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Athletes Battling Resistant Bacteria

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Before his right hand swelled like a balloon, before he had to leave the most important football game of his career and before he spent six days in the hospital wondering if his arm was damaged for good, UC Davis quarterback Ryan Flanigan thought he had an ingrown hair on his finger.

Feeling queasy and tired, Flanigan walked onto the field at Sacramento State on Oct. 4 to play in the Causeway Classic. He took one snap, then two, then three, his hand hurting more each time. Then it began to bleed.

Three hours later, after that game, Flanigan sat on a bed at Sutter Davis Hospital and was told this was no ingrown hair.

He -- like an apparent growing number of athletes nationwide -- had a dangerous form of staph infection known as MRSA.

"I didn't realize how serious it was," Flanigan said. "Playing football, you think maybe you'll blow your knee out, break a leg or an arm, and then I get a staph infection?"

A new danger in the sports world has more than Flanigan perplexed.

Methicillin-Resistant Staphylococcus aureus, a type of staph infection that has been associated with hospital patients and prison inmates since the late 1960s, entered the public at large for the first time in the late 1990s, according to the Centers for Disease Control and Prevention. And within the past three months, its prevalence in sports has been put under a spotlight.

In late August, an article discussing "MRSA among competitive sports participants" was released by the CDC, citing outbreaks among football teams, wrestling teams and even a college fencing team since 2000.

The article sparked a slew of media coverage. In October, USA Today and the Wall Street Journal ran prominent articles about MRSA, as did smaller periodicals. The same month, the NCAA issued a warning telling college coaches to be on the lookout for this newfound sports malady.

The most prominent victims were in the NFL, in which MRSA led to the hospitalization of Miami Dolphins linebacker Junior Seau's last month and running back Charlie Rogers in September.

There were news articles about eight stricken players on a high school team in Wisconsin and seven on the USC football team, four of whom were hospitalized.

Still, doctors say MRSA is a growing problem, not just one that's receiving more exposure. Yet while it's known that 120,000 people in hospital settings suffer from MRSA annually, there are no statistics on what occurs outside hospital doors.

"It's hard to get a number on this, but it's been a primary topic (on medical community e-mails) the last couple of months," said Dr. David Herbert, an infectious disease specialist for Kaiser Permanente in Sacramento and Roseville. "Everyone's saying, 'My gosh, we're seeing lots and lots of patients with this MRSA problem that we've never seen before.' "

Without hard statistics, there are only stories.

Flanigan, a Rio Americano High School graduate, two of his football teammates and two UCD wrestlers are among the local tales. While Sacramento State reported no cases among its teams, former Hornets center and Del Campo graduate Terence Wagner -- now a member of the New Orleans Saints practice squad -- spent three days in the hospital in August because of MRSA.

The danger of MRSA, according to CDC epidemiologist Jeff Hageman, lies in its ability to resist traditional antibiotics. Whereas staph infections have usually been treated with a penicillin-related antibiotic, MRSA is impervious to tradition.

Left untreated, life-threatening blood or bone infections can develop. The swelling will spread, and the victim will suffer a fever and flulike symptoms. Hageman said most cases are mild and treatable, but a CDC report released four years ago addressed the infection's grave potential. From 1997 to 1999, four children in Minnesota and North Dakota died from MRSA.

"It normally happens to people that have been on dialysis, had surgery or received a lot of antibiotics," Hageman said. "But now it's happening to people with no ties to health care -- normal, healthy people."

Athletes, it seems, are the perfect candidates. Especially in sports such as football and wrestling, in which nicks and scrapes are the norm and cleanliness is a relative term, staph -- transmittable bacteria that most people carry on their skin or in their noses -- can thrive.

When a lineman rubs elbows with another lineman, or a wrestler lies on his pinned opponent, MRSA can be exchanged.

Treatment for the infection is through new antibiotics called vancomycin and Zyvox, though the CDC does have a few rare cases of vancomycin-resistant staph on record.

"Penicillin has been abused for so long, for sore throats, runny noses, and the next step (in treatment) was vancomycin," said Dr. Bill Winternitz, the UC Davis team physician and an orthopedic surgeon specializing in sports medicine who drove Flanigan to the hospital.

"If the organisms become resistant to vancomycin or Zyvox, then what do we have? The infection would take over the body, and that's bad."

The night before his final Causeway Classic, Flanigan had no idea how sick he was. By the time his ordeal ended more than two weeks later, Winternitz would rate the severity of the illness as a "seven or eight on a scale of 10."

As Flanigan lay in bed on the eve of the game, the pain in his right ring finger negated thoughts of football.

A few weeks before, he suffered a turf burn on his right wrist. No big deal, Flanigan thought, even though the wound was healing slowly -- in retrospect, it now appears that was the bacteria's entry point.

The infection had spread to his ring finger, where there was a cut that looked like a bug bite and felt like an ingrown hair. The finger was swelling, and the Tylenol that Flanigan was taking wasn't easing the pain.

In the morning, Flanigan headed for the UCD student health center. After a culture was taken, he was told he had a staph infection. With his hand looking "like a (baseball) mitt," Flanigan said he had yet to grasp the severity of the situation.

"I didn't know anything about a staph infection, so I asked them, 'Is this going to be OK for the game?' " Flanigan said. "They were like, 'No, I don't think so.' "

But this was his senior year, and the opponent was rival Sac State, so Flanigan ignored the medical advice.

He played the first half, but he could hardly throw the ball. He was overcome with fever and nausea. By halftime, Flanigan had completed just 4 of 12 passes for 68 yards, fumbled once and been sacked twice. His team trailed 14-10 when Flanigan took himself out.

After begging Winternitz to let him watch the second half from the sidelines -- when the Aggies rallied for a 31-27 victory -- Flanigan received a police escort through the departing crowd to Sutter Davis. The concern, Winternitz said, was that the infection would quickly spread to Flanigan's bones and tendons, doing irreparable harm.

"You bet we rushed him over," Winternitz said. "I didn't want to spend an hour and a half getting over there. I was worried the infection was spreading up his hand. It wasn't life threatening, but I wanted it treated real soon."

For the next six days, Flanigan was given vancomycin intravenously as well as rifampin, an oral antibiotic. A magnetic-resonance imaging test showed that his bones and tendons were healthy, but the infection wasn't going away.

"After that first night, I'm thinking I'll be out tomorrow, but then I wasn't getting better," Flanigan said. "It was boring and depressing."

Before he was released almost a week later, doctors inserted an IV line that started in Flanigan's arm and ran to his heart. He would administer his own drugs, spending approximately three and a half hours every day for the next two weeks fighting the infection.

His routine had two cycles, with the first of two doses of vancomycin starting at 7 a.m. and lasting 90 minutes. The last came at 10 p.m. when he pumped another antibiotic, cefazolin sodium, into his system. The treatment made him weary, and Flanigan couldn't lift weights or run, let alone practice. Finally healthy, he returned to the practice field Oct. 22.

"When it wasn't getting better, I went from, 'When am I going to play football again?' to 'I've just got to get healthy,' " Flanigan said. "Those thoughts definitely run through your head, like, What if? "

Wagner, the Del Campo graduate, was one of a handful of Saints players with MRSA. The infection couldn't have come at a worse time.

In the Saints' preseason finale against Miami, Wagner had plans to shine. He'd been told by the New Orleans coaching staff that he'd play the entire game, and this was his last chance to make the regular-season roster.

On Monday, three days before kickoff, a cut that looked like a bug bite showed up on his elbow, hardly a surprise in the Louisiana bayou.

"There's all kinds of insects out here, so I just figured something bit me out on the field," Wagner said in a telephone interview.

By Tuesday, the cut was infected. By early Wednesday morning, Wagner was popping Advil, eventually progressing to team-administered antibiotics later that day. That night, he went to bed with a 102-degree fever and the chills. Come game time Thursday, the antibiotics weren't working, and team doctors inserted a needle into his elbow to drain the pus. Wagner decided to play, with the help of pain-killers.

"By the time the first-half ended, the pain-killers were gone, and it was absolutely killing me," Wagner said. "They finally took me out, and by this time (the arm was) swollen from my wrist halfway up my triceps. You couldn't see my veins or any muscle definition in my whole arm."

Wagner spent the next three days in a New Orleans hospital. With local anesthesia, doctors performed successful drainage surgery, pumped antibiotics into him "around the clock" and then released him. Wagner missed the next week of practice.

"At the beginning, it was more of a nuisance to me, then it got to the point where I'm thinking I'm going to lose my arm," Wagner said. "When they're saying they don't know what it is, and they don't know how to cure it, it doesn't make you feel good."

According to Herbert, the Kaiser doctor, preventing MRSA is easier than curing it.

Athletes need to tend to wounds quickly, cover them and keep them clean, he said. They also need to take routine showers, wear clean clothes and not share sporting gear.

"The important message is that it doesn't have to happen to you," Hageman said.

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