Cassi Moore
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June 20-21 - Carefree Weekend On the weekend of June 20 & 21, 1998, Cassi Moore and her three children attended a camp out with their Taekwondo school at Hendy Woods State Park located on the Navarro River in Northern California. Sometime over the weekend Cassi sustained a very small cut on her left thumb. She cannot recall how she cut herself but remembers washing the cut and applying antibiotic ointment and a Band-Aid. When practicing defensive tactics she received a slight trauma to the left side of her rib cage, either a bruise or a pulled muscle. June 21-22 - First Symptoms Cassi returned home on the morning of the 21st and felt very tired and sore. On the morning of the 22nd she awoke feeling the same way, but now her left side hurt as well. By that afternoon, shortly after her husband Dan had gone to work, she became quite ill. The symptoms included vomiting, diarrhea, a fever and pain in her side. She was taken to the doctor by her brother and returned home after being diagnosed with the flu and a possible pulled muscle on her left side. June 23 - Symptoms Increase June 23rd, Cassi continued to feel ill and also began complaining of severe pain on the upper left side of her rib cage. She returned to the doctor who prescribed medication for what appeared to be a faint bruise that had appeared on her left side. By that evening the area became a very large (6' by 102) bruise that was very dark in color. June 24 - Diagnosis and Emergency Surgery On the morning of June 24, just 3 days after her first, mild symptoms, Cassi was very weak and needed assistance to get out of bed. She could not breathe well and had trouble seeing things around her. By 11 a.m. the bruise on her side began to ulcerate and leak fluid and blood. By 1 p.m. Cassi, who by now couldn't walk unassisted or see, was taken to the emergency room at Palm Drive Hospital in Sebastopol, California. When Cassi arrived at Palm Drive ER her family practitioner was waiting for her. She had no detectable blood pressure and was in septic shock. Her doctor immediately called in and consulted with a surgeon and an infectious disease specialist. They decided to perform a C.A.T. scan on Cassi's side. The scan revealed the underlying necrotizing fasciitis or decaying flesh. Cassi was then rushed into the operating room for emergency surgery. During the surgery they removed a large portion of flesh from the left side of her rib cage and part of her breast. Approximately 6 to 8 percent of her body's surface was removed. After surgery, Cassi was moved to the intensive care unit where she remained on a ventilator and vaso constricting drugs or "pressers." Pressers are used to artificially elevate the blood pressure when a patient is unable to maintain their own. They work by constricting the blood vessels in the extremities, thereby forcing the blood into the abdomen to help profuse the brain and vital organs. A very unfortunate side effect of these drugs is that under prolonged use the extremities, such as fingers and toes, can suffer damage due to the lack of blood flow. After Cassi's surgery the wound on her side had to be left open for a couple of reasons. The first reason was that most likely there would have to be additional surgeries to remove further necrosis. The second reason was that a wound that size would have to be covered by a skin graft and first needed to begin granulating or healing from the inside. The first night in I.C.U. at Palm Drive was a very rough night for Cassi and the whole family. She became fully conscious, however, due to the possibility of additional surgeries and her precarious condition, her ventilator tube could not be removed. She also began having pain in her fingers on her right hand. The family began praying in earnest for her to live and come off the vasal constricting drugs that were beginning to do damage to her hands and feet. June 25 - Grave Condition By the morning of the 25th, the doctors were concerned that Cassi was soon going to require hemodialysis and since they did not have the capability on site they recommend transferring her to Sutter Medical Center in Santa Rosa. They also feared that she may soon be too unstable to attempt transferring. At this point Cassi was unconscious and the whole family was devastated. That afternoon Cassi was transferred to Sutter where the attending physician in charge of I.C.U. did not give the family much hope for her survival. He immediately made arrangements for her to be airlifted to the University of California San Francisco Medical Center. This turn of events was extremely hard on the family, all of which battled desperately to maintain some kind of hope and composure. Cassi's children were kept from knowing about her condition, all that they knew was that mommy was sick but she would be ok. Cassi arrived at U.C.S.F. at approximately 5 p.m. and was admitted into 9- I.C.U., where she would wage a battle for her life over the next three weeks. Her family set up camp in the waiting room and never left her side during the entire ordeal. The Fight for Survival During the first few days the family began to have hope that Cassi would survive, however, it also became apparent that there would be some serious damage done to her hands and feet. Cassi's fingers, toes and parts of her right foot, began to first turn purple and then black. Still there was hope that even this would be reversed until on the third and fourth days her fingers and toes began to shrivel. She now also required hemodialysis treatments because her kidneys were still not functioning. Through all of this the family prayed and pulled for Cassi's blood pressure to improve on its own so that the vaso constrictors that were taking such a toll on her extremities could be gradually reduced and eventually discontinued. July 4 - Turning the Corner Finally on the 4th day her blood pressure began to rise and on the 5th day she came off the vaso constrictors. This gave the family renewed hope that maybe her fingers and feet would begin to show improvement as she stabilized. In the meantime friends of the family began efforts to rally assistance and support for Cassi. Dan Wylie, Dan's best friend from high school, set up a trust fund with the help of Cassi's brother in-law, Britt Cooper. Also, Chris and Rhoda Hauth, Cassi's Taekwondo instructors, began organizing a benefit fund raiser, one of many fund raising events organized by the Hauths. July 11 - People Rally to Help On July 11th, the day before Cassi's benefit, she produced her first urine on her own after almost 3 weeks of daily hemodialysis. While treatments would still be necessary, this was a sign that her kidneys were beginning to function on their own. This was source of joy for family and friends at the benefit. On the day of the benefit, Cassi's brother Steve, stayed at the hospital with her while Dan and her parents, Bill and Pat, attended the event. The benefit was a huge success. Everyone in attendance agreed that they had never before witnessed such an outpouring of support and compassion. Cars were parked up to half a mile away and people stood in line for up to half an hour just to get in. The line went out the door of the gym and stretched about 50 yards to the parking lot and split in 2 directions still further. Approximately 2500 to 3000 people attended and $22,000 was raised. At the time of the benefit, Cassi was conscious but still very disoriented and not completely lucid. She had been off the ventilator for about I 0 days and was able to speak, though at times hallucinated and was delusional. Cassi was still unaware of her condition. She had not asked about her fingers or toes or about what disease she had. The waiting was very painful for the family. They had no idea how Cassi would respond once she became aware enough to ask. By this time it was certain she would lose a large percentage of all her fingers except for the left thumb. Ironically, the left thumb, which was the lone survivor, was the sight of the small cut where the bacteria entered. It was also clear that she would lose her right leg below the knee and 1/3 of her left foot. Her fingers and toes were completely black and shriveled, they were without warmth or a pulse. Her right foot, while showing some improvement a few days earlier, had now turned gray. There was a pulse in her heel and on the side of the foot, but a large area on the top of her foot extending up to her shin was without a pulse and cold to the touch. July 13 -15 - Cassi Becomes Aware Finally, on July 13th, Cassi asked about her fingers, toes and foot. When informed that she would most likely lose all of them she responded, "Oh well, I'll just have to deal with it." At the time her family figured that it would hit her harder later, however, Cassi proved to be far stronger than anyone could have imagined. There were times later that things got to her a bit, but she always pulled out of it and the way she responded has been an inspiration to all who know her. On July 14, Cassi was stabile enough to move out of 9-I.C.U. to the 14th floor. On July 15, she asked her husband and parents what was the disease she had contracted. When told that she had the flesh eating bacteria, Cassi burst into tears and praised and thanked God that she was alive. Cassi had numerous blister like sores on her leg that the surgeons were waiting to heal before they amputated in order to provide healthy tissue at the amputation site. The wounds required dressing changes 3 times a day and this procedure was painful. Because her right leg was giving her such considerable pain, she was ready to go ahead with the amputation. Finally the doctors felt that the sores had healed sufficiently enough to do the surgery. July 28 - Amputation On July 28, Cassi had surgery to amputate her right leg below the knee and surgery to apply a skin graft taken from her left thigh to the wound on her side. Cassi went to the operating room around I p.m. and the surgeries were completed by 6 p.m. All had gone well with both procedures. Cassi's sister Stephanie, her son Robbie, Dan and Cassi's parents were all there the day of the surgery. While Cassi was in recovery, Dan and her parents went in to see her. This was a very emotional time for all of them. Seeing her leg gone for the first time really drove home the terrible tragedy that had happened to her. For about 24 hours after the surgery there were some problems keeping Cassi's pain under control. She had to wear a sling that kept her left arm immobile for IO days making sure the graft did not pull lose. This was particularly hard on her because she is very claustrophobic. Recovery went well and after IO days the plastic surgeons removed the bandage from her side. They were pleased to find the graft had taken about 95%, which meant further grafting would not be necessary. Also, her leg healed very well and there was no sign of infection at either site. Now the only remaining issue was Cassi's fingers and the toes on her left foot. These were being left to resolve themselves, or heal as much as possible before any surgery. They did this to generate the maximum amount of healthy tissue and maximum amount of length on all sites. August 11 - Into Rehab Finally on Aug. 11th, after 49 days at U.C.S.F., Cassi was transferred to North Coast Rehabilitation Center in Santa Rosa, where she would begin rehab and wait for her last surgery. Cassi's stay at North Coast Rehab consisted of physical therapy, occupational therapy and mostly, waiting. Shortly after arriving at the Center, an infection set into her fingers. As a result of this, a very strong course of antibiotics were started to kill the infection and allow more time for regeneration. Unfortunately, two types of I.V. antibiotics which had to be given separately, ran for one hour each every eight hours. This made it impossible for Cassi to get any long periods of rest. August 31- More Amputation The antibiotics did their job and on Monday Aug. 31, Cassi went to Petaluma Valley Hospital to have her fingers and 1/3 of her foot amputated. She went into the operating room around I p.m. and came out about 5 p.m.. The surgeon said everything went well and that he was able to remove all of the dead tissue. The family was allowed to go to her immediately in the recovery room. Cassi was not doing well after the surgery. She was in a lot of pain and the nurses in recovery were unable to give her enough medication to bring it under control. On top of this the ambulance company had been called and was standing by to transport her back to North Coast. It became apparent to the family that this should not have been an outpatient surgery and Cassi's husband requested she be held overnight so her pain could be properly managed. The anesthesiologist and surgeon recommended she be transported back to North Coast because they would not be able to stay and take care of her. The nurse gave her one last dose of morphine and sent her on her way. When Cassi arrived at North Coast things went down hill fast. They had only just received her orders for medication. The staff clearly lacked the necessary training or experience to effectively manage a case such as Cassi's. As a result she experienced much pain that night and the whole family was very upset with the poor manner in which the whole procedure was handled. Finally, a pain management specialist was called in and he was able to effectively manage Cassi's pain, so the following days went smoother. September 9 - Home At Last On Wednesday Sept. 9, Cassi was discharged from North Coast and went home. After being in the hospitals for 77 days she was finally going home to her children, her cat, her dog and her own bed! There would be no more nurses waking her up in the middle of the night to give her medication. No more doctors waking her up at 5 a.m. or 6 a.m. to see how she was doing. Needless to say, Dan and Cassi were very happy to be home. Fall 1998 - Recovery The last months of 1998 were spent trying to get things back to as normal as could be expected. John Batsdorf of Sierra Orthopedic Lab., put Cassi in a leg with a Flex-Foot. This foot allows her to simulate balancing by using a split base so she can rock side to side on her right leg. It also springs at the ankle allowing Cassi to walk more naturally and gives her more flexibility for going up and down inclines. After Cassi received her first prosthetic leg she began the process of learning to walk again. This process was slowed considerably due to the fact that not only had she lost her right leg below the knee, she had also lost approximately 1/3 of her left foot. The left foot became a problem because now she had a much smaller surface to support herself on. The bones that used to be her arch were now being called upon to bear her weight. Also, this made it difficult for her to balance. John came to the rescue and made her an insert for her shoe that would roll the foot into a more natural position. This helped considerably and further improvements have enabled Cassi to begin walking more naturally. She still has a limp, because her foot could take up to a year to completely heal, but she has already made considerable progress. Cassi found she could still play her keyboard despite losing 90% of all of her fingers. John Batsdorf helped her further with this by designing some extensions on the fingers necessary for her to reach all of her notes. She found that she really could do all of the things she did before. Every time something came up that she couldn't do, a way was found for her to do it. She was driving in no time and her father helped by modifying a device that moved the gas pedal to the left side of the floorboard so she could use her good foot to operate it with. He also modified a curling iron and constantly came up with gadgets and ideas to help make things easier for her. December 31, 1998 - Celebration On New Years Eve 1998 the whole family went out for the night to celebrate. All holidays have extra special meaning for Cassi's family, nothing will ever be taken for granted again. It was a special night, her family not only celebrated The New Year, they celebrated the special life that God had spared. They also celebrated the newfound love and closeness they each felt for one another. Cassi danced for the first time and looked very beautiful, it was a very special night. 1999 - Victory 1999 has brought continued improvement in all areas for Cassi. Her walking has slowly but surely improved, and her endurance and pain continue to improve also. On March 9, 1999 Cassi returned to work. This was a big step in her recovery and brought her enormous satisfaction. She is still in her temporary socket on her prosthetic leg, because she had so much fluid pumped into her body it could take up to a year to lose all it. As her leg continues to shrink, she will remain in her temporary socket. When the residual leg stabilizes, her will then receive her permanent socket. Cassi hopes to return to Taekwondo this summer. Special gloves will be made to protect her hands while punching. Moves and techniques will be modified some to allow for the lack of fingers and flexibility on her feet.