The Return of the Gallstones? AKA The adventure of the past few days
11:59PM, July 07, 2008 - [ Permalink]
This is far longer than I originally intended, but it is full of linky (28!) goodness and does have a particularly good twist to it.
Oh, and I'm not a doctor, so I'm not making any recommendations as to what you should do about your gallstones if you have any. ;-)
Thursday
It all started shortly after dinner on Thursday. A familiar pain on my right side began to blossom after a four year absence, much to my surprise, and obvious dismay.
At first, I thought that it wasn't going to be such a big deal, but the pain continued to escalate into a full-power gallstone attack. For those of you who have never experienced one, the level of pain has been equated to giving birth, which I have never personally experienced from the mother's point of view.
Friday
By late Friday morning, the pain continued to persist, but at a much lower intensity (why can't I use that word anymore without thinking of that scene in Lost in Translation where the translator says "Again, with but with more intensity"?). I decided that this was quite unusual and I should go to the hospital to be checked out, throwing my normal Friday schedule into complete chaos (errands, back-up exchange, Patty's).Tracey drove me to the hospital. We got checked in, and I saw the Triage nurse and a few minutes after that, a clerk to confirmed my address and a few other details. I sent Tracey home, because the wait time said three hours, and I had a book (R.A. Salvatore's Exile Part 2 of the Legend of Drizzt).
In the end, I was out of there in touch over two hours. With the doctor instructing me to take it easy and take a couple of ibuprofen's and to come back if things worsened. He said that it was likely a gallstone attack or, possibly, appendicitis as the appendix is in the same general area.
So, I went home, lay down on the couch and took it easy. I watched the rest of Season 3 of Babylon 5, finished reading the book and started another - same series, but Part 4, The Crystal Shard, and surfed in my iPod Touch.
I'd like to make a short aside about how an iPod Touch is a *fantastic* device that let me keep answering email, twittering and surfing the web without the weight of a laptop on me (which would have been bad). If you will be spending considerable time in bed-bound an iPod Touch & wifi or, as of Friday, an iPhone (but far more costly over time), look into an iPod Touch, as it will help you keep your sanity while idle like I was. The Ottawa General Hospital *does not* have publicly available wifi in the waiting room, unfortunately, but I think they are busy fixing people.
Saturday
Continued forced R&R, and by this point I was quite certain that I was undergoing some kind of prolonged gallstone attack due the continued pain and the persisting change in the colour of my urine (to a dark orange). Sorry if that is too much information, I'm trying to get all the details here.
Around 5:00 PM, I was still in pain, we'd measured my temperature above 38°C (~100°F) and my eyes had acquired a yellow tinge (a sign of the onset of Jaundice). I began to suspect that I had a gallstone stuck in my Common Bile Duct, which would require an Endoscopic Retrograde CholangioPancreatograph to remove (I've already had one of these back in July of 2004).
That said, I decided to call Telehealth Ontario to see what they said. I spoke to an operator in about a minute, maybe less who told me it could be between 15 and 30 minutes before I spoke to a nurse, and if would I rather they call me back or to hang on the phone and wait. I hung up the phone and lay back down. About *two* minutes later they called back, and we went through a checklist to narrow . The nurse I spoke to told me I needed to see a doctor within the next 3-4 hours, and that I shouldn't eat or drink anything more now, and so off we went to the hospital.
We arrive at the hospital a few minutes before 6:00PM and checked in. I saw the triage nurse who asked me what was going on, I explained it to her and that TeleHealth said that I needed to be here - to which she chuckled, to which I inquired if it was because they always sent people to the hospital, which she confirmed. She took my vitals and send me into the waiting room. Waiting time was listed as 4 hours.
The hospital waiting room is a great place to people-watch, or, if you have a thesis to write, study human behaviour under duress. You might be surprised what you see, good (strangers helping strangers) and bad (a single belligerent person and a noisy child ignored by her grandmother - the mother was the patient).
We probably did wait about four hours before being moved to a small room - Tracey came with me partially to get away from the noisy child and partially to listen to the doctor with me. A technician came in to ask for a urine sample (again, orange), and we returned to our books.
The doctor came in and chatted with me, asking questions, listening to what I believed to be going on, he tested the various areas of my belly, looking to isolate the pain. It was kind of neat when I realized he was poking around my McBurney's point to poke at my appendix. He went off and got an emergency room ultrasound unit. He began to hunt around for something when I said that he was looking for the "goop" - the lubricant used to make the scanning easier.
He looked around inside, but said he couldn't see any, but the resolution of the unit wasn't terribly good. I believe he said that it could see stones as small as 1 cm (~0.39 inches) and that a nurse would be in shortly to take some blood samples for testing, then we could return to the waiting room for the results in about an hour.
The nurse came in about five pages later, and took two vials of my blood - it always amazes me when I watch the needle go in and all I feel is a tiny prick. Back to the waiting room.
More pages of books get read, more people-watching takes place, coincidentally, time passes as well.
It actually did take nearly four hours to be seen, but that was fine, as the people who came in after and got served before me, likely were in worse shape than I - triage in action. One thing I did observe in my time in the waiting room was how infrequently people appeared to arrive in dire need of immediate emergency treatment, either walk in or by ambulance.
We get called up and the doctor mentions us to follow him into the hallway. He said that my liver levels were up just enough to be of concern, not enough to keep me over night, but he was ordering a ultrasound there at the General. He said they'd call on Sunday (by now it actually *was* Sunday) or Monday to schedule it. He actually said "If it walks like a duck, quacks like a duck...then it probably is gallstones". He said if I got nauseous, threw up, or turned yellow to come back straight away.
I speculate that my liver levels were not extremely high because as soon as I noticed my urine changing colour, I began to drink much more water than usual, which I think assisted in passing much of the bilirubin before it could build up more - but it is a speculation.
My only real issue with the hospital is the coin-operated parking "attendant", which is a real pain to deal with if you don't have enough change to pay for your parking (get out of your car, go to the coin dispenser, put in paper money, get the coins, feed coins into the attendant, get back in your car, start it and get out, while others wait behind you). Drove home and to bed.
Sunday
Tracey managed to sneak off to the Dancing With The Elements workshop that she and Michelle Hrynyk were putting on without awakening me - my first reasonably full night not spent carefully repositioning myself to minimize pain.
I woke up feeling considerably better, got up, walked to Patty's (albeit quite late), somehow the staff already knew I was ill so they were surprised to see me and inquired as to how I was, and spend an hour or so chatting with Susi and briefly, Gailene. Once Susi left, I moved to the back to start working on this post (really!), and awaited people to show up for the ByMUG. Dave and Jonathan arrived early - I had warned them that I might not be there, and I tentatively ordered my first real food since Thursday, a salad with chicken with no dressing or sauce.
I was scheduled to present Defcon, which I did, but I was so out of it and unprepared, I did a terrible job of it - sorry folks!
After that, I was exhausted. I went home and crashed on the sofa for untold more hours.
Monday
Today, I really started to feel like myself again - I was able to walk upright painlessly, and my urine was returning to its normal colour - I expect by Wednesday it should be normal at this rate). I started to plow through all the piled up email, catch up on news, and generally get my bearings. The call for the ultrasound came and they offered today at two, which after quickly checking iCal, I took.
We drove out, and found the ultrasound unit, the clerk asked if I was me, and I praised her psychic abilities. I sat down and about two pages later, Tracey came in, and two pages after that, the ultrasound technician handed me a green.. thing and told me to change into it. So, I went into the change room, took off my shirt and looked at it. It had three holes, roughly positioned where my head and arms should go, so I put it on that way. Apparently it was wrong. There was no manual or diagrams. I looked. Oh well.
The technician asked me a few questions about my condition, and I explained to her about the stones and my previous ultrasounds (at least two prior in 2004 and the one late Saturday night). We chatted as she did the ultrasound, pleasantly answering my questions about what she was looking at, and the other questions I had about how everything worked. She was a little surprised how much I knew about ultrasound, I think.
She was operating a Philips iU22 Ultrasound System (which sounds like marketing-speak for a kick-ass sound system).
She spent about twenty minutes looking through my entire abdominal area, when she dropped the bomb:
I have no gallstones.
Then she took her data and brought it to a radiologist (I believe) to get a report for me to bring to the emergency room, leaving me to stew.
When I got home, I looked up what the ultrasound unit's resolution was - which is hard to come by - the Phillips iU22 Fact Sheet (PDF) indicates that it goes up to 17 Mhz, which I compared to this Ultrasound Physics page, which maxes out at 10 Mhz. If I'm doing the math right, it means that it *should* be able to resolve down to an axial resolution of 0.1 mm (0.0039 inches) - anyone who knows better, I'd love to hear from you.
Considering how thoroughly she examined the area from many angles, I think it is safe to say that there are no stones above 0.2 mm (allowing for errors) in my gallbladder. Hurray!
But... Where the heck did they go?
I don't know.
Being me, I'd read this article that discusses that the "stones" that are passed are not actually gallstones, but merely semi-solidified olive oil some time ago as well another paper that indicated the same thing that I am no longer able to locate (vanished behind paywall, I suspect), so I had begun to suspect that the flushes I had been doing back in 2004 and 2005 may not have done anything.
But, from my earlier ultrasounds I *had* gallstones, but I never could find out how many or what size they were. The surgeon said the report didn't include those kinds of details.
Maybe the cleanse did work. Early on, I decided I should keep samples of what passed just in case. So now I'll have to go back and look over the data I have, and maybe if I can find a biological lab in Ottawa willing to do some tests on samples for me that would definitively answer the question as to what they are. I suppose I could do one more cleanse and see what happens.
Rampant, wild speculations:
- Body chemistry? Unlikely, as any unusual body chemistry would have been flagged in blood tests - my blood is extremely high quality according to Canadian Blood Services, so it's unlikely to be chemically different from regular blood)
- Reiki? I can safely say that I don't think Reiki has the power to nuke gallstones, I will accede the point that it *did* treat my gallstone-induced pain on many occasions (Tracey has her Second Degree/Level in Reiki).
- Diet? If the cleanse didn't work, I eat *a lot* of apples - disregard the stuff about the flush, although it is close to what I did in the past. More study on this would have to be done. When I mean a lot of apples, I mean in the fall we get two or three paper grocery bags full, and I eat at least half of them (not all at once!).
- I never had gallstones in the first place? Well, that did cross my mind, but after the multiple attacks, the ultrasounds, and confirmation by the doctors, I'm pretty certain this isn't the case. The only other thing in the area that could potentially cause that much pain would be my appendix, but it wouldn't change my liver levels (which we've seen), and once an appendix gets inflamed, you have Appendicitis, and that requires the removal of the appendix, which hasn't happened.
- Because I'm "Tom", or more maybe because I am "The Superhuman Camping Dude"? Possible, but really, people.
Okay, but what was the cause of the pain?
In afterthought, I suspect that I did indeed have one small gallstone lodged somewhere either in my gallbladder or somewhere in my Biliary tract, considering the pressure the doctor put on my abdomen when he was poking around. Considering how well I slept that night, and that the pain started to seriously abate sometime that night, that the doctor may have popped it loose or crushed it and it passed into my intestine and out of my body.
Now What?
Well, I'll have to go look through the data I've collected over the years, and see if I can figure it out, but really I'd need a doctor and a lab to study my specimens (which have been sitting in sealed containers in the back of our freezer for 4 years)
This certainly doesn't mean that I'm going to start eating double bacon cheeseburgers every day, but that for now, I have a fresh start. Just because I don't have any gallstones now, doesn't mean that they won't form later - in fact they likely will - but it will take some times.
Currently, as I write this, I'm not in any serious pain - I think it can be best described as residual pain, and I expect that to be done with tomorrow sometime. Hurray!
Thank you all
Here's where I deeply, humbly thank my wife Tracey for all of her efforts to keep me comfortable and changing her plans when I needed to go to the hospital. She's the awesomest.
Thanks to my friends, Facebook peeps, Twitter friends, IM buddies, and everyone else who has been sending well-wishes and offers of assistance my way and to Gabriel and Michele who offered to keep an eye on me if Tracey wasn't able to or to take me to the hospital if required. It is really fantastic to know I have so many people who care.
A very special thank you to the staff at the Ottawa Hospital's General Campus, who were overall, extremely friendly and treated me very well.
And I apologize to those you who've been email/IM/Tweeting asking what's up since this afternoon while I wrote this now freakishly long post. It may be a record. Yup, it's a record length - a touch over 3,000 words. Sorry about that, really.
