Mustilidae gastris: Or, My Winter with The Tummy Weasels

Filed under: @ 6:03 pm

‘Round about the end of November I started having episodes of what my GP refers to as “epigastric pain”. Heartburn, gas, nausea, the standard trappings of a dandy gastrointestinal upset.
I was under a lot of stress, in my job when am I not under a lot of stress? I just figured that with the holiday treats that were all around, the stress, the long hours, and my exposure to a constant stream of the general public, that I’d managed to come up with some sort of crud.
So I did all the natural crud repellant things. I took Pepcid, I ate bland food, I slept on my right side (helps reduce gastric reflux), I ate slower, I tried not to eat within an hour of bedtime and so forth. Pepcid is a standard H2 receptor antagonist drug. To translate that into people English, Pepcid blocks histamine production by the parietal cells (acid producing cells of the gastric lining), thus decreasing gastric acid production. When I found the Pepcid unsatisfactory I switched to Prilosec. Prilosec is a proton pump inhibitor. It doesn’t reduce gastric acid production, it STOPS gastric acid production.
The Prilosec worked……sorta. I took it for two weeks, a standard course, and when I was still having GI distress after two weeks I, like the good little instruction reading consumer that I am, went to see my GP.

She poked, and she prodded, and she asked about the hours that I was working, how much stress I had been dealing with, and how much caffeine and ibuprofen I’d been ingesting. She prescribed me a 30 day course of Nexium. I’m not even sure what Nexium does, I don’t use it for my patients. Then she told me that if I was still having problems after a month that I’d need some diagnostic testing.
Well that was enough to make me sit up and take notice.

Most of you probably know that I have a double curve scoliosis. My spine is curved in two places. I spent a lot of time in my pre-teen and teenage years stripped to my skivvies being radiographed, poked, prodded, and corseted by a parade of pediatric orthopedic specialists and one cold handed unibrow in particular.
It has left me, ironically, with an overwhelming mistrust, disgust, and horror of the medical profession in general. In specific there are MDs whom I actually quite like, my GP included. She treats me like a doctor and I treat her like a doctor and we get along quite well. It’s the unknown practitioner, especially those who are responsible for doing anything more involved than ordering me to have my blood drawn, that give me the grue.

My pointless idiotic insurance plan wouldn’t cover the Nexium because, as they put it I hadn’t “demonstrated a lack of response to a formulary alternative” which basically translates into “it’s too expensive, try something cheaper”. So I was back to taking Prilosec. LOTS of Prilosec. And with careful management of what and when I ate, I did okay for the rest of December and into January. After the month was up I made a recheck appointment with my GP and stopped taking the Prilosec.

Which was a bad idea.
The tummy weasels returned with a vengance at about 2 a.m. one Tuesday. I called in sick to work, took Mylanta and went back to bed. I spent the rest of the day sitting upright watching The Lord of The Rings and ingesting little other than Mylanta, rice, pudding, and white meat chicken. I am most heartily sick of white foods.

At my recheck appointment my GP, who is also mightily frustrated with my pointless idiotic insurance plan, told me that in order to get coverage for the Nexium that she wanted me to take I had to demonstrate lack of response to Prilosec. Not just any old OTC Prilosec, no, the insurance wants me to take prescription Prilosec regardless of the fact that I’d been taking the exact same thing for the prior 6 weeks and not getting any better at all.
So my GP wrote me a prescription for the pharmacy version of Prilosec and scheduled me for a series of upper GI barium x-rays.

Barium is a thick radio-opaque paste that one swallows. With a sequential series of radiographs one can outline the entire GI tract and potentially pinpoint ulcerations, strictures etc. I use it to find gastrointestinal foreign bodies in my patients. Doing an upper GI series properly requires that the upper GI tract be empty so you can’t eat or anything for at least 8 hours prior. On any other day that would have been annoying but not a serious concern.

Early in the morning of the day my upper GI series was scheduled I woke up with a migraine. I get them sometimes, stress will trigger them sometimes, and usually when I wake up with demons dancing in my head I take one of my migraine pills, chug a Coke, and go back to sleep.
Except I couldn’t eat or drink anything.
Later that morning I was delivered, pale, nauseous, and sweating to the radiology department where the fluorescent lights proceded to pound the hell out of my head. Did you know that under the right circumstances you can actually FEEL the waves of light from a fluorescent tube? I submit that one extremely good way to not be nervous about having a medical procedure done is to have little pointy hobgoblins hammering railroad spikes through your right temple.
And after the radiologist told me I could take one of my migraine pills, which I very promptly did, and the demons calmed down a little bit I have to admit that what I could see of the x-ray series was pretty cool. They were using a digital x-ray which not only decreases the radiation required, but also allows computer manipulation of the image. Pretty neat, but there wasn’t anything that I could translate as abnormal.

So the radiology appointment transmogrified into a referral to a gastroenterologist which rapidly transmogrified into an appointment for an upper GI endoscopy.
And there it was again. That annoying, completely irrational disgust and horror at the idea of medical procedures. I realize that no one actually relishes the idea of medical procedures, but in my case it is irrational to the point of pathology. I perform these types of procedures routinely at work and understand, probably better than the support staff that were trying to be professional and soothing to me, what happens during an upper GI endoscopy. And it didn’t make a damn bit of difference.
They dropped an IV catheter into me (have I mentioned that humans and needles really gross me out? I can’t even watch Andrew inject his insulin without getting all weak in the knees) and wheeled me into the endoscopy room where I proceeded to be grouchy and shake like a leaf. That is until the procedure nurse took pity on me and said “you look a little bit nervous Hon, let me give you a little Versed.” And I immediately became REALLY INTERESTED in a little spot on the ceiling tiles. I remember my gastroenterologist coming in and trying to talk to me about the blood chemistries that they had run the week before, but since there were two of her I really couldn’t figure out which one of her was talking to me or what she was trying to say.
That is the last coherent thing I remember for the next 2 1/2 hours.
I will also submit that a really good way to not be nervous about having a medical procedure done is to be stoned out of your gourd. A combination of IV Versed and Fentanyl is a goooooood thing.
Surprisingly the upper GI endoscopy was dead normal. Endoscopic biopsies were taken to rule out celiac sprue and helicobacter infection, the biopsies were unremarkable.

So the endoscopy appointment transmogrified into an appointment for an abdominal ultrasound which happened the next week. I also do abdominal ultrasounds as part of my every day career and have a fairly good idea of what I’m seeing on the screen, so when the ultrasound tech was prodding me in the liver with the probe and a spot came up that was brighter than the surrounding tissue I asked “What’s that there?”. She, being a radiology technician not a radiologist, and as such unable give me any interpretation of what she was seeing, said “Oh, it’s just part of your liver.” To which I, with great restraint, did not reply “Yeah, I know it’s part of my liver genius, why is it so dense?!” There really isn’t any point in antagonizing someone who has tacit license to poke you in the liver with an ultrasound probe and who can’t tell you anything anyway.
When I send radiographs or ultrasound images to my radiologist I usually get a report back the next day. The ultrasound technician told me that the radiology report should be with my gastroenterologist in 2-3 days. That was on Wednesday. So on Friday I was calling my gastroenterologist’s office every two hours or so leaving messages for her assistant asking what the hell the radiologist had to say about my liver. She didn’t call me back.
That is to say, she didn’t call me back until the following Monday when I was working a relief shift at a clinic that belongs to one of my vet school buddies and had a semi-full day complete with surgery. THEN she called me back. And told me that the radiologist had found what they were calling a “2 x 5 cm hyperechoic lesion in the left lobe of the liver”.

You want to have a really bad day at work? Have someone call you and tell you that they’ve found something nonspecifically bad in your liver and you’ll go all to pieces. Melinda, fortunately, is a very understanding sort and was willing to let me blow off the rest of the day and just go the hell home. Which is really probably a good thing because I wasn’t going to be of much use to her for the rest of the day. I still don’t know how I managed to drive home without hitting anything. Every so often I’d wake up and realize that I hadn’t the faintest idea where I was and yet somehow I managed to get home. I give full credit to my car for her directional sense. SOMEone’s autopilot was working and I’m pretty sure it wasn’t mine.

They scheduled me for a CT scan two days later to further define the “lesion”. I couldn’t talk my gastroenterologist into, or rather, she talked me out of, doing biopsies of my liver at the same time as the CT scan. It’s remarkably frustrating being in this position. I know how I would handle my case if I were my own patient and given my druthers I’d be much more aggressive about diagnostics than my gastroenterologist is being. I would have done exploratory surgery and biopsies last week. I should have been comforted by the fact that my gastroenterologist told me that she didn’t want to biopsy my liver unless it was absolutely necessary, but I was not.
You want to have a really bad week? Sit around waiting for an appointment for further diagnostic testing on a nonspecific something bad on your liver and then wait and sit around for the results of those diagnostic tests.
I did manage to keep myself busy, God knows. I usually reserve bathtub cleaning for every other presidental administration and I consider mildew on the shower curtain God’s way of telling you that you need to buy a new shower curtain. Our bathtub and shower curtain are now *spotless*. I also managed to get rhododendron bushes, my rosemary, and three lavender plants pruned as well as all of my backyard rhododendrons fertilized. I don’t have to worry about the municipal yard waste pickup going unused this week at least.
The CT report indicated that the “lesion” was probably a fat deposit, but the radiologist couldn’t be certain and recommended an MRI to be sure. My gastroenterologist has plumbed the depths of my frustrations and has basically told me to chill out. Chilling out is remarkably difficult.

So there it sits. The tummy weasels are sometimes better and sometimes worse. I keep a bottle of Mylanta on my side of the bed and a second one at work. My blood chemistries are essentially normal and several thousand dollars worth of diagnostic testing has told me little other than I probably have a chubby liver. I have managed to thoroughly freak out in some really remarkable ways and have discovered that, if nothing else, I am not a very patient patient. Breaking my leg would have been easier. At least it would have been considerably more straightforward.
Weirdly the “fat deposit in the liver” diagnosis has been moderately soothing. Still not sure why I’ve been sick on and off for four months, but if they haven’t found something bad yet they probably aren’t going to. The next step is the MRI and some more sophisticated blood testing for pancreatic function.

That is, if they can catch me first.

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