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Little Leviathans: Monsters and Saviours That Will Kill You

This is not a happy post.  It is not a light and frivolous post.  But this is an important post, maybe the most important one I have written.  You see,  I am afraid that there is a war coming.   It won’t be a war with guns, bombs or missiles.   It won’t even be a cool war with conspiracy theories, robots, aliens or guys in iron suits.  No, I am afraid that this war will be fought internally, individually and against heart wrenching odds.  It will be wet, phlegmy and pale as death.  There will be no Geneva conventions in place to attempt to control atrocities, and no regard for gender, age or innocence.  Our enemy is faster, more agile, and more versatile than we are.  Some of them come in numbers too staggering for the brain to comprehend.  And in this on going war the enemy also has a track record of beating us…in fact; we have been winning in the on going battle only in the last 100 years or so.  But maybe the worst part of all is that it is not just the direct enemy that threatens us, but our own attempts to combat it, both of which can and do kill us. 

The threat I am referring to the growth of resistant bacteria and the toxicity of the drugs that we use to treat them.   There is a plethora of reasons to be afraid of this, starting with basic facts, but we as humans have an almost unlimited capacity to ignore unpleasant facts…. that is until it hits home, or it is too late.  But sometimes (and only sometimes) a personal story can make a difference, either in the form of retained information or in helping change behaviour.  It is for this reason that I have decided to share my personal story. But first let me set the stage by giving you some ominous stats.

 

The Attack of the Single Celled Monsters

The World Health Organization is in something just short of a blind panic about the increase in resistant strains of bacteria.  Here are just a few titbits from the very scary fact sheet that they released…

 

  • About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths.
  • Infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death.
  • Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
  • A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
  • Inappropriate and irrational use of antimicrobial medicines provides favourable conditions for resistant microorganisms to emerge, spread and persist.
  • The achievements of modern medicine are put at risk by resistant bacteria. Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised.

I put the last bullet completely in bold, because if this doesn’t scare you then I don’t know what will.   Think about it.  This means that all those annoying illnesses that we now poo poo as no big deal (because we can treat them with antibiotics) can suddenly morph into the perfect storm.  Childhood illnesses become lethal again.  STD’s are serious business.  There is no small case of bronchitis, and so on and so forth.  And that’s just the tip of the iceberg.  Let’s not even think about what happens to the treatment options for those with the big diseases.   So it’s not without cause that the WHO is freaking out.  We should all probably join them.

What is really disgusting is that we brought this on ourselves with the overuse of antibiotics.   You know the drill, you go to the doctor with a sore throat and, even though it’s most likely viral, he gives you an antibiotic…”just in case”.  We all know this is illogical.  Antibiotics don’t work on viruses.  Nor are they likely to be prophylactic against a secondary bacterial infection that you may or may not contract.   But we have all been guilty of taking them anyway.  And this would be fine if we were only putting ourselves at risk.  But the result of all this is that we are killing the “normal” bad bacteria.  The only ones that remain are the superman bad bacteria, and with no “normal” ones there to compete with, they are the ones that propagate…and spread.   This is the heart of “adverse selection”.   

On top of the over prescription of antibiotics, there is agribusiness …with its propensity for using antibiotics for just about everything.   A shocking 80% of antibiotics produced in the US alone are used on farm animals.  The reasons for this are to promote growth and the counteract for the fact that many of the animals are living in disgusting environments.   Thus the term “mad cow” begins to take on new meaning, but I am getting off topic.

So all that’s the “Bad News Part 1”, now for “Bad News Part 2”…the drugs that are used to treat us for these sort of bacteria infections can and do kill us.   They do this with more regularity that anyone probably wants to know about.  According to the Agency for Healthcare Research and Quality, an arm of the U.S Department of Health and Human Services, “adverse drug events (ADEs) result in more than 770,000 injuries and deaths each year and cost up to $5.6 million per hospital, depending on size”.  And that, my friends, is only what is being reported. 

What is equally scary is that it is almost impossible to completely predict who will have adverse reactions and what medications will trigger them. Why? Because clinical trials are conducted on limited numbers of people under controlled conditions.  They don’t test the broad spectrum of humanity.  As a result, the real side effects of medications are only discovered after people start using them.  In essence, the public beta tests them…just like with software updates.    If that statement doesn’t put the fear of God into you, then you have never used a computer and you live on an island somewhere, in which case you are not reading this. 

And just in case you happen to be thinking that one only gets adverse drug reactions to the “big and scary” drugs, let me assure that’s not true…and dangerous thinking to boot.  All sorts of drugs have been implicated in ADR’s, including but not limited to, antibiotics, analgesics or pain medications, electrolyte concentrates, cardiovascular drugs, sedatives, anticoagulants or blood-thinning drugs, gastrointestinal drugs, antipsychotics, diabetic medications, antihypertensives, antidepressants, diuretics, hormonal agents, antihistamines, and the list goes on and on.  In my particular case, the drugs that caused a potentially life threatening reaction were a combination of antibiotics, anti-nauseates and Demerol.  For anyone who has ever had any surgery, you will know that this is a very common combination.     Which brings me to the point where I tell you my story.  For those who don’t like to read personal, or uncomfortable stuff, you should skip the next entire section.

 

Up Close and Personal with The Enemy

Up to this point, I have been giving you facts and theories, but anyone over the age of 6 has probably become fairly de-sensitized to this sort of thing by the media and the glut of “gloom and doom” journalism. But as I said above, sometimes the story of someone’s actual experience can cut through the jaded nonchalance.  So, I will now share mine.   Why do I do this?  Because if I can prevent just one adverse drug reaction incident by giving someone the information and paranoia to question the drugs they are taking or being given, then I will consider it more than worth the discomfort of disclosure.  However, I will warn you that the following might not be appropriate for the squeamish, or the skittish. 

In September of last year, I went into a hospital on Hong Kong for a hernia operation.  After two pregnancies during which I grew to roughly the size of a whale shark, I had a diastasis in my abdomen that you could have driven a truck through.   So, I went in to get it stitched up.  While this is not open-heart surgery, it’s not a walk in the park either, so I did my research before hand.  I chose a surgeon that I trusted and went in with only minor apprehensions.  The surgery itself went quite well, and I was allowed to go home after a few days, with the drainage tubes still in.    “Drainage tubes” are just about as disgusting as they sound.   And I was required to empty them of blood and yucky fat type material several times a day, and then swab everything down with alcohol.  I did this diligently because I am neurotic about such things.  After two more days, I went to my doctors office to get the tubes removed.  I was delighted with this because the tubes were creeping me out in principle and it was hard to sleep with them in.  So far, so good…but that was the last of “good” for weeks to come. 

The day after I got the tubes out, I started to feel weak and sick.  Not just a little weak, mind you.  It was more of the “I can’t get out of bed or even sit up without hyperventilating” variety of sick.   At some point, I turned to my husband and said “We have to go to the hospital, right now!”. A quick call to the doctor and she was out the door to meet us there.   I could barely stand, let alone walk, so my husband pretty much carried me downstairs and to a taxi.  When I made it to the hospital, my blood pressure was sky high and my pulse rate even worse.  I had no fever, but I never get fever.   By the time they got me into a room, I was also vomiting.    My left side, where the tube had been was red, hot and inflamed.   My doctor put me on an I.V. immediately and started a general antibiotic drip while I vomited into a plastic bag.   Imagine having the flu and add in feeling like the top of your head is going to blow off…and that’s about how it felt.  So all of this was bad, but not nearly as bad as I was going to feel later.  

At this point, my doctor did something that might have actually saved me from, …well, from worse.  As they didn’t know the exact bacteria infecting me, she decided to re-insert the tubing and flush out my abdominal area…thus physically reducing the bacterial load.   At this point, I felt so sick and out of it that I barely noticed.  The only thing I remember was watching a yellowish / whitish chunky looking liquid being sucked out of me by a vacuum in the head of my bed.   At this point, they started me on two antibiotics, Ciprofloxacin and Metronidazole (Flagyl) and gave me something to help me sleep.   The Flagyl would come back to haunt me but at the time I nodded off blissfully. 

 Over the next couple of days, I got better.  The doctor came in daily and flushed me out via the tubes.  At each “flushing” less and less chunky stuff came out.  On day 3, we got the test results back and determined that the bacteria were of the MRSE variety.  That’s sort of the second cousin of MRSA.   At this point, there was a bit of a freak out on the part of the hospital.  They immediately put me in quarantine and everyone started wearing gloves, masks and gowns when in my presence.   As I was feeling much better, I basically found this somewhat amusing. Also, they cleared out my room mate, which meant that I had a private room at no extra cost.  So I had no problem with all of that.  What was to be a problem was that they put me on a new antibiotic. 

Sometime around midnight of the 4th night I was in the hospital, a nurse came in to give me Imapenem, which was one of the two antibiotics against which my little strain of bacteria was not resistant.  This was in addition to the Flagyl that I was already being given.  At same time, she gave me Zofran for nausea and Pethadine (Demerol) for some reason that is still a bit unclear to me.  I think it might have been to help me sleep.  However, not 5 minutes after being given this, I started to feel really really weird.   It began with a feeling of heaviness in my chest, quickly followed by heart palpitations.  I was a bit nervous about this, but heart palpitations are not unknown to me, so I just tried to go to sleep, but without success.  After staying up most of the night, I felt worse and weirder.   My husband came in that morning at around 7 am and we had some breakfast.  While we were in the midst of eating an oh-so-delicious bowl of hospital oatmeal, the nurse returned and administered the cocktail of antibiotics again.  I am not sure if she made it to the anti nausea medication because at that point all hell broke loose in my brain. 

Friendly Fire

I will try to explain what happened to me over that next 8 hours but, to some extent, it defies description.  It started with a feeling and a sound.  The feeling was as if I was falling back into my own head…like my own brain was being sucked into some kind of vortex.  If anyone has seen the movie “Trainspotting”, it was a little bit like the scene where the character overdoses.  The sound in my head was, and is, indescribable.  But if there is a soundtrack to the approach of the four horsemen, then I am pretty sure it would include the noise my brain was making.  My eyesight got blurry and it was hard to focus.  I felt my eyes trying to roll back in my head.  I felt compelled to jerk my head back and forth, over and over..because somehow this helped with mounting panic.  Worst of all, I started losing my ability to think.  When I read that last statement back it seems so clinical, and factual.  But the terror of not being able to focus my brain is something that is beyond my ability to express, no matter how many analogies and metaphors I use.  There is a word for it though…dementia.  I tried to tell my husband that something was happening but I think all I managed to say was “oh shit”.  I felt like I was trapped under ice.  It was almost impossible to breath.  Panic, and a sense of impending insanity, built up like some horrible tidal wave of chemical garbage.  The only way to get any relief from it was to scream…which is what I started doing.  I never understood why mentally ill people occasionally walk around screaming.  Now, unfortunately, I do.   I also realized that living in that state constantly would be almost impossible.  So I was also given a very visceral lesson in why someone in such circumstances might commit suicide.

Through all of this, my doctor was trying to communicate with me, but it was so hard to say anything.  I think I finally managed to get out, “I feel like I am going mad”.   At this point, she turned quickly and left.  I knew she was taking this seriously because I could hear her heels on the tile of the hall, and she was running.  She had suspected what was happening.  At some point, and my memory is hazy on this point, there were about 3 doctors in the room.  One was a general surgeon, one was my doctor, and then there was a man who I think was the head of the emergency room. They came to the agreement that I was having ‘serotonin toxicity’ as a result of an adverse drug reaction to the antibiotics (particularly Flagyl) , anti nausea meds and Demerol.   They administered a large dose of Xanax to try to increase GABA to block the serotonin.  X-ray technicians were brought in to check my lungs to make sure there was no blockage forming.  Cardiologists were alerted because my blood pressure and pulse were well into the “panic, a heart attack is coming soon” range.  I was also set up for an MRI to make sure that I was not having a stroke or something.

All this time, my wonderful husband sat next to me, holding my hand.  He spoke calmly and reassuringly to me even though I am not sure he knew that I could understand him.  But I knew he was scared.  You see, he had lost his father just the day before.  And knew from his voice, despite his attempt at calm, that he was desperately afraid he was about to lose his wife as well.  He told me over and over that I was strong…that I would make it through this.  And so I am, so I reached in and clamped down on my brain as hard as I have ever had to.  I let them put me in the MRI tube, despite the fact that I am normally claustrophobic and already felt like I was crawling out of my skin.  I lay there counting my breaths to 50 with the bounding of the machine…over and over again as they took 6 MRI readings.  

So this is how it was…the panic, the screaming, the suffocation, the terror, and the insanity…for 8 hours.  Finally, slowly, the drugs began to work and my serotonin level came down.   And when I came to myself, there was my husband…still holding my hand. 

I would like to say that this was the end of the story and I completely went back to normal the next day, but it wasn’t like that.   You see, this particular form of adverse drug reaction involved neurotransmitters… and it can take months, if not years,  to completely sort these out when they get out of whack.   But now I am almost there.

Post Op Recovery, Analysis and a Call to Arms

So, I got a little lesson in “almost worst case scenario”.  The MRSE infection was bad.  The “Serotonin syndrome” was significantly worse, and could have killed me.  As I didn’t really explain it in the above section, I will do so now.  This fun little alliterative term is where several drugs given cause your body to produce too much serotonin.  The symptoms can be any or all of the following: hypertension, tachycardia, hyperthermia, dilated pupils, excessive sweating, tremors, neuromuscular dysfunction, convulsions, acute dementia, convulsions and death.  Yes, death.  I was fortunate in that I had a great doctor who recognized what it was and prescribed the appropriate medicines to combat it.   In 1984 Libby Zion, was not so lucky.  She was an 18-year-old girl who died of serotonin syndrome because her doctors DID NOT know it and diagnose it.  In fact, they basically called her hysterical and put her in restraints.  It is a horrific story but it changed the medical system in New York by limiting the number of hours that residents can be on call.  But once again, I digress.

So why do I bring all of this up at this point? Let me assure you that it is NOT because I enjoy re-living all of this.  I write this because we have been tenuously winning this war against the bugs, and I want to keep winning.  But you can’t win a war without an army and weapons that don’t kill the unintended.   The army will have to be us, all of us.   So how to we enlist in this army?  We think twice before reaching for the antibiotics, for the sake of our children and ourselves.  We are a little more paranoid about taking drugs, prescription or otherwise. We look up ALL drug interactions before we put pills in our mouths or needles in our arms. We realize that medical professionals are people, not gods, and they can make mistakes.   So when the stakes are life and death, the onus is on the individual to check and double check everything being put into his or her body…or the body of his or her child.  If a doctor has problems with being questioned then he or she is suspect.   

In addition to this, we push the pharmaceutical companies to focus a bit on new antibiotics…and not just drugs that “prolong erections and prevent hair loss”.  We can do this through political channels or economic channels.  We invest in companies that are working on solving these problems, as opposed to those who are simply looking for quick economic wins.   We use whatever voice we have to tell our politicians that it is NOT ok for agribusiness to use antibiotics as an alternative to sanitation.   We exercise our power with our wallets by purchasing meats that are free range and antibiotic free. 

For those of us who are parents, we don’t want to leave our children to a future that has reverted back to a Python-esque skit of the middle ages….do we?

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