Glastonbury, 2013. Photo: Ian Gavan/Getty Images
Show Hide image

Ketamine users, beware: your trip might end on an operating table

The drug can cause symptoms akin to a UTI – recurrant use may lead to severe bladdar damage.

Poppy came to see me, suffering from yet another bout of cystitis (an inflamed bladder). The likeliest culprit was a urinary tract infection (UTI), which would respond to antibiotics. Men rarely get UTIs but the tube – the urethra – draining the female bladder is very short, rendering it susceptible to invasion by bacteria. This was Poppy’s fourth presentation over the course of the summer, so it was starting to look as if she would be one of the group with recurrent problems.

A student in her early twenties, Poppy has a cheerful approach to life and seemed to view these episodes as no more than mildly irritating interruptions to her general mission to party, travel and attend as many festivals as possible. Although her symptoms were typical – frequent and urgent calls to the loo, with a nasty, burning, cramping pain when she passed urine – I was starting to wonder whether a UTI was the correct diagnosis. I sent urine samples to the lab on two occasions and neither of them yielded a positive bacterial growth.

I made some tactful inquiries about any link to sex. “Honeymoon cystitis” is a term belonging firmly to another era, yet it’s still widely used as a euphemism for the association between intercourse and cystitis-like symptoms, which probably arise as a result of frictional microtrauma to the urethral opening. Although Poppy said she was intermittently sexually active, there was no clear relationship to any of her episodes of symptoms.

Another possibility was chlamydia, one of the commonest sexually transmitted infections. Many people carry it without symptoms but one of the ways it can present in a woman is with recurring bouts of what seem to be UTIs, yet return negative laboratory cultures. Poppy proved to be clear. An ultrasound scan excluded a bladder stone.

I’d investigated all the causes I could think of and had drawn a blank, so I left her with advice to ensure a good daily water intake, avoid drinking too much coffee and not to use bubble baths or other potentially irritant chemicals. Time passed and she receded in my mind, the absence of any new presentation suggesting that these simple lifestyle measures may have been all that had been required.

A couple of months later, I attended an educational event convened by our local drugs team. It was arranged because over the past few years our locality had become a national hot spot for the illicit use of ketamine. While the dangers associated with common street drugs such as heroin are well described, ketamine use is a relatively new phenomenon and some serious problems were starting to come to light.

In the UK, ketamine serves as a veterinary anaesthetic. Taken in smallish doses by human beings, it produces a hallucinatory trip (“going in the K-hole”). It seems that ketamine also provokes an intense inflammation of the bladder and, sometimes, the bowel. The latter causes abdominal pains (“K-cramps”), while the former causes symptoms indistinguishable from a UTI. With regular use, this chemical cystitis results in scarring and intractable irritability in the bladder. There is a small but growing cohort of young people facing a life blighted by incurable urinary symptoms, the only remedy being the surgical removal of the damaged bladder and the diversion of urine drainage through a stoma.

The drugs team urged us to consider ketamine use in any young person presenting with recurrent cystitis without proven infection. Poppy immediately came to mind. Before I had a chance to contact her, however, she’d made an appointment with another bout of symptoms. Now I knew the question to ask. Sure enough, it transpired that she had been dabbling with ketamine and we were able to link each of her cystitis episodes to an instance of drug use. She was shocked by the connection and sufficiently alarmed by the prospect of permanent bladder damage to forswear any future trips through the K-hole.

This article first appeared in the 30 January 2015 issue of the New Statesman, The Class Ceiling

Show Hide image

For the first time in my life I have a sworn enemy – and I don’t even know her name

The cyclist, though, was enraged. “THAT’S CLEVER, ISN’T IT?” she yelled. “WALKING IN THE ROAD!”

Last month, I made an enemy. I do not say this lightly, and I certainly don’t say it with pride, as a more aggressive male might. Throughout my life I have avoided confrontation with a scrupulousness that an unkind observer would call out-and-out cowardice. A waiter could bring the wrong order, cold and crawling with maggots, and in response to “How is everything?” I’d still manage a grin and a “lovely, thanks”.

On the Underground, I’m so wary of being a bad citizen that I often give up my seat to people who aren’t pregnant, aren’t significantly older than me, and in some cases are far better equipped to stand than I am. If there’s one thing I am not, it’s any sort of provocateur. And yet now this: a feud.

And I don’t even know my enemy’s name.

She was on a bike when I accidentally entered her life. I was pushing a buggy and I wandered – rashly, in her view – into her path. There’s little doubt that I was to blame: walking on the road while in charge of a minor is not something encouraged by the Highway Code. In my defence, it was a quiet, suburban street; the cyclist was the only vehicle of any kind; and I was half a street’s length away from physically colliding with her. It was the misjudgment of a sleep-deprived parent rather than an act of malice.

The cyclist, though, was enraged. “THAT’S CLEVER, ISN’T IT?” she yelled. “WALKING IN THE ROAD!”

I was stung by what someone on The Apprentice might refer to as her negative feedback, and walked on with a redoubled sense of the parental inadequacy that is my default state even at the best of times.

A sad little incident, but a one-off, you would think. Only a week later, though, I was walking in a different part of town, this time without the toddler and engrossed in my phone. Again, I accept my culpability in crossing the road without paying due attention; again, I have to point out that it was only a “close shave” in the sense that meteorites are sometimes reported to have “narrowly missed crashing into the Earth” by 50,000 miles. It might have merited, at worst, a reproving ting of the bell. Instead came a familiar voice. “IT’S YOU AGAIN!” she yelled, wrathfully.

This time the shock brought a retort out of me, probably the harshest thing I have ever shouted at a stranger: “WHY ARE YOU SO UNPLEASANT?”

None of this is X-rated stuff, but it adds up to what I can only call a vendetta – something I never expected to pick up on the way to Waitrose. So I am writing this, as much as anything, in the spirit of rapprochement. I really believe that our third meeting, whenever it comes, can be a much happier affair. People can change. Who knows: maybe I’ll even be walking on the pavement

Mark Watson is a stand-up comedian and novelist. His most recent book, Crap at the Environment, follows his own efforts to halve his carbon footprint over one year.

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood