Tuesday, September 30, 2014

Once more unto the breach

Greetings, loyal readers. Once again I have gone a month without a blog post and I really need to get one done before the end of the month. I guess I can still blame it on a summer hiatus, since summer did not officially end until September 22. Anyway, it's time for another Mom update. And be sure to check out the monthly blog stats at the end of this post to see which country was number 100 to visit the blog.

In the last post we learned that Mom had been hospitalized from July 30 through August 3 due to gastrointestinal bleeding, but the source of the bleeding could not be determined. We also learned that Mom has diverticulosis (not diverticulitis), and there is not much that can be done proactively about that. We'll just have to wait and see if she starts bleeding again.

I don't know if it was the blood transfusions or something else, but Mom's hemoglobin started going up toward the end of August and into September. Given her history of anemia this is a good thing, up to a point. Naturally, her hemoglobin went over that point. Normal is 10 or above, and hers got as high as 13.1 on September 8. For a typical person 13.1 is not high, but her nephrologist was concerned because they do not like dialysis patients to have a hemoglobin level above 12.0. He stopped giving her Epogen during dialysis and said if her hemoglobin did not come back down in a week or two they would have to do something about it. (What they would do is just keep some of her blood during dialysis, which causes the hemoglobin level to drop. People with blood disorders such as hemochromatosis that cause high hemoglobin levels have blood drawn periodically to lower their hemoglobin levels.)

Well, we didn't have to wait for Mom to lose some blood during dialysis because her bleeding issue came back over the weekend of September 13 and 14. It wasn't too bad at first, then it got worse, then better, then worse again. On the one hand we did not want to take Mom to the ER for them to do nothing (like the visit in May), but on the other hand we did not want to wait until she became very anemic and was in need of a blood transfusion. She was not feeling very good during dialysis on Wednesday, but she started feeling a little better later in the day and did not think she needed to go to the emergency room.

Then on Thursday, September 18, things started to happen. I got the following text message from one of my sisters just before 7:00 AM:

"Wow! Just pulled up to Mom's house and found 3 fire trucks and ambulance . . . 

Electrical fire 3 doors down and across the street!"

Yes, my heart also skipped a beat when I read that first sentence, before I read and processed the second sentence. Sorry to put you through that. Anyway, later that morning I talked to Mom to see how she was doing and convinced her she needed to go the hospital since things were not getting any better. My sister Laura took her around noon and they took her back to the emergency room fairly quickly. Her hemoglobin was 8.7, down from 12.0 on the Monday morning blood draw at dialysis. She obviously had lost a lot of blood so they admitted her. The next morning Mom sent me a text message saying her hemoglobin dropped to 6.8 that evening so they gave her two units of blood overnight.

I won't go through the play-by-play description of what happened over the next several days, but here is a summary of what happened before she was released from the hospital on Thursday, September 25:
  • They did a few different types of scans trying to pinpoint the source of the bleeding, but none were good enough to really make a decision on what to do.
  • Depending on what the issue is, there are three options to deal with it. Those are:
    1. Repair the bleeding site during a colonoscopy
    2. Repair it using radiology (I am guessing something like aligning x-rays to zap it.)
    3. Surgery to remove the bleeding section of the colon
  • She had a colonoscopy in the hospital on Monday, September 22 but her gastroenterologist was still unable to determine the source of bleeding that would account for the blood loss that was occurring when she was admitted. He said the AVM (arteriovenous malformation) did not look like it had been bleeding. He did see a few blood clots and saw some minor bleeding when he rinsed those away, but those are not a major source of bleeding.
  • Mom and I talked with a surgeon several times about her situation, and he was very good at explaining what they know and don't know. He also explained that they want to rule out all other possibilities before doing surgery, since it is a major surgery to remove some or all of the colon. So we felt good that they would not recommend surgery unless they felt it was the last option.
  • One reason this bleeding issue is so difficult to diagnose is by the time Mom notices the blood she has probably been bleeding for some time, and it may have even stopped. These imaging scans that are used to locate the bleeding tend to produce better results if there are only clear liquids in the colon, but by the time the colon gets clear the bleeding may have already stopped.
  • The day before she was discharged from the hospital they started Mom on a drug called Sandostatin (generic name octreotide), which the nurse told us is a commonly used first line of defense to stop intestinal bleeding. Supposedly it constricts the smaller blood vessels to reduce the chances of bleeding. It is injected into the abdomen, so now Mom has to give herself this shot once per day.

So we really are not much further along with solving this bleeding issue, but maybe this new drug will stop it. All we can really do is wait and see. At least now we know as soon as Mom sees blood she needs to get to the ER to increase the chances of the source being located.

On a sad family note, Mom's older brother Wayne passed away on Saturday, September 27 at the age of 77. He appears to have had a sudden heart attack while out on the tractor at his farm, which is probably the way he would have chosen to go: quickly, while working around the farm. He was never tested for the Afib mutation, but he did have kidney issues and was also diabetic. His descendants consist of one son and two grandchildren.

=====Monthly Blog Status Update===== 

As of August 31, 2014:

Total posts: 141 (1 in August)

Total pageviews: 19,100 (~700 in July)

Email subscribers: 10 (no change)

Total number of countries that have viewed the blog:100!!!

1 new country viewed the blog in August:

Fiji (I wonder if it was Truman Burbank?)

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