Progress of Sorts

Where did we get to? Oh yes, I remember… I was in ‘yellowland‘ having the nasal prosthesis removed under sedation. That’s just over a year ago now and I guess you’d like to know how my head has been in the interim? Here goes…

When I returned to see the surgeon for a check-up, it was lovely to be able to report that I’d had no headaches or active infection since the prosthesis had been removed. However, I also had to report that the healing of my nasal septum had broken down again and this was confirmed on examination. We both looked at each other in disbelief. What to do next?

I was given two options… return to Nottingham for advice or do nothing and see what happens. I chose the latter as I couldn’t stomach the thought of any further intervention. A month later, I went to discuss the situation with my GP. I wanted to find out if there could be an immunological explanation for my long history of infection and failure to heal. My GP agreed to run some blood tests.

A month later, when I was in the throes of a bad flare-up of infection in my head, my GP phoned with the blood results. I did indeed have a ‘blip’ in my immune response which was considered worthy of further investigation. A letter of referral was sent to the local hospital requesting an appointment with the immunology team. I expected to wait months for this appointment within the public system but within a week, I’d been called into the hospital to undergo a rigorous assessment of my immune system. When I queried why I’d been seen so quickly, I was told that I was a “fascinating” case and as a result, I’d been bumped up the waiting list. My hopes were raised.

Three hours and many blood tests later, I left the hospital having been thoroughly grilled on every aspect of my medical history… and also examined from top to toe. I couldn’t believe the thoroughness of the assessment. Following the blood tests, I was injected with the pneumococcal vaccine, started on a long-term prophylactic dose of antibiotic, two new inhalers (one oral, one nasal) were added to my prescription and I was given a date to return for pulmonary function tests.

When I returned to the hospital three months later for all the test results, I had high hopes of receiving news of a breakthrough. The appointment turned out to be a complete anticlimax. I didn’t get to see the consultant as had been promised. Instead, I was told by a seemingly bored, doctor that the blood tests confirmed a minor defect in my immune system… no IgM factor… and that there’s “no treatment available for it”. The tests had also confirmed my allergic status, asthma etc. and I was simply told “Keep taking the pills and come back in a year’s time for review.” Hopes dashed again.

The good news is… since undergoing the original immune assessment, I’ve only had one acute infection in my head since last June and I’ve also had fewer headaches. This is an all-time record! I’m convinced this progress is due to the continuous prophylactic dose of antibiotic. In the past, I’ve been on antibiotics for months at a time but never, for a year at a time. It’s seems such a simple solution and apparently, can be continued indefinitely. The question is… why didn’t someone think of this before?

So… progress of sorts. My nasal septum has still not healed and I’m due a check-up with the surgeon next month.

Tune in next week and I’ll tell you about my tooth extraction which… wait for it… failed to heal!

Reasons to be cheerful

I don’t need to be admitted to hospital…Having consulted my GP about the latest infection in my head, he advised that I should be admitted to hospital for IV treatment. With my extensive resistance to antibiotics, treatment is limited to antibiotics which can only be given under hospital supervision. With a heavy heart, I presented myself for admission through A&E yesterday morning. After a long day of tests and assessment, the doctors concluded that I did not need to be admitted to hospital.

The infection is not systemic… While the recent swab analysis showed resistance to the antibiotic which saved my bacon last year, as well as resistance to methicillin (MRSA), yesterday’s tests confirmed that I am not systemically unwell with the present infection and therefore there is no need for intensive antibiotic treatment.

I was assessed by a new doctor… My own consultant was unavailable and so my care was overseen by his senior registrar whom I’d not met before. This worked to my benefit as it meant that my head was fully assessed from a new standpoint. Following a thorough endoscopic examination (the surgically altered internal anatomy of my head earned some interesting comments as he’d not seen anything like it before), I was sent for a CT scan.

The scan ruled out any serious complications… Reassured by the scan result, the doctors decided to opt for conservative treatment. I’ve been commenced on a rigorous regime of daily sinus wash-outs with a hypertonic saline solution. It’s not pleasant but if it manages to flush out the infection without recourse to systemic antibiotics, I’m happy.

It was heaven to come home to my own bed last night… When you are admitted to hospital with a positive MRSA status (colonization or infection), you have to be nursed in isolation to prevent cross-infection. In the hospital which I attend, all MRSA cases are put into a large isolation unit as they do not have en-suite single rooms. I had been dreading going back into this particular isolation unit.

I awoke this morning secure in the knowledge that the right decision has been reached… Conservative treatment is the right decision for now. It makes no sense to bombard my system with potent antibiotics just because I’ve tested positive for MRSA. While pus is discharging down the back of my throat, I’m not having severe headaches and I feel reasonably well. I’ve been instructed to return to the hospital if my symptoms worsen but otherwise I will be reviewed in a few weeks time. I told you I was in good hands!

I’m enormously grateful for the messages of support received over the last few days. It’s a real pleasure to bring you this good news.

You win some, you…

The good news is… I’m on the mend.  The bad news is… I missed a weekend away with good friends. You can’t win ’em all, I suppose?

I was a bit “under the weather” last week. The back of my throat felt congested and my chest was a bit wheezy but as I’d no cough or cold, I concluded that the symptoms were probably viral in origin and not a cause for concern. I was wrong.

On Thursday evening, the congestion in my upper throat gradually turned sore… very sore… and I began to feel distinctly unwell. I tossed and turned all night in discomfort and while my throat had eased by the following morning, I’d developed severe pain in my head. I now had all the signs and symptoms of a bacterial infection which had homed in overnight on the vulnerable area of my head and I knew treatment was urgently required.

My GP took one look at me and sat down to write a letter to the admitting doctor at the hospital where I’ve been treated on many occasions for the severe infections in my head. However, luck was on my side on this occasion.

Being a Bank Holiday Friday, my GP agreed to let me go home to my own bed armed with oral antibiotics and a concoction of opioid pain relievers, with the promise that I would report to A&E if my condition worsened.

To be honest, the rest of the weekend is a bit of a blur… thanks to whatever was in that prescription. All I can tell you is that the pain in my head has now eased and the worst is over. While I missed out on the holiday with friends, I’m very happy to have avoided being admitted to hospital. Not only is the battle won, I feel like I’ve won my own lottery.

Failure To Diagnose

Headaches are a common symptom of many conditions and almost everyone will experience headaches at some point in their lives. Normally the average headache is nothing to worry about, despite the discomfort you might be experiencing. However, if you get a severe/sudden headache unlike any you have had before, you should always seek medical advice. Sometimes, a headache can be a warning of something serious that needs to be investigated so don’t delay in seeking help.

As I have a long history of chronic sinus infection, I’m well-used to getting headaches. I don’t panic when a headache occurs as I’m familiar with the signs and symptoms of acute sinusitis and have the necessary prescription medications to relieve the pain. However, if I develop a severe headache that I’m not familiar with/it continues to worsen, I will always seek medical advice. If the headache is considered a cause for concern, my GP/specialist will refer me for an urgent CT/MRI scan in order to rule out any serious cause. As I hold private health insurance, I rarely have to wait longer than 24 hours to undergo a scan. If, however, I had no health insurance and was a patient in the public health service, the story could be very different…

THE HSE has apologised before the High Court to the family of a young woman over deficiencies and failures which led to her death from a massive brain haemorrhage. The apology was part of a settlement of court proceedings.

“Louise Butler (21), Cappa Lodge, Sixmilebridge, Co Clare, died at Limerick Regional Hospital on November 16th, 2006, from a large subarachnoid haemorrhage, the court heard. She had worked as a security guard at Shannon airport.

Her family claimed the HSE had failed to properly diagnose she was suffering from the condition when she presented at the hospital just weeks earlier suffering with a serious headache.

Had she been properly diagnosed and referred for treatment after being admitted on October 6th, she would probably have survived, they alleged.

As part of the settlement yesterday of the family’s action for mental distress, the HSE apologised for the anguish and distress caused to the Butlers due to Louise’s tragic death.

The HSE also acknowledged there were failures and deficiencies which led to Ms Butler’s death and accepted her family did everything it could in the circumstances.

The settlement also includes a payment of €40,000 to Ms Butler’s family and was approved yesterday by Mr Justice Michael Peart. The action was brought by her brother James, Cappa Lodge, Sixmilebridge on behalf of the family.

They claimed they suffered mental distress and injury arising from their older sister’s death due to the HSE’s alleged negligence and breach of duty of care. The HSE had denied the claims.

The family claimed Ms Butler’s attended the hospital between October 6th-12th. It was claimed she was ill with a very substantial headache, which she had described as like “a hammer blow” to the back of her head, and photophobia.

She was discharged on October 12th without a CT scan being carried out. She was due to have a CT scan subsequently as an outpatient.

Despite the best endeavours of Ms Butler’s mother and the family GP it was claimed the scan was not arranged until November 13th. It was claimed Ms Butler never got the results of that scan as she collapsed the following day. The scan revealed she suffered a massive bleed in the brain and she died two days later.

It was alleged the HSE had delayed a CT scan which would have alerted medical staff to the existence of her condition. The family claimed their experts would argue, in October 2006, Ms Butler was suffering from a “sentinel” or “herald” bleed, which was a precursor to a large bleed.”

Information Source: The Irish Times 13/07/10

Did Not Attend

I recently wrote a post about ways to save our health service. One of the issues I spoke about was the problem of patients not turning up for out-patient appointments. I proposed that the high DNA (did not attend) figures in our hospitals were due to a lack of respect for our inefficient health service. The first comment I received in response suggested that the problem was most likely caused by patients not receiving notification of their appointments in time. I now have reason to believe that Ian is absolutely right.

It’s been 5 weeks since I last had an out-patient appointment with my surgeon. I was advised and given a prescription lasting two months. This new treatment failed within a couple of weeks so I was seen by my GP. He mentioned that he’d had a letter from the hospital detailing my treatment and saying that I would be reviewed again in 3 weeks. This was the first I’d heard about any review appointment so I joked with my GP that it was only the stuff of routine dictation and meant nothing. However when I became ill again 10 days later, my GP decided to phone the hospital himself to see if he could get an appointment. He was told that my name was already on the list for the next out-patient clinic in two weeks time (the surgeon was away in the interim) and that I would be notified by post. Again we laughed at the absurdity of a system that forgets to inform the patient.

I’ve still heard nothing and as the appointment is scheduled for tomorrow, I phoned the hospital today to query the appointment. It was confirmed that I was on the list for the morning but no explanation could be given as to why I’d not been notified. The fact is that had I not become ill since I last attended the hospital, I would never have known that an appointment had been made for my return. Through no fault of my own, I would have been registered tomorrow as a ‘DNA’  and my appointment which could have benefited another patient, would have been wasted.

Our health service is being bled to death by administration costs and it seems that patients no longer matter. What ever happened to the concept of patient-centred care?

No Sense of Outrage

A recent letter to the editor of of the Irish Times pointed to an accusation once made by the wife of a former US ambassador to Ireland who said that the Irish had “no sense of outrage”. This accusation is highly applicable to us as a nation when it comes to our toleration of a health service that is failing us. It seems that it’s not until we are confronted head-on with the failures within the service, that we wake-up to how inhumane and inefficient the system really is.

The letter continued…

“My recent experience of the A&E system was in the company of my elderly mother. A&E is like the Red Cow Roundabout. You need to go to an entirely different place but the ‘system’ dictates that everyone must first ‘congregate’ in A&E, regardless of whether they are an accident or emergency case, in order to get eventually – if they are lucky – to where they need to be in hospital.

My mother had a GP’s letter recommending her immediate admission to Mayo General Hospital. Yet for two days, in severe pain, she was forced to run the gauntlet of gross duplication (her medical details alone were demanded and written down by seven different people in A&E), lack of treatment, lack of privacy, lack of communication, lack of care, inadequate toilet facilities and a total lack of dignity. My mother died suddenly and unexpectedly a mere 32 hours after her ordeal in A&E.”

This person’s experience prompted her to ask some very valid questions…

“Is it not time to call time on the HSE as it is presently devised? Remove decisions on medical treatment and care from accountants and form-fillers to medical staff. Return the hospital management to the matrons and clinical staff who have the training to determine patients’ needs. Or, like the banking system, is the present system that governs the HSE all about money and greed — the same disease that has wrecked our economy — with the patient’s clinical care merely an appendage?”

The late Susie Long advocated on behalf of all patients to bring about change in the system which had failed her. Susie turned her own personal tragedy into a force for positive change. She succeeded in waking the Irish nation out of it’s stupor of indifference and toleration. Surely we owe it to her memory to unite to become a force for change and to continue her fight for proper reform of our health service? It’s time for the Irish nation to stand up and be counted and to prove that it does indeed possess a sense of outrage.

Source:  Irish Times online.

Rumpy Pumpy Medicine

An interesting case came before the Medical Council in Ireland this week. The first public hearing of a fitness-to-practise committee inquiry took place following a complaint lodged by a female patient. A  Dublin GP who used inappropriate and insensitive terminology, was found not guilty of professional misconduct.

The woman attended the GP complaining of lack of energy, difficulty sleeping and flu-like symptoms.  The doctor conducted a thorough examination and referred her for a brain scan for her headaches. In the course of the 30-minute consultation, the doctor asked his patient was she “next or near a man’s willy bits” in the last six months.  She was offended at this because she had already told him she was single. He then suggested  “rumpy pumpy” as one of the possible ways she might relax in order to help her sleep.  The woman later wrote to the doctor to say that she felt his language was inappropriate for a doctor. The doctor replied apologising unreservedly for the remarks and said his questions related to the possibility she might be pregnant or have a sexually transmitted disease. The woman felt his explanation was patronising as he had tried to justify his inappropriate terminology so she decided to lodge a complaint with the Medical Council.

The fitness to practise committee found the allegation that the doctor had used inappropriate and insensitive language proven but did not find this to be professional misconduct.

What’s your reaction to this story? Would you be comfortable if a doctor spoke to you in this manner? Was the patient right to complain? I’d love to hear your views.

Dementia is…

Dementia is an umbrella term used for a range of symptoms that manifest in a progressive decline in a person’s functioning, caused by degenerative disease of the brain. It is characterised by a gradual deterioration in memory and in the person’s ability to carry out everyday activities, make decisions, understand information and express themselves. It may also affect the person’s mood and personality. Dementia usually has an insidious onset, with most people developing symptoms gradually over a period of years. At present, it is not known what causes the different types of dementia. Medical research is ongoing throughout the world to discover the cause and develop new treatments. Put simply, dementia happens.

Alzheimer’s disease, the most common cause of dementia in Ireland, accounts for more than 50% of all cases; the second most common form is vascular dementia, which may be preventable. While the risk of dementia increases with age, dementia is not a natural part of ageing.

Early signs and symptoms of dementia:

Usually a person will display a number of these signs:

• Memory loss, particularly for recent events
• Difficulty in performing everyday tasks
• Changes in mood and behaviour
• Changes in personality
• Disorientation in familiar surroundings
• Problems with language
• Poor or decreased judgement
• Misplacing things regularly
• Difficulty solving problems or doing puzzles
• Loss of interest in starting projects or doing things

Facts and figures:

• There are currently more than 40,000 people in Ireland with dementia, with the number expected to be in excess of 104,000 by 2037 unless there is a medical breakthrough.
• Dementia can affect younger people; currently approximately 3,800 people in Ireland under the age of 65 have Younger Onset Dementia.
• Dementia affects the lives of nearly 50,000 people in Ireland who are involved in caring for someone with the symptoms of dementia.

If you are worried that a family member may be experiencing the early symptoms of dementia, you should contact your general practitioner (GP). The GP may refer you on to a specialist, such as a geriatrician, neurologist or a psychiatrist in the psychiatry of old age services, who will conduct a full assessment to try to establish the cause of symptoms. The earlier help is found, the better the family and person with the condition will be able to manage and cope.

For further information on dementia and on services, contact the Alzheimer Society of Ireland.

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.

Listen-up guys!

If you are aged 40 or more, you may have become aware of some changes in your physical appearance and general health such as increased weight gain, feeling depressed, disturbed sleep, loss of interest in sex. Recent studies have revealed that Irish men are reluctant to visit their GP with the these symptoms as they believe their symptoms aren’t serious enough to warrant treatment. Have you lost your lust for life?

Testosterone is the principle male hormone and while production declines naturally with age, some men’s testosterone levels decline to a level that may affect their overall health and well-being. When this occurs medical advice should be sought as it may lead to testosterone deficiency (TD). An early diagnosis of TD may mean that many of the early symptoms can be reversed and the more serious effects of non-treatment can be avoided. If left untreated, testosterone deficiency can lead to:

• Decreased bone mass that may lead to osteoporosis
• Decreased muscle size and strength, and increased weight gain
• Decreased virility
• Decreased facial hair/the need for regular shaving decreases
• Sparse or absent pubic hair
• Smaller/softer testes
• An increase in breast size

Testosterone deficiency is treated by administering testosterone, which is available in a number of forms including a colourless, odourless gel or an injection. Treatment of TD is proven to reduce the symptoms of testosterone deficiency and return testosterone levels to normal levels.

So guys, if you find you’ve lost your lust for life and these symptoms sound familiar to you, speak to your doctor and get yourself checked out. Get back on track. Life is too short to suffer needlessly.