Antony Mulcahy
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Necrotizing fasciitis (aka Flesh Eating Disease) What is it? Necrotizing Fasciitis a condition caused by a Streptococcus (Group A) bacteria infection invading the layer between the outer skin and muscle called the fascia. The process kills the tissue and leaves necrotic flesh behind, which, must be removed by a surgeon. Date 15 January 2005 Location: Gokarna, Karnataka, India I was traveling with a group of 5 friends; we managed to hook up in Mumbai and Goa and had traveled together to Gokarna. We were having a great time, Gokarna is a very beautiful, spiritual place with some great beaches and we were all relaxed and enjoying our trip. I had spent a couple days exploring the beaches and walking around the hills where there are temples and caves. We walked around the brush on the tops of the hills and went to the top of the cliffs. We saw fantastic views of the Arabian Sea and the Indian fishing boats passing in an endless stream. A haze hung over the sea and we could just about see as far the end of the beach we had walked to the day before some 15-20kms away, While we were walking something stuck in my leg - I first thought was a spider, but paid little attention. Later we made plans to travel to Hampi about 250kms inland. We booked taxi for the next day and we went to eat our last Gokarna dinner. I first noticed a small red lump on my left shin about the size of a (English) penny; I remember thinking it was quite sore. I made a remark to my friend that I thought perhaps a spider or insect had bitten me. I didn't pay too much attention at this point. Next morning we got our taxi, after the usual mayhem that seems to accompany all forms of travel in India, we set off for Hampi. We had a great time singing and watching the Indian countryside pass by the windows of our Jeep. A few hours into the journey I started to feel a little feverish and hot. I didn't connect this to my leg at this stage even though the swollen area was now the size of a large marble. By the time we arrived in Hampi I was feeling totally wiped-out and feverish. I went straight to bed and slept for 24hours. When I woke up we took a rickshaw down the bumpy road to the local GP surgery about 15Kms away. The first thing I noticed inside the surgery was a very shiny new car and a beautiful Royal Enfield motorbike in pride of place in the middle of the waiting room. A young lady pointed me in the direction of the Dr; after a quick examination he sent me to the technician to have blood samples taken. After a wait of 30 minutes or so I was informed it was nothing to worry about and that it wasn't malaria either. The Dr said it was a small infection and prescribed two different antibiotic pills and an antibiotic cream to apply locally to the affected area. Cost 270 Rupees (about £4 sterling) Over the next few days my leg continued to swell and I started to feel unwell, fever came and went and sometimes I had the violent shakes. One morning we had decide to get up early a watch the sunrise from the top of a hill near our hotel. Whilst walking in the early morning twilight I walked straight into a metal gate that had a horizontal bar at exactly the same height as the infected part of my leg! It made an almighty crack and felt like no pain I had felt before! Later that day I went for aruvedic massage and a lady, called Meena, gave me a steam treatment and massaged my bad leg with some oils. This seemed to help a little at the time. Meena was nice! ;-) My leg continued to swell and became more and more painful. I thought at this stage that the antibiotics had probably kicked in and the pain was the result of walking into the fence. After Hampi we were to go different ways, the girls went to the south of India, my friend went back to Goa to meet some other friends and I headed to Madras to catch an internal flight to Delhi. I had a bad night in Delhi waiting to fly home; I had the shakes a couple of times and I was feeling hot and then really cold, sleepy and very spaced-out. By now my leg was extremely swollen so much that I could hardly get my shoes on. The shin area was a very angry looking red with blisters appearing here and there. I spoke to my girlfriend in London on the telephone and asked her to get the address, opening times, etc for the Tropical Diseases Clinic in London and to be prepared to go straight there when I got back the next day. I remember trying to stay awake so as not to die in Delhi. 22 January 2005 Delhi to London Before going to the airport I had put a compression sleeve over the swollen leg on the advice of a friend. About an hour into the flight my leg was hurting more and when I looked inside the sleeve I could see a large area of blackened skin had appeared over my shin. I informed the hostess who called "Med Link" and put me into Club Class with a big box of tissues to mop up the serous fluid that was leaking out. About an hour from London I got the shakes bad and the hostess wanted to divert the plane to Frankfurt and drop me off, I had to convince her I was ok to continue to London! After arriving home I dropped off my baggage and went to UCH, Euston. I was admitted straight away and given painkillers including morphine. Over the next few days I met many specialists: Pain, Tropical diseases, Infectious diseases, surgeons. Surgeons told me they would remove some flesh (debride) from the front of my leg and sent me to theatre to have the operation. When I came round they informed me that he area was much larger than expected and went quite deep so they had had to remove a large area of necrotized tissue. The morphine made me paranoid, delusional and hallucinatory; I was horrid to the nurses and generally grumpy. I wont use that again! I ended up having 4 operations in all: three to debride the necrotized tissue and one to make a skin graft for which they used the top of my left leg as the donor site. The anesthetic made me feel pretty rough and took ages to get over each time. During the third operation I managed to vomit which was weird, as I had not eaten in 5 days. I woke up in intensive care with my sister and my girlfriend both looking extremely worried; I could not talk as I had an enormous tube in my mouth, which was pressing on my lip and really hurt. When I tried to lift the tube they held my arms thinking I was trying to remove the tube. I convinced myself that the next operation would finish me off and I would never see my daughter again. The last op took place the day before my birthday and I opted for a regional anesthetic, which was much better than a "general". Ten minutes after the operation I was chatting with the nurses and I felt clear-headed. I spent another four weeks in UCH before being allowed home. Being at home was a nightmare as it was very difficult to move around. I got stuck on my floor on the first day and my leg hurt lots. It took about 6 weeks until I could walk again; 4 months until I could walk without pain and a year until I felt back to old(er) self. Anyway thank heaven for the wonderful NHS and all those staff that helped me. And thank heaven for my family and friends without whom I would never have survived and I did survive!