Casey. One More Definitive Diagnosis.

Casey and Punk...

Good Morning Everyone-
We are home.

A long week- a few tests, (blood, and endoscopy); and a meeting with Dr. Datta, a hematologist, in Minnesota, Casey has one more diagnosis.

I will get right to the point...

Casey has an Anastomotic Ulcer in her stomach.
This may be a common side effect of her Roux~en~y~Gastrojejunostomy.
"The chronic inflammation caused by the presence of the suture as a foreign body at the anastomosis may lead to ulcer formation, and also may be implicated in the development of stomal stenosis"

Casey's ulcer was not shown to be bleeding- However, just because the gastroenterologist did not see blood at that point does NOT mean it isn't bleeding from time to time.
Reading further, this type of ulcer is also common after bowel surgery- Perhaps she also has an ulcer in her bowel? (Seems like a good question for the doctor).
We go back in December for more tests and/or repeat testing.

In the meanwhile, she is to double up on her Oprimazole. But stressed those are to be taken at 2 separate times too.
I hope this doubling up might help to heal her ulcers? Or maybe just to not make them worsen.

And with respect to her low blood counts... Dr. Datta (hematologist) is going to contact the clinic here, strongly suggesting that Casey be changed to a drug called "Infed" for her infusions. (This would replace the Ferrlecit she is currently using; perhaps even eliminating some of the side effects she has had to that).

The Infed treatment takes longer at the office when compared to the Ferrlecit. This drug is prefaced with steroids and benedryl, then a small amount of the Infed. If no reaction they wait an hour to repeat the test. Still if no reaction, she can proceed to being treated with/by this drug/method.
Apparently, the results are more immediate and longer lasting. Casey would also need to be infused less often.
We will call her GP with this information tomorrow, as she has her next infusion scheduled for Tuesday.


A few pictures---


Her ponytail in the mirror, it is high on her head, and shows how long her hair is.
Yes, it still falls out by the handful...


Off then, to her endoscopy...

How it works, in a nutshell-


pic from here

Yes, they did take a few biopsies. I am not sure when we will hear back about those.
They also did the tests for Helicobacter pylori infection. (H-Pylori is the bacteria that causes "most" ulcers).

We were given a copies of the gastro's written and pictorial findings.

Warning:
If you get queasy with pics, scroll down past the next 4.


These 2 sets of pictures are Casey's results-

Unfortunately, their copier's toner cartridge needs attention; the pages printed information is of low quality...





this too


The report commented that her "normal esophagus"
It did not comment on the duodenum, even though the picture is included?
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These 2 pictures are what "normal" should be:

This is a 'normal' duodenum 
(Not sure why it looks so pale- It should be pinker)?


This from here.

This is what a normal GE (Gastro-Esophogeal) Junction will look like.


(This, also taken from a Google search).

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Back to Casey's endoscopy.

The machine they used...


Showing only a part of the tubing...


And here's the rest of the tubing...





While I know what most of the letters on it represent, I can't for the life of me figure what the dickens "FUD" would be.


FUD?  Isn't that a Bugs Bunny guy?  hehehe


We were to be to her appointment for 11:30. She had confirmed this earlier in the day. The man told her to be there for then.

We got there and waited in the waiting room for 25 minutes. This is OK, and generally how it goes.
Then back for a bit of prep- getting an IV started, and reading and repeating her vitals. This took about 45 minutes...

We were then sent to the little procedure room.
We waited about 45 minutes more.
This gave me ample time to take a few pictures... hehehe


Casey. Waiting.


This is the Benzocaine spray they use to numb her throat- to quell her gag reflex.





I then spied their cupboards.
Those cupboards were all neatly labeled as to what was kept inside.
A good idea for everyone!

But then I got to this cupboard...



I told Casey she had to behave!
- - - After all, they have a six shooter right at their disposal!
Then again, if she wanted to leave, she could just hotwire one of the the 4X4s too. hehehe

Wait!
(Thinking)...
It sure has been a long wait...

So we asked when the one nurse had come in...  She told us that the doctor had "an emergency with a patient upstairs" at the hospital, which is completely understandable.

Another nurse came in about half an hour later and told us "the doctor is still at another hospital."  Huh?

Later still, and we were told we had been late, and that the doctor had left.
WHAT?!
See, this is exactly why Casey had called that very morning to confirm her appointment!
Grrr...

At any rate, the doctor did return. Her own explanation was that the nurses had told her to go at noon because we weren't there. (Suffice to say she was not a happy camper when we told her we arrived for 11:30)!

Anyway, I was told this would take about 5 minutes, and they would come and collect me from the waiting room when Casey was done.

I went back to the waiting room.
45 minutes later I asked the receptionist to please check for me?
She called back- Casey was still in the procedure!

An hour later Casey was done.

More, from their findings...

Also stated within those pages was this: "ASA Grade Assessment: III"
Not sure what that means.

Later in the report, it noted "Patient mental status examination: Normal" hehehe

After that, "A patient with severe systemic disease"... I am thinking that this must be referring to her chronic pancreatitis and all that followed? (Will ask her doctor here).



After her endoscopy...


Casey, a wee bit loopy, after the procedure...
It also took a long time for her to waken- She has become tolerant to a lot of the drugs especially those used for conscious sedation. The doctor had needed to use more than they had originally thought they would need.

Suffice to say it was a LONG afternoon for us both.
And for Punk too as she waited in the car in the parking ramp.

Nothing that a little love wouldn't cure...



For them both!

If any part of her ulcer is not gone in December then Casey will be facing more surgeries.

Hope all is well with you-
My love to all!

XOXO
Me