Tuesday, 11 March 2014

The dangers of antibiotic overuse.

Soooo. I've just been in hospital with something that was totally preventable.

Let me lay out some context. 

Since March 2013, I've been struggling with recurrent UTIs (urinary tract infections). I've had some infections that have been further up as well, i.e. in the bladder - these infections are known as cystitis. The treatment for confirmed UTIs and cystitis is antibiotics. I've had about 18 suspected bouts of UTIs/ cystitis in the last year, which means I've been prescribed a fuck ton of antibiotics. However, not all of these were tested and confirmed, meaning I might have been treated with antibiotics inappropriately when the symptoms could have just been due to an irritable bladder as a result of previous infections. Certainly the urologists I saw prescribed me some low-dose antibiotics as a preventative measure (despite the many courses of antibiotics I'd taken previously). This was in spite of my protestations that I didn't want to take any more antibiotics and despite my suggestions of other options based on my own research. They insisted that the antibiotics were the only way forward. It was the most recent low-dose prophylactic course of Cefalexin that seems to have caused the issue that led to me being hospitalised. That issue being a Clostridium Difficile infection.

Clostridium Difficile, or C. Diff as it's widely known, is a bacteria which can infect the gut and cause some truly nasty symptoms. Those that are deemed susceptible are elderly people, those with weak immune systems, and those who have been on antibiotics. I'll describe my experience of it. 

Last week, I woke up one night in the most horrific pain I've ever been in. On a scale of 1-10, it was an 11. The pain consisted of the most crippling stomach cramps I've ever had. I've had bad stomach cramps before, but they've usually gone in 10 minutes and as soon as I've had an episode of diarrhoea (TMI I know, sorry!). In those situations it was like something I ate didn't agree with me. However, this time those stomach cramps lasted 3 agonizing hours and I was trembling, vomiting, and had about 7-8 episodes of diarrhoea with blood in. I was in so much pain I wanted to get an ambulance out because I was terrified something had ruptured and because I was desperate for some pain relief, but I live on my own and had no way of getting to a phone because I was so incapacitated. In the morning I was tempted to phone my GP surgery but I figured they'd probably fob it off as IBS since they seem to do that with most things bowel-related, in my experience! Also the episode had passed so there wasn't really a lot they could do. I still felt really unwell in myself, but I had an appointment at hospital that morning (heart-related) and didn't want to miss it as I'd have to wait months for another, so went to that. A bit later in the day I had another episode of diarrhoea but this time the only thing that came out was blood which was when I knew something was definitely very wrong.

I couldn't get through to my GP surgery so phoned 111 and asked what I should do. Based on my symptoms, they said I needed to go to A&E immediately and sent out an ambulance which was pretty mortifying because I really didn't feel like I needed it. I've been to A&E three times in the last three months and quite a few more times in the last few years and every time I've been treated like crap by doctors because my symptoms (usually heart-related) are invisible and they presume I'm just over-reacting. I always get sent home, told to take some pain relief and get over it.

An ECG was done in the ambulance (I think to rule out my stomach pain etc being caused by an aortic aneurysm) and they marvelled at my arrhythmia (yes, I have a heart arrhythmia too. The brokenness of this body is extensive!) and we also talked about my EDS as they hadn't heard of it before and wanted to understand it.

When I got to A&E I was actually given a bed straight away rather than made to wait in the waiting room - that's when you know that shit's going down. They initially suspected that I had a bowel bleed related to my EDS. They stuck in a cannula, took some blood, started me on some IV fluids and gave me some pain relief. 

I also had a doctor's finger stuck up my arse to make sure the bleeding had stopped which was obviously a lovely experience (my face when he did this resembled Munch's Scream.) My boyfriend was kind enough to come in and keep me company for most of the evening while I was stuck in bed attached to a drip and while they waited for my blood results (although I should add that I made him leave the room when arse-gate was under way). By about 11pm they'd decided I'd need to be admitted to the Surgical and Trauma Assessment Unit ward for observation and further tests. They didn't have a bed, though, so I had to sleep on an A&E trolley with the inevitable chaos of an emergency department surrounding me. That and being woken up every hour for obs was not particularly conducive to meaningful rest, but there you go. I was woken up again at 5.30am to be moved to the ward - and can I just say, so much love for the proper bed I was greeted by! Although not so much for the incredibly ugly 70s-style hospital decor.

Later that morning I was visited by about 10 medical professionals who all crowded into my room and stared at me in bemusement. I was told that my bloods were fine, but that I had ++++ ketones in my urine (I hadn't eaten at all since Wednesday and this was Friday morning, so that's unsurprising). They said I needed to produce a stool sample for further testing. I ate breakfast and that set off the bloody diarrhoea again, but on the plus side it meant I could give them a sample. For the rest of the day I was given more IV fluids and pain relief. They also gave me some IV Tramadol which was the biggest mistake ever. I've taken Tramadol orally before and it's done nothing (probably due to my absorption problems related to gastroparesis) - but IV? Holy fucking shit. I was tripping balls, man. Literally within about 30 seconds of me being hooked up to it I was off my tits. I moved an inch and everything would be spinning and I felt excruciatingly dizzy, not to mention nauseous. It was awful. During this time I phoned my boyfriend about him going home and getting me some stuff from my flat, but I don't think I made much sense... I barely remember the conversation! Luckily the nurse realised Tramadol and me don't mix so stopped my IV and let me sleep off the effects and I felt better later on. Generally though I still felt uber unwell and looked like shit; my complexion was kind of grey. Luckily by the evening they had the results of my stool sample and diagnosed me with C. Diff. I was relieved that at least there wasn't a rupture and that this was easily treated. The nurse told me that given my medical history and the amount of antibiotics I'd been taking, especially the Cefalexin, it's likely that was why I got the infection. Ironically, the treatment for C. Diff is a course of heavy-duty antibiotics! 

The reason antibiotics can cause infections like C. Diff. is because they basically kill off both bad AND good bacteria, which means that the gut flora (the bacteria that occur naturally in the gut to help you digest and assimilate food and nutrients etc) are knocked out of whack. This creates an environment where bad bacteria such as C. Diff. can thrive. Some people have small amounts of C. Diff. in their guts naturally (about 3% of people, I remember reading) and don't have any problems since there's enough good bacteria to outweigh it, but in those who have been on lots of antibiotics and ingested C. Diff. bacteria there isn't enough good bacteria to fight it off (especially in my case considering I've been on a LOT of antibiotics for the past year). The toxins and poisons released by the C. Diff. bacteria are what results in the symptoms you get with it. Left untreated for too long, it can lead to severe complications or death. As far as I'm aware, I probably had it for a couple of weeks before it really kicked off. I had been feeling a bit more unwell than usual for a while. This also seems to explain why, two days before I started getting awful symptoms, I went to the pub and got completely *wasted* on only 1 and 3/4 pints of relatively weak beer. I mean I'm a lightweight usually, but this was in a whole new league! There are mild and moderate cases of C. Diff. which cause fever, diarrhoea and stomach pain. Sometimes these cases can be treated by taking the patients off the antibiotics which caused them to be susceptible to the infection in the first place. In my case it was severe and the C. Diff. had caused colitis hence the blood, so it was imperative I started on the heavy-duty antibiotics (Metronidazole).

Mmmm C. Diff. bacteria. Lovely.

Once I'd been diagnosed with C. Diff. (and before actually, as a precaution in case I did have an infection) I wasn't allowed to leave my hospital room apart from to get some fresh air occasionally. I wasn't allowed to other areas of the hospital in case I spread the infection to patients who were vulnerable and susceptible to infection. It made me feel a bit like I was in prison, but I'd rather that than risk spreading it. 

I started on the Metronidazole on Friday 7th and was discharged on Sunday 9th. It's now the 11th and I'm feeling quite a bit better, but still a bit gross probably as a result of a combination of the remainder of the infection and the antibiotics I'm on. I'm making sure to take some VERY strong probiotics alongside my antibiotics to try and replenish the good gut flora I'm obviously so desperately lacking. I'm going to try and make strong probiotics a daily thing because I don't want to be in this position again - especially since now I've had it, I'm 20% more susceptible to catching C. Diff. again. 

It is very contagious so I'm having to stay away from places with lots of people, especially vulnerable people with weak immune systems. It's making me feel like a bit of a leper to be honest, but hopefully once I've finished this course of antibiotics the infection will have kindly fucked off.

I'm sharing this story because I think patients should be aware of the risk factors antibiotic overuse. ONLY take them if you REALLY need them. If you don't feel comfortable with being prescribed antibiotics, talk to your doctor about it and ask if there are any alternatives. If you do need to take a course of them, please try and get hold of some probiotics to take alongside them to avoid obliterating too much of the good bacteria in your body (especially if it's a long course or the antibiotics are broad-spectrum, targeting your entire body rather than one specific area). Probiotic drinks such as Actimel can be helpful, as can capsules and sachets. I'm currently taking Bioglan which have 20 billion bacteria of 8 varieties per capsule. I'm also waiting on a delivery of the most concentrated probiotics there are which have 450 billion bacteria per sachet! (I only plan on taking those ones short-term).

Before I go, I should also say this: despite the fact that it was the poor choices of some medical staff that likely resulted in my infection, all the staff I came into contact with in my resultant hospital stay were utterly lovely. The nurses, doctors and even the people who came in to give me my meals were just wonderful. I could not have asked for better care and I was treated with respect at all times. This is why I'm so grateful for the NHS despite its occasional shortfalls. (The food also wasn't as bad as is often reported! Or maybe I'm just really unfussy...)

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