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Friday, October 07, 2005

One lucky SOB

It all started about a month ago. I asked for a refill on a prescription for Imitrex, it treats migraines. My doctor being a thorough guy approved one more refill, but told me there would be no more till I came in for a check-up.

It seems that over the years my blood pressure has risen moderately and I’ve put on some weight. So, he had some concern that the Imitrex, combined with the blood pressure medication and too much weight, would cause more problems.

That request for a refill led to an appendicitis operation on Wednesday morning.

There’s no guessing about this, I’m one lucky son-of-a-bitch. I have a high threshold for pain, I have a history of kidney stones and I was assigned in my first week at work to a new company to work an area about 50 miles from home, and literally, in the corn fields.

So, although there were some signs of something going wrong, particularly on Monday, I ignored them. The signs were gas and the movement of a kidney stone…

But, I’m getting ahead of myself here. About two weeks ago I reported to the doctor as requested. High blood pressure and overweight, neither of them extreme, was concerning my doctor. That would be Edward Blumen. I doubt he’ll mind my mentioning him here as he clearly comes out knowledgeable and thorough. A hero of my little story.

Blumen ordered me to undergo a stress test and return to the office afterwards. I think everyone knows a stress test involves getting your heart using 85 percent of its estimated capacity. Maybe you forgot that they are using ultrasound imaging on you in the process. The down and dirty was that my stress test came out okay. My heart is strong, thanks.

However, a radiologist at Evanston Hospital noticed that I have a cyst in my right kidney. Now the kidney is not the focus of the stress test, so this radiologist noticed something in a part of the ultrasound that wasn’t the focus of the work. That’s worth noting, good work…

A cyst is a fluid filled body, in this case smaller than a billiard ball and larger than a buckeye. They can be cancerous. I didn’t tell my wife, though I talked to my daughter, who is undergoing her own ordeal with kidney stones.

Blumen now orders me back to an urologist and before I get there, could I get a CAT scan of the kidney.

I don’t know what a CAT scan is, though I’ve had them several times. The machine consists of a ring which allows your body to enter, it spins around you and takes very detailed images of your body in such a way that a three-dimensional representation of the inside can be formed.

That was Tuesday at about Noon. In the meantime, I’ve been coming home from work tired. Tired to the point of dropping immediately into bed from exhaustion. Plus, there was the slight pain in my kidney and some night sweats. So, on Tuesday, I went to bed for several hours.

At this point my wife still didn’t know about the kidney exam. Could it have been the same radiologist? Anyway, while I was sleeping, the radiologist had gotten on the telephone with Blumen and told him to get me in immediately, he or she saw an enflamed appendix.

Again, nice work. The kidney was the focus of the exam, not the appendix.

These aren’t the easiest calls to take right after you’ve woken up, a nurse somewhere saying the doctor thinks you are suffering appendicitis. Did I hurt? No, not particularly. Just some back pain (not usually associated with appendicitis). Fever? No, just a bit of night sweats. Vomiting, nausea, anything? No, no and no.

The nurse and I paused… I said, “my wife is an RN, it’s time to bring her into this. We’ll call you back in a few minutes.”

Jane had had an exhausting day at work. The beginning of the school year is like that. So, she was laying down, listening to some program when I walked in to have this discussion. She says that she thought I was pulling her leg, but realized I wasn’t when she saw my eyes. I’d fessed up about the cyst, why else could I explain that the doctor’s office was calling about my appendix?

Anyway, down on the bed and some poking around and I hit the ceiling. My symptoms weren’t normal, but that would be explained later by the surgeon. I had one classic hot point for appendicitis. We were spending the night at the ER.

Am I the only person who takes a shower before going into the ER? Am I the only person who packs two MP3 players, books and a change in clothes, as well as their toothbrush? That night, I was ready for an operation. I was ready to stay. At that point, I was hoping I could return to work by late week. After all, I’d just started and I have no sick time this year.

The ER triage nurse asked why I was there. I knew it was going to be a long night… “I have appendicitis.” Did I hurt? No, not particularly. Just some back pain. Fever? No, just a bit of night sweats. Vomiting, nausea, anything? No, no and no. What gave me the idea I was suffering appendicitis? “My doctor told me I was.” And did he do an exam? No.

Okay, wait (for several hours) out there, till we call you.

It was about four hours after I entered the ER when the ER doctor saw me. Did I hurt? No, not particularly. Just some back pain. Fever? No, just a bit of night sweats. Vomiting, nausea, anything? No, no and no. Lift your shirt. OUCH! How did your doctor know? The long story of the prescription refill, the stress test, the ultra sound, the CAT scan.

Evanston hospital has something way cool. These images are associated with my file electronically, so that any doctor who is seeing me can see my tests and office visits. So, the ER had access to the CAT.

Okay, there is a way for this to happen, I’m calling in the surgeon, he’ll be here soon.

Surgeon gets there just a few minutes later. There are no more questions now. A brief exam, he says there’s a third year med-student and a resident who will interview me, he’ll be back in a bit. He went to call Blumen.

When the surgeon returns he says he’s 80 percent certain I’ve appendicitis. My blood work doesn’t show it yet, and the pain shouldn’t be on the back, unless my appendix is tucked into my back. I can undergo surgery now, in the morning or go home and wait. Waiting increases the certainty of the problem.

My only question was, at nearly midnight, how fresh is the surgery team? Should we wait for a fresh team in the morning? No, they are ready.

The cut for this surgery is only a few inches. I compare it now to the C-Section that allowed my first wife to give birth to my daughter. For two days now I’ve struggled to straighten myself, to stand, and I’ve shuffled along like an old man. Good god, they’ve got me out for a week, and I have no sick time left.

But, frankly, I feel very fortunate. This could have been much worse. Two good radiology readings and a thorough doctor. I think they may have saved my life.

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