When 16-year-old Logan Maggard was first diagnosed with acute lymphoblastic leukemia (ALL), or blood cancer at age 14, it came as a complete shock to his family. His mom, Angela, had chalked up his complaints about leg pain to sports injuries and growing pains.
“Logan is very outdoorsy,” said Angela. “He loves to hunt and fish and ride his 4-wheeler in addition to playing football and wrestling. When he started to complain about aching in his calves, we thought he was working out too much.”
After consulting with his pediatrician, he was placed on muscle relaxers, but the pain continued and moved up into his hips and back. Bloodwork showed something was off and Logan was referred to pediatric oncologist Dr. Steven Kuerbitz at Akron Children’s Showers Family Center for Childhood Cancer and Blood Disorders.
“Logan was admitted in March 2019 and was officially diagnosed with B cell ALL, the most common type of pediatric cancer – which thankfully is also highly curable,” said Angela.
After a 2-week inpatient stay, which included daily chemotherapy, Logan was allowed to go home. Although he continued on an outpatient treatment regimen, he started to regain his strength and longed to be able to do some of his favorite outdoor hobbies.
“We wanted to have some normalcy, so we relented and allowed him to go 4-wheeling,” said Angela. “A few days later Logan woke up with a fever that landed us back in the hospital.”
It turns out the muddy water that had splashed Logan’s face while he was on his all-terrain vehicle was full of bacteria which caused his compromised immune system to allow his body to quickly become very ill.
“We were instructed that any fever above 101 degrees required us to bring him into the hospital, so we did,” said Angela. “We had no idea within hours he would be in the pediatric intensive care unit (PICU) intubated and on a ventilator.”
“Because Logan had abnormally low levels of white blood cells, he is at higher risk of infection,” said Amy McHenry, lead APP (advanced practice provider) critical care. “When he came to the hospital his vital signs were abnormal, which is a sign of sepsis. Left unrecognized or untreated, sepsis can quickly become a life-threatening emergency.”
In 2019, Akron Children’s joined the Children’s Hospital Association’s national collaborative called Improving Pediatric Sepsis Outcomes (IPSO), in an effort to help create the needed infrastructure to recognize sepsis, initiate timely care and ultimately reduce the number of pediatric deaths resulting from sepsis. Sepsis infections hospitalize roughly 80,000 children each year and lead to about 5,000 deaths.
According to Dr. Anita Raghavan, pediatric hospitalist and member of the sepsis leadership team, “To put that into perspective, more children die from sepsis than from cancer. Through tissue damage and organ failure, sepsis can quickly become serious if it isn’t recognized and treated early.”
For the past few years IPSO hospitals have been focusing on key processes that have been shown to reduce mortality rates and the incidence of hospital-acquired sepsis. These processes include an early detection trigger tool in Epic, bedside huddle with the sepsis team, using goal-directed therapy order sets and reducing the time it takes to get diagnostic tests and antibiotics – undoubtedly all things that led to Logan’s swift diagnosis.
Even though Logan’s sepsis was caught quickly, he deteriorated rapidly due to his inability to fight the infection. In addition to respiratory failure, Logan’s liver wasn’t functioning properly, and he required numerous blood transfusions.
Logan remained intubated in the PICU for 3 days. Once his medical team felt confident the antibiotics were working, he was moved to an isolation room.
“At one point he developed red spots all over his body as well as a pus pocket in his knee that needed to be surgically drained,” said Angela. “Thankfully, Logan didn’t realize the seriousness of it all because he was so out of it. On his 15th birthday, after a 2-week stay, he was finally discharged.”
With chemotherapy postponed during his sepsis recovery, he focused on good nutrition and taking care of himself and bounced back fast. A junior at Marlington High School in Alliance, Logan joked that the COVID-19 quarantine hasn’t been all that different for him.
“He’s been in quarantine and online school throughout his cancer so the pandemic didn’t really affect him that much, with the exception of limiting how many friends can visit him,” said Angela.
Logan will continue with monthly maintenance chemotherapy until July 2021 and then he hopes to be done.
“If his bone marrow aspiration comes back clean, we should be able to discontinue treatment,” said Angela.
Although Logan was at higher risk of sepsis, Dr. Raghavan says anyone can get sepsis and plenty of other conditions – like COVID-19, a cut on the leg, a urinary tract infection or the flu – can mimic sepsis symptoms.
Here’s an easy way to remember the signs and symptoms:
S – shivering, fever or very cold
E – extreme pain, as in the worst ever
P – pale or discolored skin
S – sleepy, difficult to wake, confused
I – “I feel like I might die”
S – short of breath
“Sepsis is a scary word, but part of our committee education work is desensitizing its stigma,” said Dr. Raghavan. “Since sepsis can be seen anywhere in the hospital, it’s imperative that both parents and staff know they can initiate a sepsis alert or ask for an evaluation. Saving a life could be as simple as asking if it could be sepsis.”