Back in January my husband nearly killed himself due to a long-term addiction and severe overdose of combined Codeine and Ibuprofen. He was addicted to the codeine, but it’s only available OTC when combined with Ibuprofen over here. That’s ostensibly to stop addicts. It doesn’t.
The short story is the ibuprofen ate through the mucosal lining in his stomach and caused an ulcer right on top of a blood vessel. It took 5 units of blood and a week in the ICU to get him back on his feet.
After he left hospital, he spent some time on a maintenance program, taking methadone and trying to stay off the nurofen. He went off the program after a couple of months because there was only one outpatient clinic where he could get his dose before work during the week, and they threatened to cut off his program when he missed a couple of days due to trains being late & his needing to get to work on time.
So since about March he’s been on his own. I’ve been trying to keep an eye on him and keep him off the nurofen, but he’s an adult and I can’t watch him every day. He’s admitted there were a couple of occasions where he started using again, but says to me he was only using a fraction of what he was using before, and no more frequently than once every couple of weeks, whereas before it was every day, up to 36 tablets a day.
In the last couple of months, however. He’s been getting sick again. Not the cramping and vomiting that were hallmarks of the ulcer and bleed last time. Just losing weight, feeling tired and cold, legs swollen, skin dry and flaky, mouth sore and cracked, small injuries (scratches, bruises) not healing properly, sleeping badly. Then in the last 6 weeks, his weight has just plummeted and he has started having gut problems and issues keeping food down again. So about four weeks ago I got him to the doctor.
He saw the doctor at 6pm on a Friday. Had a blood test. At nine am the next morning (saturday) the doctor called us at home and told my husband “You need to come and see me NOW, don’t make an appointment just come in and I’ll see you. I’m sending you to hospital”
It turns out he’s hyper anemic now. The doctor told him his iron count in his blood, which is normally meant to be in the mid-20s IIRC, was 3. But there’s no blood in his vomit or stool, so where’s it all going? So we go to the hospital at lunch time on the Saturday. He gets in to the ER by about 5pm. They do some more bloods and basically say that his kidneys, thyroid and other functions are all fine, he’s just bleeding from somewhere and they don’t know where. His iron and haemoglobin are scary low. So here’s a referral to the Endoscopy clinic, they’ll call you or send you a letter on Monday, your options at this point are a blood transfusion or iron therapy.
The doctor at the time said to us that a blood transfusion would mean a stay in hospital for a minimum of 2 days, so they could watch him for signs of rejection/sickness after the transfusion. And each unit of blood would only really add about 10 to his haem (which was about 70-something), so a 2 unit transfusion would not make him better right away, it would just improve things slightly. So my husband opted to try the iron therapy, and we were on our way back home by about 8 that evening.
So we get home, things go on as normal. He starts taking iron, then starts taking more because the normal therapeutic doses aren’t quite high enough for what he needs. He has an endoscopy and they say that they really can’t see anything apart from a small ulcer that looks like it’s mostly healed. Maybe that’s where all the blood came from over a long time and it’s on its way to getting better now?
Except it’s not. The iron is only just having any effect on his energy levels, he’s still having problems with his lower GI constantly roiling and making noises and cramping any time he’s got food in there, he’s having trouble keeping food down, the edema in his legs is still getting worse and he can’t sleep now because if he tries to lie down at night, the pain comes back. So on Sunday the 28th of September, around lunchtime again, we end up back in the ER. This time we actually got into the ER after only 2 and a half hours in the waiting room, but then there were more blood tests and more waiting. This time the decision was made to do the transfusion. I left him in the ER at about 10pm, just as they were prepping him for his first unit of blood.
Over the next 24 hours he got 2.5 units of blood in total, plus fluids and more blood tests. Haemoglobin levels were up about 35 points on his last visit to the hospital, so the transfusion did something. Just. Monday was mostly blood test and waiting, Tuesday nothing at all happened. Wednesday, another endoscopy.
This time, they said they’ve found a rather substantial ulcer and it’s nowhere near healed. So the gastroenterologist says to us that he’d like my husband to stop the iron treatment, to start taking the biggest PPI (proton pump inhibitor) they can give out and to take anti-spasmodics and antacids as necessary. And then, because my husband was threatening to pull his cannula out and walk, they let him go home with me on Wednesday evening.
So now we’re a week and a half on from that. Husband says for the most part the nexium (the PPI) is stopping most of the pain in his guts. Most of the time. Still can’t eat spicy food. Or acidic food. Or food after a certain time of night. And we’ve had a couple of vomiting instances. And he’s still nearly passing out during the middle of the day at work, he’s so tired. And barely able to eat enough calories in the day to stop him from losing more weight (he’s 6’1" and at one point was nearly 65kg). And the edema in his legs is still so severe he can’t walk up and down stairs properly. And he’s sleeping on the couch all day and all night for most of the weekend. And the house is filthy, dishes are piled up because I’m just too damned worn out to get to them.
Did they threaten to cut him off and he just chose to stop going? Or did they actually tell him not to come back?