Saturday, April 9, 2011
Finally - Dr. House
Life here at my house has been not only hectic but in a tizzy. I have not been blogging, and I have been staying close to home mostly because I had to help manage someone else's serious health issues and my Mom needed me close by. She does not have the coping skills to keep up when events turn sideways quickly. Tonight I have some time to blog because while the crisis is not totally past I know everyone involved is safe and well cared for at this time.
The crisis was an hangover from the prior week, so my week got even better when kidney stone #2 of 2011 decided to pass Tuesday night. I debated about calling an ambulance. The pain (even with the fentanyl patch) was so severe I could not drive, stand or doing anything but squeak icky noises. My Mom was having enough problem coping with the other issues, I just couldn't leave her at home while I went to the ER to get help with KS#2. I rationalized that the ambulance would take 20 minutes to get to my house, the ride would take another 45 minutes, and I wouldn't get any pain relief at the hospital for at least another hour - and by then the stone might have passed. I toughed it out and finally got some liquids down my gullet to help push KS#2 down the path after about five hours of extreme spasms. Not something I would recommend if you didn't have to. Big sigh.
Wednesday I wasn't eating much of anything because of KS#2, but I had a tiny piece of some cashew brittle. I don't eat cashews very often and never cashew brittle but thought maybe the sugar would pick me up and the protein in the cashew would actually digest. I started having an anaphylactic reaction - joints swelling, stomach hurting awfully, hives popping out, itching itching ITCHING. I thought - if I use the Epipen I will have to go to the emergency room, so I took two benedryls and a phenergan instead. This did drop the swelling and some of the itching and stomach pain but I had forgotten I am wearing a fentanyl patch for pain. I got a little scared because it did become difficult to breathe. With anaphylaxis it is hard to tell if the problem with breathing is asthma, anaphylactic reaction, or medication problem. I used my rescue inhaler but it didn't help much. I think this was a drug-drug interaction between the benedryl, phenergan and fentanyl. Too much too quickly. I guess next time I will use an epipen. Bigger sigh.
I had my appointment Thursday with Dr. House in St. Louis concerning The Legs and the neuropathic pain and weakness. I had planned on taking Wednesday to drive up to St. Louis (because I fall asleep so badly when I drive it takes me at least a couple more hours to drive this than normal) spend the night, go to my doctor appointment, toodle around St. Louis some, maybe eat some really good Italian food on The Hill, go to Union Station, shop at the Dillard's outlet store - my usual St. Louis jaunt - spend the night again and drive back home Friday. With The Problems at home taking precedence I decided to drive up and back on Thursday. Very Big sigh.
I left at one in the morning. The normal four and a half hour drive took me almost seven hours. I had to keep pulling over to take a nap. Nothing kept me awake. Lately driving at night has gotten me very disoriented. I seem to lose directional sense and depth perception. Just what all the other drivers really needed to have on the road with them. If I had only had the money I would have gotten airplane tickets to St. Louis, and then taxi'd it to Barnes Jewish for the appointment. Ah well, I was very cautious driving and as dawn approached my vision difficulties got better. Sigh yet again.
Fecal incontinence makes traveling a difficult problem. Normally I won't drink very many fluids for two or three days before traveling, and don't drink very much during travel. However passing KS#2 became a priority so I was primed full of fluids. I took extra clothing with me, and was very glad because mid way I had an accident. Since my external sphincter is not as functional as it should be, I just don't have pucker power. As I explained to my colorectal specialist once the poop chute is loaded the payload delivers regardless. I changed clothes twice before my appointment. I was so glad I had brought the extras!!!
My appointment with Dr. House was at 9:30 am, but I got there early and was seen much earlier. I had been to the Center for Advanced Medicine for Washington University Medical School, and Barnes Jewish Hospital before. I saw Dr. Bellyfixer about the digestive issues I had from the radiation therapy overexposure in 2004. He was quite helpful, and I found Dr. House and his team just as thorough and helpful. Wash U definitely Rocks!!!
A young neurologist took my history and did a physical exam. He did notice my permanent hive on my nose - I told him it was my Rudolph the Red Nosed Reindeer spot. I guess it helps that I had gotten some sun, because that makes it shine more perfectly beautiful. I warned him I already had several rare diseases, and if I got one more rare disease I might not believe it. Ha!! I was so tired I am not sure if I made very good sense. Good lord I had to remember who was president and do math and spell things backwards! This is a woman who just pooped her pants twice in the last 7 hours. I don't know if I was competent to do anything that required brain power... When he got out the large safety pin to poke me with, I almost pooped my pants again. Ouch!
I had brought copies of xrays/mri's/ct scans that Young Dr. Kildare had said Dr. House would need. Nope - didn't need any of them because I don't have a physical issue with my spine or hips. I brought copies of Dr. Kildare's notes, nope they didn't need any of them. They were glad that I had brought the immunology labs and some DNA testing I had done (I thought of that on my very own - take THAT Dr. Kildare!!!). Dr. House and the young neurologist consulted with each other out in the hallway, then Dr. House came in and introduced himself. Very nice, not like the TV Dr. House at all. No arrogance, no immediate attempt to blame me for my problems.
Dr. House repeated part of the physical neurological exam. Thank heavens - no current event quiz, spelling bee or math problems. I was halfway expecting him to make them more difficult - there is a train traveling east at 40 mph etc. etc. etc. Whew!!! We discussed why Dr. Kildare had sent me there, and his conclusion that I had small fiber neuropathy. We also discussed my problems with my bowels, bladder, pelvic pain, and nerve pain and that I associate the onset with my vaginal brachytherapy treatments in 2004. Dr. House said he was going to repeat the EMG and nerve conduction tests using their techniques before he decided I had small fiber neuropathy. If the tests were negative, then I might need to have a nerve biopsy. He said their techniques were generally more sensitive than the ones I had in Springfield by Dr. Welby.
I got my blood test orders and the nerve test orders and was sent directly to the EMG lab. The lady doing most of the test took her time and did much more extensive testing and also warmed up my foot saying if it was cold it could distort the test. A doctor came in after she was done and read the results of her tests. It showed a very subtle difference between the speed of the nerves in my arms verses the speed of the nerves in my legs. He said that he would probably say I had large fiber neuropathy, but did the needle part of the test which was normal first. He went to discuss his findings with Dr. House.
The lab got me admitted to their services and I gave about a gallon of blood for some tests for other causes of neuropathy. Not sure what they were but Dr. House said it would take a couple of weeks to get the results back so they may have to ship some of it off.
I went back to Dr. House's office to see if I needed a nerve biopsy. He said that they had all concluded that I had large fiber neuropathy (which Dr. Welby had not detected). I asked the cause and he did not say that it was diabetes, but he did say he just couldn't prove it was the radiation. I asked him about the weakness and the pain increasing with activity and he said that was normal with this type of neuropathy. I asked about physical therapy, would it benefit me, and he said probably not. I asked about medication and he said I was getting what he would have recommended, but that I might double the fentanyl for more adequate pain relief. He said I should call back in a couple of weeks if I didn't hear from them about the blood tests. He said I might have small fiber neuropathy also but the majority of The Leg issues are from the large fiber neuropathy. Huge sigh.
I got out at about noon, which is fantastic with everything that I did, and started home. I got home about 6 PM and ended up going to a hospital and leaving there at about midnight because of The Problem. By the time I got home I was so exhausted I was falling asleep standing up. I slept very late Friday, and a lot of the day today. Right now I am so tired I am falling asleep writing this - you probably can tell!!! Triple huge sigh.
I go back to see Dr. House in six months. I see Dr. Kildare in a couple of months. I know that I have large fiber neuropathy, which is more consistent with radiation induced plexopathy but can also be from a lot of different things as it is the most common kind of neuropathy. I also know that I do not feel cold the same in both of my feet. One does not feel cold the same as the other. Hoping the warm foot can teach the rest of my body how to feel warm instead of cold!! I know there is not a lot that can be done other than what I am already doing for the pain. Maybe a reason for the problem will come up when the blood test results are in.
The Headache behaved pretty well for all the activity. The Legs and the pelvic pain and KS#2, not so well. My mind is the same jumble it was before The Problem hit, and all the travel, and all the walking. Hoping getting more rest tomorrow will help. If this post is a little goofy, that is because I am majorly goofy tonight. Gonna try to get some sleep. Biggest Sigh Ever!!!