Billy Bob's Wild Ride: January 2018

Thursday, January 18, 2018

Tap is not always a fun time

The Word Tap is not always a fun time.........

Most people in American society think of one thing when they hear the word tap.

Tap has a good connotation. Most American people (not entities like myself, the forever taken for granted liver) have good thoughts when they hear the word tap. High school friends meeting in the mountains on a Friday afternoon as graduation approaches, buddies meeting at the bar after work, family parties on a hot summer afternoon. All these have at least one thing in common and that is beer. Goodness knows Notbillybob enjoyed a fair share of it. That is part of the reason he has me the pickle I find myself in today. But I digress....
Notbillybob and I have a new connotation for the word tap. The new thoughts include a large needle, tubing, a liter plastic tub and yet another speech from the hepatology docs about the evils of sodium. In other words paracentesis. Paracentesis always includes an infusion of albumin (material in egg whites). Liver disease can mean weak cell walls because of low albumin. Weak cell walls allows fluid to seep from the organs into the space in between. If this is a new word see the prior post "Happy New Year from the Liver". The sodium lecture is important because kidneys like salt and salt likes water. Too much salt in Notbillybob's diet means we hang on to too much water. Notbillybob takes "water pills" to be rid of the extra water, but this is hard on the kidneys. His are in good shape so far but we cannot be too careful.

So today was to be a typical post hospital visit with the hepatology nurse practitioner. Instead she was concerned about the weight gain since our release. Upon exam of me and Notbillybob she went for the ultrasound. She then asked if I would like to be "drained". Knowing it would make us both feel better we agreed.

Today she drained 9.8 liters (that is roughly 2.5 gallons, without exaggeration 20 pounds) of fluid. No sign of infection. Today was a basic outpatient procedure. No hospital admit. When we arrived today Notbillybob weighed 216 pounds. After the tap he weighed 196 pounds. The last time he weighed this low number was at the 6 week mark of Navy boot camp.

Needle came out and the three of us headed home. By three of course I mean myself BillyBob, Notbillybob and the lovely Princepessa.

Before we left the building we indulged in a cup of homemade Chicken soup. If you are one of my docs I did count. This came to only 630 mg of sodium.

Wednesday, January 10, 2018

Happy New Year from the Liver

Weeeeeeeee!!!!!

Today is day 6, six days in the ANSCHUTZ HOTEL. Notbillybob
arrived Friday morning at the hepatology clinic. The hepatology PA said "can I be totally honest with you... you look like POO. This may sound funny, but in reality I, Billybob was very ill. She said "I am putting you in the hospital." Notbillybob started to cry. Princepessa started to cry. The hepatology PA did not start to cry. She said "don't worry, we are going to take very good care of you." We are going to do a paracentesis. A paracentesis involves inserting a large needle in the space in the belly between the organs to draw out the extra fluid. The PA took care of this in her office.The biggest worry comes if the fluid shows signs of infection.
The procedure did not hurt because notbillybob was so swollen. The PA was shocked at the amount of swelling in notbillybob's belly. PA took 10 liters of fluid. A liter is a little more than a quart so 10 liters is 10.5 quarts or 2.6 GALLONS!! Notbillybob arrived at PA's office at 255 pounds. After paracentesis he weighed 229. He felt sooooo much better. Tests came back the lab fairly quickly. NO INFECTION!!
Next notbillybob was admitted to the hospital. Now the hard part started. Getting off the rest of the fluid! It had collected not only in his belly, but in notbillybob's legs, feet and even his behind.
His weight on Saturday was 219. This is the same weight as when he left for boot camp in 1981!
Unfortunately the sight would not stop seeping. Docs finally had to stitch the sight closed. Notbillybob was VERY brave. No anesthetic. He does not recommend this as it was not fun.
Monday they took an additional 3.5 liters of fluid!! There is a sofa that makes into a bed so Princepessa spent the night to keep us company.
Tuesday fluid loss has plateaued and blood sodium was low. These things caused docs to limit fluid intake and add IV diuretics.Ugh. Lots of peeing. Found urinary tract infection so the docs added antibiotics to the already large number of pills we have to swallow. Another night with Princepessa.
Wednesday 203.5. OMG. Notbillybob has lost 52 pounds in fluid. Princepessa is shocked she has never seen her love this thin. Notbillybob says "No giving up!" He has a good appetite this morning and ordered a hardy breakfast.
PT came by and pressed how important it is to keep moving.
Doctors rounded at 10 AM and said you can go home!
Sodium restriction is in place 2000 mg per day, diuretics will return the dosage in place prior to this event, but fluid restriction has been removed.
Nurse is here with the discharge papers. We are headed home.....

Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)