Still Miles to Go

About 7 hours after I posted my last blog, I was finally settled in my room. By that time, my temperature had started rising. Before I fell asleep (around 8:30pm), my temperature had risen to 100.6. That’s nothing, my body told the nurses, just you wait and see! But the next vitals (around midnight), my temperature had risen to 101.8. I can’t still do better than that. My temperature at 4am was 102.4 and rising. Almost there… I hit 103.2 before it started going back down.

But my temperature wasn’t what really had them worried.

My heart was going berzerk! They upped my fluids so I was getting D5 at 200 mL/hr and had a gravity drip of saline concurrently. This did nothing. My heart rate – while I was sleeping, mind you – was 154-170 bpm. Not good at baseline. Terrible, Horrible, No Good, Very Bad when they’re running fluids at that rate. I had an EKG and they placed a heart monitor to watch my heart dance. I should also put a disclaimer here that my heart rate is almost always high. A “normal” heart rate is 80-100 bpm. Mine usually run 120 bpm when at rest and up to 160-170 when active (or just walking across the room). When I’m on fluids, however, I respond incredibly well and my heart rate drops to 105-112. I realize that’s still high, but I can feel a huge difference.

My blood pressure was doing its normal thing: staying low. Again, I’m usually low at baseline (85/60 or so), but relatively “normal” on fluids (about 100/70). I was hovering around 92/60 at each vitals check. A more concerning matter, though, was my O2 saturation. I’m usually dandy around 95-96% when not in crisis. But we were just watching it plummet. During my first vital check upon reaching the room, I was at 92%. Overnight, I fell to 80-82% before I woke up. At this point, I demanded oxygen.

Unsure whether my scary state was due solely to the pancreatitis, the doctors drew blood cultures (4 Tabasco-sized bottles full of blood), took urine and throat samples, a chest x-ray, and an abdominal and chest CT scan. Luckily, they learned a lesson from my last potassium plummet and had been drawing regular labs. This time, they actually caught my potassium at 3.0. Yes, low, but before it became critical! Success! And after about 12 hours on the oxygen and 31/36 hours spent asleep, I began to feel better. The fever started dropping slowly, my heart rate came back to 120, and my O2 sats were holding steady at 95-96% with the O2. Finally!

I must admit that I was pretty scared during all this. The doctors had no idea what was going on, we couldn’t reach my mito doc, and they couldn’t figure out how to stop it. We still don’t know if it was just the progression of the diseased pancreas, or if something else was setting it off. So far, all the tests have come back negative, except for the CTs which showed another episode of Intestinal Pseudo-obstruction (Yes, pseudo-obstruction can cause mildly have pancreatic enzyme levels. Mine were NOT mildly elevated) and what looked to be the early stages of a brewing pneumonia. The solutions: GoLytely (usually used for colon prep for a colonoscopy – doesn’t exactly make a normal person “go lightly,” but it doesn’t make me “go” at all); and regular breathing treatments to make sure I didn’t get a full-blown pneumonia. They’re pretty optimistic that this will be sufficient. And I’m feeling alright, so I think I’ll trust them on this one! 😉

All that being said, I’m feeling quite a bit better. Fever has broken, heart has calmed and I’m weaning from the O2. I’ve got Potassium added to my D5 drip (after 3 bags and a bolus through my tube), the Golytely combined with enemas and suppositories has moved my bowels ever so slightly (but moved nonetheless!), and my O2 sats are remaining stable without constant O2!

On the pancreas-front, I’m doing better, too. The pain is decreasing and my lipase/amylase levels are decreasing slowly. Also, no gallstones means no surgery. Good, right?  But pancreatitis that’s idiopathic in nature means it’s more likely to return (somewhere around 70% from what I’ve read). And while we’re hopeful that this is just a one time deal, one of my doctors noted that it could be a presentation of my mito. My friend Gwen dug up this article for me. Yes, I realize this is a case study (a study of a single patient’s medical case doesn’t carry as much weight as a randomized double-blind trial, for instance), but it’s still eerily similar. My presentation is this man’s. I have very elevated lipase and amylase levels, but no morphological alterations. They’re treating me with H2 Blockers and food restriction. And I’m improving. Now, I’m not sure what the other presentations of his pancreatitis were (were they as critical as mine?), but it’s definitely something my doctors will have to monitor.

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And finally, for a little chuckle:

As usual, I have a single room because I have True. The nurses hunted down a cot for Keith and we pushed our twin beds together – how romantic, right? As Keith was falling asleep last night, True spontaneously jumped from my bed (where she was fast asleep) to Keith’s bed. She promptly vomited about a foot from his head, turned and jumped back to my bed. We’re pretty sure this is a case of “you don’t sh** where you sleep” extended to “you don’t sh** OR puke where you sleep.” Too bad for Keith though… 😛