Sleep Deprivation

May 15, 2008

Ever heard of sleep apnoea? The most common form of this is known as obstructive sleep apnoea (OSA). It is a chronic condition which causes poor quality sleep and results in excessive tiredness during waking hours. OSA can affect people of any age and of either sex, but it is most common in middle-aged, somewhat overweight men, especially those who use alcohol. During inhalation, the airway will collapse causing pauses in breathing for about 30 seconds, then the person usually startles awake with a loud snort and begins to breathe again, gradually falling back to sleep. OSA has the potential to have serious negative effects on a person’s quality of life and many people go undiagnosed. In order to confirm the diagnosis, it usually requires an overnight stay in a specialized sleep laboratory where sleep is monitored and measurements are taken while the person sleeps.

In Dublin, there is only one sleep apnoea clinic available to patients in the public hospital system and this is based in St. Vincent’s Hospital. There is a delay of at least two years for an appointment to see a specialist in this clinic and if sleep apnoea is suspected, the patient is referred on to the specialized sleep laboratory at the hospital to be monitored overnight. Again there is a long waiting list for an overnight bed in this unit. At present the sleep apnoea unit in St. Vincent’s Hospital is undergoing renovation and the old casualty unit at the hospital is being used as a temporary sleep laboratory.

A recent radio programme exposed major flaws in this temporary accommodation. The conditions sound horrendous. Firstly, the one toilet in the unit, is filthy and unfit for purpose. The unit is used as a pain management clinic during the day and by evening time, it’s unsuitable as a sleep environment. The windows cannot be opened due to noise outside in the corridor and patients complain that they cannot get to sleep due to the heat and lack of air. It is a shared unit for men and women, with little or no privacy. It makes no sense whatsoever to call it a sleep laboratory if the conditions are so bad that patients cannot sleep. And remember, these are patients who have been waiting for years to be monitored. Frankly, this is sleep deprivation of a different kind and it could even be called obstructive.

Just another example of bureaucracy gone mad, while patients continue to suffer.

You can listen to a podcast of the programme by using the link below.

That’s Life!

August 30, 2007

I heard an item on the radio this morning concerning an article written by the journalist Kevin Myers, in today’s Irish Independent. In this piece he refers to the perfect contours of the late Princess Diana’s nose which, when combined with her appealing eyes, made her into a real photogenic beauty. It started me thinking about the contours of my own nose and forehead which have been altered by recent surgery. My medical history is complex – I’ve had a lot of surgery, in various specialities and have the surgical scars to show for it – but none of these compare to living with a slight facial disfigurement.

I was admitted to an NHS hospital in northern England earlier this year to undergo a complex operation at a specialist Head & Neck surgical unit. This surgery is unavailable in Ireland unfortunately. I have a long history of serious sinus infection which has necessitated regular surgical intervention and intensive antibiotic treatment over the years. As a result of this, I now also (surprise, surprise) have a history of recurrent MRSA infection. The MRSA presented itself as orbital cellulitis following my last episode of frontal sinus surgery and this infection manifested into chronic osteomyelitis in the frontal bone of my skull. All surgical efforts to establish drainage from the frontal sinus had failed and despite intensive antibiotic treatment, I continued to develop abscesses in the bone close to the base of my brain. As this had an associated risk of developing into a brain abscess/septic meningitis, I was referred to the UK for assessment. Here I was advised that the most effective way to stamp out chronic osteomyelitis would be to have all the infected/dead bone removed, and an operation called the ‘Riedel procedure’ was recommended. I was fully informed that there would be a cosmetic disfigurement post-operatively and having considered my predicament very carefully, I finally agreed to proceed.

My little friend, the superbug, is thankfully still responsive to a tetracycline antibiotic, Vibramycin (Doxycycline), and this enabled me to obtain the requisite ‘all-clear’ from MRSA screening prior to the surgery. The operation itself went very well and was completed in just under four hours. My head was opened from ear to ear (zig-zag coronal incision), my ‘face’ was peeled back to the bridge of my nose and the anterior and inferior walls (bone) of both frontal sinuses were removed completely leaving a large hollow in my forehead. The margins of the frontal sinus along with the supraorbital rims were then ‘chamfered’ (planed) to make a gentle curve rather than a sharp step out of this hollow. This allows the soft tissue of the face to fall in and line the vacated frontal sinus area and improves the cosmetic defect which results from the procedure. My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in situ to minimise haematoma formation. I had no post-operative complications other than vomiting copious amounts of blood when in the recovery room – this had drained into my stomach during the surgery. Ten days later when I had the staples (59 of them) removed from my scalp, the incision was healing beautifully and I was well on the way to making a good recovery.

That all happened five months ago and I remain free of infection. The post-operative numbness of my scalp has almost resolved though it has left behind an unpleasant neuralgia which requires medication. The surgery has left a definite legacy – a facial cosmetic defect. The bridge of my nose ends abruptly where the large hollow begins in my forehead. I’ve got used to seeing my new ‘look’ in the mirror although photographs still tend to take me aback. I’ve also had to get used to having conversations with people, usually strangers whose eyes are firmly fixed on my forehead while they try to work out what’s happened to the contours of my face. I’ve had a few tactless comments but nothing that humour can’t handle. You have to keep things in perspective – I’ve been given a second chance at life – not everyone gets that chance. My surgeon has offered re-constructive surgery (a split calvarial bone graft/titanium plate) in the future but for the moment anyhow I’ve no wish to go there and certainly no wish to invite further trouble. And anyway, I’m proud of my war wound – my husband refers to it as the ‘bomb crater’- it was a hard fought battle and I’ve come through it still smiling 😀

I’ve just gotta face it – I’ll never be a Princess Di. But then, that’s life!

I am not a radio advert

August 14, 2007

I am a patient

I am an MRSA statistic

I am disgusted by the level of hygiene in Irish hospitals

I am sick of watching the bureaucratic HSE waste our money

I am tired of listening to apologies from Mary Harney

I am sad to hear of patients suffering unnecessarily

I am in awe of hospital staff who work hard despite their conditions

I am not in favour of a 2-tier health service

I am all for equity in health care provision

I am only one voice but I’m not alone

Planet Beverley

June 25, 2007

I don’t know what planet Bertie and Beverley are on but the rules there seem to be very different to the rules I have to follow. Beverley Flynn, T.D. in Mayo was declared bankrupt following the legal action she took against RTE, which failed. She subsequently was expelled from the Fianna Fail party after losing her libel action. Next we hear following the recent election that An Taoiseach, Bertie Ahern has her support as an independent deputy and that he would like to welcome her back into Fianna Fail “her natural home” once she settles her debts. And surprise, surprise, today Beverley announces during an extended interview on the News at One, that she has reached an agreement with RTE to settle for half of the costs involved and owes no apology to anyone. The arrogance of it is unbelievable! And when asked if she considers that she might serve in the Cabinet during the lifetime of this government, she replied “one step at a time – I’ve been through a tough time”. My heart bleeds for you Bev – yeh right! One thing has become abundantly clear to me however – I’ll have to get myself some Brasso to polish up my neck!

I must be dreaming

June 19, 2007

Would someone pinch me please. On the front page of the Irish Times today I read “HSE fails to spend nearly fifth of capital budget – The Health Service Executive failed to spend €97.7 million that was allocated to it by the Government for new developments and facilities last year, it has emerged”. Unable to believe I’m really reading this, I turned on the lunchtime news to hear Mary Harney, our Minister for Health, comment on the situation. “We don’t want to spend this money just for the sake of spending it” the Minister said.  Now I really must be dreaming I’m hearing this.

How about spending it just for the sake of saving some lives!  The mind boggles when you consider all the areas of the health service that are crying out for funding.  Just imagine what could be done with €97.7 million. Dream on!

A Way Forward – The Nurses’ Work to Rule

May 11, 2007

Yesterday the Minister for Health, Mary Harney, spoke to 400 members of the Irish Nurses Organisation (INO) at their special delegate conference in Dublin. She told the nurses that the Health Service Executive (HSE) was looking for a ‘way forward’ in this dispute – not a ‘victory’.  I’ve got a suggestion for you Minister.

It seems to me that the nurses have already achieved their goals with their ‘work to rule’ – with HSE picking up the tab. The nurses have reduced their working hours (while on the picket line) and they’ve stopped doing all non-nursing duties such as administrative work so that they can concentrate on their patients.

We’ve been repeatedly told by HSE that it’s costing €2 million per week extra (paid out of our taxes) to manage the Health Service throughout this dispute. In fact, this morning on the radio (Morning Ireland RTE 1) I heard HSE CEO, Prof. Drumm state that it’s costing €3 million per week. Has anyone heard HSE state ‘why’ it’s costing €3 million per week?

Surely, the way forward in this dispute is there for all to see?