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.

Equity of Care?

Misdiagnosis and inappropriate treatment are common concerns for individuals suffering from a serious medical condition. In Ireland more than 1.5 million people can access a second opinion service at no additional cost to themselves. Best Doctors helps people facing serious illness to get the most appropriate care. It’s unique database has harnessed the knowledge of over 50,000 doctors identified by their peers as the best in their specialities. Access is available through three insurance companies in Ireland – VHI Healthcare, Hibernian Life & Pensions and Combined Insurance (IRL) – who pay an annual fee for the service.

The service operates as follows. An insured person who is diagnosed with a serious illness, has the option of having their case reviewed by Best Doctors. On the patient’s request, the health insurance company arranges for Best Doctors to contact the patient. A Nurse Advocate is then assigned, who contacts the patient or their doctor for a copy of all the patient’s medical records. Using their database, Best Doctors identify the most appropriate specialist from around the world to assist in reviewing the patient’s case. The selected specialist(s) comprehensively reviews the test results, diagnosis and prognosis and a report is sent to the patient and their doctor. Doctor patient confidentiality is maintained at all times throughout the process. Patients wishing to have Best Doctors review their medical file continue to have medical care with their own consultant who now has the back-up of other world renowned specialists.

This all sounds very reassuring until you realise that almost 50% of the Irish population hold no insurance cover added to which, not all health insurance companies pay into the scheme. Surely every patient facing serious illness, should have access to the best and most appropriate care available? Do all patients not deserve access to the skill, experience and insight of these highly trained doctors? Nope, sorry! Unless you’re a member of an insurance company which is participating in the scheme, access is denied. It seems care is given based on a person’s ability to pay for health insurance instead of their medical need. There is a fundamental struggle going on over the soul and shape of Irish healthcare.

Decontamination

Infection control in Irish hospitals is a serious problem as the superbugs are constantly developing resistance to disinfectants. In spite of hospital cleaning regimens, the bacteria can form spores which survive for months or even years in the environment. When a serious outbreak occurs, preventing cross-infection and the further spread of endemic strains requires effective control measures.

In years gone by, there was no range of sophisticated cleaning agents available to disinfect a room following a case of infectious disease. The room was sealed off and a combination of disinfectant and a formalin lamp was used to decontaminate the air.

Here’s another excerpt from Home Nursing in the early 1900’s…

Disinfecting the Sick-Room

Whenever possible the help of a Sanitary Inspector should be sought. If this is not available:-

1.  Open all cupboards and drawers, and hang up dressing-gown and blankets on a clotheshorse or on cords stretched across the room

2.  Paste paper over the fireplace, the framework of the windows, and all other crevices except those about the door.

3.  Paste ready for use the strips of paper required for the door and the keyhole.

4.  Place a formalin lamp on a metal tray (as a precaution against fire) raised from the floor; ignite it, and leave the room quickly. To disinfect a large room, several lamps placed about it will be required.

5.  Close the door; cover the crevices about the door and the keyhole with the prepared strips of paper.

6.  Keep the room closed for twelve hours.

7.  Re-enter the room, open the windows wide, uncover the fireplace, and allow the room to remain in this state for another twelve hours.

8.  Send the bedding and mattress to be dis-infected.

9.  Burn all books, letters, etc., which have been in the room.

After her duties are finished the home nurse must disinfect herself, taking precisely the precautions which has adopted for her patient.

Battling On

I turned on the news this evening to hear that 909 patients around the country are waiting to have a colonoscopy and some of those people have been waiting for more than two years. In December, our Minister for Health told the HSE to comply with a target of access to a colonoscopy within four weeks of being referred by a doctor. I had a private consultation with a gastroenterologist this afternoon and have been booked for an urgent colonoscopy next Monday morning. This sadly, is the difference between public and private health care.

Unfortunately, the antibiotic I’ve been on for the past 8 days (Vancomycin), has failed to bring a nasty colitis under control. After almost six weeks of worsening symptoms, I’m in real need of help. While this means having to go through a dreaded colonoscopy again, right now that seems like a doddle compared to my present circumstances. The diagnosis is most likely to be an antibiotic-associated colitis caused by the ongoing treatment for the chronic infection in my head. However, biopsies are required to confirm this and also to rule-out other possible causes, such as Crohn’s Disease.

While queueing to see the doctor today,  I received a call from another doctor’s office. The surgeon in the UK has requested a CT scan of my skull before I travel to Nottingham for a review consultation. My surgeon in Ireland has organised the scan for tomorrow and I will travel to the UK in a couple of week’s time to receive the verdict. It’s certainly been all go today.

The reason I’m able to access prompt medical care for my health problems, is simply because I hold private health insurance. The policy is a huge burden on our family budget each year but I cannot afford to be without it. The delay in accessing investigations in our public health service, is costing lives. It seems that little has changed since the untimely death of Susie Long who succeeded in highlighting the inequities in the system. The Irish Cancer Society has described the waiting times as unacceptable. I’d describe the situation as scandalous and it’s time the HSE was held accountable.

RTE News Bulletin

Infection Control

In the first decades of the 20th century, wealthy households employed trained professional nurses to care for seriously ill family members. These nurses stayed in the patient’s home, carrying out the doctor’s instructions, monitoring the patient’s condition and providing general care – making beds, bathing the patient, giving medicines and keeping the sickroom in good order. The role of the private nurse was not an easy one: she had an ambiguous social position – above domestic servants but below family members. Private nursing slowly died out after 1918, at the same time as did the live-in domestic servant.

Here’s another gem I found in my little book of Home Nursing from the 1930’s, on the precautions taken against the spread of infection. The HSE would do well to take note!

The following rules should be observed whenever a case of infectious disease is being treated at home:-

1.  At the outset of the disease soak a sheet in disinfectant and hang it outside the sick-room door, allowing the lower end to remain in a bath containing disinfectant.

2.  Immediately pour a strong disinfectant over all excretions, cover the bed-pan with a cloth, remove and empty it at once unless the doctor desires it kept for his inspection. After emptying the bed-pan scald it out and cleanse with a disinfectant.

3.  Burn in the fireplace in the sick-room all rags, cotton-waste, tow or cotton-wool used for discharges, also all dust taken up in the sick-room.

4.  Place in a pail of disinfectant for one hour at least, all soiled bed linen, including handkerchiefs, before boiling them.

5.  Keep a basin of disinfectant in the room but out of the patient’s reach, in which to wash your hands every time you have done anything for him.

6.  When the patient is declared free from infection, give him a bath to which disinfectant of the appropriate amount has been added, not omitting to wash the head. Put him into a dressing-gown which has not been kept in the sick-room, move him into another room, and dress him.

Disinfecting the Sick-Room to follow.

At the Front Line

A draft document from the Department of Health has been circulated around HSE managers warning of further job losses in the nursing sector. Staff nurse levels will be cut by 700 this year as part of a move to optimise resources. The Irish Nurses Organisation (INO) has claimed that these further cutbacks will have an unsafe impact on frontline services and that patient care will be compromised. The HSE  is defending the proposal and continues to insist that frontline services will be maintained. I wonder what the VAD nurses would have made of today’s working conditions at the front line?

The British Red Cross Society formed the Voluntary Aid Detachment (VAD) in 1909 to provide auxiliary medical service in the event of war. While it was mostly men who fought on the front lines during the First World War, some women also worked close to European battlefields as nurses. These graduate nurses and members of the Voluntary Aid Detachment – a corps of semi-trained nurses – worked in war hospitals, drove ambulances, and served as cooks, clerks, and maids. Most women who volunteered with this unit were not professional nurses. They attended classes in first aid, home nursing, and hygiene with the St. John Ambulance Association for between three and six months and also volunteered in hospitals, making beds, taking temperatures, and performing other duties. Open-air drills also taught VADs to build and cook on camp fires, pitch hospital tents, and care for wounded soldiers.

The work was physically and emotionally taxing. Nurses worked long hours in crowded and chaotic hospitals treating severely wounded soldiers from the front lines. They slept on bunks, ate rations, and went without the usual comforts from home. Although the work was stressful and sometimes traumatic, it also produced a sense of satisfaction in many nurses by allowing them to make significant and public contributions to the war effort.

Image courtesy of the British Red Cross Museum and Archives.

Infectious: Stay Away

Are you infected? From Friday April 17th something contagious will be spreading from Science Gallery. Stay away if you wish avoid exposure to infectious agents. If you are brave enough to enter the containment zone on Pearse Street you are advised to wear protective clothing. As soon as you enter the gallery you will be screened for what you might be carrying and will be electronically tagged to monitor your state of infection. Whether you are addicted to brands, obsessed with an idea, coming out with a strange rash or just can’t get that catchy jingle out of your head, you might be infected.

INFECTIOUS is a major new exhibition exploring mechanisms of contagion and strategies of containment through science and art including a live epidemic simulation, an opportunity to have your DNA swabbed from your cheek and analysed and to get up close and intimate with a Petri dish as you cultivate the bacteria from your lips in our Kiss Culture experiment.

INFECTIOUS will start spreading on April 17th and will hopefully be decontaminated by July 17th.

INFECTIOUS is supported by the Wellcome Trust, and curated by Luke O’Neill, Cliona O’Farrelly and Michael John Gorman.

Please note that INFECTIOUS is not suitable for visitors under 15 years of age.

INFECTIOUS EXHIBITION: Science Gallery, Pearse St, Trinity College, Dublin 2.

Tuesday – Friday 12:00-20:00 and Saturday – Sunday 12:00-18:00 Admission Free.

* Much as I’d love to go to this exhibition, I’d be afraid that with my history of resistant bacteria, I might close this exhibition down 😉

Thanks to Roy @ Irish Taxi for reminding me that the exhibition is open.

It’s a big YES!

Something extraordinary was witnessed on the ‘Britain’s Got Talent‘ show last week.

This lady has talent.

No one’s laughing at her now. There’s a lesson in this for all of us. Enjoy!

Get It Right

I’m fed-up listening to the mixed messages coming from the Department of Health and the HSE. One minute our Minister is vowing to provide extra beds in the health service and the next we’re being told that we’ve got too many beds. It’s time that Harney and those muppets in the HSE made their minds up.

We have a new chief medical officer (CMO) of the Department of Health, Dr Tony Holohan and in his first media interview since taking up his appointment, he announced that the Irish health system has too many hospital beds. Brendan Drumm, CEO of the HSE, is also peddling the same message. Meanwhile, our Minister for Health’s solution to relieving the bottleneck in A&E, has been to promote private for-profit co-located hospitals as a means of fast-tracking new beds into the system. At the same time, the Dept of Health has deemed our smaller hospitals ‘unsafe’ and is busily closing them down without first adjusting the conditions in the ‘centralised’ units’, with adverse consequences predicted.

The reality is that as things stand at the moment, our health service is in disarray. We have chaos in our A&E departments because of the bottleneck caused through lack of beds. The reason for the log-jam is because our tertiary healthcare services have been neglected over the years and many OAP’s now have no choice but to occupy hospital beds long term. Instead of Harney wasting her time and our money on privatising healthcare in this country, the focus should be put on developing primary care. Nobody refutes the fact that hospitals are not the safest place to be when recuperating from surgery. Primary care is the way forward, with enhanced outpatient care taking place in GP surgeries and public health clinics. This would cut the need for bed numbers with patient care moved to an outpatient or a community setting.

However, the Dept of Health and HSE have repeatedly failed to explain their role. The mixed messages emanating from the Health department are doing nothing to improve public confidence in the health service. Let the new CMO of the Dept of Health come out and tell us what the plans are. We need to know that the problem of  overcrowding in our hospitals will be solved. We need to hear that primary care will get the investment needed to take the pressure off the hospitals. Stop the indecision, we need reason to be hopeful.

There’s one thing that mustn’t be forgotten in all of this and that is the patient. Think back to the last time you were in hospital. What meant the most to you? Was it the good/bad facilities or was it the friendly staff who cared for you? What really counts when one is ill, is kindness but sadly, this is rapidly disappearing as our health service is decimated by mismanagement. The Minister would do well to remember the need for a familiar smiling face.

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.