One dose or two?

I received my swine flu vaccination yesterday as I belong to the category of people considered more ‘at-risk’ from the virus. The vaccine was administered by the practice nurse at our local surgery and it caused minimum discomfort. However, it seems that the mixed messages emanating from the vaccination campaign, are causing major headaches.

On arrival at the surgery, the reception staff were clearly harassed from trying to deal with multiple enquiries about the vaccine. I was asked to fill out a consent form which requested my name, age, at-risk status and a PPSN (Personal Public Service Number). The information supplied with the form clearly stated that two doses of the vaccine would be required, at least three weeks apart. I was surprised to read of this as I had understood from the vaccination campaign, that one dose was sufficient for adults.

While having the injection, I asked the nurse to clarify the situation and she confirmed that a second dose would be required. She asked me to make a booking for it at the reception desk on the way out. When I consulted the receptionists, the story changed again. I was told that one dose may be sufficient for adults but that as studies are still under way to confirm this, I should check back with the surgery in a few weeks time. Having waited the required 15 minutes to ensure that no adverse reaction occurred to the vaccine, I left the surgery feeling decidely sorry for the staff caught up in this evolving campaign.

On checking out the HSE’s website (Frequently asked questions for Healthcare Professionals – last updated 28th October 2009), it read…

“Current recommendation is two doses of pandemic vaccine are required at least three weeks apart. Preliminary studies indicate that one dose might be enough to give full protection for those aged 13 and over but this has not yet been confirmed”.

I recommend that people consult the HSE website regularly for the latest updates on the vaccination programme rather than bombarding the busy GP surgeries with phonecalls.

For information, visit www.swineflu.ie or Freephone 1800 94 11 00

Today, I’ve experienced some of the common side effects of the vaccine and they’ve served as a welcome reminder of the need to be protected from the swine flu. Any adverse reactions to the vaccine should be reported to the Irish Medicines Board online.

Making History

Last June, I was admitted to a specialist unit of an NHS hospital for surgery on my head. I was no stranger to the place having had a major operation there two years previously. Revision surgery was now required as further complications had developed. On this occasion, I was under the care of  a surgeon who specializes in image-guided endoscopic surgery. I was about to undergo an operation which required high precision and carried a significant risk of accidental damage to critical organs. I was also about to make medical history.

I was admitted to the hospital the day before the operation, to be assessed for the complex surgery which lay ahead. My first port of call was to a photographic studio in the basement of the hospital, to have my head photographed from every angle. This was because of my stunning good looks to record the cosmetic defect in my facial profile, due to previous surgery. Next, it was off to the nuclear medicine department to have my head scanned under the supervision of the surgeon. These scans were subsequently used for navigational purposes throughout the technically demanding surgery.

When all the preparations were complete, it was time for a consultation with the surgeon and his team. It was at this stage I learnt that plans were afoot to record my operation for teaching purposes. My history of multiple sinus surgeries* provided the surgical team with an unusual challenge and the operation now planned, had the potential to become a valuable training resource. I had absolutely no hesitation in granting them permission to make me a ‘film star’ for a day. Anything that helps to lessen the risks associated with complex surgery and ultimately, increases patient safety, is to be encouraged.

*For those with an interest in Otorhinolaryngology…

My ENT surgical history includes : A bilateral antrostomy; a Caldwell Luc procedure; multiple endoscopic nasal surgeries; 5 external frontoethmoidectomies; a Riedel’s procedure and a modified endoscopic Lothrop procedure (Draf 111).

My ENT medical history includes recurrent sinus infections, chronic frontal sinus disease, MRSA infection, orbital cellulitis and osteomyelitis.

I also have an inherited connective tissue disorder called Ehlers-Danlos syndrome (EDS) which has added to the complications over the years.

Well, as you can see, I’ve lived to tell the tale. While the signs are encouraging, it’s still too early to know if the latest operation will prove successful in the long run. After what seems like a lifetime of surgery, I feel I’ve earned a place in medical history.

Any guesses what label I’ll be given?

Original of the Species

I recently wrote about a crisis point when I came close to losing hope of winning the battle against a serious infection. I’d been re-admitted to hospital having developed complications at home following specialised surgery in the UK. It was a tough time but I never expected the outcome that followed…

Osteomyelitis, an infection of bone, was raging inside my skull and was failing to respond to a combination of IV antibiotics. I was considered at high risk of developing cavernous sinus thrombosis, meningitis, intra-cranial infection or septicaemia, all potentially fatal conditions. My eyesight was also under serious threat. When my condition deteriorated further, it was decided that I should be taken to the operating theatre to have multiple bone biopsies taken for analysis. On waking from the anaesthetic, I was informed that osteomyelitis had been confirmed and that a new regime of IV antibiotics would be commenced. Within hours of starting the new treatment, I’d turned the corner and was out of danger.

When the surgical team arrived at my bedside the following morning, they were beaming from ear to ear. The senior registrar turned to me and said, “You do realise that you’re famous, don’t you”? I looked at him in puzzlement. He told me that when my head was examined in theatre, it had caused enormous excitement. The pioneering surgery carried out in the UK, had proved fascinating to the Irish surgeons. The internal anatomy of my skull has been so radically altered, I’ve become an original of the species. It seems I’m now regarded as a rare medical specimen. Thankfully, an alive one!

Next week, I’ll tell you about how I became a ‘film star’ for a day.

Saving Your Bacon

At long last, the swine flu vaccine has arrived in Ireland. The vaccine and it’s administration, are free of charge for everyone. The distribution of the vaccine to GP surgeries begins today and the vaccination programme will start on November 2nd. It’s not a minute too soon. Rates of infection with H1N1 virus have been increasing week by week. So far, four people have died from the virus in Ireland, of which three had an underlying health condition. The arrival of the new vaccine brings a whole new meaning to saving one’s bacon!

At-risk people will be vaccinated first. Pregnant women, patients with underlying health problems, people who live with someone with a compromised immune system and healthcare workers, will be the first to be offered the vaccine. People aged 65 and over seem to have some immunity to swine flu so they are not in the most at-risk group and will be vaccinated at a later stage.

Most people will need only one dose of the vaccine although children will be given two. Test results of the swine flu vaccine have indicated that children under 10 are likely to need two shots to be fully protected.

The HSE has a 24 hr Flu Information Line Freephone 1800 94 11 00 for up to date recorded information on swine flu or you can link to swineflu.ie

The H1N1 virus is highly contagious and spreads quickly from person to person through tiny droplets in coughs and sneezes.

Here’s something nicer to pass around instead…

A Smile

Smiling is infectious, you catch it like the flu.

When someone smiled at me today, I started smiling too.

I walked around the corner and someone saw me grin.

When he smiled, I realised, I had passed it on to him.

I thought about my smile and then realised it’s worth.

A single smile like mine could travel round the earth.

So if you feel a smile begin, don’t leave it undetected

Start an epidemic and get the world infected!

A Bitter Pill

I don’t know about you but I’m finding the expenses revelations very hard to swallow. At a time when the country is in financial crisis, the idea that somebody who’s on more money than the Taoiseach, should get a bonus is highly questionable but it’s all the more outrageous when you consider the current state of the health service. Add to this, the revelations about expenses accrued by Mary Harney as Minister for Health and it becomes a bitter pill to swallow…

The Sunday Tribune has revealed that Mary Harney ran up the highest departmental bill in terms of ministerial costs and expenses. Granted our Minister for Health is a busy woman but you have to question why it was necessary for her to travel by the ‘€7,000-an-hour’ Government jet for her business trips abroad.

“Health Minister Mary Harney and her husband Brian Geoghegan ran up a bill of nearly €65,000 on hotels, limousine hire and accommodation in the space of just three years. That figure does not include the massive bill for the Government jet, which Harney used on almost every occasion she travelled abroad and which cost the taxpayer more than €735,000.” The Sunday Tribune, October 2009

Next, we are told that the HSE board has awarded it’s CEO Prof Brendan Drumm, a bonus payment of €70,000, based on his performance in 2007. This bonus is being awarded at a time when the HSE is making plans to reduce spending on the health service by up to €1.2 billion!

Here’s what Dr James Reilly, opposition Health spokesperson, had to say on the subject…

Morning Ireland – RTE News

My thanks to The Sunday Tribune, to Dr James Reilly and RTE radio, for exposing this outrageous carry on.

Be Aware, Be Active

Did you know that regular physical exercise is important for your breast health? Inactivity is estimated to cause 10-16 percent of breast cancers. Engaging in moderate exercise for at least 30-60 minutes every day can help your future breast health.

Breast Health Day on 15 October 2009 aims to raise awareness of the benefits of physical activity on breast health and to encourage women to choose a more active lifestyle.

Europa Donna Ireland (EDI, the Irish Breast Cancer Campaign, is urging women throughout Ireland to do something active to mark the day. Events are taking place around the country and you are invited to come along and join in the fun.

Please see the EDI website for more details.  

This is an awareness-raising, not a fund-raising day!

Information source and graphic: Europa Donna Ireland and JBBC blog.

Where There’s Hope…

I’ve been in hibernation. I was battle weary after the long illness last summer and the medication which was prescribed to dampen down the neuropathic pain in my head, had the side-effect of dampening me down as well. For the past month, I’ve been sleeping like a baby at night and feeling drowsy by day. The good news is that the severe headaches have now gone and I’m beginning to feel energised again. There’s life in this old dog yet!

I’d like to thank those blogging friends who continued to send words of encouragement even after I’d disappeared off the radar. If there’s one thing I’ve learnt out of all of this, it’s never to give up hope.

The enforced rest has enabled me to rediscover the joy of reading books. Thanks to Lily’s recent review, I’m busily re-reading an exceptional book written by Lia Mills, an award winning novelist. Lia was diagnosed with advanced cancer of the mouth in 2006. She had to undergo radical surgery and aggressive radiotherapy in order to survive. Her book ‘in your face‘ is an account of that experience.

Lia talks about hope in a way that really resonates with me. She says “Hope is something you can’t always feel but I think you can lead yourself towards it even when you don’t feel it, by taking everything as it comes, minute by minute, and by appreciating small changes as they happen”.

While undergoing treatment in hospital last summer, my condition suddenly took an unexpected turn for the worse. The flurry of activity around my bed and the look of concern on the medics’ faces, was enough to confirm my worst fears. The infection was winning the battle and I sensed that my life was in real danger. Despair began to set in. The hospital chaplain happened to visit when I was at my lowest ebb and the poor guy got the full brunt of my despair. The infection was visibly worsening around my eyes so he went off in search of a fan to see if it would help to ease the discomfort. That fan was to become my beacon of hope throughout the difficult night that followed. It really was a breath of fresh air and bit by bit, I came to realise that I had the strength to survive. Hope had been restored.

Where there’s hope, there’s life. Check this out!

I highly recommend Lia’s book to anyone who wants to understand illness and recovery, fear and hope and love.

‘in your face’ is published by Penguin, Ireland (€19.99).

Riding Through The Woods

Thanks folks for all your kind wishes last week for my trip back to see the surgeon. I’m sorry to take so long to report back on the outcome. While the day in Nottingham went smoothly, I was totally exhausted following it. With the arrival of our late summer, Connemara beckoned and I joyfully obeyed the call. I’m now suitably revived.

Since finishing all the treatment for the osteomyelits, I’ve been having recurring headaches along with episodes of acute bone pain. Despite taking strong pain killers plus an anti-inflammatory medication, the headaches have continued intermittently leaving me to wonder if the bone infection had really cleared. A recent blood test did little to allay this fear as it confirmed that the inflammatory marker (CRP), is markedly raised again.

(Image credit: Display at entrance to Nottingham Castle – photo taken on my mobile phone)

In Nottingham, the surgeon carried out an endoscopic examination of my head and and the report back was encouraging. The bone which was exposed by the surgery, has healed well despite the set-backs. However, the surgeon agreed that the abnormal blood test was a cause for concern. I had another blood test before leaving the hospital and a radioisotope bone scan has been requested, to check for any residual infection in the bone.

Due to the nature of my ongoing symptoms, the surgeon has advised that neuropathic pain is the most likely cause. This type of pain occurs as a result of damage to nerves following surgery/bone infections. Neuropathic pain is difficult to treat but can be eased by ‘tricyclic’ antidepressant medicines, by an action that is separate to their action on depression. Treatment is usually long term.

“Neuropathic pain (‘neuralgia’) is a pain that comes from problems with signals from the nerves. There are various causes. It is different to the common type of pain that is due to an injury, burn, pressure, etc. Traditional painkillers such as paracetamol, anti-inflammatories, codeine and morphine may help, but often do not help very much. However, neuropathic pain is often eased by antidepressant medicines – by an action that is separate to their action on depression. It is thought that they work by interfering with the way nerve impulses are transmitted. There are several tricyclic antidepressants, but amitriptyline is the one most commonly used for neuralgic pain. In many cases the pain is stopped, or greatly eased, by amitriptyline”.

I was sent home with a prescription for a low dose of amitriptyline. The side effect of this medication is increasing drowsiness so I’ve been advised to take it only at night and to persevere with it as it can take several weeks to get maximum benefit. If, after 3 weeks,  I’ve not experienced any relief from the pain, I’ve been instructed to double the dosage every week until benefit is achieved. So… if my blogging becomes more sporadic with words slurred, you’ll know why!

The surgeon’s parting words to me were “you’re not out of the woods yet but there is light at the end of the tunnel”. That sums it up nicely.

(Information Source: WebMD and Patient UK)

While I’m Away…

I’m off to Nottingham tomorrow for another surgical review.  I last saw the surgeon in June, just 12 days after the 4-hour operation on my head. He was pleased with my progress at that stage and asked me to return again a month later. I never got to that appointment thanks to the development of an unforeseen complication. Before consenting to surgery, I was warned of the dangers of the operation. Osteomyelitis was not on that list but it sure is now! I hope to have more news to share with you when I get back.

I have something for you to ponder on while I’m away. While undergoing prolonged treatment in hospital for the osteomyelitis, it was very noticeable how few Irish nurses were working in the system. It was a large teaching hospital with the usual cohort of trainee nurses on the wards but there were very few fully trained Irish nurses to be seen. The majority of the nurses were recruited from overseas, from the Philippines and India. These nurses were highly trained and  professional except in one regard. While working on the wards, they had a tendency to speak to one another in their native tongue. As a patient, I found this disconcerting as it excluded me from discussions concerning my own care. I wondered if there was a hospital policy requiring staff to speak in English only, while on duty. Do you have any views on this?

A-Z of being a patient

My good friend, Grannymar has been practising her ABC’s on her blog and set her readers a challenge. She said, “Pick not one word for each letter, but three that sit well together”.

I’ve had fun mulling over this task all day. In keeping with the theme of this blog, ‘a patient’s perspective on life‘, I decided to base the alphabet on my summer spent in hospital. Here’s what I came up with…

A-Z of being a patient

A’s for A&E, antibiotics and analgesia.

B is the bacteria, blood pressure and breathing.

C’s for cellulitis, colitis and complications.

D is the diagnosis, doctor and dietician.

E’s for ENT, ECG and ESR.

F is the flare-up, fluids and fasting.

G’s for gargle, gastric and gut.

H is the hospital, hygiene and hypertension.

I’s for investigations, IV’s and injections.

J is the junior doctors, joints (sore) and jelly (and ice-cream).

K’s for kidneys, ketosis and being kind.

L is the light-headed, laughter and longing.

M’s for microbiology, medication and meals.

N is the nurse, needles and nausea.

O’s for osteomyelitis, oxygen and operation (and ouch!).

P is the pulse, PICC line and pain.

Q’s for questions, queasy and quiet.

R is the respiration, rest and results.

S’s for scans (CT), syringes and samples.

T is the temperature, tachycardia and tired.

U’s for ulcer, uncomfortable and unwell.

V is the veins, vision and vital (signs).

W’s for ward, wheelchair and WC.

X is the x-ray, Xysal (antihistamine) and Xanax (for anxiety).

Y’s for yawning, feeling yucky and YES ( in response to) “ready for home”?

Z is the Zoton (antacid), Zestril (ACE inhibitor) and Zimmer frame (not needed yet).

Please Missus, I did my best. Do I pass the test?