One of my favorite sites on the Web is called the “oops” list:


The Oops list has many photos and a few video clips – funny and odd things, many of airplanes in various states of not flying.  Give it a look.

So, my “oops” is that yesterday I wrote that Nancy’s PICC line had been inserted.  I called that one too soon – sort of a “Dewey Defeats Truman” thing:


I was out-maneuvered by the medical folks.  In searching for internal blood loss their tests were coming up with a lot of nothing.  Thus, the PICC inserter was pushed away from the insertee and folks showed up (mid-afternoon) with a yummy barium sulphate drink.  X-rays have an unfortunate propensity to pass through empty intestines but not through barium.  By ingesting and thereby coating the walls of the gastro-intestinal tract (in Nancy’s case now, the small intestines) with barium the snaky little thing shows up clearly on the X-ray pictures.

Barium in its elemental state is not found naturally as it combines easily with lots of other things thereby producing a variety of compounds, one being Barium Sulfate (BaSO4).  In most mineral collections you can find Barium-“Desert Roses” and these are a concentric pattern of increasingly larger crystals stained red with iron.  Picture here:


That is about as familiar as one gets with Barium unless you are lucky enough to be handed a glass of Barium Sulfate liquid mix.  This is not anyone’s favorite drink.

So you drink the stuff, gag, spit, and wait.  After sufficient time the small intestines are ready for their time before the “camera” and then you wait some more and they are back for second and third exposures.  This exam is sometimes called a “Barium follow through” and in Nancy’s case yesterday the follow-through ended at 10:30 P.M.  She had gone a couple of days without real food and her digestive tract – well cleaned out – was not prepared for crispy chicken and biscuits.  We have one very unhappy Southern belle.

The day ended with no PICC line so that procedure was today but delayed because the PICC-inserter had a full schedule and did get to Nancy until about 3:15 P.M.  They finished with an X-ray to check for proper placement of the end of the catheter.  She called me about 5 P.M. to confirm all is well.   Except for the known issues with her health they have found nothing new.

I have a car-service appointment (a mile from the hospital) at 10 A.M. tomorrow so we are hoping she might get walking papers by noonish.

We’ll see.   John

MONDAY — Anticipation

Yesterday nothing showed up on the CT scan of the pancreas but the spleen had two spots indicating, I think, blood clots.  These so called “splenic infracts” are blockages of the veins or arteries for the blood supply to the spleen.  Atrial fibrillation and bacterial endocarditis are known contributors to splenic infractions.  These are expected to be reabsorbed after awhile.  Nancy’s current case of endocarditis has been halted.  We also hope something can be done to reduce the incidents of A-fib.  In any case, now the infractions are known about and fit into the general situation and are not a big worry.  It is also a relief to know that the pancreas is without problems.

Splenic infarction can occur without symptoms (asymptomatic), which was the case with Nancy until this week.  This week the typical symptom — severe pain in the left upper quadrant of the abdomen showed up.  Sometimes the pain radiates to the left shoulder but that wasn’t the tell-tale sign.  Fever and chills develop in some cases and she did have these, but, again, with the other things happening (including the bladder infection) they were not the symptoms that led to the CT scan.

So, onward.  This morning the nurse told Nancy that her colonoscopy was scheduled for one o’clock.  The nurse didn’t seem aware that an upper GI endoscopy had been talked about and so went off to check.  Sometime later she came back to report that both were to be done – and so they were.  So they looked into her from both ends and found nothing.  Good news.

They refer to the upper GI exam as an “EGD” – and for good reason.  Who wants to say “esophagogastroduodenoscopy” more than once?  Rather than me explaining that you can read about it here:


A follow-on regarding the duodenum (the first section of the small intestine) is here:


This test ruled out any bleeding within the three structures, and that’s good.

The last procedure for the day is the instillation of a “peripherally inserted central catheter” (PICC or PIC line) for which, in previous reporting, I used the acronym PICC.  You can read about it here:


I will add a bit more on this tomorrow.  We then may have some indication of a release-from-hospital date because there are no more procedures scheduled and the PICC line can be used at the Ebrg hospital to infuse the antibiotic therapy as was done last July.

So while no plans are yet made, we are anticipating escape release soonish.

Cheers, John

SUNDAY — A trip to the CT lab

Being Sunday, this is the one day of the week that we have been writing.  If you are returning for the first time since last Sunday you will want to go back and start on Monday (a catch-up day) or on Tuesday when an early morning event sent Nancy back to Yakima Regional’s ICU.

~ ~ ~ ~ ~ ~ ~ ~

The only news for today is that late this afternoon Nancy had a CT scan of her spleen and pancreas.  This site:


shows the location of these.  The spleen has important roles in regard to red blood cells and the immune system.  The pancreas is a gland that produces many different substances to both aid digestive functions and regulate other processes.  If you look at the image on the suggested web site you can see that these organs are within a three dimensional jig-saw puzzle with other soft tissue parts, namely, the stomach, liver, and gallbladder.  Projecting X-rays through the body to the far side and onto an imaging surface or film will give a muddled picture.

Think of taking two thin clear wine glasses of different shapes, say one is more cylindrical and tall and the second is more of an onion bulb shape.

Set one in front of the other and look along the line that goes through the center of both.  This might make for a confusing image, at least, more so than if you slid the one out to the side from behind the first.

When trying to “see” internal body parts with X-rays we can’t just move the parts around as with the glasses.  But, by moving an X-ray source and the film to many different positions the technician can get individual thin sections, pick only ones imagining, say the spleen, and then stitch those sections back together again and reassemble a picture; or you can just look at the individual slices.

There is an explanation and color image here:


The word “tomography” is explained there.

Nancy had to drink a bottle of Gastrografin, which contains a molecule with Iodine and aids in producing ‘contrast’ so the image picks up the target tissues, that is, the intended part or parts.

Nancy left her room at about 5 P.M. and was back by 5:30.  She said they took about 400 images.  This information will be sent out to an experienced person who will interpret and consult with the doctors in charge of Nancy’s care.  So at this point we do not have any results.

Meanwhile, she stays on a liquid diet in preparation of the upper-GI and colonoscopy, now planned for tomorrow.

She has given up on the Jell-O and is very tired of the special juice drinks provided for sustenance.  Who can blame her?

WEDNESDAY — slips to Thursday

Last evening, when I normally would have been writing something for here, I responded to a batch of e-mails and just as I finished with those the phone carried a call from a friend.

She and I share the unwelcome situation of have spouses that suffered major heart related illness in 2009.  This also means that her husband and Nancy have many experiences to compare.  He had a major heart attack last spring that culminated in a heart transplant late in the fall.  They live in  a sparsely populated mountainous area remote from a major medical center and so he has been hundreds of miles away – and still is.

We each knew of the unfolding medical issues of the other but keeping in communication was nearly impossible.  Thus, we had a long phone call and when it was over I had some chores to do and never thought again of making my “occasional” update about Nancy.

She is still doing well – I’ve talked to her twice this Thursday morning – and I will remember to get something on here tonight.

THURSDAY — the year ends

MORNING : I spoke with the night nurse at 10 min. to 6 this morning.  Nancy had a good night.  The ventilator was still providing a little oxygen but no mechanical assist for breathing.  So, lungs and heart (now minus the balloon pump) are doing their things.  Ventilator tube is still in because they want to wait until later when the ICU is full of doctors – just in case the thing has to be put back in.  She still has to communicate via them asking Yes/No questions or pointing at letters and she still has post-operative pain and is getting lots of pain medication.  I know she felt frustrated yesterday because she could not talk to us.

NOON : Our horses got their feet trimmed this morning – after several postponements this month.  Snow was falling softly as we finished.  Travel highway-cameras showed snow on Interstate 82 and National Weather Service folks have issued a winter storm warning.  I called to check on Nancy.  She was still doing fine.

5 P. M. : I spoke with Nancy’s nurse earlier than usual because they had taken the ventilator tube out this afternoon and then a procession of doctors visited.  Her voice is very soft but she asked the nurse to call me.  I was out moving that white fluffy ‘insert your favorite term here’  off of the driveway so called back.  Everyone seems to be pleased about Nancy’s progress following the operation, including Nancy.

Some of you know Nancy plays fiddle in a group that visits retirement, nursing, and rehabilitation centers.  They play old-time country music –think Appalachian Mountain Music.  With continued progress she will soon be in one of those places to which they go. Players and spouses are meeting tonight for a pot luck dinner and maybe a little music.  There is other music I’d rather listen to (except for a few tunes) but the food is always good.  So, I’m off to a place just 5 miles away.  If it snows too much while I’m there it is close enough that I can walk home.

~~~~~~~~~~~~  HAPPY NEW YEAR ! ~~~~~~~~~~~~

FRIDAY — presents time

An early morning phone call to the Intensive Care nurse provided my Christmas present.

I had spent an hour with Nancy last evening only 3 hours after the procedure that installed the balloon pump.  She was alert but exhausted and while the read-outs on the monitors showed the equipment working as designed there was little to show for it from the person in the bed.

The evening shift nurse had just been briefed and taken on Nancy’s care as I arrived.  She gave me a quick course in evaluating the lines and numbers on the monitors connected to the intra-aortic balloon pump and the related sensors inserted into Nancy’s heart.

At 6:30 this morning the nurse said Nancy had a good night and was talking and had just asked for some ice-chips.  The screen info last night was positive and the nurse now says all those signals continued to improve and have translated into an improved Nancy.

I hope you all got nice presents too.