Bob Harrington

Bob Harrington has always been an avid sportsman. He played varsity baseball in college, spent long summer afternoons teaching his sons to water-ski, and found his most enjoyable moments on the golf course. He never imagined anything slowing him down. "I was going to be like the guy you see on TV: 80 or 90 years old, skiing barefoot," he says.

In the mid-1980s, around his 50th birthday, Harrington began having intermittent attacks of sharp pain and swelling in his wrists, hips, knees, ankles. The symptoms would last for a couple of days, and then go away — but they always returned.

Concerned, Harrington sought help from his family physician. But just as a car seems to stop making troublesome noises when it is taken to the mechanic, his joint pain and swelling always diminished before the doctor could see him. "He just thought it was trauma, or maybe the early signs of a little arthritis," Harrington recalls.

Then, in May 1990, Harrington had a very severe attack. He left work, drove to the doctor's office, and found his physician walking down a hallway. "Look! Here! That's what I've been trying to tell you," Harrington said, pointing to his tremendously swollen right wrist. When the doctor's tests proved inconclusive, he was referred to a nearby rheumatologist.

"Working Diagnosis"

Further examinations, including blood and joint fluid tests, failed to turn up any answers, although a long list of possible disorders was ruled out, including lupus, scleroderma, Lyme disease, and gout. Harrington's new doctor, unable to reach a definite conclusion, pronounced a "working diagnosis" of idiopathic palindromic rheumatism: recurring, sharp episodes of joint pain and swelling that arise spontaneously, or without a known cause.

Harrington was frustrated. The attacks had caused joint damage that was beginning to interfere with his daily activities. He found it difficult and painful to walk, especially over uneven surfaces.

He was also determined to find a reason for the attacks. "I was keeping a daily log and writing down my symptoms. They were getting more frequent and more severe," he recalls.

Harrington's baffled doctors referred him to specialist after specialist. He came to appointments well prepared, armed with articles on new potential treatments, as well as a battery of questions.

"I kept pestering these people for answers, because I wasn't getting any. I mean, they were doing the best they could. All doctors are going to do for you what they can. But I think it got to the point where they didn't want to see me coming," he laughs.

Harrington was put on many different medications, mainly in an attempt to manage the pain and reduce some of the swelling. Doctors also prescribed an aggressive physical therapy program to help him remain functional.

Despite aggressive treatment, the disease continued to cause painful destruction of Harrington's joints and bones, and the attacks became more frequent. Much of his motion became restricted.

"I couldn't even roll over in bed without severe pain," he says. He had difficulty getting up. He had difficulty standing, fearing that his left hip might give way and he would fall. "And I would get very tired. All I'd do is sit down and fall asleep."

By 1996, the damage was so extensive, X-rays showed Harrington's left hip needed to be replaced.

Calling the Fire Department

Bob before his hip replacement and diagnosis (top) ... and one year later (bottom).

In November 1996, Harrington's cousin Jack came to visit from his home in Arizona. "He's our family caretaker," Harrington says fondly, "worrying, taking care of everyone."

For the previous two years, Jack had been encouraging his cousin to visit Mayo Clinic in Arizona. "He believed that Mayo's evaluations are so thorough, the trip would be worth it," says Harrington. "But I couldn't see traveling all the way from Pennsylvania to Arizona just for a doctor's appointment, so I put it off."

But the mysterious arthritic attacks had left Harrington's body ravaged. "I was barely able to move," he says. "I could walk only with a cane. It had a flat handle, and I would use it with both hands to shuffle along.

"So I asked Jack, 'Do you think I'm in a situation where it's too late to call the fire department, because all that's left is the doorknob?' And he said, 'Absolutely not.'"

Harrington and Jack both called Mayo Clinic to set the appointment. Jack, a physician, gave a detailed analysis of Harrington's symptoms. And in February 1997, Harrington boarded a plane to Arizona.

His brother John and sister-in-law Lee met him at the airport. "We were shocked when he got off the plane," they recall. "People had tried to prepare us — but he was just skin and bones."

In addition to his mobility and pain problems, Harrington had lost about 20 percent of his body weight — down to about 120 pounds. "I tried to eat as much as I could," he recalls, "but I couldn't gain anything."

Underlying Cause?

Harrington met with Leroy Griffing, M.D., of the Department of Rheumatology at Mayo Clinic in Arizona. Although Harrington's symptoms seemed to be consistent with rheumatoid arthritis, Dr. Griffing felt it important to keep an open mind about the underlying cause of the attacks, which could possibly be an undefined illness.

"It was apparent that his arthritis had some features unusual for rheumatoid arthritis after 12 years," says Dr. Griffing. So he discussed with Harrington the concept of several diseases that could result in arthritic symptoms. One was a rare disorder, Whipple's disease.

At the time, there were only about 800 cases of Whipple's disease worldwide. Whipple's is caused by a rare bacterial infection in the body, causing arthritis, diarrhea, weight loss and dementia later in life. The disease is most commonly known for its gastrointestinal symptoms — of which, weight loss aside, Harrington had none. But, says Dr. Griffing, "Rheumatic symptoms may precede gastrointestinal problems by many years."

"If it wasn't for Dr. Griffing, I doubt if I would be here today."

What's more, Whipple's disease is curable with antibiotics.

Because Harrington was planning to have a left-hip replacement upon his return home, Dr. Griffing advised him that a special study on the hip tissue removed during surgery might be a means of confirming if he had Whipple's disease. A special stain could be applied to the hip joint tissue, and it could be examined under a microscope to check for the bacterial infection.

That was all Harrington needed to hear. This test could provide the answers he'd been seeking for 12 years. He changed his surgical plans, arranging for the hip replacement to be done at Mayo Clinic in April 1997.

An Answer — At Last

The tissue analysis took time. In June 1997, Harrington headed back to Mayo Clinic for a follow-up with the orthopedic surgeon who'd managed his hip replacement. While he was in transit, Dr. Griffing called Harrington's wife Ina at home with good news. "We know what's wrong with him."

It was, indeed, Whipple's disease.

"The first question you ask is, 'How did I get it?'" Harrington says. "I've traveled to some of the worst areas of the world, and it made me wonder."

The entry point for the bacteria that causes Whipple's disease is unknown. But at last, he had his answer, and more importantly, there was a cure.

Harrington's rheumatoid arthritis medications were stopped immediately, and he was given a two-week intravenous antibiotic, administered at home, followed by a year of oral medication.

"I was feeling better and better," he says. "And soon my wife noticed, 'You don't sit down and fall asleep anymore.' And I got my weight back."

"The one thing I've learned is that you can't ever give up."

Although Harringtonb was cured, 12 years of joint destruction had taken its toll. His right hip needed replacing also, and he was left with some restricted movement in other joints.

Still, you can't keep a good man down. Sunny weather finds him back out on the golf course, perfecting his game. "The one thing I've learned is that you just can't ever give up," he says.

"Before, I really felt miserable. And now I feel wonderful. If it wasn't for Dr. Griffing, I doubt if I would be here today."