December 16, 2004

Swirling emotions

Pedicure infection will leave lifetime scars

By Kymberli W. Brady
Staff Writer

Even though as many as 30 years separates them, several victims of the recent mycobacterial outbreak—that now has county health officials taking a closer look at San Jose pedicure salons—became instant “sisters” during a support group last Wednesday night.

Given the opportunity to let their hair down—and lift their pant legs up without inhibition—victims of the growing mycobacterial infection outbreak came together last Wednesday. They openly shared stories, lifestyle changes, homeopathic remedies and most of all inspiration, after having lived in humiliation and near isolation since they were inflicted. Photo by Kymberli Brady.

After our initial reporting of the outbreak in November, and following letters, emails, and phone calls from victims, the Almaden Times’ decided to switch gears and focus more on what we feel is the real story—the physical and emotional toll this infection has had on its victims. We brought some of these women together for an evening of shared experiences, group support, counseling and encouragement as they prepare for the coming months ahead.

At that time, 11 cases had been verified and three salons were under investigation. By Tuesday, the numbers had risen to include 82 victims with 18 salons implicated.

The term “empowering” only served in this case to underplay the mounting energy as evening progressed. Complete strangers became instant friends with a common experience, one that until last week left them feeling alone, withdrawn and isolated in their plight.

While some shared all too familiar accounts of fear, discomfort, cancelled plans, ongoing sacrifices and the horrors surrounding permanent scaring, others lent their support and offered much-needed reassurance looking forward.

Rocki Kramer, founder of the Almaden Valley Counseling Service generously agreed to attend and offer guidance, but admitted that she didn’t do much—and didn’t have to. The magic happened all by itself, as the bonds formed the moment they walked in the door.

Struggles and tenacity
Along with the inspirational tenacity of an 11-year-old middle school student and a teenager coping with the decision to cancel her birthday celebration in Mexico are stories of sacrifice and acceptance. One is of a nurse looking for answers, another is the struggle facing a nursing mother trying to reach a delicate balance with her treatment.

Each of these women, and others, agreed to speak out in the hope that their experiences will help champion the effort for tougher health and safety laws, which should have been enacted after the first wake-up call hit Watsonville three years ago.

Although their real names are not used in this article (out of respect for their anonymity), their stories are real, as are their tears and the fear of recurring outbreaks with a condition that even health officials claim they don’t know enough about yet.

Karen had been going to Silver Nails since April. She believes she contracted the infection sometime in July after noticing what seemed to be a spider bite a few weeks earlier. By the time she went to her doctor in October, the infection was already taking its toll.

“I took Biaxin and then had to go on Cipro because I got so sick,” she said. “I’m much better now. I haven’t had any new outbreaks and my kids don’t have it—at least not yet.”

It’s also a constant concern for Joanna, a nurse who is now relegated to a strict routine of separating her things from the rest of the family and bleaching practically everything she comes in contact with. But the real fear lies in questioning whether she got everything clean enough or did she miss a spot?

“My dermatologist said my kids can’t be in the tub with me,” she explained. “I have to bleach it out every time I use it and not use the same washcloth. Then, when my littlest one wants to take a tubby, it’s absolutely creepy.”
The forced lifestyle change has stripped her and her two young daughters of treasured bonding times in the bath—a ritual they have put on hold indefinitely.

More experiences
“You know how far this goes?” Elaine asked, as she chronicled her experiences over the past several months and how she now hones in on anything that might shed light on the extent to which the infection has grown. “My friend works in Fremont and noticed something in September but thought it was an ingrown hair. She went to Kaiser and they put her on antibiotics for only 10 days. Now she has it all over her feet.”

Those who were infected at Silver Nail believed that the hot towels and “pounding” on their legs only served to “pound” the infection in deeper.

“I looked it up on the Internet,” explained Amanda, who contracted the infection after a pedicure at Silver Nails in August. “It is so disgusting—it’s a little attacking monster, and I have so many of these inside my legs. Just thinking about it makes me shiver, and all I wanted was to have cute toes for our vacation.”

Although the youngest in the group, Amanda’s attitude became a source of motivation for the others. She spent weeks worrying about her friend after they had been in a hot tub together—before she knew it could infect her.

She also had to forego her swim unit at school and instead produced a research project on the infection to educate others.

After several rounds with different antibiotics and her ongoing struggle to hide her legs from classmates, Amanda has endured a lot. But, she said it could have been worse had it not been for her mother’s passion for homeopathic remedies, which she credits with keeping the side effects at bay, including nausea, vomiting, loss of appetite, yeast infections, headaches, blurred vision and hallucinations.

Linda didn’t know exactly when she contracted the infection and had been going to the same operator at Kathy Nails for over six years. Even her experience as a nurse did little to prepare her for what lay ahead once the first few bumps appeared on her legs.

Following a pedicure at Silver Nails in September, Jennifer had been undergoing treatment for her outbreak when she read the initial Almaden Times article last month and immediately took it to her dermatologist, who until then hadn’t been able to diagnose her condition.

“He didn’t even know what it was,” she said. “Now I’m with an infectious disease specialist.”

Four different antibiotics
Kaley’s doctor didn’t know what he was dealing with either. After four different antibiotics, she now thinks she’s on the right track and looks forward to going back to work, something she hasn’t been able to do for months. The side effects from the antibiotics kept her home most of the time. Acting on the advice of Amanda’s mother, she has decided to try homeopathic remedies as well.

For Sarah, the struggle has been a difficult one that has stripped her of her femininity, as well as the closeness with her husband, whom she hid her unsightly legs from for months.

“People don’t realize just how much this affects you,” she explained. “I haven’t been able to shave my legs for months. I look like Sasquatch and that doesn’t do much for intimacy.”

In addition to offering up what has and hasn’t worked for them, including Neosporin, which could lead to systemic problems. Cortisone cream, a popular skin remedy on most rashes, fueled the conversation further because those who had gone that route quickly related it to “putting fire on kerosene.”

No matter what they tried, everyone agreed that finding the right doctor was paramount. Trying home remedies could lead to complications, especially if you don’t know what you’re dealing with, they agreed.

“I was treating them like zits,” Joanna exclaimed. “I was popping them and pouring hydrogen peroxide on them. It only made is worse.”

As the evening wore on, sound advice was offered up in between anecdotal moments spent lining up leg-to-leg comparing bumps and healing times. Those who were months into treatment offered hope and eased the fears of those with fresh lesions.

The scars however, will last a lifetime and most of these women will be left with spots on their legs that look much like cigarette burns. Although the road ahead will be fraught with challenges, they left with the knowledge that they were just a phone call away from someone they could seek out for advice and talk openly to about their plight.

Taking action
While the addition of seven inspectors will aid in finding and combating the immediate problem in Santa Clara County, additional resources will need to be tapped into in order to provide more realistic checks and balances for the booming pedicure business.

If you break it down, with just 17 field inspectors assigned to 296,375 licensees in 37,000 nail salons, regulation at best is reactive, rather than proactive. Each inspector would have to play watchdog to nearly 17,433 licensees each year, or 75 per day [not counting weekends and holidays] in order to inspect them all only once per year.

According to the State Department of Consumer Affairs, most of the 8,200 inspections performed last year answered to client complaints and health department concerns.

Seven of those inspectors have been temporarily assigned to address the current outbreak in Santa Clara County. Still, the board is horribly understaffed.

“A majority of the inspections we do come from consumer complaints,” admits Patti Roberts. “We rely heavily on everyone being our eyes and ears so we can take action and make sure salons are doing their due diligence.”

On Tuesday, the California Department of Consumer Affairs mailed a safety alert to 37,000 establishments in English, Spanish and Vietnamese in a concentrated effort to educate both the licensees and the consumer.

The alert outlines regulations for proper cleaning and disinfection procedures of whirlpool footbaths—regulations enacted three years ago in response to the bacterial outbreak in Watsonville.

Anyone with one or more persistent skin boils following a whirlpool footbath pedicure are advised to contact their doctor for an evaluation and explain that they had a whirlpool footbath before the skin infection started.

“Safety guidelines are especially important during the holiday season,” said Terri Ciau, executive officer, California State Board of Barbering and Cosmetology. “Consumers use salons more often to get ready for holiday gatherings, and salon gift certificates are being bought for gifts.”

While officials with the State Board of Barbering and Cosmetol-ogy and the Department of Health Services, along with local officials in the Santa Clara County Public Health Department continue to work on the outbreak, Health Department spokesperson Teresa Chagoya admits they have neither the resources nor manpower to tackle the problem single handedly. She’s confident there isn’t just one single answer, but attributes successful prevention to education and joint efforts from their office, the State Board of Barbering and Cosmetology and the public.

The Public Health Department has also been working with the California Department of Consumer Affairs Barbering & Cosmetology on the outbreak, offering consumer tips on whirlpool foot spas, as well as general information on Nail Salon Services. Complaints can also be filed online. For more information, visit www.barbercosmo.ca.gov or call (800) 952-5210. Those who do not have a physician or have additional questions can call the Public Health Information Line at (408) 885-3980.

Guidelines for consumers

State issues safety alert for consumers receiving pedicures

To help protect yourself, use the following guidelines before you get a pedicure treatment that includes a whirlpool footbath.

- Don’t shave your legs before the appointment. Shaving makes you more susceptible to nicks and cuts, which are gateways for bacteria.

- If you have broken skin or lesions on your lower legs, do not get a pedicure.

- Check out the salon. Make sure its Board of Barbering & Cosmetology license is posted in plain view in the reception area and is current.

What to look for
- Make sure the operator’s license is posted at his or her workstation.

- Make sure the Board’s Health and Safety poster is displayed in the reception area.

- See whether the salon is clean, free of trash and set up with clean instruments.

- Don’t be afraid to ask the operator how the foot spas are cleaned and disinfected. If they hesitate or won’t answer you, that could be a sign you may want to take your business elsewhere.

- If you have any doubts about the cleanliness standards at a salon, leave.

- If the foot spa’s basin looks dirty, consider having a pedicure without the use of a whirlpool spa.

The first step consumers should do - if they suspect that they are infected through a pedicure procedure - is to visit their doctor, according to the State Department of Health Services.