Week 5: Guardians of the galactocele

I had to find a Marvel pun somewhere right? Titular jokes aside, this week I was on infectious diseases and as a happy coincidence, it was also World Antimicrobial Awareness Week. As a result, I will try to keep my message quite clear this week:

Without antibiotics, a scratch on your finger could be fatal. It’s as simple as that. Take a look at the links at the bottom of this blog for information on how to support good antibiotic use.

Aside from this overarching message, I have two main learning points from this week:

  1. Infections in hospital can really complicate an otherwise simple health picture
  2. HIV patients are not a single stereotype, and I now think of it as a “state” (like pregnancy or menopause) as opposed to an isolated disease.

Bugs and boils

Apologies in advance if you’re eating, or squeamish, but whilst inspecting the seven inch incision over the patient’s hip, buttocks and leg, it occurred to me that patient flyers for hip replacements probably don’t show the pictures of red, pulsing pockets of infections. Unfortunately, anytime you introduce “foreign” material into the body (calm down, Mr Farage) you risk pesky bugs sticking to them and forming stubborn biofilms– picture Glastonbury but just with more bacteria. Actually no, just picture Glastonbury.

A patient with an infection can essentially get there in two ways: either the infection is what brings them into hospital, or they get it whilst they’re there. To further complicate matters, the mainstay of treatment (antibiotics) can introduce a cocktail of side effects, allergies and even cause infections in the form of C. difficile, which takes advantage of a patient’s freshly sterilised gut by multiplying and causing a myriad of issues.

This complex picture taught me the importance of managing patient expectations and desires. Infections can persist and it’s important to keep patients aware of what is happening, what exactly is growing in them (even if they consistently get the names wrong- I sincerely hope there isn’t a “Strepicoccus aureus“) and keeping their primary problem in mind. Infections can crop up at any time, and if a patient is post-surgery, under treatment for cancer or has weeks to live then the infection is something to add to the picture, not consider in isolation.

Stereotypes and serotypes

As an Asian male, I’ve become increasingly aware of how stereotypes can bias healthcare professionals with patients. This bias is probably best demonstrated in HIV positive patients (chances are an image just flashed in your head of a homosexual male, probably with tattoos).

However, I saw quite a few HIV positive patients this week and the only thing that linked them appeared to be their HIV status. The other interesting part was the dichotomous approach to treatment: most HIV patients comply well with treatment, and thankfully the drugs we have can render the virus effectively undetectable in the patient (look up “U=U” for HIV treatment). However, some patients have disengaged from treatment, allowing the virus to run rampant. There are many reasons for this, and it’s a situation I can’t pretend to understand because I imagine the weight of the diagnosis, stigma and mental health burden can really take its toll.

The problem is, HIV stigma is ironically a massive barrier to eradicating its transmission. From what I understand, HIV transmission persists because we firstly have patients who don’t control their viral levels, then there is a large percentage of undiagnosed people and finally those unlucky few whose HIV doesn’t respond to treatment. If we could effectively treat diagnosed patients and decrease the number of undiagnosed, positive patients then we could maybe get a handle on HIV transmission. But like most things in medical school, the picture is undoubtedly more complicated than that.

I’ve kept this week’s blog quite “educational” because of the overarching message, but I certainly felt privileged to still be able to talk to and examine these patients despite the pandemic. I also got a lot of brilliant teaching and some exemplary patient advocate work by juniors and consultants alike.

I saw a lot of patients suffering from antibiotic resistant bugs, a truly terrifying prospect. Thankfully, it won’t happen to us. Except it might. So this week I became an official antibiotic guardian. Please do the same at http://www.antibioticguardian.com, do some research on antibiotic stewardship and please don’t demand antibiotics from your doctor.

Next week is a mishmash of lectures and seminars but I’ll hopefully have some guest blogs to publish as well. A special thank you to everyone who reads these- they’re mainly for me, but getting positive feedback is always a highlight of my week. Especially if you like my puns.

(FYI- a galactocele is a cyst in the breasts, often treated with antibiotics.)

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