Cellulitis

I recently had another episode with cellulitis. I had never heard of cellulitis when I had it for the first time five and half years ago. I decided to put this webpage together in hopes that it may be informative to others.

As I said, my first episode of cellulitis was five and a half years ago. In one year I had six episodes: four times I was hospitalized for three to five days, and twice I was treated with IV antibiotics in the Emergency Room and released. When one has chronic cellulitis like I did, the standard course of treatment is what's called "antibiotic therapy": in other words, take antibiotics for the rest of your life. Some people find this horrific, but I figure, hey, antibiotics are cheap, and if this is the only chronic illness I have to deal with in my fifties, then I consider myself very fortunate. The antibiotic I take was effective enough to keep me out of the hospital for five years.

I am often asked "Does it hurt?" In my experience, the cellulitis itself is not that painful. The fever is the source of the pain. Though sometimes there is pain while the resulting wound -- which resembles a severe sunburn -- is healing.

Cellulitis is pretty easy to recognize: the redness is always localized. By that I mean it has very clear boundaries: the redness starts here, and stops here. In the hospital, they often trace the boundaries with a pen, to make sure that it is retreating in response to the drugs. Speaking of drugs, the most effective drug for me has been vancomycin, which I am pretty sure is given by IV only. It is expensive: on my most recent trip to the hospital, each bag of vancomycin was $375.

I am often asked "How does this happen?" I have been told by doctors (1) every incident is a brand new infection, and (2) every incident is the result of a break in the skin; a point of entry. For men, this break is often athletes foot, or cuts on the legs from lawn work.

For me, every case has been indicated by a very sudden fever. One night I was in a hotel in Milwaukee doing some work at the desk. I felt a chill and five minutes later I was in bed, under the covers, shivering violently, on the phone to my wife, sobbing like a baby.

I am not entirely convinced that "every incident is a brand new infection". I have my reasons for thinking that this can actually lie dormant in you. My first episode occurred shortly after what was arguably the most stressful period in my professional career. Could stress be a trigger? On another occasion, I was at a scout activity in Indianapolis in late winter. I was walking from the cabins to the dining hall and took a nasty slip on the ice. My feet went out from under me so fast, and I came down hard, landing on my hips and banging my head on the slippery sidewalk. Within an hour I was shivering, not from the cold outside, but from a fever inside. Could it be that a traumatic injury brings this dormant infection to the surface? In my most recent episode, I had been complaining to my family for weeks about the stress I had been under with work, a part time teaching position, and graduate school. Could it be that stress brings this dormant infection to the surface? Just one man's opinion.

Below you will find pictures from my most recent episode. I don't mean to gross you out, just to inform you. As you will see, when this think strikes, it can move very quickly.

Still want more? Here are photos from my March 2007 episode.

Upon arrival at the Emergency Room. Just the slightest hint of redness. I am feeling the chills of an approaching fever.

Perhaps 15-20 minutes later, still waiting at the ER. (Sunday, 7:33pm)

Just 27 minutes later. Now being checked out in the ER. (Sunday, 8:00pm)

The next morning. Fevers of 103-104 last night and for the next day and a half.

Monday night, about 24 hours into this. Meds don't seem to be helping. I told the doctor to use vancomycin -- I've been through this before -- but he insisted on using Amcef instead, in my opinion wasting two valuable days in my treatment.

Tuesday morning, about 36 hours into this. No improvement.

Wednesday morning, about 60 hours into this. Cannot sleep due to fevers and poorly functioning IV pump which beeps incessantly. I get myself so worked up that I have trouble breathing. Minor panic attack brought on by fever and no sleep? I tell the nurse, and other nurses appear out of nowhere, rappeling from the ceiling, hooking me up to machines to monitor my heart. My heart is fine. They leave as quickly as they appear. I am left with the beeping IV pump.

Note the swelling. Scarring on right leg is from prior episodes.

Thursday morning. About 3.5 days into this. You can see a nice blister forming at the bottom center: this is like a severe sunburn, but from the inside out. My days as a runway model are probably over. Still off and on fevers of 101-102.

Friday morning. About 4.5 days. I suspect it has just about run its course now. The wound will take time to heal. No word yet when I will be out of here. I hope it's today but I doubt it.

Saturday morning. Waiting for the doctor...please send me home.

Sunday morning. One week. At least I get to sit outside under my huge elm tree and enjoy the fresh air.

Monday evening I am at home. I had swelling in my knees. Hospital discharge instructions said if you have swelling in your knees, it could be a sign of blood clots. We go back to the hospital. I have an ultrasound done on my leg. No blood clots. But they can't decide why my knees are so painful (by this time I can barely stand) so they admit me again. That night, fevers again. The next morning I cannot stand without assistance. More fevers. Hospital staff informs me that I am there "On observation". What does that mean? "You aren't really sick enough to be in the hospital, but you aren't well enough to go home." I think what they are saying is that I should expect a hassle with my insurance company. This picture is from Wednesday, May 30. I believe it was on that day that they assigned a physical therapist to work with me: initially I need a walker to move from my bed to the couch in the same room.

I was in the hospital until the Sunday night. So relieved to get home. The next day, against the protests of my family, I take the train to Chicago. I am scheduled to attend a training course all week, and I don't want to miss it. At the end of the day I am tired, but holding up well...until Wednesday morning, when I break out in hives. Legs, arms, chest, all covered with hives. I make the decision to stop taking my medications. On Friday afternoon I see my family doctor for a followup visit. His nurse is going over the list of medications prescribed at the hospital. One of the meds was Diclofenac. She points out that Diclofenac is another name for Cataflam. Cataflam is my only known drug allergy: when I took it in 1995 I broke out in hives all over. I was asked about drug allergies many times at the hospital, and every time I told them "Yes, Cataflam". And still they prescribe the one medication to which I am allergic. Rookie mistake. They -- and I -- are lucky all I got was several days of discomfort and not something more serious. That blister shown earlier, well it broke when the infectious disease doctor insisted I use a "sequential compression device" (think: series of blood pressure cuffs) on my legs for swelling. So here is the wound on June 7th (18 days since this all started).

Wound on June 13th, six days later.