Friday, August 25, 2006

Now it's Jim's Turn, Unfortunately

V decided that if Jim was too sick to go to the thoracic surgeon with her, he was sick enough for her to get very serious about him seeing his GP ASAP. She got him in Thursday afternoon. A couple hours before the appointment, V was running Jim through the shower (his dizziness makes it dangerous for him to shower alone), and she found he was severely jaundiced.

First words out of the DR's mouth two hours later: why are you so yellow? He did some initial evaluation, including for disorientation, which Jim had exhibited earlier that morning, and scheduled him for a direct admission to a local hospital. GP diagnosed Jim as having liver disease (although he used the scary term liver failure).

Jim and V came home and waited and waited and waited. Finally got a call Friday morning to come to the hospital "immediately." Rushed down there, and in the morning only got an initial consult with a hospital-based internal medicine practitioner and a blood draw. Had to wait until 4pm for a room and 4:30 for an abdominal ultrasound. A gastroenterologist (GI DR) showed up around 5:30.

Jim's primary symptoms are-

1. Jaundice (he looks like a yellow post-it note);

2. A distended belly that means fluid is accumulating around the liver (V thought his shirts had been shrinking) (OK, you who know Jim will say he has had a "pregnant" belly the last who-knows-how-many years, but he had been slimming down lately);

3. Darkened urine from the presence of bilirubin, which results from the breakup of the hemoglobin of dead red blood cells (normally, the liver removes bilirubin from the blood and excretes it through bile); and

4. Spider veins on his belly.

His possible secondary symptoms (present and past) are dizziness, queasiness, inappetance, edema (swelling) of the lower legs and feet, skin rash, and difficulty breathing. He has no abdominal pain.

From the initial blood and US tests, and a health history, the GI DR has initially ruled out liver cancer and focused on a cirrhosis (advanced scar tissue) through chronic alcohol use. However, her practice (there will be 2 different GI DRs the next two days) will continue to consider these probable diagnoses--

1. Hepatitis, which is an inflammation caused (most likely in Jim's case) by viruses or poisons;

2. Cirrhosis, which can be caused by viral hepatitis, alcohol, or other liver-toxic chemicals (including some of the prescription drugs Jim may have been on recently, the GI DR needs to check Jim's records with his original GP); and

3. Cancer of the liver.

Other possibilities that the GI DR mentioned that V didn't quickly find mentioned (or discernible) in the wiki article on the liver and liver diseases were--

1. Vascular (a clot in a vein);

2. Fatty liver (which despite having read about it on the FDMB, V still doesn't understand);

3. OTC drugs, such as Tylenol.

Tomorrow's procedures will include a different kind of US (doppler) that will look for vascular involvement, more bloodwork (to look for iron overload or other metabolic causes), and a drainage of the fluid in his belly (with culture and analysis of the fluid).

Starting tonight, Jim is getting a multivitamin and folate and thiamin, B vitamins. This is because if chronic alcohol use is the cause, his system is generally run down and depleted in many vitamins, especially the Bs. He also will be started on a low-salt diet (which is not that far from how he eats now) and a diuretic (water pill).

A social worker came in to talk about the possibility of institutional care after Jim's discharge from the hospital. (Jim will likely be in the hospital until Monday night or later.) Jim and V didn't think it was necessarily a bad idea for Jim to be in a facility for a few days to a week after his release. Given where V's health is right now, she can't give him the help (or patience) he needs. (The nurses/techs at the hospital are being so patient with Jim's wobbliness. V. just sat there in wonder today, because she doesn't have the strength to do that.)

V did look at the history that Jim's GP sent to the hospital with her. Jim has been going to his DR for annual blood tests since 1996. Interestingly, the only tests that have been done were cholesterol and PSA (for prostate). Nothing in the way of a CBC or other "full blood value" testing. (V has no respect for this DR. He used to be her DR, for a short time. What the hell is this all about for a 65 YO person?)

After more than 13 hours on her feet today (or sitting in a chair with her feet on the floor), V's feet and legs are dying. She almost fell getting out of the hospital. Her neuropathy is bad enough without putting constant weight on it. Hopefully, that chemo side-effect will be gone soon.


Alice said...

Sending hugs to you both. I hope Jim feels better soon. And I hope the Chemo effects go away soon.

Love Alice

DebandGiz said...

Dearest, dearest Venita,

I'm so glad Jim finally got his hospital room/bed... Have been thinking about and praying for you both extra hard since our "chat" Thursday night... Didn't even turn on my computer since earlier that day because of the unbelievable work load and resulting exhaustion, so just saw your update post this morning...

Please tell Jim that a yellow post-it note is not his color! And that we're all hoping and praying he recovers completely! And you, my dearest, dearest Venita, please take some time to rest and recover yourself, okay? He's getting the care he needs... You get the rest you need...

Much love and it sure as hell looks like we're not in Kansas anymore kind of hopeful, healing hugs,
Deb & Giz, too...

DebandGiz said...

Just checking in for any updates, dearest Venita,

And sending hugs and pawpats because we're thinking about you both...

Much love and we'll check back in later kind of hopeful, healing hugs,
Deb & Giz (And hopeful, healing pawpats for your cheek, dearest Venita, and Jim's too...)