Week Three in Kings: Discharge and Clostridium Difficile

Monday 27th August to Sunday 2nd September 2007

Thursday 30th August to Sunday 2nd September 2007

I have a nice sleep-in to 7.40am on my first day of freedom and have my usual breakfast but struggle with the thick toast we have at home. I walk up to Janton’s for my paper at 11am and drop into the Rodgers for some coffee. Funny having coffee for the first time for well over six weeks, but it is proper filter coffee as ever with Jim and Cath and works well with my taste buds. I admit that it is a bit of a try-out as I have no idea what it would be like. I am back on my regular lunch menu - Covent Garden soup, pastrami and Ryvitas - but no salad yet as I am still neutropenic. I am still a bit wobbly so Tina came back from work to drive me down to the RSCH for a blood test arranged for 3pm. Great news - I break through the neutrophil barrier with a count of 1.1! My full blood results are - Wbc: 1.5; Neut: 1.1; Lymph: 0.4; Hbn: 9.2; PLT: 83; and CRP: 12. My weight is 75.5kgs.

My diarrhoea has returned so on Friday morning I go to see Richard Cook for a prescription for seven days of Metronidasole. This is not good news as, not only has the C-Difficile returned, but I cannot drink alcohol for the next 12 days! While I with Richard I also get a prescription for a supply of Fortisip build-up drinks and then I walk round to the Swallows and deliver Dris’ Moroccan melon to them for Anna. I think Richard might have thought it was for him!
We had a very quiet weekend, simply resting, doing nothing and having no visitors either. It was just what we both needed. We celebrated the return of a certain amount of appetite with fillet steak - Clive Miller’s finest! I spend as much time with my feet up as I have a lot of oedema.

Wednesday 29th August 2007

I am awake and doing Sudoku from 5am for the second day running. But lots of catarrh and coughing up phlegm - and some sneezes too! After 30 minutes of the heat pad, my morning blood sample is offered up by my right arm with no difficulty, as opposed to yesterday. For the fifth day running my weight is 75 kgs. That is with a pretty good breakfast and two cooked meals a day, plus three Fortisip drinks. I am advised by Staff Nurse Helena to keep building up my weight over the weeks ahead as the likelihood will be for me to lose weight post transplant. Sounds like good advice to me plus a daily diet of Fortisips to look forward to! My blood results today are - Wbc: 0.86; Neut: 0.60; Lymph: 0.25; Hbn: 9.1; and PLT: 64. So small but steady progress with the neutrophils and we are aiming for my discharge for later in the day. Tina is here at 4pm. I am packed and ready but have to wait to get the all clear on my thumb from Kat at 6pm and then my medicines, including 14 days worth of the three anti-biotics. At last I escape at 7.30pm after a total of just short of six weeks incarceration! We have a good run and are home at 9pm. It’s so good to get home again, but I have left hospital with two unwanted “presents” - a bad cold and Clostridium Difficile!! - not exactly a “healthy exit” plan!

Tuesday 28th August 2007

My weight is 75 kgs again. My early morning anti-biotic bolus is quite uncomfortable - not really unexpected. Despite the heat pad Jinky cannot get blood from me this morning and Kat decides that alternate days will suffice. I would prefer to know what my counts are every day, but recognise the practicalities once again of the “trying to get blood out of a stone” syndrome. Because of my awkward left wrist I have a right handed wash, after which I notice that my thumb “wound” is open, tempting me to do a little squeezing and up pops another small piece of foreign matter looking like a tiny black headed grub. I wait to be seen by Kat and a new registrar (Dr) Jane who ease out what could be the tip of a rose thorn followed by a small piece of tissue - or something. I wonder is that everything now? I am told that a decision may be made to change me to oral anti-biotics this afternoon. I go for a routine x-ray - apparently this happens every week to all the patients on this ward. My 2pm bolus is equally uncomfortable as earlier. After several days of extra effort I have managed to completely catch up with my blog, made easier thanks to my habit of making lots of notes! Talking to Matthew on the phone, he checks my blog on the internet - my last entry is dated Friday 15th June. So I am over ten weeks out of date!

I am told that my diarrhoea sample from Saturday has shown that I have the infamous Clostridium Difficile infection - great! Frances gives me an explanatory leaflet and I am seen by Kat. Because the symptoms were gone in two days, I do not need to have any anti-biotic treatment. However the infection will remain in me for 14 days, so I must be even more meticulous with hand washing after using the toilet - the alcohol-based hand cleanser in ineffective in killing off the spores. Apparently the spores are very hardy and can be transported to and from patients, etc. by the hands. It is likely I have caught it because I have been on anti-biotics, altering the normal bacteria in my bowel and allowing Clostridium Difficile to multiply. However it is not always very clear how it gets there in the first place. If I get a return of the diarrhoea I must get the anti-biotic Metronidozole from my GP - probably a seven day dosage. Lets hope that doesn’t happen. Because of the recent promising developments with my thumb, Kat has also decided to take me off the intra-venous anti-biotics and put me on to oral. I have Flucloxicillin, Amoxycillin and Augmentin three times daily, starting this evening. She will check how the thumb looks after three doses, ie late afternoon tomorrow, with a view to my possibly being discharged then. To my immense relief I have the cannula removed from my wrist in the evening, so that I can move my left hand without the stabbing discomfort of the last 24 hours. I finish “Rough Crossings” -what a brilliant book!

Monday 27th August 2007

It’s August Bank Holiday, the weather is good, as it’s been for the last two days and forecast for tomorrow as well. My cough and cold seems slightly better and the diarrhoea has gone. My weight is 75 kgs again this morning. I see Dr. Vidya and she removes some “stuff” from the hole in my thumb. In the middle of it is a piece of thorn! At last! Maybe now it can start healing itself. The not-so-good news is that my neutrophil count is down to 0.41. My full blood results are - Wbc: 0.80; Neut: 0.41; Lymph: 0.38; Hbn: 9.6; PLT: 51; and CRP: 14. I have a celebration Guinness with my lunch on the strength of the thorn removal. I have a good chat with Michael, the ward volunteer, in the afternoon. I have been increasing the number of knee bends I am doing for my exercises and am now up to 15. It doesn’t sound much but it is hard and quite painful, so I guess it is doing me some good! My cannula becomes too painful for me to have my evening anti-biotic, so it is removed and replaced by one on the inside of my left wrist. This is an awkward place and very uncomfortable, as any movement hurts. However the first dose of anti-biotics goes in painlessly. I have felt that the filling on one of my lower right molar teeth has shifted position in the last couple of days, but could not work out was has actually happened. This evening, with a little help from my thumb nail, out pops a crown! It feels like I now have an enormous gap in my back teeth! - and an urgent and expensive visit to the dentist as soon as I get home. At least it has happened now and not while I am having my transplant!