death on 8 legs

Robert Allen (Robert.Allen@Eng.Sun.COM)
Sun, 25 Jul 1993 17:17:21 +0800

Just to show you that this CP hobby could have it's practical
sides... (alert: if you're squeamish you may want to skip parts
of this).

This is the story of a boy and his (unfriendly) brown recluse
spider.

Robert

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> Newsgroups: sci.med.telemedicine
> From: dale@unislc.slc.unisys.com (Dale Clark)
> Subject: BROWN RECLUSE (COMPLETE >LONG< STORY)
> Message-ID: <1993Jun28.212843.7117@unislc.slc.unisys.com>
> Date: Mon, 28 Jun 1993 21:28:43 GMT
> Lines: 254

BROWN RECLUSE - THE ENTIRE STORY
--------------------------------

[Memorial Day Weekend] Friday, May 28th, 1993. An amusing side to this
story is the fact that the reason I ever went into the basement closet
was to find a book to use as reference material for an article I was going
to post to another group on this network! Well, anyway, I knew it had to
be in a box in a closet under the stairs we use for storage. There
are also a bunch of old coats and clothes hanging on a rack. The boxes
I was going through were underneath this rack of clothes and I
moved them with my body as I bent over to look for this book. I can't
remember, but I either had no shirt on at all, or a short sleaved
shirt. It was warm here in Utah that weekend. We live in Bountiful,
Utah, approximately 15 miles north of Salt Lake City, along the
mountainside called the 'east bench.' Prior to this time, I had
never heard of the brown recluse in my life. Growing up, we were only
told of the black widow. You see them around once in a while, but
generally they just stay in a corner by themself and you only rarely
hear of someone getting bit. Anyway, I had got in the closet about
8-9PM.

Saturday, May 29th, 1993, 11:32 AM (Sounds like Dragnet don't it?) I
had finished mowing the lawn and came in and took my shirt off to cool
down. I was sitting in front of the TV and I was just rubbing my hands
along my arms when I felt puffy skin on my right arm, near the shoulder.
I looked and saw an area about the size of a quarter that appeared as
though it was burned! It shocked me because I couldn't figure out what
could have happened. My immediate thought was that I did it just
minutes before while I was outside, but I couldn't possibly see how.
The skin was wrinkled and thin. It appeared to have 'pus' under it
so I grabbed a kleenex and just hardly touched it. The skin came away
easily and a yellowish-brown fluid discharged. I'd never seen anything
like this. At this point it looked harmless, like a blister or
floor-burn. The area left after the skin came off was just light
red or pink and seemed as though it would heal-up and be gone in
a day or so. I didn't put anything on it or even give it much
thought the rest of the day. By 8PM the area had increased
to about the size of a half-dollar and looked bad. I had taken a
shower and was getting ready to go out when I looked at it. It was
weaping clear, light-yellow fluid and the skin had strange spots and
was appearing to turn to a dark red color. I showed it to my Dad and
he thought 'it looks like impetigo.' My mother didn't think so, she
said then that 'it looks like you've been bit by something.' I
decided to put 'Gentian Violet' on it.
(Now, this was a mistake in the fact that the dark violet
color hinders diagnosis because color is an important
part of identifying problems on the skin. Doing this
did cause a slight delay in diagnosis. However, of all
the things I tried, viz., Hydrogen Peroxide, Burn Cream,
Hydrocortisone, and Neomycin, it was the Gentian Violet
that seemed to work the best. If I were bitten again,
and knew I was bitten, I would use Gentian Violet for at
least the first 6-7 days. Anyway, back to the story...)

Sunday, May 30th, 1993, 7:45 AM. Get out of bed and --- YEECH!
What have I got on my arm? It was weaping something fearce and
there were 3 spots on the sheets where it had weaped yellow fluid
but they were also stained blue from the damn Gentian Violet which
drained out along with the fluid. Now, I had a thin piece of gauze
taped over the wound, but it had drained to the point that it had
become saturated and oozed through to the sheets. That's how much
it was leaking. Gross. I shower and before I had put more stuff
on it that day I noticed that our neighbor, a Pediatrician, was
walking by the house. As I picked-up the morning paper I asked
him to take a quick look at the ulcer on my arm to see if he had
any idea what it was. (I'm sure doctor's are constantly asked about
things by neighbors, but no more so I guess than I'm asked about
computers). He looked at it and said, "You need to have this looked
at, today if you can." Today? It's Sunday on Memorial Day Weekend -
What's the sense of urgency? "That might be a brown recluse bite and
I would really have it seen today." he said, and added, "Don't put
any more of that violet crap on it." It kind of shook me up that
he had a sense of 'do it now' to his voice. At 11 AM I went to
the Bountiful "Instacare" (An 'always open' chain of medical
clinics in the Salt Lake City area). The doctor said she was
sending me to Salt Lake City LDS Hospital Emergency room right
away. That she felt it was indeed a spider bite, but needed it
confirmed and the clinic couldn't handle 'surgery' there if it
was required. This really scared me to death. Especially when
she told me about some people needing 'amputation' in extreme
cases, etc. Went to ER and the doc there wasn't sure because of
the 'violet shit' I put on it. (Those are the words he used).
So, I got a painful shot of antibiotics in the rear. (Don't
know what or how much unfortunately. I usually ask about everything
I'm getting but in this one case I forgot). I was started on
Prednisone (20mg - 4/day for 4 days, 3/day for 4 days, 2/day for
4 days, then 1/day for 4 days), and basically told to see my
personal physician on Tuesday. Topically, I was to put bacitracin
on twice daily when I changed the 2 x 2 guaze.

Monday, May 31st, pain begins. I have diarrhea, stomach cramps,
hot/cold flashes but didn't even once consider it was in any way
related to my possible spider bite. I went to the store and bought
several cans of Ortho Indoor Insecticide, making sure that the
brown recluse was listed on the back of the can. Apparently, lindane
is a necessary ingredient to kill them. I went to the basement and
sprayed like crazy. We have no children nor pets so I really went
wild. No one sleeps down there either. I had been asked the previous
day by the doctors if I had been in any attics or dark closets,etc.
At first I had said no. It didn't even hit me until sometime later
when I remembered going into the closet for that book. That was the
only 'dark unfrequented' room I had been in in the last several days.
I gave the closet under the stairs a double-dose. Then I closed
the doors to all of the basement rooms and made sure the windows were
shut. I left it that way for hours, then went it and sprayed again.
I wasn't messing around.

Tuesday, Jun 1st, I see my doctor in the morning. I was lucky to get
in - there had just been a cancelation and apparently he was booked
solid from the long weekend. By now, most of the violet stain had
disappeared. It was the size of a dollar and looked terrible. I hurt
terribly and didn't feel well. He didn't know what it was but wanted
me to see a dermatologist in the same building. He set up the
appointment himself as he didn't want me waiting more than a day at
most to get in to someone. The appt. was for Wednesday. He told
me to stop putting ANYTHING on it. Just leave it completely alone
except for the guaze to soak up the drainage. He wanted the dermatologist
to be able to see it without it having been affected by anything.
At this point, the pain wasn't bad enough that I needed anything and
I didn't even ask. When I got home that night, my Dad and I carefully
removed everything from the closet under the stairs. We found 2 dead
spiders. One was a small common black house spider, the other was
strange. We had never quite seen a spider like this in Utah. It's
legs were smooth and light brown. It's body was definitely brown
and the fangs on its head were huge. On the cephalothorax was a
little brown 'line' that on inspection with a magnifying glass
looked like a small upsidedown violin. Bingo. The violin spider.
It was so damn tiny! "Oh, come on.", my Dad said, "How could this
little thing do that to your arm?" I doubted that it did also.
My Dad thought about it, then said, "Hmmmm. It's so small it makes
me wonder if there isn't others around here. Maybe this is just a
baby one." The entire breadth of it was no more than the size of
a nickel.

Wednesday, June 2nd, the dermatologist just happened to be from
North Carolina and had treated 2 bites in the past. As soon as she
removed the gauze she said, "Yup. Brown recluse." The wound was
disgusting. It was huge and had a light brown/clear center with
a dark/purpleish-red ring around it, then another thin ring of red
skin. She called it a 'bulls-eye' and it did in fact resemble the
eye of a bull. Pain was getting bad. I didn't like to do anything
that put any torsion on the skin of my right arm at all. Even having
a shirt on which rubbed the gauze hurt. When you put your hand lightly
over the gauze you could feel 'warmth' from the wound - it was hot.
Well, she wanted me to change the bandage twice daily and apply
bacitracin again. Whenever I applied it, the wound would 'bubble'
up with little pustules and drain crud out of it. This was not
a fun wound. I showed the doctor the spider in the bottle and she
said, "Well, I'm almost 100% sure that's was bit you. From your
description of what happened, the fact you found a brown recluse,
and the bull's eye wound, I just feel sure about it." She recommended
a professional spraying and agreed that the fact that it was small
may indicate there may be more. We called Orkin that day. I
went back to my personal internal medicine physician and got a
prescription for Mepergan Fortis (Demerol for pain, Phenegran
ingredient for the frustrating itching).

I saw the dermatologist and my regular physician each Wednesday for
the next 3 weeks. I watched with dismay as the wound increased
in size and swelling began in my right arm. After about 2 weeks,
it began to 'separate' into 2 circles. At first they were hooked
together like a figure eight (8), but gradually they separated into
2 distinct circles (OO) about the size of a half-dollar each.
Pain would wax and wain. The wound looked awful, after 2 1/2
weeks it turned a honey-brown color and looked disgusting. The
purple part came off and I had 2 nice 'holes' in my arm, the pieces
that came off were almost 'corroded' looking, not like a scab or
skin or anything else, but like tissue that was destroyed. It was
kind of scary. Each day you think, "This has got to be as bad as
it's going to get, I'll be improving soon." But it goes on and on.
And you can't hardly believe that it's expanding. I took good care
of the wound and changed the bandages and took my medication
religiously. Finally, the color of it concerned the dematologist.
The honey/color suggested to her that staph might be in it.
On Tuesday, June 22nd, she had me go in for a biopsy and possible
surgery. Here's the posting I made to the news when I returned to
work 2 days later:

GAK! I'm back!

Well, for those interested, here's what happened...

Biopsy confirmed presence of staph infection and deep areas of
necrosis so they laid-on surgery for 11:30 AM.

Went in and stripped. Was given Valsed (not sure how much) and
150 mg Demerol. 20 minutes later I felt wonderful and scared to death.
They put iodine on the arm (felt cold), then told me the numbing
injection would be painful. Boy they weren't kidding. One nurse
actually held me down on the table with both hands on my chest.
Apparently it is an involuntary reaction to 'jump' and I did.
The doc said, "OK you're going to feel the needle." And I certainly
did, but it didn't hurt anything like the Xylocaine (or was it
Marcaine?) going in. Good Grief that hurt like nobody's business.

Well after just a few seconds the pain went away. They used a
'burning needle' to cut away and I remember seeing smoke drift
up towards the ceiling. I was starting to enter la-la land and
my memory gets foggy here. I do remember a LOT of honey-colored
crap being taken out. I felt them 'tugging' and heard 'noises'
but felt nothing. Anyway, the doc told my Dad that he was
'suprised' at how much tissue was involved and just 'mascerated.'
Dad said I had a 'hole' in my arm that was pretty deep. Approximately
6-inches long roughly the shape of a banana or diamond. It
was sewn up and it <HURTS>. I don't even use my arm to try
to open a door as it invokes pain. I drive with my left hand.
To sit here and use the computer - I push the keyboard to the
back of the desk and rest my arms on the desk so that no
muscles are needed to support my arm.

The docs say, "Now, if we were to remove tissue from your left
arm it would heal nicely. But this area here in your right arm
is *not normal tissue* and it also has staph in it. Therefore,
I'm on Cephalexin (250mg 4/day), Prednisone again (same dosage
regimen as before), Dapsone (which required blood tests and
crap), and my old friend that has helped me combat the pain:
Mepergan Fortis.

Ladies and Gentlemen, if you have these things in your area I
implore you to call Orkin. We spent $125 for inside and outside
spraying by them and they found 2 more down behind a deep freezer
we have in a darkened room not frequented. I don't know how much
all of this is going to cost me but I'm sure it won't be cheap.
The surgery I had will probably reach $2000.00.

Well, Today is June 28, 1993, 32 days since I was bitten and
6 days after surgery. Finally, finally on Sunday I could tell I
was not only feeling better, but my arm is getting better. I can
see absolute signs of healing going on. I'm sure now, that this
thing will be healed up soon. I'll have a scar, but it will be
a long thin one, instead of 2 huge round ones. The skins is
red around the scar and there is a kind of scab there but I'm
not worried about it anymore. I'm getting good use now out of my
arm (it doesn't hurt nearly as bad - I can even open a door now)
and I'm well on my way to recovery. I've only taken 1 pain pill
all day and I wonder if I'll need one tonight. Thanks for all
of your concern and thoughtful letters. If anything else
happens - except for normal healing - I'll let you know!

Dale W. Clark

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| Dale W. Clark (801) 594-4982 | again!
| dale@unislc.slc.unisys.com UNISYS Corporation |
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