So, what kind of week have you had then?

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I would like to share with you a short story about what happened to me over the last week – a little diversionary excursion from podiatric matters, which you might find interesting – as long as you’re not reading this over breakfast or lunch!

Last Thursday I had a day off. I’m doing a concert in Lytham St Annes in November to raise funds for our local Hospice so I had planned a day with a couple of musicians to practice some songs that we’re aiming to do, so I rose about 9am and went in the shower just after my better half had left for work. When I came out the shower I thought my nose was running – but when I looked in the mirror I was surprised to see that it was, in fact, a nose bleed. Nothing too desperate, so I did what we’re told to do and pinched the fleshy part for 15 minutes until it stopped, then finished shaving and towelling dry and dressed and went downstairs to make a coffee. As I drank the necessary, my nose started bleeding again – so I spent another 15 minutes pinching it and watching the news. I’ve never had a nose bleed before a an adult – so it was a new – and annoying – experience. However, fifteen minutes later, it had stopped again, so I finished my coffee (cold by now – but isn’t it always?) and picked up my guitar and started playing. Within 10 minutes my bleed had started again, so this time I decided to pack it with gauze and gripped it with a clothes peg for good measure – and kept on playing. Goodness knows what the postman thought when he delivered the post around 11am – having a clear view in the front music room!

An hour or so later I removed the gauze and studied the nose for any permanent disfigurement from the peg, but was delighted to note the bleed had stopped and what’s more – so had stopped bleeding down the back of my throat. The next few hours were uneventful and we managed to rattle off some John Martyn, Nick Drake and Amy Winehouse covers – as well as a few of my own – and near 6pm we would up and I cooked dinner and opened a bottle of shiraz for the evening.

Four hours later I was tidying up in the kitchen when suddenly my bleed started again – only this time it was quite prolific and involved both nostrils. Back to the pinching and gauze packs and a couple of hours later, with my better half in a deep sleep I removed them and headed for bed, fairly exhausted by this time. No sooner than my head hit the pillow, the bleed started again so I ran back to the bathroom and went through the rigmarole again – only this time, as soon as I released the pressure, it would continue at an alarming rate, saturating the gauze packs within seconds. And so it was thus throughout Thursday night and into Friday morning. As I was awake, I even managed to post on Pod Arena at some unearthly hour – 3.40am or so – which perhaps demonstrates the addictiveness of this site and the obsessions it produces in its members! But I suspect few can make claim to have written posts with gauze packing and three clothes pegs or their nose at the same time. Be glad the site isn’t more interactive and has live webcam facilities, my friends!

Next morning I was still at my desk and the bleed was still prolific when I removed pressure. I had lost over two pints of blood by now and even though I hate the thought of hospital treatment, it was obvious that’s where I would have to go to get it stopped. I had a busy surgery on Friday and didn’t want to cancel, but had little option. As tolerant as my patients are, I don’t think the prospect of me sitting with blood soaked gauze pack and clothes pegs would have been very attractive to them. Besides, I was beginning to feel a little unwell by this stage. I sent my other half off to work and headed for A&E in a taxi with just my phone and enough money to get a taxi back home – but by the time I arrived at the hospital, ten minutes later, the fresh gauze packs were leaking badly and my hands were covered in blood. The one positive manifestation of this was priority triage and admittance to the emergency ENT ward, where, after a brief examination, the decision was taken to plug my nostrils with an inflatable nasal pack. Now, like me, you’ve probably never seen a dressing like this before. I don’t think we can ever have any use for them in podiatry – but for your elucidation, they are similar to a seven-inch tampax with an inflatable core attached to a plastic tube, instead of a string. The procedural insertion of these packs – into an already very tender conk - was not a pleasurable experience, by any description. Even though it was performed superbly by a beautiful Iranian doctor with a delectable smile! The entire length of the pack was insterted and I was then told that I would have the packs in place – and inflated for between 24 and 48 hours and furthermore I was being admitted as an emergency patient onto the ward.

One thing should be understood here is the anatomy of the nasal passage, which aside from being an extremely vascular plexus, is connected to a number of sinus passages – and it was up one of those, behind my right eye that the bleed was occurring - or so they thought. Once the packs were inflated, I could feel the pressure building inside my head – a curious feeling at first, but within an hour or so, it started to become acutely painful. Within half an hour of notifying the ward doctor, I was started on a pain management regime which consisted of paracetamol, dihydrocodeine, diazepam and morphine – which lasted initially six hours before the acute pain started back up behind my right eye. More drugs – then the consultant came round to take a look and asked a few questions – what I did, recent trauma, medical history. Like most podiatrists, I’ve had a few episodes of irritation in the nostrils – years of working in environments of dust and debris take their toll from time to time, but usually a few days of some topical antibiotic cream clears it up – but I recalled a paper a few years ago detailing some cases of unpleasant nasal lesions in podiatrists and I mentioned it to the consultant who said he would give it some thought and see how I was after 48 hours. Until then, I was to have complete bed rest, no standing – and whatever pain management I needed.

By Saturday night, 36 hours after admission, I was in a bad way – barely recognising my visitors – and fluctuating between lucidity and unconsciousness, depending on the cycle of drug administration and recurrence of the pain, which, by this time was incredible. Worryingly, I was quickly building a tolerance to the drugs – so the frequency and dosage were increased to compensate and by early Sunday morning, I was having morphine every two hours and the remaining three every six. Strangely, despite the fact I was taking more Class A’s in a day than the average Glasgow junkie enjoys in a month – I had moment of incredible lucidity – or so it seemed – and even managed to send of some texts and emails to friends and colleagues (apologies to anyone who received one), which on retrospective reading, were, of course, complete gobbledygook!

On Sunday evening, the consultant made his ward round again and decided to deflate the packs and see if there was any evidence the bleed was still occurring. Within a few seconds, it was obvious that it was – so to my dismay, the packs were re-inflated – slightly larger this time and off he went home, no doubt to a comfortable night in front of the telly, leaving me to my drug-fuelled exploding-headed nightmare.

I don’t remember much during the next 24 hours or where I had descended to, but I managed to escape somewhere by listening to some relaxing nature sounds on my iPod and headphones, interrupted only by the regular visit of the ward dealer with the cups of morphine every hour or so or whenever I called for more. At one point I remember crying blood through my tear ducts which was a novel experience, if a rather distressing one, for my nearest and dearest, who were keeping a worried vigil, by this time. I had nothing to eat during Sunday or Monday, but had a few units of plasma and some boiled sweets to keep the taste of blood out my mouth. At one point, early Monday morning, I had drifted away for a few moments and when I woke again I nearly chocked on some ice or a boiled sweet and had to swallow it quickly and coughed in the process. I cannot begin to describe the next half hour or so, but I was almost ready to quit at the end of it – until the morphine worked its magic again.

Monday lunchtime, the decision to remove the packs was taken and if the bleed was just the same it was down to theatre to cauterize it manually. Now, if any of you are unfortunate to experience a posterior arterial nasal bleed and have to have inflatable nasal packs inserted, you might care to forget the next part where the ENT sister comes over to your bedside and deflates the packs and gently smears some Vaseline around the bottom of your nose and reassures you that it’s going to be a gentle, painless process when she slowly slips the packs out – remembering they are six or seven inches inside your head at that point. Because she’s lying. Really.

She grips the end of the plastic air tubes and pulls them down as quick as she can and in that half second or so you feel as if your brain has just been evacuated down your nostrils into the waiting cardboard waste bowl you’re holding under your chin. If it had been a less horrific experience I would have floored her, but as it was I simply couldn’t – just slumped forward and moaned uncontrollably whilst she patted my back with a “there, there, it’s all over now – nothing to worry about, it’s all better…!" Remember, she will lie: you have been warned!

Thankfully, this time, the bleeding had stopped – well to the most part – like a normal nose bleed, I guess – and after 15 minutes it was under control – so after another morphine and a few hours sleep I was examined by the consultant who was delighted to tell me that I had a large secure clot in my sinus which had effectively stopped the arterial bleed and that I could go home and get some well deserved rest – and what’s more the pain would disappear completely, even after the opiate had worked off. I am to go back to clinic after two weeks to have the clot removed and it scoped – but hey that’s two weeks away – whoopee!

Thirty six hours later, I’m still pain free and nice and dry, but starting to come down from the morphine and codeine high and was looking forward to a nice restful sleep….however, I discovered earlier this evening, after sucking on some ice – that a large gold molar crown, which cost me more than £500 recently, is missing and that it was this, rather than some ice or boiled sweet, that I had swallowed in the delirious small hours of Monday morning! Given the amount of morphine and codeine I have had in my system over the last four days and their well-known effect on the alimentary compositions, I fear that as I sit here, contemplating a large glass of Epsom salts and Moviprep and with a bucket and sieve outside in the garage, I am in for another interesting evening. Only this time, after this, I will not be posting further on Podiatry Arena – for 24 hours at least. Just in case you were wondering.

Wish me luck!

MR

 

Good to hear you on the mend!

Can you post the photo you sent me from the hospital!

 

Mark:

Don't think I have a medical story to top that yet. Maybe when I get old like you are. The story of the bloody nose incident sounds painful and messy but the good news is that things will hopefully improve from here on.

Makes you better appreciate that saying....does the nose smell and the feet run or rather do the feet smell and the nose runs?

Get well soon!:drinks

 

He forgot to say he also rang me from hospital to have a discussion about an annoying post on an even more annoying forum. In case you didn't realise Mark, it's gone!

Pleased the nose is behaving, and I hope your missing tooth is reborn with no complications.

 

Gentlemen - thank you for your kind wishes and David and Craig, sincerest apologies for the unsolicited and unwarranted intrusions to your weekend. The first two photographs were taken shortly after the insertion of the right epistaxis pack, prior to inflation. After that, I didn't take any more - they were too horrific to show or to remember! The final photograph - my Angels of Mercy - Sister Atkinson (sitting) the highly skilled drain puller!

I have to say that my experience at the hands of the NHS was superb - these girls - and the various medical personnel of an international flavour - Iranian, Hungarian, German, Czech, Polish - were all consumate professionals, exhibiting levels of kindness and compassion that is extremely rare in today's society. My heartfelt gratitude to them all.

What is really sobering two days on from the event, was the realisation that if the haemorrhage had occurred a few milimeteres away from the site it did - I would have suffered a massive crainal bleed with unthinkable outcomes. Makes you realise just what fragile creatures we are....

 

My Angels of Mercy!

 

Hope fishing for your crown is less traumatic than your nose bleed Mark. Please though, no pics :empathy:

Be well,

Mand'

 

Yeah, Mark. Going through the motions never makes good viewing

Get better soon,

Bel

 

There is an addendum to this rather bemusing tale, which I recount now for the sake of completeness, even though it is probably one of the most humiliating incidents of my life - and there have been a few contenders to that coveted crown, if you excuse the pun. Readers of the previous posts will have left thinking that all finished well - Russell still writes and patients are still walking - all must be good. Post-epistaxis recovery of the gold crown proved more difficult than initial thoughts suggested. Despite close inspections - the offending crown made no sudden and welcome appearance to the point that I thought it must have made a sneaky escape disguised as, well, something else... Two weeks passed, then a month - still nothing. October ran into November and gradually I became increasingly unwell and was unable to eat any solid foods without severe discomfort. An x-ray late November showed the crown firmly lodged in my diverticulum and with a suspected abscess/peritonitis, an appointment was made for me to have it removed over the festive period.

It was decided to remove the crown via a colonoscopy with the Black Mamba with a snatch attachment but first I had the glorious experience of an evening with the bowel preparation. This will be something familiar to everyone who has undergone a similar procedure and is everything that is described by the likes of Billy Connolly and more besides. Vesuvius or a slurry truck on full pelt comes to mind.

The next day the procedure was carried out and the offending crown removed and I was sent home - in a deflating rather than deflated state. But much, much happier. Especially as I was due to spend the evening in the Lake District at a friend's New Year party. After a shower and a couple of bacon sandwiches (I hadn't eaten for the previous six days) I set off up the motorway - guitar and overnight bag packed - and in good spirits. All was going well until about six miles from my destination I started having severe abdominal cramps and felt terribly nauseous. I pulled over for 10 minutes but felt no better and realised I was going to have to find a bathroom fast.

I called my friend Graham and explained my predicament. No problem he said. The party had already started, but I was to go straight there and upstairs to their ensuite where I could be undisturbed for as long as I needed. Have a shower and a sleep if you want, he said. Which was very kind.

Graham lives in a very select private estate in the south Lakes - a superb Lakeland stone house surrounded by beautiful countryside. There are another dozen or so houses - equally delightful. When I arrived around 7.30pm, the party was in full swing. I parked the car, ran, carefully , down the drive and opened the door before shouting hello in the lounge then scampered upstairs to the safe haven of the ensuite. Good taste will curtail the description of the following quarter of an hour, but at the end of it I felt very much better and a good deal lighter. Unfortunately the bathroom was in the eaves of the house and was windowless, so generous use of Graham's aftershave and his wife's perfume was the order of the day. I didn’t bother with a shower or a lie down, but headed back downstairs for a much needed glass of wine. Five minutes later I was chatting to some guests in the front room when a very pleasant lady asked who I was. A friend of Graham I replied. When he worked in Scotland. Oh, I see she replied, that explains it. Graham lives two doors down - I think you're in the wrong house.

And I was. Truly. Turned out to be the home of a District Court Judge and his wife - a local Magistrate who were hosting a New Year's Dinner Party and were enjoying pre-dinner aperitifs when I inadvertently gate crashed into their bathroom. We wondered if you were alright, her husband - the Judge - said. We were just about to call one of the neighbours over - he's a doctor. I managed to say, it's a wonder you didn't call the police. But then there was no need. One of his guests was the Chief Constable of Cumbria and his wife. You couldn't make it up. Thank goodness I didn't have the shower or took a nap in their bed!

Needless to say mine hosts found it hilarious, but I was still mortified the next morning and still shiver when I think of it today. Hopefully that's closure - in more way than one! As the saying goes - tall oaks from small acorns grow.

All the best
MR

 

Ho dear,

At least all aspects were covered should you have required medical aid, judicial sentencing or indeed , arresting! Case concluded hopefully M'Lud.

 

Just re-read your first post Mark - where you said "I opened a bottle of Shiraz".


Anyway, back on topic my week so far has been fair. The young dog came in to heel from 150 yards away with one whistle this morning at first light, which was good.
The Speed Awareness Course I had to do to avoid points on my driving licence after being picked up by a speed camera was completed on Wed afternoon. Actually a good course to do if anyone else has one pending.

And I have a meeting to discuss some consultancy work this morning, and two medicolegal cases sitting in my inbox waiting for attention, so all in all not bad so far.

 

Mark, I missed this thread so i have read all and I do lead a boring life ....
all the best, Mark
I did get to grandchildsit this afternoon so nothing better than that

 

Good God Mark, sorry to read about your ordeal and wish you a speedy and full recovery!:drinks

 

Mark I SO enjoy your stories! Isn't it wonderful that truth IS always stranger than fiction - you could not have made that story up!

Davidh -

Thank you for your helpful comment on the Speed Awareness Course.

At the tender age of over half a century and with over 30 years of driving, I (nearly achieved) my very first set of points on my licence. This was at a point on the road (approaching Dartford Tunnel) that I have spent 20 odd years virtually parked at the speed I progress every morning on the way to work!! One accident on that fateful day (unexpectedly cleared up suddenly) and I put my little foot down in gleeful joy...... only to find that dreaded letter on my mat a week later!

The £85 cost for this course, I could well not afford right now having recently set up my own clinic (Does your kind offer Mark Russell apply to other struggling year-old graduates??).

So it heartens me that it wont be a complete waste of a morning, having read your comments David, perhaps I will learn a trick of two. (I also realise its a better bet than £65 plus ££s extra on my insurance.)

Cheers
Linda

 

Of course. You can find my contact details on my blog at the foot of the page - give me a call when convenient.

All the best

 

Joined the masses for signing on the dolel at the Job Centre and got drunk with the natives - on the local homegrown brew.....(oops sorry that is what is going to happen next week)

 

Hi Linda,

A little more info. When you get to the venue you will meet 20 or so others who will say much the same thing - viz - "what a waste of time", "how are they going to fill in a full four hours", and "I was only doing 4 (or whatever) miles an hour faster than the speed limit".

You are split into groups, there is a bit of talking, but not as much as you would think, and quite a lot of table-to-table tasks to carry out. And it does go on for the full four hours. It could be worse though. The ex-squaddie, Lee, at our table did one three years ago - then it was a full day!

Once complete you are free to go, nothing more is said, and no points or insurance penalties. I found it useful, although like you I could have found something else to blow £85 on.

For those who don't know what a Speed Awarenes Course is, in the UK if caught speeding you can elect to have a fine and points on your licence, or do a speed awareness course at your own cost. Doing the course avoids points on your licence.