Tuesday, March 29, 2016

My ER Visit And An Uncomfortable Wake-Up Call

We had just turned in at 11.30 p.m. Easter Sunday night and I'd slept about an hour when I awakened with excruciating, crushing pain on my middle right side. The pain was such that I couldn't catch a breath and had broken out in a cold sweat. Unable to barely move or speak, I pushed wifey awake and asked her to dial 911. When she asked what was wrong I replied "I might be having a heart attack but I'm not sure!"

She immediately phoned as I sat on the edge of the bed grabbing my side, trying to breath and finding enormous difficulty. I'd never experienced pain like that before and though reluctant to make a fuss at first, I'd just read an AARP Bulletin article (three days earlier) warning seniors not to dismiss these events or take them lightly. Of those 65 and older who dismissed symptoms only 9 percent survived if it was a myocardial infarction.

On reaching the 911 operator, Janice put her on speaker and she instructed me to immediately grab 4 baby aspirin and chomp them up and swallow them down with water. Within minutes of doing this, the paramedic team arrived with an ambulance as I sat on the edge of the couch. They took vital signs and I heard one guy remark "His BP is 124 over 75, even better than mine".

After further readings they seemed to concur with Janice's initial diagnosis that I was having a gall bladder attack (Similar thing  happened to her in December, 1994). Somehow or other, a gall 'stone' (actually a pellet of cholesterol) had become embedded in the common bile duct and was causing bile to back up and wreaking the god-awful pain.  The team asked if I wanted to go via an ambulance to the nearest hospital, or go with my wife. I chose wifey and we got ready to go as I watched the paramedics hop back into the ambulance and move off.

By now the pain had subsided to about a level 3 out of 10 instead of 9.  17 minutes later we reached the ER of Memorial Hospital and I checked in with security, after which the front desk took my info and signed me in. Within another five minutes two ER nurses had taken me to an exam room,  inserted an IV and again took vitals.

The head RN, "Angel" (her real name, if you can believe it),  told me the evidence pointed to a gall bladder episode and I was being scheduled for an ultrasound. We waited for an hour or so, after which I provided a urine sample, and then another hour when the resident technician arrived to do the scans.

She wheeled me into the ultrasound room with Janice accompanying us, and then guided me to the station and slabbed on a bunch of goop which was to facilitate the scan using the instrument. The whole process consumed well over 20 minutes as the tech did multiple scans and repeats, then had me turn on my other side - take more deep breaths (to increase image clarity) and did the same. The whole time Janice watched the image monitor with total fascination, but alas, couldn't decipher what exactly she was seeing.

As I got up I observed the monotone screen too, but saw nothing other than the definite shape of a kidney in one of them. The tech, after wheeling me back to the exam room, said the doctor on call would have to evaluate the images and he'd get back to me maybe in a half hour (it was now 3:45 a.m.)

She was as good as her word and the doc appeared by 4:05 a.m. and informed me I had a 'pack' of gall stones lodged in the gall bladder, including one biggie at 2.3 cm across (or nearly one inch).  For reference, the gallbladder is a small organ located on the underside of the liver. Its primary purpose is bile storage. The liver makes bile, a substance that helps the body break down fats. The gallbladder then stores the extra bile the liver makes. Gallstone disease is called cholelithiasis and the surgical removal is choleocystectomy. (The more invasive, open method is called "open  choleocystectomy' and is a surgical option if the gall bladder is too diseased to be removed via the 'keyhole' or laparascopic method.)

The ER  doc said the good news is that the organ wasn't infected (in which case I'd have to have immediate surgery) but I still had to have it taken out and he provided the name of a surgeon at Memorial.  I was to call him up and schedule a prep appointment, which I did yesterday morning. Then he will go over the surgery with me (laparascopic) and the needed preparations.

In general, these surgeons prefer to wait at least 6 weeks or so for the flare- up to settle down. In the interim I received an anti-spasmodic med in case of more gall bladder attacks, as well as a med to combat nausea and vomiting (usually for cancer chemo patients). It was just as well as I had a severe bout of nausea and vomiting at 6 p.m. yesterday, barely four hours after eating a light lunch.

What was the culprit that set off this incident (since there usually is one in the case of gall bladders)? Well, even the paramedic team agreed it was most likely the huge portion (probably a half pound total I ate myself) of lamb roast that my wife had cooked for our Easter meal. This was part of a 5 lb. leg of lamb purchased the day before, real Australian lamb.

But as most of us know, lamb is one of the fattiest meats around and definitely not the protein of choice for someone with a touchy gall bladder.  The end result? Over 4 1/2 delicious pounds of lamb left over, most of which Janice had to freeze in separate containers - and hardly any of which I am likely to eat again. (Minus a gall bladder, of course, one is much less able to handle fat from any source.)

Meanwhile, I will likely be getting the surgery done sometime in the second week of May. While the ER doc referred me to a general surgeon, I will be going instead to a gastric -endoscopic specialist, given the size of the stone and that laparascopic methods are generally limited to 1" incisions.

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