Hi everyone, this was in the Toronto Star today....i thought it important for all to read.....you really need to see this girls scalp after surgery to freak out....please take the time to read, IT COULD HAPPEN TO ANYONE...thanks janICE:> Some piercing questions A young Ajax woman nearly died from a brain infection. The suspected cause: her tongue piercing Catherine Porter Life Writer It took Carla McPhie less than a second to decide to get her tongue pierced. She was in France with her best friend and just wanted to do something wild. So they walked into a parlour and a few minutes later she walked out with her tongue swollen, bloody and adorned with a new silver barbell. What she didn't realize was she was also walking out with an open wound in one of the most vascular and bacteria-covered organs in the body. Ten months later, that little fly-by-the-seat-of-your-pants barbell would be the number one suspect behind a brain infection that almost cost her her life. "I'd never heard of anything like this happening before," she says, sitting with her family in a waiting room at Sunnybrook and Women's College Health Sciences Centre. "I didn't realize I was taking a gamble." It's been three months since the pea-sized abscess on the right frontal lobe of McPhie's brain was removed. In that time, her hair has grown in thick and brown to cover the menacing scar left from the operation. For the most part, her life has returned to normal. The only sign of "the episode," as her family still calls it, is the hollow at her temple where the surgeons removed a piece of her skull to allow room for swelling after the operation. She can fit her palm neatly inside it and feel the soft, doughy surface of her brain. "The episode" began last September when McPhie, 22, was starting her fourth year of a Spanish degree at Wilfrid Laurier University. She started to get frequent, throbbing headaches unlike any she had before. Then, one day after returning to the home she shares in Waterloo with fellow students, a muffled song filled her head and her legs and feet started to go numb. By the time the paramedics arrived, her whole body was shaking uncontrollably on the couch — she was having a full-blown seizure. A CAT scan at the hospital a couple days later revealed an abnormality on her brain that doctors put down to one of four things. The best they could hope for was an infection, an after-effect of the seizure or a benign tumour. The worst possibility, the McPhies were told, was a cancerous growth. "As soon as they said tumour, I was like `Ahhh,'" says McPhie, as her parents look on from either side, tears welling. "Then I say, `Okay, this is not the time to get frantic. I have to be strong to fight something like this.' So we all tried to be strong." They would need that strength. Within days, McPhie was transferred to Sunnybrook hospital and after a more thorough MRI scan, was scheduled for surgery two weeks later. Suddenly, though, her headaches got worse. Neither the regular doses of morphine nor the ice packs her father held against her temples helped reduce the pain. "She literally sat up two or three times that night and only said one word. She yelled it at the top of her voice — `Pain,'" her father Garry recounts. By the next morning, she had settled down and seemed to be sleeping calmly. Her parents, standing at her bedside, took this as a good sign. But, when they reported it to the nurses' desk, they received a different reaction. A nurse charged into McPhie's room, pinched down on her finger and screamed her name. When she didn't get any response, she pulled an emergency cord on the wall. Within 30 seconds, the room was flooded with people and both Garry and his wife Anne Marie had been pushed out into the hall. "My brain was swelling so much it started to move down my spinal column," McPhie says. "It caused me to be comatose. My eyes had dilated to the point close to death." Her parents are less matter-of-fact about it. One of the sudden arrivals was a chaplain, which they took to mean the worst. "We thought we lost her," Anne Marie says in a shaky voice. After she was stabilized, McPhie was rushed to an operating room where doctors opened her skull, found the source of the swelling and removed it. They emerged almost three hours later to tell her increasingly frantic parents that she had survived and that the source of "the episode" had turned out to the best of the four possibilities. They weren't sure what had caused the pus-filled abscess but they sent it to the laboratory to be examined. Later that day, McPhie was in an intensive-care hospital bed. The right side of her head had been shaved, and where there once was hair now was a gruesome red line that curved like a question mark and was interspersed with wide black staples. She was groggy, but awake and lucid. "The term `miracle patient' has been used a few times by doctors," Garry says. "I think they were all very surprised Carla came out of this with no damage." Days later, a bacterial culture from the abscess, formed in a Petri dish, was identified as a strain of streptococcus originating in the mouth. That confirmed the family's suspicion that it was the small, seemingly innocuous bar of metal through Carla McPhie's tongue that caused the infection. Carla's piercings — the one in her tongue as well as nipple and belly button rings — were the first thing Carla's doctor zeroed in on when the two met in the hospital before the surgery, Garry remembers. "At that point we didn't even think they were a possibility," he says. Over time, they would come to not only see it as a possibility, but as the cause. "That was the number one candidate a few doctors said could cause the problems. And to this date, they haven't given us another possible cause," Garry explains. "There's no other reason why you'd get an infection in the brain by a strep virus commonly found in the mouth." McPhie's neurosurgeon, Dr. Sagun Tuli, wouldn't comment on the case beyond releasing a verbal statement through the hospital's chief of public affairs, Sandra Cruickshanks, who said, "any facial infection can spread to the brain. Those infections could be caused by many different things, including tongue piercings." Brain infections are very rare. According to Dr. Richard Martinello, an infectious-disease specialist at Yale University's school of medicine, only one in every 10,000 hospital patients suffers from a brain infection — roughly one or two a year at a large-sized hospital. Most start as middle-ear or sinus infections that, unattended, migrate directly to the brain, he says. To date, Martinello and a colleague have treated the only widely reported case of a brain infection caused by a tongue piercing. They presented the case last fall at the Infectious Disease Society of America conference. In that case, the patient was a young woman in her early 20s. A couple of days after having her tongue pierced, it became swollen and tender and was oozing a foul-tasting discharge. She removed her new tongue ring and the symptoms quickly cleared up, Martinello says. But four weeks later, she began suffering from severe headaches, fever, nausea and vomiting, and had difficulty maintaining her balance. After she was referred to Yale, the doctors found an abscess in the cerebellum — the part of the brain that controls co-ordination and voluntary muscular activity. As in McPhie's case, the bacteria found in the abscess were those typically found in the mouth. The tongue, Martinello explains, is full of veins and arteries. Any infection there would drain directly into the body's bloodstream and then be pumped through the heart to the rest of the body, including the brain. "Are we 100 per cent certain that it was the tongue piercing?" Martinello asks during a telephone interview. "No. But we don't have an alternative explanation that's better." The tongue is also teaming with bacteria that grow quickly in the mouth's warm, moist environment, says Dr. George Sweetnam, the president of the Canadian Dental Association. And while the hole left from a yanked wisdom tooth will completely heal over time, the skin around a tongue piercing will not, he says. "With a tongue piercing, you've got a tube right through the tongue and a sort of skin forms over it but it's not a good covering. ... Anything that can twist the (appliance) or move it, can rupture the skin. That's why there could be an opening later on, at any time. It's something, from a professional point of view, why take the risk? It's just an area that's loaded with bacteria and it's a warm, moist environment that's perfect for incubating," he says from his office in Lindsay, Ont. Although it the risk of infection from tongue piercing would seem quite high, in reality it is fairly low. Most of the problems Sweetnam's association confronts when it comes to such piercings are chipped teeth and receding gums. Unlike the American Dental Association, the CDA has not taken the official stand that piercing the tongue, lip or cheek represents a public health hazard. Sweetnam does advise, however, that people deciding to get their tongue pierced ensure the establishment that does it uses good sterilization techniques, and that those with piercings clean them regularly. Getting your tongue pierced is a quick and easy procedure lasting only a couple of minutes and costing around $60. The unusual part of McPhie's story is that she never experienced any problems with her tongue ring. She cleaned it with mouthwash regularly, and two weeks after her visit to the parlour, the swelling in her tongue receded. Neither has she suffered any noticeable sinus, throat or mouth infections recently, she says. Three weeks after the operation, McPhie was released from the hospital to her parents' home in Ajax, to convalesce. Besides sensitivity around her temple, where her brain remains exposed behind only a thin piece of skin, she suffers none of the possible after-effects of a brain infection, which can be as serious as brain damage and death, according to Martinello. The scar left on her brain by the operation could cause another seizure, so she continues to take anti-seizure medication as a precaution. After taking a semester off, she's back at Laurier and plans to finish her degree by the end of the year. The remaining piece of her skull, stored in a hospital fridge, was scheduled to be slipped back in place today. But, because the swelling hasn't subsided enough, that final operation has been postponed for a couple of months. The experience, McPhie says, has strengthened her relationship with both her family and friends. "After such a close call, that made me tell people how I feel while I'm here. My bother Carter says I've gone all mushy. But, at the risk of sounding clichéd, still it's a whole new lease on life." Secretly, she says, she misses the pull and twirl of her tongue piercing. But, she would never get one again. And, to friends contemplating it, she has a few gentle words of advice. "I don't want to force my experience onto someone else. But I want them to know this could happen. Why gamble with something like that just for a ring in your body?"