Wound care professionals treat non-healing wounds through use of state-of-the-art techniques including low-frequency ultrasound, selective debridement and compression bandaging.
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Nurse who contracted necrotizing fasciitis and sepsis believes she wouldn’t be alive today without the aggressive treatment of Methodist staff.
By Maureen Gilmer, IU Health senior journalist, email@example.com
As an ICU nurse, Amy Sprunger knows the signs of sepsis and necrotizing fasciitis, both of which can be fatal. But when she started feeling sick last June, she assumed she was coming down with the flu.
She was finishing up her nurse practitioner program and had just diagnosed two people with the flu that week in her clinical work.
“I started feeling feverish and thought for sure that’s what I had,” she said. “But when I woke up, my finger was completely black, and I knew, ‘that’s not the flu.’ ”
Her training told her something worse was going on.
She eventually lost that finger, her right index finger, but says the now-missing digit saved her life.
“I think I would have waited longer if it wasn’t for that finger.”
Had she waited, the 41-year-old wife and mother of three has no doubt she would be dead.
RACE AGAINST TIME
Sprunger’s ordeal started after spending an otherwise ordinary June day doing yardwork. She started feeling ill June 13, she recalled, and within two days, she was septic. Her discolored finger gave it away. Her body was shutting down.
The Fishers resident was rushed to IU Health Saxony Hospital with a temperature of 105.4.
“I was not in my right mind at that point. By the time I got to the hospital, I had blisters all down my leg.”
She was quickly transferred to IU Health Methodist Hospital, where her medical team prepared her family, including her husband, Mark, and her twin sister, for the worst.
“The doctor was very honest with my family,” she said, telling them that the necrotizing fasciitis attacking her left leg was a fatal infection but they were doing everything they could to save her.
NF, commonly known as flesh-eating disease, results in the death of parts of the body's soft tissue. It starts suddenly and spreads rapidly, with bacteria entering through a tiny scrape or cut in a person’s body.
“I was doing yardwork, and we assume I contracted Strep A in the bloodstream at that point, which developed into necrotizing fasciitis,” she said.
She doesn’t remember having a cut or abrasion for it to enter, though she does recall later having what felt like an unrelenting charley horse in her leg, in addition to flu symptoms.
Symptoms of NF include red or purple skin in the affected area, severe pain, fever and vomiting. As it attacks, the body begins to shut down, going into septic shock, a life-threatening condition caused by a severe localized or system-wide infection.
“I was septic,” she said. “It affected my liver, my kidneys, my lungs. I went into acute respiratory distress, I was on a ventilator on 100 percent oxygen and ended up on ECMO.”
Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream. The system provides heart-lung bypass support outside of a person’s body.
While she doesn’t remember most of it, she knows from her nurse training that ECMO patients are the sickest of the sick.
“THEY KNEW WHAT TO DO”
Sprunger works for a different healthcare system as a nurse, but she is grateful that she was taken to Methodist because the hospital has more experience with NF patients.
“I don’t think I would have made it if I was anywhere else because they were so aggressive here,” she said. “I’m very lucky. I had a lot of complications, but they knew what to do – and I’m here.”
Doctors eventually had to remove skin and tissue amounting to a third of her left leg, part of her left abdomen and her right index finger. Skin grafts were later used to restore fullness and function to her leg.
She was hospitalized from mid-June to the end of July before being released to rehab for a few weeks. While she was slowly recovering, her in-laws took the lead on caring for her and her husband’s three girls, even taking them on a trip to Hawaii that had been planned to celebrate Sprunger’s completion of her nurse practitioner program.
She is grateful for the support system that has helped carry her this far.
In August, she began coming to the Wound Care Center at Methodist for outpatient therapy. Physical therapist Gregg Toy remembers her arriving in a wheelchair in those early days. In time, she progressed to a walker, then a cane, and now she walks in unassisted.
“I feel like I’m starting to get my life back,” she said as Toy rewrapped the large wound area on her leg. “Everyone tells me I’m doing well, and I’m going to believe them.”
Toy says her progress has been rewarding to see.
“She’s doing amazing,” he said. “I don’t know that I’ve seen patients smile through as much as she has. She’s kept a great attitude.”
None of it has been easy. In fact, the pain was worse than childbirth, Sprunger said. “I can’t even describe it.”
Early intervention is key with NF, Toy said. “It’s so aggressive and you can get septic and die.”
Removing all of the dead tissue and cleaning out the wound is where the healing starts. Once the patient is stable, the Wound Care Center team swoops in to continue treating the wound, using a wound vacuum to apply pressure, manage drainage and help fill in the space so healthy tissue can grow at its base.
“Bacteria loves that nonviable tissue and wants to hold onto that,” Toy said. “We decrease the bacteria by getting rid of that nonviable stuff. We have to get down to healthy tissue.”
And now, after months of treatment, Toy said his patient is in the home stretch.
“For the level of damage she had, the recovery is pretty miraculous – 99.8 percent from a wound standpoint,” he said.
“It’s rewarding to see that kind of progress, to see her bounce back from something so devastating and life-altering.”
She will need to continue to see specialists for follow-up, but the worst of this ordeal is over for Sprunger.
It all seems like a bad dream to the nurse, who still hopes to complete her nurse practitioner program in the months ahead.
REUNION WITH CVCC NURSES
Before she left Methodist last week after her PT appointment, she stopped in the cardiovascular critical care unit, where she stayed during the worst of her illness. She brought cookies for the nurses and a plaque that reads: “Not all angels are in heaven. Some work in IU Methodist CVCC.”
A swarm of nurses soon gathered around her, exchanging hugs and stories.
“They remember me even if I don’t remember them,” Sprunger said, acknowledging that for much of that time she was in a fog and suffered hallucinations.
“You look great, I don’t even recognize you,” one nurse said. Another said, “I took care of you, I’m glad to see you doing so well.”
“I don’t really know what to say, but thank you for saving my life,” Sprunger replied.
To CVCC clinical manager Jessica Jones, she said, “I can’t say enough about your team.”
Not just for her but for her mom. Because one year ago, Sprunger’s mom received a double lung transplant at Methodist and recovered in the same unit.
“I have a lot to be thankful for,” Sprunger said. “Everybody here has been phenomenal.”
Photos by Mike Dickbernd, IU Health visual journalist, firstname.lastname@example.org