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CdA surgeon applies lessons from war to MRSA

Fri., June 7, 2013

Barbara Allen-Kelsay smiles with Dr. Edward deTar at his office in Coeur d’Alene on Thursday. She credits the Coeur d’Alene medical community with saving her life by diagnosing what doctors elsewhere missed: a MRSA infection. (Kathy Plonka)
Barbara Allen-Kelsay smiles with Dr. Edward deTar at his office in Coeur d’Alene on Thursday. She credits the Coeur d’Alene medical community with saving her life by diagnosing what doctors elsewhere missed: a MRSA infection. (Kathy Plonka)

Barbara Allen-Kelsay delivered sweet treats to two of her doctors Thursday – a token of her thanks for diagnosing and treating a severe infection that has plagued her for most of a decade.

“They saved my life, there’s no question in my mind,” the North Idaho retiree said. “If not for their quick action, I would not be here today.”

Allen-Kelsay was suffering from MRSA, staph bacteria that are resistant to common antibiotics. Her case was serious, and Dr. Edward deTar with Kootenai Surgery Associates operated on her within a day after first seeing her red, swollen abdomen.

“All I thought of was this is pretty darn urgent, we need to take care of her quickly,” deTar said.

As MRSA has grown more prevalent in patients, hospitals are taking aggressive measures to detect and prevent the spread of infections. Kootenai Health requires a rapid screening for all intensive care patients and recommends surgeons screen all patients admitted for surgery involving an implant.

“If it continues to grow we may reach the point where we just assume everybody has MRSA,” deTar said.

Dr. Kirk Hjeltness at Kootenai Urgent Care said, “It’s something we’re seeing quite a bit more of, and we’re culturing for it in the walk-in clinics quite often and trying to treat it immediately before it gets a large foothold.”

Hjeltness saw Allen-Kelsay in April when, after days of feeling poorly, she drove to the urgent care clinic.

“When she came in she didn’t look toxic, she didn’t look like she was over the edge and really, really sick,” he said. “But it became pretty obvious pretty early that she had a long history of issues.”

Nine years of problems, she said, following a surgery in Las Vegas to repair a hernia. Infection took hold and a regimen of antibiotics had little effect. Allen-Kelsay was referred to the UCLA Medical Center, where they operated on her to remove infected mesh from the hernia surgery.

“It was a very long recovery period,” she said, and 2 ½ years later the problems returned. “The hole in my stomach, the pus, the bleeding. It started oozing.”

UCLA Medical Center operated on her again, and after both surgeries she spent months on negative-pressure wound therapy, a technique that uses a vacuum dressing to promote healing in wounds.

About a year ago, Allen-Kelsay noticed the symptoms of infection once again. She went back to UCLA Med and was told she should expect another operation and long recovery.

“I didn’t know if I wanted to do it. I thought I’d live with it like I have,” she said.

Allen-Kelsay, who was born and raised in Spokane, instead migrated back to her summer home on Lake Coeur d’Alene. Within days of arriving, the retired Wells Fargo broker was feeling lethargic, and her right side was red as a tomato and hot to the touch.

At urgent care, Hjeltness took a blood test, prescribed an antibiotic, booked her for a CT scan and referred her to a surgeon.

“He was very calm, cool and collected. He didn’t give me the impression I was in major trouble,” she said.

The next day she met with deTar, who had reviewed her CT scan and medical history. “He said, ‘I’ll walk you over to the hospital and I’ll operate this afternoon,’ ” Allen-Kelsay said.

Surprised and unprepared, she put the surgery off until the next morning. But she went home feeling if she didn’t let them treat her immediately, she might die.

“I think it shocked her because here she’s dealing with a problem that’s been going for nine years, and then somebody she meets and spends five minutes with is saying let’s go now. And that’s hard,” deTar said.

It had been a chronic problem for Allen-Kelsay, but deTar compared it to a smoldering fire that suddenly was whipped to life by the wind. A culture taken during her surgery confirmed her infection was caused by methicillin-resistant Staphylococcus aureus.

Bacteria had colonized the mesh left from her hernia surgery, and she may have suffered from MRSA all that time, deTar said, but it’s difficult to know.

“She may have started off with a different bacteria nine years ago, but in attempts at treating her all this time it selected out a resistant bacteria,” deTar said. “And we see that in patients that are in the health care community, whether it be nursing homes or hospitals, that over time their bacteria tends to become more resistant to antibiotics.”

Allen-Kelsay has recovered from this surgery far more quickly.

“I could tell a difference immediately. I feel better than I have in nine years,” she said. “And this recovery has been a piece of cake, whereas both recoveries from UCLA were three to nine months.”

She credits that in large part to deTar’s use of the wound vacuum while the abdominal incision was still open, rather than at the base of the closed incision, as has been the practice. He learned that method while, as an Air Force major stationed in Balad, Iraq, he treated patients during the 2007 troop surge there, and he brought the technique home with him.

“All the contaminated wounds that you would see in war, if it works there, it ought to work very well in the civilian setting. And it’s being applied more and more because of the experience of Iraq,” he said.

Allen-Kelsay said she felt compelled to praise those who detected and fixed what has ailed her for so long.

“We need to acknowledge people who are very caring and react immediately,” she said. “We have great doctors here. You find the gems in the smallest places.”

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