2014: July Health Crisis

This past Friday (7/25) my coughing jags and mild fever got to annoying for my very patient wife, she told me I needed to go the doctor.  While it didn't seem too serious to me, I certainly didn't feel well and if Linda wants someone to go the doctor, they certainly should.

First Doctor Visit, 7/25

Dr. Harding had picked this Friday to get an early start on his vacation, so I got a same day appointment with another doctor in the Town Center Family Medicine practice. As I ran down my symptoms, fatigue, no endurance, persistent headache (the kind where it seems someone is driving a nail ever deeper), fever (100-101.5°F), general aches, and joint pain in my hip, I realized I was describing the flu minus nausea, which according to WebMD is a good summary of the symptoms of walking pneumonia.



My doctor agreed and said that a patient reported symptoms diagnosis would be walking pneumonia at this point. He listened to my lungs, heard crackling and listened some more.  He had me say "Eeeeeeeeeee" a bunch and reported that in my lower right lung it sounded like "Aaaaaaaaaa" which is another pneumonia sign, the same place he heard crackles. He was reasonably confident in the diagnosis, and wanting to get a cure started ASAP, prescribed a strong antibiotic (Levifloxacin) and a wicked strong cough medicine (Hydrocodone polistirex & chlorpheniramine polistrex pennkinetic).

One slug of the cough medicine and my cough vanished, I mean gone, didn't cough again after taking the med as long as I didn't let it expire.  It also made me pretty much looped and sleepy for the first time in a week or more.  I had been exhausted, but not sleepy and was unable to sleep.  With the cough med in me, I slept for the majority of the next 24 hours.

The antibiotic as expected, had no obvious impact, though I thought I could feel some improvement. The most direct measurement seemed to be my fever which was remaining stubbornly between 101 and 102°F when I wasn't on aspirin/Tylenol/ibuprofen, all of which knocked the fever down quickly and kept it in check for a number of hours,

I stayed strictly in rest & recovery mode popping meds as needed to keep my 100.X° F in check for the next two days.

Fever Pushes Past 102°, 7/27, Sunday

Sunday evening Linda added checking my temp to the vital signs we routinely check.   She took it once, said something like "oh shoot" (but with more of an "i" in place of the "oo") cleared the thermometer and for the second time saw 102.7° F pop up.  She wanted to take me to the ER.  My brain came up with the idea to call a nurse line for advice.  I tried to find one associated with our health care provider (Anthem) but came up empty.

My next idea was to call my physician's office and try to reach the oncall doctor.  After leaving a message I had a return call from my Doctor's office in less than 5 minutes.  A quick review of my symptoms and recent history got us quickly to a go to the hospital recommendation, exactly what my wife wanted to do when she saw that over 102 thermometer.

I interrupted Brian's shower to tell him what was going on, not intending to make him go on another hospital trip.  When he heard my plan, he came back immediately with "that's a bad plan".  "You can't drive in your current condition and Mom has taken her sleeping pills making her nighttime driving skills questionable at best."  He said he could be ready to drive us to the ER in 5 to 10 minutes, I agreed and went off to gather a few items.  When I got downstairs, toward the garage, he was already standing there ready to go. Brian is an amazing young man, yes I am biased, but truth is truth.

INOVA Loudon ER 7/27-28

We arrived to a quiet ER waiting room.  It appeared to have just one other patient, after checking in, they asked us to sit, we just barely sat down and a nurse came out and called "Joseph Michael."  I heard my name, as did the other likely patient, we both stood up but our respective support groups remained seated, the nurse clarified "Joseph and Michael, yes, both of you."

I rode the short distance to my ER exam room where a nurse immediately started asking questions, after less than a minute she was interrupted by an ER Doc who asked his own questions, saying he wanted to get my care started as soon as possible.  I have never had a shorter time between walking through ER doors and seeing a doctor.

They listened to my lungs, reporting nothing  that sounded like pneumonia, ordered up a chest x-ray gave me an IV pain killer which also controls fever and an IV antibiotic.  The tech arrived to take me to x-ray about the time the doctor was completing his initial exam so off I went for another x-ray.

The ER doc told us he wanted to admit me to the hospital around midnight.  He didn't bother with the typical "23 hour observation" dodge that hospitals so seem to like these days.  At about 2 AM admission was on course and we managed to send my family home, Linda was nearly asleep walking, good thing Brian was with us.

First Day In Hospital 7/28

I was taken up to my room about 3AM and given a brief exam and orientation.  I've never been in Loudon Hospital before, but it is an INOVA facility so a lot was familiar.  My room was a double and my roommate looked to be having some issues, groaning and such, he also liked to have his TV on and blasting even when asleep.  I have a very hard time sleeping with a TV in view especially if I can hear it, so this looked to be an unexpected challenge.

My nurse and team finished their check in things about 5AM and I tried to sleep, totally failing. My team did manage to persuade on roommate to use headphones and I was able to pull a curtain to block my direct view of the TV but the glow of the TV, my roommates lights and groans combined with my pain to keep me far away from sleep.

Pain Killers, Please

Predictably I had at least one painkiller control freak or another making sure I didn't get too much pain killer.  The initial dosage was pathetic.  The web site drugs.com, says this about initial IV Dilaudid dosage:  The initial starting dose is 0.2 to 1 mg every 2 to 3 hours. It goes on to discuss patient tolerance to opiates (of which I have a quite a bit at this point) and other factors all of which lean to a higher dose.  They started me on 0.5 every 4 hours.  That dosage helped for a bit, like an hour, but once again put me in a battle for painkillers with my medical team.  It only took 12 hours or so to get my dosage bumped up to 1.0 every two hours, even that seemed inadequate.

I continue to be amazed at the different attitudes in nurses relative to painkillers,  Quite a few nurses and even some doctors seem to be afraid of them, want to not give them if they have any choice, but there are nurses that care more about patient's well being than fanatical adherence to safety guidelines, I'm very glad the second group exists.

More Tests

Yesterday's chest x-ray came back inconclusive for pneumonia. The doctor suggested the result could be caused by my relativly dehydrated state which kept the pneumonia from fanning out, or something like that.  I may need a new x-ray now that I have been hydrated. The team did order a CAT scan of my hip and an Ultrasound of the area.  The ultrasound was clean, confirming that I am not pregnant but not helping otherwise.

The CAT scan was painful as it required me to lay still and flat on a hard bench, driving my hip nuts.  The feeling was familiar, I think I have had that pain before at previous CAT scans for my pancreas.  This "abscess" may have been brewing for a long time, beaten down but not eliminated by various antibiotics I have taken in the past year.

Call Button Follies

When I push my button to call a nurse, which I needed to do at least once every two hours for pain management, a call screen on the wall opposite our beds lights up.  Sometimes it stayed lit until a nurse checked on me, often it quietly went out.  Apparently, the display says, in small type which bed issued the call, but reading comprehension seems to fail often, or perhaps it is simply a poor design.

Truth is, its a horrible design that forces nurses to look at the wall instead of the patients, so of course they choose the patients and just tap the button to silence the call without looking.

At one point I saw my roommates nurse/tech reach past the curtain to turn out my call light almost immediately after I hit it.  I still had my hand over the button so I hit it again, and once again I saw a hand flash out to turn off the call light.  I tried a third time with the same result.  I waited for them to go and tried one more time, this time it stayed on for quite a while and eventually my nurse showed up.

This was very frustrating, happening several more times. I think the hospital needs a much clearer differentiation of who is making the call to keep the bed nearer the door from shanghaiing the staff on a regular basis.

Another Sleepless Night

To no one's surprise, my night passed sleeplessly, with a drone of various noises from my roommate and a glow from his lights and TV, accompanied by my bed's ceaseless shifting of air with occasional stabbing pains as the bed shifted my hip.  My nurse started turning off his TV when he was asleep, but that never lasted long as he would wake, turn it back on and almost immediately start sawing logs again.  I figured eventually I'll get used to the sounds or so tired that I will be able to sleep, eventually.

Rubber Pancakes & Sugar-free Syrup, 7/29

I asked for pancakes and bacon for breakfast, rather surprised that was an allowed choice.  The two silver-dollar pancakes that arrived were slightly warm, no where near hot enough to melt the imitation butter sent with them but I decided to dig in anyway.  I poured the sugar-free Syrup on them, the syrup looked like maple syrup and smelled like maple syrup but didn't taste like anything edible I've encountered.  The pancakes felt like they were stamped from rubber.  I ate a few bites and gave up.  The two bacon strips were nicely crisped, relatively thick and quite tasty, other than seeming like something I shouldn't eat, they were quite good.

Breaking Health News, 7/29, 12:30

I was just informed that the CAT scan of my right hip shows an abscess (likely puss collection, normally an infection) on/in a muscle which runs over my right hip.   The scan didn't cover the whole area of interest, they were looking at the joint, not muscles over it, so an additional scan is needed.  The tentative plan is to do a new CAT scan, then hope that interventional radiology can go in and remove the abscess in a closed procedure and that the abscess tests out as a simple infection.

It appears this may be the root cause of all the symptoms.

Follow-Up CAT Scan and Drainage Procedure, 7/30, Wednesday

The next day I had a follow-up scan which confirmed the extent of the abscess and the plan of treatment.  Essentially, they want to drain the pocket of ick and leave a drain line in it, connected to a bag to collect the stuff.  Also, they want to culture the bacteria to see what it is and what it is vulnerable to in terms of antibiotics.

The drainage procedure went smoothly.  I was wheeled down to Interventional Radiology, hooked up to more bags of saline and meds, sedated and woke up with a tube coming out of my right side, just above the hip. The doctor told me he drained 110cc of fluid from the abscess, and that wasn't all there was in the pocket of badness.  This puts the abscess at roughly the volume of a tennis ball (137cc), which had grown inside a pocket formed between my right hip bone and various muscles.  No wonder my hip (and leg) hurt.

Waiting for Results,  7/31, Thursday

The next stage of treatment depends on what the culture tells us.  It might say the bacteria is dead as a result of the heavy IV antibiotics, vulnerable to a specific treatment or perhaps many. I need to wait, so I do, mostly patiently, I am a patient after all.

 Bateria Identified, 8/1, Friday

The culture came back positive for Streptococcus anginosus, it is one of the normal bugs that most people carry around in their heads and one of the buggers that can give you strep throat.  It can cause brain and liver abscesses, presumably similar to what I have; but, mine is in muscle far from my breathing passages and a medical oddity.

The good news is that this bacteria is vulnerable to nearly every antibiotic treatment available, so I can use something as simple as ampicillin (a penicillin derivative) to kill it, after other potentially hidden and perhaps more serious infections are ruled out.

The doctors are quite concerned about the bacteria being located so far from their normal home.  The leading suspect is another unidentified infection that seeded my hip abscess.  A strong possibility is a strep infection on my heart or valves, something that definitely would need attention asap. To determine this, I'll need an electro cardiogram, apparently with bubbles, to clear my heart as healthy (or not).

A bubble test seems an odd choice, it is a variation on an ECG that gives a better view of heart valve functioning and potential valve leakage, something that I have shown no signs of so far and none of the Doctors can explain why I need it.

Unfortunately, the hospital can't do a bubble test until Monday, so I get to wait in the hospital over the weekend.

My family came in to visit this evening with a special treat, a truly sinful cupcake from the cupcake shop in Leesburg.  The durn thing cost something like $4 and spiked my blood sugar to 211 mg/dL, the highest I have ever measured, but boy was it good.  I really needed something to lift my spirits, my family bearing sweets was just the ticket. :-)

Waiting in the Hospital, 8/2, Saturday

A boring day, trying to eat and stay motivated.  I complained to Doctor Bassi about growing depression and that I thought I should be placed back on antidepressants, with this hospital stay starting to bear strong resemblance to my last ordeal and my thoughts turning black on occasion. Bassi acknowledged my concerns and made noises about writing the order.

Shannon came in for a visit in the afternoon.  She had come home this weekend so that she could see me and she delivered with several visits, just her spending time with me.  We talked about all kinds of things both important and trivial.  She held my hand and helped me with things like getting up while not yanking on my bag, never shying away from an unpleasant or potentially embarrassing experience.

The best part of her visit, she helped me convince the nurse to take me off my IV and let me walk around a bit in freedom.  Shannon and I immediately seized on the chance to get me outside in the really nice weather.  We walked quite a distance, about half way around the outside of the hospital, taking a selfie in front of the hospital to prove our travels. This time with my daughter was precious, lifting my spirits far higher than they had been since my admission.

Waiting in the Hospital, 8/3, Sunday

Another day in the hospital waiting.  No signs of antidepressants, other than Shannon.  This place is looking like a bad version of Hotel California, complete with a new roommate who is great at groaning, poor at bathing (I can smell him from my bed), and a fan of Indian food which his wife prepared for him in our room, stinking to high heaven.  His son stayed the night as a companion care giver, talking until 3AM and then snoring loudly enough to keep me awake the rest of the night.

So When is that ECG Going to Happen? 8/4, Monday

After my morning attempt at a nap, my roommates family having temporarily allowing the room to quite and stink a bit less,  I became more anxious about when the ECG was to be performed.  The results of that test seemed to be the only things between myself and freedom.  I feared that they hadn't even scheduled the test and laid into my poor nurse when she asked what was wrong.

My fears turned out to be well founded, the test had not been scheduled, they knew I it was needed since Friday but no one (Dr. Bassi, to be specific) had bothered writing the order.  My nurse told me she was chasing the doctors.  I told her, I was on the verge of pulling my own IV and walking out of Loudon hospital, as I didn't think I was receiving appropriate care.

My nurse came back and told me they wanted a ECG with TEE test and that it could be done later this evening or tomorrow.  My experience in this hospital suggested that, with that schedule I could expect the test by maybe Wednesday. I told my poor nurse that was not good enough and I wanted discharged, now!  I'd walk out if they didn't move along.  She asked for just a bit more time, offered to get the Hospital administrator for me and dashed out of the room.

She came back in a few minutes and told me the test was scheduled for 3PM, just an hour from now.  Since I hadn't been allowed food or drink I could have the procedure real soon now. That seemed about as good as it could be, so I settled down for another, hopefully shorter wait.

Tee Test is Negative and Discharge, 8/4, Monday Evening

The TEE test showed that my heart was clear of any visible infection meaning I didn't need a strong IV antibiotic and I could be discharged, which the nursing staff set about making happen with uncharacteristic speed.  They offered me a meeting with hospital management, which I declined, not wanting to spend an extra minute in that place.  

I was given a prescription for 5 days of ampicillin and a painkiller along with instructions on how to manage my drainage tube and bag.  I was told to measure the discharge, when it fell below 15cc per day for two days, I could go back in to have the tube removed. 

Needless to say, I took these instructions and with Linda's help, we bolted for the door.

Healing at Home, 8/5-8/8

As usual, Linda and Brian took great care of me at home.  Helping me with my drainage bag, showering, moving about, providing encouragement and support, making sure I took my meds on schedule and offering me pain killers and pouring out boundless love and support.

With this care, I improved rapidly.  My discharge falling below the 15cc line on the first day home and making a bee line toward clear and zero.  We called for my followup appointment to have the tube removed and were told that Monday was the first available time, meaning another weekend wait, though this one was at home.

Tube Check and OMG Dr. Bassi is Incompetent, 8/11

I started fasting at 11PM Sunday night, so I was mighty hungry around noon when I went in for my CAT scan of my hip and then headed toward Interventional Radiology (IR) for the tube removal. The IR department was backed up, so my 1PM appointment slowly headed toward 3PM as my blood sugar level trailed off toward problems as my fasting continued.

I asked for a blood sugar test and measured in at 83, not yet the 70 threshold for hypoglycemia, but heading that way.  I could feel symptoms starting to come on and agitated for attention which got me moved from the waiting room to a bed and an IV was started, to at least get me hydrated and perhaps help with a bit of sugar.

The IR doctor, Dr. Varma, checked my drainage and told me it was far to yellow and he thought the infection was active.  The CAT scan showed a second pocket of pus, which had not drained, but appeared to communicate (that's flow in colloquial speech) into the larger pocket which appeared to be well drained.

Dr. Varma's jaw nearly hit the floor when I told him I was not on antibiotics, that I had been prescribed just 5 days worth which corresponded with my drainage clearing and then clouding again as the infection roared back when the ampicillin ended.  He demanded the name of my infectious disease doctor and then roared off to call Dr. Andrabi with smoke coming from his ears.

When he came back he told me that I had an appointment with Dr. Andrabi immediately after I leave IR and he had a plan.  Dr. Varma proceeded to irrigate my abscesses, determining that the pockets were well connected and was otherwise satisfied that the drain was working.

Linda and I headed to Dr. Andrabi who asked about how I was and what meds I was on.  She almost blew a gasket whey I told her I had been on 5 days of antibiotics and that my drainage was clear until they stopped.  It seems she ordered 5 days of meds after my tube was removed.  Dr Braindead, oops, I mean Dr. Bassi managed to translate that to 5 days after discharge which caused the whole infection thing to roar back after providing my bacteria with a bit of Darwinian training in how to resist ampicillin. Dr. Andrabi's anger, obviously rooted in care for my health was heartening.  She is a doctor who truly cares about her patients.  Dr. Varma also gets points for seeing the problem and sending me immediately to her for help.

I left her office with a prescription for Augmentin and an understanding that I needed at least 5 days of meds AFTER the tube was removed.  I will not allow that mistake to be perpetrated on me again.

Recovering at Home, Again, 8/12-8/14

The new antibiotic seems to have knocked the infection bugs quickly on their tails and is stomping them while they are down.  I feel much better, again, back to being annoyed by the bag more than having my leg and hip hurt.  The drainage is once again minimal and mostly clear.  I have a followup with IR on Monday and Dr. Andrabi on Tuesday.

Dr. Harding, our family doctor, checked me out on Tuesday and said things look to be in order / getting better as they should.  He joined in the chorus of amazement at Dr. Bassi's 5 day antibiotic prescription.

Apparently I am on a relatively clear path to recovery now.  I am intentionally holding myself back, emphasizing rest over other pressing tasks that I feel need my attention.  I'm telling myself I'll get to them after I beat the dickens out of this infection.