Muscle and Joint Progression (2017-Current)
Updated: Oct 27, 2021
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 running. The joint was on fire. For months and months the issues compounded. A series of escalations and new developments ensued...the progression of randomized migratory joint pain, more constitutional changes, and THE MOST ridiculous disproportionate inflammatory conditions (ultimately, required bladder and oral-maxillary facial surgery; developed dental trismus, TMJ hematoma, pelvic floor dysfunction, hydronephrosis, a ureterocele, trigonitis, multiple allergic reactions/rashes/edema, skin striations, progressing hip dysfunction and a change in my migraine profile and vertigo). My body was so inflammatory and caught in a downward spiral of unknown origin. It continued to fluctuate, but my concern for an infectious disease like bartonella was at an all time high.
Work-ups continued to come up empty. Eventually, I put it to rest and accepted this as my new normal. My support network started to feel overwhelmed by the onslaught of new issues, work became less tolerant and I began withdrawing. I started to remain silent on all new medical problems as my list of symptoms continued to grow. Some days felt foreign while others seemed manageable (something that has remained consistent throughout this battle).
By May 2018, I was scheduled for hip surgery (laproscopic labral repair, bursectomy and femoral-acetabular osteoplasty). In pre-op, my surgeon noted hypermobility which was not present on exams prior. Post-op Dr. Philippon reported that my synovial tissue was friable and severely deranged, much worse than expected for the duration of and presumptive cause of injury... Now we know why! The first 4 weeks post-op were brutal but showed slow and positive improvements. Interestingly, Doxycycline was one of my post-op drugs since it has chondroprotective properties. It was a month long script at 100 mg twice a day. A part of me felt thankful...maybe this will target any underlying infections. Upon trying to re-enter work, the demands of the shift caused an abrupt decline. I developed a severe disproportionate inflammatory response and symptoms of Complex Regional Pain Syndrome (hyperesthesia, tingling, burning, pins and needles, mottled cyanosis on lower limb, inability to tell the difference between hot and cold, severe swelling and progressive muscle weakness).
For weeks, I lost the ability to use my surgical leg, was unable to work for months and approaching financial ruin. The myofascial tightening (fibrous connective tissue that provides support and protection to your muscles and bones), pain and feedback was excruciating. After consulting with multiple specialists, my hip surgeon and their team internist was at a loss, the Immunologist misdiagnosed me with Scleroderma, while the first Rheumatologist diagnosed me with Fibromyalgia and "wind-up" (a response to repeated high-intensity pain impulses leading to nonresponsive or chronic intractable pain). It took 4 months (by end of September 2018) for me to attain a good functional capacity again (just in time for my best friend's wedding). By December 2018, my recovery seemed back on track, these symptoms were greatly improved and I was able to work more of a full-time shift load. It finally felt like I was healing! This was a short-lived success as a neurologic injury soon followed...exacerbating my rheumatic symptoms and leading to continued injury and joint breakdown.
Check out associated research and case reports on the Rheumatologic Manifestations of Bartonellosis
Check out the connection between Bartonella and Connective Tissue Disorders