Raj Nagarajan

I am a survivor of NF. The first indication that I had a problem was on December 23, 2005, when I had a sudden spell of shivering (very uncharacteristic for me) that lasted for about half an hour. I checked my blood pressure and it was lower then normal (I have high blood pressure and was taking medicines to lower the BP). Then I started having fever. I called my primary care physician. He was on vacation but was available on the phone. He thought I had flu, and prescribed Tamiflu plus pain-killers. This treatment seemed to work and I felt normal on that day as also the following day. In the afternoon I noticed swelling and pain in the left feet below the knee. The pain level steadily started increasing. I was swallowing Tylenols and Advils like candy, but nothing worked. By midnight the pain increased to an unbearable level with a corresponding increase in swelling. Past midnight I went to Memorial Hermann Southwest Hospital and got myself admitted in the emergency room. That was in the early morning of Christmas Day. The first day passed off without any appreciable reduction in my pain level. I suppose they were treating me with some antibiotics, but it did not make any difference. On 26th I called my primary care physician and requested him to contact the hospital to find out what was happening. He did make this call, and immediately afterwards there was a flurry of activity. Suddenly I was visited by quite a few physicians. One of them was a young physician by the name Dr. Bhai. He bluntly told me that my "numbers" were all looking wrong, and he is arranging for immediate treatment for me. He also arranged to transfer me to the ICU. He told me that they have to cut open my leg to see what was happening inside, and warned me that my chance of recovery is only 70%. This did not bother me at all. I thought that since it is over 50% the odds are in my favor. I didn't even bother to share this information with my wife and some of my family members who were visiting me. Later a surgeon, Dr. John Fisher, visited me. He wanted to do the operation (Fasciotomy) immediately. On the evening of 26th I was wheeled to the operation theater. I regained consciousness later in the night only to see two persons removing dressing from my leg and replacing it with fresh dressing. I knew that there were multiple openings in my leg (looking at the quantity of dressing that they removed). The next day (12/27/05) I was quite OK, chatting with relatives and friends, though I don't remember much of what happened on that day. At some point on that night or the early morning of the next day I went into a septic shock. This was followed by multiple organ failures. Dr. Bhai started issuing dire warnings for my survival. At one point it went as low as 30% according to my wife. He also told her to call all the relatives, just in case the worst thing happened! What was happening in the next 5 or 6 days were various organs failing to function on after the other and frantic attempts by the physicians to reverse this process. First my kidney failed and massive quantities of water were pumped into my body. I suffered very low blood pressure. Then my heart gave some problem which could be categorized as a minor heart stroke. One half of my lungs got filled with fluids and I developed pneumonia. Just before this happened the physicians hooked me to an external breathing apparatus and inserted a tube through my mouth. I also lost a lot of blood at some point of time and was provided with multiple blood transfusions. There was also a discussion about amputating my leg. While all this was happening, I was in a blissful state of unconsciousness, thanks to the continuous feeding of Morphine. I was also given a cocktail of antibiotics including Cefapime, which was subsequently modified (Ampicillin and Clindamycin) after culture tests revealed that the bacteria was Streptococcus Type A. This state of unconsciousness lasted for about 10 days. During these days my leg was subjected to multiple 'debridments' both in the operation theater and in the ICU. Fortunately for me, I survived all the dire warnings about my precarious state of existence. My white blood cell count started decreasing and the blood pressure stabilized. Dr. Bhai started increasing my odds of survival, from 30 to 40 and then 50%. One by one the organs returned back to their normal functions. The lung was the last to fall back in line. I was "extubated" in the first week of January, and slowly recovered consciousness on January 7th or so. Finally, after ten grim and tense days, the physicians succeeded in fighting the bacteria. On January 9th, I moved out of the ICU into the Surgical Recovery Unit. I was immediately put on a daily routine of Whirlpool (washing the wounds with water being circulated in a tub) treatment and physical therapy. The first time I saw my wounds I felt as though I am going to pass away. Luckily it didn't happen and I managed to stay through the dressing change that followed. I had five wounds in either side of my leg, starting at both sides of the ankle and going all the way above the knee. The wounds near the ankle were like craters. The other wounds were smaller. Other than the Whirlpool treatment I also had daily dressing change everyday in the night. As days passed I noticed steady improvement in all the wounds with the yellow areas disappearing and replaced with healthy granulation of red color. Only the wound on the interior side close to the ankle was somewhat slower in getting rid of the dead tissues. My recovery would have continued well had I not contacted another bacteria called Clostridium Deficile (C-dif). I had to go through a bout of diarrhea that lasted for more than 12 days. The antibiotics that the doctors prescribed for this bacteria did not work and only after discontinuing the treatment did the diarrhea stop! I lost an additional 10 pounds of weight as a result of contacting C-dif, which I understand is prevalent only in hospital environments. On January 25th, I underwent a skin grafting, the final phase of my battle with Strep A. The two wounds near my ankle and another small wound were provided with new skin removed from the top of my left thigh. The other wounds were stitched together. Five days later, on January 31st, I was discharged from the hospital and came back home. Overall I spent 38 days in the hospital with 14 days in the ICU. Even in my wildest imagination, I would have never considered a scenario of spending this much time in the hospital. A week later I visited the Plastic Surgeon for a follow-up and he removed the stitches and staples on my skin graft. As a part of the in-home nursing care, I have daily dressing changes by a nurse, and physical therapy sessions. My situation as of today (March 6th, 2006) is that I am able to comfortably walk without any help. There is still swelling in my leg. One of the wound still continues to drain and needs daily dressing change. I will be seeing the Plastic Surgeon again tomorrow. I plan to return back to work on March 13th. I am also able to drive my car. After I got discharged from the hospital, I went through many web sites on Necrotizing Fasciitis, and found that what happened to me was a text book example of a typical NF case. I consider myself very fortunate (and I keep thanking God) that I am alive and have not lost my leg. My recovery has been faster than what my physicians had initially predicted. I am just happy to be alive and determined to make the best use of my second life. I credit my being alive mainly to the determined efforts of a team of young physicians, the prayers of many friends, relatives and acquaintances, my own attitude in being positive, and most importantly due to God's blessing. I think it was just not my day, and God sent me back to this world with a second chance to prove that I am worthy of His consideration and benevolence. The facilities and nursing care at Memorial Hermann were excellent. The team of physicians who were involved in my case includes Dr. Aziz Wali Bhai, Dr. John Fisher, Dr. Adriana Wechsler (Internal Medicine), Dr. Carl Vartian & Dr. Maria Carlini (Infectious Diseases), Dr. Tehmina Badar (ICU and Asthma), Dr. David Altamira (Plastic Surgery) and Dr. David Portugal (Cardiology). There were also other physicians who from time to time rendered specialized assistance. I sincerely thank these physicians for their valiant and determined efforts. I am 56 years old. Prior to this attack I was taking medications for blood pressure, seasonal allergies and cholesterol. Also my blood sugar level was just close to being diabetic. With all these problems I survived NF. I believe that there is always hope for other victims of Strep A, provided, the diagnosis and treatment starts in time.