Bowel Talk

This time last year, I was diagnosed with a type of inflammatory bowel disease called Microscopic Colitis (MC). The condition gets it’s name because the large bowel (colon) lining looks normal during colonoscopy (a test to look inside your large bowel) and can only be seen when tissue samples are taken from the colon and examined under the microscope. The exact cause of microscopic colitis is unknown and treatment depends on the severity of symptoms which can range from mild to very severe. Some people recover spontaneously and continue to keep well, while for others the condition comes and goes. There is no cure at present.

Microscopic colitis is the term used to cover two types of bowel inflammation that affect the colon, called Collagenous Colitis and Lymphocytic Colitis. The main symptom of both these conditions is chronic (ongoing), watery diarrhoea without blood. Urgency and fatigue are also common. Nocturnal diarrhoea differentiates this condition from irritable bowel syndrome.

At first, my GP thought that I was suffering from an antibiotic-associated colitis (Clostridium difficile) as the severe colitis followed prolonged antibiotic treatment but repeat laboratory tests ruled this infection out. I was subsequently referred to a gastroenterologist who scoped my entire digestive tract and took biopsies for analysis. Two weeks later, the biopsy results confirmed a diagnosis of collagenous colitis and treatment was immediately commenced. As anti-diarrhoeal drugs had already proved ineffective in my case, I was prescribed the same anti-inflammatory drugs used to treat ulcerative colitis and Crohn’s, with good effect.

Microscopic colitis is classified as a type of inflammatory bowel disease (IBD), but is different from and not usually as severe as the better known types of IBD, Crohn’s Disease and Ulcerative Colitis (UC). However, this condition is still commonly overlooked or misdiagnosed.

One year on from diagnosis, my colitis is well-controlled with an anti-inflammatory drug called mesalazine (Asacol). However, antibiotic use will still trigger a nasty flare-up and corticosteroids, in particular budesonide (Entocort), are required to bring it back under control.

As the saying goes, “What can’t be cured, must be endured!”

Now if you’ll excuse me, I’m off to powder my nose.

Information Source:  The National Association for Colitis and Crohn’s Disease (NACC).

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.

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.

Infection Control

Ireland’s first National Isolation Unit was opened yesterday by the Minister for Health, at the Mater Hospital in Dublin.  The unit has 12 beds in total and will be used for patients who contract highly infectious diseases such as tuberculosis, SARS and pandemic influenza.  It will also be used to treat patients with other infections including HIV, hepatitis B & C, meningitis, MRSA and malaria. This all sounds pretty good until you stop to think about it more deeply.

Firstly, I was amazed to learn that this highly specialised ‘state-of-the-art’ facility with it’s own infectious diseases multidisciplinary team, is actually the first of it’s kind in the whole country. Six of the isolation beds in this new unit will  be under negative pressure to help prevent airborne transmission of infection by microscopic droplets. Two of the isolation rooms will have different air handling systems to enhance infection control. It begs the question as to what has been happening with highly infectious patients up until now? I know that some of bigger public hospitals already have isolation units which are used to hoard all the MRSA infected patients together but they do not have any specialised facilities.

And secondly, with healthcare associated infections (HCAI) such as MRSA and C. diff now endemic in Irish hospitals, it strikes me that it might make more sense to use the isolation units for the patients who are clear of HCAI’s, to keep them free from contamination?

Spread The Word

Tomorrow, Saturday, a health protest is due to take place in Dublin and I’m in need of your help.

The main objective of the MARCH & RALLY is to have a large gathering of trade unionists, patients, health campaigners and the general public to demand:

– an end to privatisation of the Health Service

– an end to cutbacks

– a first-class, equitable Health Service

The protest has been organised by the Public Health Service Campaign (PHSC) group which is an alliance of the Dublin Council of Trade Unions, the Youth Committee of the Irish Congress of Trade Unions and Patients Together. The campaign is supported by the Health trade unions and a wide range of patients, hospital and medical campaigners.

In the run up to the imminent budget, the campaign aims to put a stop to the underfunding of our Health Service. In recent years, we’ve seen chaos in our A&E Departments, a shortage of hospital beds, reduced services for the elderly, cutbacks in funding for disability services, the misdiagnosis of cancer patients, and an alarming rise in the rate of hospital acquired infections such as MRSA and C. difficile.

“On October 11, we will demand not only that the cutbacks end, but that we get the first class health service we deserve. The PHSC is calling on all trade unions, patient and hospital campaigns, community organisations and the general public to get out on the streets on the day, to achieve the loudest possible protest,” said Patients Together spokesperson, Janette Byrne.

YOUR HEALTH – YOUR PROTEST.

Assemble 2.00 pm, Saturday, 11th October 2008.
Garden of Remembrance, Parnell Square, Dublin, 1.

Speakers at the rally will include:

Prof John Crown, Consultant Oncologist
Liam Doran, Irish Nurses Organisation General Secretary
Janette Byrne, Spokesperson for Patients Together,
Conor Seville, brother of Beverly.
Kevin Callinan, National Secretary, IMPACT
Audrey Deane, Social Policy Advisor, St. Vincent de Paul Society,
Peadar McMahon of the Health Services Action Group and the Monaghan Hospital Community Alliance,
Louise O’Reilly, National Nursing Official, SIPTU,
Dr. Teresa Graham, (SIN) Stop Infections Now Campaign, (MRSA),
Walter Cullen, Unite Trade Union

Live music will be provided by ASLAN members and other artists.

Please spread the word about this protest and if you can support the march & rally, all the better.

Now, this is where I need your help.  What wording do you think I should use on my placard?

UPDATE: No placard was needed as I joined-up with the S.I.N. (Stop Infections Now) campaigners who had produced their own teeshirts and placards for the march and rally. I am very proud to be a SINNER!

This peaceful protest was better organised than the last one in March but I suspect the numbers were down by comparison.  For me personally, the highlight of the day was to witness two consultant doctors represent the rights and interests of patients and advocate for a better health service. I admire them both hugely for publicly taking this stance and for not being afraid to speak out about the faults within the system. If only their colleagues would follow suit.  

Knowledge is Power

I wrote a post recently lamenting the lack of information available to the public on MRSA and suggested that a well-orchestrated campaign was needed to correct this deficit.  Well, now my wishes have come true with the launch of a new campaign group called  S.I.N. (Stop Infections Now). Would you like to consider becoming a SINNER?

Did you realise that members of the public get most of their knowledge about the measures needed to prevent MRSA from the media?  The information given to patients who have acquired MRSA in hospital can be insufficient or sometimes, even non-existent.  The result is that there are some thousands of patients being discharged from our acute hospitals every year with MRSA (in wounds, in bones or in their respiratory systems) and with very sketchy knowledge on how to prevent the spread of the infection to others.

Health Care Acquired Infections (HCAIs) such as MRSA and C. Diff, are a major problem in the Irish health system and many people have been affected.  These infections often result in prolonged stays in hospitals, sometimes with permanent disability or even death occurring.  The human and financial costs are enormous. Appeals to the Minister for Health, the HSE and hospital managements have proved ineffective in preventing HCAIs, so a campaign has been set up to approach the problem from a different angle i.e. people power.

The SIN Campaign has been established to do the following:

– provide information to the public (and to health care staff) about HCAIs, their causes and what is needed to prevent them.

– outline what can be done by a prospective patient before he/she goes into hospital to help prevent infection.

– what to do if an infection is acquired, the questions to ask, and the appropriate responses to demand.

– how to complain in a non-confrontational manner, and the options open if satisfaction is not achieved.  These options include legal action.

This information is contained in a Patient Information Kit which includes a leaflet, flyer and a CD.  Thus informed, it is hoped that people will simply refuse to accept a service which, while being excellent in some respects, is severely sub-standard as far as these infections are concerned. The SIN Campaign will also include research into the social and psychological effects of HCAIs from the point of view of patients and health care workers.

The campaign group is asking for help from individuals and from companies. This help can be in the form of:

– donations or sponsorship of any size to help with the information kits and the research,

– becoming a patron so your name can be used,

– helping with fund raising or introductions to others who can help.

S.I.N. is the brainchild of Dr.Teresa Graham (formerly of MRSA and Families Network) and the Campaign and Patient Information Kit will be officially launched next Wednesday, 10th September in Dublin.  I’ve already become a SINNER by registering my personal details with the campaign group and I’m very much looking forward to attending the public launch and meeting the people behind this worthy campaign.

If you’d like any further information on this campaign, you can contact:

Dr. Teresa Graham at 051 386651 or  tvgraham@gofree.indigo.ie

Salmonella Agony

The latest figures for the recent outbreak of salmonella agona show that some 132 people have now been infected with the bug and it’s already spread to 5 countries within the European Union. The genetic fingerprint of the microbe has been linked to a particular production line at Dawn Farm Foods in Naas, Co. Kildare. The company has decided to close the entire plant for a week and has contracted the expertise of Limerick company OMC Scientific, to decontaminate the entire production facility. How times have changed.

Many years ago when holidaying in Connemara, our holiday plans came to an abrupt end when the friends who’d been staying with us, had to return home following the sudden death of a relative. Our little holiday cottage felt very empty with just my husband, myself and our young son rattling around in it so to cheer ourselves up, we decided to treat ourselves to lunch in a local hotel. Later that evening, I became violently ill with nausea, vomiting and diarrhoea which continued relentlessly all night. I still felt very unwell the following day so we decided to give up on the holiday and return home. I shall never forget that 6-hour car journey with awful nausea, every mile was agony. My husband and son luckily were unaffected and sang songs together all the way home to help pass the time. As far as I can remember, I recovered within a few days but a week or so later, I again became increasingly nauseated until the whole unpleasant episode started all over again.  I consulted my doctor who prescribed medication to ease the symptoms. This pattern repeated itself every few weeks until eventually about two months later and two stone lighter, I was admitted to hospital for investigation and treatment. This is when it emerged that I had a dangerous form of infective diarrhoea and the bacteria was linked back to the piece of chicken I’d eaten for lunch on that fateful day in Connemara. My infection was officially notified to the Food Safety Authority and that was the last I ever heard of the sorry tale. I’ve often wondered since how many other poor souls suffered the same fate after eating food from that kitchen and I have to admit, I still to this day shudder whenever I pass by the doors of that hotel.

The HSE is presently in talks with OMC Scientific to consider using it’s technology in Irish hospitals, to reduce the incidence of hospital-acquired infections (HCAI’s) such as MRSA and clostridium difficile. OMC’s bio-decontamination service is already used in a number of British, French and American hospitals. A study published in the Journal of Hospital Infection found that this technology is 66 times more effective than manual cleaning in removing hospitals superbugs. It’s estimated it would cost the HSE about €14 million a year to cover all 52 acute hospitals in the country but this would lead to a reduction in the prevalence of superbugs which is thought to cost the HSE about €200 million a year. Now there’s a cutback worth considering!

Knowledge of MRSA

Did you know that hand washing is an effective way to prevent MRSA contamination and infection? According to a recent survey, the main source of the public’s information about MRSA, is through the media. The results of the survey have shown that there is a clear need to further educate the public on how to prevent the spread of infection. You can find a report here in The Irish Times online. Ever since my own brush with MRSA, I’ve tried to make it my business to become better informed about infection control and to spread the word.

MRSA is a subject close to the heart of The Biopsy Report. Consistently, the top posts on this blog are the ones which contain information on MRSA. The most frequently used search engine terms all refer to queries about MRSA. Terms such as “boils on butt”, “do you have mrsa forever”, “antibiotic resistance”, “chances of mrsa recurrence”, “superbug news”, “what is difference between mrsa and C Diff” and “mrsa nasal swab”, appear regularly and show that there is a huge hunger out there for more information on MRSA. Two funny search terms which appeared recently were “mrsa bed and breakfast” and “steph and staph infection together.” The mind boggles to think what was going through the minds of those people?

There is no doubt that infection control would benefit from greater public awareness. The media coverage of MRSA is far from an ideal source of information because of a tendency towards a sensationalist approach. We need a well-orchestrated campaign to combat the spread of MRSA and where better to start than online. Spread the word, not the germs.

Tighten your Belt

Well, it’s finally happened. The economic downturn is upon us, our public finances are under severe pressure and major cutbacks in healthcare spending are anticipated. Our already ailing health service is set to suffer even further and it almost goes without saying that patient care will be compromised.

Brendan Drumm, the HSE chief, believes that in the present economic environment, the health service could face five years without any extra funding. He also believes that there is no reason why the standard of health service provision should suffer as a consequence. Our Minister for Health, Mary Harney has warned that hospitals must operate within budget and must do so without impacting on patient care. We’re told that the way our hospitals are being run is both ineffective and inefficient. I turned on the news last night to hear that hospitals across the country are facing a scaling back of services with staff cuts and ward closures. One hospital has already accused the HSE of gross neglect of patients and claims that the cutbacks are being done at the expense of patients. A spokesperson for the HSE insisted that patient care will not be compromised by the cutbacks. Who do they think they’re fooling?

My biggest fear is that patient’s lives will be put at risk by these further cutbacks in spending. There is already a serious problem in our hospitals with the level of healthcare associated infections (HCAI’s) such as MRSA and Clostridium difficile. 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. There is also growing public disquiet. We are constantly promised that improvements are “planned” or “under way” but how can this be so when cutbacks in basic front-line services are being simultaneously requested. This is not the time to talk about cutbacks and the necessity of hospitals staying within budgets. The HSE has lost sight of the needs of the patients. It increasingly prioritises bureaucracy and finance rather than health, with numbers and budgets taking precedence over real people and care.

We are once again being asked to tighten our belts. Brendan Drumm says that it is the duty of everybody, including the health service, to use taxpayers’ money more effectively. This is all very well and good but could someone please explain why this situation has arisen after a whole decade of unprecedented economic growth? Is there any Government accountability left in the area of healthcare?

UPDATE: In case anyone ever thinks I’m exaggerating about the state of our health service, have a look at this post which can also be found over at Irish Election. It details the experience of bringing a child to A&E and is a classic example of how the system is failing to provide emergency care. This post completely mirrors my thoughts.

Superbug Fear

Now, I don’t know about you but I have a fear of hospitals. I have good reason to be afraid. I don’t mind needles and I’m not afraid of pain but I would be concerned about picking up another hospital acquired infection (HCAI). My fears are well-justified as it’s no secret that Irish hospitals are rife with superbugs. Mary Harney says she doesn’t accept that people are afraid of our hospitals. She would say that, wouldn’t she? She hasn’t had to fight for her life following a serious MRSA infection.

Today’s news (and I particularly recommend that you listen to the audio links at the bottom of RTE page) has done nothing to allay my fears. Over a 7-month period last year, a high incidence of deaths which were directly or indirectly attributable to superbugs, was recorded at one Dublin hospital. This hospital has no consultant microbiologist in place and is forced to ‘borrow’ these services from another hospital. It beggars belief after the outcry over the prevalence of HCAI’s in Ireland, that this relaxed attitude to infection control continues to exists in our health service.

Mary Harney says she is learning from best practice and that plans are in place to minimise the possibility of acquiring HCAI’s. You know what Mary? Two can play at your game. I don’t believe you!