A concerned Slater mom and a talented team at Mary Greeley solve the mystery of a teenager’s health emergency.
Slater teen Syd Finn and his mom in the
room at Mary Greeley's Pediatrics
unit where Syd spent several days.
Call it a mother’s intuition, but Sara Finn knew something was up with her son Syd.
He’d taken a tumble at a friend’s house, and a pain in his back was lingering.
Syd, a typical teenager, wasn’t initially forthcoming with many details, but Sara sensed that Syd was dealing with something beyond embarrassment and a bruise. She was right, but it took a team at Mary Greeley Medical Center to figure out what was wrong with Syd, and how to fix it.
Not Just an Injury
Messing around in his friend’s basement, Syd lost his balance and wound up on his back side. Sure, it hurt. But the pain that radiated up through his back wasn’t significant enough to compel Syd to mention it to his mom. It happened three weeks before Christmas and initially there was nothing more than a little discomfort, the kind that comes with a bruise, for the 16-year-old sophomore at Ballard High School. As the holiday got closer, things started to change.
Syd developed a fever that got as high as 104 degrees and he began experiencing more intense pain in his back. By that time, Syd had shared with Sara that he’d taken a fall, but made it clear that it was nothing out of the ordinary. To be safe, Sara decided to take Syd to the family physician in Slater.
“With the holiday coming up, we wanted to be sure it was a virus and not something more serious,” Sara says. “They ran tests and there were no bacteria or anything that would indicate an infection. He also had an ultrasound and an X-ray that didn’t show anything.”
Antibiotics helped with his fever, and a series of chiropractic appointments offered relief from the pain. He managed to get through January feeling pretty good, but as February began, his condition got worse. Clearly, this was more than consequences of a fall. Syd was facing a serious health issue.
On the eve of a scheduled appointment, Syd was in a good deal of pain, which began in his lower back and radiated around his side. “We didn’t anticipate it was that big of a deal,” Sara says. “We knew he had an appointment the next day so I encouraged him to try to sleep. When the pain became too much, we decided to head to the Mary Greeley Medical Center emergency room.”
“I must have thought it was more than just a bruise,” she recalls. “As we left for the ER, I made sure I had a bag packed with a few extra things in case we got admitted.”
Dr. Gina Erickson, with McFarland Clinic Emergency Medicine, was the first to see Syd in the Mary Greeley emergency room. Taking in his history, Erickson suspected there was some trauma from the fall that was continuing to cause Syd’s discomfort. She ordered an X-ray of his pelvis, but it came back normal. Another round of rapid blood tests designed to identify any sort of infection didn’t indicate anything. This was beginning to feel like an episode of “House.”
Doctor Detective Work
With no obvious diagnosis, and Syd still in pain, Erickson ordered IV anti-inflammatory medications along with muscle relaxers and then visited with Sara about her suspicions.
“I felt pretty comfortable that any fracture from the fall had been ruled out,” Erickson says. “More unusual diagnoses, such as a mass or infection of the spine, are possible, but rare and almost never found in the ER. When I spoke to Sara, I felt that an outpatient MRI in the next couple days would be the best course of action to identify what the underlying issue was.”
But when the anti-inflammatory meds and muscle relaxers failed to provide relief, Erickson knew her role as “sleuth” was just beginning. She suspected Syd may have one of the more rare diagnoses because his pain was so chronic and difficult to control.
Erickson ordered a CT scan from Mary Greeley’s radiology unit. The scan indicated there was a mass surrounding and pressing into Syd’s spine.
After reviewing the radiologist’s report, Erickson offered a detailed summary to the team of physicians who would care for Syd while he was in the hospital.
“I have not had a patient present quite like this,” Erickson says. “It was very unusual because he is young and otherwise healthy, the lab work didn’t show infection and he was not having chronic fevers.
“I contacted the pediatrician on call for the emergency room and spine surgeon that evening, before Syd was admitted. Once he was admitted, Dr. Laura Hufford, our pediatric hospitalist, assumed oversight of Syd’s care and our infectious disease specialist was brought in.” Syd was admitted on a Sunday night but he and his family would have to wait a day for test results. Sara was scared. She knew her son had a mass on his spine, but neither she nor the doctors yet knew if it was the result of an infection or a tumor.
Once the full team was assembled, a care plan was developed to remove the mass, manage the infection and get Syd back to normal teenage life. “When I was called in the next day, the team had some suspicions but nothing was confirmed,” says Dr. Ricardo Arbulu, an infectious disease specialist with McFarland Clinic. “It was my feeling that the symptoms he had been experiencing since around Christmas were due to an abscess that was growing into his bone. The blood culture that had been done in the ER the night before came back positive for Staphylococcus aureus, an infection that is the most common cause of this problem.”
While unsettling, Sara says the diagnosis provided a sense of relief. “I just wanted the pain Syd was experiencing to stop,” Sara says. “While we weren’t thinking it was an infection at all, it was a diagnosis we could deal with. I just tried to remain calm regardless of what the diagnosis was and take in the information.”
Armed with the diagnosis, it was decided surgery was the best course of action.
“Left untreated, the abscess could have grown into his spine and caused paralysis. He was starting to have some leg weakness so time was of the essence,” Arbulu says.
Dr. Sarkis (Sam) Kaspar, McFarland Clinic orthopedic spine surgeon, performed surgery a day after Syd was admitted to Mary Greeley’s Pediatrics unit.
“In the course of 36 hours, Syd had been on a remarkable journey,” Kaspar says. “With no improvement in his condition, despite strong antibiotics, and the blood cultures now showing markers for infection, we had to operate.”
After intense study of a variety of diagnostic tests, coupled with consultation with the growing group of physicians who had worked with Syd, the surgeon determined the best way to get at the abscess was by approaching it from the side. The surgery allowed the access necessary to remove the abscess while reducing the risk of damaging the spine or surrounding nerves.
On the Mend
Syd Finn catches up with Jessica Allen, and RN
on Pediatrics. Allen helped care for Finn
when he was a Mary Greeley patient.
The surgery was a success, and Syd was soon up and around on the pediatrics floor.
“We watched him carefully after surgery,” Hufford says. “We wanted to be sure his pain and his markers for infection were improving. “He required prolonged antibiotic therapy. This medication regimen can be hard for many adults to adhere to and even harder for an active teenager. So we also wanted to be sure he was ready to manage medications for many weeks after he was discharged.”
Syd was on the pediatrics unit for just over a week. Once home, he was required to take IV antibiotics for close to a month. All his follow-up appointments have gone well and he is anxiously awaiting the opening of the local pool where he will serve as an attendant again this summer.
Looking back, Sara says the experience was incredible, even considering the circumstances. “Throughout, the communication among the doctors, nurses and everyone we came in contact with was amazing,” she says. “They made sure they spent the time with us we needed and that every question was answered.”
“Syd’s case is a great example of how many truly remarkable specialists we have at Mary Greeley Medical Center and McFarland Clinic,” Kaspar says. “The open communication we share, along with the wide range of skills we bring, makes it possible for us to handle significantly complex cases right here in Ames."
Help at Home
“It was a very difficult and frightening time,” Sara adds. “But everyone worked so well together. The physicians were incredible, the nurses were incredible, everyone made sure we were taken care of.” In addition, Sara says the care team made sure they had the resources necessary to be successful at home.
“It would be easy to just discharge a patient and tell them to get in touch with an [antibiotic] infusion company,” Sara says. “But Mary Greeley had a social worker walk us through the process and then we had a nurse from Homeward (Mary Greeley’s home health service) come to the house to teach us how to use the IV.
“I am so grateful that we were cared for at Mary Greeley,” Sara adds.
“They went from A-to-Z to make sure everything was handled.”