Do Not Enter

I had a great bit of fun last week on my last night in the A&E department. If there’s one thing I’ve learnt over the years of being admitted to hospital, it’s to use humour to get through difficult situations. This time, it really helped me through a potential emotional meltdown. I won out in the end too!

Those of you who’ve read this blog before, will know that I have a past history of MRSA infection and although I am clear of this horribly resistant bacteria, I’m still regularly stigmatised by it when in hospital. On this occasion, on admission to A&E, I was carefully questioned about my MRSA status and swabs were taken for analysis. A very kind ward manager found me a bed rather than a trolley and it was pushed into a little side room to ‘protect’ the other patients in case the swabs came back MRSA positive.

The side room had four walls, a bed, one chair and a door. No television, nothing. No en suite either which means that potentially infective patients use the same facilities as everyone else. As I was only a ’suspected’ carrier of MRSA, no restrictions were placed on my movements around a very busy A&E department. On the third night, I came out of the side room to find a new sign on the door… “Do not enter, please contact staff desk first”. My immediate reaction to this was “Help! My swabs must have come back positive”. I went back into the room and lay down on the bed in despair. That’s when the fury hit. “How dare they put up this sign without first informing me of a change in status!”. I was tired and in danger of losing my cool. Humour was called for. I sat up and carefully made a sign which proclaimed “Enter at own risk, I bite!” and using a sticking plaster from my handbag, I stuck it to outside of the door below the other sign. About 30 mins later, a night nurse stormed into the room and asked if I was responsible for the sign. I smiled back at her cheekily and replied,  “two can play at your game you know. Nobody consulted me about the restrictions placed so I didn’t consult you”.  I demanded to know if my MRSA status had changed. She replied that it hadn’t and admitted that they were playing safe. She then left the room clearly annoyed. I chuckled to myself in victory.

Shortly afterwards, she returned with a smile.  “You win”, she said.  We’ve taken both signs down now”.

The following morning, I left the room briefly and on my return, my bed and all my belongings had disappeared. Nobody could tell me what was going on but I was hopeful it might be a sign I was about to be transferred to a ward. Another patient was wheeled into the side room and my bed was eventually found in the middle of the department, lined up with trolleys all groaning with patients. Later that day, I was informed that I was to be moved to a ward and as you can imagine, this news came as a huge relief.

The swab reports came back negative on my fourth day in the hospital. Phew! If I’d tested positive, it would’ve compromised my treatment and also meant that I’d been infective to others in the hospital, for a full four days. Countries like Holland, which has brought MRSA contamination under control in the hospitals, must laugh so hard at the Irish interpretation of  infection control.

The Sky Is Falling In

I’ve been run over by a lorry. Well, perhaps not but it sure feels like it. I was dropped off at the hospital at some unearthly hour on Monday morning and my parting words were that I’d probably be ready for collection by elevenses. Having had many colonoscopies over the years, I knew what to expect, or so I thought. I should have known better. With a medical history like mine, nothing can be taken for granted. I live and learn.

On admission to the day ward,  I was shown to a curtained cubicle and asked to change into a theatre gown. I was duly weighed and labelled and then an overly cheerful vampire arrived to take my blood for a multitude of tests. Shortly afterwards, a nurse began the task of wading through my medical history. It was all fairly routine until we got to the “any previous surgery” question and then it was my turn to wear the pants! When we reached the “MRSA” part, the mood changed again. Despite my protests that all recent swabs have been clear, I was quickly moved to another part of the day unit while the nurse went off to phone infection control at the hospital where I’d been treated in isolation. On her return, I was granted clearance but not before two swabs had been taken for analysis. I was also informed that I would be moved to end of the theatre list as a precautionary measure.  It seems that no matter how hard you try, you can never be rid of the stigma of MRSA.

The scoping itself was no bother. I was told that I needed a gastroscopy as well as a colonoscopy as biopsies were required from both the upper and lower gastrointestinal tract. I was sedated shortly after arrival in theatre and knew no more until I woke up back in the day ward. I was told I was due to have a CT scan later in the day. Shortly after regaining consciousness, I developed severe pain in one side of my abdomen. My doctor explained that the pain was most likely caused by the gas used to inflate the intestines during the procedure and would resolve in time. I was given peppermint water to drink. Despite numerous trips to the bathroom, the pain continued unabated. I soon had to drink half a gallon of contrast solution in preparation for the scan. Once the scan was over, the nurses began to make noises about getting the house-doctor to review my pain. I knew I was at high risk of being admitted overnight so I declined further help and instead took two strong painkillers of my own. An hour or so later, I felt well enough to summon a lift home and a nurse accompanied me to the door of the hospital. The car journey was a nightmare. The pain got so bad at one stage, we had to stop the car so I could put my head between my legs to stop passing out. I lay across the back seat and groaned all the way home.

I had a really uncomfortable night with intense abdominal pain and as I was running a temperature by morning, I gingerly contacted the hospital for advice. The nurse in charge remembered me (how could anyone forget) from the previous day and handled the situation very competently. I was afraid I’d be told to come straight in to the hospital but no, she was happy to contact my specialist and then phoned me back to let me know the plan. The specialist contacted me directly having reviewed the scan, to confirm that there was no evidence of a bowel perforation following the scope. It appears that I’ve had an inflammatory reaction to the procedure and have been prescribed medication to ease the symptoms. So far, the results are encouraging  in that no structural abnormality has been identified but I have to wait another two weeks before the biopsy results and blood tests come back, to find out what’s caused the colitis over the last six weeks. It’s still thought to be antibiotic-associated.

Today I still feel totally buggered (in all senses) and the frequent dash to the loo continues but the sky is no longer falling in. I’m back at my blog (albeit in bed) and that is always a good sign. Comments and emails have been a great boost (thank you) and I apologise that my replies have not done them justice. The saga continues.

It’s a Bug’s Life

I had an infection in my head recently which recurred repeatedly despite treatment with antibiotics. An antibiotic called Suprax finally knocked the infection into submission. Unfortunately, it also knocked the lining of my large intestine into submission. Since finishing the antibiotic just over three weeks ago, I have suffered from intermittent colitis. For those who don’t know what the symptoms of colitis are, I’ll spare you the details. Suffice to say, I’ve spent a lot of time in the bathroom in the last few weeks.

Diarrhoea is a common side-effect of antibiotic treatment. When I consulted my GP with worsening symptoms a week after stopping the Suprax, he suspected that I may have developed an infection known as Clostridium difficile. This highly contagious bacterial infection of the bowel can occur following antibiotic treatment but laboratory tests last week ruled it out. Or so we thought.

I was given medication to quell the increasing nausea but over the Easter weekend, the pain in my intestines worsened and I was forced to seek medical help again. This time the hospital came back saying that the antibiotic-associated colitis must be urgently treated. There are two antibiotics used to treat C. Diff and associated infections, called Flagyl and Vancomycin.  I had a severe reaction to Flagyl many years ago and as I am considered high-risk because of a previous history of pseudomembranous colitis, I have been prescribed the drug of “last resort”, Vancomycin.

Vancomycin is normally given intravenously for the treatment of serious, life-threatening infections such as MRSA but it can also be used to treat colitis. When taken orally, the drug does not cross through the intestinal lining and remains in the intestines. As this is exactly where it’s needed at the moment, it is the drug of choice. Fingers crossed please!

In the meantime, tests results have suggested that chronic osteomyelitis is recurring in the bone around my eye. I am presently awaiting an appointment to return to the specialist unit in the UK, for assessment. The bugs go marching on.

Fighting MRSA

Hospital cleaners may one day use ionic liquids to clean wards. Scientists at the Queen’s University, Belfast have come up with a new way to kill off bacteria, including the hospital superbug MRSA. In this era of finite resources in our health service, any development which declares war on the superbugs, is to be welcomed.

Many types of bacteria, such as MRSA, exist in colonies that stick to the surfaces of materials. The colonies often form coatings, known as ‘biofilms’, that protect them from antiseptics, disinfectants, and antibiotics. Ionic liquids are up to 250 times better at killing ‘difficult to treat’ biofilms. Ionic liquids are essentially salts which are liquid at around room temperature. The liquid can be sprayed onto a surface where it will kill any existing bacteria. Significantly, the liquid doesn’t evaporate so once it is on a surface, no bacteria can withstand the treatment. It continues to destroy any bacteria that arrive subsequently provided the ionic liquid has not been wiped off. The liquid has low toxicity but has not yet been tested for use in human treatments.

The development was carried out by eight researchers from the Queen’s University Ionic Liquid Laboratories (QUILL) centre, supported by a grant from Invest NI. The research has been published in the journal, Green Chemistry. The Queen’s University group plans to introduce commercial products based on the technology, and is also studying possible uses with humans, eg as hand washes.

The prevalence of superbugs in Irish hospitals is thought to cost the HSE about €200 million a year. Poor cleaning, overcrowding, inadequate facilities, lack of infection control staff, poor management and a lack of accountability have all contributed to unacceptable levels of infection and death within our health system. Almost every year, we hear of a new breakthrough in the war against the superbugs. It remains to be seen if ionic liquids will become the weapon of choice.

Source:  The Irish Times and BBC News Channel (NI).

Marching On

Some people go off food when they’re unwell, others take to their beds. I think I’ve discovered a new phenomenon which has yet to be documented in any medical journal. Whenever I succumb to an infection in my head, I lose all appetite for blogging. To understand this, you have to realise that the blogsphere represents the outside world, a world which crumples at my feet each time illness strikes. The battle of the bugs continues…

St. Valentine’s Day marked the beginning of this particular episode. I woke with a severe headache and as the day wore on, pain and pressure started to build behind my right eye. My GP prescribed a tetracycline antibiotic, Doxycycline which has been the stalwart of my treatment in recent years. My symptoms subsided but a week later, my right eye began to close over with swelling and the pain and pressure returned in my head. On account of my previous history, I was seen urgently by a specialist. A swab ruled out MRSA but this new resistance to Doxycycline, was a definite cause for concern. I was started on a cephalosporin antibiotic, Keftid which seemed to work well so after two weeks the dose was reduced with the plan that I would continue on it long term to break the cycle of chronic infection. That plan fell apart when another bacterial superinfection took hold last week. The headaches gradually returned and my life ground to a halt once more. This time my GP prescribed a different cephalosporin antibiotic, Suprax which I’m happy to report, appears to be taking hold. The headaches have eased and so has the sense of despondency which accompanied them. Where to from here?  Who knows but for today anyhow,  I’m happy to have had my world open up again. On I march.

While on the subject of  nasty bugs, one of my regular readers kindly sent me details of a worrying outbreak of the Norovirus (Winter Vominting Bug) in Limerick. This highly infectious virus is usually found in our hospitals and can be potentially dangerous in the very young or old. The outbreak occurred on a college campus which has been temporarily closed while infection control measures are implemented by the HSE. See press release.

It seems that healthcare associated infections (HCAIs) are no longer confined to hospitals. The bugs are marching on.

Not MRSA again!

It’s been a strange week after all the excitement of the blog awards. I’ve got a swollen head but for all the wrong reasons. My right eye started to swell on Sunday evening shortly after my arrival home from Cork. I wasn’t unduly worried as this has happened before following a flight and anyway, I was covered by an antibiotic  following a recent infection in my head. By Monday the swelling hadn’t subsided and the pressure behind my eye was growing worse. I also felt rotten and had pus oozing down the back of my throat. On Tuesday morning, I sought urgent help and was lucky to get an appointment to see my surgeon at the hospital. He took a swab of the pus and did his best to reassure me but we both knew that with my previous history, there was real cause for concern. My biggest fear was a return of the superbug, MRSA but it would take another 48 hours before my destiny was known.

This afternoon I had some good news.  I have an MSSA (methicillin sensitive Staph aureus) infection, not it’s resistant relative, MRSA. This is really welcome news as it extends my treatment options. Had it been MRSA again, I might well have been faced with many weeks of IV treatment in hospital due to antibiotic resistance. I was started on a new antibiotic last Tuesday but worryingly, it hasn’t kicked-in as yet.  My eye remains swollen and my head still hurts but I’m feeling good.

You see, in the midst of all my woes, I received a lovely surprise from Absolute Vanilla and it’s really boosted my spirits. AV is a highly creative writer, a hugely talented photographer and a very popular blogger so I’m honoured to receive this award from her.

BEST BLOG THINKER AWARD

To Steph of  The Biopsy Report who has written tirelessly and courageously about illness and the Irish health system.

“This award acknowledges the values that every Blogger displays in their effort to transmit cultural, ethical, literary, and personal values with each message they write. Awards like this have been created with the intention of promoting community among Bloggers. It`s a way to show appreciation and gratitude for work that adds value to the Web.”

This beautifully timed award has worked far better than any antibiotic. I wear it with pride. Dankie! AV.

My Two Cents

The HSE is facing more than a €1 billion shortfall in it’s finances this year. Are we surprised? I don’t think so. The HSE is a faceless organisation wasting millions of taxpayer’s money every year to fund it’s quagmire of management levels and all at the expense of frontline healthcare. In a bid to address the budget deficit, the HSE is devising a major cost cutting plan to downsize our health service and you can be sure that it won’t be the HSE to suffer the consequences. While waiting to see a specialist yesterday in an over-crowded out-patient clinic at a large public hospital, I came up with some alternative ideas for the HSE to consider. Instead of solely concentrating on cost-cutting measures in our hospitals, I would suggest that the HSE would be well-advised to look at opportunities to complement our health service.

For starters, let’s look at the area of catering in our hospitals. The catering budget  must be astronomical and yet the wastage of food is phenomenal. Over the years, I’ve had many stays in hospital and I’ve often joked that this provides a saving on the family budget as my board and lodgings when in hospital, are fully covered by my health insurance. I pay dearly for health insurance and am fully entitled to this return. All medical card holders when admitted to hospital, are entitled to free care in our public health service. Those patients who are not entitled to a medical card and who do not hold private health insurance, pay a small daily levy for in-patient care. The point I’m trying to make here is that everyone regardless of income, has to budget for their daily nutritional expenses so why should the State or an insurance company be expected to pick up the tab for our food requirements when we’re in hospital? I guarantee you that if patients were  charged for their meals, the wastage of food in hospitals would be radically reduced.  Granted a lot of hospital food is inedible but again if patients were subsidising the cost, the standards would automatically improve.

Another aspect of hospital care which should be addressed, is the way out-patient clinics are managed in our public hospitals. There is no charge for appointments or investigations once a patient is in the public system and like all free services, it is open to abuse. By comparison, those who hold health insurance, must pay-as-they-go to be investigated within the private system, the difference being of course that they enjoy the benefit of shorter waiting times. While private health insurance is fairly comprehensive for in-patient expenses, out-patient expenses are generally poorly reimbursed. I would like to propose that all patients should be expected to pay something towards the cost of their appointments. I believe that a small charge for an out-patient appointment in a public hospital, is not unreasonable. It would not only help to offset budget deficits but would also reduce the number of appointments as public patients would take ownership of their healthcare just like privately insured patients are forced to do. This in turn would free-up non-consultant hospital doctors (NCHD) and reduce overtime expenses for the HSE.

I know I’ll be unpopular for these suggestions but I don’t care as I see it as the right way forward. At a time when the government is asking everyone to shoulder the economic difficulties, we can start by taking responsibility for our own health service. Every single person in this country should have equal, speedy, and efficient access to safe healthcare. At the moment, we have a 2-tier, apartheid health system where those that can afford health insurance, have the fastest access to health care.  Let’s use patient power to save our public health service and stop the degradation planned by the HSE.

And before anyone asks why as a privately insured patient, I was seen yesterday in a public out-patient clinic, let me explain. I had no choice in the matter as I required endoscopic investigation and this service is no longer available in private consulting rooms as a result of the boom in MRSA litigation. MRSA has little to recommend it but in this regard, it has worked in my favour. I got to enjoy an appointment with my own choice of consultant, in perfectly adequate facilities and at the expense of the State.  Point taken?

Thumbs Up!

The Biopsy Report received some unexpected news this morning.

It’s been shortlisted in the Best Specialist Blog category for the Irish Blog Awards. Yeah, I made it!

Having scanned the other 19 blogs which made it through the 1st round of judging in this category, I didn’t think my blog stood a chance against such talent.  Last year, when ‘biopsy’ got through to the final round,  I was convinced that it was probably because of a sympathy vote as I had spent much of my time writing about my experiences of battling MRSA. I made a positive decision after last year’s awards, to move on and instead feature  health topics of interest to everyone. My biggest problem now is finding enough time to cover all the topics I want to feature.  I love blogging, it just keeping getting better and better.  Thank you to all my faithful commenters and thank you especially to the judges who have deemed my blog fit for purpose.

Here’s my category… Best Specialist Blog – Sponsored by iQ Content

• xbox4nappyrash.blogspot.com
• biopsy.wordpress.com
• irisheconomy.ie
• thefamilyvoyage.blogspot.com
• irishtaxi.org

When I appealed to my technical advisers for help in designing a new logo to mark the occasion, I was told “do it yourself”.

So, with a little bit of help, here’s what I eventually produced…

I wear it with great pride. If you’re an IBA finalist and would like to use this logo, please feel free to help yourself.

Good luck to you all and I look forward to meeting-up in Cork.

Rapid MRSA Identification

Ireland is one of only three countries in Europe where antibiotic prescribing outside of hospitals, is on the rise. Antibiotics are frequently taken for viral colds and flu, when in fact they are only effective against bacterial infections. The more frequently antibiotics are used, the more resistant forms of bacteria become to them. The HSE recently launched a national education programme to change prescribing patterns in a bid to curb the use of antibiotics. The level of superbugs like MRSA and C. difficile in our hospitals would fall if antibiotic use was reduced. However, there’s another side to the superbug problem in our hospitals which I believe, has been overlooked.

When I developed serious symptoms of infection some years ago, it took three days for a nasal swab report to come through from the laboratory. In the meantime, I was treated in a ward shared with four other patients, two of whom were recovering from surgery. When my positive MRSA status emerged, I was quickly moved out of the ward and into isolation. You have to wonder at how many patients were cross-infected as a result of this delay in diagnosis. Multiply this by the huge number of MRSA cases passing through our hospitals each year and you get some idea of the scale of cross-infection.

The sad fact is that there is a Rapid MRSA test available which gives same-day results but it appears that the HSE restriction on budgets has ruled out it’s use in Irish hospitals. This decision is short-sighted as rapid MRSA identification can help hospitals make cost savings.

“The 3M BacLite Rapid MRSA test allows fast, affordable screening of patients for MRSA. It also has the potential to improve patient outcomes and decrease treatment costs. Rapidly identifying MRSA colonised patients provides hospitals with another tool to assist in pro-actively managing health care associated infections (HCAI).”

If I’d been rapidly screened, the result would have been available in hours, not days thereby enabling infection control teams to act quickly. My MRSA infection was hospital acquired (HCAI) following surgery and resulted in six weeks of expensive in-patient treatment. The infection recurred a year later and since then I have frequently been screened for MRSA as an out-patient. I always have to wait 2-3 days for a result and as far as I know, a similar delay still applies for in-patient screening.  I’d be very interested to hear if anyone knows different?

Everyone has a role to play in stopping hospital infection, patients and their families included.  However, if the HSE seriously wants to reduce MRSA figures and make reductions in their budgets, then it should address the problem of delayed identification. The rapid MRSA test would ultimately lead to huge cost savings for hospitals and more importantly, save lives.

Missing In Action

Have you noticed that our Minister for Health, Mary Harney has been ominously quiet of late? What’s going on at the Department of Health? Leadership has been notably absent despite the spiralling chaos in our health service.

This is what Senator Fitzgerald, Fine Gael Senate Leader and Spokesperson on Health, has to say about Harney’s silence…

Silence from Health Minister as co-location big idea looks increasingly shaky

“In 2005 Minister Mary Harney announced her co-location big idea claiming it would deliver 1,000 extra beds ‘in the fastest and most cost-effective way in the next five years.’ Almost four years later, not a single brick has been laid and not a single bed opened.”

“Recent media reports revealed that six Beacon head office staff have been let go and senior management have agreed to pay reviews. Considering this group has won three of the tenders for co-located hospitals, it’s financial condition is pivotal to the project. Together with the lack of bank credit for developers, the whole project has to look increasingly shaky. The HSE’s own service plan for 2009 notes that projects will only be progressed to completion phase ’subject to satisfactory banking arrangements’. The current crisis in banking does not bode well for the co-location project yet the Minister has had nothing to say on the subject.”

“Whilst co-location remains uncertain the reality for patients is that 500 existing public beds are currently closed and the Minister has rubberstamped a HSE plan to remove 600 more. The Minister is actively reducing capacity, not increasing it and the HSE are seeking a further €900 million in cutbacks for 2009. The result is her big idea is terrible news for patients meaning less isolation facilities to stop the spread of MRSA, more overcrowding in A&E, more cancelled operations and longer waiting lists.”

“The crisis in the health service continues unabated in the first two weeks of 2009 but the Minister for Health is missing in action. Many of the ongoing problems began long before the present financial crisis but while responsibility rests with this Government, leadership is absent. In December, the Minister signed off on the closure of 600 more acute beds and the slashing of €900 million from the health budget before riding off into the sunset. Instead she should be telling us how she intends to deliver long-promised reform, beginning with tackling waste and inefficiency in the back room rather than constantly hitting the front line and hurting patients.”

Well-said! Senator Fitzgerald. My thoughts exactly.

Source: Fine Gael website – Latest News 12/13 Jan ‘09

UPDATE: Sara Burke, journalist and health policy analyst, may be able to solve the Mystery of the Missing Minister for us. She believes that there is currently a stand-off going on between the HSE and the Minister. You can read Sara’s excellent analysis here.

Source:  Irish Times online 29/12/08.