Tuesday, 9 February 2010

A morning in hospital with sarcoidosis

Sherlock Holmes ... he may have had a room in Sidney Sussex, but he also provides an early link between Irish writers and sarcoidosis (Photograph: Patrick Comerford, 2009)

Patrick Comerford

I spent the morning in the Adelaide and Meath Hospital in Tallaght for another round of tests and consultations about my continuing battle with sarcoidosis.

In the past week, my cough has disturbed me, and I have been anxious to know how this condition – which I have been living with for al ittle too long – was going. Is it stable? Is it developing? Is it being controlled by the inhaler I now use twice a day? Has it reached a peak?

It was great to good news. It appears this is about as bad as it gets. There has been no change in the growths or granuloma on my lungs for the last few months, no change in the swelling of my glands, and my lungs are functioning well.

Tell me that when that dry coughing assaults me in the middle of singing at Choral Evensong.

But it is good news. I have reached the peak or the plateau. I can now hope my sarcoidosis has stabilised, and that sometime soon I may even begin to hope for rermission.

I was amused recently to find that Sir Arthur Conan Doyle – the creator of Sherlock Holmes and Dr Watson – had his own brush with sarcoidosis. Well Doyle did make Well Doyle did make Sherlock Holmes a student at Sidney Sussex, my favourite Cambridge college.

In 1926, Doyle introduced a patient with cutaneous sarcoidosis as a key figure in his plot for The Adventure of The Blanched Soldier. In Doyle’s novel, the patient is misdiagnosed with leprosy, but in many ways this highlights the varied presentations for sarcoidosis and the potential for a delay in the diagnosis.

Dr Seamas Donnelly of the National Pulmonary Fibrosis Referral Centre Saint Vincent’s University Hospital, Dublin, wrote last year in The Irish Medical Times about the diagnosis and treatment of sarcoidosis, saying Ireland has one of the highest incidences of sarcoidosis in the world. And yet the specific cause of sarcoidosis remains unknown, although at Saint Vincent’s they have identified a specific pattern of genes associated with aggressive disease in sarcoidosis.

The symptoms include intense fatigue, and the lungs are affected in 90 per cent of cases, with discrete but well-formed non-caseating granuloma in up to 85 per cent of cases.

Sarcoidosis is a multi-system disorder, initially affecting young people in their 20s and 30s, which adversely affects quality of life. Dr Donnelly pointed out that while sarcoidosis does not feature prominently in the media in Ireland, more Irish people suffer from this disorder than from cystic fibrosis or cervical cancer.

Up to 30 per cent of patients show progressive disease, and mortality is the range of 1-5 per cent. In some cases, sarcoidosis is a chronic progressive disease, affecting the central nervous system, bone and skin.

And so, as you can understand, I’m hoping today’s good news translates into a joyful reality for me in the months to come.