Nancy
February 28th, 2006, 06:26 PM
***Warning, this is about ADVANCED heart and other health issues, don’t read if you think it might worry you**
Joe’s been through quite a few things in the past two months. He’s been in and out of the hospital three times, and is probably being discharged tomorrow making this the fourth time. The basic issues are his continued upper GI bleeding which has caused lots and lots of anemia requiring somewhere around 8 transfusions or so (I lost count), which then led to kidney failure, chronic and acute, which led to severe CHF which increased all his internal pressures, making the bleeding worse and thus making a nasty and downward-spiraling vicious circle. Diuresis became a difficult issue due to the kidney failure. So his CHF worsened to an alarming degree, into Class 4 by the time I took him to the ER last Wednesday, and he was coughing up bloody mucous and he could barely walk. He was very, very ill. Several doctors had said that there wasn’t much they could do about the whole thing and it would be a constant balancing act, with a very small therapeutic margin.
He was in a very difficult and fragile situation, since he had thrown some emboli recently, causing splenic infarctions and causing a retina artery occlusion, which left him blind in his left eye. His INR had been raised to try to prevent any more emboli from forming. However this higher level made the GI bleeding worse. So his INR has had to be reduced again to control the bleeding, and will probably stay at the lower level, which is the lower end of the range for a double valver.
During the course of his GI examinations, we were fortunate to have a young gastroenterologist who told us he had an idea. The cause of Joe’s bleeding, apparently, is from areas of gastritis which had been oozing. He also has varices from portal hypertension coming from his congestive liver disease and his PH, but they showed no evidence of bleeding at this time. He’s had three endoscopies, one thought the varices were Grade 2, but the other and final one said they were Grade 1.
This gastroenterologist had trained on a procedure using argon vapor cauterization, which seals off the bleeding areas. Other gastroenterologists had thrown up their hands and told us that Joe would be managed by giving him periodic transfusion, and nothing could be done about the bleeding. But transfusing has also become quite an issue, since Joe is now a difficult blood match due to all the transfusing. The bloodbank has told us he requires a 48 hour notice after typing and crossmatching, and his blood has to be ordered from the regional bloodbank which is in a distant city. So continual transfusing is clearly not a benign situation.
Well, Joe went through the procedure, and it went very well. I would say that approximately one-third of his stomach was treated. In two days, his hematocrit has come up 4 points, and his hemoglobin 1 point. His stools are now a normal color, no more tarry diarrhea and his kidneys appear to be working much better. His CHF is vastly improved, although not completely gone. His BUN and creatinine have lowered dramatically.
As a follow-up, he had a small bowel barium study today, and if all appears OK with that, he will have a capsule endoscopy of the small bowel to rule out any other bleeding issues, that will be done on an outpatient basis. He has also had a large bowel colonoscopy which was OK.
I am hopeful that he will be home tomorrow. He feels the best he’s felt in a very, very long time.
I can go back for several years and remember him having to have transfusions. The thoughts were that the blood loss was from hemolysis from his valves, but I wonder if this has been an issue, possibly in concert with the hemolysis, all along.
Please say a prayer for him that this great procedure will continue to hold for him and give him some peace for a little while. And while you're at it, say a prayer for the young doctor who had a good "idea".
Joe’s been through quite a few things in the past two months. He’s been in and out of the hospital three times, and is probably being discharged tomorrow making this the fourth time. The basic issues are his continued upper GI bleeding which has caused lots and lots of anemia requiring somewhere around 8 transfusions or so (I lost count), which then led to kidney failure, chronic and acute, which led to severe CHF which increased all his internal pressures, making the bleeding worse and thus making a nasty and downward-spiraling vicious circle. Diuresis became a difficult issue due to the kidney failure. So his CHF worsened to an alarming degree, into Class 4 by the time I took him to the ER last Wednesday, and he was coughing up bloody mucous and he could barely walk. He was very, very ill. Several doctors had said that there wasn’t much they could do about the whole thing and it would be a constant balancing act, with a very small therapeutic margin.
He was in a very difficult and fragile situation, since he had thrown some emboli recently, causing splenic infarctions and causing a retina artery occlusion, which left him blind in his left eye. His INR had been raised to try to prevent any more emboli from forming. However this higher level made the GI bleeding worse. So his INR has had to be reduced again to control the bleeding, and will probably stay at the lower level, which is the lower end of the range for a double valver.
During the course of his GI examinations, we were fortunate to have a young gastroenterologist who told us he had an idea. The cause of Joe’s bleeding, apparently, is from areas of gastritis which had been oozing. He also has varices from portal hypertension coming from his congestive liver disease and his PH, but they showed no evidence of bleeding at this time. He’s had three endoscopies, one thought the varices were Grade 2, but the other and final one said they were Grade 1.
This gastroenterologist had trained on a procedure using argon vapor cauterization, which seals off the bleeding areas. Other gastroenterologists had thrown up their hands and told us that Joe would be managed by giving him periodic transfusion, and nothing could be done about the bleeding. But transfusing has also become quite an issue, since Joe is now a difficult blood match due to all the transfusing. The bloodbank has told us he requires a 48 hour notice after typing and crossmatching, and his blood has to be ordered from the regional bloodbank which is in a distant city. So continual transfusing is clearly not a benign situation.
Well, Joe went through the procedure, and it went very well. I would say that approximately one-third of his stomach was treated. In two days, his hematocrit has come up 4 points, and his hemoglobin 1 point. His stools are now a normal color, no more tarry diarrhea and his kidneys appear to be working much better. His CHF is vastly improved, although not completely gone. His BUN and creatinine have lowered dramatically.
As a follow-up, he had a small bowel barium study today, and if all appears OK with that, he will have a capsule endoscopy of the small bowel to rule out any other bleeding issues, that will be done on an outpatient basis. He has also had a large bowel colonoscopy which was OK.
I am hopeful that he will be home tomorrow. He feels the best he’s felt in a very, very long time.
I can go back for several years and remember him having to have transfusions. The thoughts were that the blood loss was from hemolysis from his valves, but I wonder if this has been an issue, possibly in concert with the hemolysis, all along.
Please say a prayer for him that this great procedure will continue to hold for him and give him some peace for a little while. And while you're at it, say a prayer for the young doctor who had a good "idea".