At Long Last

Lying in the recovery room in a post-anaesthetic induced haze, I remember hearing the surgeon say, “we’ve taken multiple biopsies, you have a nasty osteomyelitis in your head but don’t worry, you’ll be fine.”

Exactly a year to the day later, the same surgeon had a look inside my head yesterday and declared it “mended.” Hallelujah!

It’s been a long journey. Thanks for keeping me company!

HOW TO MAKE EXERCISE FUN…

Watch how few people use the stairs at the beginning of this video. And then watch what happens when they make the stairs into a piano.

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.

Swallow This

I had the dubious pleasure of donning a theatre gown again yesterday but thankfully, only briefly on this occasion.  Some weeks ago, I attended my GP with intermittent discomfort in the centre of my chest. The pain had gradually worsened over a period of days and as there is a strong history of hiatus hernia in the family and I was otherwise feeling well, I felt sure that a hernia must be to blame. Following examination, my doctor agreed that a hernia was a possible explanation for the symptoms but refused to prescribe treatment until first ruling out other potential causes. Despite my protests about not wanting any more medical intervention, he put me on the waiting list to have a gastroscopy performed at our local public hospital.

These days, GP surgeries are able to bypass the consultant system to fast-track patients for endoscopic investigation. In the past, a patient had to be referred to a consultant before a decision could be made to proceed with further investigation. Nowadays, family doctors have set guidelines to follow and if the patient fits the particular criteria, they are referred via a direct access scheme for endoscopic examination. This speeds up the investigation process and eliminates unnecessary specialist consultations. The endoscopy unit is consultant-led, it’s highly staffed so that it runs efficiently and the waiting list is the same for everyone regardless of health insurance or medical card status.

I only had to wait three weeks for the gastroscopy appointment and attended the hospital yesterday having fasted overnight as instructed. I’ve undergone this procedure before so I knew exactly what to expect.  There was no delay, I was assessed immediately by a nurse and asked to change into a theatre gown.  Following a short wait, I was escorted to the examination room to meet with the doctor and his assistant. I was given the option to have light sedation for the procedure and I didn’t hesitate in accepting. I’ve seen enough of hospital procedures to know I’d rather not see any more. I lay up on an examination trolley and following the insertion of a cannula into the back of my hand to administer the sedative, I was asked to lie over onto one side. A plastic mouth guard was placed between my teeth to protect them and stop me biting the endoscope. The next thing I knew was when I awoke in the recovery room feeling relaxed and sleepy following the sedation. An hour later, I was ready for home having received the diagnosis. I was informed that I have a significant peptic (gastric) ulcer in my stomach and shown the pretty pictures taken during the procedure. This news came as a surprise as I was expecting to hear I had a hernia but No, there was no evidence of a hernia seen.

The leading cause of a gastric ulcer is currently believed to be infection of the stomach by a bacteria called “Helicobacter pyloridus” (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs). I had two biopsies taken yesterday which will show if H. pylori is the cause of the problem and in the meantime, I’ve started on a six-week course of tablets to reduce acid production and aid healing of the ulcer – yet more pills to add to the daily pile!  If H. pylori infection is found, I will be commenced on two different antibiotics to eliminate the bacteria.  It’s quite possible that NSAIDs are to blame in my case as I’ve been on various types for years (though always in conjunction with a gastro-resistant medication), to control the joint pain I experience from my connective tissue disorder (EDS). Whatever the cause, I have to return in two months time to have a repeat gastroscopy performed to assess the situation.

I’m really in favour of this direct access scheme for out-patient care as it’s an equitable system which is efficiently run. I left the hospital yesterday feeling lucky to have received such good attention. The only difficult thing to swallow now is the fact that when I next return to see my GP, I have to admit that he was right and I was wrong.

Anyone for Arrogance?

For those of you who’ve been following the story of my biopsy, you will remember that I had a recent contretemps with a private consultant surgeon. Yesterday I received his response to my letter.

I wrote to the consultant two weeks ago to let him know of my discontent following a recent check-up. My appointment was an hour late with no apology given, the consultation lasted all of five minutes and I was asked to pay €150 for this pleasure. To add insult to injury, the doctor removed only one stitch and asked me to return a week later to have the final stitch removed. I declined settling the invoice on principle and when I phoned the office the following day to enquire if a charge would be made for the final consultation, my call was not returned. I felt distinctly uncomfortable with this sort of treatment and considered it important to make my views known to the doctor. In my letter, I made the point that I was surprised by the charge considering the brevity of the appointment and the fact that I was being asked to return again. I also mentioned that his office had not returned my call. I never questioned the wisdom of his decision to ask me to return for such a minor reason although I strongly suspected his motive. My letter was polite and to the point.

The doctor telephoned me in person yesterday. I was told the following, very quickly and in no uncertain terms – “I am sorry to find that you do not appreciate my professional integrity. The delay you experienced was due to the fact that some consultations take five minutes while others may take up an hour – that is the nature of my practice (no apology given). I have to charge everyone who comes into my consulting room if I am to be able to continue to consult on these premises. (Voice begins to shake) It is a great pity that you do not respect my integrity…” Then the phone was rapidly put down before I could respond.

To put it mildly, I was gob smacked. I think the fact that this guy jumped to the conclusion that I was questioning his professional integrity, is very revealing. It’s obvious he considers himself to be above and beyond reproach. The bullying manner of his phone call was disgraceful for a man in his position – his intention was to silence me by denying any opportunity for discussion. Thankfully, I did succeed in butting in at one point to say that an apology for the delay would have gone a long way but this fell on deaf ears. I couldn’t tell if his quivering voice towards the end of the call was due to rage or upset – whichever – it was a sure sign that his arrogance had been dented. If he’d offered a simple apology I would have accepted it but he instead chose to take offence to my letter and to blame me for daring to question his arrogant behaviour. And to make matters worse, he expected me to sympathise with him for the expenses he incurs in running his salubrious private practice. Come on!

It gave me great pleasure to take out my own stitch and as expected, I’ve had no further need to see a doctor. I shall also very much enjoy recounting this tale to my GP when I next see him. He knows me well and knows that I’ve always enjoyed a good rapport with the many specialists I’ve had to consult over the years. For the doctor/patient relationship to work, the respect has to be mutual. Maybe I’ve just been lucky up until now to have experienced the care of some fantastic doctors who are a credit to their profession. I suppose there are a few bad apples in every cart and medicine is no exception. I find it disheartening to consider that this sort of experience is likely to become more commonplace if our Minister for Health gets her way to promote a 2-tier system of healthcare in Ireland.

I’ve no doubt that I’ll receive another invoice for the outstanding charge. After all, this jumped up arrogant git has to protect his integrity! If I do hear from him again I think I’ll do what my wise blog friend, Grannymar, has suggested and bill him for the extra expense incurred in the car park, thanks to his delay. It ain’t over yet, folks!

Just call me Staph

Today I returned to the private specialist to have two stitches in my hand removed. I waited one hour to be seen, had one stitch removed during a very brief consultation and was then charged €150 for this pleasure. And to cap it all, I’ve been asked to return next week to have the last stitch removed. Can you believe it?

I’m still angry about this check-up. I arrived five minutes early for my appointment but had to wait until four people ahead of me had been seen. When I was eventually called in to the doctor’s room, I received no apology for the delay and this did not impress me. I had a punch biopsy performed on an infected lesion a week ago and was asked to return to get the biopsy report and to have the stitches removed. Only one stitch was taken out today – the specialist felt that the wound hadn’t fully healed thanks to my history of Ehlers-Danlos syndrome (EDS). I was surprised by this as my hand looked pretty good to me but I didn’t argue.

The only good bit of news today was that the biopsy report showed the lesion to be non-malignant. The not-so-good news was that the swabs taken one week ago, show that I remain colonised (in my nose) as well as infected (in the hand) by the Staphylococcus aureus bacteria. I’m all too familiar with Staph aureus having fought a long battle with it in the past, with infection due to MRSA, the antibiotic resistant strain of this bacteria. About 20-30% of the population are colonised with Staph A at any given time but unless they become infected by it, it does not pose a problem. A swab taken two weeks ago established that my present infection is sensitive to penicillin thankfully and I’ve been undergoing treatment with an appropriate oral antibiotic since then. I now also have to begin a de-colonisation treatment which involves using an antibiotic nasal ointment for the next year.

I think what bugged me the most about today was the sheer arrogance of it all. I’m well used to delays in doctors’ clinics and I don’t have a problem with this as long as I receive a simple apology. I can appreciate that doctors are very busy people but that doesn’t excuse bad manners. My consultation was very rushed lasting just 5 minutes or less, and I was given little or no opportunity to discuss anything. When I was asked to return in another week’s time for follow-up, I presumed that there would be no charge for today’s consultation. Not only did I presume wrong, I was asked to pay the same amount as I paid for the initial consultation two weeks ago. Usually a lesser charge is made for a return visit. And as if to rub salt into the wound, I also had to pay double the car park fee thanks to the long wait to be seen.

Now, I’ve seen many doctors over the years but I’ve never, ever felt as ripped off as I did today. I despair if this is the sort of health service we can anticipate when/if our Minister for Health gets her wish to privatise healthcare in this country. I did not settle today’s bill on principle and instead offered to pay next week when my treatment has been completed. The doctor’s secretary was not amused and insisted I took away a bill showing that €150 was still due for ‘Con 2’. I sure felt conned alright! You have to realise that the specialist will also be handsomely paid by my insurance company for carrying out the biopsy as a day procedure. It looks as if consultation no. 3 may well result in another charge and I’m suspicious now that this may be the real reason for why the final stitch wasn’t removed today. I think I’ll ring in the morning and query whether or not there’ll be another charge. If this is the case, then I might have to remove my own stitch and treat myself to some retail therapy instead.

My Christmas wish is that one day I’ll be able to wave goodbye to ‘Staph’ and resort back to being just plain old Steph.

The Biopsy

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.

An Eyebrow Raised

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.