Wednesday, November 23, 2016

Rhab-dough, or how THB spent the few days before Thanksgiving

Hello all:
Hmmmm...what's going on here?

THB has rhabdomyolysis...what the hell is that? Large proteins unable to be processed by the kidneys, a pretty rare and serious problem for you and your kidneys if left untreated for too long.

What causes it? Just about anything THB's case, the cause is most likely 
  • The use of medications such as antipsychotics or statins, especially when given in high doses

Here's a site that gives more info:

In THB's case, more specifically, let's hope it is not antipsychotics, since THB doesn't think he is taking any antipsychotics (though clearly THB is having hallucinations...President-elect Trump?????). And, THB is not on a high dose of statin. Maybe it is an odd confluence of things including post-Rio malaise (THB and DB think that is also a likely contributor). 

Insert homage to Leonard Cohen: I said this can't be me. Must be my double. And I can't forget, I can't forget. I can't forget but I don't remember what)

On the other hand, it may be better that antipsychotics is the cause because statins are a major preventative of a recurrence of heart problems, which is why THB was taking one (no longer, stopped immediately).

My shadow for 3 days: the IV drip machine

The treatment for rabdough: lots of fluids (of pretty much any kind). THB started pounding down fluids and was on an IV saline solution, and that has helped reduce the immediate problem. 

Background: 2-3 weeks ago, THB noticed that it was getting harder to do stairs, especially the step-up part of the 7 minutes of calisthenics, and a bit harder for pushups. Then walking also seemed more challenging (though riding the elliptical was not a problem), with a sense of weakness in the thighs (not pain, more like discomfort). Finally, THB called his primary physician, went in Friday morning for a quick review and some blood work. The doc's likely diagnosis: 

which is sort of a generic auto-immune type thing, more common in women, can come on at any age, and is treated over time with diminishing amounts of prednisone.

The real problem showed up in the blood tests. Here's the results for CPK: only 30 times the acceptable level...

ComponentYour ValueStandard Range
Creatine Kinase,Total,Serum6521 U/L24 - 204 U/L

Day 1: When the blood work came back and THB's doc checked it over the weekend, the CPK (large protein) count was 6500. Normal is 20-200. Thus phone calls from THB's primary doc started coming in on Sunday, along with urgent e-mails. Rhabdo can result in kidney failure as the large proteins find their way into but not out of the kidneys. How rare is rab-dough? THB's primary doc is in a similar age bracket with THB and she's never had a patient with rab-dough. Too bad it got caught right away or THB might have been written up in the NYT, which would have been a bad thing for THB since he would have spent many a year peeing every 1/2 hour before a proper diagnosis.

We hustle back from beach (DB driving and THB drinking on and on and on, more than a week's worth of fluids) and check in at John Muir Hospital in Walnut Creek, the same spot THB got his stent installed 33 months ago (a nice hospital if you have to rate hospitals).

My night time companions: used to avoid unplugging my shadow ever 1/2 to 1.5 hours and dragging the shadow to the toilet 

Saline solution pumped in ER at a rate of 200 (200 what?) via an IV, which means THB is now peeing pretty much constantly. Sort of like the guy drinking beer in the men's room at a football game.

CBM and EM bring in sandwiches for dinner in the ER. THB is now checked in for an overnight stay to keep the IV running, now at 90 whatevers, which translates to peeing every 1.5 hours
Hey, maybe Toto can figure out how to move this handy-dandy feature to Japan! Or, maybe it upside down?

Day 2:  by 6am Monday the CPK count was down to 4400.

That's not low enough to be checked out, so THB spends another night at the hospital. Laps of the 5th floor with THB's shadow (IV) in tow. DB brings in Arizmendi pastry (monkey bread from our freezer, awesome!) and decaf au lait for breakfast, burritos for lunch, and LB brings in burritos for dinner. Around 1:40am, THB is awoken for a blood test. 
The snuggle bench, a very nice fit for two

Day 3: More defrosted Arizmendi and a decaf au lait from downstairs at John Muir. CPK is stabilized at around 4200 this morning (the 1:40am blood draw), which meant the hospitalist doc could give THB clearance to leave, with a recommendation of 2-3 liters of fluids per day and follow-up blood work next week. THB to do walking as only moderate exercise. Two more blood draws, one at 6am (with no test for CPK!) and one at 10:40.

The board was updated constantly with the names of the nurses, the aides, and on the last day in the last hour, with a picture of the hospitalist

OH NO!! The doc was releasing THB based on the 1:40am draw without seeing the 10:40 blood test results, where THB's count went up to 5100. Wrong direction! Discharge cancelled (Trump punishment for voting for Hillary?). DB goes for Le Cheval and THB has pork kebabs with vermicelli, DB chicken with vermicelli, and we share shrimp rolls (not fried).

KBM and EM stop by and DB heads off to start Thxgiving prep without THB. EM leaves to take care of their dogs and KBM goes off for falafel and pita and we very nice father-daughter picnic in the hospital.
Note the tangling of cords behind my shadow. Required reaching around and through the maze to unplug not one but two different wires. All the while hooked up to the IV with another thin tube

To get more fluids in THB, the new setting for the IV is 125, which means peeing every 1/2 hour. Not bad during day, deadly at nighttime. With the normal interventions (e.g., vital signs, fixing the IV machine), it does not make for a restful night. 

Day 4: THB learns what the IV setting is: drips per second. Really? Drips? Is that an official measurement. Hmmmmm...the blood test at 6:15am this morning is problematic, it is getting harder to find a vein. The left arm is a no-go because that is the saline drip side. The right arm is over-poked.

Another day and another mix-up on the CPK test; the new (to THB) nurse catches the problem around 9:30 that the CPK level was not part of the blood test. She scrambles to find the hospitalist and the lab can apparently use the 2nd vial taken this morning.

At 10:45 the nurse comes and says the CPK is back in the low 4000s so THB is going to be released. DAMN! Now to get the official word from Dr M, the hospitalist.

11:55: no sight of Dr. M

12:05: discharge nurse shows up, processes the paperwork, unplugs THB from the IV pole

12:15: Dr. M comes in for final words. As an aside, his kids go to EBI, Escuela Bilingue Internacional, right down the street from THB and DB in E-ville (and where a grand-neice attends also)

How'd you do on the Pop Quiz?

Here's the make-up quiz: does overdrinking of wine during the Xgiving weekend count towards the 2-3 liter count? Does any wine count? 


Happy Thanksgiving to all!!!!!!!!!!!!!!!!!!!!!!

And a bonus: how to remind yourself to drink, drink and drink more fluids when at home...

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