“I’m not the same person”
Tom Keleher was sure it was a urinary tract infection when he had difficulty urinating one night two years ago. Physicians at an urgent care center prescribed antibiotics, but several days later, things went from bad to worse. He awoke one night with violent chills that produced such strong convulsions, he said “I thought I was going to break my teeth.”
Keleher’s wife called 911 and he was rushed to Falmouth Hospital.
Meanwhile at Cape Cod Hospital this past March, doctors first thought Marianne O’Malley was having a stroke when her husband rushed her in one day on her way to have blood drawn for a medical appointment, she started “talking foolishly,” as she put it, and her husband turned the car and headed to the hospital instead.
O’Malley, 69, and Keleher, 70, had each experienced something that affects about 1.7 million adults in the U.S. annually and is responsible for 270,000 deaths each year: Sepsis.
They both survived the ordeal, but, particularly in Keleher’s case, have been left with some lasting effects.
“I feel like something in my brain is fried,” he said.
Sepsis is a condition brought on by the body’s response to an infection, and can be life-threating, according to Hala Karnib, MD, a critical care specialist and medical director of the Cape Cod Hospital Intensive Care Unit.
“Most commonly, the sources of infection are urinary tract, lung, skin and GI tract,” she said. “Depending on the severity, it can lead to other organ dysfunction.”
Sepsis can present in fever and chills, as in Keleher’s case, and confusion, as in O’Malley’s situation, said Dr. Karnib. Other symptoms can be shortness of breath, a change in vital signs, an increase in heart rate or decrease in blood pressure.
“Early recognition and early treatment is definitely very important,” she said.
Started With a UTI
The source of O’Malley’s sepsis was a urinary tract infection (UTI) caused by an E. coli bacteria. She has had many UTIs in her life and was taking an over-the-counter medication to alleviate some of the more troublesome symptoms until she could see her doctor.
On the day her husband rushed her to the hospital, she had started the morning having trouble walking and making it down the stairs. “My husband thought I was fooling around,” she said. But, having just had a cast removed due to ankle replacement surgery, she thought it was related to that.
Then, on the car ride to have her blood drawn, her husband, George, became concerned when she was talking nonsensically.
An MRI and CT scan of her head and neck ruled out a stroke and the ER team eventually diagnosed sepsis.
“I don’t remember anything until the next day,” O’Malley said. “I slept all day and then George told me all this happened.”
She remained in the hospital for four or five days on an antibiotic drip, which continued when she got home, where nurses from the VNA of Cape Cod visited daily.
“I had the visiting nurses go over the list of things to listen for in my body to see if I have an infection and, if I do, I go immediately to the hospital,” she said. “They said ‘you don’t want this to come back, and I said ‘Jesus, Mary and Joseph, I do not!’”
Keleher remembers a small cut on his hand that happened around the same time he got sick. He and his doctors are unsure if it was related, but he then developed a UTI and the cascade of events began.
Test results at the hospital showed that Keleher’s prostate was putting so much pressure on his urethra, the urine had backed into his kidneys and had become an e coli infection. It was the beginning of the sepsis condition that would land him in Falmouth Hospital for five days for the initial visit, returning again after only being home for three or four days.
“People get UTIs all the time and it’s treated and they’re fine,” said Dr. Karnib. “It’s hard to pinpoint when the body’s response is going to be more severe. It’s dependent on a lot of things.
“Generally, these kind of things are picked up when people are evaluated, so when they’re starting to have symptoms.”
The most common bacteria found to cause UTIs is E. coli, said Dr. Karnib. Skin infections and lung infections are caused by other bacteria, which doctors know to look for, she said.
“When we treat people with sepsis, we treat them based on the knowledge we have of those organ systems and what types of infections we most commonly see in those organs,” she said.
Antibiotic treatment is based on those findings, and customized, if need be, based on cultures obtained from the patient.
“I’m Not the Same Person”
About 50 percent of people who survive sepsis recover with no ill effects, Dr. Karnib said. But the rest may have symptoms that linger, such as fatigue, muscle weakness, cloudy brain, difficulty concentrating, memory issues, and mood and or sleep disorders.
“People who are at risk for those symptoms are people that land in the ICU or end up having a prolonged hospitalization,” she said. These patients are also at risk for other medical issues or setbacks, as well as re-hospitalization or another bout of sepsis or infection, she added.
“It’s really important for people that are admitted with sepsis to have close follow-up with their primary care for follow-up labs and even to go over their medication list. A lot of times when people are admitted with sepsis, there may be changes to their medication list based on their vitals or lab work, and that has to be re-addressed,” she said.
Keleher, who worked for the Woods Hole and Martha’s Vineyard Steamship Authority for many years, says he is a changed man since his hospitalization for sepsis.
“I can’t even begin to explain to you the horrors that I’ve had,” he said. “When I came out of the hospital, I was not the same person. I used to be more outgoing, more enthusiastic.”
One day, while trying to help his granddaughter with repairs at a horse barn, he had trouble holding the screws and chose the wrong screwdriver, things he would never have done before.
“Now, everything is insurmountable and becomes a chore,” he said.
A neurology exam ruled out other sources of the problems, such as multiple sclerosis, Keleher said. His primary care doctor told him it would just take time to regain his strength and mental sharpness after the sepsis. He is now being treated for his depression.
“I keep asking (medical providers), ‘will I be me again?’”
Patients who have had more severe cases of sepsis are more likely to suffer from long-lasting symptoms, said Dr. Karnib. But it’s hard to say if sepsis is the cause of some chronic symptoms in some patients or whether it’s the prolonged hospitalization or ICU stay, she added.
“Some people that are in the hospital for a long time have the same problems and they may or may not have had sepsis,” she said.
The investigations into whether sepsis is the root cause of these post-hospitalization problems is ongoing, she said. But most patients will need time to recover fully after a long hospital stay, she added.
“The expectation that you’ll leave a prolonged hospital stay back to where you were mentally and/or physically is unrealistic. I think a lot of people underestimate that or overlook the fact that just being hospitalized may have long-term effects – functionally and cognitively,” Dr. Karnib said.
Before patients are released from Cape Cod Hospital, they are evaluated by a physical and occupational therapist, and recommendations for any follow-up physical or cognitive rehabilitation are made, she said. Rehabilitation can also be prescribed by the patient’s primary care provider, she added.
What You Need to Know
It’s very important for people with UTI symptoms, especially those with risk factors for sepsis, to call their primary care provider, Dr. Karnib stressed. Risk factors include:
- Age – 65 and older.
- Other co-morbidities such as diabetes, lung disease, kidney disease, cardiovascular disease and those who are immunocompromised.
- If you have recently been hospitalized or had another recent infection or illness.
“The strongest message needs to be that sepsis is not uncommon and early detection and treatment are very important,” Dr. Karnib said.