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Crista
climber
Las Vegas
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Nov 12, 2006 - 05:06pm PT
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2 friends... Staph came to both of them by settling in their hip joint. I'm not sure what kind of Staph it was, but since we are on the topic of warning people.
1st friend believes he got Staph from an open sore coming into contact with guano while crack climbing. Unfortunatly for him, they thought he had some sort of joint problem, shot his hip full of cortisone and sent him on his way... later (when he became severely ill) he was treated for Staph. Now he has a "frozen hip"
2nd friend believes she caught it while performing in a diving show in mission bay. Again it also settled in her hip, she refused the cortisone shot and instead got a second opinion because she felt ill. The only thing that clued in the docters was an onset of fever and (I think) pnenomia. She is lucky and regained almost full use of her hip, but was in the hospital for a month and on antibiotics for 6 months.
both of these individuals tested positive for ecoli also. I don't know if that helps give away what kind of Staph it was, but it makes me think twice about climbing routes with bird/bat/rodent poo.
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meg_
Trad climber
Boston
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Nov 12, 2006 - 09:03pm PT
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I feel the need to clarify some things about CA-MRSA. It lives on the skin and in moist body cavities (like the nose or throat). You can become colonized with CA-MRSA by touching a shared surface where another infected person has left the bacteria, or by coming in direct contact with that person's skin. CA-MRSA does not need to enter an open wound. If the infected person has a breakout, the bacteria is especially present and it is more likely for that individual to spread the bacteria to other surfaces or people. If you pick this bacteria up on your hands, then pick or rub your nose, well then it can live inside there too. It doesn't necessarily cause infections right away, and with some people never will. It can just hang out on you for a while with no visable effect. However, at some points the bacteria is able to get into microscopic openings in your skin, and then colonize forming spider bite looking infections.
Short summary: CA-MRSA is spread by hand to hand contact, or through shared use of athletic equiptment. After you climb in the gym, it's a great idea for you to wash your hands thoroughly- this helps to get rid of any nasty bacteria that you might have picked up on your hands while using the gym. It's also just good hygene- Other than that, it's pretty much up to getting word out about what to look for with this one. It makes itself very clear with spider bite looking infections. If you, or someone you know is getting these, let them know it could be CA-MRSA and that they should get a culture done. For some people these infections may not be a big deal, but for others they can be very impactful. It's good to know about it in case it may happen to you or someone you know.
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Fingertrouble
Mountain climber
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Nov 13, 2006 - 04:28pm PT
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Here's how it happened to me.
In late August I contracted a staph aureus infection of unknown origin (no "spider bite," no inflamed wound, no CA opportunity, etc). At first I thought I just had a mild sprain and a fever. After a few days the pain became so intense that I went to an urgent care facility, where I was diagnosed as having gout (a condition mainly of lower extremities). The treatment for gout creates 15 hours of debilitating and unrelenting diarrhea, before blood tests showed I didn't have gout. The urgent care MD missed whatever else the blood workup showed. That and my GP's absence consumed a few more days before I decided to see a hand specialist at the orthopedic hospital that previously had fused my lower spine and nailed my shoulder back together. The doc put on a compression bandage and gave me some NSAIDs. Three days later when he cut the bandage off he said, "My goodness that's red! I'm sending you to an infectious disease specialist, NOW."
The ID-MD put me on oral antibiotics (Levaquin, because it penetrates well) and ordered blood tests and cultures. Back in her office a couple of days later she got the preliminary blood culture results and immediately hospitalized me, four year old daughter in tow.
The infection was in my blood and left wrist. I spent a week in the hospital, had two wrist surgeries, then six weeks on in-home IV antibiotics (Rocephin, 2 gm) through a catheter (PICC line) from my elbow into my vena cava. Whoa! I coulda, like, died, man. Now I'm in intensive physical therapy, including electrical stimulation (getting the crap shocked out of my left arm) and much painful wrenching and pulling on recalcitrant tendons. Maybe another surgery in several months after things settle down. There's constant big time pain and I'm on a nerve pain killer cocktail that alters reality just a tad; adds entertainment to freeway driving with one hand. Maybe I'll eventually get most of the functionality back; maybe I'll be able to ski and climb again, but not any time soon. Right now I can't touch my thumb to my fingers or pick up a pencil with my left hand; typing, I could use my foot just as effectively. Sucks, but would suck much less if I had the correct treatment a week earlier.
But wait, there's more. While they were doing nerve tests on my arm they discovered an (old) unrelated problem in my cervical spine, a crushed disk. No symptoms so far, but it seems that if I hyperextend my neck I could become an instant paraplegic. That could happen in a skiing/climbing fall or a fall around the house, but hasn't so far. The fix is "simple; we just go in through the front, stick in a plate, and fuse your vertebrae. No problemo." But the spine guy seems reluctant to do this "just in case," especially since I've just had a staph infection of unknown origin.
Lessons? Don't assume your doc will spot a staph infection; if it swells and looks inflamed, be sure staph (or flesh-eating strep) is definitively ruled out. Don't waste time.
Also, in my many visits to clinicians of late, I've noticed that right along side the WASH! sign and soap dispenser is a squirt bottle of alcohol hand sanitizer. Used often. Wouldn't be a bad idea to carry your own little bottle and use it from time to time if you think you might be exposed to unfriendly microorganisms, wherever you are.
Craig Connally
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Karen
Trad climber
Mammoth Lakes
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Nov 13, 2006 - 05:10pm PT
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In November of 2004 I had an outbreak of MRSA and the site of infection was initially mis-diagonosed as a spider bite by the urgent care. I followed up with my primary care physician who was clueless as well. This infection spread quickly and I ended up with several other areas becoming infected. My quack primary physician finally took a culture which showed the infection to be MRSA. However, by then, the areas of infection were inflamed and extremely painful. He wasn't helpful so I ended up at the ER where they lanced and packed the sites, all done without any anesthesia, I am sure my screams rather unsettled the rest of the ER !!!!
I went back to my primary and told him he needed to take some action, so he ordered IV Vancomycin to be adminsistered at my home. The home care nurse arrives and proceeds to "teach" me how to put in the am & pm drip, what a f*#king joke....
My veins would not hold the IV and the drip would end up infiltrating, so I would have to pull out the IV and call the nurse to return. Well, I only was given 2 paid visits through the HMO-f*#kers-when all along I feel I should have been hospitalized. During this ordeal I was on my own, in intense pain, fear over what the hell was happening to me and feelings of helplessness. I was never able to receive my full doses of vanco due to the issues with the IV.
All I can say is thank goodness for Vicodin, at least the quack MD gave me the full strength ones.
The initial sites of infection cleared but I continued to have outbreaks at other random sites on my body. I was given Cipro, it worked but the side effects were unpleasant. All in all, I battled this for six months and it took its toll on both my physical and mental health.
I must add, prior to contracting MRSA I was training at an indoor gym, one located up in Victorville. This gym was also a boxing gym, so a lot of sweaty and I imagine unsanitary conditions were present.
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meg_
Trad climber
Boston
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Nov 14, 2006 - 11:58am PT
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Sorry to hear of your experience, Karen. It's a crazy experience to get this and not be able to rely on the medical professionals for education. When you're sick, and noone is clear as to what the problem is, it is an extremely frightening place to be in. I often find I am educating my doctors and even ID doctor about things with this.
There are people who know about this, and they all admit (as with other afflictions) that there is so many things that are still a mystery with CA-MRSA. There is also so much new information that comes out on it each day. I'm learning every week.
Shoot me mail if you ever want to chat about this or need to vent- I've learned so much in the past few months about this from medical, personal, microbiology, and emotional perspectives...
I am fairly certain we will hear more and more examples of CA-MRSA "popping" up in indoor climbing facilities, but time will tell on this one.
take care-
meg
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looking sketchy there...
Social climber
Latitute 33
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Nov 25, 2006 - 07:55pm PT
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I was just released from the hospital on Wednesday and am on a lengthy course of antibiotics to fight a MSRA infection. What started with a bothersome, but very small cactus thorn (yes, I tried to dig it out) quickly became a very inflamed thigh.
I figured it would get better, but after several days, it was only getting worse, so I showed it to my wife (who rightly got pretty steamed that I hadn't mentioned it or done something about it sooner). It was off to several visits to the emergency room and IV antibiotics. On my third visit, they were not satisfied with how things were going and I was admitted.
A surgeon removed a nice bit of my flesh (down to the muscle -- now I can relate to Shakespear's Merchant of Venice) and have been fitted with a portable "Wound Vac" which is to be my constant companion for the next couple weeks (think Borg implant sort of thing that makes farting noises).
A nose culture found MSRA happily in residence. In addition to a current course of multiple oral antibiotics, I have to swab the inside of my nose with another antibiotic gel.
Perhaps I wiped my nose while trying to get the cactus thorn out?
As a person who does frequent the gym, this seems the most likely source of the bacteria (no other particular risk factors). Now, it seems that washing up after using all those holds is an excellent idea. The gym also has decided to really crack down on barefoot climbers (though already prohibited).
Because I have a strong immune system, waiting to get treatment didn't result in more serious consequences. I never had a fever. The ER and hospital treated for MSRA from the get go (apparently it is that common) and I received excellent care.
I'll probably miss only a few weeks of climbing and biking. It could have been a far different result. I was lucky.
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meg_
Trad climber
Boston
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Nov 28, 2006 - 12:06am PT
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Thanks for sharing the story, and I'm sorry to hear what you've been through.
I am curious about a couple of things. Did you happen to get your culture results back? Did they tell you if you have CA-MRSA or HA-MRSA, or perhaps a necrotizing bacteria if they had to remove tissue? To let you know, CA-MRSA is sensitive to a broader range of antibiotics, but is also more virulent with healthy people. There are a couple of forms of CA-MRSA, and it does posess a toxin that can cause death of tissue.
The thing that is tricky with CA-MRSA is that it's REALLY hard to get rid of. In fact, not many people do "get rid" of it. Less than 1% of the population has this particular strain of bacteria on them, and I certainly don't wish it on anyone.
I don't want to bring somber news to you, but I urge you to learn a bit about the specific type of bacteria you harbor. For your wife too-- this stuff really sticks around, and can be put into remission, but rarely goes away completely. I know because I'm going through a second try of getting rid of my own invasive bacteria, but it's still hanging on. It appears to give me infections at least once every two months when I am not on antibiotics. I am also an otherwise completely healthy person. Everyone responds differently to it.
Its always good to play safe and be aware of what you have in order to take precautions to prevent infecting your loved ones and others- this has happened before. CA-MRSA is treatable, and containable with the right medications and precautions. CA-MRSA has a pretty distinguishable sensitivity pattern, and will also cause tell-tale boil-like infections. If your infection required IV antibiotics, it may have been HA-MRSA, which won't effect you when you are healthy. Anyway, all questions for your ID doctor, right? I certainly feel for you, and don't want to cause worry, but think it may be something to look into.
I hope you heal fast, and do get rid of this nasty stuff!
megan
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meg_
Trad climber
Boston
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Jan 12, 2007 - 09:46am PT
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There has been a slew of recent articles written about gyms and Ca-Mrsa. When I was searching on this topic earlier in the Spring, it was hard to find news on this subject, now when you google the subject, there are pages of articles.
I will post a few;
http://news.nationalgeographic.com/news/2006/04/0425_060425_staph.html
http://www3.whdh.com/features/articles/specialreport/DBM1269/
http://www.nbc4.tv/station/4510495/detail.html
just google staph and gyms, and there will be many, many more. A recent statistic says 25 percent of Ca-MRsa cases lead to hospitalization. This is a serious issue!!
I still wonder how other climbers would want their gyms to respond to this issue? Mine hasn't taken any proactive stance what-so-ever. In fact, the owner of my gym seems to be under the impression that I must have been unhealthy to have contracted this in the first place. I feel he thinks I have been through trauma and am over-reacting.
I'm trying to be diplomatic, but I am finding the lack of pro-activeness in my gyms response to this extremely aggrevating. Am I the only one to feel this way? If you climbed at a gym where someone else was diagnosed with this, how would you want your gym to respond?
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Irisharehere
Trad climber
Gunks
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Jan 12, 2007 - 12:56pm PT
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Can you think of any practical measures a gym might take?
You can't identify people colonised with CA-MRSA when they walk in the door.
You can't make people climb in latex gloves
You can't steam-clean the holds every time a person touches them.
All I can really think of is warning notices about CA-MRSA and its presentation.........
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meg_
Trad climber
Boston
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Jan 12, 2007 - 01:30pm PT
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What about posters reminding people to wash their hands and covering their wonds/gobis? And reminders that if they look like spider-bites, to get your infections cultured.
It just worries me that I myself had several infections before being diagnosed. I hope everyone can learn from that and get cultures right away.
Each time I climbed with an infection (even though it was covered) I still put people at risk. I wish I had known better then, but didn't have any access to that info.
Do you feel that people who climb at the gym should be informed somehow that it is has been present in the facility? (Sort of like the note that gets sent home when someone gets lice at school). Right now, it is starting to be approached this way. Inmates who have contracted CA-MRSA in facilities where there have been breakouts are forming lawsuits against their prison for being aware of the situation, but not educating the inmates. This brings up interesting ethical questions.
thanks for all the thoughts- it helps me be a bit more relaxed about this all.
-m
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meg_
Trad climber
Boston
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Jan 26, 2007 - 07:06pm PT
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For those of you following this thread, there will be an article in April's issue of Rock and Ice about CA-MRSA. The article gives a brief, yet informative, description of what CA-MRSA is, and discusses concerns about this disease in indoor gym environments. April's issue will be available starting March 1st.
Healthy and happy climbing to all!
-m
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meg_
Trad climber
Boston
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Jan 28, 2007 - 04:58pm PT
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Education as prevention- a study on it's effectiveness in athletic
environments.
In fall of 2003, an outbreak of Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) occurred in Mecklenburg County involving athletes and non-athletes in the Charlotte-Mecklenburg School System.
In response to this outbreak the Mecklenburg County Health Department developed an educational video, brochure, and website with a fact sheet to educate athletes, parents, athletic personnel, and the public about proper hygiene procedures used to prevent and control this type of infection. Pre and post tests were administered along with the video to a sample of high school athletes to assess current hygiene knowledge, attitudes, and practices. Pre/Post testing showed:
* 86.4% increase in knowledge and attitude of effectiveness of hand washing,
* 6.4% in showering,
* 240.4% in cleaning shared equipment, and
* 145.4% in reporting suspicious sores to their school nurse or healthcare provider.
You can visit this link to read more about this study:
http://www.charmeck.org/Departments/Health+Department/Top+News/MRSAResponse.htm
Here is a link to an informational page on the site about CA-MRSA and also a link to the video mentioned in the athletic awareness campaign:
http://www.charmeck.org/Departments/Health+Department/Top+News/MRSA.htm
Maybe we should all try to pass this video around? Thanks,
Meg
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paganmonkeyboy
Trad climber
the blighted lands of hatu
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Jan 28, 2007 - 07:37pm PT
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lots of good information
lots of food for thought
and one of the best lines ever
"Climbing plastic? Isn't that like scraping the bong?"
I'll never be able to do either again without thinking of MRSA ;-)
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meg_
Trad climber
Boston
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Feb 28, 2007 - 01:12pm PT
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NATIONAL ATHLETIC TRAINERS’ ASSOCIATION (NATA) ISSUES OFFICIAL STATEMENT ON COMMUNITY-ACQUIRED MRSA INFECTIONS
Organization Addresses Potential Risks and Offers Prevention Tips
DALLAS , March 16 – In an effort to educate the public about the potential risks of community-acquired methicillin-resistant staphylococcus infection (CA-MRSA), the National Athletic Trainers’ Association (NATA) has issued an official statement recommending all health care personnel and physically active adults and children take appropriate precautions if suspicious skin infections appear, and immediately contact their physician.
NATA represents 30,000 members of the athletic training profession through public education and research. Certified athletic trainers (ATCs) are allied health care professionals who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. They can be found in sports settings, performing arts, corporations, the military, schools, clinics and hospitals, physician offices, and other health care facilities.
According to the Centers for Disease Control and Prevention (CDC), Staphylococcus aureus , often referred to as “staph,” are bacteria carried on the skin or in the nose of 25 to 35 percent of healthy people. This is known as colonization. It occurs when the staph bacteria are present or in the body without causing illness. Infection occurs when the staph bacteria causes disease in the person.
In the past, most serious staph bacterial infections were treated with an antibiotic related to penicillin. In recent years, treatment of these infections has become more difficult because staph bacteria have become resistant to various antibiotics, including the commonly used penicillin related antibiotics. These resistant bacteria are called methicillin resistant staphylococcus or MRSA. According to the CDC, one percent of the population is colonized with MRSA.
MRSA infections usually develop in hospitalized patients. However, MRSA rates have increased recently in persons outside of health care facilities, affecting athletes and the physically active.
“Staph or MRSA infections develop from person-to-person contact, shared towels, soaps, improperly cleaned whirlpools and sports equipment,” says Ron Courson, ATC, PT, NREMT-I, CSCS, head athletic trainer at the University of Georgia in Athens, Ga. “Such infections usually appear first as pimples, pustules and boils. Some can be red, swollen, painful and/or have pus or other drainage. The pustules may be confused with insect bites in early states. The infections may also be associated with previous existing turf burns or abrasions. Without proper referral and care, more serious infections may cause pneumonia, bloodstream infections or surgical wound infections.” Courson believes maintaining good hygiene and avoiding contact with drainage from skin lesions are the best methods for preventing MRSA infections.
NATA’s official statement recommends the following precautions be taken:
Keep hands clean by washing thoroughly with soap and warm water or using an alcohol-based hand sanitizer routinely.
Encourage immediate showering following activity.
Avoid whirlpools or common tubs. Individuals with open wounds, scrapes or scratches can easily infect others in this environment.
Avoid sharing towels, razors, and daily athletic gear.
Properly wash athletic gear and towels after each use.
Maintain clean facilities and equipment.
Inform or refer to appropriate health care personnel for all active skin lesions and lesions that do not respond to initial therapy.
Administer or seek proper first aid.
Encourage health care personnel to seek bacterial cultures to establish a diagnosis.
Care and cover skin lesions appropriately before participation.
ATCs throughout the country are celebrating National Athletic Training Month in March promoting the message: "Rehabilitation: Accelerated Return to Activity."
To view the NATA official statement, visit http://www.nata.org/publicinformation/position.htm. For more CA-MRSA information, from the CDC, visit www.cdc.gov/ncidod/hip/aresist/ca_mrsa_public.htm or visit www.nata.org.
About the National Athletic Trainers’ Asssociation (NATA):
Certified athletic trainers (ATCs) are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. The National Athletic Trainers' Association (NATA) represents and supports 30,000 members of the athletic training profession through education and research. March is National Athletic Training Month. www.nata.org. NATA, 2952 Stemmons Freeway, Ste. 200, Dallas, TX 75247, 214.637.6282; 214.637.2206 (fax).
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meg_
Trad climber
Boston
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Apr 13, 2007 - 10:30am PT
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Hello all-
It seemed like there were quite a few med folk following this topic, and I thought this news was significant to share. Basically, for those of us who are recieving MRSA infections (and for you med folk treating us), be aware that CA_MRSA can be very quickly lethal if it forms respiratory pneumonia. It has a rapid onset and is often fatal. I'm reacting to this in the following ways; I will treat any respiratory infection very carefully and monitor them, and also make all medical professionals who treat me aware of this condition. I will also be careful to not freak out about this all the time...:-) , but I do think as many people as possible should be aware of all of this to ensure that we get the fastest treatment possible if anything happens.
This is a recent announcement by the CDC:
CDC Reports Severe Influenza-Associated MRSA Pneumonia
The CDC reports 10 cases of severe influenza-associated
community-acquired pneumonia caused by methicillin-resistant
Staphylococcus aureus infection.
The cases, six of them fatal, occurred last December and January in
Louisiana and Georgia; the patients' median age was about 18.
According to a report in MMWR, the cases were especially notable
because of the rapid course of the disease. Death occurred within 4
days of respiratory-symptom onset for four of the six patients who
died, suggesting that the influenza and S. aureus infections occurred
concurrently in these cases.
Four of the patients had documented history of MRSA skin and
soft-tissue infection in themselves or a close contact before
developing pneumonia. The CDC said MRSA should be suspected in severe
pneumonia cases, particularly during flu season, and in patients with
cavitary infiltrates or a history of MRSA infection. In such
instances, treatment should include vancomycin or linezolid.
thanks,
Megan
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pc
climber
East of Seattle
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Apr 13, 2007 - 12:05pm PT
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Yikes! Thanks Meg. Very good to be aware of.
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Lambone
Ice climber
Ashland, Or
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Apr 13, 2007 - 02:19pm PT
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Gym climbers should keep a watch out for inconciderate climbers on the wall with open finger wounds, cuts, or gobis. Tell them to wash up, tape up, and/or stop climbing.
If you see blood on the holds or wall tell the gym staff and make sure they clean it...
wash your hands, A LOT!
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