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The doctors ordered tests of blood and urine to look for the fungus.
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Yes, she was an avid gardener - and she had many bird feeders. When Bates went back to the patient’s room, she asked whether she’d had any exposure to soil or birds. The organism is carried by infected bats or birds and deposited into the soil in their waste. The patient’s home was in a region where the fungus could be found. Histoplasmosis is one of the most common endemic fungal infections nationwide but is seen primarily in the Southern and central United States - around the Mississippi and Ohio River Valleys. Different fungi are common in different areas of the country. Many live in soil and cause infection when the fungus is inhaled. There are approximately 1.5 million different species of fungus on Earth, but only about 300 make people sick. He gave the woman something for the pain, and then he went to see his next patient. He asked that a rheumatologist and a dermatologist come by later that day. Partain ordered antibiotics just in case. If arthritis was causing this rash and black thumb, then why weren’t her medications helping? Maybe she had an infection as well because the meds she took suppressed her immune system, our most important defense against invading organisms, she was vulnerable to all kinds of bugs. The young doctor wasn’t sure what was going on.
HOW TO CRACK YOUR THUMB SKIN
There were other areas of scaly, deep red skin on both her arms, but nowhere else. Her thumb was shockingly ugly, the raw flesh on the tip covered by a thick black scab.
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Her right hand lay mostly immobile on her lap, swollen and covered with red blotches. The woman told her story cheerfully enough, but it was clear to Partain that she was in pain. But her hands, especially her thumb, just got worse. When that didn’t help, he switched her to more powerful drugs. The rheumatologist attributed it to a flare-up of her psoriatic arthritis and increased her immune-suppressing meds. The joints didn’t hurt, but the rash did. Then, three months earlier, the swelling started - and the ugly red patches appeared all over her hands and arms. She’d been on those medicines for four years and was doing fine. He started her on strong immune-suppressing medicines, and she did feel better. Left untreated, this disease can destroy bone. A few years earlier she started to see a rheumatologist, who told her she had something called psoriatic arthritis - an aggressive type of arthritis caused by the body’s immune system, which mistakenly attacks itself. Until recently, arthritis had been her biggest health problem, she explained. Daniel Partain, the doctor in training assigned to her care, introduced himself. It was past midnight when the patient was admitted and settled into a hospital room. Clearly they’d brought her in just in time. To her daughter, she seemed disoriented and confused. In the waiting room, she suddenly began to shiver. By the time they arrived, the mother could barely walk to the door. On the RoadĮarly the next morning, mother, two friends and another daughter set off on the 10-hour, four-state trek north to the Mayo Clinic. “Don’t make an appointment,” he told her. After a moment of silence, he made his recommendation: She should take her mother to the Mayo Clinic in Rochester, Minn., nearly 600 miles away. But this was new, he told the daughter after seeing the pictures. The next time he saw her, just a few weeks ago, the skin on her hands had red, painful blotches. The patient came to his office a few months back when her hands first swelled up. She and her mother’s internist worked in the same medical center in nearby Joplin, Mo., and he needed to know how serious this was. The daughter wondered: Was this gangrene? Was her mother going to lose her thumb? She took out her phone and snapped a picture of the digit. “Then I realized it was my thumb.” She couldn’t do anything with that hand now, not even work in her garden. “Yesterday I thought there was a dead mouse in my living room,” the woman told her daughter. The flesh that remained was black and hard. The top third of what should have been the fleshy part looked eaten away. As she gently revealed the injured finger, her daughter gasped. The 72-year-old woman carefully loosened the bandage she had wrapped around her thumb.