How bacteria, dental cleaning endangered and saved heart
LAFAYETTE, La. (AP) — Jonathan Hunter will be the first to tell you to go to the doctor, and not just because he is one.
The family medicine doctor and Rapides Parish coroner learned that lesson a different way — as a patient.
“It was very strange,” he said. “I’m very comfortable on the other side of the stethoscope.”
It began with a low-grade fever he couldn’t shake one week in November. He was sweating and fatigued.
Hunter figured it was flu and waited for the virus to pass.
Another week went by, and he was still sick. He ran some blood work, as he would for any patient.
The results weren’t completely normal, he said, but they didn’t point to anything conclusive or serious either.
By his third week of fever, sweats and fatigue, he told another doctor in his clinic it was time for more tests. She put her stethoscope on his chest and asked, “What about this heart murmur?”
“What heart murmur?”
She moved the stethoscope to his ears, allowing him to hear it for himself.
Immediately they knew what it was.
“Any doctor would know,” Hunter explained, that his flu-like symptoms paired with a heart murmur meant infective endocarditis.
She called an interventional cardiologist, and Hunter was admitted into Rapides Regional Medical Center in Alexandria.
Hunter believes the illness began a few months before symptoms got his attention in November. The bacterium, streptococcus viridan, is a germ found in the human mouth.
He suspects it got into his bloodstream during a routine teeth-cleaning in September.
“That’s normal,” Hunter said. “That’s not a revelation.”
It can happen during surgery or dental visits or even tooth-brushing and chewing if the patient has gingivitis, according to medical professional manuals from Merck.
Normally the body’s healthy immune system takes care of the bacteria on its own.
But those with a heart abnormality of some kind tend to have different results, prompting guidelines that recommend taking antibiotics before dental procedures, according to American Heart Association News.
“That’s because bacteria can enter the bloodstream during dental treatments and these patients face a higher risk of endocarditis, a bacterial infection of the lining of the heart and heart valves,” according to the American Heart Association.
Hunter didn’t think he had a heart abnormality, but now he suspects a thermal ablation procedure years prior might have altered his heart enough to qualify. Perhaps it caused the mitral valve murmur, allowing that bacteria to take root this fall.
An echocardiogram in the hospital confirmed the diagnosis and showed Hunter needed surgery.
Bacteria had grown on the mitral valve in his heart, preventing it from working properly and causing damage.
Hunter spent about 24 hours in the hospital “bathing” the bacteria with IV antibiotics, which got rid of his fever and other symptoms.
Then he had to think about surgery. He spoke with two local cardiologists and a cardiac surgeon to set his heart surgery for Dec. 14, going home until then.
“It was kind of an odd presentation,” said Dr. Tommie Mack Granger, who performed the surgery. “I routinely do mitral valve repairs for people with weakened mitral valves. But for somebody who was previously very healthy and very fit to have a teeth-cleaning and next thing you know has fever and developed a heart murmur ... that was not the normal way to find it.”
Hunter had to make decisions he hadn’t expected to face at 45.
“This is a very big medical condition,” Hunter said, not to mention the seriousness of heart surgery. “People die from this.”
In what he called “the worst-case scenario,” his heart valve repair would have become a replacement.
He knew he wanted a mechanical prosthetic rather than one made of tissue. As a doctor he knew the shelf life of each and didn’t want to be back under the knife in 10 years.
His worst-case scenario didn’t happen. The surgeon was able to remove the bacteria and repair the valve.
The next day Hunter was working on his laptop in ICU. His recovery has been pretty smooth.
He can work and drive now, but he’s still not hitting the gym, of course, he said.
“I bounced back quick,” he said, attributing that to his faith and being in good health before this episode.
But being fit doesn’t replace going to the doctor regularly, especially when there’s a problem for more than a week, he said.
That advice applies to medical professionals, too, he said.
“Being a physically fit guy with medical knowledge doesn’t absolve you of (the responsibility of) getting medical care,” he said.
While he hadn’t thought to listen to his own heart, his doctor likely would have, just as Hunter does when he sees patients. They could have caught it faster.
“I’ve learned to listen to my body and go to the doctor,” he said, advising everyone to do the same. ”... Because people love you and depend on you. You owe that to them.”
And, just like the American Heart Association, Hunter won’t advise you to avoid the dentist’s office. Regular cleanings can reduce the risk of other heart complications.
He’s still planning to go for all his check-ups and cleanings. He’ll just take antibiotics first.
Information from: The Advertiser, http://www.theadvertiser.com