Anaphylaxis: The poem of Adrenaline.

Allergic Reaction

It started with an itch,

I never thought it would come to this,

A little rash on my right arm after washing dishes,

Antihistamine taken, to counter a skin reaction.

I took a seat to watch tv with my family,

All seemed fine till I looked down,

The rash moved from a small patch on my arm down my arm,

Now it's on both arms and it is itching,

Fingers swelling and Hives forming.

Worry starts to set in whats going on,

Then the game changes when my Philtrum swole,

Talk of calling NHS 24 squashed,

This no longer a nuisance its life-threatening,

Into the car, we pile,

 I kept my cool even though I knew what was happening,

As we drive my face begins to swell.

I was surprised by how cool I remained,

I see the worry in my family,

The desk takes my name but doesn't need to ask my problem,

Shortly the nurse calls my name to take me to triage,

We Bypass it and go straight to a bed in ED,

A junior Dr came to see me,

My throat hurts, it is hard to breathe through my nose,

He noticed dysphonia and goes to get his senior,

While he went away panic started to grip as breathing became harder,

My throat closing, not instantly but slowly like a vice.

Enter Dr Yvonne Moulds,

The junior Dr seemed anxious, I was starting to fear,

But she spoke to be in a calm tone,

Reassuring me that she was in control,

I was being taken to Resus as a precaution in case things went bad,

I was wheeled in, I was aware of what the room meant,

Resus was like ICU, it was not a place for 'healthy' patients.

Canula was to be placed for the drugs that would be needed,

however, Dr Moulds gave me the first dose of Adrenaline,

Explaining why I needed it and the plan going forward,

The calmness and reassuring nature of her demeanour stopped me spiralling out of control.

The junior Dr went to place the cannula in my vein,

Adrenaline shakes making it hard,

But the air flowed into my lungs as my throat opens,

My words to the Junior Dr, "You get two goes then your out.",

Perhaps e thought I was kidding but when I told him after his second fail no more,

He looked taken aback but I am no pin cushion,

Dr Moulds took over getting the line in.

I laugh as Dr Moulds asked me if I thought, a second dose of Adrenaline needed,

My response, "If you think I do then I do too, you're the Dr.",

The second dose, not the big impact the first one had,

most of the swelling was down but not all,

Antihistamines given between doses, Family allowed in now.

Calm and to spend a day in the hospital to watch for a biphasic reaction,

Most of the swelling down before I left the ED for the Combined Assesment Unit.

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I spoke with Dr Yvonne Moulds prior to writing this to make sure she was ok with it before I wrote this. Her calmness in this very scary moment in my life changed this from me being fearing for my life to almost being relaxed. Her quick reactions most likely meant my throat did not close fully though I think a few minutes later I would have been fully closed. It should be noted that from the rash forming till my getting adrenaline was about 25 minutes which includes a 20-minute car journey. I will next month be getting allergy tests to determine hopefully what I am Allergic to.

The NHS is filled with staff like Dr Moulds who save lives on a daily basis, whom you never hear about and never seek thanks or praise. These people are the heart and soul of the NHS. Anyone who knows me will tell you, I do not give praise lightly but the NHS is the sole reason I am alive without the many Drs, nurses and supporting services it has provided my extensive health issues would have overcame me.

So if you are British and you have had treatment from the NHS and it was better than you expected or someone did something which made the experience better, please write to them and tell them they did a good job because NHS staff get alot of complaints and little in the way of positive feedback. They do a wonderful job under some difficult pressures and restrictions.

Ode to ICU: A patients perspective pt1

My eyes open is my torment over,

Have I return to my life once more,

Why can’t I speak? Where is my voice,

Why is there a tube in my throat? Where has my strength gone.

What is this place I find myself,

Who are these people staring at me,

Nurses, Doctors and Family,

Oh thank god my nightmare is over.

“You're in ICU” is all that I parse,

I look and see faces I vaguely recognise,

Part dream, part reality. Unsure what is true,

Is this a delusion, confusion or the truth.

It is hard to tell what is real when your brain has been misleading you,

When you have to question all that is said to you,

Family tell you it’s ok,

Doctors tell you your on your way,

That it’s remarkable that you have recovered.

In this room where I lay so much action every day,

Bells, bleeps, people coming and going,

My family looking worried.

The tube in my throat very uncomfortable,

Pulling at my lips, but I am aware why it is there,

Raising my hand to get suction because I feel like I am drowning,

The nurse frowning saying that not much came up,

But doing it again when I insist this time moving the weight in my chest,

The relief you will never know, that moment of compassion you have shown.

Who am I

My name is Mark and I am to most Doctors an interesting case, why you ask because I have an abnormal number of autoimmune conditions, the blog title maybe gave you a clue. My immune journey started when I was about 14, I was 6'1" and about 133lbs. I looked like a skeleton my mum thought I might have celiac disease because it ran in the family. Little did we know what that set of blood tests would start, I didn't have celiac disease but I had an abnormal liver enzyme results at a level that worried my GP and got me referred to a gastroenterologist.

Now after lots of blood tests, ultrasounds, biopsy and other scans. The Doctors eliminated everything they could test for but where sure it was Autoimmune Hepatitis a diagnosis of exclusion, some of you might think that is a bad enough condition to have but a year later aged 15 I developed gastric issues having to spend a week in the hospital every 3-4 months. So back to blood tests, scopes  and biopsies and soon(ish) we had a diagnosis of Ulcerative Colitis over the next 7 years we tried a load of treatments steroids, azathioprine, Cellcept, foam enemas, Mesalazine and at the end an IV infusion that took a lot of paperwork on my doctors end but that I have no idea what it was before at the tender age of 22 I had to have a Subtotal Colectomy do to being refractory to treatment. This was the first time I ever thought I was going to die, prior to my surgery I phoned my parents from my bedside phone begging them to get the surgeon to see me because I was losing liters of blood out my bum (Or at least it seemed so) the surgeon was going to do the surgery on Monday (2 days)  I told him I would not make it to that and he decided to do it as an emergency operation the next day, this brought its own issues, the stoma nurse didn't work weekends so it was left to the surgeon to mark where my stoma should be placed and as I later discovered he marked it too low.

That said the colectomy started a stable time in my medical life, a time where for 2 whole years I was not in the hospital, a glorious and happy time for me. A time where I had no visits to the hospital and by all measures a happy time, I thought things might be turning for me but fate decided otherwise.It was the start of my issues with my stoma and over the last 6 years I have had 3 refashions and 1 stoma relocation as well as a few bowl twists which resulted in a few, week or more stays in the hospital. But the start of the of my issues with my stoma coincided with a new immune issue Immune ThrombocytoPenia aka ITP. Which is where your body produces antibodies against platelets which leads to them being destroyed in the spleen and liver. I went through the normal treatment options high dose steroids, IV IGg, Revolade and Romiplostim. For the first few months, my platelet count sat between 0-20  thousand when the normal is between 150-400 thousand, this caused me to have one or two-hour long nosebleeds and blood in my urine,  the first six weeks following my diagnosis was one week in the hospital and one week out. This was the scariest of my diagnosis because every time I would get petechia I would think I would have one of my hour long bleeds or if I had a nosebleed I would worry that it might not stop. I went through a lot of treatments the last being Romiplostim which didn't seem to be working I was raised and raise my dose to the maximum so they prepared rituximab but when I was in the hospital getting prepared for the severe suppressing of my immune system to be told the blood drawn while placing the cannula came back with a platelet count of 95,000 a count I had not had since before my ITP had activated, they repeated the test with the same results. So I was sent home and followed up on it has not been a condition without its ups and downs but I am and have been for a long time now stable, it was one of the few times when the light at the end of my medical journey was not an oncoming train.

ITP was the start of my second wave of immune issues as over the last 5 years I have developed autoimmune neutropenia, lymphocytopenia and sclerosing cholangitis. While I may not have a lot of neutrophils or Lymphocytes I am blessed to not catch more infections than I had before but when I catch one it can quickly overwhelm me and put me in hospital. This means that whenever I feel the start of an infection I have to get to my Dr and get the antibiotics.

In my next post, I will talk about my time in ICU which started in late December 2015 and had me waking up in the middle of January 2016 and the long journey of recovery and the issues that came from it