Real Life Impacts: The Story of Barb PruittBarb Pruit was an active person prior to her Salmonella illness. She and her husband enjoyed the outdoors immensely, particularly hunting and fishing. In summary of her life immediately prior to August 2009, she stated:
I was a happy and energetic mom and a happily married woman with an active social life. I was proud of my recent accomplishments and was pushing myself ahead, trying to advance my career through hard work and further education. For 15 solid months I worked full time, continued to be a full time mom and wife, and studied until wee hours in the morning. The path I choose quickly paid off and shortly after completing my studies, I was promoted at work.
Exposure to Salmonella and Illness
Barb was exposed to Salmonella-contaminated lettuce on August 6, 2009 in a Subway sandwich. Her illness began on August 8 or 9 with the onset of nausea and general malaise. “The strange ill feeling continued to worsen on into Monday [August 10],” she recalls. “That morning, I knew I was in trouble.”
Barb’s first bouts of explosive diarrhea occurred later in the evening or the next morning, and were accompanied by extreme abdominal cramps. By August 14, Barb was in serious trouble and had to be taken to the ER. She was quickly admitted to the hospital and started on intravenous fluids, anti-nausea medication, and a potassium supplement. The admitting diagnoses were acute gastroenteritis and hypokalemia, and a stool sample tested shortly after admission showed that Barb had been infected with Salmonella Typhimurium.
First Hospitalization for Salmonella
Barb continued to be seriously ill over the next several days in the hospital. The diarrhea continued—it was, in fact, so uncontrollable that Barb was frequently incontinent—and Barb began to suffer from significant fevers, difficulty breathing, and growing abdominal pain and distention. By August 16, in fact, Barb’s abdomen had become so painfully swollen that a tube had to be inserted to decompress it.
The swollen abdomen was highly concerning. An x-ray also done on August 16 showed dilated loops of small bowel, consistent with an obstruction or other paralysis of the bowel, resulting in a buildup of gas and pressure. The first significant clue as to the process that was really at work in Barb’s abdomen, however, came the next day when a sample of her urine tested positive for Salmonella. This suggested that the Salmonella bacteria that she had ingested had somehow escaped her gastrointestinal tract and was causing systemic, septic illness.
Barb continued to deteriorate. Her breathing problems continued—a chest x-ray on August 18 showed that both of her lungs had collapsed—and she developed a rapid heartbeat. Her temperature fluctuated wildly, spiking to 103 F on multiple occasions. She also continued to suffer from marked mental-status changes, and was frequently confused and disoriented, and constantly scared.
On August 20, Barb’s condition worsened furthter. Her abdomen continued to expand, her cognition continued to be poor, and her respiratory problems just continued.
The next day, the decision was made to transfer Barb to another hospital for more intense treatment.
Hospitalization II for Salmonella Infection
Barb was directly admitted to the Intensive Care Unit (ICU). The admitting diagnoses included severe salmonellosis and possible acute respiratory distress syndrome (ARDS), which is a potentially fatal respiratory complication that can occur in the setting of a septic illness.
The doctor attending in the ICU believed that Barb was “much more severely ill than a healthy immunocompetent person w/ salmonellosis should be.” His diagnosis included a missed microperforation, which would explain how the Salmonella bacteria escaped the gastrointestinal tract. It was also theorized that Barb was suffering from a bowel obstruction, an unrecognized immunodeficiency, a nosocomial infection, or “ischemic bowel”—a reference to possible death of intestinal tissues due to lack of bloodflow.
A CT scan of Barb’s abdomen on August 21 showed progressive accumulation of fluid in the peritoneal cavity, a badly distended small bowel, and a lot of free fluid. A sample of the fluid was drawn, and gram stain test results were consistent with fecal contamination, which allowed Barb’s physicians to whittle down the differential diagnoses to one: intestinal perforation.
Accordingly, Barb underwent exploratory surgery on August 22, during which doctors removed a total of 90 cm of Barb’s small intestine. In follow-up (“second look”) exploratory surgery the next day, an additional 8 cm of Barb’s small intestine was removed.
Afterward, Barb was maintained on mostly supportive treatment. Her abdomen, remained very swollen. Barb had also become anemic, requiring transfusion of at least two units of red blood cells. She also received intravenous pain medication and antibiotics.
In the days following her successive bowel resections, Barb gradually began to show signs of recovery. Barb demonstrated sufficient respiratory drive to be able to be weaned from the mechanical ventilator on August 24.
Ultimately, Barb would remain hospitalized until September 4, 2009. During the final week of her hospitalization, Barb continued to struggle with severe pain, breathing difficulties, temperature fluctuations, and severe diarrhea—two episodes daily through the time of discharge.
Of the final week in the hospital, Barb recalls:
I had nasty long matted greasy hair. I wanted a shower but they told me no because of my stomach. Picture that, nearly a month without a shower. I had thrush and my tongue hurt. It prevented me from talking right. My throat was tender and dry and my right knee was numb. How in the world can you get your stomach cut open and your knee go numb is beyond me but it bothered me that I could not feel it. My back hurt and my tailbone dug into the bed. I knew that I had lost an extreme amount of weight, over 40 pounds. Once I had my mind about me, I clearly understood that I would not bounce back overnight like I wanted to. I was messed up and recovery was going to take a while.
Barb’s Post-Hospitalization Course
Once home, Barb was constantly nauseated, in pain, suffering from diarrhea and excruciating gas pains, and in and out of hospitals and doctor offices. She began to suffer from joint pains in her lower extremities and the fingers of her right hands—a condition that would later be diagnosed as reactive arthritis. And the large wound at her surgical site was incredibly sensitive, demanding significant attention from doctors and home health nurses to help Barb avoid infection, and from Barb to prevent her from causing a rupture during her continuing bouts of diarrhea and vomiting. Barb recalls:
Home health came by three times a week. I bawled like a baby every time because I knew they were going to change my dressing. They would turn the machine off and when the suction stopped my incision would throb. You could see all the way down to the muscles. I knew when they would pull the sponge off of the incision it was going to burn and wake up every nerve. I would beg them not to change it. They would give me pain meds and Ativan to calm my nerves but I will guarantee you it did not work. They would peel back the sheet of tape and then start peeling back the sponge out of the deep incision. It was like putting a knife to an open wound and scraping it without numbing medication. I would have to beg them to give me a break because the pain was more than I could take. I endured dressing changes for over two months.
In fact, Barb’s generally ill state, and concerns about infection, caused her to be taken to the ER on September 13. She was immediately taken to the ICU for treatment. She would remain hospitalized for six additional days.
An undeniably driven woman, and also the primary breadwinner in the family, Barb desperately wanted to be able to go back to work. Nowhere near ready, she finally returned to work on November 2, 2009. Initially, she could tolerate no more than two hours a day. Gradually, however, her hours increased, and by the end of the year, Barb was working half-days or slightly more on a fairly regular basis.
During regular visits with doctors in late 2009 and early 2010, Barb routinely reported persistent problems with severe diarrhea, gas pains, bloating, flatulence, and incontinence.
Barb says she continues to be profoundly fatigued. She is working 6-8 hours a day. Sometimes, she has to go home, either because she is tired, or because she has bowel issues. The patient says, on a good day, she will go to the bathroom 8 times a day, on a bad day, she might go 20 times. The patient continues to have trouble with getting sick once in a while. She gets nauseated and throws up. She says at times, she might spend 1 ½ hours in the bathroom. Sometimes, both having diarrhea and throwing up.
Barbara is tearful today. She says she feels depressed. She is having 10 bowel movements a day of water diarrhea. She said she feels like she can never quench her thirst, because if she drinks liquids to quench her thirst, it gives her immediate diarrhea. She said she is just tired of feeling bad and on the one hand she said she is glad to be alive, but on the other hand, sometimes she gets depressed at the thought of having to live the rest of her life like this.
Indeed, by the beginning of 2010, Barb’s medical picture was becoming painfully clear. She would never again be the woman she was. Barb’s husband poignantly remembers her as “my partner in everything, absolutely everything.” “Now,” he says, “medical problems literally dominate her life . . . our lives.”
Barb’s struggle with gastrointestinal issues has continued since 2010 with no end in sight. She has worked with a number of doctors and has been prescribed an array of medications – none of which have curbed her bowel problems. She continues to struggle with reactive arthritis brought on by her Salmonella infection. She has to visit the restroom up to 20 times daily. Her work life, social life, and family life will never be the same.
Barb’s Prognosis Following Multiple Hospitalizations and Surgeries for Her Salmonella Infection
Experts maintain that Barb will never return to “normal life”.
- Diarrhea: She will have chronic diarrhea and may have fecal incontinence when it is severe. She can become dehydrated more easily than normal individuals. Chronic diarrhea can significantly limit quality of life in terms of enjoyment of many activities and ability to hold a job unless it is well controlled.
Barb’s medical expenses to date total over $220,000.
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