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As Children Suffer, Parents Agonize Over Spinach


The New York Times

September 24, 2006

MILWAUKEE, Sept. 22 — The hardest moment came when Elaine and Dennis Krause’s 9-year-son, who had stoically undergone kidney dialysis, blood transfusions and drug treatments that made him hallucinate that spiders were all around him, quietly asked his parents whether he was going to die.

“What do you say when your child asks you, am I going to die?” asked Elaine Krause, who has spent nearly all of this month beside her son’s bed at a hospital here, watching his skinny, lanky body do battle with E. coli. “I told him, ‘These people are trying to help you, and you are getting good care.’ But the truth is, I couldn’t answer him directly. We didn’t know.”

By this weekend, a national outbreak of E. coli linked to fresh spinach grown in California had sickened 165 people in 25 states and killed at least one here in Wisconsin, where more people have grown ill than in any other state. The authorities in Idaho and Maryland were investigating the deaths of two others, including a toddler whose parents said they gave him a fruit smoothie with spinach days earlier, trying to determine whether their deaths, too, were linked to the outbreak.

But beyond the raw statistics were individual stories of a sudden, mysterious, life-threatening illness, one that struck most often in the homes of those who viewed themselves as more health conscious than many other Americans.

In many cases, it crept up with frightening force after what had seemed a harmless, even healthful meal — a spinach salad with walnuts, a sandwich layered with spinach or, as for the Krause family, a baked, boneless, skinless piece of chicken on a small bed of spinach. Then what had seemed a simple bout of diarrhea in the morning often led to a harrowing, bloody race to the emergency room by midnight.

And around the country, some families still wait by bedsides, wondering which foods they could ever again feel safe giving their children, what the government or the spinach industry could have done to protect them, and, most of all, whether their loved ones will ever fully recover.

“Here you think you’re feeding your child a great, healthy meal,” Dennis Krause said sadly. “But here I was, poisoning him.”

Not all E. coli is harmful to humans, but certain strains produce toxins that kill cells in the gut and in the blood vessels, leading to abdominal cramps and watery to bloody diarrhea, said Dr. John Flaherty, associate chief of the division of infectious disease at the Feinberg School of Medicine at Northwestern University.

One area where the toxins can wreak particular havoc is in the kidneys; when it happens, Dr. Flaherty said, the inflamed cells lining the blood vessels get “roughed up,” causing red blood cells to break open as they pass by and jam blood flow to the kidneys.

“In the course of one week, he went from this healthy, lively little boy to a boy in a hospital bed fighting for his life,” said Anne Grintjes, of Brookfield, Wis., whose 7-year-old son developed a dangerous form of kidney failure linked to E. coli, called hemolytic uremic syndrome. “He turned yellow and gray, literally. It was shocking and terrifying and unbelievable to watch.”

Of the more than 160 cases that have been confirmed as part of the spinach outbreak, more than half required hospitalization, and about 16 percent developed the dangerous hemolytic uremic syndrome.

Doctors say they cannot be certain what long-term effects the syndrome may have; it varies from person to person. Many patients recover entirely, they say, while others may suffer from chronic kidney problems and other health risks.

Although the youngest children and the oldest adults are considered most vulnerable to getting sick from the bacteria and to struggling to recover from its effects, more than 70 percent of those who grew ill in this outbreak were somewhere in between: older than 4 and younger than 65.

At 27, Gwyn Wellborn of Salem, Ore., described a sudden onslaught of slicing, stabbing abdominal pain and bloody diarrhea in late August, days after eating baby spinach at work, thinking she was being especially virtuous. At first, doctors sent her home, Ms. Wellborn said, with a painkiller and a diagnosis of food poisoning. Hours later, though, the pain became so excruciating and the bleeding so constant, she said, that her husband rushed her back to a hospital.

From there, she quickly deteriorated. Her kidneys began failing. “At one point, the doctors told my family there was nothing they could do, that that was it,” she recalled. But after three transfusions and several weeks in a hospital, Ms. Wellborn went home.

Hers is one of at least four lawsuits filed in courts around the country by William D. Marler, a Seattle lawyer, in connection with the outbreak. Ms. Wellborn said she would not consider eating spinach anytime soon. “Not in a million years,” she said.

Marion Graff, 77, a former bank clerk and widow from Manitowoc, Wis., is the nation’s only confirmed fatality in the outbreak, but deaths in Maryland and Idaho are also considered “suspect” cases, federal authorities said on Friday.

Kyle Allgood, 2, of Chubbuck, Idaho, died at a Utah hospital from cardiac arrest after contracting hemolytic uremic syndrome, his family said, a case Idaho authorities said was “probably connected” to the tainted spinach, although laboratory tests have been inconclusive. Kyle’s mother, Robyn Allgood, said she had mixed vegetables into blended fruit and juice smoothies, as a way to get Kyle and her two daughters to eat vegetables, and had given him such a drink on Sept. 12.

Three days later, she said, Kyle had flu-like symptoms, including severe diarrhea.

On Wednesday, despite specialized treatment at a hospital in Salt Lake City, Kyle died, hours after his father, Jeff, said he had urged the boy “to fight for me.”

Relatives tearfully recalled Kyle as generous and good-natured though mischievous — a boy known as the “stuntman” for his antics, which inspired fear and awe in adults.

He liked to twirl his hair into knots, dance wildly to the music of Jack Johnson and give lingering kisses to his aunts, the family said. He was also impish; at Primary Children’s Medical Center in Salt Lake City, Kyle was pinching his nurses and ripping at his IV’s until near his final moments, they said.

In Maryland, an elderly woman died of E. coli on Sept. 13 after eating fresh spinach, state health officials confirmed, but because of a lack of DNA specimens from the victim, officials have yet to determine whether it was the same strain of E. coli that infected others who ate spinach. Family members identified the woman as June E. Dunning, 86, of Hagerstown.

Warren Swartz, Ms. Dunning’s son-in-law, said she had eaten steamed spinach from a package on Aug. 30 and Sept. 1 and baby spinach from a bag on Aug. 30. She had signs of E. coli, including rectal bleeding and bloody diarrhea, on Sept. 1 and went to the hospital the next day.

For the Krause family, of McFarland, Wis., the illness began a few days after a family dinner on Aug. 24. First, their 15-year-old daughter grew ill. Then their 9-year-old, who was healthy enough that he had a perfect attendance record last year in third grade, grew even more ill, and has suffered debilitating effects, including acute renal failure, fluid buildup near the heart, raised blood pressure, soaring blood sugar.

In a hospital cafeteria here, miles from their home, the Krauses at first could only bring themselves to eat peanut butter and jelly sandwiches. Everything else — lunch meats , salads, everything — scared them.

“For me, there’s anger and paranoia and fear for others — for the safety of food we get that’s supposed to be monitored,” Ms. Krause, 47, said. “I don’t know what to trust. Should we grow it all ourselves?”

On Friday, their strawberry-blond boy lay weakly in his hospital bed, surrounded by balloons and cards from the school where he says he fears falling behind his class. He had physical therapy, then occupational therapy to begin rebuilding his body. He told his father he only wanted to be well, to somehow rewind to the day before the spinach.

A few days ago, his body seemed to turn a corner and doctors removed him from the dialysis machine, a crucial step toward recovery. His parents have not asked when he might be well enough to go home; they said it was too early to look ahead.

“I keep thinking we will at some point go home and it’ll all be like it was,” said Mr. Krause, 52. “But we don’t know yet what the long-term effects are. He will be monitored probably for the rest of his life. It’ll never be the same.”

Libby Sander contributed reporting from Chicago; Martin Stolz from Bountiful, Utah; and Gary Gately from Baltimore.

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