The Biopsy

November 29, 2007

So the saga continues with an infected lesion on the back of my hand. The infection has responded well to a heavy dose of antibiotics over the past week and the lesion has reduced to a fraction of it’s original size. However the centre of it remains incredibly painful to touch, as I discovered to my cost when I caught my hand briefly on the edge of a cardboard box. Ouch!

Yesterday I attended a day centre at the hospital to have the lesion biopsied. I was somewhat surprised to have a repeat swab taken from the lesion and another one from my nose before a punch biopsy was performed on my hand. Local anaesthetic was first injected around the lesion to numb the area and then under sterile conditions, a 5mm diameter chunk of tissue was removed for analysis. I felt no pain whatsoever though the wound spurted copious amounts of blood and the surgeon had his work cut out trying to stem the flow. Two stitches were inserted to close the wound and then a pressure bandage was applied to ensure that no further bleeding occurred. With my history of having the connective tissue disorder, Ehlers-Danlos syndrome (EDS), extra caution is needed following surgery due to skin fragility and poor wound healing. Unfortunately, my hands do indeed suffer from delayed healing and so special care is required to prevent infection. I was sent home with antiseptic cream, spare dressings and instructions to return in a week’s time to have the stitches removed, and to receive the biopsy report. I was also given a prescription for a further week’s supply of the oral antibiotic (Flucloxacillin) plus an antibiotic ointment (Bactroban) to be applied to the inside of my nose. My legacy of previous MRSA infection seems to follow me everywhere though I suppose I should be grateful that every precaution is taken to ensure there is no return of this unwelcome superbug.

As procedures go, yesterday was plain sailing. I had a somewhat disturbed night due to discomfort in my hand but it’s no big deal. The best bit of all yesterday was that I received strict instructions to avoid doing washing-up. My only regret is that I didn’t succeed in getting this in writing 😉

The Biopsy Report now awaits the biopsy report.

The Mary Harney Debate

November 27, 2007

Today is the day that the Dáil debates a motion of ‘no confidence’ in our Minister for Health for her handling of the health service. They have it all wrong – it’s not about Mary Harney – what we need is a proper debate on the way forward for our health service.

Whatever way you look at it, the Irish health service is in melt-down. For far too long the “ah, sure it’ll do” mentality has been allowed to continue and now the cracks have really begun to show. Every week another story emerges about a failing in the system and it’s likely that what we’ve seen is only the tip of the iceberg. How many more lives are to be lost before the penny drops that our health service is letting us down? There is no doubt that heads should roll for mistakes made but this is not just about accountability – the whole system is in disarray and we need agreement on a plan to put it right.

We’ve all heard about the opposition faced by the Dept of Health and the HSE in their efforts to sort out the problems in the health service. Mary Harney was a brave (many might say foolish) woman to take on the job – she’s proved her worth in politics over the years and let’s face it, as long as Fianna Fáil remain in power we don’t have much choice. However if progress is to be made, we need to take the politics out of health. It’s patently clear that as long as there are vested interests in the running of the service, it doesn’t stand a chance. It appears that the majority of people in this country are happy to sit back and allow politics to determine the future of our health service. Almost everyone is in agreement that a 2-tier health system is not the way forward and yet we continue to allow our government to push forward a strategy of co-located hospitals with an emphasis on private healthcare insurance. Studies of successful healthcare practices in other countries have clearly demonstrated that a single-tier healthcare system based on a universal health insurance scheme is the way forward. This issue is crying out for debate and yet the opposition’s only priority appears to be one of accountability.

The health service holds all our lives in it’s hands. Irish patients deserve equity of care and a better healthcare service. The time has come for Irish people to wake-up to the reality of what’s happening before it’s too late. The late Susie Long, a cancer patient, did her utmost to bring about change by highlighting the inequalities in the service. Sadly, the system failed Susie but we owe it to her memory to unite to become a force for change and to continue her fight for proper healthcare reform. It’s become abundantly clear that we cannot rely on our government to do this for us.

An Eyebrow Raised

November 23, 2007

It’s been a strange week. It all started with a hand infection that needed urgent medical attention. I finally got to see a specialist yesterday and the day ended with the surprise offer of a new eyebrow.

I’ve had a small lesion on the back of my right hand for some time but as it wasn’t bothersome, I was not concerned to do anything about it. With my history of complex medical problems it didn’t quite figure as a medical priority. Anyway, when I eventually showed the lesion to my GP, he was puzzled by it but concluded that it was most likely a basal cell carcinoma (BCC) and advised that it would require surgical removal. He reassured me that a BCC is very treatable – it is the most common form of skin cancer. I was then told that there is a waiting list of over two years for an appointment in the public system and was advised to consider seeing a specialist privately. Three months later and with a lesion that was by now troublesome, I finally took action and picked up the phone to book a private appointment. This was in early November and the first appointment available was next January so having got myself into this pickle, I now had no choice but to wait my turn.

Last Sunday the lesion decided to take the matter into it’s own hands. I awoke with a throbbing, swollen hand. Over a period of 24 hours the lesion had changed radically from an innocent cyst-like structure to an angry looking sore which oozed pus. My immediate reaction was “oh no! Please, not MRSA again!”. I’ve fought a hard battle over the past two years to overcome a recurring MRSA infection in my skull and while I’m now supposedly free of the superbug, it’s hard not to think the worst whenever trouble strikes. Being a Sunday, I went straight to A&E to get checked out as I’ve been instructed not to delay in seeking treatment for any infections. Luckily it was a quiet day and I was seen promptly. I was told that my hand needed urgent specialist advice and as I already had a private appointment booked, this was the route I now had to follow. Sadly, our 2-tier health system is still alive and well. A swab was taken from the lesion for analysis and I was sent home with an antibiotic cream to await, a now urgent appointment with a specialist. I got to see the surgeon privately yesterday. The first bit of news I received was that the swab confirmed a significant infection but he assured me that it was not MRSA. Hurray, hurray, hurray! I was told that the lesion was ‘unusual’ and that it would definitely require a biopsy but not before an appropriate antibiotic had tackled the infection. I left the swish consulting room with an appointment arranged for day surgery next week plus a prescription for a course of heavy duty antibiotics. I felt well-satisfied with the advice received.

On exiting the building I decided on the spur of the moment to pay a visit to another specialist in the same hospital. I go back a long way with this top Head & Neck surgeon having been under his care for almost two decades for treatment of recurrent sinus infections. He has operated on my head many times performing surgery that ranged from minor procedures to fairly complex operations. Despite going through many set-backs along the way, I never lost respect for this surgeon. We shared a similar sense of humour and this really helped me through those difficult times. We came to know each other well and when I was referred on to another specialist some years ago, I was sorry to have to say goodbye to him. He has changed speciality since those days and now specialises in surgical hair transplantation. Yesterday, I decided to pay him an impromptu visit to pass on my best wishes. His receptionist was somewhat surprised by my intentions but she obligingly agreed to let him know that I was in the waiting room. Within minutes he appeared in full theatre garb and warmly welcomed me into his consulting room. It was strange meeting a doctor whom I’d consulted for many years and yet here we were meeting like old friends. He was genuinely delighted to see me again and wanted to know every detail of my medical history since I’d last seen him. We agonised together over my battle with MRSA and of course, he was fascinated by the complex surgery I’d had in the UK earlier this year. He studied the resultant cosmetic defect in my forehead and greatly approved of the neat scarring across the top of my head. He then recommended that I should seriously consider returning to the surgeon in the UK in about three year’s time, to have a final re-constructive operation carried out on my forehead. I really hadn’t expected this sort of advice but I was chuffed to find that he still had an interest in my case. What came next really caught me by surprise. He offered to re-construct my eyebrow, after the bony re-construction has been completed and not only that, he offered to do it free of charge – this sort of surgery costs mega bucks! I was bowled over by his kind gesture of help. My right eyebrow has multiple scars from repeat surgery near my eye but it’s not that hugely noticeable. It was at this point that I learnt from my old buddy that he is specialising in work to restore the faces and scalps of people who have suffered horrendous head injuries from bomb blasts. I was well-placed to benefit from his new expertise in this field. I thanked him for his very kind offer and requested that he put it on-hold for the time being. Frankly, I’ve had enough surgery already and as long as I have the choice, I won’t be volunteering for any more. We parted on the best of terms.

When I set out yesterday to get my hand sorted I really didn’t expect to end up discussing my head as well. My medical journey has been a long, hard road but yesterday was a real turn-up for the books – the tide has turned in my favour at last. Next week I’ve another small hurdle to cross but in the meantime all I have to do is to keep popping the pills. As I drove home yesterday, I raised both eyebrows to the world and thanked my lucky stars that the day had gone so well.

You can kiss MRSA goodbye

November 16, 2007

Some exciting news has emerged today in Ireland. Research has found that a wild flower growing in West Cork could hold the key to wiping out the deadly superbug MRSA (methicillin-resistant Staphyloccus aureus). A post-graduate student, at the Cork Institute of Technology (CIT) has identified a wild flower which is effective against the antibiotic-resistant superbug. Inula helenium (elecampane) is a tall plant which grows wild and blossums in late summer. It is indigenous to Europe and Asia and is now grown in the USA as well. The dried roots and rhizomes (branching part of the the root) are collected and used in herbal preparations to treat respiratory and digestive problems.

The 2-year research project in Cork has shown that extracts from the plant were 100% effective against MRSA as well as a broad spectrum of other bacteria. It now looks as if this plant has the potential to become a useful weapon in the fight against MRSA. It’s fantastic to see Ireland lead the way in research which in time, could help to save lives worldwide. This is good news indeed and holds great hope for the future.

MRSA – who’s to blame?

November 15, 2007

We live in a world today where sadly the culture is one of blame and shame. When things go wrong medically, we are very quick to point the finger of blame in an effort to console ourselves. I would suggest that the time has come to look at the bigger picture and to take more responsibility for our own health.

Whatever way you look at it, the Irish health service is in disarray. The present debacle in cancer services in this country has come about through years of political mismanagement. Despite massive government spending on the public health service, there is still a serious shortage of beds causing back-up throughout the system and the waiting lists for treatment are a joke – except that it’s not a bit funny if you happen to be waiting on a list. The consultants are unhappy with the new contract on offer from the Department for Health and while the negotiations drag on year after year, there’s still a serious shortage of consultant doctors throughout the country. The NCHD’s, junior doctors, nurses, paramedical staff and ancillary staff are not exactly happy with their lot. The infrastructure of most public hospitals is crying out for re-investment and in many places equipment is lacking or out-dated. Almost every week another story hits the news headlines about the latest failing in the system. This week it emerged that a leading Dublin teaching hospital, Beaumont Hospital, had inadequate facilities for the control and prevention of MRSA as well as for other infections. The report raised serious questions about the safety of patients due to inadequate isolation facilities and a cramped, out-dated intensive care unit. This hospital is the national centre for neurosurgery and kidney transplantation and yet it’s unable to achieve adequate infection control due to lack of resources. Yesterday it was reported that no Irish hospital had scored highly in the first national hygiene audit carried out by HIQA (Health Information and Quality Authority). It concluded that most hospitals should and could do better. This is appalling news at a time when hospital-acquired infections and especially MRSA are causing so much concern. I think what really galls me the most is the fact that our Minister for Health, Mary Harney continues to insist that a 2-tier health system is the way forward and yet she freely admits that she and HIQA have little or no control over private hospitals. Who might I ask will be responsible for them?

When I was first diagnosed with an MRSA infection following surgery some years ago, the source of the infection was not an issue for me. All that mattered was that I got the right treatment and got better. At a later stage in my treatment, I discovered purely by accident that I’d shared a room post-operatively with an MRSA infected patient. Initially, I felt angry about this as I knew it should not have happened but in time I realised that my anger was misplaced. I had no way of proving the source of the infection – MRSA is everywhere and I could have picked up the bacteria from numerous sources within the hospital. I may indeed have already been colonised with MRSA (from previous hospital admissions) when admitted to the hospital – who knows? Many people are carriers without realising it as it does not affect them as long as they remain healthy. Hospitals are reluctant to introduce mandatory pre-admission screening for MRSA. They cite lack of funding and inadequate pathology services as the reason but I suspect that fear of litigation is more likely the cause. My infection had serious consequences for my health but I was lucky, I survived it – many don’t. I had no desire to play the blame game because I knew that it would be a futile course to follow. It was more important to put all my energy into getting better, and staying better.

Patients face many challenges in today’s crowded and strained medical system but there is a great deal that patients can do to protect themselves. Hospital-acquired infections are not new, they’ve been around for as long as hospitals but the amount of antibiotic resistance has changed over the past few years. The overuse of antibiotics in the general community for viral infections like the common cold is also contributing to the MRSA problem and this is evidenced by the recent increase in community-acquired infections (CA-MRSA). Poor hygiene standards in hospitals are only part of the problem. Hospitals are breeding grounds for resistant bacteria due to heavy use of antibiotics and the over-100 per cent bed occupancy rates. Hand-washing amongst staff is extremely important to stop the spread of superbugs and there is a continuous need to improve preventative measures. Any strategy to minimise healthcare associated infections (HCAI) must include the education of all healthcare workers on what is appropriate practice, as well as the education of patients, visitors and the public. Patient’s visitors have a part to play in improving infection control – they should keep hospital visits to a minimum and always wash their hands before and after visiting a patient. If you are unhappy with any aspect of medical care received, you don’t have to put-up with it – make your feelings known. Ask questions – don’t wait to be told. This is the best way to bring about change for the benefit of all. It’s also important to remember that people do have good experiences in hospital as well and hospital staff welcome acknowledgement of this. Personally, I will never go into hospital again for elective treatment without ensuring that I have first tested clear of MRSA, both for my own safety and for the safety of others. The time has come for Irish people to stand up for themselves. We need to let the powers that be in this country know what we want from health care delivery. Politics, both medical and party driven, have influenced decision-making and the patient has been forgotten. The health service holds all our lives in it’s hands. We owe it to ourselves to be informed so that we will be in the best position to manage our own health care.

Does She Take Sugar?

November 6, 2007

I had occasion earlier this year to use a wheelchair while travelling home by air. I was en route back to Ireland following a stay in a UK hospital for complex surgery on my skull. I had been discharged from the hospital earlier in the day and felt totally elated to be on my way home at last. However, the journey proved to be more of a challenge than anticipated and I ended up needing a wheelchair. The experience was a real eye-opener.

I’d walked happily out of the hospital to the car with my husband but by the time we reached the airport, I had lost all enthusiasm for the journey home. I knew I was in trouble. On getting out of the car I was overwhelmed by nausea and dizziness and could feel the blood draining from my extremities. I felt so ill on entering the airport terminal building that I had to lie down on the nearest row of seats while my distraught husband contemplated the next step. We had two options. He could call an ambulance to take me back to the hospital or we could soldier on and try to endure the flight home. We had been told at the hospital that the flight would not represent a risk following the surgery. I knew what I wanted to do and when I’d recovered enough to be able to speak again, I proposed the idea that I could manage the flight if only I had a wheelchair. I was sure that if I did my utmost to appear well enough, I would be allowed to board the flight. It felt like an insurmountable challenge at the time but I was determined to get home that night. My husband soon found a rickety airport wheelchair (with zero suspension) and we proceeded to the check-in desk. Now it’s a well-known fact that you need to be in the full of your health to fly with Ryanair but this was taking things to the opposite extreme! I could barely even hold my head up at the time. However on reaching the top of the Ryanair queue, I smiled sweetly at the member of ground staff while my husband made light of our circumstances and to our surprise and delight, we were checked onto the flight no problem. No extra charges were requested – wonders will never cease – not only that, Ryanair also provided a decent wheelchair and promised that I would be boarded first, ahead of all the other passengers. Life was looking up again!

However we still had nearly two hours to fill in the passenger departure lounge before take-off and that time seemed to go on for ever. I can remember noticing that everyone seemed to be snacking on some fast food or other and it all seemed really busy and noisy compared to the quiet of a hospital environment. I was still feeling very nauseated and also very cold. My head was heavily bandaged and while I wore a large headscarf to cover-up, I was unable to disguise my swollen face. The thing that amazed me the most was that people were so rude in the way that they stared. While we battled our way through airport crowds I could really sense the unwanted attention. I had no idea that the experience of being pushed in a wheelchair could feel so demoralising – all independence is lost – and a wheelchair seems to represent a passport to others to stare. It really opened my eyes to the conditions that wheelchair users endure and of course, not everyone is as lucky as me to have been only temporarily using one.

When the time came for departure I was dutifully wheeled to the steps of the aeroplane by my husband, accompanied by a Ryanair escort and was helped to board the plane while all the other passengers waited in the terminal building. It was a great help to get this little bit of VIP treatment though it wasn’t long before everyone else followed and of course many of them had another ‘gawk’ on boarding the plane. The flight itself was fine and on landing, Ryanair again came up trumps by providing a wheelchair for transport through the airport. Again, I had to endure endless stares and by the time we got to the arrivals hall, I burst into tears on being met by a dear friend. It was such a huge relief to be whisked home, away from the public glare.

Yesterday I repeated the same journey as I had to make a return trip to the UK for a check-up with the surgeon. This time I did the journey alone and in the full of my health. The news was good – the surgery has been very successful and I felt like dancing in the streets afterwards. On the way home through the airport last night, the memories of that wheelchair journey came flooding back. I thanked my lucky stars to be able to walk to that plane. I also resolved to never, ever stare again at anyone in a wheelchair.

And Ryanair – you can take a bow 😉

The Hospital Patient

November 3, 2007

I was reading an interesting blog the other day and it started me thinking about life in hospital – from the patient’s perspective. This excellent blog is written by a medical student who details a first encounter with a ‘real’ patient. It was an insightful glimpse into the world of student doctors and clearly demonstrated how they learn from direct contact with patients. While ‘real’ patients are important for medical education, it’s also important to remember that patients are ‘real’ people too.

It has to be said that life in hospital is incredibly boring – the days can be endless and the sleep-disturbed nights are even longer. A hospital environment is alien to most patients – in fact it could even be described as ‘territorial’. From the moment a newcomer arrives on a ward, they become public property and remain on display for the duration of their stay. The boredom factor in hospital is such that a new admission provides a welcome distraction to the other ward occupants. Every detail is observed and scrutinised and before long, the interrogation will begin. “What are you in for? Oh, that’s terrible – my friend had that too!”. The new patient must divulge sufficient information to satisfy everyone’s curiosity and then they will be left in peace to settle into their ‘new home’.

The majority of patients in acute hospitals today are admitted through A&E where they will have been processed for many weary hours and often days, before being transferred to a ward. A small proportion of patients are admitted directly to a hospital bed to undergo elective surgery or thorough investigation and these are what are known as ‘elective admissions’. All patients, no matter how they arrive in hospital, are placed under the care of a specific medical or surgical team. Over the course of their stay, each patient will get to meet many variations of this team ranging from the most senior, the consultant, right down to the most recently qualified, the intern. Those with a complicated medical history may be put under the care of several teams and this inevitably multiplies the number of doctors seen. Medical students are an add-on ‘bonus’ in all teaching hospitals but only patients who are deemed to be a suitable case-study, will be asked to consent to undergo interrogation.

The ritual of ward rounds is another great source of entertainment for bored patients. While usually terrifying for the patient involved, they still provide great entertainment for the rest of the ward. The doctors swarm in and surround the bed of some poor unsuspecting individual who is then subjected to a barrage of questions, all delivered at an audible volume to the rest of the ward. The patient is then used as a ‘demo model’ before decisions are made and a care plan is put in place. The whole team then moves on in search of it’s next victim leaving behind a bewildered and often humiliated, patient. This is when the room mates come into their own. Within minutes, the other patients come to the rescue with reassuring anecdotes and invariably, the doctors will each be analysed in detail. No stone is left unturned! Patients in general are hugely protective of one another – everybody is in the same boat in hospital and it’s a natural instinct to look out for the welfare of others. This is particularly evident in the case of elderly patients who are unable to fend for themselves and who do not always get the respect or the attention they deserve due to short-staffing on the wards. Nurses too, are by no means exempt from a patient’s analytical skills. Favourites are quickly identified while others will be given nicknames appropriate to their behaviour. Humour is a great weapon in hospital – it often succeeds where reality fails.

There can be no doubt that patients will always be indebted to doctors for their in-depth skills and knowledge but doctors should never forget that patients are REAL PEOPLE who possess a unique talent to spot REAL DOCTORS ❗