Eugenio Ramos, 60, was no stranger to aches and pains. But in all of his years of working in hotel maintenance, he hadn't really encountered anything that a few aspirin and a little rest couldn't take care of. So when his left hip began to ache, he took aspirin and carried on, working through the pain. When he noticed blood in his urine, he chalked it up to a urinary tract infection, drank some cranberry juice, and continued working. But the pain increased. "Then I did something I had never done in my life," Mr. Ramos said. "I went to my supervisor and said 'I have to stop working; I am in too much pain.'"
Mr. Ramos visited the emergency room at the hospital nearby his workplace. He left with a diagnosis of sciatica and a prescription for painkillers. He took his medicine as directed, but the pain in his hip only intensified. He visited another emergency room, and received a diagnosis of a pinched nerve and hernia, for which he was admitted.
"When I was discharged to an inpatient rehabilitation facility, I did my physical therapy, did all of my exercises, took my medication, but the pain kept getting worse. I honestly didn't think I was going to make it through the pain. The supervisor thought I was being dramatic but finally asked if I wanted to go to the hospital. I immediately said yes-anything that might help me find relief."
The ambulance brought Mr. Ramos to NYM's Emergency Department, where he received an MRI (magnetic resonance imaging) exam, which uses magnetic fields to provide extremely detailed images of the body. The MRI revealed that Mr. Ramos had neither sciatica, nor a pinched nerve, nor a hernia; instead, his left hip socket was so deeply infected that almost all of the femoral head had been eaten away. Henry Tischler, M.D., chief of orthopedic surgery, and Hiram Cortes, M.D., infectious disease specialist, were immediately called in.
"The infection had been allowed to rage unfettered for months and disintegrated his femoral head to such a great degree that his hip was totally unsalvageable," recalls Dr. Tischler.
The workup at NYM showed that Mr. Ramos had had a urinary tract infection for a very long time, long enough for the bacteria to seep from the urinary tract into the bloodstream, triggering sepsis and eventually, to settle, festering in his left hip. "Not only were we dealing with an orthopedic emergency, but an infection emergency as well. Sepsis can be fatal, and Mr. Ramos was very, very septic," says Dr. Cortes.
Treating the infection was the first priority. "Although the bacteria had been active for quite a while and done a lot of damage, antibiotics, which we administered intravenously at first and then orally, achieved a quick response." Once the infection was under control, the focus could turn to the hip.
"The infection had eaten away so much of the bone that there was no choice but to remove what remained of the hip joint and replace it with an artificial joint. However, because of the infection, it was necessary to stage the replacement process slowly to ensure that the
infection was entirely and permanently gone. There is always the risk of infection with any surgery, but when the surgical site had such rampant infection to begin with, extra caution was needed," said Dr. Tischler.
Dr. Tischler removed the hip joint and thoroughly cleaned the area. For two full months he waited to see if any infection appeared again, and when it did not, he implanted the new hip. "Of course there was pain after the surgery," Mr. Ramos remembers. "But it was nothing like the pain I had before. And I knew this pain was the pain of healing, and that felt wonderful."
Mr. Ramos grew stronger and stronger through his physical therapy, "now that I actually need it!" He decided this would be a good time to retire, and he recently returned from a trip to his native Puerto Rico.
"Dr. Tischler is my angel. He saved my life. His entire team: anything you need, they will get it for you. For me? I got my life back."
Read this story, other inspiring patient stories and more in the Annual Report to the Community 2012-2013.
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