THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, March 31, 1995 TAG: 9503310520
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 101 lines
Joseph Mason owes his life to the stuff of smog and cigarette smoke.
The same chemical that spews forth from factory smokestacks, that the Food and Drug Administration classifies as an industrial pollutant and possible carcinogen, enabled the 4-year-old Norfolk boy to survive a bout with deadly meningococcal disease, which has killed two teenagers in Virginia this year.
Without the experimental gas, called nitric oxide, Joseph would have been added to the death toll, said Thomas A. Nakagawa, one of the physicians who cared for the boy during his three-month stay in the pediatric intensive-care unit at Children's Hospital of The King's Daughters.
King's Daughters is one of 20 hospitals in the United States conducting clinical trials on the new drug.
``It's the hot, sexy drug for the 1990s,'' Nakagawa said. ``It's the happening thing in intensive-care medicine.''
It was Oct. 27 when Joseph, the kind of kid who never sat still, never took naps and was never sick, began complaining he was tired. That night, he ran a 106-degree temperature. When his mother rushed him to the emergency room, however, the doctor sent them home, telling her Joseph had a virus.
Early the next morning, he broke out in spots. Thinking Joseph had chickenpox, Tara sent her boyfriend to the store for lotion. By the time he returned, Joseph was covered in a rash - a telltale sign of a meningoccocal infection. An ambulance rushed the boy to King's Daughters.
Doctors immediately put him on a ventilator to help him breathe, and started massive doses of antibiotics for the infection. The infection cleared up relatively quickly, said Nakagawa. But the infection was only the beginning of Joseph's problems.
The infection resulted in a lung disease called ``adult respiratory distress syndrome,'' or ARDS, in which fluid leaks into the lungs, making them stiff. This affects the amount of oxygen the lungs can absorb from the air. So blood began pumping harder through Joseph's pulmonary artery, which sends blood to his lungs to pick up oxygen. This increased the pressure of the blood pumping through it.
The result: too little oxygen getting into the bloodstream and a body starving for oxygen.
Historically, high blood pressure in the pulmonary artery has been treated with drugs called ``vasodilators.'' But the problem with those drugs, Nakagawa said, is that while they lower blood pressure in the lungs, they also lower blood pressure in the rest of the body, often to dangerous levels.
Nitric oxide, however, is the same substance blood vessels release to regulate pressure. When inhaled, it acts only on the pulmonary artery, then disappears when it mixes with red blood cells.
But when doctors asked Tara if they could give Joseph the experimental treatment, she hesitated.
She worried that the side effects of the drug - not the disease - would kill her son. But in the end, she signed the consent form, bolstered by a supportive family and Nakagawa's confidence.
Joseph received the gas twice, once just a couple of days after he was admitted. It was the second time, several weeks later, after the meningococcal infection had been defeated but while he was still sick with other infections, that doctors feared he would die.
He was so sick that Tara signed a ``do not resuscitate'' order, or DNR, to allow him to die if his heart suddenly stopped.
In another case, Nakagawa said, King's Daughters would have transferred the patient to Georgetown University Hospital in Washington for a heart/lung bypass. But in Joseph's case, he said, that was out of the question.
``He wouldn't have survived the transport,'' he said.
A day after he received the nitric oxide, however, doctors beeped Tara on her portable pager.
Her first thought was that Joseph had died.
No, they said, he's getting better. And the DNR was removed.
From that point on, Tara remembers, Joseph began his true recovery. A few weeks later, in mid-January, he left King's Daughters for a rehabilitation hospital in Richmond.
When Joseph left Norfolk, his mother remembered, he couldn't walk, could barely talk, and couldn't even roll himself over in bed.
Thursday, that boy was gone, replaced by a Joseph who jumped, ran and climbed over the bright blue-and-orange equipment at the Discovery Zone indoor playground in Norfolk, yelling to his friends and parents.
Just the day before, Joseph had left the Richmond hospital. He was now home for good.
To celebrate, the people at Discovery Zone donated a party for Joseph, his family and the staff at the hospital.
Said Tara: ``I knew a lot of the nurses would want to see Joseph doing the things they never thought he'd be able to do again.'' ILLUSTRATION: Color photos TAMARA VONINSKI, Staff
Joseph came home this week after spending 155 days in two hospitals
recovering from meningococcal disease. He and his family spent
Wednesday night at Bubble's Cafe.
Joseph Mason, 4, kisses his half-brother Andrew, 1.
Photo by TAMARA VONINSKI, Staff
Rose Mason watches her grandson Joseph play at the Discovery Zone on
Thursday in Norfolk. The 4-year-old, who wears a headpiece for
protection, nearly died of meningococcal disease.
by CNB