the saga continues

Greetings all.
If anyone is interested I thought I’d give a little update on things in my world of late. Had medical emergency number two for the semester last week. Had some stomach trouble, what the hell, I vomited blood last week and was persuaded to go to the ER. Turns out, I have two ulcers, one almost perforated my stomach. Was in the hospital from Mon – Fri and missed my exams. Luckily the profs were very cool about it. Am taking orgo tomorrow and physics on Thurs.
This is a NSAID thing, not h. pylori so it’s just avoid them and take Nexium.
Hope your semesters are all going better!

Oh my God, I hope you’re o.k. Sounds like you are and you’re recovering. Good luck on your finals. I’m glad your professors were understanding–they would have been real jerks if they didn’t.

Oh, no! I think my husband’s medical luck has rubbed off on you. Must have happened at the Old PreMeds conference.
He spent a day and a half in the hospital with kidney stones, just this very week. (He just called me at work to ask if the discharge instructions said that his kidneys would hurt when he urinated. I had to tell him the doctor said EVERYTHING would hurt when he urinated for the next few days.)
Good luck with your ulcer. Thank goodness they have good drugs now. I hope your knee is healed enough that you don’t really need the NDSAIDs too much.

I’m so sorry to hear that! I hope you are feeling better this week. I’m glad your profs were understanding about it too. Anyway, take it easy, and I hope you get a relaxing break once classes are done.

Take care of yourself and try to relax over the holidays!

Hey Alison,
Glad to hear that you getting better. Did you have an EGD? NSAIDs are very dangerous and have become more so since ibuprophen and naprosyn have been available over the counter. You are off this class of drugs for good. Be sure that your bone physicians know this when you are having knee problems.
I can’t tell you how many times I have seen spontaneous GI bleeding from NSAID gastritis. Be very careful with these dangerous medications that are everywhere (cold medicine).
I hope the classes worked out all right too. You should be resting and gearing up for next semester.

Thanks, everyone for your kimd words. Spent a few more days at the Washington Hospital Center this week and had a final postponed (again) as I wasn’t out in time (more bleeding). Natalie – talked to my orthopod this week and he said the same thing you did – no more NSAIDs for me, which does suck. It looks like (from the 2nd EGD)that healing has started and it doesn’t still pose a perforation threat (that was a concern last week).
Now all I am going to do is rest and ready myself for next semester (and my physics final, the dean joked with me that my orgo final might have given me at least one of my ulcers!)
Thanks again,


Thanks, everyone for your kimd words. Spent a few more days at the Washington Hospital Center this week and had a final postponed (again) as I wasn’t out in time (more bleeding). Natalie – talked to my orthopod this week and he said the same thing you did – no more NSAIDs for me, which does suck. It looks like (from the 2nd EGD)that healing has started and it doesn’t still pose a perforation threat (that was a concern last week).
Now all I am going to do is rest and ready myself for next semester (and my physics final, the dean joked with me that my orgo final might have given me at least one of my ulcers!)
Thanks again,

Hey Alyson,
The next time you are a patient at Washington Hospital Center, ask one of the nurses to page Jonathan Buck. He is one of the Respiratory Therapy Supervisors and a very close friend. If you tell him that you are a friend of mine, he will make sure that you get the best care. He is one of those Harly Davidson-driving guys that will have you laughing so hard, you will forget why you came to the hospital in the first place. Another person that will come and hold your hand if you need TLC is Miss Blossom Doyley who is also in the Respiratory Therapy department. She is from Jamaica and so funny. She too, is very kind and is a great friend.
I am glad that you were at WHC. They have an excellent GI department. Cardiology is even better but you DON’T need those folks and WON’T need those folks.
I am coming to DC to hang out around the Yule Log on the Mall. I can’t get into the holiday spirit until I have spent some time at the Pageant of Peace breathing in the smoke from the Yule Log.

I wish I had remembered your friend, Natalie. Spent yet another few days at WHC, one of my ulcers was bleeding and I almost needed a transfusion. Had the scariest experience I have ever had in an ER and will never go back to that ER. I fainted twice in the ER – in the bathroom, the call cord didn’t work, or it did and no one responded so I had to call the ER on my cell phone. That’s part of it. I really hope 2004 is better because this has me really depressed, though I know I am really lucky to have access to good care and so many have much problems.
Is there a good place to find info on what different hemacrit results mean, like what is a good vs. low reading? How low can it be before I should be worried? I am really paranoic right now because mine was 42 when I first went to GTown and was 30 the other day. I have become obsessed with my blood pressure and pulse.
Hope THAT goes away, too.
Thanks, once again for listening.

30 is low, but not dangerously so. It would correlate with a hemoglobin of about 10.0. Normal is 12-16 for women’s hemoglobin, and hematocrit for a woman is 37-47%.
So, at 42 you were within normal limits, but with an actively bleeding ulcer, it takes time for the resulting anemia to show up in the hematocrit. Values may not be reliable immediately after hemorhage because the percentage of total blood volume taken up by the RBC has not changed. Not until the total blood volume is replaced with fluids will the hematocrit decrease.
According to Mosby’s Manual of Diagnostic and Laboratory Tests, transfusions are not normally considered as long as the hemoglobin is above 8 g/dl or the hematocrit is above 24%.
Take a deep breath, get some rest, and get the ulcers under control. . . . and try not to stress out too much!!
Hope you feel better soon.

Oh, Alyson, I’m so sorry to hear that the continuing saga is STILL continuing. And really sorry to hear about your unfortunate ER experience. That really sucks.
Don’t get too caught up in looking at the H&H numbers. It’s how you FEEL that’s more important. Someone who develops anemia over a very long period of time can run shockingly low numbers and feel a whole lot better than it sounds like you do right now. (I’ve had iron-deficiency anemia on occasion and can tell you that with a Hct of 28 I felt FINE, or at least I thought I did.) As you’ve discovered, losing blood over a short period of time is going to leave you with symptoms.
It’s the symptoms, not the numbers, that should drive the discussion about whether and when to transfuse. If your life and work situation are such that you can tolerate feeling tired, short of breath, and somewhat tachycardic for awhile as you re-build your red blood cells, then you don’t transfuse. If you were in a situation (e.g. cancer chemotherapy) where it was really critical that you get your red blood cells back to normal levels as soon as possible, then transfusion is called for. If you can’t sit up without passing out, that would be “symptomatic anemia” such that you really would have to have a transfusion - or at least would be advised that you should.
Hang in there. Who is managing this overall for you? Do you have a primary care doc? Because if not (clearly you’ve needed a lot of specialists recently), YOU NEED ONE. Someone needs to be looking out for all of you instead of just the requisite parts. (sorry, gotta plug my own business!)
My New Year’s wish for you is: good health in 2004!

Sorry to hear about your terrible ordeal!! Makes my little knee surgery seem like nothing. Please take care of yourself and get well soon!!!
Although I am getting a little nervous. I assume since it is same day surgery that they still will have an iv in and I will be intubated since I am under general anesthesia??
Should I ask them what drugs they are using? I don’t know much about anesthetic drugs, except sodium penathol.
I don’t anticipate any problems I have been under a couple times before and didn’t suffer any side effects.

Mary – I do need to find a new primary care doctor and I am looking for a new GI person as well. I like mine but I need someone at GW or Georgetown. Thanks for all of your kind words – 2004 has to be healthier than 2003!
Cathy – what kind of knee surgery are you having?

Cathy – what kind of knee surgery are you having?

I tore my meniscus and have to have arthroscopic (sp) surgery to remove the torn part. I guess in older people they don’t repair it. I go in Tuesaday. It will take about 6 -8 weeks to heal. So no football for me for a while.

My thoughts will be with you on Thursday! Before this year, my major health problem was my knees. Actually saw my orthopod this morning (I want to start training for some mountains) so I can relate. Hope your surgery goes well.
I feel a lot better today than I have in weeks – I finally have some energy – yay!

Sorry to be so self absorbed.
Am finally (I hope) getting better. Saw a new GI doc who didn’t think my problem is NSAIDs as I have been off them for a long time and the Nexium isn’t healing the ulcers. Am trying to look at this all as a good learning experience. One doctor told me last week that my ulcers ‘couldn’t possibly cause the pain’ I was experiencing – she said she knew better because she ‘was the one in the room with the medical education.’ An experience that still has me seeing red. If I am ever lucky enough to become a physician and those words, or some like them, EVER escape my lips I hope to be struck down by lightening.
The decision for all of us to give up whatever we were doing and pursue medicine has been hard and it worries me that some of the bad experiences I have had have shaken my resolve a bit. I mean, if going into this is going to just turn me into either an uncaring person or an arrogant jerk, well there are cheaper and easier ways for to get there. I still want to do this – I started shadowing a new orthopod last week and that helped remind me why I am doing this but dang, some people really suck.

I think that there is some degree of transformation in medical education. But I don’t believe it is to the degree that a deep-down nice person becomes an a$$hole like the GI doc who discounted your pain. YOU are not going to become a jerk as a physician any more than I have, or Dave, or Nat, or… see what I mean?
I have some classmates who I would regretfully characterize as jerks. They started out that way. Med school definitely hasn’t helped. Fortunately I have many more classmates who started out pretty nice and seem to have remained pretty nice. So don’t lose hope! I am sorry you had to have such an encounter.

I’m sorry to hear about your continuing struggle. It sometimes seems like the doctors you deal with are worse than your medical situation! It makes you wonder though…
I know you will never be like some of the arrogant pricks you had the misfortune of dealing with. Hang in there.

I’m so sorry to hear about the hell you’ve been experiencing
lately! Hang in there!

Thanks again. I was upset because I called the hospital’s ‘patient advocate’ to let her know and felt (at first) like the reponse was that the doctor who treated me had a different take on what happened (no surprise there) and they were going with her version. Now this isn’t what upset me – really – they work with her and I am just some random person. I think I was more upset because she really thought I was in there looking for drugs and anyone who knows me well, knows the last thing I want is something that will make me MORE TIRED, which is what they do. If I am telling you something hurts, really it hurts a lot.
The upshot is, and I cannot thank you enough for all of your support and kind words, really. I have been spoiled by such good health most of my life I probably am pretty wimpy now. Well, the upshot is that not all the medical people have been as bad and I made a point of thanking most of the people who treated me well. I called an ER doc who treated me at GTown (not the one I mentioned above) who was incredibly understanding, which often is all I need, really. He was pretty surprised to get that call, by the way. And you’re all right, I like to think I am not an [censored] and don’t think going to medical school will change that. If it does, I hope you all will call me on it!