So the week around Labor Day weekend were interesting, but before I give the details, I'll give the conclusion - everything is fine!
The problem started out on Wed. Aug. 28th, with severe spasming and pains along my lower back on the left side, and wrapping up around my ribs on the side. I couldn't really move even a little without that area going nuts (okay, not a medical phrase, but you get my drift). Although I couldn't figure out how it had happened, I assumed I had pulled or strained a muscle. The spasming pain continued on till Friday evening and then began to subside a bit, but when it did I was left with this dull, radiating ache on the left side of my back, mid-way down.
Now as I've indicated in earlier posts, it takes 1-2 years for a new immune system to grow after a bone-marrow or stem-cell transplant, and after about 18 months almost all of my numbers were back in the normal range except for the Creatinine, which is a measure of kidney function. The desired range is 0.5 - 1.5 and I was high throughout that time. Everytime I saw a summary of lab work they would describe the status of that outlier number as 'chronic kidney failure,' which always scared the crap out of me because it sounds so bad. When I asked what it meant, though, they said it's just how they describe the kidney function in that area outside of the range. They also said it could stay the same, get worse, or improve, and since I felt good, I left it at that. With this dull ache in the area of my left kidney, however, I got a little anxious.
Unfortunately by the time I started transitioning my thoughts from 'pulled muscle' to 'kidney problems' I was into the holiday weekend. The pain had diminished, even though it hadn't gone away, though, so I decided to wait it out until Tuesday to see a doctor rather than going in to the emergency room. For a day or so over the weekend, I also experienced a burning sensation upon urination, and began to wonder if perhaps it wasn't actually a third option - kidney stones.
On Tuesday I was able to get an appt. with the doc. She agreed it could be a general kidney issue, or kidney stones, but also, since I had some shortness of breath, that that symptom, along with back pain, could suggest pulmonary embolisms. Now I've had pulmonary embolisms and it didn't feel like that to me, but you don't want to mess with that potential, so she included a test for it. They collected blood and urine for three tests, two for the kidneys and one for a test called the D-Dimer for a clue as to the PE condition.
The urine test came back with no blood traces, which generally eliminates kidney stones - yay!.
The second blood test came back with great news - for the first time since the transplant my creatinine level was in range (1.3 in the 0.5 - 1.5 range) - yay!
The third blood test, the D-Dimer, was going to take a bit longer to read, and she sent me home with the understanding that if it came back with an elevated reading she would be sending me to the hospital for a CT scan. I'd barely pulled into the driveway when I got the call and the news that the test result was indeed out-of-range high, although only slightly so (the desired range is 0.0 - 0.49 and I was at 0.53). So we didn't get out of the car, but instead went on to the hospital - No Yay!
Before I get to the next part, I have to explain that while at the docs, the technicians had had trouble accessing a vein for a blood draw. They'd managed to get into several veins, but couldn't get a blood draw-back. They finally managed it in my hand and recommended that I drink more water as vein problems can be caused by dehydration. This was pretty ironic considering that my last entry, about my mother's health, involved what we finally determined to be dehydration and I've been harping at her ever since to drink more water each day.
How does this fit into the CT scan? To see pulmonary embolisms from a CT scan, they need to power-inject a contrast dye just seconds prior to the scan. The injection is about 20cc's, and it power-injects at a rate of about 5cc's per second. To do this safely you have to have a good vein, or risk blowing it out. Well, they couldn't get a good vein, so they called in a nurse who specialized in IV's. She couldn't get a good vein, so they called in another nurse who was part of their 'flying vascular' team. She used an ultrasound to look for good veins, but was also unsuccessful. After about 10 attempts over the course of 2 hours I was feeling almost faint with the adrenaline response of the deep needle probes that were near a few nerves and arteries, and they gave up.
But they had a backup plan. The other way to assess the potential for pulmonary embolisms is via a nuclear medicine protocol, which involves a regular IV (without a power-injection), a different scanning device, followed by a chest X-Ray. This is a less effective test, but was the only remaining option available. The last vascular nurse had left an IV in my hand for this test.
So off I went to admissions again (they needed to re-admit me to the Nuclear Medicine department). It took a while because that department isn't open 24/7, so they had to call in a technologist from home to run the test. Here's how it works.
1. You lay on a narrow movable tray that slides into/under a scanning device that looks like a cross between a CT scan donut and an X-Ray machine. Before they do the scans you have to breathe in a radioactive mist for about 8 minutes (with your nose plugged and your mouth sealed around the breathing tube so none of the radioactive material gets out of your lungs to contaminate the exterior of the test equipment.
2. After the 8 minutes, they take four scans of your lungs. Each picture takes about 4-6 minutes.
3. After the first set of pictures, they inject a nuclear dye, and remove the IV.
4. The next step is to repeat the 4 scans, although these take place a little bit faster than the first set. Then two sets of images shows the difference between oxygen in and oxygen out of your lungs, and any irregularities that might indicate blood clots there.
5. The last part of the protocol is two chest X-Rays, front and side. I had to go back up to the radiology and imaging department to have these done.
I'd gone in to see the doctor at 2 pm, and by now it was almost 9 pm. At that point I had to wait there until the doctor on staff at the hospital had reviewed the scans, and called the results in to my doctor. Luckily this happened within about 15 minutes of finishing the chest X-Rays. My doc called me and said the tests did not indicate pulmonary embolisms so I could do home.
So, long story short? I spent 7 hours in the doctors office and hospital, with resultant heavy-duty black and blue marks all over my arms and hands, all over what appears to be a strained back muscle. Oh well, at least I learned that my kidneys had finally fallen into the normal, in-range level.
And in summary, my advice is the same as I gave in my last entry - Dehydration Bad! Water Good!
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