MRSA & Shingles While Pregnant (detailed post)

*I will start the post with a "Readers Discretion". If you get grossed out/queasy easily, you may want to think about skipping this post. I will discuss in great detail my MRSA skin infection, and it gets a little gross.*

The last two weeks of my second trimester, my immune system (or lack there of) got the best of me. One morning, I woke up and noticed what I thought was a mosquito bite on the left side of my belly. Over the next two or three days I complained a lot about how it hurt more than most bug bites usually do, and I remember my co-worker telling me that I was a big baby, and sounded like her 9 year old. It just didn't feel like a normal bug bite though- it was more swollen than usual, and really hurt a lot. I tried taking some Benadryl to help with the swelling, but that didn't help. I ended up going to the ER that evening (a Thursday) as the swelling had grown to about the size of my palm, and was starting to get red. The ER physician saw me in the triage bay (didn't even take me back to a bed), and told me that I had been bit by a spider. He prescribed me Bactrim and Keflex. After doing some research, I found out that Bactrim is a pregnancy category C drug, and called my OBGYN right away. I informed her I was uncomfortable taking a category C drug, and asked if it would be fine to just take the Keflex. She told me that was ok, so I continued taking the Keflex as ordered. The swelling still got worse, the redness got larger, and the pain got worse… a lot worse. Sunday afternoon I got a bit of pus to come out when I picked the scab off and applied pressure. I was so happy, and expecting to wake up Monday feeling much better. Well I was WRONG about that! I was not able to sleep that night. I woke up at about 3am, in an insane amount of pain. I tried adjusting my position, moving to the couch, the recliner, etc., but nothing I did would take the pain away. I tried my hardest to wait until 8am for an urgent care to open, as I had just spent $100 in the ER that Thursday for my bite, and that Friday for some spotting. There was no waiting however. I was in tears the pain was so bad, so at 6am, I got off the couch, dressed myself, and drove myself to the ER. This time, the ER physician (a different doc), saw me very briefly in the triage bay, then in the waiting room (they were not busy at all!) where he told me I had MRSA, and then told the nurse to give me a tetanus shot and discharged me. I asked him begged him to incise and drain the wound and do a culture. (After all, with MRSA, you have to do a culture & sensitivity to determine if it is MRSA, and if so, what drugs it is susceptible to) I KNEW there had to be a pocket of pus there. But, he said he couldn't feel any pockets of pus. He prescribed me Augmentin (which DOES NOT work for MRSA!) and Clindamycin. Meanwhile I was so unbelievably frustrated, I just cried and cried. I called my mom and told her I was so upset, I was in so much pain, and no one was willing to do squat! My next step was trying an urgent care. Surely enough maybe they would be willing to incise and drain me, to do a culture to confirm it was MRSA, SOMETHING! I called a local urgent care and asked to speak with the nurse. They said they would not incise and drain me as I was pregnant. I told her “I know if I pull the scab off I will be able to get some pus out. If I do that, will you guys culture my wound so I can figure out if it truly is MRSA or not? After all, I know MRSA can kill people!” She said yes, so I was off to the urgent care! Unfortunately the NP I saw didn’t want me pulling the scab off with my finger nails, so she decided she would poke a hole in the scab with the needle. Well, that didn’t work. She tried, and pressed on my stomach, and I cried and about threw up I was in so much pain. I asked her to stop, and didn’t care at that point that I had wasted $50 on the visit for absolutely nothing. She did advise me to use warm compresses and take probiotics, plus drink a lot of water though. I took her advice and used the warm compresses, and the following afternoon I attempted to drain the abscess again. I (thankfully) sat down prepared with toilet paper, and peeled the scab back. It started gushing out pus like a river!!! That lasted for about a minute and a half, without me applying any pressure to my stomach at all. I then spent the next 30 minutes draining about 2 cups of pus from the abscess… Yea Dr. _______, there wasn't any pus in there… IDIOT! Thankfully I started feeling a lot better, and the pain decreased drastically after it drained. In case it was indeed MRSA, I covered it, and then went out and spent like $30 in bandages and tape to keep it covered so I couldn't spread it—after all, MRSA is highly contagious. In the hospital they keep patients in contact isolation when they have MRSA, which means anyone who enters the room must wear a gown, gloves and a mask. I still continued working, but I let the infection control nurse know what was going on, and kept them up to date with my appointments and efforts at figuring out exactly what was going on. I made an appointment to see an Infectious Disease Specialist that Friday, Dr. Bachir Younes, in Palm Desert. I saw his wound care specialist at my appointment, where they took a swab of the fluid draining from the abscess for a culture. They gave me another appointment for the following Tuesday to review the results. MRSA cultures take a few days, as they have to wait for the bacteria to grow, and then test different drugs on it to see what it is resistant and susceptible to.  Fast forward to Tuesday… I’m sitting in the room waiting to see the doctor. Brett, the wound care specialist comes in and tells me it is indeed MRSA (which we were all pretty sure of anyways at that point), and that the doctor would be in soon. My hole from the abscess had fully closed by this point, and Brett said I may be just fine, but we’d have to see the doctor to see if I needed further treatment. Dr. Younes came in, introduced himself, and then the rest happened so fast. He said I was infected with MRSA, and needed 4 WEEKS of IV antibiotics (Cubicin), 4 weeks of putting an antibiotic ointment (Bactroban) up my nose, and needed to use a special body wash (Hibiclens) once the first day of treatment and once the last day of treatment. (Usually he would make patients wash with it every day, but I am pregnant and it is a pregnancy category C wash) I would be off work for at least two weeks, if not four, and my roommates and boyfriend would need to use the special body wash and put the antibiotic ointment up their nose as well. My treatment began an hour later, after I went out to get something to eat, as it’s not advised to get the infusion on an empty stomach. (Picture on right is of my first day of IV treament)

I tolerated the infusions well, absolutely loved the nurses at the infusion center (connected to Dr. Younes’ office), and I’d be lying if I said I didn’t enjoy being able to sleep in for two weeks.

Two days before I was due to go back to work, I started feeling nerve pain radiating down my right arm, on my right upper back, and up the right side of my neck. At first I thought maybe I had a pimple on my back or something because it was irritated, but then the nerve pain started radiating to the other areas. I asked my roommate, as well as my mom the following day if they saw anything on my back or arm, and they both said no. The night before I was due to go back to work, I was still having the radiating pain, and my back hurt (nerve pain) quite a bit. I looked in the mirror and noticed a small rash on my back, and a small rash under/on my armpit, both on the right side of the body. I took my brother to the doctors and helped him a lot when he had shingles in high school, so I had a feeling I had shingles. I can be a hypochondriac at times, so I figured I wouldn't stress on it and would just ask the infusion nurses to take a look at it the next morning. I was hoping I was just having a reaction of some sort to a medication I was on—God knows I was taking a lot!

(On the left is a picture all the different bottles of medication I was on during this month long ordeal.) Sure enough, the following morning when I went for my daily infusion, the nurses all agreed it looked like shingles, and immediately put me in the isolation room (in case one of the other patients hadn't had chicken pox before). I was there for four hours before the NP could squeeze me in. She initially didn’t think it was shingles because it didn’t seem to have the characteristics of shingles to her. She wrote me a note however to keep me out of work for two more weeks—until the end of my iv infusions, as she wanted to be safe (Yes! Two more weeks of sleeping in every day!). She believed it to be contact dermatitis at that time. Over the next couple days, the rash began to get bigger, more painful, and start to blister… There we go, more characteristics of shingles. At my next appointment with the NP, she agreed it was shingles, and wrote me a prescription for Valtrex (see picture of giant blue pills on right, which I had to take 3 times a day),

and told me to use calamine lotion to help dry it up, and oatmeal baths to help with the itching. My lord did it itch! Thankfully we either caught it soon enough or it was just a mild case, because by the time I went back to work, the scabs were already gone. To this day (two weeks later), the scars left from the shingles still itch a lot; but thankfully I do not have PHN (postherpetic neuralgia), which happens when the shingles virus damages the nerves on the skin (PHN can last up to a year!) I am so thankful the MRSA and shingles are behing me now, and I can focus on the task at hand— moving, and getting ready for baby Delaney to arrive. J