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A teenager's nasty cold may actually have been the symptoms of dangerous infection that still has her doctors puzzled.
In the middle of September, Montana Smith, then 14, was suffering from what she thought was a respiratory infection that wouldn't go away. A test for strep throat was negative, so urgent care doctors advised she treat it with over-the-counter decongestants and lots of fluids. At first, they seemed to help.
“After three days, the fever went away, and she was feeling better,” her mother, Crystal Smith told TODAY.
Montana returned to school, but realized that simply walking was difficult.
“I was really out of breath and I had to take breaks,” Montana told TODAY. “All my friends were like, ‘You need to go to the nurse.’”
The nurse sent Montana home. The family had been planning on taking a vacation cruise and Montana was scheduled to drive with her sisters and grandmother to Florida. She didn’t have a fever and felt better, so Montana joined the road trip from Warren, Ohio to Orlando.
As soon as Montana arrived, a rash blossomed on her legs. Smith gave her daughter Benadryl and the rash went away. But the next day, the teen could barely walk and struggled to breathe. Her ankles and feet were swollen.
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“I lost my appetite I couldn’t eat. I couldn’t walk. It hurt really bad. I would just fall asleep randomly,” Montana told TODAY.
On Oct. 1, the day they were supposed to board the cruise, Montana was rushed to the local hospital. Doctors took blood and gave her oxygen, but still couldn’t identify what was wrong.
“I thought I was going to die,” Montana said. “I was pretty scared.”
Her mother was distraught. "She did, at one point in the emergency room, ask the doctors if she was going to die. To hear your child ask that is something that no parent should have to see or go through,” said Smith.
Finally, a doctor from the pediatric intensive care unit suggested an echocardiogram, an ultrasound test that takes pictures of the chambers of the heart. Montana had developed a murmur, indicating a serious condition — bacterial endocarditis.
“The majority of her pulmonary valve was gone,” Smith said.
It "can happen out of the blue."
Bacterial endocarditis is an infection in a heart valve or blood vessel that occurs after bacteria enters the blood.
“Bacterial endocarditis can happen out of the blue,” Dr. Elizabeth “Tess” Saarel, chair of pediatric cardiology at Cleveland Clinic Children’s, who treated Montana, told TODAY. “But, it is fairly rare.”
That nasty, lingering cold could have been the symptom of the infection.
"The cold symptoms may actually have been the endocarditis affecting her lungs," said Saarel.
Doctors are still unsure how Montana contracted it.
“She was one of the rare cases where she was an otherwise healthy teenager who had bad luck and bacteria got into her bloodstream and attached to her heart,” Saarel said.
Even though Smith was happy with the care Montana was receiving in Florida, they wanted her to be closer to home.
“There is something about a mother’s intuition,” Smith said. “We needed to get home as fast as we can.”
Montana's infection had spread and she developed complications, including sepsis. After doctors stabilized Montana with IV antibiotics, Cleveland Clinic flew her from Florida on October 10 — Montana’s 15th birthday.
Risky surgery provides a chance
There was a narrow window when they could perform open-heart surgery and replace the faulty valve. Montana had an infection in her lungs that the antibiotics weren’t clearing fast enough. Yet, the doctors had to perform surgery before Montana worsened.
“It was risky, but we knew that if we didn’t take that risk that she wouldn’t survive,” Saarel said.
Doctors replaced the valve, but Montana still wrestled with septic shock.
“We had at least a chance of getting it under control by getting rid of the infected valve,” Saarel said. “Cardio pulmonary bypass puts a strain on her body. She was critically ill.”
For the next several weeks, Montana was in the pediatric cardiac ICU. When she started waking on November 10, she thought it was her birthday. Slowly, she improved.
“I asked my mom a lot of questions,” Montana said. “I didn’t get told the whole thing at once. We went at my own pace.”
If a cold doesn't go away
Most people contract bacterial endocarditis if they have a cut or sore on their skin, which allows the bacteria into the blood. It occurs more frequently in IV drug users, but can also happen when people have skin disorders or from brushing their teeth. Based on Montana's history, doctors can't pinpoint the cause.
It sounds scary, but Saarel stressed bacterial endocarditis is rare. However, if a cold lasts more than seven to 10 days with no improvement, Saarel urges people to get to the doctor.
“I would recommend that you go to a doctor where they can listen to your heart,” Saarel said.
At last, Montana moved to a rehab hospital where she re-learned how to eat and breath while building her strength to walk. She was able to return home December 20 to celebrate Christmas with her family.
“It was the best day ever beside the day of her being born. It was phenomenal being out of the hospital,” said Smith.