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littlefingers
Nov 16, 2006, 5:59 AM
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I'm passing on some relevant news to all of us as climbers, (and a bit of a personal story.) The main point is this, if you are recieving spider bite looking infections, there is a very good chance that they are not spider bites at all, but rather misdiagnosed bacterial infections caused by Community Acquired Staphylococcus aureus (CA-MRSA). You should inform your doctor of this possibility, and insist to have a culture taken of any new infection. This is of concern to you all, because I believe, as do others, that indoor climbing gyms are high risk environments for spreading, and becoming infected with CA-MRSA. This will take some explanation.
According to the Center for Disease Control, "Outbreaks of CA-MRSA have been associated with sports that require physical contact and result in frequent damage to skin (3,4) and with crowded settings (e.g., correctional facilities, military settings), where access to hygiene measures is limited (5,6)." This would be our local indoor climbing gyms.
My Story: I started recieving recurring "spider bite" infections early this spring, and they were repeatedly misdiagnosed by my doctor as such. Some were lanced and drained, and I was sent home with antibiotics. Complications from recurring use of these antibiotics lead to a more serious infection in both kidneys, a hospital stay for 6 days, and then a PICC line (permanant IV) that was used to give myself antibiotic for the remainder of the month. It wasn't until recieving another infection on my ear that a culture was finally taken of these recurring skin infections (with my insistance) and it was determined that I had CA-MRSA. Needless to say, this meant a serious break from climbing-- like three months. Believe it or not, climbing was the last thing on my mind.
Also of note, with this last infection, I was told if I waited another day before coming to the doctor, I would have to be admitted to the hospital, (again). The infection was significant (only slightly smaller than a golf ball). They sent me home with a high dose of antibiotic while I waited for culture results- it took me 6 days. I was sick during this time due to the infection with low grade fevers and lots of pain. When the culture results came back, they found I was completely resistant to the antibiotic they had given me, and that I had been fighting the ear infection off on my own. Luckily, I was ok, and I had successfully fought of the ear boil with no assistance.
CA-MRSA has been around since the 1980's, and recently grown exponentially in the community. It is highly infectious; spread my hand to hand contact, or in cases that may concern us, by shared use of equiptment without proper cleaning measures. We can all help the spread of CA-MRSA by becoming aware of what CA-MRSA is, and the symptoms to look for (spider bite looking infections), and by practicing simple steps of good hygene. This would simply mean washing your hands before and after climbing at the gym, and covering any wounds you may have.
I climbed at the gym while infected not knowing that what I had was contagious. I believed I had spider bites. I suspect many other climbers may do the same thing-- and unknowingly put others at risk. I believe I contracted CA-MRSA from another climber, who possibly could have contracted this from a gym or elsewhere- we will never know certainly.
These infections are treatable, and most often do not lead to the serious complications I had. However, if not treated correctly, they can cause blood poisoning and death in certain cases. It's important to know if you have CA-MRSA so you can get proper treatment, and this can be determined by taking a culture of the infection.
FYI: I am much better now - a picture of health and back into climbing. I have gone through a decolonization process that appears to have been successful in getting rid of this bacteria.
Thanks for reading, and hope this will be of help to you all.
Here is a link to a more reputable source about CA-MRSA if you care to read:
http://www.tufts.edu/med/apua/mrsa/mrsa.html
ask any questions, I'll try to answer.
-m
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mturner
Nov 16, 2006, 6:48 AM
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And I'll add, to any gyms that don't at least occasionally clean their holds with acid or anti-bacterial soap, shame on you!
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mattyp
Nov 16, 2006, 8:04 AM
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I'm glad to hear I am not the only one. I got a similar infected site this summer. I lanced it myself and drove on thinking nothing of it. Then I got to Afghanistan in august and another popped up on my arm. IT got huge. Our medic gave me some mild antibiotics but they didn't work. So he cut the site open and that was that. A month later another popped up in a different spot. So, we hit it with heavy antibiotics (Vancomyacin) and I started bathing with Iodine scrubs and antibacterial soap. It's been 2 months since the last infection, but in hindsight and with some research I am farily certain it was MRSA. Unfortunately, out here in the mountains of Afghanistan medical labs are few and far between so we can confirm what it was. I did however spend 3 days a week at the local climbing gym in NC for the 3 months prior to deployment. It's a possibility I got it there. Who knows. Definitely something to be on the lookout for if you gym climb often.
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lambone
Nov 16, 2006, 8:45 AM
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In reply to: According to the Center for Disease Control, "Outbreaks of CA-MRSA have been associated with sports that require physical contact and result in frequent damage to skin (3,4) and with crowded settings (e.g., correctional facilities, military settings), where access to hygiene measures is limited (5,6)." This would be our local indoor climbing gyms.
Sorry to hear about your illness.
But I don't think it is fair to cast blame on the climbing gym. As a gym owner it makes me cringe.
Are you sure that's where you got it? How could you know? Have other people from the gym gotten it?
You could have picked up that infection anywhere unless you live in a bubble.... airport, ball game, swimming pool, public shower, music concert, public bus....etc, etc.
In climbing gyms you grab holds. In the outside world you grab dirtty doorknobs, stair case railings, phones, currency...etc. That is covered in human skin cells. It's called dust.
Granted, I think many gyms could do a better job cleaning. We try hard to vaccum the dust all the time, and wash the holds in a dishwasher with hot water about once every three months, per route.
Regards, best wishes on your recovery and thanks for the warning.
matt
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littlefingers
Nov 16, 2006, 2:07 PM
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I contracted CA-MRSA from another climber who didn't know that they had CA-MRSA, because they thought that the infections they had were spider bites. If they had known what they had, it's possible I could have avoided this whole experience all together. Education with this one can do a lot of good. Not only can people get proper treatment for infections, but poeple can also prevent spreading this to others.
I can understand your concerns about why this is bad new for a climbing gym, but it is an important thing to be on the lookout for, especially with the use of shared equiptment in the gym. Ca-MRSA is spread by hand to hand contact, or through use of shared equiptment- and a climbing gym is just full of shared handholds that provide a good place for this bacteria to be spread. FYI, the bacteria can live for up to 3+ days on climbing holds, so if it makes it's way onto them, it will see a lot of traffic in four days.
Some people carry this around with no symptoms, but for others it can be potentially deadly. In any case, it's good to be aware of the spider bite looking infections, and to reinforce simple good hygene (encourage people to wash their hands before and after climbing.)
We (the two of us that were infected) cannot prove we were infected at the climbing gym, although based on our daily life habits it is certainly the most likely place this was picke dup. No matter where it comes from, it's certainly good to be aware it's out there.
-m
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czo
Nov 16, 2006, 2:16 PM
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In reply to: In reply to: And I'll add, to any gyms that don't at least occasionally clean their holds with ACID  or anti-bacterial soap, shame on you! Are you serious?
Good story, thanks for sharing with us. Ever since I was misdiagnosed 3 years ago, I don't trust doctors to know anything right off the bat and very much appreciate increasing my general knowledge of health concerns.
(This post was edited by czo on Nov 16, 2006, 2:18 PM)
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mattyp
Nov 16, 2006, 2:16 PM
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It's nothing negative for gyms, but just a heads up for people to be aware of the possibility. Any kind of gym is a breeding ground for bacteria of all sorts.
We can all wash our hands before and after climbing. Maybe wear pants. I know I am always scraping up my knees on the texture painted walls.
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littlefingers
Nov 16, 2006, 2:46 PM
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Not all gyms would cause me so much concern- when you can wipe down equiptment after use, it definitely helps. Shared mats are a problem because they are not cleaned often, Contact sports are definitely an issue (skin to skin contact), and I would imagine that the climbing holds (combined with climbers poor hygene, likelyhood to believe they have spider bites, and poor skin quality due to abbrasions) would definitely provide a risk.
This particular strain that effects atheletes, (USA 300) has been showin up in the community since 2000, and since has grown in incidence numbers exponentially. It is currently the leading cause of soft tissue infections in emergency rooms across the country. Even the Celtics have had it in the past year! There is not enough awareness of this given that it is becoming increasingly common.
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littlefingers
Nov 16, 2006, 3:52 PM
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Matt-
It sounds like CA-MRSA for sure to me. Please tell me they cultured the infection? This is really important, so they know what antibiotics work and don't work against it. There are even strains of MRSA resistant to Vanco now..
I hope you are better now- I went through the whole hibiclens wash thing too. So far so good, but we have to be careful still. FYI- i've heard of several stories of peole in the military who have gotten this. Apparently it's going around in the military. Not surprising with crowded living conditions there- you would know better than I. One man came home and spread it to his family (wife and three kids) because they weren't educated on how it was infectious. It's a shame. They have been getting recurrent infection for the past few years- not casual stuff. I'm sorry to hear of your infections, and if you ever want to pick my brain about what I've learned over the past summer, feel free to email me--
take care,
-m
(This post was edited by littlefingers on Nov 16, 2006, 3:57 PM)
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overlord
Nov 16, 2006, 6:10 PM
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In reply to: It's nothing negative for gyms, but just a heads up for people to be aware of the possibility. Any kind of gym is a breeding ground for bacteria of all sorts. We can all wash our hands before and after climbing. Maybe wear pants. I know I am always scraping up my knees on the texture painted walls.
LOL, i usually wash my hands before climbing, but thats because i found out that i get better friction if wash some skinoil off first.
to the OP, thanks for the heads up.
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mattyp
Nov 16, 2006, 6:30 PM
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Thanks for the concern Littlefinger. While the medic here is very good, our medical facility is very primitive (mostly trauma oriented) I will have the opportunity in a week of so to get to an area with a lab and I will have them draw blood for a blood culture since I don't have any active infections going on, thank god. I was on Mefloquine for preventing malaria, but I stopped taking it and switched to Doxycyclin for malaria and it also seems to have stopped the infections for the last couple of months. I do look forward to getting to the bottom of the whole thing and finding out if this was MRSA indeed.
The Vanco was a trip. I was sitting in our common area and started itching all over. The medic looked back in on me and was like " Yeah, you're pretty red" I took some Benadryl and that cleared up.
Like I said, I hope to get to the bottom of this. In the meantime a war is going on, so I get by as I can.
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littlefingers
Nov 16, 2006, 7:06 PM
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Hey Matt-
Again, based on the fact they put you on Vanco and that you ar getting recurring spider bite lesions, I'd be very surprides that you didn't have CA-MRSA, (specifically USA-300). It is sensitive to several antibiotics, including bactrim (which is cheep and common) which is opften presribed with Rifampin. Again, I'm no doc, but this is common info- you can suggest these things to a medic if you get another infection.
I'd definitely insist on getting a culture with any new infections though- the bacteria live on your skin and in moist body cavities (like your nose and throat) so it won't show up in bloodwork- even if you have a breakout. The infections are colonizations of the bacteria that get under you skin- these are what you need to culture, and you need a good sample of what's inside (gros, i know).
As for the allergies- I've been there too. I was exposed to lots of new meds over the summer, and had a similar reaction to Levquin that I took through an IV. It caused my veins to start bulging like a weightlifters veins, and then a bright red rash crept up my arm and neck. The whole dose was in me before we got help in the ER-- The allergy also prohibited me from absorbing IV fluid for the next 4 days and I retained 16+ pounds of fluid that blew me up like a parade balloon- no joke. I'm a little over 100lbs, so that's a significant gain. Allergies are no fun- be careful with new meds, and make sure you know how to shut off you own IV if you start to have a similar reaction with any new meds!
Let me know if you have any questions, and take care over there. I'll be thinking of you-
megan
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littlefingers
Nov 16, 2006, 7:18 PM
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Matt-
btw- CA-MRSA is usually sensitive to Doxy too (which is what you are on now, right) I hope the malaria clears up and you have no more recurring infections. I'm sure being under the weather due to the malaria would make you more vunerable to MRSA infections too. Stay as healthy as possible over there! I can send links to info about what you have too, if you want more reputable sources.
-m
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percious
Nov 16, 2006, 7:49 PM
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Thanks for the great info. I actually had a discussion with my supervisor about cleaning the holds at our wall. This discussion goes a long way in encouraging management that we need the maintenance on our wall.
-percious
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matterunomama
Nov 17, 2006, 1:20 AM
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Let me preface this with the information that I am a medical professional.
"Spider bites" is a widely used and usually incorrect diagnosis. Most spiders little mouth parts cannot penetrate human skin. General practitioners and internists like the diagnosis, and its satisfying to patients, but it is very unlikely that a pus-filled papule is a spider bite. Those that can bite leave a nasty necrotic sore.
CA-MRSA (community aquired methicillin resistant Staph Aureus) is becoming more and more common. I have to agree with Lambone that the climbing gym should not be automatically faulted. Although it is more common in athletes because of the sustained skin-to-skin contact and abrasions, I have several patients A MONTH with MRSA. They include an elderly lady who keeps geting it, and at least once a month a teenage girl with exquisite hygiene.
All doctors should do a culture of any recurrent, treatment resistant, or quickly developing bacterial infection.(This tells you what antibiotics will work on the bacteria).
The main hygiene problem to me is the BLOOD on the holds, and as one of the (clumsy? overreaching?) contributors to that problem, I don't think I can blame the gym owner for not cleaning enough.
Take Home Point: Don't ask for or accept the diagnosis of 'spider bite' unless you saw/felt the spider bite you-the kind that can bite you will feel it!
Ask your doctor to do a culture if you have pustules or abcesses. And wash your hands. As a dermatologist, I am one of the few that wash BEFORE I use the restroom as well as after. because you know, warts are contagious too......
Mel
***************
Hold on tightly, Let go lightly
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littlefingers
Nov 17, 2006, 2:00 AM
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Thanks for the info. I just want to reiterate that I don't think anyone is blaming anyone else here in particular for where this stuff is picked up, but I do think awareness of CA-MRSA is important— especially for those in higher risk groups. And we *are* athletes participating in a sport that definitely uses shared equiptment.
The gym has some creepy things that make it more prone to sharing bacteria, and seeing as so many kids frequent these facilities, it's a good idea to let people know what to look for on this one. Kids, by the way, are six times more likely to get this than adults.
I would love to see coaches and owners of athletic facilities be proactive in educating people about this, although can understand that puts gym owners in a tricky spot.
The reality is this; CA-MRSA is becoming more and more common, and right now (as it is commonly misdiagnosed) it can pose some serious health risks. Climbing gyms *could* potentially be a place that could put people at a higher risk of getting this. I for one, climbed at a gym with a break out not knowing what I had. Other people could do the same. Maybe that's how I got this in the first place.
Do you want infected people climbing in your gyms not knowing they could pass this to you or your children? Wouldn't you want people using environments that you come into contact with that are higher risk to be educated about this? College athletics have an organized approach towards this problem, and are proactive in educating their athletes and coaches. I would hope established athletic facilites would all act in a similar fasion, but understand this takes time, and unfortunately, numbers of directly effected people to make that happen.
Until then, I'm just trying to let as many people know about this as possible. Very little, very simple information can save A LOT of unneccessary hardship with this one. Lots of people can't get rid of this once they get it- it's not like a cold you just "get over".
Most often CA-MRSA is not life threatening, and it is not something we should all panic about. But I am terrified at the current lack of information about it in the medical and general community. Especially when just a little info can save so much here.
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mattyp
Nov 17, 2006, 2:47 AM
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Just a misunderstanding abotu malaria. No malaria in me. Everyon in the military that goes to Afghanistan is required to take Mefloquine or Doxy to prevent the contraction of malaria.
I did take Bactrim while I had an active infection. The doc put me on Doxy to suppress any further infections while out here away from solid medical facilities.
As fas as shutting off IV's, we've all been trained to give IV's(some of us even practice self administered IV's). You never know when you'll be in a situation without a medic and need to stop bleeding and replenish fluids to help raise BP until a chopper can evac the wounded.
We've gotten in some materials to take a sample if I get another infection so we can send it to a lab.
Thanks for all the info. I did quite a bit of my own research and you are right, there is a lot of info out on the net about this. Also, I was on the phone with my mom a bit as she has been a nurse for 15 years.
I think a lot of people take everything a doctor says as gospel and fail to find things out for themselves. A little education goes a long way in prevention, diagnosis, and cure.
You must have been looking like a cartoon with that reaction to Levaquine. I'm sure it can only be funny in hindsight.
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littlefingers
Nov 17, 2006, 2:56 AM
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Matterunomama-
Even though your concerns are primarily with blood on holds, do you agree that bacteria thrives on sweaty, plastic surfaces? Isn't it plausible to assume that we are sharing bacteria with say *at least* 1600 people each time we use the gym? (bacteria live 3+ days on plastic, let alone sweaty plastic... ;P)
Other factors of concern to me;
• We use these shared surfaces having compromised skin
• we lower our immune systems because we are working out
• climbers i know tend towards bad hygene habits
• YOUTH in the gym- this scares me each time I go there- they are everywhere, and have no idea what CA-MRSA is, (nor do their parents)
• as climbers we can easily attribute infections to spider bites (since we sit in the woods so much.) It took me 6 infections to *really* question the doc on this one...
It's definitely an environment I have concern about with this. All I have to back this up is personal experience, a fair amount of research, and a couple of other infected folk who share my point of view.
Again, education is really the best way we can try to keep our facilities free of this- or at least to try to keep it from being a much greater health risk than it needs to be.
thanks for reading if you made it this far :P
-m
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littlefingers
Nov 17, 2006, 3:23 AM
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Matt-
Good new about the malaria! And yes, I was quite shocked at the way I looked inflated— I was just puffy everywhere, like the stay-puffed marshmellow girl :) Noone believed me when I said I felt "bloated" until they took an xray. They couldn't believe all the fluid.
It's crazy they were treating you for CA-MRSA but didn't really tell you what it was. Crazy. It drove me nuts not getting a clear answer on this one.
This site has a great support forum and loads of information on CA-MRSA, I diagnosed myself through the site, before my doctor finally took a culture.
www.mrsaresources.com
It has been an invaluable resource for information and support. The forum there is fantastic, and there are several people with MRSA willing to help and respond to any questions yo umay have. We are all infuriated with the lack of knowledge about this condition.
Be aware that HA-MRSA is a different strain than CA-MRSA, and patients of both visit this forum. HA (hospital aquired)-MRSA often effects those with more compromised immune systems and is most often contracted in hospital environments. It has different qualities than CA-MRSA. Just thought I should clarify that before you go snooping around and hear horror stories about HA-MRSA (not that CA-MRSA doesn't have its fair share of stories)
good to know you can go to your mom for questions!
Take care over there- you've got enough to worry about without having to deal with this one!
meg
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nedsurf
Nov 17, 2006, 3:57 AM
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S. aureus is fun to study in the lab. Think i'll head down to the gym to culture a hold or two and see what I get. It does seem very plausable to get this and other bugs from gym holds. Perhaps there should be some sort of push to institute cleaning procedures. Glad I climb in a gym very little. If I get the permission to culture from holds, i'll post my results.
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littlefingers
Nov 17, 2006, 6:28 AM
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I'm not sure if there could ever be a way to clean holds in the gym based on their unique circumstances. You simply cannot clean them once they're up on the wall.
I think educating people about CA-MRSA would be extremely effective in disease prevention. And it helps people get the right treatment. And it helps people not to be scared of it. We are mostly scared of the things we don't know about.
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matterunomama
Nov 18, 2006, 12:01 AM
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Littlefingers,
IF your gym knew that someone had had MRSA, yes they should have told people. Maybe they thought it would turn off customers, maybe they didn't realize how bad it could be--usually from the misdaignosis. Its bad what you went through.
I am not sure what is practical as to cleaning holds that are on the wall. They are indeed filled with bacteria but after cleaning they are again touched by so many people that the load of bacteria would be the same at the end of the next day (though it might not now include MRSA) Also loaded with germs is the money in your pocket, any railing you touch during the day, and the TV controller in your hotel room (the maids don't disinfect it-ever-everyone's hands have been on it, and people touch inner nose/groin/youdon'twanttoknow while they are alone in their room and then touch the remote). All you can do is wash YOUR hands. And if you wash in a public restroom, remember that not everyone does, then they grab the door handle on the way out....which you just opened with your freshly washed hands....you see the problem. I hope I'm not causing people to feel obsessive-compulsive here.
Physicians are being informed and hopefully their index of suspicion for MRSA is rising, but an informed patient is important. You are doing a service by making people aware of the problem so they can protect themselves and ask for appropriate diagnostic consideration and treatment.
Stay Healthy!
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littlefingers
Nov 18, 2006, 12:29 AM
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Matterunomama,
My gym knew nothing about MRSA until I informed them of my summer's experience, and I'm sure they wished I never told them. Because this is unreportable, because it cannot be proven I contracted this at my gym, and becausee my gym owners know close to nothing about CA-MRSA, there will be no action taken by my facility in regards to CA-MRSA. Why should they when there is no proof that this is where I contracted it in the first place, and because it could only possibly cause them to lose business?In their eyes I could have gotten this anywhere. Maybe I did get this elsewhere.
Regardless, I know of at least two people who climbed at this facility (me included) who had active infections. That's definite exposure- I would hope all people who go here would know and be able to look for symptoms of CA-MRSA, but I am not able to communicate this to them.
I feel it is important for *all* high risk facilities to become educated about CA-MRSA, and to help educate people who visit their facilities. It is their responsibility to know about the conditions they provide to the public— this is a new condition that will have to be dealt with.
The most effective solution, I believe, is through education. It is our most effective means of disease prevention. If everyone who visits a particular gym knows to look out for these infections, a huge part of the problem is solved. The likelyhood of infected persons climbing in your facility is greatly reduced. Having an uneducated clientelle visiting your gym is a real problem. The best way to keep outbreaks from happening in your facility is by telling people what this is and what to look out for.
The reality is that this is spreading at an exponential rate, and if hasn't been in your gym yet, at the rate it's going it wil be soon.
As it stands now, most people haven't a clue about it.
(This post was edited by littlefingers on Nov 18, 2006, 1:08 AM)
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jakedatc
Nov 18, 2006, 5:34 AM
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awesome info Meg. as an athletic trainer so far i've had 3 cases this year through football.. one kid has missed a ton of school with a PICC
i've become pretty OCD with washing hands and rocking the purell/germX at work. Also pretty dillegent with the lysol cleaner on my treatment tables.
with wrestling season coming up i'll have to write down that website and pass it along to the coaches and probably send a copy home with all the athletes too.
hope this hits home to people and they become more aware of things and not just hope it will go away.
glad you are alright now
jake
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