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20.08.2014 18:20
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Rancho Mirage, California Physician Saves Casino Worker from Deadly 'Flesh Eating Disease'
Ein Spieltisch in einem Casino (Symbolbild).
© vadimguzhva / iStock / Getty Images Plus / Getty Images
PR Newswire
RANCHO MIRAGE, Calif., Aug. 20, 2014
RANCHO MIRAGE, Calif., Aug. 20, 2014 /PRNewswire/ -- The National Necrotizing Fasciitis Foundation (NNFF) today announced that a patient named Fernando Davila has been successfully treated for a life threatening form of necrotizing fasciitis, or "flesh eating disease", by Dr, Anibal R. Gauto, Medical Director of Inpatient Wound Care and founder of The Wound Care Center, at Eisenhower Medical Center in Rancho Mirage, California.
Dr. Gauto used a new treatment pioneered by Dr. John Crew at Seton Hospital in Daly City, California. "Without this treatment Mr. Davila could have had both legs amputated or even lost his life. This is a significant advancement in treatment and I believe we will be able to significantly improve the care of patients suffering from this disease", said Dr. Gauto.
Despite suffering from diabetes, chronic kidney failure and being on dialysis, Mr. Davila had led an active life working full time as a casino employee. He enjoyed his family life and taking his grandchildren to the park and swimming. He developed small discolored darkened lesions on both lower legs that became painful and infected. He was admitted to the hospital, treated with antibiotics, and a surgeon took him to the operating room to debride his wounds. The real nature of the infection was not initially recognized and he was discharged and sent home to be cared for by visiting nurses. He became progressively worse, his wounds enlarged, and the infection extended to his left foot. He was readmitted to the hospital once again, but this time Dr. Anibal R. Gauto was consulted.
Dr. Gauto treated his first severe case of necrotizing fasciitis in 1971, while in training at the University of Cincinnati's General Hospital. This hospital was a major tertiary referral center for all kinds of severe "surgical infections". In the ensuing 43 years of general surgery, vascular surgery and wound care practice, Dr. Gauto operated upon close to one hundred cases of necrotizing soft tissues infections.
"Many victims of necrotizing fasciitis lose limbs and about 20-70% lose their lives, even with aggressive treatment because doctors often don't diagnose the disease early enough, failing to recognize its biological behavior and severity," said Dr. Gauto. "Many physicians believe that antibiotics alone can stop the infection and cure the disease. That is wrong and far from reality. Infections such as these require early surgery and antibiotics," explains Dr. Gauto. "What makes necrotizing fasciitis especially deadly is that the invading bacteria in the wound produce toxins that kill tissue but they also diffuse away from the dead tissue and soak surrounding live tissues. These areas of tissue soaked in toxins, not visible to surgeons' eyes, are frequently left behind during surgeries. They go on killing more tissues and are responsible for the subsequent progression of infection and the repeated surgeries frequently necessary to ultimately control this disease. Also when bacteria die, killed by antibiotics, and their cell membranes rupture, they release more toxins into the wound."
In the traditional treatment, surgeons treat the disease by cutting away all dead infected tissue, with reasonable margins to stop the damage from toxins. The tissue that is alive looks viable, but it is soaked in invisible toxins and if left, will later die and the patient will have to return to surgery to cut more tissue out. Dr. Gauto had patients that have had 4, 5, and 6 operations over a period of 8 to 10 days.
The earlier surgeons start the surgical treatment, the greater the chance that more lives and limbs will be saved. But too often the correct treatment is not started soon enough. "I have been terribly frustrated for years and years," said Dr. Gauto. "When doctors don't quickly recognize the disease, the consequences are devastating and terrible: multiple surgeries, amputations and/or death. The suffering of patients and their families is absolutely atrocious."
In addition to the need to diagnose and properly treat the disease sooner it is obvious, what has been badly needed is a way to neutralize these deadly toxins. "We never had a toxin neutralizer," said Dr. Gauto. But now, doctors have that crucial toxin-neutralizing weapon in the fight against this disease. A few years ago, Dr. Gauto learned that Dr. John Crew, an old friend and colleague who directs the San Francisco Center for Advanced Wound Care at Seton Medical Center in Daly City, California, has been working with an Emeryville, California biopharmaceutical company, NovaBay® Pharmaceuticals, Inc. (NYSE MKT: NBY), to develop a wound cleanser named NeutroPhase. The active ingredient in NeutroPhase is a substance called hypochlorous solution (HOCl), which mimics a natural chemical produced by white blood cells as a first defense against microbial invaders. Laboratory studies have shown that in addition to killing bacteria, hypochlorous solution neutralizes the toxins and appears to stop the spread of the dying tissue. Dr. Crew developed a method of irrigating wounds with NeutroPhase in combination with a common vacuum technique called negative pressure wound therapy. He has now used the treatment for more than 20 patients, saving the lives and limbs of every patient treated, as he has reported in journals like WOUNDS.
When Dr. Gauto learned of the new method he said "In theory sounds great, if it works it will be extraordinary and I would love to be part of it". The first patient Dr. Gauto treated with NeutroPhase in 2012 had a spectacular recovery. So when Fernando Davila came back to Eisenhower Medical Center in danger of losing his legs - and even his life – and Dr. Gauto took over his care. He applied the new treatment method. By then 50% of the soft tissue of the back of Mr. Davila's right lower leg including his Achilles tendons, two thirds of the anterior surface of his left lower leg and the dorsum of his left forefoot including tendons and two toes were infected, dead or dying. Davila felt very sick and was in excruciating pain. He and his wife knew that the situation was grim.
Dr. Gauto performed extensive surgical removal off all dead soft tissues, including his right Achilles tendon and also, the dorsum of his left foot, tendons and the left 4th and 5th toes. His wounds were treated with NeutroPhase instillations and negative pressure wound therapy as recommended by Dr. Crew, stopping the potential spread of the disease. All of his wounds were eventually skin grafted successfully. His legs and foot were saved. He was discharged from Eisenhower Medical Center to go home. Mr. Davila's wife, his children and grandchildren were very happy to have him back home.
"I am now able to stand up on my own legs and feet and I am very excited to get back into life and do things I was not able to do" said Mr. Davila.
After seeing the results from the use of NeutroPhase, Dr. Gauto is now eager to work with the National Necrotizing Fasciitis Foundation and other doctors and hospitals on a national awareness campaign to spread the work about the dangers of the disease and the benefits of new NeutroPhase – based treatment. "I think this has the potential to be really big and if we can continue with these types of results we not only minimize deaths and amputations but we will significantly decrease the number of operations we will need to do on these patients," said Dr. Gauto.
The NNFF is equally eager to publicize the efforts and successful results of doctors like Dr. Gauto who are bringing new hope to patients like Mr. Davila. "For years I could only offer emotional support to those struggling with this devastating disease" said Jacqueline Roemmele, Executive Director of the NNFF (herself a survivor of the disease). "But now, we can direct them to a new life –saving treatment and to a growing number of doctors like Dr. Gauto who are experienced at using this treatment.
Dr. Gauto also personally knows the pain and suffering of necrotizing fasciitis patients. As Jacqueline Roemmele, executive director of the NNFF describes in her new book, "Surviving the Flesh-eating Bacteria: Understanding, Preventing, Treating and Living with Necrotizing Fasciitis". Dr. Gauto contracted the disease himself in his right shoulder two days after operating on a patient with a highly virulent infection. He was urgently hospitalized, underwent three operations in four days, spent 16 days in the hospital and took four months to heal his wound and to recover.
ABOUT THE NATIONAL NECROTIZING FASCIITIS FOUNDATION
The National Necrotizing Fasciitis Foundation (NNFF) is a 501c3 non-profit organization established in 1997 by two survivors of the disease. Since that time, NNFF has evolved to become the world's leading resource for information regarding necrotizing fasciitis, as well as repository of cases reported worldwide. Its mission is to educate for public awareness regarding recognition of symptoms and preventative measures; to advocate research; to offer resources; and to offer support for those affected by necrotizing fasciitis, so that it may help save lives. The two founders of the organization, Jacqueline A. Roemmele and Donna Batdorff, have a second edition of their top-selling non-fiction book "Surviving the Flesh-eating Bacteria" being released this summer.
Jacqueline Roemmele
Executive Director
National Necrotizing Fasciitis Foundation
908-422-7744
SOURCE National Necrotizing Fasciitis Foundation
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