SUNDAY — Views past & forward

Thankfully, we did not have any earthshaking events happen, and we can report the same ole, same old.  We like it that way at the hospital.  Another week passed means one more step toward the end of my infusions on September 28th.  That’s right before my retirement “party” on Oct 2nd.  Looking forward to both and for both to be in the rear-view mirror.

I’ve had far fewer (as in “almost none”) atrial fibrillations or other arrhythmias since introducing and balancing ‘amiodarone’ (am-ee-OH-duh-rown) with other meds.  Also sold as Cordarone, amiodarone interacts with many other drugs and stays in the body for weeks after one stops taking it.  I’m off digoxin because of an anticipated interaction. If you are around someone on amiodarone you can read about it here:

http://www.medicinenet.com/amiodarone/article.htm

This next week has some health events happening–another try at the Holter heart monitor, and another echocardiogram to see how my heart is doing.  Will report in next weekend, and hopefully NOT before.

We have been continuing to raise the puppy that we are keeping till after his titer has shown he has immunity to Canine Parvovirus, sometime after Oct 4th when we will take him in for the lab test.  The vet’s lab is in Phoenix, so not as handy as I get here at our hospital on my blood tests.  If my INR is too high or too low I know in a couple of hours and can subtract or add Coumadin with the evening pill intake.

We went every day during the work week to the hospital to Out-Patient Services for the infusions, now of just Rocephin.  It usually lasts only a half hour not counting the setup and take down time, but it totally is less than an hour, so that’s nice.  They are so good to me and have brought me a Glucerna-boosted chocolate milk shake every session.  They put me under a heated blanket because the rooms are cold, and have me in a nice bed for which I can control the height, the head, and under my knees, to lift them as well.  I get very comfortable for my infusion.  There was only one day last weekend when I was subjected to have it done in a chair with no warm blanket, and that was no fun.

On weekends we go to Medical Surgical, or as happened Saturday, the beds in MedSurg were full, so I was taken care of in the Critical Care Unit (CCU).  I had a nurse yesterday who remembered me (and I her) from my stay there, way last summer when I also had bacteria in my bloodstream, which started all this heart mess, the Endocarditis.

There was no one staying in the CCU, but the day before it and Medical Surgical floor had been filled with young people, all kids.  There were 6 appendectomies in one day, by one doctor.  He said there must have been something in the water.  He has worked at hospitals before in large urban areas and never had a cluster like this.

We also went to garage sales a couple days this week (Friday and Saturday).   Found neat stuff, not the least of which is a case (50 cents) for my Dulcimer… it’s a case for a keyboard that died.  They want $50 plus for special cases on the web.   I’m obviously feeling better to be going back to yard sales.  John is kind to drive me fairly close and let me out, so that I don’t have to walk too far, even though I’m getting better on my stamina each day.  Two stops we went to were neighborhood sales with 5 or 6 sales on the block.  Another was at a retirement community with the folks unloading knickknacks collected over a combined 943 years.  There is a lot of “stuff” accumulated in such a long time by so many people.

John says I’m supposed to keep this blog to my health, so I will relate that I did get some things to aid in my health.  I nice new pillow for my recliner foot rest (free); a lap blanket for cool nights, even though our heat has been coming on; a pair of Ray Ban sunglasses for my trips outside.  I lost a lot of weight, so clothes and coats are nice to find deals on at yard sales too.   I got a nice “Rawhide” looking coat with fleece from a friend at a yard sale.  I found one of the foam seats for cushioning chairs.  So, that’s my news of the uneventful week of hospital care, but how it influenced my healing process.  The prices, except the coat, were 50 cents.  Also, I take my many pills with chocolate milk in an ‘Old Fashioned’ (squatty) glass.  This shape is easier to rinse out and clean than taller shapes.  At one sale, for $1.50, I got 8 owl-motif glasses so can put the Christmas scene ones away for a few months.  I continue to spend gas money on finding good deals at sale, and it gets me some fun exercise too.  I pick up shirts that fit for a quarter, and that’s nice.

Also, I played music at the Rehab last Thursday, the place where I spent 6 weeks back in January and February, with physical therapy 3 times a day to regain use of my muscles that had atrophied.  Those are happy memories only now, and it is nice to be able to walk down the hall, past my old room, and into the cafeteria to play for some people / patients I met while there, as a patient myself.

Okay, I had best stop this so John can put out on the blog.

Have a nice week and we hope to do the same.

Nancy

SUNDAY — Happenings before Labor Day

Many of you were not expecting anything to be written this past week till today, but we sneaked some in on you when things starting happening.  The end of the week was less eventful, thankfully, on the health, antibiotic infusion part.  The rest of the time after the mess on Monday, was pretty smooth sailing.   Today had a funny note, but the infusion went well.

The Out-Patient services put in a standing order for me for a milkshake with boost of Glucerna added to chocolate ice cream, two scoops.  Yesterday went without a glitch and the kitchen provided my shake.  Something got lost from yesterday to today, and first they brought a bottle of Glucerna with a cup, no shake.  The people in Med-Surg sent it back requesting a shake.  What came next was the Glucerna in a cup with ice as the base.  Finally, the third time was a charm, but it was only 10 minutes before I ended for the day.  I drank a bit and took the rest with me for the trip home.  We’ll see if tomorrow the kitchen gets it right the first time.

The other nice thing that happened today was a visit with friends, now in Rockville, MD who we have known a very long time – since starting at the Univ. of Idaho as an undergraduate student, going on through to a Masters, and being involved with me while a GIS manager on the west side, by employing several of my students as interns.  He and his family flew to Seattle, rented a car, and were driving over to Spokane, when they stopped off for lunch and a visit with us.  We met them at the Deli at Super One in town.  That was a good choice because the town is inundated with rodeo and fair goers and all major restaurants probably were packed.

The rest of our last couple of days was filled with moving hay (John), and playing with the puppy, who has taken a liking to the sofa in the den.  He actually made it halfway through the night in the washroom, went out to “pee” at about 2:30, and spent the rest of the night till morning, happily sleeping on the sofa with his mom.

We do not have any special plans for labor day so doubt there will be any blogs till next weekend, but that’s what we said last week.  So we will not speak ahead and just keep you informed if anything big happens.

Much of my time this past week was spent on email, contacting former students and workers who employed my students to invite them to my retirement party.  If you didn’t get an invite and are interested, let me know by email (nancyh@ellensburg.com) and I will send you the invite, knowing you cannot come but might just be interested in seeing the celebration the Geography Department has planned for me, Oct 2, Saturday afternoon.

Former students have responded by email with some good memories that make my day.  There are comments from them about their connection to me (and John) that I would never have known.  There will be a memories book at the reception, for people to write in, and they also can send to our secretary, for her to include in the memory book.  I hope she will just print the emails and save herself  the effort of writing in the book, and just slip them in the back.  Otherwise it might be an impossible task.

Other things have happened this week, on the minor side, but major in my book.  John had planted some tomatoes, but our temps have been low and the winds high, so we had broken plants and not a lot of ripe tomatoes.  Yet, this week he has harvest a few small ones and they are wonderful, tasting like tomatoes.  What a concept !  [from jfh, We have had many clear-sky nights and at 2,240 feet elevation the night temperature will and has dropped well below 50o F.  Tomatoes hate that.]

I’m sure I left something out, but not to worry, there is another week.  Thank you for your phone calls and birthday and get well cards.

Have a nice week, and we will try to do the same.  I still have till September 28 to go daily to the hospital for the infusions, which have decreased this week from two to only one – 30 min., Rochephin.

See you on the blog hopefully only next weekend.   Nancy

THURSDAY — Smooth flow

Have to report on my birthday (67) yesterday, Sept 1.  It was a good uneventful day.  I didn’t want John to make me a Chocolate Cake with Chocolate Frosting, but I did want two presents.  One was a squeaky toy and a rawhide chew for the puppy, Rhu.   He now has a name, and a neat toy hamburger he loves.  He can jump up on the sofa along with it and settle down for a nap with his mom, John, or an aunt.

John put in more time digging for the bottom of the stand pipe where the leak is suspected.  He then went to the pasture to mow old grass, roses, and other nasty weeds, and ended up getting a stick caught under the drive-belt.  Apparently the belt and the stick both fought gallantly until they both died. The mower quit moving forward when the friction and heat stretched the belt.  So, yet something else to fix.

Birthday afternoon at the hospital out-patient clinic was delightful.  They were all attentive and everyone on the staff came by to wish me a happy birthday.  They had a little snuggle bear on my pillow for me to have and take home.  There was a milkshake ready with extra protein and supplements.  All went well, and they changed the dressing on my PICC (has to be done once a week).  It is nice to be able to report nice things.

Today is Thursday and was another great day.  We got my other present I requested when John got a haircut from the lady who has done my hair cuts since I arrived in town in 1988.  I normally do John’s hair, but was unable in the past few months and his hair was beginning to look like Einstein’s.

Then I went to play fiddle and sing at a nursing home and had another good hour.

Finally, left there in time to get to my infusion, which again went smoothly.

That’s all, but wanted to give you some good news for a change.

TUESDAY — A fibrin tale, er, tail

[posted Tuesday, after John said no more reports till Sunday]

A continuation of the drip, drip epistle:  We’re good at prematurely speaking about successful activities.  For my blood draw and infusion today, at 3:00 p.m., we found that the the PICC line would not flow, unlike the water line at home that won’t stop.  There was not a drip of blood to be had because there was a clot in the line acting as a stopper and wouldn’t allow anything by or from.  The first saline solution seemed fine, but subsequent attempts to draw blood resulted in dry air.  This normally is just over an hour in and out for the antibiotic infusion.  Not today.

The problem would have been either a fibrin tail or an intraluminal thrombus.

These and other PICC issues are reported here:

http://www.medscape.com/viewarticle/508939_6 Here are quotes:

#1  “Fibrin also may build up on a catheter without completely enclosing it. In this scenario, a small piece of fibrin hangs off the catheter tip. This is known as a fibrin tail, which also represents a persistent withdrawal occlusion. These can sometimes be resolved with an infusion of low-dose alteplase over 2 to 4 hours, but this is not always successful, and the fibrin tail may develop again.”

#2  “An intraluminal thrombus forms inside the catheter and can result in partial or complete occlusion. It often can be dissolved with a small dose of alteplase, a fibrinolytic agent that is instilled for 30-120 minutes and then withdrawn from the catheter.”

~ ~ ~

When the PICC is to be used the first thing done is to apply suction until blood is seen.  When none shows up it indicates a blockage.  Fibrin is explained here: http://en.wikipedia.org/wiki/Fibrin

When fibrin attaches to the inner-end of the line or tube (lumen in hospital speak) it floats in the blood stream until that backward flow from the external suction causes it to be pulled into the open end of the tube. If the lump or clump (thrombus) is formed inside the lumen then the condition is called an “intraluminal thrombus” as in quote #2, above.

If you have a broadband connection, try this video for an explanation of these things and the solution.  (This is an ad-like video for the chemical used in my PICC.)  http://www.cathflo.com/media/cathflo_moa.mp4

The production of this stuff involves recombinant DNA technology, fermentation, and Chinese hamster ovary cells.  Why Chinese hamsters?  Who knows?  We didn’t even realize hamsters had nationalities!

Which ever it was, we had to go to plan B.  That meant an extra hour plus while we awaited delivery from the pharmacy of  Cathflo Activase® and its forced entry into the PICC line with turbulent motions.  Push, push, to get the fibrin broken up and the line unclogged.  Meanwhile, John retrieved me a warm blanket to try to get me comfortable.  Those 45 minutes seemed to last forever.  I called a friend on the cell phone to tell her my plight.

Finally, the time came to search again for blood from the PICC turnip.  It came!

First item on the agenda was to draw blood for an INR test, from the PICC.  Before that, one has to clean out the Cathflo Activase® and about 10 cc of throw-away blood.   (No wonder I’m anemic; they put blood in one week and take it out the next).  So we continue.  She draws a full vile of blood for the INR test, more than enough to be on the safe side.

I had started the paperwork over a week ago from my family physician’s office to put the INR on tap for being done by a nurse in the Out-Patient Services where I am every day except the weekend.  This is a great service that prevents being “poked,” but Lab personal cannot take from a PICC line; only a trained nurse is allowed.   When I came in, before she started the antibiotics I mentioned the need to do the INR test and that the paperwork was in place.  Normally, I have a standing order at the Lab, but nothing at the Out-patient Services.   This nurse couldn’t find anything in the records, so off she went to call my family physician’s office to request it before she could draw.  There was plenty of time while we waited for the fibrinolytic agent to work its dissolving wonders.

Once done, as mentioned above, the nurse could change the head on the PICC line (cannot use one through which blood has been taken, and infuse the antibiotics into my PICC.  I think it was 4:16 when this part started that usually takes an hour.  We were about on schedule, only an hour + later than usual.  So begins the drip, drip – one from each bag of the two antibiotics, combining into one tube headed into my superior vena cava — a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart’s right atrium.

http://en.wikipedia.org/wiki/Superior_vena_cava

I slept through the first 35 minutes, but by now my back was hurting, the pillows weren’t right, and I was a basket case for reclining in an uncomfortable set up so long.  Oh, I had made a couple more cell phone calls to friends in the set up stages when we were just waiting.

So, I mentioned my discomfort to the nurse.  I was in a special bed with remote controls to determine height of back raised and the same with knees.  I played with the controls and finally found a good position.

At some point I was really wanting a chocolate milk shake.  The nurse overheard me and said they could order one for me.  They did.

I managed to rest through the last hour of the infusion.  We didn’t walk (wheel) out of there until 6:30.  That was 3.5 hours for an expected 1 hour stay.  I was not a happy camper.  Except I was thrilled to see the double saline solution flushing with a turbulent short pushes motion to force the solution to the line with the hopes of breaking up any clots.  I surely don’t want a repeat.

~  ~  ~  ~

In the “for what it’s worth” department:  At home, the day started with nary a drip.  In order to prevent loss of water from the well John flipped the circuit breaker to the pump; turning it on only as needed to have running water in the house.

A Culligan man was due at 10:00 a.m. but was delayed ½ hour.  He got to the house and John explained the problems.  They determined the Culligan-Softener (21 yrs old was shot) and the Iron removal equipment was doing fine still. (Ours is ferrous iron that oxidizes in the lines and tanks.)  The Culligan-man and John discussed the pressure problem in the tank and decided there was a leak in the house or between the house and the barn somewhere.  Turns out it is between the house and the barn but John hasn’t yet located it.  He has to dig 4 feet down through alluvial fan material that has been refilled in a ditch for the buried water pipe.  He’s hopeful that the leak is in a frost free stand up faucet for the horse tank at the barn. While the exact location of the leak is sought, replacement equipment has been ordered to provide sparkling water inside the house.

Blood and water go drip – drip.  Money goes in clumps.  Ouch!

Life continues . . .

SUNDAY — Drip. Drip!

Nancy’s follow-up to a week of intensive care . . .

Hello folks, I’m back.  We stayed till 9:30 at the potluck and jam session.  Each day at 3 P.M. I get infusions.  Rocephin.  Drip. Drip. Gentamycin. Drip. Drip.

Saturday and Sunday the procedure differs because out-patient services are not open on the weekend.  So I go to the regular Medical Surgical nurse station (MedSurg in hospital-speak) and check in.  They treated me like a million dollars too… and all went well.  John brings a book and I sleep.

I’m a thousand percent better, if that is possible mathematically, from last Tuesday a week ago when I entered ER in Ellensburg.  They still did not really find a source of internal bleeding, so I’m blaming it on the bacteria and hopeful the antibiotics will vanquish them forever and the blood loss. (Maybe it could be suppressed production and not a loss?  Just a thought.  Either way, maybe it will vanish.  JFH)  Only 5 ½ weeks to go.  Drip. Drip.  The Gentamycin was added because of my pig valve in my heart.  Previously, June/July ‘09, I was on straight Rocephin.

I think the one day I had the CT Scan, Endoscopy, Colonoscopy, and a ton of Barium X-rays of the whole track, upper and lower intestines, from 2:45 till 10:00 P.M., and about 5 blood draws, that I deserved the an award for the most procedures one patient was subjected to in one day.  I might have had the TEE that morning too.  That also included a rude awakening early morning by the nurse who had seen a succession of atrial fibrillations and thought there was a V-tac going on.  It was not.  She was obviously upset and wanted to know if I had any chest pain; well no, only the continuing pain from the two clots in my spleen.  I also said I was having a night mare (probably caused by the antibiotics, she said).  So I was ready to go back to sleep and await the morning blood draw at 5:15 a.m.

Rest in the hospital has to come in pieces. One morning (night?) they woke me at 3:30 to weigh me.  Hello!  I’m supposed to rest. I got pretty good at it.  The last few days there I was moved to a MUCH quieter room on the 4th floor in ACU (Acute Care Unit).  That is one step down from ICU (intensive care) but honestly in my case I was still on telemetry and oxygen and still very monitored.

We’ll return to Sunday postings now.  I trust the next reports will continue with my feeling better and improving.  Don’t quite have the stamina back yet after a week of bed rest, but I’m getting there.

~ ~ ~ ~It seems when Nancy has issues the house colludes with her.  Our water system – well, house, barn, yard – seems to be leaking.  We have a 30 gallon pressurized tank.  The pump is supposed to keep water in it and another gizmo inflates an internal bubble and presto we have water when and where we want it. Currently the pump and gizmo do their stuff and then the water drains back out via some unknown leak. Then the pump – pumps again, and it drains out again.  Drip. Drip.

Nice folks came this morning and carried away the penultimate puppy – I turned the pump on and got enough warm water so we could send her off without the dirt.  We still have the male but need to wait a few more weeks until he develops immunity to parvovirus because of the known incidence of it somewhere visited by the family that got the little guy that died (and the virus is now in their own house and yard).  We stopped and got him an extra vial of prevention today.  So he gets a shot tonight. Ouch!  — but hopefully no drip, drip.

We have a report back on the little puppy who left today.  She slept the entire 3.5 hour trip home.  They have introduced her to their securely fenced backyard, and their older dogs in the house.  She has explored the house.  She also found out about a water sprinkler and enjoyed getting her head wet, staying a happy puppy.  We are grateful for yet another fantastic home.

THURSDAY — Double Dang!

I think Nancy feels better today than she has in a couple of months.  A lingering question about the blood loss remains.  If not caused by the bacterial infection, then what?  The heart issues will be treated continually, so, while she is examined, tested, and treated appropriately for her finicky heart over the next few weeks, the anemic aspect will be watched.  Multiple exams ruled out many things, so with respect to this, we are in a period of watchful waiting.

She went to the local hospital for antibiotic infusion via the PICC line today.  The pharmacy folks indicated they were okay with both of the compounds going in at the same time.  That cut the procedure down to about an hour.  They fixed up a nice comfy bed for the duration and when I returned she was ready to go.

I hadn’t stayed.  That’s the “double dang” part.  One of my jobs yesterday was to clear out the hospital room.  Things such as un-opened fruit juice and the plastic pans for holding tape or other incidental items – these things all get sent home with the patient or tossed out. I cleaned up all these things into a couple of small boxes and a plastic bag.  A nurse brought a wheelchair, I went ahead and brought the car to the front door, and minutes later we were on I-82 heading toward home.

Big mistake.  Someone (me?) forgot to unplug two power supplies – one for her cell phone and one for the laptop.  Bummer.  Ensconced in a fluffy bed, Nancy recharged while I boomeranged from Ebrg-to-Yak and back.  Wind gusts today were nearly 50 mph and the passenger side of the car sometimes makes an odd woodwind sound when air begins passing over us at about 100 mph.  I got that a lot today along with the turbulence.  I did see a large column of dust coming from the lower valley south of Yakama and streaming into the area above the clouds over my route. That was very interesting.  On the ground these dust steams make for nasty driving, accidents and closed roads.

Now that Nancy has her computer back I will expect her to write on Saturday.

There is a potluck by and for the Kittitas Valley Fiddlers and Friends tomorrow evening, so, Friday will be an off-day for our communications.

WEDNESDAY — Dang!

I got the day right but missed the time.  Last week I had to pick a time to get the car serviced and hoped to combine activities, thereby having to make one less trip to Yakima.  So, I said to the man, “Sure, lets do it Wednesday.”  Then I estimated they would discharge Nancy right after lunch and picked a 10 A.M. appointment with the service shop.

There was a problem.  Magnesium (Mg).  This element is used by the body in many chemical reactions.  It is an important electrolyte along with sodium, calcium, potassium, and chloride.  The last is discussed here:

http://en.wikipedia.org/wiki/Chloride

Magnesium is discussed here:

http://en.wikipedia.org/wiki/Magnesium

… where it claims it to be the 11th most abundant element by mass in the human body.  Scroll to “Biological role” more than half-way through the page.  Well, the point is that the doctor decided Nancy was a quart low and as long as she was in the shop, why not just top-er-up some.  Why not indeed?

Time is why.  Slower is better.  Look at this: “Supplementation with 1 to 4 g of MgSO4 over 1 to 4 hours is usually adequate, depending on the extent of deficiency; the administration rate should be slower for infusing increasing amounts in nonemergency situations to avoid hypotension.”

http://www.heart-disease-bypass-surgery.com/data/articles/35.htm

Hypotension simply means abnormally low blood pressure.  Sure thing we don’t want to do that to Nancy, so slow it is.  So, over lunch and into the afternoon Nancy was infused with antibiotics and then switched to a slow drip to bring her Mg level up to the “full” line.

Long-story-short:  She exited through the front door at 4:05 P.M. and we were home at five o’clock.  She is feeling good.  Sleeping.

TUESDAY — Oops!

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

http://micom.net/oops/

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:

http://en.wikipedia.org/wiki/Dewey_Defeats_Truman

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:

http://new.minerals.net/mineral-variety/Mineral/Desert_Rose.aspx

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:

http://www.gicare.com/endoscopy-center/upper-gi-endoscopy.aspx

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

http://en.wikipedia.org/wiki/Duodenum

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:

http://en.wikipedia.org/wiki/Peripherally_inserted_central_catheter

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:

http://pedsurg.ucsf.edu/conditions–treatments/splenectomy.aspx

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:

http://en.wikipedia.org/wiki/Tomography

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?