3264 Moving forward, but slowly

Tuesday, May 24, 2011

“The deeper insanity becomes, the more consistent it becomes,
until it wraps around and looks like sanity.”
-- Silk, August 9, 2008 --

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It was a beautiful day today, sunny and warm with a gentle breeze, the first nice day in the past week and a half. And I spent most of the best part of the day, from 10:30 am until almost 4 pm, in the doctor's office or the hospital.

I admit I was worried when the doctor, to all appearances, was in no hurry to look at my scans, and then once he did look at them he wanted to see me immediately. That's almost never a good sign.

Last night I ran through all the bad scenarios, what he could say, end-stage renal failure, kidney cancer, bladder cancer, etc. etc., and pretty much came to terms with it all.

When I got there, the nurse put me in an examining room, and then later the doctor stuck his head in the door and asked me to come to his office. You know, with the big desk, and the two chairs in front, and the box of tissues on the corner. Another bad sign.

That made his news a relief. The most recent scans do not confirm either the first set which implied one collection chamber and one ureter on the left, or the second scan which says two collection chambers and two ureters. This latest set says two collection chambers, with the stent in the upper, and the obstructing stone and a few smaller ones in the lower, but neither the x-ray (IVP) nor CT confirm a second ureter, because I've got really good kidney function apparently, and the upper chamber cleared the contrast solution so quickly that it never even reached the second chamber or ureter (which is blocked anyway, remember?). So we still don't know exactly what we've got in there. But at least it is pretty clear where the stone is.

So we're going to smash the stone(s).

Not this week, because of the holiday coming up, but probably the end of next week. The procedure is Extracorporeal Shock Wave Lithotripsy (ESWL), described here: http://www.healtheast.org/st-joes/programs-services/kidney-stone/treating-stones/shock-wave-lithotripsy-eswl.html.

I told him how the stent is now causing bleeding after physical activity, it's irritating the bladder, and how I can feel it poking and it is getting worse, to the point where the seat belt hurts, and the urinary urgency is getting worse, so will we be removing the stent at the same time? He said no, because we're not sure where and how the second chamber drains, and the worst case is only one ureter, and some piece of the smashed stone gets stuck in it, blocking the entire left kidney. So no, the stent stays until we know what's going on.

Crap. I can lessen the bleeding and poking and irritation by avoiding physical activity. No lifting, raking, mowing, walking far, dancing, driving long distances, etc. etc. etc., anything that makes the stent move. Crap crap crap. I want this damn thing OUT! NOW!

So when I got home I read up a bit on ESWL. Two possible negative consequences are damage to the pancreas leading to diabetes, and damage to the capillaries in the kidney, leading to renal failure. The pancreas thing is unlikely because we're working only on the left kidney. The capillary thing worries me a little. I have fragile capillaries. I'll have to tell him about that. However, my stone isn't very big, so it (I hope) won't require much to break it up, and it's localized, and my clotting abilities are ok, so maybe that will be ok.

[My theory of what's in there is different from his, I think. I do think there's a second ureter, which the larger stone is blocking, because there are also a few much smaller stones in that chamber which, if that chamber connects with the chamber with the stent, seems to me that I should have passed those stones by now through the stent. A few other details argue for the second ureter joining the first somewhere north of the bladder. So the stent could actually CAUSE the moving stones to get jammed at the joining point. But at least then the second ureter would show up on a contrast x-ray for the length that it's open, and the blockade could be eased by pulling the stent. So I'm not going to argue with him.]

I just want this DONE!

After I left his office I went to the hospital to pick up my personal copies of the scan and x-ray done elsewhere a few weeks ago, that they had asked for for comparison, and to get copies of the recent scan and x-rays with contrast. There were at least three misunderstandings. It was three and a half hours before they managed to get it all together. About every 40 minutes or so they'd bring out part of it, and I'd have to ask again for the rest. And then wait. (At one point they actually insisted that I had NOT had the CT scan.)

When I first arrived at the hospital, at about noonish, as I was putting the top up on Hal, I got a call from Piper. We had a lot to talk about, and about 20 minutes in I mentioned that I had a bone to pick with The Angel, and told Piper about the IRS and NYS letters. Piper said he was worried about The Angel. He's had some kind of serious medical problem for the past few weeks or months, and Piper had called him twice yesterday and again this morning, "...and he always returns my calls immediately", but he hadn't heard from him. Piper was afraid The Angel was in the hospital, and if so, it was bad because otherwise The Angel would have contacted him.

Piper said if he hadn't heard from The Angel by this evening, he'd call his parents. He'll let me know.

So. Onward. Fred's tire is still flat. Sigh.
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3245 Stray Stone?

Tuesday, May 10, 2011

We ought to keep the rich as rich as possible, because
nobody poor was ever able to afford to give anybody else a job.
-- Lewis Grizzard --

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You hear that green quote above all the time, mostly from rich people, and from poor people who have been duped. I'm not sure I agree with it. There is such a thing as being so rich that the only jobs you have to offer are menial minimal-income jobs. Petting and pampering. The rich folks that offer real living-wage jobs are those who still have to scramble to support their lifestyle.

If we make sure there ARE no poor, then everyone can buy stuff, and that's what keeps everyone employed.

Sheesh. I sound socialist, but that's not such a bad thing, actually.

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After Sunday's post I went for a walk with Daughter, Hercules, and Nugget. We walked down to the bay, then along the bay until we ran out of pavement, then across some beach (that monster stroller is not fun on sand), to a park (where Hercules and I freaked Daughter out by pretending to give Nugget her first trip down a slide), and then back along some streets. Altogether about 2 miles.

Walking was a bit uncomfortable, because I can feel the stent in the bladder, swinging like a bell clapper. And Saturday evening I had noticed a sort of firm lump under the skin between the clitoris and urethra. I wondered if the stent had moved and was poking. There was no pain, just a slight pressure, like when a tampon is too low. I'm 14 years past menopause, but I still remember that feeling.

Then I took a shower, and went over to the kids' house for dinner, steaks grilled by Hercules.

Something very scary happened in my shower. I piddled before I got in the shower, but I didn't look at it, you know? Sometimes (well, usually, actually), even though I always go before getting into the shower, as soon as the water hits me I piddle a little more.

It was red. Blood. Like Psycho. Swirling down the drain.

It was Sunday. My urologist wasn't in, and not on Monday, either. My first fear was that the stent had poked through the bladder wall, or rubbed a spot raw, or something. If I call anyone, they're going to tell me to go to the ER. But hey, not only is there no pain, but the slight nagging ache I'd had in my right lower back for the past week was gone suddenly! And the firm lump and feeling of pressure were gone, too.

So from then on, when I had to go, I piddled a bit in a glass so I could see what was happening. Later Sunday night there was a bit of pink, but not as much as earlier. Monday morning, it was brown at first, but got lighter and lighter as the day went on. By early evening it was the usual pale yellow.

I think I passed a stone. From the right. Where according to two CT scans and two x-rays, there were NO stones. Which is why I didn't connect the back ache to the right kidney. Ho hum. Par for the course.

Today, Tuesday, I was to call the doctor's office to find out how my kidney function blood test from last Thursday had turned out. It needed to be good in order to have the CT with contrast. I had to leave a message, and the receptionist called back a few hours later to say that it was fine, and I should go ahead and schedule the CT scan. I didn't mention Sunday's blood. I seem to be fine now, and I figure the CT scan should notice if anything's gone flooey. (Yeah, you'd think I'd have learned a lesson by now. They miss a LOT!) I will mention it next time I see him.

Anyway, today I ran a bunch of errands in the morning, then about noonish went with Daughter and Nugget for the two-week OB appointment, then to a wonderful fruit/vegetable/bakery store where we had late lunch/early dinner outside from the deli counter. We got home about 6 pm.

It was funny - Daughter went off the pain meds almost immediately after leaving the hospital, and she's been walking a few miles every day, and taking Nugget everywhere with her, including in the car. Today, the doctor gave her permission to go off the meds, drive, and walk. Snork! If he only knew....

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Ever notice that on CSI and Criminal Minds, whenever the crime involves torturing the victims, it's almost always women who get tortured?
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3240 Ok. I'm weird.

Thursday, May 5, 2011

Violence is the last refuge of the incompetent.
-- Isaac Asimov --

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Appointment with the urologist today. Last week I had the blood test, x-rays, and CT scan. Also a urine something-or-other, but the doctor hasn't got the report from that yet, so I assume it was a culture. I expected to get some good news, like that we can break up the stones and then remove the stent.

I didn't get good news, or bad news, but certainly unexpected and very annoying news.

Remember how I said CT and MRI scans are slices, and small things can be missed because they might fall between slices?

The CT scan (and the x-rays, too, which I don't understand) from the White Plains hospital a month ago missed something important.

A normal arrangement looks like this:
Inside the middle of the kidney there's a hollow urine collection area. The urine produced by the kidney collects there and then flows through the ureter to the bladder. At White Plains they told me that I had a large stone blocking the ureter at the top, and a smaller stone blocking the same ureter at the bottom. They removed the bottom stone, and put in a stent (a long hollow tube that goes up through the ureter with one curl at the upper end in the kidney collection hollow, and another curl at the bottom in the bladder) to bypass the larger stone and allow urine to pass and drain. The larger stone could be handled later, after the infection was under control, and then the stent could be removed.

Last Thursday's scans and x-rays say something different.

Look at the kidney on the left side of this sketch:

Two ureters. Turns out I have two ureters on and two separate collection areas in my left kidney. This is not rare, something like 15% of the population has it. Apparently mine is slightly different from the sketch, in that the two ureters must join just above the bladder, and the smaller stone that was removed was therefore blocking both ureters. When that stone was removed, it allowed ONE of the two collection areas to drain. The other was still blocked by the larger stone at the top.

Here comes the annoying part.

They put the stent into the collection area that DOESN'T have a stone. They didn't realize I had a double kidney. The stone is still blocking the OTHER (hitherto unknown) collection area. Translation - the stent isn't doing a damn thing! It's totally useless! I still have the blockage. We don't know why I don't have any pain, and that must be what the x-ray technician noticed last Thursday, and why he asked if I was in pain.

So the urologist wants another CT scan, this one with contrast dye, so he knows exactly what he's got there. But I can't have the contrast dye without first ensuring that my kidney function is good. (They told me in White Plains that my kidney function was good, but that was then, this is now, with another month of blockage.) So I had to have another blood test today, and then call on Tuesday to find out if we can schedule the CT scan.

This time I was very clear with the phlebotomist that my arms were absolutely off limits unless it could be proven to me that the blood absolutely could not come from my hand. This time they listened to me. It took three tries, and I now have a huge purple knot on the back of my right hand, but it was still easier and much less painful.

So, this isn't finished yet. And I don't know when I'll get back to the old house.

This is ridiculous.
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