The Dallas Morning News
Sepsis is a sneaky and lethal enemy
On the last Monday in January, a Fort Worth woman named Angie Barwise went to her doctor for flu treatment.
On Wednesday, she was feeling no better, and her husband took her to the emergency room. She was admitted to the hospital on Thursday.
By Saturday, she was dead. In less than a week, an otherwise healthy adult who took the flu seriously and followed medical instructions was gone.
These are the scariest stories coming out of the current influenza outbreak: Seemingly low-risk patients who die or suffer permanent, devastating complications within days of the first cough or sore throat.
A 38-year-old Weatherford teacher died days after coming down with flu. A healthy Dallas man and selfdescribed “gym head” sought care within hours of his initial symptoms, yet got so sick that he now faces amputation of his fingers and toes. A smalltown Central Texas woman was airlifted to Dallas when her flu suddenly turned so deadly she needed a ventilator to keep breathing.
These aren’t people who ignored basic health advice or delayed getting care. The Weatherford teacher, stung by the high price of antiviral medication, delayed buying it for a day, but doctors say they have no way of knowing whether it would have made a difference.
What these stories all have in common is the worst sickness you never heard of: sepsis.
For a condition that causes such swift and widespread devastation, sepsis is not widely understood. It kills more than a quarter of a million Americans every year — more than breast cancer, prostate cancer and AIDS combined. It’s the leading cause of death in patients in hospital intensive care units.
Up to half the people who experience the most severe form of sepsis, septic shock, will die — and many of them die swift, horrible deaths that leave their families, and even their doctors, stunned and reeling.
Yet nearly half the American public doesn’t even know what it is. A Harris poll commissioned by the nonprofit Sepsis Alliance in 2016 determined that 45 percent of the respondents weren’t familiar with the term, and fewer than one-third could name its most common symptoms.
The bottom line, according to the U.S. Centers for Disease Control and Prevention: “Anyone can get an infection, and almost any infection can lead to sepsis.”
So, what is sepsis? Well, if you think of your body’s defenses to sickness as warfare, sepsis is friendly fire. It’s a haywire immune response to infection that can happen to anybody — not excluding the fit, the healthy, the strict adherents to good diets and exercise programs.
I talked about it this week with Dr. Trish Perl, chief of the Division of Infectious Diseases at UT-Southwestern Medical Center.
In discussing sepsis, Perl chooses her words carefully — in part, because it’s not a disease for which you can take a test or make an instant diagnosis. Instead, it’s a cluster of symptoms triggered by your own body’s response to infection.
“Sepsis is a spectrum. It’s series of clinical features,” she said. “Your immune system sends signals in response to infection, but sometimes they go into overdrive.
“The problem is that it’s really hard to define,” she said. “There’s not a single test or a single presentation that we can say, ‘This is what’s going on.’”
The way most people learn about sepsis, I suspect, is by experiencing it, either first-hand or watching the struggles of a family member. I got a crash course in late 2016 when my husband developed sepsis after suffering a perforated appendix.
The doctors did not lie: Mike’s life hung in the balance. I remain convinced that had we not been at a large teaching hospital — Clements University Medical Center — where a skilled team carefully managed his condition, he likely would not have recovered.
Even for those who eventually get well, it’s terrifying. Patients may require life support, breathing machines, and powerful drugs with potentially catastrophic side effects. Some suffer permanent organ damage; others can experience overactive blood clotting that leads to loss of limbs.
That’s what happened to 51-year-old Brian Herndon of Fort Worth, who had to have both feet and parts of every finger amputated after he developed sepsis following flu and pneumonia.
In a brief interview via Skype with WFAA-TV (Channel 8) on Sunday, Herndon — his voice a rasping whisper after weeks on a ventilator — said, still bewildered: “One minute you’ve got the flu — and the next minute, you’re septic.”
Most people who get flu, of course — even this year’s virulent strains — get well after a week or two of discomfort bordering on downright misery. An unlucky few, through no fault of their own, will suffer a cascade of worsening symptoms that could threaten their lives.
Sepsis has general symptoms, such as rapid heart rate, shallow breathing, clammy skin and a sense of overwhelming malaise — all or some of which may be present with other conditions. The challenge doctors face is in carefully evaluating those sometimes vague symptoms, but also acting with lightning speed if they suspect sepsis.
Like so many of the disasters that can befall the human body, this one requires a lot more research and study to be better understood. That demands an application of science — and, inevitably, funding.
In the meantime, though, we should know that even the most routine infections can have tragic consequences, and that sepsis is a deadly enemy. We should at least know its name.