by Duane Marsteller, The Tennessean
At first, the steroid shot that Joan Peay received for her chronic back pain was like all the others she's had before.
The Nashville woman's pain subsided within days of the early September injection at Saint Thomas Outpatient Neurosurgery Center. But over the next three weeks the 72-year-old grandmother of 10 experienced odd, and increasingly frightening, symptoms: an aching tailbone, a throbbing back and "killer" headaches.
Peay didn't know it then, but she had fungal meningitis. And she was about to become part of a national, precedent-setting outbreak.
"I know I'm lucky to survive this, but right now I just don't feel ...," she said as she recuperated at home Thursday, her voice trailing off as she choked up.
The outbreak has sickened 328 people and killed 24 in 18 states as of Thursday. Tennessee, with 70 cases and nine deaths, has been among the hardest hit.
Officials have linked the outbreak to steroid shots - prepared by a specialty pharmacy in Massachusetts - that may have been contaminated with a common mold. The pharmacy, New England Compounding Center, has since closed, recalled all of its products and become the subject of a federal criminal investigation.
Lifetime of pain
Like Peay, nearly all of the victims received epidural shots of the steroids for chronic back or leg pain.
Peay traces her back pain to her childhood, when a chair was pulled out from under her one day. She fell again when she was 43, this time breaking her tailbone when she landed on the metal leg of an office chair.
Despite surgery that included bone fusion, her back pain steadily grew worse through the years. She also developed scar tissue and arthritis in her spine as well as sciatica, in which injury to or pressure on the sciatic nerve causes pain in the leg.
She tried to live with the pain but opted to begin epidural steroid injections three years ago, after her son said they helped him. Peay estimates she received "eight or nine" shots in all, usually two to five months apart, at the Nashville outpatient center.
But the symptoms she developed after the last one prompted her to call her physician's office on Sept. 28, a Friday. She got a prescription for pain medication, but Peay said it was ineffective and her pain worsened.
"It was right at the top" of the scale, she said. "Not as bad as childbirth, but right at the top."
She called back the next Monday and made an appointment for Wednesday. But those plans changed when she sat down to watch a local television newscast that evening: The lead story was health officials announcing the outbreak.
Peay's initial reaction was a four-letter expletive. She waited until the next morning to call her doctor's office, which urged her to go to the emergency room immediately. A spinal tap there confirmed she had the rare but noncontagious form of meningitis.
"It was scary but also a relief because at least I knew what was going on," she said.
A two-week hospital stay at Saint Thomas followed, with twice-daily doses of anti-fungal medication given intravenously, a treatment that Peay said has been almost worse than the ailment.
"It makes you nauseous and leaves a horrible, horrible taste in your mouth like sour milk," she said.
Treatment isn't over
Although she was released Oct. 16, she still must take the medicine through an IV tube twice a day through at least Thanksgiving. She said she has been told she will have to take anti-fungal pills for at least three months after that.
There also are weekly doctor appointments, plus an upcoming spinal tap that Peay is dreading. She is among 18 Tennesseans with fungal meningitis who state health officials said have been released from the hospital because their conditions had improved.
Despite what she has gone through, Peay praised the staff at Saint Thomas.
"They all did a great job, they really did," she said. "Considering how busy and how full they were, they did a great job - doctors, nurses, everybody."
But she is angry at New England Compounding, which she is suing. The suit accuses the company of negligently preparing her steroid injection and seeks $5 million in compensation and punitive damages.
The family's anger continues to increase as more details about New England Compounding's laboratory conditions and previous problems surface, said Peay's son, Scott Johnson. He also questioned the outpatient center's decision to use the pharmacy: The center had received at least 2,000 vials of the steroid, officials have said.
"If an organization is purchasing from a company with these kinds of practices, why are they doing that?" he said.
Officials of the outpatient center have not publicly said why they ordered from New England Compounding.
As far as getting another shot for her back pain, Peay said she's not sure.
"I haven't even considered that, and I probably won't for a while," she said.