...and hopefully just a blip. I awoke on Friday morning with stomach ache which, after breakfast, developed very quickly into what they call in the trade 'D&V', that is diarrhoea and vomiting. It very quickly knocked me completely for six and I was stuck in bed needing all my willpower to haul myself to the toilet every 20 minutes or so. My temperature by the afternoon was running at 38.8deg C (101.8 F) and both I and especially poor old Vicky were starting to get quite worried. Vicky rang the Papworth team and they said they wouldn't usually do anything until 24 hours had passed - they are not especially keen to have anyone admitted with D&V unless absolutely necessary as they don't want to introduce these kind of infections into the hospital if they can avoid it. Vicky ended up ringing twice and the second time spoke to the transplant doctor on call who basically just said if it is still bad after 24 hours, or if you feel you need to, go to A&E at Addenbrookes. Great, we thought, I can barely move and the prospect of waiting for hours in A&E on a Friday night with the usual selection of drunks doesn't sound great.
A bit later, Vicky called my sister, Ellie, who is a GP and she recommended going to the out of hours GP service as they should be able to fast track you through A&E if we needed to go. So we managed, just, to get out to Chesterton on the edge of Cambridge and wait to see a very nice GP. She was just about to send us back home, since the vomiting had stopped and the trips to the toilet were getting less frequent, but then took my blood pressure which was low at 95/60. This was likely a combination of dehydration and the ramipril anti high blood pressure pills I take. So she recommended we go to Addenbrookes A&E after all and get some IV fluids into me.
So to Addies (as we know it). By the time we saw a doctor in A&E it was 1:30 in the morning. They did a load of bloods, an X-ray of chest and stomach, an ECG of the heart and a physical examination. At one point we overheard the doctors discussing my X-ray and one saying it looked like I had pneumonia, but the other saying that he didn't hear anything in my chest when he had a listen. This confusion was cleared up when I explained I had the fluid perfusion around the right lung post-op that was still hanging around, so that would explain the shadow on the X-ray. They put a cannula in and got me on IV fluids, and decided to admit me to a ward for the night, which took a bit of time as they needed to find a side-room so I was isolated and could be barrier nursed because of the D&V.
By 3am we were installed on ward M4 in quite a nice new big room with bathroom and a big window over the back of the site, out over fields. A great deal better than that awful side room in Papworth you may remember me describing a few months ago! Vicky went home at 4am and I tried to get some sleep.
A doctor who looked classically doctor-y came by in the morning, Professor Carmichael, wearing a bow tie (surely only doctors can continue to get away with this sartorially challenging move?). He had concerns about my ECG which showed some oddities. So he wanted that repeated, as well as a stool sample done. Once those were in the bag (as it were) he came back and had an extended and extremely careful listen to my heart, thought he could hear some slight 'rubbing' and arranged for an echo to be done, which is an ultrasound of the heart. He himself pushed me in a wheelchair the not inconsiderable distance to the Echo room where he left me with a young cardiologist to do the scan. The cardiologist said it was the first time he had met the legendary and 'incredibly intelligent' Prof. Carmichael and sounded slightly in awe of him. This probably explains why he pushed me to the echo room - once you get to a certain level of importance you feel able to do that without the insecurity that it would somehow jeopardise your authority...
The echo was a little uncomfortable as the probe seemed to have to be positioned right on my scar most of the time and pressed quite hard. Still, the cardiologist said he couldn't see anything untoward and couldn't really explain the odd ECG traces. There might be some slight thickening of the right ventricle (right ventricular hypertrophy) but that's really to be expected from a heart chamber that has spent years trying to pump blood into heavily diseased lungs. The poor old heart had to work really hard for a number of years.
Eventually then, at 8pm on Saturday evening, I was discharged and we came home. My CRP from the blood tests was high, and higher than normal for a viral infection, so the docs suspected a bacterial infection. However, I remember the Papworth crew saying before that the immunosuppression can raise the CRP, so it may still have been viral. They will only know for sure when the stool sample results come back and that takes a few days. Now I am a lot better, the bowels are still pretty dodgy and my appetite isn't great, but I think I'm getting there. I do feel that my chest is a tiny bit rattly when I breathe in fast, and that's a bit worrying, but I have my Papworth clinic appointment tomorrow, so I should be able to discuss all that's happened with Jas. They'll get another X-ray and have a listen to my chest and I guess if it seems there is something awry they might admit me for some IV antibiotics. Also I hope they will do another ECG and get the Echo results from Addies and make sense of all this heart stuff, which never would have turned up if it wasn't for the fact that A&E routinely do ECGs on people since I don't normally have them at Papworth.
A very stressful few days, especially for Vicky, so if any of her friends or family read this please do give her a call as she is so rubbish at asking for support when she needs it. I guess we should admit to ourselves that episodes like this are bound to happen however hard you try to avoid them, especially when your immune system is suppressed. It's interesting to note that Vicky, with a fully functioning immune system, thought she maybe had a very slight bit of diarrhoea yesterday and that might have been the sum total of her version of the symptoms.
I'll report on developments after clinic tomorrow.
5 months ago