Tick nightmare ends in death for decorated Vietnam veteran

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Editor's note: Tick illnesses such as Lyme disease and Rocky Mountain spotted tick fever often go misdiagnosed while patients get sicker and, in worst case scenarios, suffer permanant physical or neurological damage or even die. The report that follows details one such worst case, that of decorated Vietnam veteran Bob Schneider - who lost his final battle to a tick in the summer of 2006.
 
Family blames member's death on tickborne illness
Evansville Courier & Press, Indiana, August 2006
 
By LIBBY KEELING
Staff Writer
 
Robert "Bob" Schneider collapsed in his Spencer County home July 5, 2006. Two days later, neighbors found him lying on the floor where he had fallen.
 
The former Evansville resident was hospitalized for more than 25 days before his death Aug. 2 at St. Mary's Medical Center. He was admitted to the intensive care unit with multiple organ and respiratory failure, low blood platelet levels, altered mental status and septic shock, a condition occurring when massive infection results in More...low blood pressure and flow.

Members of his family are convinced complications of Rocky Mountain spotted fever caused his death. Although an initial positive laboratory test for the tickborne bacterial illness was not confirmed prior to his death, Schneider's son said medical staff found an embedded deceased tick and a live tick crawling on his 63-year-old
father's body.

"The signs and symptoms all point to it," said Trent Schneider, 40. "I found out, that like colds or flu, children and elderly people are its prey, per se - the people most likely to develop severe complications."
 
When identified in early stages, Rocky Mountain spotted fever typically is a highly treatable disease. Its initial symptoms, however, are vague and flu-like, which complicates diagnosis.
 
Many people who develop the disease after receiving a tick bite are hospitalized. Without timely and appropriate antibiotic treatment, Rocky Mountain spotted fever can be fatal.
 
Sudden fever, intense headache, nausea, vomiting, muscle pain and confusion are among the first signs of infection. Many - but not all - people develop a rash after the initial onset of symptoms. Abdominal pain, achy joints and diarrhea may occur.
 
If the disease progresses without treatment, the bacteria can attack and damage cells in the blood vessels. That damage allows blood to leach into nearby tissues. Leaking blood can be responsible for the rash. It also can damage tissues and organs.
 
"The tests came back and he did test positive for Rocky Mountain spotted fever," said Judy Schneider Kron, his younger sister. "The medical staff at St. Mary's was absolutely wonderful. They worked so hard to save his life."
 
Schneider's family has been working to reconstruct the chain of events leading to his hospitalization.
 
Trent Schneider said he spoke with his father on the telephone shortly before July 4. During that conversation, his dad said he had been feverish and not feeling well for a few weeks.
 
The elder Schneider, a decorated Vietnam veteran, made several unsuccessful attempts to obtain treatment at the Veteran's Administration Outpatient Clinic in Evansville , according to his son.
 
On July 5, he was diagnosed with sinusitis at a Deaconess Urgent Care Center before collapsing at his home later that evening, Trent Schneider said. Two days later, neighbors found his father, still on the floor.

 
An ambulance took him to Perry County Memorial Hospital in Tell City, Ind. The next morning he was taken by helicopter to St. Mary's Medical Center . The family did not learn of his hospitalization until after his admission to the Evansville hospital, Schneider said.
 
His dad was having difficulty breathing and could not speak when Schneider first saw him at St. Mary's. The news was grim: Bob Schneider had a 40 percent chance of survival.
 
"I saw my dad with a mask on and he was sitting there upright and he was huffing and puffing and his eyes were about as big as half dollars," Schneider said. "You could see the fear in his eyes."
 
Before the end of the day, Schneider said his father was placed on a ventilator, the ticks were discovered and antibiotic treatment for tickborne infection was initiated.
 
"If anything, Bob was healthy. He was a procrastinator and he procrastinated too long on this one," Kron said through tears. "People need to check for ticks. That's the important part."
 
She believes the ticks on her brother's body likely came from his small farm in Evanston , Ind. After retiring from his position as a social worker at Evansville State Hospital about 12 years ago, he moved to the property on the Spencer-Perry county line.
 
With the exception of a few good days when he squeezed her hand or responded to conversations with eye movements, Kron said her brother remained unresponsive as doctors worked to improve his deteriorating condition and ascertain its cause.
 
"A tick. A little tick," Kron said. "I think my brother and my nephew really were the ones that said this is serious. We need to get the word out."

Although Trent Schneider authorized St. Mary's physicians involved in his father's care to speak about the case, requests for comment received no response.
 
According to Bob Schneider's medical records - provided to the Evansville Courier & Press by his son - doctors were still considering tickborne illness as a potential underlying cause of his systemic infection three days before he died.

Schneider's records indicate he tested positive for both Rocky Mountain spotted fever and erlichiosis, another related tickborne disease. A second test for Rocky Mountain spotted fever was ordered July 24. The results of that test are not included in his medical records.

Physician's notes, however, indicate Rocky Mountain spotted fever was considered more of a possibility than erlichiosis, but neither appears to have been considered a conclusive diagnosis.
 
Schneider said a doctor told him a positive test for Rocky Mountain spotted fever could indicate previous rather than current disease, but no other potential underlying cause for his father's illness was offered. A physician also said an autopsy would be inconclusive, according to Schneider.

No evidence of prior Rocky Mountain spotted fever infection exists in Bob Schneider's records at the VA Medical Center in Marion , Ill., according to information requested by his son.
 
Irreversible brain damage, hypertension (more likely hypotension, based on his medical records), sepsis with multi-organ dysfunction and a severe lung problem were reported as his cause of death, according to the Vanderburgh County Health Department. His death certificate does not mention Rocky Mountain spotted fever.
 
"I can't say if he did or didn't have it," said Dr. Lloyd McGinnis, health officer for the Spencer County Health Department.

A state epidemiologist characterized the three potential cases of Rocky Mountain spotted fever reported this year in Spencer County as previous, not current, infections, McGinnis said. Other tests or clinical observations could change that impression, he added.
 
In the days before his death, Bob Schneider reached near complete organ failure. His blood pressure became dangerously low, and his white blood cell level plummeted. The prognosis was dismal.
 
"I went in and talked to him. I said, 'You know, it's not looking very good,'" Trent Schneider recalled. "I told him I loved him very much. I wasn't ready for him to go, but you know, I told him that I felt that he was suffering and we needed to let him go."
 
Kron said her brother watched what he ate, exercised and was aware of the risks of tick exposure.
 
"He was very careful, very careful, about checking himself for ticks," she said. "If you have any of the symptoms of fever, rash, tiredness, whatever, they may be any of the tickborne illnesses. Immediately get to your doctor."

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