• Dr. Nicole Vumbaco | DVM

Muscle and Joint Progression (2017-Current)

Updated: Oct 27

During the acute period following hospitalization for a cat bite (Jan 24, 2017), I started to develop migratory joint pain, joint swelling, severe inflammatory reactions and lymphadenopathy...little did I know the collateral that was about to ensue, an incident that would change my life forever.

On January 24, 2017, it was early morning, and I was just starting my emergency shift at a specialty hospital. Within the first few hours I sustained a cat bite to my left index finger. Wound care was performed immediately but unfortunately the HR department could not find coverage for the ICU floor and thus informed me to wait to be relieved by the next ER doc coming in for their swing shift. This delayed my ability to seek medical intervention till later that afternoon. Because of this, my first dose of antibiotics (Augmentin) was not started till early evening.

By the next morning (January 25th), I was flushed, had an elevated heart rate and was developing a deep red streak (lymphangitis and cellulitis) extending from the cat bite up to my mid bicep region. There was again a time delay in my ability to leave the ICU. Luckily, our internist took lead and the specialists came together to take my open cases. By the time I arrived at the human hospital, a few hours had gone by...and this streak progressed even further, making it's way to my neck. I did not feel sick but also did not feel right. After being admitted to the hospital, my symptoms started to progress even though the lymphangitis and cellulitis were improving with IV antibiotics. By the next morning, I was experiencing severe pain, nausea, vertigo, shortness of breath, and extreme fatigue...just a general feeling of being unwell. Because I had a history of motion sickness and vertigo, the doctors were rather unimpressed by the development, treated my symptoms and I was discharged hours later. A few hours after arriving home, my infected finger continued to swell. My finger became blanched white. There was black tissue overlaying a small pustule or abscess that developed at the initial site of infection. This ruptured releasing a pea size amount of mucopurulent material (pus). That release of pressure led to improvement of my pain, a return of normal color to my finger and resolved the vertigo. However, my status continued to wax and wane. For days I fought through the fatigue, confusion, shortness of breath, joint pain, finger pain and axillary pain. Giving my best attempt at continuing a normal lifestyle.

Within 24 hours of finishing the prescribed antibiotic my body entered a downward spiral.

By February 6th, 2017 my symptoms escalated. I developed swelling (of my face, and legs), reactive airways and trouble breathing, hives, progressive constitutional changes and a transient heart murmur. Ultimately (many urgent care, ER, work comp and specialty doctor visits later), the blood cultures were negative and my heart scan showed no evidence of endocarditis (heart valve infection). Despite voicing my concerns, not one doctor agreed to check my bartonella antibody titers. At this point, no doctor, except my close friend, Dr. Rich Giroux (an Emergency Physician in South Florida) suspected or would consider bartonella. Doctors repeatedly declined my request for testing...disregarding my concern for this zoonotic disease. Continually circling back to "the wound has healed". Their top suspicion was a delayed antibiotic reaction to the Augmentin...and one ER doc had the nerve to tell me it was stress (yup, stress). Immunosuppressive doses of steroids were started hoping to quell the inflammatory response and improve my difficulty breathing. My swelling and malaise persisted. Later an infectious disease specialist concluded Immune Mediated Polyarthropathy (a condition where your immune system starts attacking it's own joints and other tissue). He too suspected it was all secondary to an antibiotic reaction. The general advisement was to continue supportive care and wait it out. By the end of February/beginning of March 2017, I was off steroids and weaning off albuterol. The symptoms were manageable, I started to re-enter recreational activity and cardiovascular re-training.

During the months that followed, I started to develop what seemed like little incidental injuries while exercising. But by June 2017, I had torn my left hip...presumably from run