When dentists hear the words infective endocarditis (IE), they often reflexively think of the same precaution: prophylactic antibiotics before dental treatment, 2g Amoxicillin or 500mg Clindamycin. IE is one of the few diseases our patients may develop following bacteremia from invasive dental procedures, but thankfully, its incidence is relatively rare. Some health conditions place patients at a higher risk for IE, such as an artificial heart valve, a cardiac transplant prone to developing valvulopathy or a congenital heart defect. Men over the age of 50 are also predisposed to developing IE. When we consider this fact, you might wonder: what are the chances that a 25-year-old, healthy female could contract IE?
It was the spring quarter of my first year of dental school. I had just returned from a mission trip and was recovering from what I assumed was a traveler’s bug. I was unusually slow to recover, but I attributed this to a lack of sleep due to a demanding schedule so I did my best to push through the stomach pain, nausea and severe fevers. I was prescribed oral antibiotics halfway through the quarter, which alleviated my symptoms. Yet, after the quarter had concluded and I returned home, the fever and chills returned. I promptly visited my doctor, where my blood tests indicated the presence of Gram + bacteria. I was sent straight to the emergency room, where hospital physicians confirmed the bacteremia and admitted me for an overnight stay in the cardiac wing due to my congenital heart defect: a tricuspid regurgitation. As the nurse hooked me up to a portable EKG monitor, she offhandedly mentioned I was the first patient she had ever had under the age of 60.
After my fever had subsided thanks to IV antibiotics, I was subject to an extensive panel of blood tests. At the end of the week, the hospital physicians were able to identify the bacteria: Streptococcus virdians. Everything I had learned about it came rushing back to me: S. virdians is typically part of the oral microflora, but once in the bloodstream it has the potential to adhere to heart valves. The initial test for bacteria on my valves was negative, but a transesophageal echocardiography confirmed the presence of the bacteria on my aortic valve. I had infective endocarditis.
That’s when my life changed dramatically. I was prescribed a treatment of 4-6 weeks of IV antibiotics and a peripherally inserted central catheter (PICC) line was placed in my right arm, leading to my heart. I was discharged from the hospital the same day my summer quarter began and I took a red-eye flight to make it back as soon as I could. From there, I found myself waking up at 6 a.m. each morning to infuse strong IV antibiotics into my arm for two hours. Balancing this new routine during one of the most physically and mentally demanding quarters of dental school left me exhausted and my diminished gut flora, due to the antibiotics, made eating difficult. On top of all the side effects from my treatment, my PICC line was at constant risk for infection or forceful ejection and this worry constantly remained in the back of my mind.
As it so happened, we explored IE in depth in our didactic courses throughout that summer quarter, often discussed alongside similarly severe diseases such as diabetes, stroke or liver failure. For many of my classmates, IE was yet another condition to learn, but I felt an emotional connection because my life had been personally touched by this disease. I couldn’t help but remember the time I spent in the hospital, worrying about how IE would affect my long-term health. Having IE has even impacted my education because it means that I cannot participate in many self-teaching labs, such as practicing cleanings, injections and x-rays on other students, due to the high risk of relapse even during remission. However, I am thankful that my family, professors, classmates and the school administration have been so supportive in accommodating the limitations resulting from my condition.
When I chose to become a dentist, I never would have imagined that my life would be personally affected by one of the most prominent diseases of concern to our profession. Yet, being on the other side has also given me a unique insight towards the fears and anxieties commonly felt as patients move through treatment. On average, it takes months to diagnose IE because the main symptoms of fever and chills are common to many illnesses. As a dental student, I think about that statistic a lot. Though the circumstances were unfortunate, I still believe that experiences such as these can strengthen our sense of empathy. Facing any disease with an uncertain prognosis is just as much of an emotional experience as it is physical. And it is our responsibility as health care providers to be sensitive to this so that we can respond with compassion.
~ Caitlin Miller, Loma Linda ’19, chapter predental chair
September is Wellness Month! Dental school can be incredibly stressful. ASDA wants to ensure that all of our members have access to invaluable resources and an understanding of what to do when you’re not doing well.
Visit ASDAnet.org to find wellness activities at your chapter as well as webinars to help you maintain a healthy lifestyle while in dental school. Plus, check out our Instagram video contest and chapter step challenge.