Nicole's story

When Nicole developed chest pains in June 2007, neither she nor her family thought it could be anything serious.  She was only 16 years old and seemed to be in relatively good health otherwise.

“She was lying there, really hurting, saying she didn’t feel good,” her mother, Keitha, remembers.  “We thought it might be pneumonia.  Since it was a Sunday evening, we decided to take her to the emergency room.”

Physicians at the local hospital discovered that Nicole did not have pneumonia – but she did have an even more serious illness: pericarditis, an inflammation of the sac surrounding her heart.  Fluid had built up, restricting the heart’s actions and causing her pain.  She required more intense care to treat the problem, and needed to be transferred to a specialized facility.

At 2 a.m., an ambulance took Nicole to Geisinger’s Janet Weis Children’s Hospital in Danville.  Keitha called her husband, Steve, to meet them there.

Nicole was immediately admitted to the children’s hospital’s pediatric intensive care unit (PICU).  Specialists there prepared to treat the pericarditis, but finding the cause of this problem seemed elusive.

“Nicole was a surprise,” remembers Michael Ryan, DO, chairman of Janet Weis Children’s Hospital and a pediatric infectious disease specialist.  “She was in our PICU, sick as you could possibly be, with fluid around her heart.  We were supporting her, just to keep her alive, and were trying to figure out why this young woman had such heart problems.”

Her blood pressure was dropping, and the images of her heart from the scans that were done were frightening, Keitha remembers.  “There was a sac of fluid under one chamber of her heart, with no room for the heart to beat, and that was causing her pain,” she says.

“I didn’t realize how serious it was,” Nicole remembers.  “They brought me chicken nuggets (in the hospital room), and I couldn’t even feed myself.  I don’t even think I realized how bad that must have been – that I couldn’t feed myself.”

Doctors performed a number of tests and asked the family even more questions.  Nothing seemed to lead to an answer – until someone asked the family is Nicole had had a rash.  While it seemed an unlikely connection, Keitha remembered that Nicole had been on a class outing and developed a rash on her legs afterward.

That memory prompted a blood test for Lyme disease – and by Thursday, doctors and the family had a definitive diagnosis.

“Lyme disease tests can be somewhat difficult; the results can be uncertain.  But Nicole’s test was unmistakably positive.  There was no doubt that Lyme disease was causing the fluid around her heart,” Dr. Ryan says.  “Once we realized that, we began treatment for Lyme disease, and she improved tremendously.”

A peripherally inserted central catheter – or PIC line – was inserted in Nicole’s arm so that she could receive medication intravenously on a regular basis.  She was able to go home with the PIC line the following day, maintaining an at-home regimen to continue the treatment for the next several weeks.

“Kids will make a full and complete recovery from Lyme disease,” Dr. Ryan explains.  “They may have joint aches for a year afterward, but they don’t go on to develop heart failure or brain damage.  They go on to be soccer players, and good students, and other accomplishments.”

The family still isn’t sure that the irritation on Nicole’s legs was from a tick bite, but they know it was a fortunate rash because it led to the diagnosis.

“We have no idea where she got it,” Keitha says.

“I’m not an outdoors type of girl,” Nicole adds, noting that it could have happened on a school trip or from a tick brought in on their dog or at some other point they aren’t aware of.

While it’s not unusual for cases of Lyme disease to appear with no known history of a tick bite or a rash, the severity of Nicole’s case was unusual and extreme, Dr. Ryan says calling Nicole’s situation “a case that you could never expect to see more than once in a career.”

Today, Nicole has completely recovered.  She has regular follow-up visits with both Dr. Ryan and a Geisinger pediatric cardiologist to ensure her heart hasn’t sustained any long-term damage, but she continues to do well.

Now the battle against Lyme disease is behind her, and she has a clear focus on the future.  She is about to graduate from high school and plans to attend Penn State in the fall as a Information Science and Technology major.

“That’s the beauty of treating children and teens,” Dr. Ryan says.  “Once they get better, they move on and leave this part of their lives behind.”

Nicole's story will be featured during the 2008 Celebration broadcast May 31 and June 1 on WTAJ.