My family became a victim of the healthcare system.

It took me one whole day of rest before I can write about what happened to my father-in-law a few days back.

A bit of background first.

My father-in-law is in his 70s. He developed diabetes mellitus type 2 for the past decade already, and last year he started going into end-stage renal failure. We decided to put him through peritoneal dialysis at home.

Ever since his diagnosis with diabetes mellitus, he has gone in hypoglycemic episodes 2 times. The first time a few years when he was staying alone, my brother-in-law called me commenting on his drowsiness state. I gave him an intravenous dextrose fluid and he quickly became alert. The 2nd episode he was not so drowsy, but could not walk steadily. For that I quickly reduced his medications and gave him more surgary drinks. I wrote a letter to his specialist doctor telling them that I reduced his medication dosages after analysing his glucometer readings. The specialist doctors increased them up again, but I persisted at the dosages that I prescribed. His glucose readings stabilised without any hypoglycemic attacks…….till now.

He recently had gastroscopy and colonoscopy done at a hospital to investigate a slight drop in haemoglobin levels ( the part of the blood that carries oxygen to the whole body ). We suspected the cause of this is the recent bleeding piles he had but we wanted to rule out more sinister causes. The piles were banded, and the gastroscopy revealed oesophagitis and presence of Helicobacter pylori, for which the specialist doctor prescribed antibiotics, the standard protocol. The treatment was done in day surgery, and he discharged well.

The day after his treatment, he seemed slightly more tired, which we thought was nothing out of the ordinary, especially with the drugs they gave him for the procedure.

About 48 hours after his treatment, we discovered that he was very drowsy, and could only respond to us by eye movement and mumbled speech. We immediately checked his glucometer reading, and it was very low! We had to give him sugared water by the mouth, and keep on doing that till he was more conscious. My family had to keep a watchful eye on him and his glucometer readings for the rest of the day so that he would not go into a coma. For the next 24 hours, we were managing alright except for one hour when we had to induce some pain in him to get him to take sips of sugared water. My family, including myself, was not prepared for this episode this time round. If I was prepared, I would have instantly got him back up again with intravenous injection of dextrose fluid.

On analysing the trigger for this terrible episode, we discovered that

1. He was on dosages of the antibiotics against Helicobacter pylori which were good for those who were not kidney failure patients. The specialist doctor should have halved his dosages because of his kidney problems!

2. He was having diarrhoea as a side-effect of one of the antibiotics, which is well-known. The diarrhoea caused loss of carbohydrates and sugars from his diet.

3. His main complaint during this treatment at the hospital was for his bleeding piles, not for his stomach or oesophagus problem.

So we immediately discontinued his antibiotics.

He is now well and his blood glucose levels are stabilised again. And we managed all these without him being hospitalised, unlikely so many patients I had seen when serving in the medical wards of our hospitals.

The patients I used to have in the wards who were hospitalised because of similar situations that my father-in-law went through. They had it worse because they stayed in the hospitals on average a week, and some even more. What is worse is that sometimes they get infections from neighbouring patients. These were reasons why my wife and I decided to keep him at home for management under our care.

This experience has taught me how families feel when their loved ones suffer a similar fate, and had no choice but to admit them into the hospitals because they did not have the expertise that I had for my father-in-law.

I am now prepared for such incidents with intravenous dextrose fluids for my father-in-law. But I feel that other families should have this service too, so that it will help prevent unnecessary anxiety and costs, especially if such episodes are caused by oversights from doctors and the system they work in.

I am a medical doctor, and even my family became a victim of the system.