Endocarditis 心脏内膜炎 and Hepatitis C Come with Intravenous Drug Uses

choi

Abby Goodnough, Doctors Asks When a Heart Is not Worth Fixing. New York Times, Apr 30, 2018 (front page).
https://www.nytimes.com/2018/04/ ... t-endocarditis.html

Quote:

(a) Ms Jerika "Whitefield [of Oliver Springs, Tenn], 28, had developed endocarditis, an infection of the heart valves caused by bacteria that entered her blood when she injected methamphetamine one morning in 2016. Doctors saved her life with open-heart surgery, but before operating, they gave her a jolting warning: If she continued shooting up and got reinfected, they would not operate again.

"With meth resurgent and the opioid crisis showing no sign of abating, a growing number of people are getting endocarditis from injecting the drugs — sometimes repeatedly if they continue shooting up. Many are uninsured, and the care they need is expensive, intensive and often lasts months. All of this has doctors grappling with an ethically fraught question: Is a heart ever not worth fixing?

(b) "Certain cases haunt him. A little over a year ago, he replaced a heart valve in a 25-year-old man who had injected drugs, only to see him return a few months later. Now two valves, including the new one, were badly infected, and his urine tested positive for illicit drugs. Dr [Thomas] Pollard[, ardiothoracic surgeon in Knoxville, Tenn,] declined to operate a second time, and the patient died at a hospice.

(c) "Addiction has long afflicted rural east Tennessee, where the rolling hills and mountains are woven with small towns suffering from poverty and poor health. Prescribing rates for opioids are still strikingly high, and the overdose death rate in Roane County, where Ms. Whitefield lives, is three times the national average. Jobs go unfilled here because, employers say, applicants often cannot pass a drug test.

(d) "Treatment for endocarditis usually involves up to six weeks of intravenous antibiotics, often in the hospital because doctors are wary of sending addicted patients home with IV lines for fear they would use them to inject illicit drugs. Many, like Ms Whitefield, also need intricate surgery to repair or replace damaged heart valves. The cost can easily top $150,000, Dr Pollard said.  Advice from specialty groups, like the American Association for Thoracic Surgery and the American College of Cardiology, about when to operate remains vague.

(e) "Ms Whitefield * * * goes by the nickname Shae. She started on opioid painkillers as a teenager suffering from endometriosis 子宫内膜异位症, a disorder of the uterine tissue, and interstitial cystitis, a painful bladder condition. She got the opioids from doctors for years, and eventually from friends.

(f) "After sharing a needle with one of her brothers that day in June 2016, Ms Whitefield started shivering and sweating. A fever soon followed, and she lay for almost a week on the couch, thinking she had a kidney infection. She was delirious by the time [her oldest son] Jayden, then 8, woke her stepfather one morning and told him to call 911.  She arrived at Methodist Medical Center of Oak Ridge with full-blown sepsis, floating in and out of consciousness. Her organs had started to shut down. * * * [Lucky for her:] Ms Whitefield also had health coverage through Medicaid, the government insurance program for the poor, because she has young children. It paid for her care, whereas if she were uninsured, the hospital would have had to cover the cost.  Antibiotics cleared the infection that initially led her to the hospital, but she ended up needing surgery two months later. Her mitral valve was so damaged that she had begun showing signs of heart failure. * * * Dr [Carlo] Martinez [of East Tennessee Cardiovascular Surgery Group, at Knoxville, TN] repaired Ms Whitefield’s mitral valve in a three-hour operation. It involved sawing open her breastbone, connecting her to a bypass machine to keep blood flowing through her body, and then stopping her heart and fixing the valve. He reinforced it with a small plastic ring before restarting her heart and closing her up.

(g) "Ms Whitefield has had occasional cravings since the surgery but says she has not used drugs again, traumatized by the memory of her ordeal [That is what she says. There is no way to verify it]. * * * [In a recent visit to a cardiologist 心脏内科医生, Dr Larry Justice said] her repaired mitral valve looked good. But * * * 'One of your other valves is leaking a fair amount,' Dr Justice said, and added: 'I can't guarantee you won't need another valve surgery.'

My comment:
(a) This is a lengthy report, about two pages long. There is no need to read the rest, though, because the quotations above are the medical part of the story (the rest is about hardships of an addict, such as apathy from people who think she brings it to herself.
(b) About quotation (f). That was not necessarily the cause of her endocarditis. It is likely that she had had endocarditis but she did not know it -- until heart failure started showing up.