Friday, October 6, 2017

A scare, then a Transesophageal Echocardiogram clears the air

So, my fistula infection has shown no signs of relenting. Even though there is no fever, there is a persistent ooze from the infected puncture site. There is no collection in the area that warrants surgical intervention. Then from where the hell is this oozing?

Protocol demands an echocardiogram to rule out Infective Endocarditis. This is common in dialysis patients. So, I went and got an Echocardiogram done.  It was not without drama. The cardiologist happens to be a senior doctor and he first went through the motions and declared that there was nothing to worry. As I was getting up, he exclaimed, “Just lie down again. I want to check something else.” I lay down and he put the probe on my chest and then a little lower and as if he had found something unusual, said, “What is this?”

For the next 5-7 minutes he put the probe in various positions and at various angles and tried to make sense of something. In the end he said he could see something that looked like ‘vegetation’ - a term for infection but he wasn’t sure and advised getting a Transesophageal Echocardiogram (TEE) or a PET-CT scan to get a better view of the ‘thing’!

I took the report to my Nephrologist and he asked me to meet another cardiologist and get a TEE done. 

The internet can be an amazing source of information. It is impossible to hide anything from someone who has access to the internet. The article I linked to above had a scary statistic - a 65% 1 year mortality of HD patients who got Infective Endocarditis (IE). I started fearing the worst. As I usually do, I started imagining life with IE. I started thinking about a preparing a will, about work, about my parents.
 
Today was the day of the TEE. I was asked to have a light breakfast before 7 am and no food or water after that. I had what I would call a heavy breakfast at 6:45 am. Believe me, my ‘heavy breakfast’ is very different from what you would call a ‘heavy breakfast’! I wouldn’t have it any other way as I knew my body better than anyone else and there was no way I would be able to withstand ‘no food, no water’ without a heavy breakfast. I took a nap after that and by around 11:30 we were at the hospital. 

After the customary explanation about the procedure and billing for the test, they sprayed some anaesthetic into my throat that numbed the walls. They then inserted a thick tube coated with anaesthetic jelly. The first few moments were very uncomfortable as the tube was pushed down my throat. But once it was in, it wasn’t bad at all. The doctor looked at the images being generated on the screen. After about ten minutes, they concluded that there was no infection!

I was a relieved man. I would have had a tough time being on the 35% bucket of the post IE mortality statistic!

Now that still leaves the question, “What is causing the freakin’ ooze?” unanswered. I met my nephrologist with the report of the TEE. He said let us stop all antibiotics and wait and watch. The risk of long term antibiotic usage is a fungal infection. Don’t ask me how and why!

So, for now, I have been asked to stop the antibiotics (after almost two months of taking them) and wait.

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