Archive for the ‘My illness’ Category
Illness December 2009
December 22nd, 2009 Posted 1:20 pm
Illness December 2009
PART 1 Not just a sore throat……….
December 22nd 2009. The date will stay in my mind forever…………
This is the day I awoke with a sore throat and itchy gums. ‘Great’ I thought a sore throat just in time for Christmas. I thought a couple of Paracetamol, honey and hot lemon, and hopefully I will still make the party on Christmas Eve. Next day it was much worse, and by the 24th I could hardly swallow my own saliva. Time to get antibiotics, and as we don’t have a G.P. here yet we went to the local hospital in General Toshevo. By now my glands were the size of satsumas, my tonsils were huge and I was in a great deal of pain (although nothing like what was to come)
The Dr had a quick look at my throat, commented on the size of my tonsils, then prescribed 3 days antibiotics, vitamin C, Strepsil lozengers and a mild analgesia called Analgin which is similar to Paracetamol.
Needless to say I missed the party and this was to be the last day I ate until January16th!
7th December. I had finished the antibiotics and now my gums had started to swell and I had developed ulcers in my throat. By this time Analgin had no effect on the pain so we went back to the hospital. They took a look and said it was beyond their expertise so I should go to a larger hospital in the city - Dobrich which is about an hours drive. We were given a prescription for Dexofen which is stronger than Analgin.
We arrived at Dobrich hospital and I was seen immediately. They inserted an I.V. line and took a blood sample.
I underwent the most horrific examination while we were waiting for the results of the blood test. It involved a throat examination which I know was necessary but the ENT specialist grabbed my (ulcerated) tongue with gause and poked an instrument down the back of my throat making me gag. This only lasted about a minute but it was the longest minute of my life!!
The blood results came back and showed a white blood cell (WBC) count of 1.04 (normal range is 5-11). Because of this they would not treat me and said I needed to see a haematologist urgently. They sent me to a major hospital in Varna which is 11/2 hours away. We set off with the address but no person in particular to ask for when we arrived. Just ask to see a haematologist.
Before we left Dobrich we called at the chemist and asked for antibiotics which to my surprise we were given without question. So I had 6 days Azithromycin and some Dexofen which is a stronger analgesic than Analgin.
Varna is a very busy city not easy to get around by car and parking is a nightmare. We finally found the St Maria hospital, and at this time I was in agony hardly daring to swallow neck head and ears so painful I could hardly speak. Ron went into the hospital to book me in leaving me in the car as we were illegally parked and once I was registered he would come back and move it.
We were devastated to be told that they do not have a Haematologist at that hospital. They suggested another hospital in Varna, so without a map and by asking for directions we arrived at the second hospital. They did have a haematologist but he was on holiday until 6th January.
It was now 3pm and I had not had a drink since 8am, so we stopped at a garage and bought bottled water which I really struggled to swallow.
Ron spoke to a local man who suggested we go to the main hospital and gave us directions.
I expected to go to the main hospital but the receptionist directed us to an attached clinic. Once there we had to sit and wait in a crowded waiting room to be seen by a triage Dr. I was nearly passing out by this time, and as I still had the Venflon in my arm from our visit to Dobrich in the morning Ron used this as a bargaining tool to get me seen faster. This worked and I was seen by a Dr who had a quick look at my throat and referred me to the ENT specialist.
We tried to explain how severe the pain was, but the Dr spoke no English at all and seemed uninterested in the pain. Then…. my worst nightmare. I saw him lighting his little bottle of meths which could only mean one thing – the dreaded hold the tongue with gauze and poke an instrument as far down the throat as possible. I said to Ron ‘I can’t do this again!!!’ Bless him, Ron tried his best in Bulgarian to get me some analgesia before the procedure, but it fell on deaf ears. I wanted to cry but I know from past experience that crying hurts like mad. I survived the examination and thought that now I would get some pain relief. No such luck…… The Dr gave us a prescription for I.M. antibiotics which they said I should take home and have a local nurse administer it. We told them that we don’t have a local nurse, but I am a nurse and could give the injections myself. I just needed pain relief. They refused to let me administer analgesia by injection myself and so after all that we left with what was basically a useless prescription.
We decided to try to get some more Dexofen which again was easy as it should be on prescription.
We arrived back home exhausted and no further to getting a cure.
I spent the following 5 days in bed. On New Years Eve we were supposed to be going to a party at the local bar and all our friends were disappointed that we couldn’t be there. I told Ron to go anyway as all I wanted to do was take pain killers and try to sleep. He did go foe a couple of hours, then at 11.45 he came home, bundled me into the car and I sat in the car outside the bar to watch the fireworks and everyone came to me in the car to say Happy New Year. It was very touching as everyone wished me well, but after 20 minutes I needed to get back to bed.
The Dexofen originally took about ½ hour to kick in then the pain was reduced, but not gone for 3 hours. They are meant to be taken 6 hourly.
As the days passed they took longer to have any effect after taking the maximum dose and the effect would wear off in 2 hours.
I would sit in the early hours of the morning desperately waiting for 3am when I could take the next dose. As the pain became more intense I would take them half an hour earlier each time. I began to feel like a drug addict waiting for the next fix.
Poor Ron was helpless, trying to get me to drink the carrot juice that he had spent hours preparing failed as anything other than water stung my mouth and the pain was becoming unbearable. I would just sit rocking, or sometimes I would get angry and kick my legs and stamp my feet!
On 2nd January things had become intolerable. The Dexofen was not having any effect and we were worried about the amounts I had been taking.
I was becoming quite confused, and Ron decided it was time to go back to Dobrich hospital for some help. There was just one problem – I would not get out of bed. It was more that I could not get out of bed. I had no motivation or energy. Eventually, I did manage it and off we went to Dobrich hospital. Ron arranged for a friend of a friend to meet us there. She is Bulgarian and speaks good English. They explained how much pain I was in and at last I was given I.V. analgesia. At this point I nearly passed out with relief or the effects of the I.V. I am not sure,
I was taken to see the ENT specialist again. The dreaded examination loomed but I had gotten past caring by now. They could have told me that they were going to cut my head off and I would have happily agreed.
My symptoms now are massively swollen glands in my neck. Grossly enlarged tonsils, bright red inflamed gums, ulcers and abscesses in my throat, on my tongue, lips, between my teeth, on my lips and inside my cheeks – oh and inside my nose. My ears ached my neck ached and my head felt about to burst. My ulvula was inflamed and had adhered to my right tonsil. All my teeth ached and everything was throbbing along with burning pain, stabbing pain which was constant and relentless.
Of course they wanted to send me to Varna hospital again, having told Ron that I was very ill and needed to go to a large hospital as they were still concerned about the low WBC count.
We wanted to get the pain and the raging infection under control first and sort out the cause once I was stable.
Ron asked ‘are you telling me that you cannot treat her here? In the end it came down to money, and although they had beds available no ward wanted to take me because of the cost. Ron was enraged at this and asked to see the hospital administrator. He also said that if he had to take me to Varna in this condition he would hold them responsible if anything should happen to me, and he wanted a letter stating that Dobrich hospital was unable to treat me.
Although Diana (the interpreter) was present Ron made a fantastic job of getting his point across in Bulgarian. He has a little pocket translation device which helps if he is searching for a particular word but on the whole he gets by on what he already knows and I am most impressed.
Eventually, and because Ron persisted a bed was found for me – on a ward for the dying- but I didn’t care as I thought I was dying too. My throat was so swollen I could swallow only half a teaspoon of water and I worried that if I should vomit I would choke to death. Sometimes in these early days I worried that I would die, and sometimes I worried that I would not.
Looking back I think I said so someone I would rather be in labour for 7 days than have this pain for 7 days.
PART 2 In Hospital
One thing really surprised me. The environment in hospital is cool to cold at times and heating is only turned on for limited times during the day. For this reason the staff wear theatre scrubs and a dressing gown!! Honestly they really do look like dressing gowns. They are thin fleece, calf length with patch pockets. Seems to be that the senior staff wear blue and the juniors a maroon or brown colour. I could hardly believe my eyes at first – I thought that the patients had taken over the hospital like some mad ‘Carry on’ film!!!
The ward was a long corridor with 10 rooms down one side there were 2 or 3 beds in each room. On the left of the corridor were clinic rooms and offices etc.
I was admitted to a large room with one bed. Diana was still with us and told us we would need to get a few things for my stay. We were expected to bring the usual soap towels etc. but we were surprised to find that we needed to buy a thermometer – and toilet paper! Also as they don’t supply drinking water we had to buy some bottled mineral water.
The room is large with one bed but space for one or tow more. The walls are pained white with stains on them, and by the window there is a radiator underneath a long shelf. All around the window frame and on the window wall is black mould.
There is a small T.V. on the wall and underneath a box for payment to watch.
My bed is a narrow steel bed frame, with no height adjustment and no back rest. The mattress is just a piece of 3’’ foam (with bits missing as though someone has bitten lumps out of it. It has no plastic covering, just a sheet. It’s a bit like lying in a trough because there is a dip in the centre.
The ‘quilt’ is a double layer of blanket inside a cotton case. The nurses never make the bed, and in the 13 days of my stay the sheets were not changed. Thank goodness I wasn’t incontinent.
The room has a sink but hot water only between 7-9 am and 7-9 pm. The cleaners come for water to mop the floor and they seem to empty the buckets of dirty water here too. There is a litter room containing a toilet and shower. I made the mistake of looking into the toilet pan when I first arrived – I have tried to avoid doing so since it is black at the waterline and looks scary.
The shower works, but it is more like a wet room with no shower tray, and the shower does not have a shower head, so water comes out like a tap.
The only chair in the room for patient or visitors is a plastic padded one with holes in it and bits of foam sticking out.
The locker and drip stand should have been in a museum. The locker was made from tin and was filthy. The drip stand rusty painted white and rusted over again.
The window faces a block of flats but there are no window blinds curtain or screens, and physical examinations take place without any consideration for modesty.
I was admitted on Saturday 2nd Jan and on Sunday morning the chief consultant came in from his holiday to see me. I don’t know why – perhaps it was because of the fuss Ron made to get me admitted.
On the first morning when I could not eat, breakfast was ½ a packet of dry biscuits. Lunch was a piece of dry bread and supper was a piece of cheese. I was thankful that I wasn’t hungry!
Nursing care is practically non existent. I never had my blood pressure taken during my stay. I was expected to take my temperature and let then know if I had a fever. I actually took it 4 hourly and recorded it so that they could see any pattern as there are no observation charts for patients.
Patients don’t have wrist tags or any visible form of identification, the nurse will just say your name then administer the medication.
There is no ‘nurse call’ buzzer and unless they come to do a procedure the nurses never just look in to see if patients are O.K. Usually 4-5 hours pass without contact.
The day begins at around 5.30 am with the first medicine round of the day and blood samples are taken, then no one comes into the room until 12-1 pm with a piece of bread for lunch. Medications are given again at 5pm – 6pm, then no contact with nurses until 9pm when they bring bottles for urine samples for the following morning. These are not collected from patients’ we must take them to a table half way down the corridor.
Not once during the night does a nurse call in to make sure that all is well, so for most of the time many hours pass without contact. Usually a medic will call in for a few minutes around 9pm. The ones who don’t speak English just have a look at the temperature that I have written down, then leave without speaking. I do make conversation with the nurses and cleaning ladies.
On the Monday our Bulgarian friend came to visit and suggested a schedule for pain relief for me and eventually I managed to get some strong analgesia.
I was so relieved that the pain was diminished and was about to sleep, when I was called to go for an ultrasound scan. I had to walk to the department which was a fair way away, and I don’t remember how I managed to walk there given the strong analgesia I had just been given by injection.
I was told to bring tissues or toilet paper to the scan to wipe my skin afterwards as they don’t provide this for patients!!
I must have been rolling around on the ultrasound table like a beached whale as the medication had definitely kicked in and I was struggling to understand the instructions to turn this way and that. Again no modesty cover and bright fluorescent lights – I was hoping that Ron wasn’t looking too closely – it would put him off for life!!
Although nursing care seems to be lacking the medical care could not be better. I was seen by 8 different Consutants including 2 ENT specialists Haematologist, a Dermatologist ( because when my illness started what was a tiny scratch hardly noticeable and should have healed within a couple of days had spread and was not healing but looking worse. I used this wound as a kind of barometer – it appeared to improve along the same timeline as my other problems.
The Chief consultant comes to see me every 2 days. He calls me Queen Elizabeth (Queen of England) and he speaks fairly good English, and as I begin to feel better we share a joke.
The nurses are all good at venepuncture although the only time they use latex gloves is as a tournoquet, not on their hands which incidentally they never wash.
Nurses have massive amounts of jewellery, earrings, dangly bracelets, big necklaces, rings on every finger and nail polish! What would Matron say??
Nutrition does not appear to be a priority, and although I was to be nil by mouth for 16 days I was given 500 ml glucose daily and vitamin C. Strangely, the only person who took an interest in my diet was the Haematologist. Her main concern was that I should avoid milk until my mouth is completely healed, and she prescribed gel for my gums which was very good and did reduce the pain. The Haematologist speaks some English but I had to laugh when she told me to coat my mouth with the gel, then ‘do not eat for 2 years’ – I am assuming she meant 2 hours!
The I.V. antibiotics twice daily and a small dose of steroids meant that after the first few days I began to improve and from Wednesday I began to feel better each day. Friends came to visit and I could actually speak to them which I wouldn’t have been able to do on Monday.
At one point the nurses asked me to provide a sputum sample. Thank goodness I didn’t have a cough I can’t begin to imagine how I would have managed to cough with my throat so incredibly painful. I told then I have no phlegm, so the next day they bring the jar again and still I tell them I don’t have any phlegm. Next day I am given medication three times daily. I ask what it is for and they say something about antibiotics so I assume it is Nystatin or vitamin B. It turns out it is an expectorate so that I can cough up phlegm…. I told one of the Drs who speaks a little English that I don’t need to expectorate and thankfully she stopped the medication.
A ‘Cell mate’
On the third night at 10.30 pm I was just about to go to sleep when the doors banged open overhead lights went on and an elderly lady patient was brought in. They made no attempt to be quiet and the light was on and off all night as they came to examine her, put drips up etc.
I was worried because the lady was coughing and as my immunity is compromised I was desperately hoping that I didn’t catch a cough. Worse was to come when the lady began having diarrhoea, and because the bathroom light does not work she had to leave the toilet door open in order to see. The smell was putrid!
They gave the lady a little pot to provide a sputum sample, this was about 4am. Good grief you would have thought she was trying to fill a wheelbarrow with the stuff!!
I had a chat with her the next morning. She is a lovely lady and not staying here as she is being transferred to Varna Hospital for more tests.
She was examined stripped to the waist with no consideration for her privacy.
On the 8th night another patient was brought into the room. They put her into the bed vacated by the previous lady without changing the sheets or pillowcase. I was amazed. This lady is in her thirties, and doesn’t speak any English but I think she is too poorly to make small talk. She too coughed and coughed from the minute she arrived at 8pm, so once again I had little sleep, and fear of catching a cough.
At around 7.30am we could hear a great commotion in the next room. A man was screaming very loudly in distress or pain, and then he began crying and sobbing. There were a lot of other loud voices then suddenly all went quiet leaving us wondering what had happened to the poor man.
That evening my drip was going through too slowly. They tried the usual, squeezing the tube altering the position of my arm etc. then she held the bag above her head and hep presto the drip ran through quickly. I motioned to the chair intending to lower my body as the drip stand would not extend higher. The nurse misunderstood and stood the drip stand on top of the chair which I held onto with my other hand for 30 minutes until the bag had gone through. – Only on Bulgaria!!!!
The lady in the next bed coughs constantly day and night and doesn’t cover her mouth. When Ron came we decided to have a walk to the snack bar and around the Hospital grounds so that he didn’t have to sit in the room with the coughing. I really hope that I don’t develop the cough it would be a disaster.
Nearly better Home in 4 days
Monday 11th January 2010.
Sore throat is 99% healed. Gums about 95% healed. They are still wrinkled where they have been stretched with the swelling, and a few craters where the ulcers were, but only a minimal amount of discomfort.
I was given an I.M. injection this morning with the I.V. antibiotics which is unusual. I have never had an injection at this time of day before. I asked what it was but couldn’t find out. The nurse was insistent that I should have it so I did. I was also given 3X 20ml medication directly into the venflon at 9am. This too has never happened before as meds are usually given all together at 5.30am. Perhaps this is a good sign and I will be allowed home soon.
The lesion on my hand which I am using as a kind of barometer to see how well things are going inside is healing well. No scab now and looks nice and pink (apart from when it’s cold in here then it turns purple)
Chief consultant came to see me with what he calls ‘the big visit’ (a ward round with Haematologist, Drs and nurses) I can go home on Thursday morning if everything is O.K. as my WBC count has increased slightly. He said you are a very lucky and beautiful lady Queen of England. He went on a bit embarrassingly saying how beautiful I am and called me a sex bomb. Some of the Drs present could speak English so they could hear all this!! Only in Bulgaria #2.
Dr Injeravo (female registrar) came to see me at 9pm she apologised for the sex bomb comment made by the Consultant. More importantly she told me that my WBC count is now 4 – fantastic news. They think that the white blood cells were suppressed by the Sumomed (Azithromycin) oral antibiotic that I was prescribed at the start of my illness, and because the infection was so severe I should have been admitted for I.V. antibiotics immediately.
The infection score has fallen from 100 to 50. Not really sure what that means but it is going in the right direction! She said I have been very lucky as I was so toxic when I was admitted it was ‘very very serious’.
Looking back I think that I was probably a day away from toxic shock and I don’t think I could have survived another car journey to Varna. Thanks to Ron being so persistent I got help in time.
Oh no!! another room mate
Wednesday 13th January. Another bed was brought into the room. It is in between the lady by the window, and me by the wall. There is about 18’’ between the beds now. This new lady brought sheets and pillows with her, and spent ½ hour carefully making up the bed. Guess what? She is coughing as well. She says she has pneumonia. Hope it’s not TB. She snores too at about 1000 decibels. Looks like I won’t be getting much sleep again.
Help – get me out of here!!!!!
Discharge day
Ward round at 9am. Consultant said blood results look good.
Br Berzole (Haematologist) came to see me. She gave me a slide of my latest blood sample. She told me that I can come back to see her every day if I feel unwell or have any pain.
I was sent for a chest X-ray. I had to find it on my own as they didn’t send a nurse with me, just told me in Bulgarian that it is on the 4th floor. Found it O.K. and had X-ray done.
Had to wait for results to be entered onto my report – I will have a copy to take home.
We have to pay bed tax of about 4 lv per night. Even though I have been here 12 nights I will still pay for 10, and in the future should I be admitted to hospital anywhere in Bulgaria I won’t have to pay this tax again.
I have a prescription for 10 days medication. Prednisolone and Ranitidine.
I have an appointment to see the Haematologist Dr Berzole in 2 weeeks to have blood tests.
Went to chemist for Prednisolone but after trying 8 different chemists we were told that it is not possible to get prednisolone in bulgaria, so we had to go back to the hospital to try to find a Dr who would prescribe an alternative. We expected that this would take quite some time. I was feeling cold and tyred by now so Ron dropped me off near to the hospital entrance and went to park the car. I was waiting for him to park when walking towards me was the Haematologist. She recognised me and came up to me. I had the prescription in my hand and was able to tell her that we could not fill the prescription.. She immediately took me into the nearest chemist and after speaking with thE Pharmasist she re wrote a prescription for an alternative steroid which thankfully they had in stock. This coincidental meeting saved us hours, and soon we were on our way home.
The final diagnosis is Toxic Infection syndrome and Agranularcytosis which means a serious lack of a certain type of white blood cells.
I will need further investigations to identify the underlying cause. perhaps here in Bulgaria or possible back in England. We will make a decision after the follow up visits.
Follow up visit
Visit to haematologist on 1st February 2010. Blood test showed that white cell count is normal, so no need to return for further tests unless illness returns. Great relief!
Will still need to have tests to determine underlying cause but this is not urgent. Will wait until we visit the U.K. and see G.P.
Posted in My illness