Hi All,

Saw Forbesy on Sunday and had a good catch up. He’s definitely looking thinner as he has lost a lot of the muscle bulk in his upper body. That said, he is able to use his biceps on each arm to bend at the elbow but relies on gravity to extend at that joint. He feels he’s making some progress with his arms which is positive but the full extent of any functional movement won’t be clear for quite a while yet – he has to learn how to best utilise these gross (large) movements of his upper arm to help him with finer activities such as driving an electric wheelchair.

Michael has had some fevers and generally felt unwell during the later part of the last week. He has been commenced on some antibiotics and was somewhat improved on Sunday. In the work-up for his fevers, Forbesy was found to be colonised with VRE, a hospital bug that has necessitated a change in his room and some extra hygiene precautions. I want to spend a few moments explaining the significance of this because as visitors you may notice that he has a single room and health care workers are wearing gowns and gloves when they enter the room. I’m an infectious diseases registrar and this is part of what I deal with every day so I know that the general public, as well as the nursing and allied health staff, and even the medical staff can have a variable understanding of what this means.

The E of VRE stands for Enterococcus, and this is simply a normal bug that lives in the bowel of every one of us. When it stays there, it doesn’t make us sick. If it gets into the urinary tract or bloodstream, it can make us sick, but it is uncommon for this to happen. In fact, this bug most commonly causes illness in people with a poorly functioning immune system (ie not Forbesy). The VR stands for Vancomycin Resistant, and implies that one drug that is used to normally treat enterococcus is ineffective in killing it. Newer, (sometimes) more toxic and definitely more expensive drugs can be used to treat it, and for this reason when someone is found to have VRE, efforts are made to limit its spread around the hospital.

It is a sad and somewhat distressing fact that many of these bugs are created because we use too many antibiotics. Most of my job is actually stopping the inappropriate use of antibiotics. Resistant bugs are then spread by people having direct contact between patients. As such, one of the many ways to prevent the spread of these bugs is for the hospital staff to change gloves and gowns when going between patients. This has now been instituted for Forbesy and he has a single room to facilitate it.

Note earlier that I said Forbesy has been colonised with VRE, and not infected? The difference is that while VRE has been found amongst the normal range of bacteria that you would expect all of us to harbour, it is not making Forbesy sick and it has not been isolated from anywhere it is not supposed to be (eg urinary tract or bloodstream). Hence he is colonised but he does not have an infection from VRE. As such, while he is receiving antibiotics at the moment, they are not targeting VRE. Sounds complicated I know, but the take home points are that he has a single room, hospital staff are gloving/gowning, and we should not be concerned when visiting but just remember to use the antimicrobial hand rub before and after visiting.

Hope this helps. Please feel free to email me or write a comment if you need any clarification or I can help out in any other way.

Cheers

Sam Hume
schume@yahoo.com