Did the Drink Bottle Do it?
A real life sporting "who-dun-it" and my epic battle with E-Coli
"If you die now, Gary, that will not be good for your reputation".
Good advice from my very wise younger brother, Bruce. Of that, I could not disagree.
Death was a rather dramatic over-the -top reference to what was going on right then, but I must admit I was feeling very, miserable when he rang me on Tuesday to pass on these words of wisdom and encouragement to hang in there. Last Saturday I contested the New Zealand Mountain Bike Championship Finals in Wanaka. Wanaka is now where my youngest sister, Delwyn, and her family now reside, having shifted back to New Zealand from the USA just a few weeks earlier, so a family reunion with them and Bruce was irresistible.
Don't do it, Gary!
It seemed this was one race I should not have contested: all the signs for the superstitious were there, but I ignored them. I was like the smokers in this video:
Yes, that video was made just for me!
First, we had the remnants of a tropical cyclone sweep over my lower South Island destination the day before arrival, wreaking devastation on huge swathes of the country. That did not stop my arrival, so a huge dump of historically un-seasonal snow was dropped on the race venue (Cardrona) the night before, but the organisers switched the race to Ohau Flats, just out of Wanaka. So it was still all go. I got on the plane.
I arrived in Wanaka Thursday last week. Bruce drove me out to the MTB course for a practice ride. I immediately struck mechanical problems; my suspension lockout was not working, so we made a quick trip into Wanaka to find a mechanic with the requisite skills to sort out my Cannondale Scalpel suspension issues. I found the man, John Hare, who I used to race against during the late 70's in multi-sports races. We returned to the shop a few hours later to find no John, just a broken Scalpel! We learned that John had fixed the suspension then took it for a test ride. While riding he changed gears and the derailleur hanger snapped! The nearest hanger for a Scalpel is the other end of New Zealand, so that meant my super-racy machine was Kaput! (It was not John's fault. The part had probably been stressed earlier on and his ride was the final straw).
John eventually arrived pushing a bike which belonged to one of his friend's daughter who was about my height. After changing pedals, chain, rear wheel and a few adjustments, I was back in action. It was not the ideal bike and not the ideal way to prepare for the Big MTB Champs, but I was still in the game. I kept reminding myself to keep positive, make no complaints, just focus on making the start line, and I'll still be in with a chance for a win.
We were back on the course Friday morning. The bike was fine and the course was good. I drank about half a bottle of my special Super Juice (steroid and stimulant-free, I might add), then headed home to rest up as much as possible. The race was Saturday morning, so it was all about recovery and preparation, such as laying out race shoes and kit. This included topping up my drink bottles which were only partially emptied during training.
The race kind of went well. Kind of. I crashed badly on the first lap, twisting my handlebars, rearranging my helmet and losing at least three positions, then dropped my chain (unfamiliar bike) on the second, losing even more. The third and final lap was trouble-free and I ended up third in the over 50 Masters.
After the race I felt pretty good but also a little mystified why I just did not seem to have that burst of high-octane energy which I'd been preparing for weeks to unleash during this race. I had a headache which I put down to the tumble during the race. By evening, the headache was becoming a real bother and I was feeling excessively tired. A bad dose of "Post-race Fatigue", I assumed.
When I woke on Sunday morning I realised I was in trouble. I had all the signs and symptoms of the Flu, other than coughing and spluttering. My entire body ached and I was running a temperature. My urge to pee was becoming constant and the act itself almost unbearable.
The long flight from Queenstown to my home in Wellington was torture, but I made it. All hell broke loose on arrival, I was rushing to the toilet every 5-10 minutes to agonisingly pee, then flop back into bed. It took me a few hours to realise that it was not urine but blood, that was coming out, some of it as long black blood-clots! I realised that I had what appeared to be an aggressive urinary tract infection. With infections of this kind, there is no mucking around because the bug can quickly migrate to organs, like the kidneys, potentially wreaking life-long damage. That means getting onto antibiotics without delay.
Sunday night was a nightmare, what with lying squirming in bed for little more than 10 minutes before rushing to the toilet to pass a tiny amount of blood. Doing so was agonising.
Fortunately, I was able to get an appointment with our local General Practitioner who turned out to have the most reassuring bed-side manner. I could barely walk by then and even talking was becoming difficult. I could not eat and had not eaten since Sunday morning. Urgent blood tests results that came back a few hours later confirmed that I had E-Coli bacteria and an "impressive" response to the infection. Antibiotics had already been commenced earlier in the day and well and truly justified. I took care to ensure that I was not prescribed any of the fluoroquinolone class of antibiotic which has an appalling list of side effects.
Would you like some horror and sorrow with that, Mr Moller?
Whenever I closed my eyes from Monday night and looked inwards I realised that my head was filled with videos, mostly of running water, water running over yellow-brown rock and gravel. As I watched the flow would morph into astonishingly complex and beautiful biological structures, but these were few. More often than not the flow morphed into deformed skeletal creatures, skulls, bones - death! Thankfully, I could get rid of these by opening my eyes. Hallucinations like these are a common side effect of many of these drugs, although it took a few days for me to realise that this is what was happening to me, but I was desperate to get on top of this infection, so opted to continue the drugs. Changing drugs at this stage of the infection could be no better, a bit like jumping out of the frying pan into the fire. Right now, the infection had the upper hand and I was at risk of quickly going downhill. It would take 2-3 days for the antibiotics to kick in. I can handle that. Yeah-right!
By Tuesday I was a blubbering emotional cot case. I was bed-ridden, sleep-deprived, hypoglycemic and depressed. I could hardly talk at times. Walking further than the toilet was an easy but slow marathon.
Come Wednesday night I had had enough. The last straw was the most horrific video that played inside my head. I won't describe it. It was time for the next level: hospital and, presumably, IV antibiotics. It was midnight when we arrived at the Accident and Emergency.
The waiting room was almost full. I was triage assessed. As the lovely nurse was assessing me I could not prevent the tears welling. I was over this. I also knew that she was assessing a very fit man in his 60's who has spent years building his tolerance to pain and exhaustion. The health norms for old men simply do not apply. Yes, as expected, the result of this assessment, I was informed, is I must wait in line which meant hours of sitting in a busy waiting room. I had to lie down and keep warm. My decision was to go back home and see my doctor in the morning. That was a decision that was forced on me by a health system that is close to breaking point.
Our health system is in crisis due to inadequate investment
Thursday morning, I was fortunate to get into the local clinic to see another doctor. I immediately began to blubber and cry. I was so fragile. She took some new blood tests and contacted me later in the day. The results had my white blood cell count down from spectacular to be normal, while my CRP had dropped considerably but still very high(CRP is a measure of inflammation). This was good news and probably confirmation that I was more or less over the infection. However, it was agreed that I should continue with the last three days of antibiotics because the worst thing to happen would be a relapse that would be driven by the worst bugs on the block and that would mean more powerful drugs.
From Sunday through to Thursday, all that I had eaten was a bowl of muesli and one apple. I just could not eat. I had no appetite. This was not helped by the mouth ulcers and diarrhea that began on the Tuesday. I was already honed to a very trim race weight of about 64 Kg before falling ill. I had little more to lose. On Thursday I weighed in at 60 Kg. That rang alarm bells. I had to start eating. The blood tests gave me the confidence to over-ride the signals not eat. I was also beginning to wonder if some of the things I was suffering, such as the now ongoing aversion to food, was due to the infection initially, but being perpetuated by the antibiotic.
My skin was developing rough, itchy patches that I felt compelled to scratch. I tried lying out on the porch to get some sun, but my skin began to burn almost immediately.
Thursday night was the pits. I had the most violent case of Restless Everything. I could not lie for more than about 20 seconds without the irresistible urge to move, scratch or roll. I was going nuts with frustration! This went on all night. No more antibiotics! I'll take my chances with the bugs. The only things that were going into my mouth from now were things like good food, probiotics and immune support formulas. Nothing more.
Antibiotic side effects
I experienced hallucinations/nightmares, depression, skin rashes, sun sensitivity, extreme restlessness. These are all documented in the literature as side effects associated with the drug I was taking. However, none of these will be reported by either of the doctors I consulted. In fact, the second tried to tell me that these symptoms which I repoprted were not from the drug.
It is now Friday afternoon. I'm still feeling very weak, but I'm feeling much better and I'm eating well. My brain seems to be working despite the lack of sleep (If you have managed to follow my story to this point, then that is confirmation to me that my recovery is now well on the way!).
Antibiotics and the end of Healthcare as we know it
I'm angry. Really angry that I have had to subject myself to all of this abuse because of the ongoing misuse of the wonder-class of drugs known as antibiotics. Drug resistance is now such that we are getting very close to the time when any kind of routine surgery is once again a life-threatening procedure, due to the risk of contracting an infection that we can not safely treat.
As older antibiotics lose their effectiveness, stronger and more powerful drugs must enter the fray that we are losing. Unfortunately, these new drugs come with longer and more exotic lists of adverse effects. It means that when a person comes along, like me, who really does need the assistance of an antibiotic, I must do so knowing that my choices are becoming limited and I must run the gauntlet of nasty side effects. The drugs I'm taking may maim or kill me.
Antibiotics should not be used for treating minor infections unless there is a compelling case to use them.
Antibiotics should not be used to enable factory farming, nor as growth promoters. Antibiotics should be reserved for humans and animals that really need them. Not so they can cram more people and animals into tighter and less hospitable spaces. We need to protect our water ways (remember the Havelock North Campylobacter outbreak).
We have forgotten how to treat wounds and infections without resorting to antibiotics. That knowledge about how to treat wounds has been pretty much lost from allopathic medicine with the retirement of the last doctors and nurses that graduated during the 1950's. We need to resume teaching these traditional skills to everyone, so that the reserve troops (antibiotics) are seldom called upon.
Right now, your doctor probably does not know what to do, other than prescribe a pill. In addition, there is no funding for the additional time required, should your doctor opt to treat a wound, for example, without the use of drugs. You see, the system they must work within is geared up for the quick and efficient dispensation of drugs from a list of approved medications and not much else. This has to change. One measure would have a specialist Infection Control Nurse or two in every medical clinic for the purpose of cleaning and dressing wounds and supervising non, or post-antibiotic treatments for things like respiratory, gut and bladder infections.
Did the drink bottle do it?
I was drinking from Camelbak bottles with the wide mouth dispensers. I now think these are not suitable for dirty sports like mountain biking. They are apt to collect, dust, dirt, mud and animal poo which may be squirted into one's mouth. In addition, when you cease squeezing the bottle any leftover residue, like cow dung, may then be sucked into the bottle, thus contaminating the liquid within.
Major blunders on my part
I was not properly cleaning and sterilising my drink bottles.
I was using a bottle (Camelbak) which can not be adequately cleaned without dismantling the cap dispenser mechanism.
The wide mouth of the Camelbak is the perfect "crud-collector" while riding a bike on farmland.
I foolishly refilled the bottle without first emptying it completely and cleaning it.
The bottle of liquid was warm most of the time over a couple of days.
This may not be quite so bad if it was not for the fact that I refilled my partially emptied bottles three times over three days without thoroughly cleaning the bottles in between. These were out in the hot sun for several hours at a time. I think I could have been poisoning myself with E-Coli since Thursday! In the past, the water remained in the bottles for only a matter of hours which is probably why I have gotten away with things previously.
Why did I not clean the bottles and change the liquid? My excuse is that I had only a limited supply of my special drink powder, due to being over the baggage weight limits for air travel and with nothing to spare. I had nothing to be wasted. This decision sure ended up costing me big time.
The two doctors discounted this means of contamination because my first symptoms were in my urinary tract and not my digestive tract. On reflection, I think I had the infection as early as Thursday evening but no symptoms other than a slightly rumbly tummy. It was only when the bug made its way via my sweaty bike shorts into my urethra that I really began to head downhill quickly. That was later on Saturday.
I do not know of anyone else around me who fell ill with this bug. The only thing that stands out as being different is my drinking from those bottles which I now realise were filthy inside their mouths - yuk!
I have since learned how to dismantle a Camelbak bottle. I was shocked when I saw just how filthy the internal parts were and how ineffective "normal" cleaning had been. Lesson learned. These are going into the rubbish bin, but not before I take this matter up with the manufacturers.
Camelbak does have a cap to cover the nozzle to stop crud getting into the nozzle's mouth, but this sells for an extortionate $13 in New Zealand. It is not practical for use while riding rough terrain on a mountain bike, thus negating the advantages of the bottle's nozzle design.
I have decided that dismantling and cleaning the nozzle mechanism is impractical, so have opted to ditch this kind of bottle and go back to the conventional design.
I'd be interested to hear from anybody else who suspects their drink bottle may have affected their health.
That's the end of my story, friends. I did get beaten up but I'm now over the worst.
We must change how we use antibiotics and we need to have change right now. The consequences of inaction may be catastrophic.
There needs to be more through reporting of drugs adverse effect so we can better understand them and use them more safely. Make your own reports to the Center for Adverse Reactions in Medicine (CARM). Your doctor is unlikely to do this for you, so do it yourself.
I do not want to go through another week like this ever again.
Reading and Action:
The antibiotic I was on: Trimethoprim - Hallucinations and depression (Btw: keep a close watch on your teenagers who may be prescribed any kind of antibiotic for acne. They may go crazy. They may become suicidal!): https://www.ncbi.nlm.nih.gov/pubmed/2426895
This is the antibiotic you should not take unless your life depends on it: https://www.garymoller.com/single-post/2017/05/21/This-is-one-antibiotic-you-should-not-take
How to report an adverse reaction or medication error (do not rely on your Dr doing this - do it yourself: https://nzphvc.otago.ac.nz/
The devastating Havelock North Campylobacter outbreak: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11853270
How to treat wounds without the use of antibiotics: https://www.garymoller.com/single-post/2017/03/25/How-to-treat-a-wound-without-using-antbiotics
Tips for cleaning a Camelbak bottle (I've since concluded that this type of cap design is simply unsafe and best avoided): https://youtu.be/AmyZeqHTAXM
An over-priced protective cap for the Camelbak bottle to prevent gunk getting into the mouth of the cap while riding: https://www.bivouac.co.nz/gear/camping-and-tramping/water-bottles/camelbak-podium-mud-cap.html