urocyon: Grey fox crossing a stream (Default)
As mentioned in the last post, our local hospital has a really bad A&E/ER department. In 2009:
Barking, Havering and Redbridge Hospitals NHS Trust’s Accident & Emergency departments were ranked 150/151 in the country on pain relief, 151/151 for health care standards, 151/151 on general patient satisfaction.

AFAICT, our local one and King George in Ilford are both big problems. I've been in the local one's A&E twice--with a horrible migraine and the autokneecapping incident from the last post--and all I can say is that at least they were not overtly rude on the migraine trip, and gave me some (inadequate) pain relief. (A small dose of OTC-strength Co-codamol, when I told them I'd already taken the equivalent and it didn't help.) The physical plant is only a few years old now, and it already looks grotty and run-down. It honestly looked as bad as what I saw of the previous Victorian premises. I didn't want to touch any surfaces I didn't have to, which kinda added to the anxiety.

OTOH, to be fair, my four trips to the Urgent Care there have been OK other than not wanting to touch anything in the waiting rooms. Two for bronchitis/asthma flares, one when my back was locked in spasm, and another for a nasty allergic reaction. They didn't give me anything other than an NSAID and advice not to lift and carry heavy stuff for the back, though; bit of a pattern there.

These items have turned up recently in the news:

Mother and unborn baby die after hospital staff ignore husband's pleas (Added racism making them less willing to listen, perhaps? As a "weird-acting" foreigner, I suspect I got worse treatment. Definitely more condescension.)

Romford's Queen's Hospital suspends midwives over death:
The care given to Ms Ali "was of an unacceptable standard" and liability "will not be disputed", Mrs Dongworth added.

Earlier this month the Care Quality Commission described the maternity unit at Queen's as frequently understaffed, with patients put at risk from broken or missing equipment.

Hospital where mother and baby died is given just days to improve:
Mrs Ali's husband Usman Javed, 29, said his wife was in "unbearable pain" after being induced at 40 weeks, but his pleas for help were ignored by midwives. Mrs Ali had suffered a ruptured womb and died five days later.
The Care Quality Commission this month found that the unit was often understaffed and employees were carrying out tasks for which they did not feel appropriately skilled. Inspectors also found that the hospital was failing to follow guidelines on safe care, such as timescales for transferring women from the antenatal ward to the labour ward. The commission, which has been monitoring the hospital since the warning, says these improvements need to be made by Wednesday.
It is feared the problems at Queen's will get worse if the maternity and A&E departments at King George Hospital in Ilford go ahead as planned.
Steven Kelly, cabinet member for social services and health at Havering council, said: "If things continue as they are you could not close King George and take the extra load to Queen's."

Yes, they have been wanting to do this with budget cuts, as overcrowded as Queens Hospital already is. And send people to what AFAICT are the worst units there. (Not that they seem to be much better at King George...)

REDBRIDGE: Reprieve for hospital wards:
CONDEMNED emergency and maternity wards serving the borough could be granted a reprieve.

The wards at King George Hospital, Ilford, are set to close after health bosses decided to send patients elsewhere, but campaigners claim the consultation on the plans was flawed and that most GPs were against the decision...

Health for North East London wants to send patients to A&E and maternity wards at Whipps Cross Hospital in Leytonstone and Queen's in Romford, where it plans to expand maternity services, instead of King George.

Reported last week: More patients at risk from CJD after surgery:
Two separate incidents have emerged in which patients have been told they were put at risk of contracting Creutzfeldt-Jakob Disease (CJD).

In both cases the fatal brain-wasting disease could have been picked up during surgery.

At Queen's Hospital in Romford in Essex, 21 brain surgery patients have received letters...

The other incident was at a hospital in Wales. In this case, Public Health Wales is not revealing the name of the hospital, nor the type of surgery involved.

Sterilise instruments
In both situations, the hospitals say they followed normal practices to clean, disinfect and sterilise the surgical instruments involved.

One of the UK's leading experts on prion diseases, Professor John Collinge, said such incidents are not uncommon.

He said the risk to patients from contaminated surgical instruments was believed to be small but is not yet quantified. He thought more could be done to stop this happening at all.

His team has developed an effective prion deactivation soak, a bit like a biological washing powder, and even has a commercial partner, but the substance is not being used in hospitals.

In the recent past, they have had problems with basic hygiene:

Infection control warning to NHS
The new health super regulator has warned that a small group of NHS trusts are potentially putting patients at risk because of poor infection control.

Twenty-one trusts have been highlighted in England by the Care Quality Commission for not doing enough on cleanliness and decontamination...

The 21 trusts are: Barnet, Enfield and Haringey Mental Health, Barts and the London, Leeds Teaching Hospitals, Kettering General, North Bristol, Plymouth Hospitals, South West London and St George's Mental Health, United Lincolnshire Hospitals, Alder Hey, Barking, Havering and Redbridge, Coventry and Warwickshire, Herefordshire PCT, Isle of Wight, Leeds Partnerships Mental Health, Lewisham PCT, Manchester PCT, Medway, Royal Surrey, Somerset PCT, West Sussex PCT, Yorkshire Ambulance.

From the same 2009 report: REDBRIDGE: Hospital trust's infection control not up to scratch:
Barking, Havering and Redbridge Hospitals Trust (BHRT) is one of 21 bodies that have been identified by the Care Quality Commission (CQC) as not meeting expectations in dealing with infections including C.diff and MRSA.

The trust itself has admitted that it did not meet the appropriatate standards for healthcare associated infections (HCAI).

Rates had apparently fallen by that point, but 2004-2006 Barking, Havering and Redbridge Hospitals had some severe problems with C. difficile infections in particular (figures only reported for patients 65 and over). Summarized from another source:
Meanwhile, the Times Public Agenda reports that figures released by the Health Protection Agency have revealed that more than 13,000 London patients have been infected by the Clostridium difficile superbug in the past two years. Barking, Havering and Redbridge Hospitals Trust has the worst infection record.

And they were still getting caught violating and ignoring safety procedures in 2009.

A story from just a couple of months ago: Hospital failed woman who died after contracting two superbugs:
A hospital has been found guilty of failings in the care of a woman who died after contracting superbugs while in intensive care.

Doreen Levey's condition quickly deteriorated after she was admitted with a cough and diarrhoea to Queen's Hospital in Romford. She was later diagnosed with MRSA and Clostridium difficile and died shortly after.

The hospital, which has been locked in a dispute with the family of the 68-year-old for four years, has now been reprimanded for failing to address serious complaints they raised. The verdict comes just days after the Essex hospital was accused of poor standards of care over the deaths of two other patients. Lili Backhouse, who was 23 months old, from Rainham, died after doctors allegedly failed to spot that she had meningitis...

Mrs Levey's daughter, Pauline, said: "The overall treatment that my mother received was unspeakably poor. Queen's was a new, state-of-the-art hospital.

"Superficially it may have looked impressive, but underneath the shiny new exterior lay a poorly managed organisation with some staff that were not only incompetent but were incapable of following basic hygiene codes, standard operating procedures and Control of Substances Hazardous to Health regulations."

Ms Levey, 44, a biomedical scientist from Swanley in Kent who has worked for the National Health Service for 22 years, added: "The undignified, uncaring treatment that I witnessed has left a feeling of distrust, disgust and horror."

She said her concerns over the state of the hospital heightened when she saw what she believed to be various hygiene lapses and disciplinary offences when she returned to discuss her mother's case.

Then, when she visited her father at Queen's in December, she claims she saw someone else's bloodstains on the walls around him.

I honestly have no trouble believing that, just from what I have seen. Including the "undignified, uncaring treatment".

They have also gotten attention for very poor financial management (REDBRIDGE Hospital trust named worst in London for financial performance), with more of the same from earlier this year:
The Audit Commission has raised alarm over the financial state of Barking, Havering and Redbridge University Hospitals NHS Trust over its failure to fulfil its statutory financial duty.

The trust, one of the worst-performing NHS trusts in England, prompted an auditor to issue a public interest report over fears that the trust is still failing despite efforts to improve.

It said the trust had failed to achieve culmulative break even over the five years to March 2010 and criticised a continuing culture that didn't recognise "the importance of financial management."...

Speaking on his move last week, Goulston said the hospital had "made great progress on improving quality, recruiting skilled staff and working more efficiently."

I guess that's why they're still so short on skilled staff, then: all that great progress. At least, as reported 2 days ago, after the recent high-profile death, REDBRIDGE: Trust forced to hire nurses from overseas:
Barking, Havering and Redbridge University Hospitals NHS Trust has hired 43 nurses from Portugal and Ireland to staff A&E and medical assessment wards at King George Hospital, Ilford, and Queen’s Hospital, Romford.

It looks like they need more than that for two large, seriously understaffed hospitals.

Now, I know this is a large urban teaching hospital (more like inner suburbs, actually, but...). I have been in two different similar type hospitals before as a patient. The patient care and atmosphere may have left something to be desired--in a "you'd better have a family member or friend to bring you drinks and run off the med students from pulling at your drain tubes like curious monkeys" kind of way--but things looked clean. And I only saw one nurse (At MCV, now officially VCU Medical Center) ignore basic hygiene practices in patient care, in the Neurosciences ICU by coincidence. She didn't expect patients to be conscious, and didn't bother changing gloves between touching them--and just ignored me when I asked her to do so. But she was the exception. Being a large teaching hospital, they're going to end up with more hospital-contracted infections, but both MCV and Wake Forest's hospital seemed to be doing OK with basic procedures to prevent that.

Then, I have also spent time in a mid-sized VA hospital as a visitor when my stepdad was in there for months after a serious car crash. It was pretty bad, though they do seem to have improved since then. They ignored it when he got extremely jaundiced until my mother got after them, he got neglected bedsores, and my mother had to keep getting after them to change the bedlinens. Things looked grotty and run down there, too.

ETA: They also both work on similar inefficient models. You need to have blood drawn. They won't do that in the doctor's office. You have to go to the hospital. So, you go to Point A and pick up Form X, which you then take to Point B on the other side of the hospital to get Form Y, then back across the hospital complex to take a number and wait for 3 hours (no exaggeration, with my last bloodwork). You'd better hope you didn't leave either form somewhere--or that the folks at Point B didn't insist on taking Form A from you before they'd hand you Form B--because you're going to need them both once your number comes up. If they've taken Form A, you'll have to try to find someone who will reissue a copy of it (good luck!) because the person who took the original from you has already lost, eaten, or shredded it. If you have to start over, the phlebotomy techs are going to close up shop before your number comes up another 3 hours later. Oh yeah, and you'd better hope somebody's with you to warn you your number is up in case you need to go to the bathroom after waiting 2.95 hours. And all that's just for getting blood drawn. When things are running relatively smoothly. *headdesk*/ETA

Yes, I'm seeing a theme emerging here: poorly managed large government-run organizations. And, no, I am not suggesting that privatizing is is the way to go at all. But cutting more funding while continuing to run things inefficiently sure as hell isn't going to give you decent results. It's going to harm people.
urocyon: Grey fox crossing a stream (Default)
I got a pretty bad PTSD attack, finally replying to a comment on the epilepsy post, and thought I would write a little about it.

I've talked about the medical PTSD before, but this might help illustrate how that kind of thing can happen. A few days ago, rather coincidentally when I was thinking about needing to see the GP to try to get my blood sugar managed better and try to get a neurologist referral, I ran across the NAS Patients with autism spectrum disorders: information for health professionals sheet, which I hadn't seen before. I really, really wished that (a) it had been around when I was little, and (b) somebody had known it applied to me.

It also struck me pretty hard again that I've tended to keep feeling embarrassed and not wanting to discuss this kind of thing, but there is no good reason that someone should be ashamed of having run into problems from un/misdiagnosed autism.

May be triggering, with medical settings and some violence )

Yeah, that was a rather extreme example, but in the back of my mind, I am still half-expecting to get treated that way.

Reading the NAS info sheet, I couldn't help but get a little more hopeful, though. At least now I do know why I behaved so "inexplicably" in overloading settings in the past, and that I did not somehow deserve shitty treatment because I'm autistic. At least with most of my mind, I'm no longer ashamed and as likely to let other people run right over me. I no longer feel crazy for getting overloaded, now that I know what's happening. And I am less inclined to let other people treat me like they think crazy people should be treated.

And I have someone who is willing to back me up--and whom I trust to do so, without deciding they know what is really good for me. Now I have a better idea of what kind of help I need from someone who goes with me to the doctor's, and can discuss what might work to keep me from getting so overloaded that I shut down and can't half remember why I'm there, much less communicate properly, in the first place. (This has been a persistent problem in past.) And I trust him not to take over with his own agenda if that should happen, and act like I have no right to complain. Hopefully, with backup, I'll be less likely to get talked down to and dismissed--or assumed to be batshit crazy--because I am not communicating the way they expect. Much less worrying about getting sectioned if I do end up having some kind of meltdown. (Also, I have Asperger's and not bipolar with psychotic features in my file now; shame this probably does make a practical difference.)

Hopefully, having backup will make the expected (if not exactly appropriate) browbeating over not having been to see the GP in years now easier to deal with. It doesn't exactly help one feel secure and comfortable talking to the doctor, getting treated like some kind of naughty child. And in past I haven't been able to say anything much, never mind object to getting talked to that way for any reason, much less because of disabilities.

Very importantly, I know that I do have the right to leave at any point, whether or not I'm able to explain myself verbally at the time. And, having actually discussed it with Ingvar, he's prepared to call the cops if anybody lays their hands on me to try to stop me. Funny how the NHS zero tolerance BS is actually described as "Policy on violent or abusive patients":
We operate the NHS Zero Tolerance Policy to safeguard staff and patient welfare. Our Team shall always show due respect and courtesy when dealing with Patients. In turn, we would request Patients to reciprocate the same. No form of aggression, verbal or physical in nature would be tolerated and may result in Patient removal and being reported to the Police.

I guess they'll call the cops if they assault you. I have already been impressed by what kind of respect and courtesy some of their staff have considered "due". Maybe you just get arrested if you reciprocate? *snort*

ETA: I do know of a couple of cases, involving people I knew back in Virginia, where similar policies were actually used against them. Including one middle-aged man who got an assault and battery conviction because he kicked a staff member who was manhandling him around and trying to strap him down in restraints because he was "argumentative". (As would most people not diagnosed with a mental illness, I imagine--turn argumentative, too, under the circumstances!) And it apparently did not make any difference to his legal culpability that he was on a 72-hour hold (in the same state hospital I was afraid of winding up in), because of a manic episode, at the time. Nor that Virginia's whole state hospital system was at that time under federal investigation for abusive and punitive use of restraints that killed people. (Including one woman who died "after lying in restraints for 300 hours, including two stretches of nearly 110 hours straight, as punishment for outbursts against staff", after they had been warned that she had health problems that might kill her if restrained.)

So I am not just being sarky here; it's a very real problem. /ETA

But, just knowing these things makes me feel less helpless and like I do have some control over what happens. As anyone should have. Maybe that will be enough to get me to the GP's for more diabetes medication.
urocyon: Grey fox crossing a stream (Default)
Some further evidence that this is, indeed, a viral problem I'm dealing with: my blood sugar has gone absolutely wild, without other factors changing remarkably. At this point, I think at least half the crappiness is down to hyperglycemia. I'm really not in good shape with that ATM, and suspect that I'd be feeling much better much more quickly (and hold up to the viral component better) if my blood sugar were back under some kind of control. It's had me scared, and even more worried about getting the house ready to move within a couple of months' time.

I've been stressing more about honestly not being able to get an appointment at the GP's (between medical PTSD and non-voice accessibility problems), which has probably not helped my health. (Especially since I'm suspecting I stressed my way into being vulnerable to icky viruses in the first place.) It's a very uncomfortable situation, which I haven't been able to see many ways out of. Being sick and drained of energy leaves me way less able to deal with just about everything else, in a "Help! I Seem to be Getting More Autistic!" kind of way. Stressing over it only makes things that much harder to deal with.

But, I am not feeling so trapped now, since I thought to look more into other options. Sitagliptin (Januvia), a DPP-4 inhibitor, is the only medication which has helped me so far, without any noticeable side effects. Apparently, it's down to poorly-understood insulin resistance subtypes whether a person will respond well to metformin or a DPP-4 inhibitor; a vanishingly small number of people are helped by both. At least, according to the doctor in the US who gave me the Januvia in the first place--and that makes sense.

So, I am tempted to try berberine, which is also a DPP-4 inhibitor (along with some other actions). There has been some promising research, and it seems worth a try after I track down a suitable supplement.

With any luck, that will at least help me get into enough better shape that I am capable of dealing with the GP, without so many worries about getting steamrolled, dismissed, and possibly even sectioned because I am obviously not in good physical shape, I'm behaving more "weirdly", and my verbal communication skills (especially in realtime) have mostly gone down the drain.

This GP has already shown a pattern of dismissing what I have to say, and it's hard to vote with your feet under the NHS. Small consolation: he's never said one word about my BMI, nor said anything to indicate he assumes I'm a couch potato--and even commented that, as fit as I looked already, diet and exercise probably wouldn't cut it. Lack of blamy comments is refreshing, even if some of his other behavior isn't. This is also the guy who didn't want to hear about persistent serious GI effects and symptoms of B12/thiamine deficiency from the metformin.

It irks me to have to do endruns and pay for stuff in the hopes that it will work--especially when I can theoretically get free prescriptions under the NHS--but accessibility is accessibility. And this is not a situation where "I guess you'll just have to do it" (complete with angry/exasperated tone) is of any help whatsoever.

September 2011

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