Friday, August 10, 2012

Day 55 TMI, d'oh! and Exeter

So, today I will eventually get around to talking about the Exeter hep C situation and why yesterday was a hard sort of day for me, but in order to get there, I will need to discuss a topic that for sure qualifies as Too Much Information. If you are worried that the payoff of hep C and what the doctor/patient discovers about her mood is not worth hearing about colons, then today might be a good day to skip out of the blog early. It's ok; if you change your mind, you can come back tomorrow; it'll still be here. I don't know why I can't get the jump to work now.

 So, here's the TMI. I have a pretty terrible gut. In fact, it was not until I was around 30 and did my first "review of systems" that I understood that most people do not have diarrhea every day. OK, so I may not have gotten the best medical care at some points in my life, but we can discuss that some other day. When I was a kid (like under seven), I remember that I was allowed to take kaopectate whenever I felt I needed it because diarrhea was such a constant and unremitting fact of life. When I think about this, I am astonished, appalled, speechless, amazed, but back in the 60's things were different--nobody used seatbelts, everybody smoked and evidently kids just had free run of OTC's in the medication cabinet or at least they did in my household.

I never had any bleeding, mucous, etc. so it never needed looking into. Clearly if something bad was going on, I would not have made it to mid adulthood without problem. I coped through two pregnancies, med school, residency, etc. until the summer of 2010 when I began having some bleeding. I went to see my PCP and because I live in Exeter, I ended up getting a colonoscopy at Exeter Hospital. Getting a colonoscopy is a nuisance in large part because it can wreck two work days--day one for the prep and day two for the colonoscopy and recovering from it.  One of Exeter's GI doctors, Dr. Ades, would on Saturdays that he was on call anyway do colonoscopies for doctors and hospital administrators. This meant that one did not have to take more than a day off from work. I showed up Saturday morning, had my colonoscopy in the main OR at Exeter Hospital with fentanyl and versed and found out that I did not have colon cancer or any crazy occult inflammatory bowel disease.

What I did have is a remarkably long colon. I have, evidently, two extra complete 360 degree loops in my guts, one in the right lower quadrant and one in the left upper. This means that after one inserts the colonoscope, instead of heading into the middle and then the left lower quadrant like most normal humans do, first my colon makes a foot or so long detour into the right abdomen for a special little victory lap around the right lower quadrant. Dr. Ades spent the first few minutes of my colonoscopy thinking I had situs inversus, in fact. Then, a normal left lower quadrant, then an extra loop by my spleen and then a normal course past the liver and into the right lower quadrant again. Here is a picture of a normal colon and here is a picture of a partially redundant colon. Dr. Ades told me that he would not have been able to complete the whole colonoscopy without being in the operating room so he was really glad that it had all worked out the way it did.

Fast forward two years to the present. Guess how happy my colon is with chemo and how much it enjoys neutropenia, zofran and dexamethasone. For variety, I developed constipation during both rounds of chemo rather than the diarrhea that would probably be more typical. I think it was mostly a side effect of the zofran, but I'm not sure. After a couple of days, things were moving again, but not in any way that could be described as functional and with a tremendous amount of gas, pain, cramping and some diarrhea intermittently. The day I left the hospital was OK, but yesterday was really pretty terrible in terms of pain: I woke up a bunch of times at night, couldn't do much during the day and here is the big revelation: I had an awful day yesterday. I was really discouraged and wasn't sure I was going to be able to cope with consolidation. When I woke up this morning and my bowels were back to their usual selves and didn't really hurt, I realized I had such a terrible day yesterday because I was in pain. What kind of lousy palliative care doctor must I be to have not figured that out sooner, huh? When one is in pain, one cannot do much of anything else. Let me say that again to see if I can remember it this time: pain requires so much attention and energy to deal with that when it is present, it is often difficult for one to attend to anything else. I spent so much of my energy yesterday just dealing with pain and fatigue from not sleeping that I did not have enough mental energy to recognize that not all days would be as cruddy as yesterday. Guess what? My PPS is not likely to be 60 again any time soon.

Since I couldn't sleep all that well, I spent some time thinking about the situation at Exeter Hospital with respect to hep C. I couldn't remember the dates in the operating room that would require testing. I let my mind flick over the possibility that the dates involved July, 2010. (they don't--I'm safe--phew!) I knew I had had the drug of choice for the accused and had been in an area he may have been in. As I imagined the possibilities what really made me angry more than the potential hep C was the potential violation. The idea of being completely helpless and having some one put something into my body without my permission was extremely upsetting. It's easy for me to say because I am not involved and for sure don't have to worry about hep C from him, however, I wonder if the violation is as potent for other people as it is for me.

According to the internet, the chance of getting hep C after an occupational exposure (needle stick) is around 1.8% in general, but is increased if the needle is hollow bore or the person has a high viral load. The rate can be as high as 7 to 10% under circumstances favorable to transmission. Of course, what happened in Exeter is not the same as an occupational exposure and the rate of transformation is not really known at all under these circumstances. I doubt it's 100%--50% would be really high. What I am getting at is that there are probably people who are now blood brothers with the accused tech who did not get hep C from their experience. They will never know who they are, and everyone who was at risk for hep C is at risk for this status too. I wonder going forward how this will play out for them, especially anyone who already had a trauma history. I hope someone continues to monitor these folks over the years--not just the positives, but the possible positives too.

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