arm and allowed him to pick the strings.

He launched into Merle Travis' Cannon Ball Rag, and the crowd cheered for the man who counts his blessings, looks to the future and refuses to dwell on what could have been.



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