Friday, 4 April 2008

Therapeutic Benefits of Blogging

Its just after 4:45 a.m. and I woke up about 30 minutes ago with an itching feeling all along the incision line running down my right thigh. I had been lying on it asleep for the last 5 hours or so and could not easily get any relief.

The previous afternoon my favourite District Nurse (who I had not seen for about 3 years) arrived with a trainee to change the dressing over the incision and to remove any remaining sutures that had not dissolved. There were about 6 and from the description given to the trainee they had been pulled relatively tight and had overgrown slightly with granulations. It sounds worse than it is and the Nurse was able to remove them skilfully and without any sense of tugging. Earlier that morning I had begun to experience an itching along the incision line which I put down to (1) the drying out of the adhesive of the 2 long dressings covering the wound and (2) the taut drying effect of cut tissue under repair. (I had begun to think about the possibility of applying lanolin or similar to soften the affected skin.). This feeling was relieved by the change of dressing and removal of the remaining sutures and I thought no more about it.

I have already described how of all the circles that describe my current existence the one related to my time in bed is the smallest of all. So despite the expanding world that resulted from reinstatement of a foot plate to the power chair described in an earlier post I woke at 4:00 a.m. wanting to get some relief from the itching but unable to move sufficiently until I got out of bed. What stops me at present from extending my world outside of the house are the thresholds of both front and back doors, Each would require lifting my right leg over a ledge about 3 inches high while striding toward the zimmer frame 1 step down. Although I do think I will manage this in a few days time I did not feel so confident at 4 in the morning!

The realisation that to all intents and purposes I was "trapped" inside the house caused a mild panic attack and feelings of claustrophobia. As a result I felt compelled to get up and after making a cup of tea in the kitchen, moved to the study where I Was able to open a window and hear bird song through the conservatory that the study window opens onto. A cool breeze also helped and the feeling passed.

It was 4 1/2 years ago that I had my first ever experience of claustrophobia. The cause was being inserted into an old style MRI scanner closed at one end, with little air flow. I slid in, on my back, head first toward the closed end. The width and height of the tube into which I was inserted was not much bigger than a coffin. Only my feet protruded into open air. I needed to stay still inside this tube for around 30 minutes while the scanner thumped and bumped around me. Fortunately a follow up scan a few months later made use of a more modern scanner which was only a couple of feet in depth and was open at both ends so my experience should not cause anyone else nightmares as the chances are there are not many of the old style scanners still in use.

The reason I needed the scans is a sorry tale in itself. I had already waited over 3 years for the operation to revise the right hip joint that had lasted about 23 years but had loosened and protruded into the pelvic cavity. (This would require a degree of remodelling of the pelvic bones to restore the damage that had occurred.) I had complained about the long wait and had an unsatisfactory exchange of letters with the local hospital. When I was eventually admitted I did have some doubts as to whether my treatment would be affected by complaining. As a result I think I was more anxious that I had been for any previous operation.

The night before the operation my heart rhythm was abnormal and required a single tablet (amiodorone)to restore normal sinus rhythm. All heart monitoring both immediately before and after this lone event were normal. (I have since discovered that about 1:10 cases of atrial fibrillation are one off events and need no further intervention once corrected) The operation was postponed and I was started on the standard therapy of warfarin, which thins the blood. I was required to attend a clinic on a regular basis to monitor the thinning effect of the warfarin and for the level to be adjusted up or down until a satisfactory balance had been found. The operation would be re-arranged once a satisfactory level of warfarin therapy had been established.

In the event within 1 week of starting on warfarin I was admitted on a Saturday afternoon as an emergency with symptoms of renal colic. I was placed under the care of the urology department and given oral morphine to alleviate the pain. On the Monday morning my Haemoglobin had dropped to 4.2 (A normal value for a male is around 14) it became obvious then that I was suffering a massive bleed into muscles in my back and this was pressing on urethra and kidneys - thus causing the colicky pain (the Soas muscle was the one affected in this way). Fortunately the warfarin was stopped immediately once this was realised and I was given a dose of Vitamin K which helps the blood to clot and prevents serious bleeding. Heart traces again showed that I had no problem and it was agreed that I should have no further blood thinning regime.

The clinical judgement to start me on warfarin was standard practice and the clinicians concerned (even in the light of its consequences for me) have said they would have to do the same again. I know that warfarin therapy continues to be one of the most fraught and hazardous of medical interventions and that what is required is a decision making strategy that works out for the best overall even if not in specific cases. However there is no escaping that this is yet another example of an iatrogenic (caused by doctors) condition that I have experienced and could have done without.

I could also have done without the claustrophobic feeling brought on by being inserted into an old style closed MRI scanner which the urologists insisted on before pronouncing an all clear for the orthopaedic surgery. The surgery in turn resulted in post operative sepsis and the resulting and recent filleting of my right leg from which I am currently recuperating.

With that realisation I have not only come "full circle" but fortunately I have also managed to put behind me the claustrophobic feelings that caused me to get up so early this morning in the first place.

I had not fully appreciated the therapeutic benefits of blogging until now!

No comments: