Okay, I didn’t plan on leaving you in that much suspense, but it turns out my room’s not so close to the wireless access point and has a rather spotty connection. It works this morning though, so I’m typing as fast as I can.
So, to pick up where we left off, I wound up receiving 1500 cc’s of fluid at the clinic before my PET scan. This time, rather than looking for cancer, the PET was to look for infection. Apparently it shows those too – go figure.
I walked over to the PET place and drank the horrid gastrografin mixture. I brought my own water this time and it didn’t really make that much of a difference. It was slightly less horrid, but only slightly.
After the exam, the tech came in the room to get me out of the tube and asked me about the chemo I had had between the last scan and this one. I explained the thymectomy and the BEAM/SCT. He said he was just wondering because he had looked at the previous scans and there was a big area of uptake in the center of my chest (you know, the alien) and it was gone in this scan. Yes, you read that right – gone. Of course, he’s not the radiologist, but later the rads agreed – no more uptake in the center of my chest. The alien’s gone!
As for the rest of the scan, I was unusual as usual. Namely, my kidneys were showing uptake in ways they don’t usually see. At this point, I’ve got my new bed in the hospital, next door to the bed I had last time. I have a slightly smaller window and older bed, but the rest still feels the same.
Next begins the procession of doctors. SuperCoop and Erin, of course. The usual groups of residents, interns and students (on one visit, I had four stethoscopes on my back as I hyperventilated and three others tried to figure out how to nose in and listen). The nephrology team. The neurology team. The respiratory team. Just to make sure I hit all of the bases, I’ll be seeing the retina expert later today. Maybe I should fake some foot pain to get those lazy podiatrists off their butts.
Probably the most important of the teams has been the nephrology team. They’re the ones who deal with your kidneys and urinary system. Not only was I peeing less and less (after filling that specimen cup, the next five or six urinations would have barely filled the cup. After 1500 cc’s of hydration), but my creatinine level was rising. The creatinine shows how well your kidneys are working – the higher the number, the worse they’re doing. Mine wasn’t outrageously high, but along with the other issues, it wasn’t good.
The first I heard from the team was through my nurse. They had given her an order to put a foley catheter in me. I’m not sure I’ve expressed my views on the catheter before, but to say I was displeased is to put it very lightly. My nurse was behind me on this too, as she didn’t see much of a reason for it (I’ve had some great nurses during this stay) either. You see, the main point of a catheter is to drain your bladder. In my case, my bladder was staying empty – there was nothing to drain out. All of my urine was somewhere else. So we made an agreement that I was a difficult patient about this so she wouldn’t get into too much trouble and then I could discuss it with the nephrology team. I told her to feel free to tell them I threatened her with my fork, and kept it from my tray to back it up. Also, you never know when that sort of thing will come in handy.
Turns out, they figured out on their own that putting a catheter in me was a stupid idea. I didn’t even get to stab anyone. Sigh… So they got my history and went into a huddle. The initial verdict was an allergic reaction. With the pain and reduced urine output I was having, along with the timing of it all, it was their belief that the oral antibiotic I was given after my last stay (avelox) was causing an allergic reaction in my kidneys. The other possibility was that at some point while I was at home, my blood pressure dropped dramatically. When they say dropped, we’re talking a top number in the 30’s or 40’s rather than the normal 120’s. When this happens, it makes the kidneys decide to start shutting down.
So how do we decide which one it is? One of three ways:
- Leave it alone. Both of these situations can resolve themselves over time, and as long as I stay off the antibiotic, any allergic reaction should stop. The drawback to this is, if my creatnine levels get too high in the meantime, I could have to get dialysis to support my kidneys. Plus, it could take a long time.
- Start taking some steroids. Assuming the problem is an allergic reaction, they could hit me with a lot of oral steroids, which would calm the inflammation and speed the recovery time. The drawbacks would be the usual ones when you take steroids.
- A kidney biopsy. This would tell them exactly what was going on with my kidneys and they can focus the treatment. The drawbacks here would be a little pain for me and the chance that it’ll show an allergic reaction and we’ll do the steroids anyway. They also made a biopsy sound quite scary.
They were leaning towards the steroid route. Everything they saw pointed toward an allergic reaction, so they might as well get me going on it. They just needed to look at a urine specimen and check my creat levels in the morning.
The next morning, the nurse comes in and says I need to be sure and not eat my breakfast, since I was having the kidney biopsy that afternoon. Pardon?
We get the doctor dragged in to do some ‘splainin’. He said it was all kind of a quick decision with a short window. The specimen was pretty inconclusive, but that my bloodwork in the morning showed a major jump in my creat levels. Basically, if we didn’t get the biopsy done that afternoon, it would be a few days before we could get it done. That would be quite bad for my health. So they made the quick decision to do the biopsy and didn’t get a chance to come talk to me before the nurse did.
So after hearing the explanation, we agreed this was the best course. They did a CT-guided needle biopsy and it was quick and relatively painless. The worst part was the numbing part. After that, it was cake. I haven’t really felt any pain at the biopsy site either. At least until the doc stopped by the next day and poked at it.
Most of the results are in and they point to the low blood pressure situation – ATN, or acute tubular necrosis. There was some evidence of an allergic reaction, but not as much as they would expect to see. They said this could be due to my lowered immune system. Without a normal immune system, I can’t throw as much stuff at the problem, so therefore, less would be seen. They’ll be getting more refined results from the slides back in a week or so.
So what does ATN mean for me? Basically it means sit and wait. ATN is completely reversible given time and lots of fluids. Already my creat levels have been coming down, almost as dramatically as they were going up. Plus, I’ve finally started feeling the urge to urinate, meaning my kidneys are finally passing stuff to my bladder. And as for output, let’s just say Barbaro’s got nothing on me.
Breakfast’s here and I’d better get this posted before I lose my connection. Part 3 coming up shortly. Hopefully.