The Penny

Example is not the main thing in influencing others. It is the only thing.

[Wednesday, November 25, 2009]

I Like This Guy

I saw a new doctor today: Dr. M, a gastroenterologist with Johns Hopkins. He was great!

He listened.

He explained.

He listened more.

He asked questions.

He thought.

He suggested.

He planned.

He wants to see my gallbladder out ASAP, given that I have signs of sepsis. However...

First he wants to do an endoscopy, to see how bad my reflux is, assess the damage it has caused, and see why I might be having the reflux. He does not think the reflux is related to the pain episodes. He sees it as a separate and equally concerning issue. That's because I have it pretty much every day, unrelated to what I eat (I wake up with it), and because I am having swallowing problems. Yeah, I haven't mentioned that one on the blog. Anyway, Dr. M wants to do the endoscopy before I have the cholecystectomy, because then he won't have to wait for me to heal from surgery, and because there's still the teensiest possibility that the pain attacks are not being caused by my gallbladder. But he thinks they are.

He thinks I probably passed a stone at the ER. While I was waiting to be seen (yes, read that with sarcasm). He doesn't understand why the ER doctor did a CT scan and kept looking for other causes, given that my liver enzymes were through the roof. Oh, and the fact that there was a .9 cm stone in my gallbladder!!! "Tiny little stones just like everyone has," my butt. Dr. M thinks I might have passed a stone with each pain episode, or there might have been just one or two that have hung out in the ductwork, causing problems. One almost certainly was blocking the hepatic duct at least twice: once while I was at the ER, based on the liver enzymes on the bloodwork, and once when I had the HIDA scan. Dr. M said there might be one still just "rattling around" in there, going up to the liver and down toward the sphincter of Oddi (where the bile duct meets up with the intestines). That could be causing some of the irritation and pain I have been feeling between episodes. That also could account for the septic symptoms. When the stone blocks the common hepatic duct, the bile backs up into my bloodstream. Nice! It would also cause plain old irritation of the liver. He wasn't sure that explains my blood clotting problems, though, and he is going to check clotting factors and take a look at my platelets. He thought maybe the combination of stones and Accutane might be doing something in that area.

He sent me straight to the lab, which was no surprise. Assuming I would need to sacrifice some blood but not knowing exactly what he would want, I had fasted this morning and not taken my Accutane. He ordered lots of tests. Two were at my request: blood sugar and cholesterol, just because I've never had them checked (and as long as I was fasting anyway).

I had a wonderful phlebotomist, a grumpy old black lady who informed me that she is one of only two good phlebotomists in the area (ha, she hasn't met Dr. D, my dermatologist). When I warned her that I am a tough stick and finding a vein usually requires multiple pokes and some digging and here is a good vein, she ignored me. But she got it in right away, no digging necessary. After filling the required seven--that's right, folks, seven--vials, she informed me that whoever said I had bad veins or had to poke me more than once (um, every Navy and BYU phlebotomist) was a fool. I completely agree. I love this woman.

So, the plan is:
-December 3, I will have the endoscopy, which Dr. M will do at the Johns Hopkins Outpatient Center. Boy am I familiar with that place! Both of Laynie's CIs were done there, as well as all of her mappings.
-I will have an appointment with another Dr. M, a surgeon. This will probably be after the endoscopy. I'm hoping for the day after, but we'll see what they offer. I'm kicking myself for leaving my phone on vibrate, because I missed a call from Dr. M-the-surgeon's office about an hour ago. I called them back literally less than 10 seconds later, having just missed the call, but naturally they were closed.
-I can't remember if I blogged it, but Dr. P, the first surgeon I visited, had scheduled me for surgery for December 3. I talked to them earlier today. They needed to cancel anyway, and I was wimpy and just said that I would have to call them back after I looked at my calendar. Not going to call them back. Not comfortable with Dr. P. Hopefully I like Dr. M-the-surgeon better.

Seriously, the timing on all of this could not possibly be worse. I have three students in crisis (ok, let's be honest, it's not the kids who are in crisis), and one student in semi-crisis. I have consultation meetings, pre-meetings, IEP meetings, planning meetings, due process meetings, and observations over the next few weeks. Plus presenting at the speech meeting in three weeks, which I have not even begun to think about. Well, it is what it is. I'm glad that I told people at work that I was having some health problems. At least they won't be surprised if something pops up on my calendar and I have to miss a meeting.

Alright, now I want to blog about more interesting things. New post!


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