Golf outing, palm frond leads to flesh-eating disease, necrotizing fasciitis, for Florida man

NAPLES, Fla. - Chester Cocozza hasn't ventured back onto a golf course, even though his wound specialist said he is healing from flesh-eating disease, which could have meant losing his left leg — or death.

"I'm still cautious," said Cocozza, 76, of East Naples. "I haven't played since October. I only got out of the wheelchair after Christmas."

Cocozza was playing golf at a Naples course in October when he went after an errant ball and scraped the inside of his left ankle on a frond.

"I had a one-inch cut. It was one of the palm fronds with teeth on it," he said. "I thought it was a snake."

The cut, which he cleaned and bandaged at home, nevertheless led to horrific pain and an ultimate diagnosis of rare flesh-eating disease, which wrapped around his lower leg.  At its worst, the open wound went a quarter of an inch deep into his flesh.

Cocozza has a compromised immune system from heart, vascular and circulatory diseases, which is likely a factor to explain why he developed the flesh-eating infection; but he is on the mend after aggressive treatment, said Dr. Philip Organ, director of the Wound Care Center at Physicians Regional Medical Center at Collier Boulevard.

"He is probably two or three or four months away from completely healing," Organ said. "He no longer has an infection. His wound is shrinking in size."

Flesh-eating disease has captured the public's attention lately because of a 24-year-old Georgia woman, Aimee Copeland, who is battling for her life against it. She fell May 1 and cut her leg on a homemade zip line over a west Georgia river. Her left leg, right foot and both hands have been amputated.

With the patient's permission, Physicians Regional staff notified the Daily News on Monday that it had a local case.

The flesh-eating disease, called necrotizing fasciitis, starts with a wound, cut or bite that spreads through the fascia connective tissue below the skin's fatty tissue.

Organ said he has treated three other patients locally in the past few years, but the case of the Georgia woman has escalated awareness and fear.

"It's the aggressiveness of the bacteria or type of bacteria, plus the cleanliness of the wound itself," he said. "There's still no answer why (Cocozza) got this. (But) his ability to fight a wound is significantly reduced."

The Chicago retiree, who had an active social life at Forest Glen Golf & Country Club before the disease, is smiling again and is quick to praise the wound center staff for saving his leg and his life.

"When it gets completely healed, I will take (the staff) to the club for a nice dinner," he said.

What really helped Cocozza turn the corner was getting on pain management therapy and getting his other medical issues under control, Organ said. That enabled Organ to take Cocozza to the operating room to remove dead and infected tissue. The surgery was on Christmas Day."By the time I got him to the operating room, (the infection) was up the side of his calf," Organ said.

Before that, Cocozza hadn't known how serious and life-threatening the cut had become.

About two weeks after the cut on the golf course, it wasn't healing, so he went to a doctor for an unrelated matter and asked the doctor to take a look at it. The wound still was about an inch in size. The doctor referred him to a different wound center in Southwest Florida where he went for five weeks for treatment, but it didn't get better.

"In one month, it was six inches and it just kept getting bigger and bigger," Cocozza said.

Later he was referred to the wound center at Physicians Regional. That was mid-December and because of pain, he was confined to a wheelchair.

"His pain was constantly a 10, at a maximum, 24 hours a day," Organ said. "Pain is an important part of (this disease). It spreads along the planes of the tissue. Fundamentally he couldn't walk. He was not able to recline in bed."

Organ and other specialists had to get Cocozza's diabetes under control and he had to get off the blood thinner, Coumadin, for his heart disease. He suffers from congestive heart failure and has a defibrillator against sudden death.

When he was stable enough for surgery, Organ removed dead tissue about a quarter of an inch deep.

"I took out about a cupful; anything that was damaged had to be removed," Organ said.

Besides having the patient undergo daily hyperbaric oxygen therapy, Organ has used negative pressure wound therapy to help drain the wound and frequent debridements, or cleaning, the wound around the edges.

Cocozza arrives premedicated for twice-a-week debridements because of the pain, and that means he has to be driven to the wound center by a friend or his wife, Norine.

Throughout the worst of the illness, which included a six-day hospital stay after the surgery on Christmas, Cocozza said his wife, Norine, took care of him.

"The only time I was worried was if I would lose the leg," he said.

Cocozza gave up happy hour and dinners at the Forest Glen clubhouse when he was sicker.

He didn't want to have to explain over and over again how he felt.

"The first time I went, they stood up and applauded," he said. "That's embarrassing."

He has two pictures, one from May and the second from this month, that show the changes in his wound.

"I will copy the pictures and send them to all my good friends," he said.

On a serious note, he is grateful to the wound center and its staff: "I am thrilled with the facilities here and I brag about it. I tell everybody."

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