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Posts Tagged ‘diarrhea’

Keeping Up With Fluids

January 15, 2009 Leave a comment

With the virus I had a few weeks ago, I’m very aware of how important it is to keep hydrated. I got into the routine of drinking coffee as my first drink of the day, and “nursed” it for about 2 hours at work. By that time, I was behind on fluid intake, had taken my immunosuppressants, and had dark urine. Now, I drink a bottle of water on my way to work, and my urine is more dilute. I know manage to get in at least 2 liters a day, and even feel better.

Speaking of the intestinal virus I had at Christmas time,  we have been having a lot of office visits and calls from both adults, children, and infants with viral diarrhea. Whichever this virus is, it’s a particularly nasty one; abdominal pain, dehydration, etc.

I mentioned last week that the child I take care of through a nursing agency on weekends had come in to our clinic and was placed on a ventilator. He apparently had this same virus and developed a bowel obstruction. As it turns out, he apparently had bleeding ulcers in his stomach for some time, perforated an ulcer when he got the obstruction, developed peritonitis (an infection throughout the abdominal cavity that is usually fatal; it’s what my mother died from almost 30 years ago), and died the next day.  The other adopted child in the house who had similar neurologic disabilities was admitted to the PICU (Peds ICU) the morning that Brian died ALSO had the virus and developed a bowel obstruction, but her’s was caught early enough, and she’ll be coming home on Friday.

Brian was a victim of Shaken Baby Syndrome, and was given less than a year to live. One of the last times I worked with him was on his 15th birthday (proof that NOBODY can predict when someone will die; not even a doctor).  His adoptive mother thinks that there’s a possibility that murder charges will be brought against his father, since his death can be indirectly tied to his injury. I’m not sure that will happen though…

There are many in the healthcare profession that believe that things happen in threes, including Keagirl. Well, I’m a believer as well. This past summer, we had 3 patients (I work in a Pediatric Clinic that sees a lot of chronically ill patients) either former or current who died within a few short weeks. Most recently, we had 3 patients since New Year’s Eve day that died as well (the day that Brian died, there was also an infant that died that very afternoon). People expect to hear of adults dying, but not children. It does happen, sad as it may be.

We saw Gran Torino last weekend; fantastic movie. I read on an online forum that the person posting had been to see it in Lower Manhattan, and there were people walking out. Not surprising, as I’m sure it was offensive to city-dwellers who aren’t used to hearing/seeing people that are similar to Clint Eastwood’s character, much like blue collar workers such as Eastwood’s character are out of touch with city living. It’s a shame they didn’t stay; the movie evolved past the initial narrow-mindedness.

It’s pretty cold here, but then again, it’s January, and it’s Pennsylvania. Listening to the news (local AND national), you would think that the end is near. I broke out the down-filled jacket, wear my gloves, and despite having to leave the house, I’m still alive. Yes, it is possible to go outside when the temperature is below 10 degrees F. And no, I didn’t have a 2 hour delay for work today, even though the schools did (I still can’t figure out a 2 hour delay for cold temps; it isn’t much warmer at 10am than it is at 8am).  The only problem I have is trying to figure out if this is global warming or global cooling….

Update

December 24, 2008 Leave a comment

I’m back to work today, and overall feel better. I was able to rest the past 2 days, which helped a lot, although I’m still not eating much (I’ve lost another 4 lbs since Monday, bring my total to 12 lbs lost since last month).  The diarrhea has slowed down, and I’m not as fatigued.

My doctor is confident it’s just a viral gastroenteritis (fancy term for diarrhea from a virus); the C. Difficile was negative. My creatinine is up to 1.5, but that’s probably just from being a little dehydrated.  Here are my labs from this past Monday:

 

Component        

Your Value

Standard Range

Flag

BUN

17

6-20 mg/dL

 

CREATININE

1.5

0.7-1.5 mg/dL

 

SODIUM

136

135-146 mmol/L

 

POTASSIUM

4.3

3.5-5.1 mmol/L

 

CHLORIDE

109

98-111 mmol/L

 

CO2

17

22-32 mmol/L

L

GLUCOSE

101

70-120 mg/dL

 

ANION GAP

10

7-15 mEq/L

 

CALCIUM

8.5

8.3-10.5 mg/dL

 

GFR ESTIMATED

53.8

>60-  mL/min

L

 

(not sure why the next set didn’t retain the same formatting)

Component         Your Value Standard Range Flag
WBC 8.13 4.00-10.80 K/uL  
RBC 6.76 4.50-5.25 M/uL H
HGB 13.5 14.0-16.5 g/dL L
HCT 42.5 40.0-47.0 %  
MCV 62.9 82.0-99.5 fL L
MCH 20.0 27.0-34.0 pg L
MCHC 31.7 32.0-36.0 g/dL L
RDW 15.4 11.5-15.5 %  
PLATELET COUNT 199 150-400 K/uL  
MPV 10.0 6.6-11.1 fL  
SEGS 28 40-75 % L
LYMPHS 72 18-42 % H
ABS. SEGS 2.28 1.8-7.7 K/uL  
ABS. LYMPHS 5.85 1.0-4.8 K/uL H
RBC MORPH MICROCYTOSIS PRESENT  –     
RBC MORPH HYPOCHROMIA  –     
RBC MORPH SLIGHT  –     

 

 

 

—————————————————————————Last night, I had to go to Wal Mart, and walked in at around 9:30. It was a funny sight, when I saw all of these middle-aged guys standing in front of the card racks getting their last-minute Christmas cards.

 

It was icy on my way to work today; part sleet, part freezing rain. I fishtailed getting onto Interstate 80, but once on, it wasn’t bad. Right below the entrance ramp, there was one overturned 18 wheeler, and another getting towed. About 1/2 mile after getting on I-80, a tandem-trailer Fed Ex Ground truck went flying by at 80 mph! It’s no wonder why there are tractor-trailer accidents when you have an idiot like this driving so fast in freezing rain.

 

Merry Christmas!

 

Sick

December 22, 2008 Leave a comment

I haven’t been feeling well the past 2 weeks. I was still getting the flank pain, no appetite, some diarrhea, sleeping more, feeling cold (but no chills) alternating with being flushed. Last Monday, I emailed my Transplant Nephrologist (I no longer see my previous Neph), and he told me that since my temp was 100.1 (which, by the way, is NOT a fever), I should go to the Emergency Department. Personally, I felt that his response was total bullshit (pardon the language), and discussed it with my primary doc. I told him my concern that I may have a kidney cyst infection, so he ordered blood work and a urine culture, and prescribed Cipro. The blood work was all fine, except my White Blood Cell count was 6.28 and my segs were down to 31; the previous WBC was 4.39 1 week before, and 4.03 last month, and my segs were running previously around 75-80. Although the WBC is still normal, it is up from previous lab draws, but the segs are low.

I felt better last week, although not 100%. But over the weekend, I started going a little downhill again, and developed abdominal pain and diarrhea (I had diarrhea for about a week, but took Immodium; the Transplant Coordinator told me to take it whenever I got diarrhea, to avoid dehydration). When the abdominal pain started, I stopped the Immodium, and the diarrhea started. Last night, I slept for about 90 minutes in the evening after working a 10 hour shift, and getting up at 4:30 to go to work. While I was sleeping, I developed chills.

The pain is in my right lower quadrant (I have my appendix out), and comes and goes. It feels like a gas pain. I also had some more flank pain today as well, but that only lasted about a minute. When I went to work, I asked my doctor to see me, so I had an appointment with him. My abdominal exam wasn’t bad; he feels I have a gastroenteritis. He ordered blood work, urine culture and u/a, and stool cultures, abdominal ultrasound, and signed me off work until Wednesday. Of course, Jackie thought I was going to be admitted to the hospital (in her defense, I haven’t eaten much lately, and have lost 8 lbs since last month), but Dr. G. wasn’t concerned that it was anything serious. The possibilities with the diarrhea include a viral gastroenteritis (lots of that going around), C. Diff (from the Cipro), or a side effect of my CellCept (immune suppressant).

I’ll post back when I get my labs and more answers. Back to bed now….

Transplant Day 31

June 3, 2008 5 comments

My new kidney continues to work flawlessly. I haven’t been as good as before with fluid intake, but WILL be back on track today.

My weight is unchanged, BP and temp are stable,  but my input and output are less.

I did have 3 episodes of diarrhea yesterday (thank you, CellCept), I continue with intermittent hand tremors, and hardly slept last night (Prograf?). But those are minor annoyances that I can live with.

I have routine lab work tomorrow (“the big 3”-blood count, basic metabolic panel, and Prograf level).

On Friday, I have a Urology appointment to remove the stent between my bladder and new kidney. Prior to that, I have a nurse appointment in Nephrology to get an IV infusion of Venofer (Iron).

Going away for the weekend did all of us a lot of good, but it’s time to get back into my routine. I thought that I would have a hard time being away from work, but I’m actually keeping quite busy. I plan on resuming my weekend job when I return to my full time job, except I’ll probably only work Sundays for August, and in September, go back to Saturday and Sunday.

Transplant Day 20

May 23, 2008 2 comments

Not much to report today, as everything is status quo for the most part. My weight and bp are slightly up; I continue to be amazed at how dependant my BP is on small variations in weight.  Ins and outs are close to even, and still no fever (not that I want or expect it).  Updates posted on Daily Vitals.

I’m still sleeping in the recliner, because when I lay flat, it puts a lot of pressure on my incision, and is uncomfortable. I tried again last night, and it’s not as bad as before, but still not yet doable.

I was a little concerned yesterday, because my urine was more dark than usual. Probably because I had diarrhea the day before, and was a little “dry”. It got better throughout the day as I drank more.

I had labs yesterday, but they won’t be back until today, because I had them drawn at a satellite clinic, and the courier probably didn’t pick them up until the end of the day. I’ll sent a message to the Transplant Nurse to check on them, and will probably hear back later today when the Prograf level is back. I still don’t have Monday’s labs available on line. I can somewhat understand, as they all go to one doctor, and he signs off on them. I’m sure he has a lot of them to do, in addition to his other responsibilities. As long as I’m told the important ones (creatinine, BUN, magnesium, white count, hemoglobin, phosphorous, and Prograf level), then I don’t mind so much.

I walked to the clinic yesterday, and it was even easier than the week before. The phlebotimist there is great; she has gotten blood on the first “stick” both times I went there. With my veins, that’s no small feat!

The weather here has been rainy and cold, so my plans for a daily walk went by the wayside. My leg edema is still there, but noticeably improved. My AFO’s (ankle foot orthosis aka splint or leg brace) went on much easier.

No diarrhea yesterday, as I took the Imodium the night before (none since). I did have 800 mg of the Magnesium Oxide with lunch and 400 mg at bedtime. Yes, I’m supposed to take 800 mg twice a day, but what good is it if it’s causing profuse diarrhea? I will hopefully build up to the correct dose. 

 

Transplant Day 19

May 22, 2008 3 comments

Good day yesterday. Input and output are better than the previous day, my BP today is lower (but not too low), no fever, and my weight is down another pound (that’s good). My appetite picked up a little, and I managed to get more phosphorous in yesterday via some nuts, milk, PB and J on whole wheat (peanuts and wheat have a lot of phosphorous), a protein bar (contains 20% phosphorous), some chocolate, and the cheese in the lasagna we had for dinner.

I did have diarrhea again last night; it happened 12 hours after my magnesium, yet I skipped my mag dose the night before, and no diarrhea in the morning. I’m convinced that is what is causing it. So, I only took 1 magnesium last night along with Imodium (which is an approved drug for me). So far, no diarrhea this morning.

I did have to take Tylenol #3 during the night. I got up to go to the bathroom, and my elbow and hand were very painful. I tried to get back to sleep, but the pain was just too distracting, so I broke down and took it. I was finally able to get back to sleep. Initially, the pain was a numbness/tingling/buring in my 4th and 5th fingers (suggesting an Ulnar nerve problem), and then went to my other fingers and the palm of my hand. It isn’t occurring on a regular basis, so I’m still not worried about it.

My father-in-law was blown away at the retail cost of my Valcyte ($4610 for a three month supply). However, I get an “employee discount”, so that cost is deceiving. Were I to get it from drugstore.com, 3 months of Valcyte would cost $6462.68! BTW, if you want to know what a drug costs, I usually go to drugstore.com  and search for the drug. It’s a ballpark figure, but it gives you some idea of what a drug will cost. Also, on some items, it’s cheaper to pay cash there instead of going through your insurance. For example, it was much cheaper to buy a year’s worth of fluoride there, than put it through the insurance (I can’t remember the numbers, as Kevin is no longer on it). My Vitamin B-12 injections (I’m on that from having the Gastric Bypass) cost about $15 dollars for the year (12 vials). At a local pharmacy, they are $5 a vial.

I have lab work today at 10am. I won’t know what my labs are until tomorrow. I’ll check later to see if Monday’s labs are available online (they aren’t available until the doctor “dones” them; he usually isn’t very prompt with that, but at least I know the important levels).