Clinical Experience

I’m due to start my first official-as-a-medical-student clinical placement in a few weeks and today we found out where we were placed. And I got, DONCASTER. It is the furthest goddamn hospital from the university and it’s around a 2-3 hour commute to get there. Also, how the hell will I get to see my consultant to check I’m not dying when I‘m at least two hours away?!

On top of that, we get £5 a day to travel to and from our placements. I live 4 miles away from the train station, so its a £3 bus ticket, then a £5 return train ticket and then another £3 bus to the hospital. So whilst everyone else is probably making money, I have to get four buses and two trains a day on five pounds. And considering for the nurses placement at least, I have to work a full 8-10 hour shift with them, add on at 4 to 6 hours travel, that leaves me with on some days only eight hours at home. How is that fair?! As if my insomnia isn’t bad enough, and then I have to write up clinical cases too.

Someone said we were supposed to get accomodation, but there has been no mention of that. How will I possibly get all my stuff there?! My medication alone is huge, when you have to take something like 14 tablets a day and two inhalers, it takes up a lot of damned space. Thank god I don’t have a nebuliser anymore because I have no idea how I’d get that there as well.

I know this is just me being pathetic, but it’s always me getting the most retardly difficult places to get to. For my patient contact, we had to visit someone at home and I got fricking Rotherham, so while everyone else got to walk down a bloody street to see their patient, mine was over 15miles away. It’s just not fair when I haven’t slept for two days I have to navigate my way through the very confusing public transport of Sheffield, and the most other people can complain about is how hungover they are because they’ve been out drinking for about 5 days in a row. IF YOU CAN’T COPE WITH THE HANGOVER DON’T DRINK.

In other slightly less depressing news, the diet from hell is working. By basically living off foods that are absolutely not fun and are not coated in chocolate I can lose some of my steroid weight. At 5ft tall I managed to almost reach 10st over Christmas, which means I’ve gained nearly 3 and a half stone since leaving hospital. I ain’t going in to goddamn double digits.

I was about 9st 3 on my last weight in monday morning, hoping to be down to 9st by Feburary. I’ve set a goal of 8st 7 in April and 8st in June. A couple of years ago I worked at the University of Surrey for a summer analysing the nutritional content of young women’s diet as part of a study the univeristy were conducting. As part of it I built a program that can analyse diet, which although it is based on USDA data, as I wouldn’t find any comprehesive UK data, it’s quite good. I’ve been averaging around 1000 calories a day, meeting my RDA for both protein and sugar (mainly through fruit), while only eating a third of the fat RDA. It seems to be working as I have lost 7 pounds in two weeks, and whilst this sounds a lot, I easily gained 7 pounds in two weeks, so if you can gain it in that time you can lose it. I’m also managing to meet my RDA’s for vitamin C, B12, E and B6, as well as iron etc. So it’s going quite well.

I never thought I’d see the day when I’d be happy to see I weighed 9st!

Current weight: 9 st 2.4 (128.4 pounds)
Weight lost so far: 7.6 pounds
BMI: 25.1
Weight still to lose: 9.4 pounds by April

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It’s a New Dawn, a New Day

So it’s one week into the new year. I guess I can say my only resolution is to do everything I can to pass this year. I returned home from university about 3 weeks ago, and have since been working as a phlebotomist part time. Whilst this no doubt provides me with valuable experience and money I so desperately need to actually fund my education, I haven’t really found the time to do much medical work. Take today for instance, this has been my first day off work in ages, and I’d meant to write up some notes, but here I am, nearly 7pm and I’ve done nothing, nada.

It also doesn’t help that in the last few days I’ve been struck down by a cold which has no developed into a chest infection. I sound like I’ve got COPD! The azathioprine probably isn’t helping me fight this, to say the least. And I’m due the second swine flu vaccine next week. I really don’t want to head for the doctors though, because that will no doubt involve high dose steroids which I really really wish to avoid.

However, in more vaguely positive news, my steroids are now down to just 7.5mg! It’s actually amazing how different I feel. My sleep has vastly improved, but I doubt it could be referred to as normal. I tend to slip off about 1-3am now instead of the usual 3-5. I’m sure this will have a huge impact on my performance at uni. However at the moment, having to start work at 8am, and it being a bus ride away, I do have to get up at 6:30, a good hour and a half earlier than at uni, so I shall probably feel the full impact of this when I head back. I have also found my appetite much more within normal ranges, and whilst I doubt with Christmas binges I have lost any of the weight I had amassed, I don’t think I’ve gained any either.

A negative side of this is within the last month, I began to feel symptoms of my asthma and polyps returning, as I had not been bothering with the extra nasal and inhaled steriods whilst on such a large systemic dose. It did kind of shock me the first time I became wheezy, when I hadn’t had any symptoms for over 6 months, so I’d almost forgotten what it was like.

Another strange occurance woke me up a couple of days ago. I was still half asleep when I ran to the sink and started drinking from the tap because my throat was on fire. The only reasonable thing I could think of is I had acid reflux, but still it hurt like a bitch, and I still haven’t got my voice back.

I have to say overall things have improved, but having not really had any academic work in over 3weeks, I won’t really be able to tell until the pressure is back on.

I’m going to start dieting and posting how I’m doing. My aim is at first 8st 7 (119 pounds), but I’m normally 8st (112 pounds), let’s see how it goes! Weights will normally be measured first thing Monday.

Current weight: 9 st 10 (136 pounds)
Weight lost so far: 0 pounds
BMI: 26.6
Weight still to lose: 17 pounds by April

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New Beginnings

I’m not sure what this will become, but I am hoping that laying things down in writing will help me deal with the problems I’ve been having recently.

I guess I should start at the beginning. For me, I see the beginning not as my diagnosis but the appearance of my symptoms. It was about 3 years ago I started getting respiratory problems. Unfortunately for me, I was on holiday. I couldn’t sleep simply because I couldn’t lie down but for some insane reason I didn’t think anything of it at the time. I remember my family went out to the beach, couldn’t face it as I was too ill. While they were gone I had what was no doubt an asthma attack, just remember sitting on the bed, so out of breath and sweating all over, knowing that I could never make it the ten feet or so to the phone. There, I sat, waited and cried. It had started to subside slightly when my parents returned and after calling out a doctor, I  received a steroid shot and bam, good as new.

On returning to the UK, I was diagnosed with asthma, given an inhaler or two and sent on my way.

A year later, whilst walking home after one of my GCSE exams, it happened again. I felt out of breath but it didn’t seem serious. It was about an hour or two later, when my symptoms hadn’t subsided, I went to the out of hours GP.  Usual tests and then I was stuck on a nebuliser. Then it really went to hell. I stopped breathing before it could really do anything, I was on a bed in A&E when I finally became aware of my surroundings again. I had an english exam the next day, and I remember clearly my mother obsessing about me being able to attend it, remember being told I’d be out in an hour, then tonight, then tomorrow, then who the hell knows as I slowly declined. My hands shook with the amount of sabutamol I had inhaled and my heart raced. The ache in my ribs was torturous.

Then to HDU. Cannulas. Tests. Pain. I spent the first night bolt up right staring at a wall. I always remember that. I don’t think I moved more than my head for about 24 hours. Just thinking in… and out… I don’t think I really became truly aware of everything until I had use the toilet. Well, commode. The sheer agony of just standing to use it. I broke down soon after when I realised I couldn’t even wipe myself because of my cannulas.

A week later I was discharged with a short course of steroids, a new inhaler and a continuing diagnosis of asthma.

In the two years that followed, whilst I was never hospitalised, new and unusual symptoms began to appear. I had terrible urticaria, which slowly changed in its appearance over the two years. My legs would swell and become infected regularly. Blister and burn. I couldn’t walk. Sleeping with wet towels was my only relief, if you could call it sleep. Muscle ache so bad I couldn’t sit up. I used to wake up feeling almost like I’d run a marathon. Four hour baths and crying when I couldn’t get out again. My joints would ache too and then I became suspicious of a cold that had gone on far too long. Polyps. Then psoriasis on my hands. Stomach pain, random irregular vomiting. It would come out of the blue maybe twice a month. Then diarrhea, constipation. More swelling, infections, antibiotics.

This was all during the two years of my A-levels. I only 80% attendance, went to the GP about once a fortnight. Saw 4 different consultants. Paid a private one. Nothing. Just a damned abnormal FBC no one could explain and vague symptoms that could be anything.

Then on the day of my last exam, biology AEA, I woke feeling what can only be described as “off”. I went to my exam. Then to a GP appointment for the results of a coeliac test. One more stab in the dark. Negative.

It was on the walk home from this appointment that the agony started. The ache in my legs was indescribable. It wasn’t first time, but it was certainly the worst. It was only a mile or so, but I knew from previous experience that if I paused at all then muscles would stiffen and I would be left unable to even stand, let alone walk. When I got through the door,  I fell over and cried. Unable to stand, I dragged myself to the freezer and stuck my legs against the inside of the door. After three hours, it subsided enough for me to walk. I was supposed to go to a friends 18th that evening and after 4 weeks of exams, I had been looking forward to it. Determined, I got ready anyway. I’d sit the whole night if I had to.

On the way I became feverish in minutes. Stop the car. Vomit on the side walk.

For the next week, I was very nauseous but still eating. I would occasionally be sick and my legs regularly ceased to function. Doctors said it was probably just a virus. I went away with my friends for the weekend, and whilst I couldn’t walk for most of it, I still had fun. On the last day bruises appeared all over my legs, a strange purple rash I’d never had before. On returning, another GP trip. Another diagnosis, Henoch-Schönlein purpura. It would resolve itself in a month or so.

Nausea, diarrhoea, vomiting. Getting worse and worse. I went to a job interview at the hospital and passed out. Dehydrated, the unhelpful and clearly too busy doctor told me. Drink more. Helpful advice for someone who hadn’t eaten in over a week and was sick on average every hour. The only way to prevent it was to not put anything in my stomach. I hadn’t drunk anything that morning so I wouldnt be sick in the interview.

The week that followed all I did was throw up and sleep. Sleeping at least 20 hours a day. I had another consultant appointment. Too ill. My GP no longer suspected HPP and decided I needed more medical attention. A few anti emetic shots later, I went to the appointment. I was sick in the car.

The female doctor did the usual physical examination and then simply said she was admitting me. I needed fluids, drugs and a proper diagnosis. I was there for three weeks when I was finally diagnosed. I had X-rays, endoscope tests, skin biopsies, blood tests. Some more blood tests. I had to be cannulated for my antiemetics as I couldn’t tolerate it orally. To say my veins are bad would be an understatement. By the last week, they had been so abused, my cannula would block pretty much hourly. Each recanulation took at least three attempts. In one day I was cannulated 21 times. So what had caused all my problems?

Churg Strauss.

My repeated eosinophilia was finally explained. The gastrointestinal problems were from these cells attacking my GI tract. My rash from them attacking my skin. The asthma and polyps from attacking my nose and lungs. In this rare condition, eosinophils, one of the white blood cells, attacks your own tissue. Autoimmune.

The treatment? Simple, steroids. You should be fine. Unless it comes back, you don’t respond or it randomly gets worse and your heart fails. Cardiomyopathy.  Without treatment, the 5 year survival rate can be as low as 25%. Yay. I just love to see the positive side.

But that, haha, was only the beginning.

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