hen Ashley Elton and her family set out for spring break 2014 at the Oregon Coast, they had no idea that, two days later, she would be battling for life against a rare illness.
“Ashley (then 14) and a friend were sitting in the back seat of the car giggling like girls do and we were looking forward to sharing a house in Seaside with another family,” said her mother, Cheryl.
Almost a year later, Ashley is ready to talk about her brush with death due to toxic shock syndrome. She believes it is important for other women to know that using superabsorbent tampons can be risky business.
The possibility that she could save someone else has conquered any shyness Ashley might have about sharing her story.
“In health class, we learn about STDs (Sexually Transmitted Diseases) and a lot of other health topics, but I think they should also talk about what can happen when girls use tampons,” she said.
The Eltons’ ordeal began on Friday, March 21, 2014, after the family arrived at the Oregon coast.
Ashley had chosen to use a larger tampon that day because she had been engaged in a sports activity prior to their road trip. Her monthly cycle was winding down but she wanted to be sure there was no embarrassing problem in the gymnasium.
“I knew that I would be running so I thought that it would be safe,” she said.
Although reports from the late 1970s claimed that toxic shock, a potentially fatal illness, could occur when a woman did not change her tampon regularly, Ashley said that is not the only cause.
She said wearing a larger than recommended tampon causes more fluid to be absorbed, setting the stage for an overgrowth of poison-producing bacteria.
Ashley’s illness was caused by the bacteria Staphylococcus aureus. In women with a pre-existing skin infection, it can be initiated by the bacteria Streptococcus pyogenes.
She had eaten some snacks purchased on the ride to the beach so when the symptoms of vomiting and diarrhea appeared late that night, the Eltons thought Ashley had just gotten bad food.
“We first thought it was a case of food poisoning because the symptoms seemed right,” said Cheryl.
Ashley spent late Friday night into Saturday morning laying on the tile floor of the bathroom because it was a non-stop cycle of sickness and she was too weak to get up. Around 8 a.m. on Saturday morning she managed to make it back to bed.
She was achy and dizzy that day but believed that discomfort was due to laying on the hard floor. Ashley remained in bed for the entire day, only eating a small piece of bread.
By Sunday morning she was still weak and stiff. A new symptom presented itself. Her tongue became sensitive and was coated with a white patch that resembled thrush, a yeast infection common among infants.
Not thinking it was food poisoning anymore, Cheryl checked Ashley’s symptoms against the potential side effects of a medication she had begun using a week earlier to clear up her complexion.
The plan was to have Ashley stop taking the medicine and call her dermatologist on Monday morning.
“We didn’t know anything about toxic shock syndrome so we didn’t even consider it,” said Cheryl. “We could explain her symptoms so we didn’t understand how serious things were getting.”
In fact, toxic shock is rare enough that it is no longer tracked by the Center for Disease Control. A study published in 2004 by Patrick Schlievert found that three to four out of 100,000 tampon users fall ill.
The manufacturers of Tampax and Stayfree report that one to 17 of every 100,000 menstruating women will experience toxic shock.
By Sunday night, Ashley had stopped trying to eat and told her parents that something was horribly wrong.
“I was begging to go to the hospital and find out what was going on,” she said.
Ashley had continued to use tampons through the weekend and no one had suspected that they could be the culprit.
“Ashley never had a fever so, at first, we didn’t think it could be anything serious. But when she kept saying that her tongue felt funny and she could not even eat anything, I knew it was time to take her to the emergency room,” said Cheryl.
Shortly after they arrived at the hospital, about two miles away, the emergency room doctor noticed a rash developing on Ashley’s inner thighs, stomach and arms. She told him that she had noticed a yellow staining on the tampon she had removed at the hospital.
Because she still had no fever, Cheryl still remained hopeful that Ashley’s condition would be easy to treat. Her mother was shocked to learn after a urine sample was taken that Ashley was experiencing acute kidney failure.
She would later learn that some women with toxic shock die within hours after the manifestation of symptoms.
“No one knew exactly what was going wrong with Ashley so they decided to send her to the Doernbecher wing of OHSU (Oregon Health and Science University) by ambulance,” said Cheryl.
The medics in the ambulance didn’t seem to feel a sense of urgency about Ashley’s condition, which Cheryl took as a good sign.
When her daughter said she needed to use the restroom, the driver pulled over at a truck stop and she had to use the men’s room, the only bathroom available, which led to some teasing.
The 80-mile journey was without lights or sirens because there was no traffic to impede travel on Highway 26 in the middle of the night.
“The driver had worked a long shift and kept wanting to fall asleep at the wheel, which was causing me some worry,” said Cheryl.
“That ambulance ride seemed to take forever,” said Ashley.
She was first taken, as directed by the Seaside physician, to the children’s wing. A new doctor quickly realized her treatment was beyond his skill level and sent her over to critical care.
“He took one look and realized she was crashing,” said Cheryl. “We were in the right place at the right time because people knew it was over their heads and got her where she needed to be.”
Ashley soon had fluid around her lungs and no radial pulse in her ankle. The rash had spread to her entire body and her eyes, which had been crusty for several days, were hurting badly.
She was in the fight for her young life as her system began shutting down.
“It all happened within hours and I was freaking out,” said Cheryl.
Ashley’s heart began racing at 268 beats per minute and the doctor had to rush to use medication to stop her heart and then restart it with a different medication in order to reset it to a regular rhythm.
This happened twice during her stay.
She was hooked up to a mix of antibiotics to fight an infection that they had not yet been able to identify.
Once cultures had been taken and rushed to the lab, doctors found the culprit for the illness and, by Wednesday, had Ashley on the best antibiotics to battle toxic shock.
She was visited by officials from the Center for Disease Control several times during her stay, which the family was told was common practice when people were unsure about the illness/infection a child was suffering.
Once medical and CDC staff knew what was going on with Ashley, they explained that toxic shock happens more often than it would seem by statistics. They said most women’s bodies fight the infection so they were not even aware of the problem.
However, others, like Ashley, were not able to stave off life-threatening problems.
Although she remained conscious through the ordeal, Ashley could not eat and her weight fell below 100 pounds on a 5-feet 5-inch frame.
When she was finally allowed a popsicle on Thursday, she said it was such a treat that she tried to enjoy it slowly, which created a sticky mess.
Her system needed to recover so she was given massive amounts of fluids intravenously to flush the toxins out and was only allowed ice chips and small cups of water until Thursday night, when she was finally allowed to begin eating soft foods.
“I appreciate life so much now – and I count every meal as a blessing,” she said.
Although Ashley has no permanent damage from the illness, Cheryl said a follow-up visit to a cardiologist revealed that all four of her heart valves don’t quite close all the way, which causes them to leak.
“If I push myself too hard, my heart beat goes up very fast and I have to take a lot of breaks,” said Ashley. “I want to be active but it’s holding me back.”
She also learned during an examination from another doctor that her cerebellum, the region of the brain that plays an important part in motor control, hangs lower than normal, which could cause her problems with her nervous system later in life.
Ashley doesn’t worry about that potential problem at this age – but her mom does.
“Every little thing, I freak out now,” admitted Cheryl. “We came so close to losing her and I can’t forget that.”
She advises parents with a daughter experiencing any of the symptoms that Ashley had to get her to the hospital right away.
“What’s a $125 ER visit compared to a potential life lost,” she said.
For a while in her recovery process, Ashley had to walk around school with a heart monitor and explain what was going on.
At the age of 15 and a sophomore, she has become comfortable talking about what had happened to her out of the desire to protect other young women.
She can no longer use tampons and, although doctors have said she can try them again when she’s in her 20s, Ashley’s not sure she will.
“Anyone who’s using a tampon and starts feeling sick should stop immediately,” she said. “If you start vomiting, having diarrhea, or a yellow discharge with or without a fever, then it’s time to get to the doctor.”
Despite the family scare, Cheryl has not given up tampons, although she is much more careful about the size she buys and how often they are changed.
Mother and daughter spent Memorial Day 2014 at the coast to give Ashley the vacation she had missed.
This year the whole family plans to head to Seaside again for a spring break “do over.”
“If I have learned anything from this it is to trust your body. When you feel something is off, make sure you take action,” said Ashley.
“We were told if we would have waited even hours more I might not be here right now. I feel very lucky that I came through this with only a small scar on my arm. It could have been a whole lot worse.”
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