On Thursday night, May 7, indigestion flared in my gut. It kept getting worse with other symptoms developing. Little did I know, two trips to the Emergency Room (ER) and two 3-day hospital stays were about to follow.
When my indigestion discomfort was joined by a racing pulse (95+ just lying in bed), dropping blood pressure (96/55), diarrhea with black stools, light-headedness, and nausea, at 4:30 AM I woke Maggie and said I was sick. “I think COVID-19 is attacking me with a vengeance.” We called Mayo’s triage line and a third of the way through my symptoms was told to go directly to our closest ER. Go now, do not pass go, do not collect $200. She gave us no diagnosis, so I was still thinking COVID-19 had got me. Maggie dropped me off at Mayo’s ER around 5:30 AM (she was not allowed inside) and after a half-hour wait, some Gastric Intestinal (GI) specialists were examining me. After a quick blood test and ECG, they told me I was down about 7 pints of blood. (Doctor: “Going from an Hb of 14.6 to 7.4 is quite a plummet – you’re down about 7 pints or half a tank.”). After admitting me they did a test for COVID-19 and started the 24-hour clock on that. Then it was off to the high-isolation floor, where confirmed, suspected or unproven COVID-19 patients resided. Nowhere in the hospital are visitors allowed, the least of which this floor. It had separate ventilation filtering for each room and was staffed by heavily-masked nurses and doctors, including eye masks. The next morning the Covid-19 test came back negative and I was moved to the third floor, east wing, room 80.
Okay, if it wasn’t COVID-19 making me so sick, what was going on? Late that morning the GI team informed me they wished to do a Colonoscopy and an Endoscopy, essentially checking my GI track from both ends. This couldn’t be accomplished until I drank a gallon of GoLYTELY. This stuff wins the award for the greatest difference between a thing’s name and the actual result produced. I’ll not describe the process or impact, but the uninitiated and curious can follow this link.
So, after a cleansing evening, I was taken down for two procedures, thankfully done in that memory-less dream state that marked the end of Michael Jackson. Several hours later I learned there were 3 ulcers in my stomach which were the most likely source of the bleeding. They administered a test for the H. Pylori bacteria known now (due to a discovery twenty years ago) to cause ulcers and a few hours later it came back positive. A contributing factor to the bleeding was an “out-of-range” INR reading of 5.3. INR relates to the anticoagulation factor of the blood. The higher the number, the greater the likelihood of internal bleeding. If you don’t have a mechanical heart valve, normal INR values are between 1 – 2. If you do have a mechanical valve, like me, it should be between 2 – 3 and they get it there using a drug called Warfarin or Coumadin. Anything over 3 is considered too high. 5.3 is very bad.
On Monday the 11th, I was finally released to go home, with a regimen of pills to address the H. Pylori and imbalance in my GI tract. I was told if additional symptoms appeared, such as black stools or feelings of light-headedness, to get back to an ER right away. Off we went, with me super glad to get out of there, although suffering from the effects of being low on blood – which include extreme fatigue, light-headedness when trying to do anything fast, and absolutely no physical reserves.
As I planned my recovery, I learned a lot about iron-rich foods, both from plants and animal sources. I’ve been eating vegan for the past several months, so I was hoping to only need to occasionally stray into the meat side of things and still make good new blood. After planning a series of menus with Maggie filled to the brim with iron-rich foods, I learned from my doctor brother-in-law (Joe Phaneuf, M.D.) that rebuilding one’s blood to normal is not a matter of eating a week’s worth of liver & onion meals. It takes a couple of months. And my plan of taking iron supplements and eating foods high in iron was further blown apart from the study Joe sent me showing that the body monitors iron ingestion. If we significantly increase iron intake, the liver makes a protein called Hepcidin which is negative feedback for iron absorption. In other words, lower doses of iron, like once a day or even every other day, are more effective than taking iron twice or three times a day. Okay, okay, I vowed to change my plans and take it more slowly.
On Wednesday morning the 13th, after just one full day at home, I awoke shaking, light-headed, and not liking the look of the toilet’s contents (sorry to be graphic). I hated the idea of going back to the ER and made several attempts to reach the doctors on the phone. No luck, so back to the ER I went and you’ll never guess what happened. I got admitted to the hospital. AGAIN! This meant another COVID-19 test, but thankfully, they judged me a low risk of having contracted COVID-19 so quickly, and after my test put me back in the hospital on the same floor, the same wing and in the same room. Even the same nurses and support staff.
If uninitiated, you should know a colonoscopy starts at one end of the GI tract and the Endoscopy at the other. Neither of them reaches the small intestines in the middle. These small intestines are over 20 feet long and none of their “wands” or scopes reach that far. So, they wanted me to swallow a small camera so they could take photographs of my entire GI tract, with particular attention to the insides of the small intestines – oh, but not today. “First you need to drink another gallon of GoLYTELY, so the pictures will all come out nice and clear.” I was livid. I hate that stuff. I promised the GI team when I got out I would introduce a bill into the legislature requiring anyone prescribing GoLYTELY to have to take it themselves with the patient. Other than some sympathy, I got nowhere with my idea. So, another afternoon and evening of drinking a 6 oz. glasses of this horrible concoction every 20-30 minutes and never drifting more than a few feet from the bathroom.
The next morning, Thursday the 14th at 10:00 AM, after being judged clean as a whistle, one of the GI team brought me a camera to eat. Well, swallow – no chewing allowed. Before ingesting this magic brightly blinking bus of a pill (remember the movie the Fantastic Voyage?), they glued a half dozen pick-up/receivers to my torso and draped a box the size and weight of a 1990 1TB hard drive and just as heavy, around my neck. Combine this with the remote heart monitor and its 6 leads, two IV drips (one in each arm), and mobility was out of the question. I couldn’t even answer my phone because bending my elbow set off an IV alarm.
On Friday morning, the GI team picked up the recording device and took it to review the photos. Sound like fun? The camera transmits 7 high-res photos per second, or 420 pictures a minute. This works out to 25,200 pictures an hour. So, after twelve hours, they had over 300,000 pictures to review – 302,400 to be precise. Just like vacation photos, it’s a good bet they weren’t all winners. But still, that’s a lot of photos to look through. It took the 3 person team until around 2 pm before they declared there was nothing new going on in my GI tract and I might as well go home.
This time, the “leaving the hospital instructions” included a different set of drugs. They decided for several reasons, the first set was not that great. But, 3 new prescriptions later and I was on my way.
It turns out, getting my GI tract back into line wasn’t as big an issue as re-balancing my INR and getting it back in range. This involves transitioning from the Heparin IV drip I was getting while hospitalized to a drug called LOVENOX (here is how it’s pronounced). The trick is this drug can only be delivered by syringe. This means twice a day I get jabbed in my tummy with a needle and injected with enoxaparin. Not fun for me or Maggie, as I can be a real baby when it comes to shots.
I got home Friday night after picking up the new meds and some wonderful take-out food from Picazzo’s Healthy Italian Kitchen (one of my favorites). I was in bed and asleep before 9 PM. Happily, I am still negative for COVID-19. That’s a good thing, as it no doubt would have killed me, given my blood count issue and non-existent reserves. My GI tract and blood situation can be repaired and brought back into line over the next couple of months. Given what I’ve been through in the past, this was just sort of a blip in the road, although it was a potentially lethal blip.
So, how was your week?