Monday, 14 February 2011

Why I recommend not contracting Entamoeba histolytica



Throughout the last 3 weeks my fortune in having an extensive and remarkable collection of aunts, uncles, cousins, parents, granny, sister and friends has really hit home. I’ve had visits, texts, phone calls, emails, wall posts, cards, gifts and loans of books, DVDs, magazines and pyjamas. All of which have been appreciated and reinforced the suspicion that if you are going to be ill you should do so at home in England where health care is free, expert (if slow) and love and worry can be most easily translated into soup, grapes and hot water bottles.

I’ve been recovering from an Amoebic Liver Abscess. As someone ameobable to a good reason to step back from the relentless cycle of emails, briefings, meetings and events that make up a working day this rare tropical disease could have come at a worse time. It has been nice to feel special. The estimated an annual incidence for liver abscesses is 2.3 per 100,000 people per year in the UK.

My illness has increased my connection to the global village. 10% of the world's population is chronically infected with the amoeba I have been home to. Infection occurs most commonly in tropical and subtropical areas. How that 10% survives without antibiotics I can’t imagine. I guess a lot of them don't.

For those interested in such things transmission is via the faecal-oral route and most common in areas of poor sanitation and overcrowding. It is likely my trip to Rwanda and the Democratic Republic of Congo last August was when I picked it up but as my abscess was calcified and was in my liver rather than intestine it is possible that it's been hanging out in my guts for 2 years, dating back to when I lived in West Africa. This ability of the amoeba to present months to years after travel to an endemic area allowed me to show off to an array of doctors the tropical countries I have visited over the last 10 years and the fluctuating performance of my bowels in these places.

Amoebae are unpleasant creatures – they invade intestinal mucosa and gain access to the portal venous system. Entamoeba histolytica causes amoebic colitis and dysentery but liver abscess is the most common extra-intestinal manifestation of infection, and while I was lucky to have but one of around 3.5cm (some people get several simultaneously and when over 10cm they drain them with a needle in case they pop although this can cause infection and septicemia) I was unlucky that mine has probably been in there a long time undetected and will take up to 6 months to disappear.

It started 3 weeks ago with prodigious night sweats and a stabbing pain below the rib cage that got steadily worse until I checked myself into A+E. My 7 hour wait there was a low point. More foolish was my decision (with the doctor’s agreement after examining and giving me very strong painkillers) that I was fine to go home.

Lying in bed at 4am screaming and biting into a T-shirt I shoved down my throat having woken my flatmate as the painkillers failed to work was the lowest point. The next 3 days sharing a ward (which took 16 hours lying in a cubicle in A+E to get into) weren’t great either. Dennis was 89 and a former boxing champion who shouted: “I’M GETTING OUT OF HERE!” all night and spat constantly all round his bed. Everyone else was old and mad except for one 23 year old who had been there for 3 weeks and no one seemed sure what was wrong with him except for him being very sick. The security guards with batons and stab-proof vests who patrolled A+E and the wards were also unsettling.

Archway’s Whittington Hospital is regularly threatened with closure and while the doctors were good everything seemed over-stretched and to take a long time. After 4 days they established I didn’t have gall stones and a week after that they discovered what I did have, 3 days after I was discharged. The contrast with the excellent (and also) NHS Hospital for Hygiene and Tropical Medicine and Infectious Diseases was stark. After my liver got more painful 3 days after leaving hospital, and with the Whittington showing no interest in me, I went Tropical and was given rapid test results and stronger antibiotics which seem to have done the trick. In future I intend to only get exotic ailments.

My work colleagues plied me with fruit, magazines and a very nice football they’d all signed. My sister and parents were constant presences and supported by granny, flatmate, cousins, aunts, uncles and friends which was great. As I’ve got better I’ve expanded my intellectual portfolio from radio, to DVDs, to books, to lengthening daily walks to Highgate, Hampstead Heath and Alexandra Palace even while continuing to feel consistently slightly nauseous. My antibiotics are what they give to alcoholics to get them off the booze – the merest drop makes one vomit uncontrollably. The addition of "anti-nausea" happy pills has been helpful.

I’m now in the odd position of feeling better but not well. I’ve decided, with agreement from doctors, that going to New Zealand on Thursday will be a useful final component of my recovery. Today's my first day back in the office, so far it has proved hard to concentrate. Even sending this email which I wrote last week has been quite an effort.

As a young fogey I have come to accept being overtaken by other pedestrians, having to make regular use of park benches, finding buses far better than tubes and gazing wistfully at elegant folk on bicycles.

While I would have preferred not to be ill it has provided time to reflect on what is important, where I am going and all that sort of navel-gazing stuff. Love and thanks to everyone who has made me feel loved, missed, cared for and supported during an uncomfortable few weeks - it has made a huge difference.