Category Archives: MEDICAL MATTERS

ME IN 2014

7th December 2015

Dr Kelly Hamill

North Bellingen Medical Centre

58 Wheatley Street

Bellingen NSW 2454

Dear Dr Hamill,

RE: LYNNE SANDERS-BRAITHWAITE

MRN: 130 02 61

DOB: 19/10/1949

BACKGROUND:

  1. Chronic liver disease secondary to chronic hepatitis C (CHC) and previous excessive alcohol consumption.  Child Pugh score A5, previous episode of decreased level of consciousness and peripheral oedema, chronic hypoalbuminaemia 26 g/L, mild elevation bilirubin 22 umol/L.  INR 1.4, platelets 48 x 109/L (chronic suppression), normal bone marrow biopsy previously.  Dr John Gibson, RPAH.  Ongoing moderate hepatitis ALT 56 U/L.

1.1            Chronic hepatitis C (CHC) genotype 1A, viral load 5.6 log IU/mL likely contracted through intravenous drug use in 1972, treated in 1997, no ongoing injecting drug use or Opioid substitution therapy.

1.2            Previous excessive alcohol use until 9/1997 now resolved.  No ongoing alcohol use.

1.3            Hepatitis B core antibody positive, hepatitis B surface antigen negative.  Hepatitis B surface antibody 54 IU/ml consistent with previous exposure with ongoing immunocompetency.

1.4            Hepatocellular carcinoma screening, November 2015; cirrhotic liver with splenomegaly, no liver lesions., organs otherwise unremarkable.  November 2015 alpha-fetoprotein 13 ug/L.

1.5            No previous bone mineral density.

1.6            No previous dietician reviewed albumin 26 g/L for nocturnal protein supplementation.

  1. Previous cardiomegaly with no specific diagnosis.  Echocardiography November 2015 normal LV size and systolic function, mild to moderate dilatation of left atrium, mild pulmonary hypertension, ejection fraction 64%.
  2. Morbid obesity.  Weight 100 kg.  Height 152 cm.  BMI is 42.8.  No previous dietetic intervention.

MEDICATIONS: Frusemide 20 mg daily, Spironolactone 50 mg daily and Salbutamol prn ALLERGIES: No known.

Thank you for referring Lynne to clinic regarding her chronic liver disease secondary to chronic hepatitis C (CHC) and resolved alcohol excess. She is a 66-year-old woman living independently in Urunga with significant history of bereavement and health crisis during 2014, which nearly resulted in death.  Since that time she has improved significantly and been able to resume home life independently. She has not previously had specialist liver review.  She is known of CHC for many years and nominates intravenous drug use from 1972 onwards as the likely source of infection.  During the period 1972 through 1987 she consumed alcohol and used intravenous drugs and was able to control substance abuse initially with IV substitution therapy and eventually through Narcotics Anonymous to avoid all ongoing issues with drug and alcohol since that time.  She has not previously had therapy for CHC. 

Lynne’s health issues in 2014 were described as decompensation of her cirrhosis in the setting of severe pneumonia which resulted in loss of consciousness and ICU care for several weeks and involved significant fluid overload. Since that time, her fluid overload has mostly resolved and she has no ongoing features of encephalopathy that previously troubled her.  Her other health issues relate to dyspnoea and morbid obesity; I believe these to be linked.  She is morbidly obese with BMI of 42.8 and has significant difficulty moving with this weight.  She has not undertaken exercise or diet programs and has no previous referral for bariatric surgery. She was previously described as having cardiomyopathy with dilatation of the cardiac changes, however her most recent echo does not demonstrate features of cardiomegaly and has normal left ventricular size and systolic function. Her echo shows mild pulmonary hypertension which may contribute to breathlessness, however I feel that her muscle bulk is likely to be quite modest in her body which is requiring significant exertion and I believe her breathlessness relates to both her liver disease and her obesity rather than cardiac or respiratory function.  She is not previously known to have ischaemic heart disease.

On examination, Lynne is obese with a soft abdomen and no evidence of ascites. She has splenomegaly and otherwise unremarkable abdomen with minimal tenderness. She has very mild peripheral oedema and few other stigmata of chronic liver disease. Her respiratory examination is unremarkable without crepitation at the bases. She had dual heart sounds which were faint. She had no signs of encephalopathy. Blood testing from November 2015 shows moderate elevation in ALT 56 U/L with other enzymes elevated, deranged liver synthetic function with albumin 25 g/L, bilirubin 22 umol/L, INR 1.4. She had profound thrombocytopenia 39 x 109/L with normal haemoglobin and normal iron studies. She has recent testing for HCV infection with genotype IA, viral load 5.6 log IU/mL and evidence of previous exposure to chronic hepatitis B with HBc antibody positive in the absence of other markers of ongoing infection. Ultrasound of the abdomen performed in November 2015 shows a cirrhotic liver with no evidence of hepatic lesions, splenomegaly and no note of ascites present. Her alpha-fetoprotein was marginally elevated consistent with her level of elevation in ALT. She has not previously had gastroscopy and has never had upper GI haemorrhage.

Lynne is reluctant to have antiviral therapy for her CHC and is unsure where she would like to be treated should this became available. The standard of care in 2016 for genotype IA infection would be three months of oral antiviral therapy using either Viekira Pak or Harvoni both of which are due to became available through the PBS over the coming months.  Liverpool Hospital treatment team consist mainly of nursing and medical staff with significant experience that are dealing with advanced liver disease and this would be an appropriate environment for Lynne.  This is a long way from home and presents significant logistics complications.  I am happy to work with local services in Coffs Harbour or in the Bega area where her son lives should treating physician be available.  In the meantime, I have asked her to alter her diet to involve high protein supplementation nocturnally (for instance, Sustagen in milk prior to sleep), a low salt diet low in other carbohydrates to try to reduce her weight.  I will seek advice on diet solution for Lynne by involving the dietician from the Royal Prince Alfred Liver Unit who has specific skills in this area. Certainly, salt free diet will benefit her with respect to fluid overload and to this end I have introduced Spironolactone 50 mg daily to assist in loss of fluid.  I would recommend water based exercise such as walking around the shallow swimming pool to assist with weight loss. I think that prophylactic banding of varices should they be present would be ideal.  However organising gastroscopy may be complex and I have not addressed this as yet. Lynne needs bone mineral density study and should have vitamin D supplementation with or without osteoporosis care if indicated. I frequently use Zoledronic acid annually and for osteoporosis care. I think that Lynne has intermediate prognosis from her cirrhosis and may benefit from control of her viral infection, however with the current profile of obesity she may struggle to overcome her significant health issues. She requires ultrasound of the abdomen every six months to assess for new lesions related to hepatocellular carcinoma and six monthly alpha-fetoprotein as a standard of care. I will be happy to see her on ongoing basis and/or provide support to treating physician who may review her regularly.

Yours sincerely,

Dr Scott Davison

Staff Specialist, Gastroenterology and Hepatology

Liverpool Hospital

cc              Clinical Information, Liverpool Hospital

cc              Gastro file

SEPSIS ON MY MIND

BY ZOE C. 

Another hand full of pills
Another time I’ve lost all will
Another yelp as I move
Another promise times will improve

Another scare as I lose my sight
Another battle to try and fight
Another series of painful tests
Another long well needed rest

Another day
Another deep breath
Another reminder of the love surrounding me
Another loving message from my family
Another blessing in disguise
Another friendship found for life
Another…..

DOCTOR. HOME AND KIDS.

The Doctor is a sweetheart. However, it was as I expected. He listened looked at me and told me to come back in 2 weeks.

I shed a tear. Something I rarely do.

I told him I have PSS but he had never heard of it. 

So I came home. Well, first I met Kaybee at Grams. Se is living in the same horror movie as me. But she is older, deaf and hasn’t lived alone like me. 

Then I came home and had hoped to go to Aldi with the Girls but I am still far too weak. 

Some things are beyond words because the words do no good.

I have 2 fans now from Kaybee and the flat is sweet and cool. 

Now miserable though I am at the moment and fully worn out, I am also lucky enough to have sustained a few ways of thinking and feeling for a year or more that keep me doing dandy.

One is ACCEPTANCE in a way I did not expect. And an awareness that it has actually been a damned fine life that I have led.

A freedom from feeling that I should, could or need to – fix anything for anyone. 

A peace of a strange kind is usually with me. A kindness to my Self. An affection for people.

Most of the time I am free of Fear and Discouragement. Didn’t expect that.

Common antibiotic doctors say could give you organ failure | Daily Mail Online

New guidance, published this month, argues for severe restriction of the drugs – and for both patients and healthcare professionals to be made aware of ‘the disabling and potentially long-lasting side effects’.The drugs in question are fluoroquinolones and quinolone antibiotics. They work by targeting an enzyme in the cell of a bacteria which stop it replicating its DNA. By not being able to carry out this process, the bacteria are destroyed.These antibiotics are very effective, but are able to penetrate tissues throughout the body, including those in the nervous and musculoskeletal system. This can cause damage to normal tissues and result in many complications.

Source: Common antibiotic doctors say could give you organ failure | Daily Mail Online

THE WEEKEND IS DONE – A SPIRITUAL SUCCESS

I am home and almost unable to walk. I was thinking I felt pretty weak and the doctor just rang and said there is something amiss in my bloods and urine and I am to come in on Friday. I am relieved because I feel really very poorly. 

SUSTAINING me is the truly beautiful weekend which was rich in joy. 

My little girls just brought my macaroni and cheese up and stayed and played. We love those times.  The moon is out and looking good.

One of the delights of my life is the visits from the Little Ones and our chats and rambling discussions. The Doctor called twice today to say that the bloods and urines are abnormal. Candida is present and something in the blood. I am to go in on Friday. I have red cellulitis patch on the back of my leg and heavy fluid. I feel very very poorly and sometimes  it makes me sad.  I never truly expected to be driven into the places of the Spirit where I now dwell. Never really expected to be wondering whether I could keep breathing for another day or walk or eat. And I definitely didn’t expect that I would find a way to see richness joy and beauty in these times. 

SICK

This morning I took myself to the Hospital. My leg is swollen and very red and hot. Cellulitis. My breathing is very congested and I am extremely weak with nose bleeds. So I too myself up there and got Dr Luke. He is a little brusque but efficient. He has me on 2 strong antibiotics and got chest xray and bloods. I am really very ill now. It is a struggle and I get frightened. 

The Doctor on Duty seems a little brusque but is rather good and when I spoke of Sepsis he understood. 

SOON. STRONG. SHORT.

Said he re treatment. Very strong antibiotics. 

My niece was on a TV quiz show tonight and she won together with a very old family friend. I found out that the damage to my IPad is only minimal $20 and maybe an hour to do. Pretty sure a little 8 year old finger pushed it in accidentally. It dont matter. 

I have stopped coughing. I do not want to eat at all. I am not thirsty. I am simply fucked.

Leigh Sales on her year of horrors: ‘I want to look this right in the face’ | Books | The Guardian

“I had such a terrible year in 2014 with a lot of stuff unravelling. Then at the end of the year with the Phillip Hughes story and the Lindt cafe siege – they both were just so rattling and disturbing. The combo of what I saw every single day on my own show and what had happened to me – it just really pulled the rug out from under me and I needed to try to get a sense of security back,” Sales tells Guardian Australia.Liane Moriarty, Fiona Patten, Krissy Kneen: books to read in October Read moreAt the end of her very bad year, Sales decided to take control in the way she knew best: “The tool I reach for is just asking a lot of questions, trying to understand and drilling down into it. When I started writing, I wasn’t entirely sure it would be a book. I just started talking to people and it went from there.”Sales spoke to people about the worst day of their life – a day that may have started off in an entirely ordinary way.The resulting book – Any Ordinary Day – is about trauma, resilience, faith, grief and how people accommodate unexpected loss. It’s a moving and sensitive account of the profound and irreversible shifts in our inner life when tragedy occurs.

Source: Leigh Sales on her year of horrors: ‘I want to look this right in the face’ | Books | The Guardian

Mike Maranhas | The Way I See It….

Hi. My name is Mike Maranhas. Welcome to my website. I am an author and a blogger and must ask you three questions.What’s the most difficult decision you’ve ever made?How did you reach your conclusion?How did you feel afterwards?I inquire because Two Weeks in Winter is my response to these questions. A memoir with the tension of a thriller, the book reveals the horrors known as ARDS (Acute Respiratory Distress Syndrome) and Sepsis, the most difficult question I have ever answered and the far reaching, unforeseeable consequences of my decision.The theme of the story is that hope always exists via faith in Jesus Christ. Please let me explain.Life can change in a micro-moment.My wife, Bela, a strong-willed business woman, fractured her leg, requiring minor surgery. It seemed like no big deal to us since, seven years earlier, Bela had undergone two brain operations after suffering a ruptured aneurysm.However, shortly after the leg operation, Bela developed a cough, sore throat, then fever. Within seventy-two hours after surgery, Bela clung to life through an oxygen mask in the ICU, her organs failing, for an ailment doctors could not identify.But Bela refused to be placed on a ventilator. I knew she strongly feared suffering cognitive damage due to having endured previous brain trauma. I also knew that she didn’t want me in a position where I, potentially, would be responsible for taking her off life support.After a long, emotional discussion, Bela reluctantly submitted to artificial respiration. She did so for me, our love, our marriage…but for two weeks only and not a second more. I promised to honor Bela’s request. Bela placed absolute trust in me.For two weeks I endured extreme stress, exacerbated by a chronic condition, while making excruciating decisions. Though weak in faith, I could turn nowhere but to God for guidance. Yet, in doing so, I became the means through which not just highly improbable, but miraculous good manifested.Two Weeks in Winter is a riveting story about the triumph of faith over fear, pain, illness and death. An experienced, award winning novelist, I wrote the memoir to share with people my evidence for hope, while entertaining them with a memoir that reads like a thriller embellished by romance, mystery and humor.

Source: Mike Maranhas | The Way I See It….