sinanju: The Shadow (Default)
So, as part of the onboarding process to work at OHSU, I have to get some immunizations (or sign a waiver disclaiming any responsibility on OHSU's part if I don't and get sick). I also have to have a 2-step Tuberculosis test. They don't want me spreading it all over. Makes sense.

Monday I went to my doctor and got one of the required vaccinations. I've had the others. I also got the TB test, and was scheduled to go in this morning for the second part, where they check to see if I have TB. I expected it to go quickly. After all, I don't have TB. Right? Right?

Well, the nurse looks at my arm, at the slight redness at the injection site (which, ideally, would be neither red nor inflamed). And then she goes and gets another nurse, who examines me, and asks me a bunch of questions about possible exposure to TB, any symptoms (none), or exposure to people who've been innoculated against it (co-workers who are from out of the country, for instance). That latter thing is possible, I suppose. But I don't know.

Then they call my doctor out of another patient room to examine me. The reaction is extremely mild, the redness is not very red, it's not very large, and it's only barely raised. But "barely" is not "none at all." So, since I need to be cleared by Monday in order to start my job, they send me across the street to the hospital, where I get a couple of chest x-rays. If the x-rays are clear, I'm golden. If not, well, they may have to repeat the skin test in a couple of weeks.

I am rather alarmed at this point. I called my wife to tell her the exciting news and get some support and sympathy, which she delivered. I'm not so much alarmed about having TB--I figure it can be treated. No, I'm worried that I won't get a clean bill of health, so will lose out on the new job--and I've already quit my previous job. That would suck mightily. So I left, stopped on the way home to get an early lunch at the local bakery (bacon/fried egg croissant). It was very tasty. I ate and read for a bit, then went home.

Where I realized was feeling increasingly anxious. Not long after I get home I got a call from my doctor's office telling me the x-rays were clear and I'm officially okay. Wow. that was an incredible load off my mind.

Fast foward to right now. I'm back from a four hour visit to the Emergency Room. I drove into town to pick up Snippy from work. She was having some trouble breathing (talking much or doing most anything strenuous was making it hard to breathe without coughing, and her chest felt tight). She'd begun feeling puny about mid-afternoon and it wasn't getting any better. If anything, it was getting worse. She has a Xopenex inhaler for asthma, which she used four times that day, to no avail.

Finally, she called her allergy doc, who--based on how she sounded over the phone--advised her that, yes, she should go to the emergency room. So I drove her there. She had an EKG, which showed no heart issues. Then was seen by a doctor (with lots of waiting between every step, it goes without saying), and given some IV steroids, and some inhaled drugs through a nebulizer. This got her breathing better. The doctor came back to say that her labs (drawn on arrival) also showed no heart issues, so based on her response to the drugs, he was confident that it was just exacerbated asthma. Maybe the cold, wet weather--I dont' know.

So we're home again, and she's in bed, and will be staying home from work tomorrow. I'll be going out early in the morning to the pharmacy to get a few days worth of additional steroids to help with the problem. So we're glad it was nothing more serious, but all the same--do we HAVE to have ALL THE THINGS happen to us?
sinanju: The Shadow (Default)
So some time ago (two years ago? three?) was diagnosed with Glaucoma. Fortunately, it was detected very early. In fact, I'd gone to see my eye doctor because of a new and rather prominent floater in my left eye--which turned out to be a speck of blood from a torn retina. The eye doctor lasered it back into place at that same visit. The floater is still there, but as he told me I would, I've learned not to notice it. But in the course of testing, he discovered my Glaucoma.

He started me on eyedrops to control the pressure in my eyes and prevent the Glaucoma from advancing. The drops worked pretty well, but not quite as well as he'd have liked. So we added a second set of drops. If we couldn't control the pressure with drugs, the next option would laser surgery--or actual surgery. So I really wanted the drops to work.

And they worked for a while--until I developed an allergic reaction. So we switched out the drops. And thus began the long, laborious process of determining (through trial and error) that I am unable to tolerate any of the eyedrops for Glaucoma, with one exception: a preservative-free version of Zioptan. (Each day's dose comes in a disposable, one-use dropper.) But that one drug alone isn't doing enough. So my eye doctor referred me to a glaucoma specialist.

Who happens to be his wife. (And technically, he only referred me to clinic upstairs, where his wife is one of several glaucoma specialists. I chose her.) So on Wednesday I spent about two and a half hours in the clinic getting extensively tested. I was rather anxious about this; giving up on finding a combination of drugs to do the job meant surgery of some kind.

They tested my vision. They tested my color vision. They numbed my eyes and did a pressure check. They dilated my pupils and had me wait until everything was bright and blurry, then examined the interiors of my eyes with the aid of very VERY bright lights, and with lenses they actually placed ON my eye. (All of this was wonderful fun for a guy who has always been extremely sensitive to glare and to having anything near my eyes.)

They did a visual field test. You stare with one eye (the other is covered) at a tiny light in the center of a hemispherical machine and click a button every time you see a flash of light anywhere). Then you do the other eye. And you fear all the while that you're missing way too many of the flashes (some are bright, some are barely perceptible). They examined my eyes again with the aid of bright lights and lenses, and took pictures while they were at it. I saw three different technicians/doctors in addition to my primary. (The technician who administered the visual field test bears more than a passing resemblance in appearance, manner and voice to the actor John Malkovitch. It was a bit odd.)

The end result of all this testing was to determine that I still have undiminished field of vision in my right eye (no loss of peripheral vision at all), and very minimal loss in my left eye (but there is some). Also, that I was a good candidate for laser surgery. So sometime in the next month or two I'll get scheduled for an in-clinic procedure. I asked the doctor how it works. Apparently, on the interior of your eye, right where the iris (the colored part) meets the white, there's a lip or groove or something. This is where, assuming it works correctly, the fluid inside your eye can drain away so that the pressure doesn't get so high that it starts damaging the optic nerve. The procedure will use a laser and some mirrors to zap fifty spots around the perimeter there, causing some inflammation. Then, when the body sends it's healing agents to deal with that, it will usually (in about 80% of patients) also cause it to start draining more effectively.

Why? I don't know. And neither does my doctor. She said they don't know why it works, they just know that it does. And it works better in patients who start with a higher pressure inside the eye (like me, so I'm almost certain to get a beneficial effect). In conjunction with eyedrops (which I'd still be using), it should lower the pressure enough to prevent any further damage.

It's not a permanent fix, though. The effect generally lasts from two to five years, and can be repeated once. So it could good for anywhere from four to ten years. And then? Well, there will probably be some new glaucoma drops on the market I can try. And if not, there's still actual surgery.

So...laser eye surgery sometime in the next couple of months, a follow-up visit at two and then eight weeks post-surgery (to compare pressure to see if worked) and then we'll see. I'm relieved that I can try laser surgery and not have to jump (immediately) to going under the knife, but it's still daunting. It doesn't help that I was definitely the youngest person in the waiting room by a good margin--at least amongst actual patients and not loved ones waiting with patients. I'm not pleased by that at all.

Progress!

Jun. 22nd, 2011 09:33 pm
sinanju: The Shadow (Default)
I saw the surgeon this morning for my scheduled one week post-hospitalization visit. We went to his office in the Pearl district rather than to the hospital. The building is laid out very badly in our opinion. We went in the door with the street address we were given, where a receptionist led us into another part of the building (near another entrance with a different street address) to an elevator. We rode up to the second floor, walked through an empty section and finally found the door to the surgeon's offices. A badly designed building, definitely.

On the other hand, my visit with the surgeon took five minutes. He asked some questions, checked my drain, and removed it. All it took afterward was a band-aid for the tiny incision where the tube had been. He warned me to be on the lookout for symptoms that might indicate we'd removed the drain too soon--he doesn't think so, but it's a slight possibility--which would be fevers, chills, nausea, but mostly pain. I won't soon forget the terrible pain I experienced. If anything like that recurs, trust me, I'll yell bloody murder for a doctor.

Otherwise, I'm good to go. I have one more dose of IV antibiotics to take, then the visiting nurse will come to remove the midline IV. I'll be a while recovering my strength--Snippy hasn't fully recovered from HER bout with pneumonia, and she was sick before I was and wasn't AS sick as I was by a long shot. So it'll be a while. But I feel more relieved than words can say to have that drain out. I think I'd focused all my fears and distress on that thing.

I have a CT scan scheduled for mid-July, and the surgeon will do a colonoscopy on me in about three months; we still want to find out what caused this and make sure it won't recur. But barring backsliding, now it's just a matter of recovering my strength.

Snippy and I went out to dinner tonight. First time since before we both got sick in early May. It was nice to spend some time together doing something enjoyable instead of worrying over chores or medical stuff. As Snippy often says, the bad things will happen whether we like it or not, but it's up to us to make sure to arrange for good times too.
sinanju: The Shadow (Default)
In our last exciting episode (June 3) I had a thoracentesis. The doctors drew fluid off my lung to help my breathing. And it did. For a day or so.

Alas, I got worse still. I spent a week taking antibiotics, and suffering from fevers and sweats, and terrible pain in my belly. I thought the pain was due to constipation and gas from the hydrocodone and codeine I was taking. It would seem to ease slightly over the course of a day, but it always came roaring back. And it was bad, really bad. I had never imagined that constipation and gas could be so agonizing.

Well, one thing led to another, and finally my doctor had me come into the hospital on June 10th. My wife left work to drive me to the hospital. I checked in, settled into a room, and eventually got a CT scan. My doctors consulted the results and then took me down to radiology again*, where they inserted a tube into my lung (through my back) to drain off as much of the fluid as possible. There was plenty of it, and infected to boot.

Over the next few days, I was in miserable shape, so sick and weak that I didn't really give a damn what they did to me despite my normal aversion to needles. Insert an IV? Numerous blood draws? Poke a tube into my torso? Sure, whatever. I spent another night in terrible pain until they gave me morphine, which helped...a little. Finally, they started giving me Dilaudid (a VERY potent narcotic), which gave me relief. I got an IV hit of it every two hours for a while.

They took me down to radiology for another, more complete CT scan, having discovered that I had an abscess in my abdomen. While I was there, they put ANOTHER tube in me, this time in my belly, to drain the abscess. All this time was on nearly constant IV antibiotics, as well as fluids. I was allowed nothing by mouth for about three days because they thought they might have to do surgery. It didn't happen, thankfully, but it was a near thing.

I spent six days in the hospital before being discharged this past Thursday. They removed the chest tube, but left the drain my abdomen, and put in a midline IV in my left upper arm. I came home, where I've been resting. A home care nurse came to see me the next day to change the dressings around my IV and drain, and to show me how to give myself IV antibiotics. I flush the drain twice a day with saline, and give myself a daily injection of another antibiotic, in addition to a number of oral medicines (include antibiotic pills) I'm taking for a week.

In a couple of days I'll see one of my doctors (a surgeon), when--I hope and pray--he'll remove the drain from my side. In four weeks I'll get another CT scan and see a pulmonary doctor to check up on my lung. I'm also going to have to get a colonoscopy (oh boy oh boy!) because they still aren't sure what happened. Apparently I had like ten doctors consulting on my case; I was the medical mystery of the week. They don't think the lung issue (caused by pneumonia) is related to the abdominal issue, but doctors--like cops--don't like coincidences either, so they really aren't sure what happened (as far as I know). Possibly it was a rupture of some kind in my colon (diverticulitis?) or maybe my appendix. A colonoscopy and/or CT scan may reveal the cause, and determine whether surgery is required down the line to fix it and/or make sure it doesn't recur. I hope it isn't necessary, but we'll do what we have to do.

So now I know that consistent or recurring severe belly pain is more serious than I thought at the time. This has been a miserable two months. My lovely wife was down with the nasty virus that causes pneumonia for much of May, and then I got it--and things went from bad to worse. She's still recovering her strength, while working full time AND taking care of me AND keeping food and supplies in the house AND trying to do some of the housework that's accumulated while we were both sick for a month. She's a rock, and I can't say how much I love and admire her.

The physical pain on this whole ordeal was bad enough, but I was completely unprepared for the emotional cost. The first couple of days of my hospital stay I was too weak and sick to feel much of anything, but as I started to improve (marginally at first), I was paradoxically feeling better enough to feel bad.

I felt like the situation was never going to end, that the rest of my life would be spent in this state, with tubes in one side of my body, an IV in the other, and simply getting up to walk to the bathroom was a major feat. I felt like I'd be feeble and dependent forever. I would never be as healthy and active as I'd been before I'd gotten sick so very long ago. I broke into tears a number of times, filled with despair and grief, and afraid that Snippy would leave me because I wasn't just not a help to her, but a burden. One she didn't need in addition to all her other burdens. She, of course, consoled me and reassured me that my fears were groundless.

I didn't sleep well in the hospital. All the jokes about being awakened frequently have a basis in fact. I had IVs started and changed, was awakened for blood draws, or to check my vital signs, to take pills (when I could take things by mouth again) and so forth. I slept when I was too exhausted NOT to sleep, or when a hit of dilaudid made me feel lightheaded and relaxed. But I spent a lot of time dozing, not really sleeping but too punchy to have any attention to pay to things. I had my Nook with me, but I never read anything the whole time I was in the hospital, I just didn't have the mental energy.

I often woke in the night covered in sweat (I had fevers for days, even after they started the IV antibiotics). I remember waking one night covered in sweat, and feeling like I was in a nightmare. I stripped off my sweat-soaked hospital gown and sat there with sweat soaking my hair and cooling on my skin all over, tethered by IV and drain tubes, ready to cry or scream or both, feeling trapped in a dark, empty hospital, afraid that if I called for a nurse nobody would come. I knew on one level that it wasn't true, but I felt that way. It was like being chained down, imprisoned by my own rebellious body, in a nightmarish scenario that would never end.

That was probably the nadir of my time in the hospital. The next day, I was frantic to get out. Not ready, physically, but I'd reached the end of my emotional rope. I wanted nothing as much as I wanted to escape my situation.

I'm home now. I've been home for five days. I still have occasional moments of despair and grief, and fear that I'm a useless burden on my wife, who deserves far better. But they're passing, and I'm getting stronger. I'll be a long while recuperating completely (my wife hasn't entirely recovered from her own bout of pneumonia and she wasn't as sick as I was), but I can see the light at the end of the tunnel. Most of the time, anyhow.

I'm sleeping on a separate bed from my wife, an inflatable bed we bought when I came home from the hospital. I fear to share our bed with her while I have the drain in my side. An irrational fear, probably, but I feel better for having a bed to myself. Plus, she needs her sleep given that she's working fulltime in addition to all the other chores that have fallen to her, so I hope it lets her sleep better too.

I'm really, really hoping to get this damn drain out of my side this week. And then the IV midline as well, once I'm done with the antibiotic injections. Those will be big days for me. In the mean time, I'm resting a lot, taking naps when I can, and generally doing my best to heal up. I'm also moving around the apartment at times, and even doing a few chores. They need doing and I need the exercise after spending so much time lying in bed, plus the exercise tires me out so I can sleep.

This has been quite an experience. It's not over yet, especially if I end up needing surgery later on. But if I won't be back to normal for a while, I can at least see it from here. Which I couldn't a few days ago (and still can't on increasingly infrequent occasions). I'm sure some of this will find its way into my writing eventually, too. "Write what you know," they say. And I know a hell of a lot more about some things now than I ever did before.




*Apparently, in addition to doing CT and MRI scans, they specialize in putting tubes in you down there.
sinanju: The Shadow (Default)
I think I spelled that right. I've been sick in bed for going on two weeks now. Saw my doctor a week ago Monday and got an Rx for antibiotics and an inhaler. It seemed to help some, but this past weekend I started feeling worse. Severe pain in my back and chest when I coughed, moved too much, or breathed deeply. Which made it difficult to sleep, unsurprisingly. Called in Tuesday morning to the doctor on call, who told me to take 4-6 hits on my inhaler each time instead of 2, and wrote an Rx for oral steroids as well. Those worked quite well, but I also saw my doctor on Wednesday because the issues weren't improving. She wrote me an Rx for codeine cough syrup and hydrocodone pills for the pain, and had me get a chest x-ray.

My doctor called later that night to tell me the x-rays showed I had pleural effusion (liquid on my lung). She also said that if I spiked a fever again (now that I'd nearly finished my antibiotic course) to let her know, as it would suggest that there was another infection. Yesterday I felt pretty good until evening, when the muscles in my stomach and abdomen started to pain me (probably because I overworked THEM while trying to ease the muscles of my upper torso.

And this morning I had a fever. Again. So I called the doctor's office and left a message, as instructed. A few calls back and forth, and at 1:30 my lovely and talented wife drove me to the hospital radiology department. We checked in, I got an ultrasound of my back, which confirmed that my left lung was clear but that there was about a quart (a QUART) of fluid on my right lung, which would explain my pain and shortness of breath.

After the ultrasound, I sat under a warm blanket for a few minutes, then the doctor came in to give me a local (lidocaine) in my back, and then spend about five or ten minutes drawing fluid off my lung (The wikipedia page on thoracentesis gives a very good description of the procedure). He couldn't get it all because it was thicker than he expected, and clearly infected. But he got a lot of it. That alone, they told me, should make me feel better in a couple of hours--my lung would reinflate and I'd be able to breathe more easily and with less pain. And I am feeling some better now, though happy to be back in bed at home.

I also got some blood drawn for a battery of tests. I imagine that in the next day or two (or by Monday) I'll find out the results and be given an Rx for another course of antibiotics to squelch whatever crap is in my lung.

In the mean time, more time in bed, regular daily doses of oral steroids, use of an inhaler, advil, and codeine cough syrup (with optional vicodin pill up to twice a day when i need it, though I mostly take just one at bedtime to help me sleep).

My lovely and talented wife has been an absolute trooper through this whole adventure, especially since she's still exhausted and recovering from her OWN bout with this bug. I love her and admire her more than I can.
sinanju: The Shadow (Default)
The human eye is not hollow. It is filled with a transparent substance called Vitreous Fluid. About the consistency of egg whites, and 99 percent water. As you age it can change in consistency.

It can also detach from the retina--and will, generally speaking, in most folk as they get older.

A couple of days ago I noticed a new and prominent floater (shadow that can look like strings, streaks, clouds, bugs, dots, dust, etc. which are the shadows of debris inside the eye falling on the retina) in my left eye. It was rather more obvious than most, and close to my center of vision. Annoying, but not terribly problematic--except that its sudden appearance worried me.

Yesterday I called my doctor and got a referral to an opthalmologist. That night I noticed a new symptom--in addition to the prominent new floater, when I looked at a light or a large, brightly lit uniform background I could see thousands of almost invisibly tiny specks drifting around, shifting when I moved my eye. Not good.

Today I had the appointment with the opthalmologist. I had a standard vision test, a glaucoma test, and then had my eyes dilated. The doctor studied the interior of my eyes--which was unpleasant, as I'm very light sensitive and it involved lots of bright lights in my eyes.

His diagnosis was, as you've probably guessed by now, vitreous detachment. The vitreous jelly is pulling loose from where it was in contact with the retina. It's occuring in both eyes, actually, though more advanced in the left. It generally happens to everyone as they get older and is not usually a serious problem...unless it fails to detach cleanly. In which case it could tear the retina. If that happens (indicated by sudden appearance of flashes of light in my vision*, or a veil falling across part of my field of vision), then we're looking at more serious issues. It could well require laser surgery to weld the torn retina back into place.

With luck, that won't be the case. I've got an appointment to go back and see him in a month--the process generally takes a month or less. So he'll take another look then. If it's done and there's been no retinal damage, I'll be good as...well, not new obviously, but as good as can be expected. The new floater won't go away, though it may eventually drift farther from the center of my field of vision. Even if it doesn't, it won't present a serious problem--I'm already learning to ignore it, and at its worst it's simply annoying.

I am, however, vastly relieved that what I'm experiencing isn't terribly serious. All my worst-case scenario fear fantasies have turned out to be just that. It was a worrying day or two, though.

*And they won't be subtle, he told me. Like flashbulbs going off, so hard to miss or mistake.

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