Doctors say Madonna looked ‘worn down’ and fatigued in days before infection

Madonna looked worn down, thin and exhausted in the days before she nearly died from a serious bacterial infection, doctors have told DailyMail.com.

The icon, 64, was rushed to the ICU and intubated after being found slumped on the floor of her New York City apartment on Saturday. Her family, who rushed to her bedside, were said to have been ‘preparing for the worst’ and ‘feared we may lose her’.

But the pop legend is now said to be back home and recovering, although it could take months before she is back at full strength.

It is still not clear what type of infection she had, but experts said that intense preparation for her tour and grueling workouts may have left her more susceptible to normally harmless infections.

After reviewing photos taken in the days before her illness, doctors said she looked ‘exhausted’ and appeared ‘thin’.

In the image of the star visiting a Karl Lagerfeld exhibition in New York City, she is shown with messy hair tied into plaits and wearing a cap and sunglasses to obscure her appearance.

Her skin also appears pale, which may be a sign of exhaustion said Dr Stuart Fischer, who has more than 40 years of medical experience. 

In another photo, posted to Instagram four days before her hospitalization with the caption ‘the calm before the storm’, she is shown lying on the floor while wearing a black jumpsuit and fishnet tights. 

Her hair and makeup are immaculate with nothing out of place, although she also appears ‘thin’ — said Dr Thomas Moore, an infectious diseases expert at the University of Kansas.

Dr Fischer, who is also a former emergency care doctor in New York City, told DailyMail.com after viewing the photos that she was clearly ‘exhausted’.

‘She looks exhausted,’ he said. 

‘Intense rehearsing and the stress associated with large-scale performances are undoubtedly risks for immunosuppression and unwanted health issues.

‘It’s the responsibility of the physician to point this out. Just because someone is an international celebrity doesn’t mean they’re invulnerable.’

Dr Thomas Moore, an infectious diseases expert at the University of Kansas, said about the images: ‘She doesn’t look much like the Madonna I am used to seeing.’

He told DailyMail.com: ‘She looks thin from the photos. She does not look well but it is all relevant.

‘She is such a dedicated performer that I wonder if she was not feeling well but then pushed herself too far.’

It has not been revealed what serious bacterial infection Madonna suffered, although rumors suggest it could be sepsis — a life-threatening reaction to an infection that sees the immune system attack the body.

Bacteria can enter through cuts, wounds and the digestive system, among other areas. Sepsis is triggered when the bacteria gets into the bloodstream.

Dr Fischer, who believes sepsis is the most likely explanation, said that the star should not have been discharged from the hospital so early.

The doctor, who has treated many celebrities, Oscar nominees and TV stars during his more than 40-year career, said doctors should have held their ground.

‘This discharge might put her life in jeopardy,’ he said.

‘No matter how hard [celebrities] push you, you don’t discharge them so quickly.

‘They may be a celebrity on the outside, but on the inside, everyone is the same and has the same organs.’

Last Saturday, Madonna was found unresponsive in her New York apartment and rushed to intensive care by emergency services where she was put on a ventilator.

As the news reached her family, they rushed to be by her bedside, and the management team held a crisis meeting.

With the star unable to make the decision herself, they had to choose to put off the much-anticipated tour.

They were concerned that the opening show of the 84-night extravaganza in Vancouver on July 15 was just three weeks away, which would not give her enough time to recover.

One source told DailyMail.com’s sister publication MailOnline: ‘The simple fact is that nobody knew at this point how it was all going to end. Madonna was very ill and in these situations, there are always fears for the worst.

‘Realizing that someone is in intensive care is scary, so there was a lot of worry and upset. These people had been her close friends for some time.

‘But they had to be fair on fans, and with the tour getting ever closer, they took the decision to postpone pretty much immediately. So plans were put in motion.’

Within 24 hours of deciding to postpone the tour, they were told that Madonna was now thankfully out of the woods and on the mend.

On Wednesday, they shared the news that Madonna had been hospitalized — but had since been discharged and was recovering at home. 

Her long-time manager Guy Oseary said in a post on Instagram: ‘Her health is improving, however, she is still under medical care. A full recovery is expected.

‘At this time we will need to pause all commitments, which includes the tour. We will share more details as soon as we have them, including a new start date for the tour and for rescheduled shows.’

It comes after doctors warned yesterday that her grueling workout regimes, fad diets and rehearsals for the tour could have put her vulnerable to infection.

Madonna is famous for exercising six days a week and was also reported to have been rehearsing six days a week since April in preparation for the tour.

Her family said that in recent weeks the star had behaved as though she was ‘invincible’ and had been ‘wearing herself thin’.

Bacterial infections are usually mild, with their symptoms clearing naturally or with the added punch of antibiotics.

Yet they can pose a much more serious threat to those with a weakened immune system.

Dr Moore warned: ‘Exhaustion, certainly when you are run down, can be an issue,’ he said. ‘It is generally true that if you are very run down and not getting enough rest your immune system can be challenged.’

Madonna’s exercise routine may have actually worked against her, he said.

‘A vigorous workout [or lifestyle] is not inherently dangerous as long as you take care of yourself,’ Dr Moore added.

‘But say your immune system is challenged [by a bacteria], if you have been working too hard this makes it more difficult for it to respond and insults arise.’

Exhaustion raises inflammation and stress levels in the body, which can suppress the number and function of immune cells making them less able to tackle infections.

Poor sleep also has an impact, leading to a decline in the number of immune cells in the body because it has less time to manufacture new ones.

Doctors also warned that the stress from preparing for the tour could have left her at higher risk of suffering a bacterial infection.  

On her most recent Madame X tour, Madonna performed 75 dates from September 2019 until March 2020 and put her ‘blood, sweat and tears’ into the performances.

Jose Extravaganza, a dancer who used to work with Madonna, told how the star had been exercising ‘a lot’ ahead of the tour.

He told DailyMail.com: ‘I think she’s exercising a lot. I mean, the rehearsals. Rehearsals are six days a week from what I hear, you know, like the only day off is Sunday.’

Mr Extravaganza also revealed how Madonna had planned to incorporate her love of boxing and fitness into her concerts by bringing martial arts into her upcoming shows, showing how important fitness is in the star’s life.

The star was previously forced to cancel more than a dozen shows during her 2019 and 2020 The Madame X Tour after injuring her coccyx on stage.

She wrote on Instagram at the time: ‘If only knees didn’t twist and cartilage didn’t tear and nothing hurt and tears never fell out of our eyes.

‘But alas they do and thank god for this important reminder that we are human.’

Madonna was left on crutches for ten months following the injury and operation she underwent and other ‘physical challenges’, she said at the time.

As the Covid pandemic put the final nail in her tour’s coffin, Madonna decided to undergo knee surgery in April 2020 followed by hip surgery in November 2020 as well as ‘regenerative treatment for missing cartilage’.