by Dawn Brazell
Public Relations

Back out on the links, Hilton Head resident Barry W. Ginn ignores the pain in his left arm bearing his badge of honor, what he now calls his 'work of art.'

Some may think it a strange name for the scars left behind from him having lost an estimated nine pounds of flesh and muscle from his arm in his brush with death. Ginn's nightmare started in February when he contracted the 'flesh-eating' bacteria known in medical circles as necrotizing fasciitis.

Barry W. Ginn enjoys being back out on the golf course after a harrowing bout with necrotizing fasciitis that required six operations. To watch a video, visit http://tinyurl.com/brzuo6q.

Gingerly holding up his arm that still gives him pain, Ginn doesn't think calling his scarred arm a work of art is strange at all. He's just grateful to be here – to still have an arm.

Instead he focuses on the salty tang of the air, the sun warming the grass, the fact that he is able to swing a club when his story could have gone so differently.

Ginn is one of several patients in South Carolina and Georgia who recently made headlines for having survived necrotizing fasciitis. Ginn's case began with a sore shoulder where he thought he had reinjured a torn rotator cuff. He visited his doctor, but the site continued to get worse. Trying to ignore the pain and tenderness, Ginn thought he just needed to tough it out.

One reason he's eager to tell his story is he wants others to avoid his mistakes. "I didn't continue to ask questions, and I wasn't honest with myself or my doctors. You're so sick you can't have a train of thought. Instead of telling him what I thought was wrong, I should have just told him I was sick."

The area became hot and very painful. Ginn, who lives alone, became disoriented and began falling down. He had bruises down his back. By the time he knew he was in serious trouble, he was too confused to call for help.

"My mind was mush. I don't think anyone has any concept of what this disease does to you. All this time I was getting progressively sicker, and I was sweating profusely."

Fortunately a friend stopped by to see him, took one look at him and picked up the phone to call 911. "He didn't even ask me. That's a good friend."

Ginn said he will forever be grateful for that visit.

"I was skating death and should have been dead by the time I got there."

Ginn went to a local hospital and on Feb. 24 was transferred to MUSC, where trauma surgeon Stephanie Montgomery, M.D., took one look at him and scheduled him for surgery.

Having few recollections of that time, Ginn said he hated his daughter had to sign paperwork giving the doctors permission to amputate his arm should it become necessary. Other painful decisions about cremation and where to scatter his ashes were made.

Montgomery said they had to act quickly.

Dr. Stephanie Montgomery was part of Barry Ginn's treatment team.

"I took him almost immediately to the OR. With necrotizing fasciitis, the infected tissue easily is pushed away, almost as if it sloughs off, and it's critical to get rid of all the infection, which is why these patients often have more than one surgery."

To the Rescue
Ginn was placed on multiple medications to keep his blood pressure up, as well as on a ventilator as they waited for powerful, broad spectrum antibiotics to kick in. "With all the necrotizing fasciitis patients, you're just not sure," said Montgomery. "I was at his bedside for most of the night, watching his wounds. He was touch and go for the first 24 to 48 hours. It can take a turn at a moment's notice."

As it turned out, Montgomery had to take him back into the OR that same evening.

"It's not like you get it all the first time. Within six hours, it had spread some more. The infection can spread while you're treating it."

MUSC has a team of seven trauma surgeons, board-certified in both general surgery and critical care, who Montgomery jokes all eat, breathe and sleep emergency care. They all love the field and work closely as a team to treat patients. In Ginn's case, the team had to decide whether to keep his arm. The infection involved the muscles in his left shoulder as well and an orthopedist was called in for a consult.

"If you have to make a decision between life or limb, limb goes."

A consensus was reached to try to keep his arm and wait to see if the infection could be contained without having to do the amputation. "You don't want to do a definitive operation like that unless you have to," she said. "You make a judgment call. That's where experience comes in. That's why MUSC is the best place to have that done. We take care of this frequently."

Two other trauma surgeons, Stephen Fann, M.D., and Stuart Leon, M.D., would end up taking Ginn in for more surgeries, and then plastic surgeon Dennis Schimpf, M.D., took skin grafts to be able to cover the wound on his arm and shoulder.

Finally on March 13, 19 days after coming to MUSC and six trips to the OR, Ginn was well enough to go home.
Ginn, who has become friends with Montgomery, said he's so thankful to have gotten the care he did. "I had doctors who weren't afraid to make hard decisions."

Back on Par
Ginn, who's undergoing physical therapy, still is working through the trauma of having had necrotizing fasciitis. Though there's no way people can avoid getting what he had, they can seek treatment sooner. His one regret is that he ignored the persistent pain in his shoulder.

The sooner the treatment, the better patients with necrotizing fasciitis fare. Montgomery said there needs to be more education in the medical community about symptoms, particularly given how often these cases occur. MUSC generally gets at least one case a month.

There are more virulent bacteria because of the overuse of antibiotics, so there are more of the cases, she said. "The more awareness that is brought up, the more physicians who don't deal with it on a regular basis, will educate themselves," she said, adding that MUSC takes transfers from every hospital in the region. "They should know we're here 24 hours a day, seven days a week to deal with this. It just takes one phone call – through Meduline. It's a one call does it all. We have the resources to deal with these complicated cases."

The way media portrays the disease isn't quite accurate.

"It's not a flesh eating bacteria or anything like that. It's an infection that has been allowed to get bad or it's a very bad organism that causes the infection and it tracks along the fascial planes inside of a patient's subcutaneous tissues. It can happen not only on arms and legs, but on your torso, your back – anywhere. It can happen from any sort of trauma, a scratch or a bug bite."

Montgomery said there are patients who are more susceptible, such as diabetics or those with low immune systems.

Normal, healthy people also can get it, though, because it can just be a 'bad' organism, such as staph, strep, MRSA or even multiorganisms in one. Treated early it's not a problem, however, often patients will let the infection set in because they don't realize how bad it is or they seek help from a physician who doesn't recognize it for what it is.

Warning Signs

• Trauma surgeon Stephanie Montgomery said it's pointless to worry about getting necrotizing fasciitis. "You have bacteria all over your body right now that can cause this. It's in the environment. Take care of yourself and wash your hands. If you have a wound that gets infected, go see somebody with experience in handling it."
• Pay attention to any wound that becomes red, starts growing, has blisters, changes colors, has red streaks that track away from the wound, is hot to the touch or develops intense, persistent pain.
  

"It's not as unusual as you think, which is the reason it's important to choose a place that sees it often and knows how to take care of it well. These patients are extremely sick. Not only do you need a prompt surgical approach, but you also need a team who can take care of the aftermath of the operation."

The patients are in septic shock, which means their system is so overwhelmed by the infection that they are in danger of multi-system organ failure. Montgomery said she's thankful for a well-trained nursing and ICU staff who know how to do the follow-up care these patients require.

"We have wound-care specialists. We have a team of wound nurses who are amazing. They help the wound close faster and be more aesthetically pleasing. That's important for these patients because sometimes you have take off quite a bit of the soft tissue to make sure the patient lives."

One of the best parts of her job is when a patient as sick as Ginn comes in and is able to leave. Montgomery said she developed a good relationship with the family and Ginn, whom she didn't really get to know well until he began to recover. "He was feisty. However, I'm feisty, so that worked for us. He's fun and witty, and I'm glad he's still with us."
Ginn, of course, agrees.

"There is life after necrotizing fasciitis," he said.

"Everything that happened to me was so bizarre, it was mind boggling. God has given me a second chance and the doctors have given me a life. That's a miracle. They made me a whole person. I can feel and touch and see what a big miracle it is."