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ladyk
06-28-2006, 04:22 PM
Thank you for the opportunity to share my situation, and ask you a question.

This is my story...
It is well document throughout this event that I am a Diabetic maintained with oral medication, and have been for about 3 years now. I’m 48. Married 26 years. Two adult children. Live in Central CA.

April 27, 2006
I discovered one extremely itchy tiny black spot mid-center L labia after gardening. I cleaned tweezers and clicked a pinpoint opening into the black blister type spot, mainly because it was so itchy which alarmed me with the creepy factor. Without removing the outer skin I rubbed my finger in an upward motion and one single drop of blood came out. Treatment done by myself: many sitz baths in Epsom Salt mixed with antibacterial soap, and applied Neosporin oint to the area, covered with a Band-Aid. By Sunday, April 30th (4th day since black spot appeared) my L labia had swollen 4/5 times normal size, inflamed, extremely painful. An 8 (from 1-10) in pain level. Deeply concerned I contacted my healthcare insurance nurseline for advice. The nurse told me to go to my closest local hospital covered by my insurance within the next two hours. Which I did with my husband.

I would feel 10 and above on the pain scale when I screamed out in the ER after feeling the raw burning pain of being sliced with a knife multiple times on un-numbed skin tissue saying finally “I can’t breathe.”

April 30, 2006
SUNDAY
Immediately upon presenting to the ER doctor, he stated he knew the condition of a Bartholin Cyst to be effecting my L labia, he stated he was “familiar with this type of cyst”, and had treated “his share.” (Since this event I’ve looked up Bartholin Gland and Cyst, because I didn’t know such a gland existed, being these glands are only present in females I thought I would have known.) I was prepared in the ER by being told this was going to be painful and don’t move, the doctor will be using a scalpel. The ER doctor picked up a syringe of numbing agent and proceeded to inject several times into the inflamed swollen labia tissue. Then he picked up his knife and started slicing into me mid-center, of outer L labia. (Since this event I’ve been told by 3 different OB/GYN doctors this was the wrong place to be cut for a Bartholin Cyst. The correct procedure if the diagnosis of Bartholin Cyst was correct, is to cut inner, lower labia where the Bartholin Gland is present. I was cut into by this ER doctor for approx. one hour, duration of time is documented in the ER notes. I screamed out in extreme pain no less than four separate times because I could feel his knife cutting through un-numbed tissue. He would stop cutting when hearing me scream, inject more numbing agent by syringe, and abruptly pick up the knife and start cutting again. His action seemed abrupt even at the time, not giving the medication time to numb the tissue. I was on my back, legs in stirrups, holding the assistant’s 2 fingers which she commented on by saying “you can’t hurt two fingers no matter how hard you squeeze that is why I gave you only two fingers to hold.” This was in response to my apologizing if I was squeezing her fingers to hard. I squeezed my husband’s hand in my other hand while bearing my feet down into the stirrups to endure the pain of being cut and not move, as I was cautioned against doing by the female assistant. She reminded me to breathe quite a few times. Her facial expressions were like a gauge to me, going from what I perceived as shocked expressions at times, to sympathy. I know her name. After approx. an hour the ER doctor pushed back his chair, stood up and said in the presence of myself, my husband and this assistant that he “was over his head” and “was going to call in a specialist” because now he believed the hardened (normal male testicle size) core within the extremely swollen L labia “was a tumor.” Not a Bartholin Cyst. And “the tumor has been there for a long time.” I expressed to him a tumor hadn’t been there prior to April 27, that I am a woman, who washes, goes to the bathroom and wipes many times a day, in addition to this my husband of 26 years and I have a normal sex life and we would have known if a “tumor” was present.

An OB/GYN Specialist came into the ER. He said upon seeing me (legs still up in stirrups, open wound now into L labia, bleeding) that the incision was not in the right place to be cut for a Bartholin Cyst, but since the incision was already made into me he stated I had 3 options: 1. Go home on antibiotics. 2. He’d go in the same incision. 3. He’d take me to the OR on the spot and remove “it.” Bartholin Cyst /tumor/lump/mass/abscess/cyst/just tissue, severe skin infection... take your pick, all have been documented by different doctors throughout this event. I was afraid to go to the OR. And didn’t want to be cut open again on another day. He said in his opinion he’d go in to see what he could find. He said he had all the time in the world and was going to do this slow. His numbing agent injections were more tolerable, although painful enough in their own right. He started cutting within the first doctor’s incision. One time with him I felt him cutting un-numbed tissue which was way down at the very bottom of my L labia... on the inside! I remember screaming out I could “feel the knife cutting at the bottom” of my L labia. I also recall screaming out a repetitive mantra of “Jesus Christ”, “Oh My God”, and apologizing to those in the room for cussing in a respect on Sunday. The Specialist cut me for approx. an hour which is also documented in the ER notes. I believe he was attempting to cut out the first ER doctor’s second diagnosis of “tumor.” After his close to an hour of cutting he said he’s “never seen anything like this, it was all tissue.” He is a 30 year veteran OB/GYN Specialist. He said he was going to stop and send me home on antibiotics. When I got up from the table I “gushed” (ER attendant’s word) blood through the wadded up washcloths the attendant had given me to press against the incision, blood leaked through my fingers holding the washcloths, and I bled a trail on the floor. This attendant helped me by covering me with a sheet as I bled on the floor and we walked to the bathroom within the ER but outside my cubical and back again. The ER attendant cautioned me this would happen every time I got up so to stay on bed rest over the night and if while in bed I started gushing blood, to go back to the hospital. The Specialist said he was covering for another doctor and I was to see this other doctor for follow up, this is also documented.

May 3rd I went to this other doctor with my husband and daughter. In all our presence including his assistant he stated I was “cut in the wrong place for a Bartholin Cyst.” He said he was outraged and he went to the hospital ER administrator to complain, and that now there was a sign in the hospital ER “no doctor is to cut on a woman’s labia.” This is when my husband and I started documenting progression photos of the L labia incision wound. (3 days after cuttings.) He offered me Neuro-linguistic Programming. I told him his description of this sounded like hypnosis to me. His example was a young woman is raped, unable to have a normal sex life after the trauma. She goes through “Neuro-linguistic Programming” and is reprogrammed over the traumatic experience so she is able to have a normal sex life bar the previous horrid experience. I declined. He also encouraged me to go to a woman (“patient advocate”) at the hospital to tell her my story. Which I did. Frankly, it was quite obvious she represents the interest of the hospital and staff and got a heads up into my feeling about my ER ordeal. She said I would never know what disciplinary action could/would take place due to what was done to me in the hospital ER. She also informed me the ER physicians are similar to independent contractors which I took as her way of removing accountability from the hospital for what the ER doctor did to me. On the next visit with who I call the “hypnosis doctor” (I saw him 3 times) he stated he knew I had seen the lady he had recommended I go to see and tell my story to, and he said there had been a BIG meeting at the hospital. He wouldn’t tell me about the meeting. He appeared offended I had gone to another doctor and that doctor had actually done a culture of the incision and put me on a different antibiotic. He dismissed the lab culture results, saying “if the lab results are even correct” and he “wouldn’t have done anything including giving me an antibiotic had he seen me first before I had gone to the emergency room.” He would have “waited for the severe swelling to go away on it’s own.” The culture reflected this medicine change would be more appropriate for the bacteria found in the culture he took. It was my last visit with this middle man/hypnosis doctor - OB/GYN Specialist.

Five days after the ER cuttings I sought the OB/GYN Specialist who did the culture, in a close town to where we live, outside the loop of these other 3 doctors and their relationship between themselves and that hospital. Dr. A is the only one up to this point who did a culture of the ER incisions. Results: Heavy Pseudomonas Aeruginosa and Staphylococcus. He expressed to me that it was an interesting place to be cut for a Bartholin Cyst, in agreement and the 3rd doctor who stated it was the wrong place to be cut for a Bartholin Cyst. He said there was never a Bartholin Cyst. He said there was never a tumor. He said this was a “serious infection from the beginning, and the core they were trying to cut out as being a cyst, then a tumor, was what seriously infected tissue does by forming a hardened core which is just that, seriously infected tissue.” He has told me it will take weeks, and weeks, and weeks for me to heal from this. He said at some point those ER doctors should have stood back and re-evaluated the medical condition I was in and their professional diagnosis, including their judgment in picking up a scalpel vs other less intrusive procedures. Especially questionable is their inability to diagnose correctly in addition to both their cutting procedures.

I now can add the 6th antibiotic since all this started. Five have different names, all six have been different strengths. I have deep pain within my L labia, L groin, and L labia incision, and I’m worried what damage they did inside my L labia. Labia remains swollen at least twice normal size to this day. The (“tumor”) core has reduced to an inner ring surrounding the size of the healing incision. I am infected. I’ve been treated for a kidney infection, and tests are being done as I’m writing this on stool, urine, AND a culture from a new development of another single black spot on my right inner thigh, along with various other painful boil type eruptions which seems to me will result in one or both of these previous cultured bacteria found during the first culture. I saw a Dermatologist who injected a needle into two spots and is doing the culture. He believes the results will show Staph. He placed me on the 6th antibiotic. My pharmacist said they brought out the “big dog” with this latest antibiotic, attempting to kill these bacteria.

I believe this persistent infection is caused, if not caused then increased, by those doctors cutting down through seriously infected tissue exposing my entire system to these hard to kill pathogenic bacteria. In addition I am immune deficient being a diabetic, which has compromised me.

As difficult as it is I have kept detailed notes of everything. I have my medical records up to current doctors seen. I have lab reports. I have progression photos. I have names of everyone I’ve come in contact with. I even have a hospital and ER doctor bill for their slicing services!

I’m deeply exhausted... physically, and emotionally it has been more than a test. Hard to control emotion of feeling beat down and defeated as a human. This event has had a great impact on my life, and the lives of my family.


As of June 19, 2006 culture report results from spots:
I have MRSA [ Methicillin-resistant Staphylococcus Aureus]

Medical Dictionary
One entry found for MRSA.
Main Entry: MRSA

methicillin-resistant Staphylococcus aureus : any of several bacterial strains of the genus Staphylococcus (S. aureus) that are resistant to beta-lactam antibiotics (as methicillin and nafcillin) and that are typically benign colonizers of the skin and mucous membranes (as of the nostrils) but may cause severe infections (as by entrance through a surgical wound) especially in immunocompromised individuals


I’m now on the 7th antibiotic and have a prescription for another 2 weeks of this antibiotic to take when the first round is finished. All this in 8 1/2 weeks since the ER cuttings.

The story has even more depth then this book I’ve written here.

From the above information, where do I go from here? Am I doing everything possible to keep my medical situation and new diagnosis of MRSA under control? Is there a proven treatment to rid a person of MRSA? At times I’m so exhausted with all this that I feel as though if I stop struggling, I’ll simply float away.

I sought professional medical help in a trusted hospital setting from who I believed to be an experienced trained doctor at a serious moment in my life, and what I got seems like the horror of torture and complications which appear to be incurable.

Please help in you can

Does this event meet the criteria of medical malpractice?

Sincere Thanks
Karen

Dr. Joshua
06-29-2006, 07:05 AM
When MRSA is causing an infection, it is usually treated with the antibiotic vancomycin, and sometimes with other antibiotics, based on lab results for the sensitivity of the bacteria to antibiotics. However, if there is no active infection present, and the patient is found MRSA positive, i.e. colonised with MRSA, attempts to rid, as you say, the patient of MRSA colonisation are often unsuccesful. MRSA colonisation may disappear spontaneously, in which case repeat MRSA lab tests and swabs are needed and if proved negative, the patient can be considered MRSA negative again, depending on local regulations.

Based on your description of the events, it is possible that you acquired a staph infection (not MRSA) when you attempted to incise the offending skin change at home, and consequently was infected/colonised with MRSA at some point during your stay in the hospital.

It's important that you get properly treated for whatever infections you may have at the moment, and also you may want to talk to your doctor about referral to a pain specialist, seeing as you seem to have developed a chronic pain in the region. It's important to find a treatment that will alleviate the pain and enable you to get on with normal life.

I cannot say whether the above events constitute medical malpractice, you'll have to talk to your doctor, the hospital patient rights advocate, and/or a medical malpractice lawyer to discuss this matter. Unfortunately I cannot recommend any particular lawyers as I'm not familiar with the medical malpractice / personal injury lawyer practice in California.

Good luck!

ladyk
07-09-2006, 04:03 PM
Thank you for your response Dr. Joshua,


It was comforting to read your response concerning the “possibility” of becoming MRSA negative. First bit of positive in a whole lot of negative, so thank you for that. You mentioned the importance of being properly treated, and I have to say it is with all my heart that I wish I could be properly treated, yet it is not from lack of my trying. I’ve seen 7 doctors/11 appointments between them/8 antibiotics... all in the past 10 weeks.

My only treatment at this time is taking my 3rd 10 day round of Septra/Sulfamethoxazole TMP DS I take one in the AM, and one in the PM. When this last prescription finishes I will have been on this particular antibiotic for 30 days consecutively. At the time of the culture discovering MRSA, it did show sensitivity to Septra. Over the past few days I’m noticing small pinpoint sporadic outbreaks, which are in no way as serious as the full blown outbreak I experienced while off antibiotics. As it stands I’ve been waiting two weeks now on a referral to see an Infectious Disease specialist. There are only two physicians in my area who are ID specialist. Both are booked beyond their ability. I was shocked (having very good PPO medical coverage) when I called the referral office and was told they didn’t schedule appointments this way. I had to have my medical record faxed to his office for review, then was told the doctor will decide whether or not he’ll see me as a patient. Since it’s going on two weeks now I guess he hasn’t decided.

I’ve yet to be prescribed Vancomycin as you mentioned for the treatment of MRSA. It is hard not to notice through my personal search for information that most MRSA patients are commonly on this medication. My diagnosis of MRSA came by way of a needle stick culture from an active eruption. I’d very much like to have another culture. I suppose there is a measure of denial being exercised here, but when considering the first culture did not present MRSA, and six weeks later the second culture results did, I feel I need confirmation. I guess hope against hope I’m wishing it doesn’t show MRSA at all since I’ve been on non-stop antibiotics.

I’m worried about MRSA spreading into my blood and requested a blood test because the degree of fatigue I’m experiencing can lay me down only a couple of hours after getting out of bed. I was told by my GYN doctor if I have MRSA in my blood I’d know it. No blood test was ordered.

Seems I’m in a fight for my life. It is far beyond me to understand why it appears the medical community where I live do not seem to take the issue of MRSA seriously.

I have another question: When considering MRI... is it possible for this diagnostic test to pick up scar tissue within one’s labia? My understanding is this area contains mostly fat and muscle tissue? Also, if the longer one waits after labial injury to have an MRI, would an extended length of time pick up scar tissue to a clearer degree? I'm still swollen approx. 2 times normal, outer incision is healing. No change in deep ache.

Thank you Dr. Joshua