Narrative medicine: Covid 19 description submitted to Gazeta dla Lekarzy

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Nadrzędna kategoria: ROOT

Kategoria: Nowości

Opublikowano: środa, 09.02.2022, 14:38

Odsłony: 1170

Karolina Harasimowicz

On a typical day, I’d work from London Fulham Ambulance Station, where I had 15km with return journey on a push bike from my house. I used to swim several times a week. In general I have never had any health issues but appendectomy (1987) and cholecystectomy (2008). BMI of 25.

On April 9th, I started my shift as usual. We have had been called in the morning to Covid19 related cardiac arrest, where after an hour unsuccessful resuscitation I started to began experience elevated body temperature, by 14:00 body temperature raised to 39*C and I have been dismissed from front line duties to home. At the evening started flu-like symptoms (sinusitis, sore throat) including a high fever 39,5*C. Rest and accordingly to the UK Covid19 protocol 1g of oral paracetamol every 4 hours didn’t help .

On April 10th, I contacted my General Practitioner who advised me to drink lots of fluids, observe as well as to take paracetamol and in case of difficulties in breathing or desaturation to call ambulance or get to the nearest accident and emergency department. No any medication was prescribed. I was essentially bedridden for about 10 solid days from this point of my Covid19 journey.

On April 11th, I drove myself to one of the so called 'mobile coronavirus test centres' for general public' as for National Health Service workers was not available at this stage of pandemic. I lost sense of smell and taste at the evening.

On April 12/13th I was so weak that couldn’t get myself out of the bed, started to experience severe fever of 40,5*C and constant sensation of 'concrete slab' laying on my chest. Excruciating stabing, non radiating left hand sided chest pain and the worst sore throat I ever had. I was not able to swallow any solid food, what more I had a great difficulty to take breath in because of painful/burning feeling – like someone put my larynx and lungs on fire. My respiratory rate decreased to 12p/min(with abnormal breathing pattern manifesting in increased depth and prolonged period of time on inhalation) but I was still able to saturating 97% on air room on ease.

On April 14th, I received positive result for COVID19 and was advised to isolate myself for next 7 days.

 On April 15th, I started with a dry cough, it felt like there was phlegm building up in my chest but it wasn’t coming loose yet (no productive coughing). I loaded up on soup, marmite, minimum 4 litres of fluids daily, cough drops, every 4hrs orally 1g of paracetamol (NSAD were non recommended by WHO) and throat spray but nothing seemed to help. My throat got progressively worse and worse that I was no longer able to sleep as simply breathing was extremely painful and insufficient. I started to desaturating whenever I did fall to sleep to 89% on an air room. At the same time, the dry cough was getting worse. I would cough so hard that I would vomit, being completely out of breath and get bloody noses. I spent 3 last days being able to sleep only in prone position and about 15min at a time before coughing/pain/breathlessness woke me up. Two days not being able to eat anything solid. Despite of taking regularly antypyretic, applying wet/cold towels and even taking cold showers I was unsuccessful to bring my body temperature down (continuously over 39,5*C). My partner decided to take me to Urgent Care at King's College Hospital London (day 6 of being sick) as my GP's advice was to observe and as long as I am not desaturating and I am not symptomatic to dyspnea or tachypnea on ease, I was qualified as 'stable from the clinical point of view'.

The strongest thing was a triage tool at King's College Hospital which accordingly to I didn’t meet the mandated criteria for hospitalisation. I explained all my symptoms and worries also presented with vital signs as follows: SAT.95%, HR110, RR12, TEM.39,7, BP 103/76.

Since, I was found clinically stable due to scoring zero on CRB-65 I have been dismissed to home without any further tests or seeing even senior practitioner.

On April 16th, during the night I experienced 41*C fever and spent most of the night cooling myself in a cold shower, started to be tachycardic (HR 115-127), felt sick, dizzy, extremely fatigue with severe joint and muscle pain as well as increased breathlessness. In the morning my partner contacted our polish friend who is obstetrician in UK and after short conversation she said although she is not an expert it sounds to her like it is pneumonia and prescribed Clarytromycin 500mg twice a day for 7 days course. After second dose of antibiotic my body temperature started to go down to 38-38,5*C. My heart rate decreased to 90b/min and saturation was maintained on 95% on an air room.

On April 17th, I was much better despite my throat felt like hamburger meat, and could feel how raw it was at the back of my mouth. All my vital signs started to stabilise but HR. I had no appetite at all so ended up on nutridrinks 5 times daily. I could not drink, and breathe without pain, I had a great difficulty to sleep as my back hurt so badly and I was super fatigued. I was totally depended on my partner Jaye, who I have been together for 6 years and he never watched me dead lift as I was a strong person, quite fit but in general he has never seen me so sick and down like this before, considering that he is also a medical professional (senior Theatre Advanced Nurse with anaesthetic specialisation at Imperial College NHS Trust) it has been genuinely scary and traumatising time for him to watch me struggle to swallow plain water, and wince in pain the whole time, not to mention he made himself off his work as I was unable to function on any level on my own for the past 7 days.

Because of my raised body temperature 38-38,5*C I was given after 7 days another antibiotic (Azitromycin) but it did not help much as this sort of fever stayed with me for another two weeks.

Approximately around 23rd of April I repeated test for coronavirus and still tested positive. The reason behind another test was continuously elevated body temperature, tachycardia, dry cough, cold sweats, abnormal breathing patterns (severe tachypnea on smallest exertion, orthopnea, night apnea, progressively worsening shortness of breath (3 breaths on one sentence) followed by pain and swelling in the joints as well as sharp chest pain increasing while inhaling.

On 1st of May, I attended King's College Hospital again as I developed severe sharp, stabbing, burning pain in the left side of the chest during breathing, especially when inhale. I also noticed that apart of my RR going up to 26 while mobilising, my saturation was dropping rapidly to 85% on as short as 2 minutes walk. I became dizzy and near fainting while walking. Also tachycardia changed in a character, previously I had mainly rapid pulse on exertion (walk from room to room brought up HR to 140-165) but at this stage also occasionally I manifested elevated heart beats on ease (115- 130b/min.).

1/05/2020 chest x-ray.

I have been discharged the very same evening with the diagnosis of: post covid19 syndrome??? No any medication or recommendation but paracetamol has been mentioned to me.

On May 2nd, I did third swab test towards coronvirus which still has come back as positive.

For next two weeks I tried some painkillers and get back to some sort of shape but instead on the 14th of May I started to desaturating to 94% on ease and 78% on tiniest exertion. The left hand sided chest pain worse and was excruciating with even shallow breathing, coughing, sneezing or laughing. The pain spread to the L shoulder, breathing effort increased significantly. I could not make few steps without pausing for rest so I decided to go again to the nearest A&E which happened to be King's.

I have been seen by consultant for the change, some blood test was done, x-ray and I was refused by multidisciplinary team (medical, radiology and A&E)to be given a chest CT scan. I was told that the benefits are smaller than the risk related to the obtained dose of the radiation. I got also worsening advice: when my saturation drops to 92% to get back to A&E. Official diagnosis was: post covid19 syndrome with no any changes noticed to my lungs.

On the discharge notification it is been written my saturation remained on 98% on ease and 95% while mobilising on room air. Truly, on my arrival was 93% but nobody mentioned that for an hour I was placed on 2l of oxygen and left for an hour to check if I am maintaining the levels.

Shortly after discharge I started slowly to drop oxygen levels again. I felt like I cannot find medical attention that I needed in UK. I managed to book and catch midnight ferry on the 15th from Harwich to Hook of Holland and drove to Poland as a last resort. It was complete lockdown, so only returning to the country polish citizens were able to cross the border. Meaning nobody else could drive me there. I reached Central Clinical Hospital of MSWiA in Warsaw within 12hours of driving on the 16th of May were was performed lung CT scan with no contrast.

14/05/2020 chest x-ray

ECG 14/05/2020

Discharge notification from King's dated on 14/05/2020

Translated Chest CT scan results as follow (16/05/2020): Transient areas of ground glass opacification with slightly dilated vessels peripherally in the a short inferior lobes of both lungs and in the superior lobe of the left lung. ln each of the mentioned lobes, the lesions occupy approx. 25% of the lobes volume.-/- Lymph nodes of the mediastinum and hila are not enlarged -/- The heart is not enlarged.-/- No fluid in the pleural cavities. The epigastrium within the limits of the study:-/-

I was admitted for 10 days to Infectious Diseases Hospital in Warsaw-translated discharge notification it is been presented below :

On admission the patient was complaining of increased back pain making it difficult for her to be lying down and sleeping, feeling of compression in the chest. In addition to this, reported shortness of breath, fever, dry cough.-/- A test for COVID-19 was positive on 9.04., 23.04.,.02.05.2020 -/- During the hospitalisation the patient was in good condition. She had periodical drops of SpO2, most likely related to sleep apnea - elective diagnostics to be considered. -/- Blood analysis revealed mildly increased ALT and GGTP activity, leucocytosis and granulocytosis. The abdominal ultrasound did not show any remarkable abnormalities. -/- Hydroxychloroquine, O2, vit.D was introduced, PCR test in view of COVID19 – negative on 21 and 23.05.2020.

Hydroxychloroquine happened to be a game-changer for me. After third dose, I finally was able to lay down on right lateral position and after 5 weeks of being deprived from sleep I managed to close my eyes for a whole two hours. Difficulties in breathing reduced greatly to the level that I started to walk a little bit again, no further support of O2 was required. After 6 days of taking well known malaria drug I got first in 46 days negative to coronavirus test result, two days after second one and I was discharged to home on the 26th of May 2020.

I spent June/July/August trying to regain some strength and giving in to my total exhaustion. My lungs would get tired and ache after more than 1min. walk at first, at the moment depends on a day but I can walk for more than an hour.

28/08/2020

After 3 months I have been referred for follow up chest CT scan which showed results as follow:

In comparison to the previous CT scan 16/05/2020, the transient ground glass opacities in both lungs have fully disappeared – full improvement. A nodule of 4 mm in diameter in the 6/10 segment of the right lung. Apart of that, the lung parenchyma is normally aerated. The mediastinal structures and great vessels of the chest are normal. No enlargement of the lymph nodes of the pulmonary hila and mediastinum was observed. Clear bronchi, no signs of narrowing. No signs of fluid in the pleural cavities.

05/10/2020

...Lingering effects 4 months later:

I had developed interesting case of tinnitus. I would listening to the phasing of the high-pitched frequencies in my ears with curiosity and trepidation. I would fall off a cliff into total exhaustion with seemingly no warning and have to spend a day in a bed. But slowly, with two steps forward and one and a half steps backwards, I was able to regain enough strength that I could take a walk by the sea side (7km). I still suffer from upper and lower limb moderate muscle weakness with tremors in hands and legs. Muscle spasms all over the body during the nights. Widespread bones, ligaments severe aching that can come and go including redness and swelling. Altered, odd feelings such as numbness, pins, tingling mainly in my fingers and foot but recently also neck and face. Funny enough my muscle with simple exercises instead of getting more flexible or stronger, are getting more shaky/trembling. I have days that I am lacking energy, what more my body is shaking like a jelly. Hands, ankle and knees joints stiffness. I still occasionally experience mild heart arrhythmias (HR 105-125). In July/August I had a great difficulties to climb the stairs as my heart rate was rapidly jumping to 160b/min. including crushing central chest pain and my RR increased to 30b/min. At the moment is slightly better and it is easier to walk on a stairs.

Typical redness and swelling of my joints:

Left elbow joint. Left wrist joint.

I am also still affected by left superior lung region pain situated next to heart that is getting worse on exertion and deep breathing. After exercising this pain is radiating to the left base of the lung and there is also an expansion feeling. Another annoying long term impact of the Covid19 is phlegm overproduction. Although, I am still short of breath while mobilising I am not desaturating while exerting. My lungs are still aching and my chest seems to be slightly tight. Bone-crushing fatigue was replaced by tiredness. Two weeks ago, someone showed me how to breath. It is strange experience to have learn how to do a thing that you never had to learn in the first place...