That Worm Feeling

And you thought your dandruff was a drag

In early August, the first wave of hookworms inside Carroll and Nelms began to die and break the skin, creating open sores.

"They were little gray, hard, L-shaped things," says Carroll. "They'd break apart when you tried to grab them with tweezers."

Horrified and desperate, the couple went to the emergency room at Maryvale Samaritan Hospital.

Jim Nelms still show signs of his  afflictions.
Paolo Vescia
Jim Nelms still show signs of his afflictions.

The staff of the emergency room at Maryvale Samaritan is not unaccustomed to horrified, desperate people walking through the door, arms and legs covered in sores, claiming to be infested with bugs. Crack cocaine or methamphetamine abuse often cause the abuser to feel as if there are insects beneath his skin, leading him to relentlessly pick open his flesh, trying to get at the bugs.

Into this context came Carroll and Nelms, crazy-eyed with fear, gaunt-faced from not eating much for several weeks (creeping eruption causes nausea and diarrhea), with open sores on their limbs and torsos, ranting about worms crawling beneath their skin, and how no other doctors would help them.

"They looked us over and started saying, 'How long have you been awake? What are you on?'" says Nelms. "I told them we weren't on anything, and they said, 'You have to help us before we can help you.' Then I started yelling, 'You can help us by getting these things out of me!'"

The situation did not improve when Nelms opened a knife and prepared to pry a hookworm corpse out of his arm. "I was escorted out by security," he says.

Carroll, a retired Air Force nurse, says she became so hysterical she was given a psychotropic drug she believes was Thorazine.

"They told me it would help me, but it just made me loopy," she says. "I didn't care about anything for a while, and then when I did, I found my clothes and snuck out."

Shortly after the ill-fated emergency room visit, new worm trails began appearing. Carroll and Nelms say they had more than 50 worm trails or lesions each, and believed they had fallen prey to a second infestation -- of what, they still did not know. They were fighting blind, and not well. Carroll had begun cleaning the house obsessively, and shampooed their shag carpeting every three days. This unwittingly created the perfect, damp environment for hookworm larvae tracked into the house from the garden by Carroll, Nelms, or their Afghan hound, which they had shaved (the dog was also infested).

At one point, the couple went to PETsMART and bought a container of Iramectin paste, a de-wormer used primarily by horse breeders.

"We knew we had some kind of worm because you could see the damn things," says Nelms. "So we put some of the horse stuff in water and rubbed it on our skin, and that seemed to knock 'em back a bit."

One frantic day, the couple took turns blasting each other with water from a high pressure hose in a car-wash stall.

"I sprayed so much insecticide in this place I thought I was going to have a seizure," says Nelms. "We didn't know what we were supposed to do, so we did everything we could think of."

Eventually, that included walking to the closest medical facility, no matter how modest. Three blocks away from the couple's house is a NextCare 24-hour emergency center, where Carroll and Nelms were seen by a Russian physician who was substituting at the clinic for a few days.

"We finally got lucky," says Nelms.

The Russian doctor looked over their lesions, then asked to see the soles of their feet.

"No one had asked that before," says Carroll.

In cases of creeping eruption, the big toe and soles of the victim's feet are usually red and swollen from toxins left behind by invading hookworms.

"She took one look at our feet and said, 'You have parasites,'" says Carroll. "She knew what it was, right off, and she got us the right medicine."

The doctor prescribed Thiabendazole, the standard treatment for any hookworm infestation. Valley pharmacies don't stock Thiabendazole, though, and the couple had to wait another two days for it to be shipped, then another five days for the medicine to kill the final surviving worms.

The NextCare doctor suggested Carroll and Nelms take her findings to dermatologists at the Mayo Clinic in Scottsdale, who took skin scrapings and confirmed the Russian's diagnosis.

The garden outside Carroll's house is gone now, and the carpeting inside is new. So is the linoleum in the kitchen, the furniture in the living room, and the air ducts in the walls.

"We got rid of it all," says Carroll. "I got itchy just looking at the couch. It was a nice sectional, but it had to go."

From one perspective, Carroll and Nelms underwent a nightmarish ordeal, real "eye of newt, tongue of dog" stuff. From another, they're lucky it lasted only as long as it did. Severe cases of creeping eruption can last more than six months. The worst case on record in the United States is that of a New York man who sunbathed nude on a beach in Rio de Janeiro and came home with an infestation that took 55 weeks to get under control.

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