A two-year battle leads to triumph over necrotizing fasciitis
February 21, 2011 5:00 AM
Garth Wise laughs during a conversation recounting his two-year battle with necrotizing fasciitis.
By Pohla Smith Pittsburgh Post-Gazette
On Friday, sheet metal worker Garth Wise of Plum celebrates two significant milestones: His 50th birthday and the second anniversary of his diagnosis with necrotizing fasciitis.
For a while, it appeared he might not make them.
Although rare -- the Centers for Disease Control and Prevention estimated in 2008 there are no more than 800 cases a year -- as many as 25 percent of those patients die of the excruciatingly painful disease also called "flesh-eating bacteria."
It kills flesh and other soft tissue, which must be removed, sometimes with amputations, to save the life of the patient. Still, those procedures can be insufficient. At one point during the first of multiple debridements, or flesh removals, an infectious disease physician told his sister-in-law that Mr. Wise had a 25 percent chance of survival.
Two factors are cited for his victory over the disease: the quick diagnosis and response of James McCormick, vice chairman of surgery and a colorectal specialist at Forbes Regional Hospital, and Mr. Wise's will to live.
"In my opinion, I think Dr. McCormick saved his life," said Robert Kang, the plastic surgeon who later would graft skin over gaping, muscle-deep wounds that covered both sides of Mr. Wise's lower abdomen and groin. "He quickly picked up on the life-threatening illness and did a great job of keeping Garth alive."
Dr. McCormick shrugs off the role of hero, although he acknowledges he recognized the disease as the variety of necrotizing fasciitis called Fournier's gangrene, which affects the groin.
"I just happened to be the guy around that day, and I don't consider myself an expert on this," although he described himself as "happy to take care" of Mr. Wise.
At the time he was taking Mr. Wise in and out of the operating room for debridements -- he had three surgeries total plus at least seven dressing changes under anesthesia -- Dr. McCormick told the family, "I cannot believe how strong that man is." About 20 percent of his flesh was removed.
His return to a normal and productive life is "a testimony to his will," Dr. McCormick said.
"I figured as long as I'm breathing I'll be able to keep fighting," Mr. Wise said recently. "I knew I was dying. ... There was a look in everybody's eyes."
If he hadn't trusted Dr. McCormick, he added, "I probably wouldn't have survived. ... I thought, 'I'm not going to let the guy down.' " He said he had the same faith in Dr. Kang.
He needed it.
"Every time I went in [for surgery] I came back with a little more missing," Mr. Wise said. Meanwhile the pain was relentless. He remembers watching morphine drip through an intravenous line and telling himself with every drop, " 'That makes me feel a little better' even though I didn't feel a thing."
Mr. Wise and his wife, Sandra, 49, a vice president for Dollar Bank, never really had time to absorb what had hit them. In fact, when the infectious disease doctor talked to Sharon Stover about her brother-in-law, the Plum nurse waited a while to tell her sister.
The illness had started with generalized but increasing discomfort when the Wises began driving home Feb. 22, 2009, from a trip to South Carolina.
By the time they reached Summersville, W.Va., Mr. Wise could no longer drive. "I couldn't bend my leg," he said. "I wasn't feeling well."
Whether he was getting necrotizing fasciitis or feeling the side effects of a bad hamstring injury sustained in a fall on ice that Feb. 3 is still unclear. The bacteria can enter the body through an opening as small as a pin prick or through weakened skin such as a blister, an abrasion or a bruise, according to the National Necrotizing Fasciitis Federation. Commonly, the bacteria at fault is group A Streptococcal, the same germ that causes strep throat, the NNFF said, but the disease also can be caused by other bacteria or a mixture of bacteria.
All the Wises do know is that by the time they got home the next day and Mr. Wise went to physical therapy for his hamstring injury he felt worse, "like I had the flu. Achy. There was a lot of pressure in my hip," he said. "It was so general [but] I knew I was getting sicker and sicker."
At 2 a.m. Feb. 24 he headed to Forbes' emergency room, where prostatitis, inflammation of the prostate gland, was diagnosed and antibiotics were prescribed. "I'd had prostatitis before," he said, "so I didn't really panic."
But the symptoms started to go beyond prostatitis, so at 3 p.m. that day the Wises went to see urologist Stuart Feldman. He ruled out prostatitis but couldn't diagnose the illness and advised them to go to the hospital.
Mr. Wise was admitted and started on IV antibiotics and pain medications, both of which would flow through his veins for days and days to come.
The next morning, Feb. 25, Mrs. Wise and Mrs. Stover went to see him and found him still in severe pain, sweating profusely from fever and with a rash on his abdomen. He had undergone test after test, but the cause of his illness remained elusive. The rash was spreading.
Dr. McCormick was called in, and Mrs. Stover told him her brother-in-law's symptoms. He diagnosed the disease and took Mr. Wise in for surgery to see the extent of the problem.
Mrs. Stover, who stayed in the intensive care unit with her sister during the operation, said she got a pretty good idea of just how bad things were when the infectious disease doctor, whose name she can't remember, came out of the OR and told her Mr. Wise had necrotizing fasciitis.
"That's when the bottom dropped out of my life because I knew exactly what it was," said Mrs. Stover, who at just 10 months younger than her sister is extremely close to the Wises. Her voice broke.
Although Mrs. Wise learned "early in the process" her husband had flesh-eating bacteria, she delayed for months doing any research to learn how serious it is.
"I don't think I ever allowed myself to believe he could die because somehow believing he would live was more helpful to me and him," she said.
"I told [Dr. McCormick] I would keep his head in the game if they would keep his body in the game."
"[Mrs. Wise and Mrs. Stover] wouldn't let me give up," Mr. Wise said.
Along with the debridements and the pain -- "dressing changes would sometimes take me right over the edge" -- there were other complications:
His intestines stopped working and a nasogastric, or NG, tube had to be inserted to bring liquid up out of his stomach, the family said. A colostomy was performed to keep the area clean. He started to suffer from psychosis from being in the intensive care unit for so long.
But clinically speaking, he already had turned the corner and was on his way back to health, Dr. McCormick said.
"When you do a surgery for any kind of severe infection you typically give 72 hours in which you hope the patient responds to what you've done," he said. "And after about two or three days, he started to show signs of improvement."
Mr. Wise definitely felt improved March 9 when the sun came out and Mrs. Stover got permission to wheel his gurney and lines outside for a couple of minutes.
"It was so nice," he said, adding that the sunshine and his sense of humor -- he would describe his clear liquid meals as tasting "pink" or "yellow" -- helped to keep him going. "It was like getting a second wind."
And 24 hours later he got an even bigger breather when he was moved to the West Penn Burn Center, where Dr. Kang would do the skin grafts and carefully trained nurses would do gentle wound care praised by doctor and patient alike.
The plastic surgeon told him that day there would be no more surgeries until he had some time to boost his immune system with rest and nutrition. The first skin graft, Dr. Kang said, was March 14. Mr. Wise also learned at West Penn he would not lose his more wounded left leg.
"I wouldn't have bet my life I was going to be keeping my leg," Mr. Wise said. "It was fileted up. Knowing I was going to walk again was really a boost."
The grafts came from healthy leg skin, which is meshed like fishnet stockings over wounds. Mr. Wise had a total of four grafts and plastic surgeries, the surgeon said.
He was sent home March 25. Visiting nurses did the dressing changes at first, but the family learned to do them and took over.
The ordeal didn't end there. Dr. Kang did an outpatient surgery April 3; then the next day Mr. Wise returned to Forbes with back pain. The diagnosis: Blood clots in both lungs that kept him hospitalized until April 9.
Dressing changes that caused enough pain to require he wear transdermal medication patches continued until late summer 2009. Physical therapy started July 21, about the same time he happily resumed golfing.
The colostomy was reversed Nov. 19, 2009, leading to more blood clots that sent him to the hospital on New Year's Eve.
Meanwhile, he suffers from and undergoes therapy for post-traumatic stress disorder. His wife said his symptoms show up when he's sleeping.
"He thrashes about, talks in his sleep and otherwise appears to be quite restless," she said. "For the most part, however, Garth does not know that he is so restless at night unless I tell him about it or he finds the alarm clock and night stand on the floor."
"The body heals pretty rapidly," Mr. Wise said, "but the mind, it takes longer."
Still, he was ready to party when Sharon and Ed Stover held a celebration of his life for 80 people on Feb. 27, 2010, and he returned to his job at supportive McCamish Inc. in Lawrenceville on March 23.
Pain, however, continues in shifting parts of his trunk. "I think his body is still adjusting to the loss of mass in his hip area," Mrs. Wise said. "Again, it's hard to say what is related to necrotizing fasciitis and what is related to normal wear and tear on a man that works in the construction industry in the winter [and] who has had a series of invasive surgeries."
He is scheduled for March 1 surgery to repair a hernia caused by the colostomy, the family said. He also has a fistula, or opening, in his flesh that requires treatment.
Still, when asked how he feels overall, he quickly answered: "Considering where I was, I feel phenomenal. Really. Obviously, I'm grateful to so many people. If I tried to thank them all, I'd miss some. And I'm grateful for the support they gave to my family."
His wife echoes his emotions.
"We celebrated our daughter's graduation from college in May. We got to go to my son's graduation from high school [in 2009]," she said. "I'm thankful every day."