by Cindy A. Abole, Public Relations
If
the Medical University of South Carolina offered a degree in perseverance,
Randy Compton could graduate cum laude
today.
His degree will be a bachelor of science from the College of Pharmacy, and it is not likely that any of his 47 classmates could challenge him in the medical obstacles he has cleared.
At the age of 13, Compton became one of the 50,000 children in the United States who have Juvenile Rheumatoid Arthritis (JRA). Since then he has been a patient as much as he has been a student.
Compton is a modern example of how arthritis has evolved from being a disease of the elderly to a disease that crosses all ages.
A pervasive illness, arthritis interrupts a person's daily activities like walking, dressing and bathing. Its effects can be devastating by generating more than 100 different diseases that affect in or around joints.
Growing up in Charleston, Compton led a normal childhood, spending a lot of time enjoying outdoor activities like hiking, soccer, marching in the high school band and hanging out with friends.
That life changed almost overnight, when Compton noticed a rash and some unusual swelling and soreness in one of his ankles. A visit to his pediatrician concluded nothing. He was placed on antibiotics and was put through a series of tests that did not yield a diagnosis.
Compton was referred to Gary Fink, M.D., a Charleston rheumatologist, who trained at MUSC.
By November, Compton's health had diminished. He was bedridden and suffered from unbearable pain in his joints. For several months, he battled a daily fever which left him weak and nauseated. He was diagnosed with polyarticular JRA, a form of arthritis which affects many joints.
Fink began prescribing the steroid Prednisone, an anti-inflammatory drug that is naturally produced by the body. Taken orally and under supervision, this glucocortoid drug is the most potent treatment for this severe ailment.
Although the steroid helped, its side effects— which include high blood pressure, slowed growth rate, Cushing's syndrome (weight gain, moonface, thin skin, muscle weakness and brittle bones)—was especially taxing for a high school student. At this time, Compton was already taking around six or seven oral medications.
He began seeing Richard Silver, M.D., director of the Department of Medicine's Division of Rheumatology and Immunology. As Compton's pediatric rheumatologist, he also played the role of coordinator for his overall team care. The health-care team involved different specialists from pediatric orthopaedic surgery, physical therapy, pediatric endocrinology, ophthalmology and dentistry.
“Compton's case was very challenging because of his high fevers and rash which is sometimes seen in JRA patients,” said Silver. “Although his systemic features ended, problems with polyarthritis in many joints continue. His situation became increasingly challenging.”
The intense drug program affected Compton's body. Although his reactions have affected his ability to participate in sports, he was able to turn his attention and energy to books. “It totally reshaped my life,” he said.
On a routine visit to the hospital checking for stomach ulcers—another side effect to his drug therapy, Compton met a pharmacy doctorate student who was working on the hospital's pediatric floor. “She helped me see a side of pharmacy that was exciting,” he said. “I liked the idea of interacting with people.”
Compton had other challenges to deal with.
By age 16, he was undersized, standing a little over five-feet. He was referred to L. Lyndon Key, M.D., director of pediatric endocrinology. Key placed Compton on calcium therapy and growth hormones. Over the next few years, he grew a total of six inches which not only added height but strengthened his spine and bones. All this was necessary in his goal to achieve pain relief and replace damaged joints.
In July 1993, Compton had both hips replaced. At the time he was studying at Trident Technical College. The hip replacement surgery became the turning point in Compton's recovery from the disease.
“The problems with rheumatoid arthritis can get so severe, the degree of arthritis can evoke a permanent disability for some people,” said Del H. Schutte Jr., associate professor, Department of Orthopaedic Surgery. Although Compton suffered cartilage loss in one joint, it will ultimately affect other joints in the process. “By living with this knowledge and adapting, Randy was able to accomplish some lifetime goals like attending school and graduating.”
Schutte's group works with a subset of other specialists involved in the patient's surgery to rehabilitation. This effort may include anesthesiologists, physical therapists and other rehabilitation support. For joint replacement therapy, Schutte looks at three factors: technique, quality and type of therapy and rehabilitation, plus long-term results.
In 1997-98, Schutte replaced Compton's knee joints with implants. It was at this time that Compton entered the College of Pharmacy's undergraduate program. Even at MUSC, Compton encountered some dissuasion. He remembers being challenged and discouraged by some individuals, who felt he couldn't surpass the rigors of the profession. “I knew I was here (MUSC) for a reason,” said Compton, “The doors were open to me and I knew this is what I wanted.”
Ultimately, Compton will have to consider wrist and ankle joint replacement surgeries. For now, he's feeling much better and in a remission state. He tries to work out regularly, especially swimming in a heated pool. The outlook is good for arthritis sufferers. Recent biotechnology advances have yielded a new generation of anti-rheumatic drugs including Cyclosporin, Avara, Enbrel and Celebrex.
Compton is supported by a strong network of family and friends. Silver has also connected him with other teenaged JRA patients who want to meet and interact with others.
“This is comforting and reassuring,” said Silver. “Going through this together, they no longer feel alone.”
For now, Compton plans to pursue a doctorate in pharmacy from MUSC. Each day is step forward in his new life relieved from pain.