By Request

I was just asked today to "post some more cool medical stuff on your blog". I have intended to do this for a while, but tonight offers me the chance to do it. I am staying up late tonight in order to prepare for tomorrow's night shift. I was told that I should try to stay up late tonight, get up early in the morning, then take a long afternoon nap before my night shift. It was one of a couple of different suggestions, and I'm excited about it, because I love afternoon naps. Maybe this night thing will work out for me.

I need to set something straight. I completely messed up on graft vs host disease when I mentioned it earlier. I said that the body launches an attack against the graft. That's not true. It's the other way around, and I can't believe I missed this obvious thing. Stinking faulty memory.

Anyway, the transplant attacks the body. There's a couple of different ways to do bone marrow transplants. Autologous means that the patient donates his own bone marrow. It is freezed. His own bone marrow is destroyed through chemo treatments, and then his preserved bone marrow is re-introduced into his body. This type of transplant poses no risk for graft vs. host disease (GVHD), because the cells in the transplant are already accustomed to the cells in the patient's body. In fact, they are the cells from the patient's body. Allogeneic transplant means that someone else donated their bone marrow for the patient. Often, the donor is a close relative. This type of transplant involves the possibility of developing graft vs. host disease.

I met a woman last week who had just begun to develop GVHD. Instead of having a completely red body from head to toe, she only had slightly reddened fingertips. The soles of her feet were also red. She had not yet complained of any itching or other related complications. The nurses still seemed to react more sympathetically to this sign than the patient could understand. I think it's because the nurses know too well the path down which these symptoms suggest this patient will go.

Also, that one patient that was yellow...they did some liver function tests. His bilirubin was, indeed high, as manifested by yellowish skin. Also, his liver function was at less than optimal which explains his jaundice. I felt pretty good about this predictive observation. My nursing assessment skills are slowly coming around.

I also came across a rare skin disorder called calciphylaxis. It seems as though the process of this disease is poorly understood, but it involves the calcification of the skin. In this patient, as is typical, her condition presented with late stage renal failure, probably related to the kidneys' inability to filter out excess calcium. The significant thing about this disease is the necrosis of the skin. "Νεκρος" is Grecian for "dead". When cells die, that's usually not a good thing. In body tissues, necrotic tissue turns black. This patient had 3-4 inch patches of black tissue on the surface of her skin. This is an ominous sign, because it represents the beginning of calcification on her skin. Spots that had started that way have now progressed to 1-2 inch deep wounds five inches in diameter all around her trunk. I was amazed to find that she had only begun to recognize signs of this disease about a month ago. It has already progressed to form significant necrotic craters on her body. These wounds refuse to heal and will eventually cause her death. The patient was experiencing enormous amounts of pain due to her abundant open sores. Somewhere I read that she has a 45% chance of making it for a year and 35% chance of making it five years.

Treatment: pain medications, dressing changes and wound care, dialysis (which is basically a huge kidney; a patient's blood is filtered through a machine).

If you are grossed out easily (Allison), don't read this paragraph. Her wounds are treated with dressings saturated in acetic acid. That's the stuff that makes vinegar smell bad. Another option for treatment of this condition involves maggots - yes, maggots. The maggot larvae eat up all the bad stuff in a wound and leave the living tissue. This patient wasn't undergoing that treatment, which I was glad about.

This patient was, however, being transported to a "hyperbaric chamber" which involves exposure to oxygen at a high pressure, a much more appetizing treatment. I thought at first that "hyperbaric" related to a high amount of fat. "Baryophobia" is a relatively newly defined eating disorder type condition in which a patient is afraid of becoming heavy. Also "bariatric" relates to obese patients. However, the root is Greek again, "βαρο-": weight. It relates more accurately to pressure. So, hyperbaric oxygen therapy relates to exposure to pressurized oxygen.

I had my first reporting off experience sometime last week. At the shift's change, each nurse records significant information on each of her patients for the nurse who will take them. Hearing report everyday is a continual reminder that each profession has its own language. There are so many acronyms on these reports. I've heard a lot of people refer to this phenomenon as B language, but it reminds me of the military. There are also random numbers thrown around like confetti. However, even with my limited knowledge, I'm able to decipher what most things are, and my unlimited M resources help me with the rest.

RMG - something metered glucose, aka: blood sugar
UCI'd - urinary catheter indwelling, aka: patient has a foley

During these reports, I kept hearing the nurses say "rie-ghers". I knew that it was something that happened during a neutropenic fever by context (neutropenic fever is when a patient who is low in neutrophils, a type of white blood cells, gets a fever. This is a big deal, because it is a sign of an infection which the patient is ill-equipped to fight), but other than that, I was a bit puzzled. "Rie-ghers" is spelled rigors. "Oh! 'rhig-ers!" I exclaimed to my nurse. I know what those are - the shake that accompanies a chill.

In other news:
I went to the dentist. They took an x-ray and told me, "Yeah, you definitely have an abscess in there." So I'll need a root canal. I'm scheduled for next Thursday.
I got paid today. Woot.
I signed up for that healthy living place. I did a couple of aerobics type classes. One was called Zumba and I followed an African American trainer in some crazy dance movies. At one point, she said, "Now show me your shimmy. You just move your shoulders and let your accessories follow."
I am self-proclaimed "less than dumb" nowadays at getting around this place I call a city.
I found out that I have some camp friends that live here. I'll probably meet up with them sometime this week.