epepke said:
I haven't been diagnosed with emphysema. I don't know what COPD is, but I do know that I have a bit more erythrocytes than normal. Not enough to be diagnosed as polycythemic, but still a bit high.
I've never had pneumonia, either. That's been checked, several times.
First off, COPD is "Chronic Obstructive Pulmonary Disease" and encompassess many diseases like chronic asthma, emphysema, etc. It's a catch-all term and is easily diagnosed by its specific pattern on pulmonary function test (PFT). Still, I'm sure they did chest x-rays when you were in the hospital, which can catch a lot of this. The fact that you have a slightly higher-than-normal RBC count (if that's what it is and not truly an across the board increase in total counts) could point to a chronic lung condition, but again if you continue to have problems you should get a PFT.
epepke said:
Well, it didn't go much below 90%. On the digital readout, the lowest it got was 89%. But there's a psychological difference between 89% and 90% that is entirely unjustified given the accuracy of the measurement. I've been doing user interfaces about half of my life, and if I had my druthers, there'd be an indicator with a Gaussian distribution giving a reasonable approximation of the error on a scale. But people seem to like numbers.
Well, this is a little tricky, though, because the O2 dissociation curve is not actually "Gaussian" and does not represent a smooth correlation with the partial pressures of dissolved gasses in your blood stream, which is what is really paramount. Percent-saturation of RBCs (which is what a pulse oximeter measures) do not correlate in a true curvilinear fashion. Typically a SpO2 of 90% correlates to a partial pressure of oxygen in the blood stream of 60mmHg. At 100% SpO2, you have a partial pressure of around 96-100mmHg, provided you're not on supplemental oxygen. This is fairly complex process that has a lot to do with the oxygen binding properties of hemoglobin and other intra- and extra-RBC regulators (such as amount of 2,3-BPG in the RBCs, pH of the bloodstream, etc.), and I'm not sure that I have the time (or the inclination
) to try to fully explain it here - especially without completely baffling the likes of Kumar. But, suffice it to say, that you can become symptomatic when your PO2 falls below 60mmHg and you can begin to rapidly decompensate. Therefore, we get a little concerned when we see the SpO2 fall below 90% because of this correlation with PO2 in the bloodstream. So, while there may be some built-in "error" of the measurement, we typically don't like to play around with SpO2's in the low 90's, even with measurement error accounted for. If I saw that, I'd probably order an ABG (arterial blood gas) to correlate and really know exactly what was going on. But, that's just me. I would have given you an incentive spirometer, and instructed you to use it every hour. This helps recruit alveoli, prevent atelectasis, and more importantly prevent pneumonia. Anyway...
epepke said:
I really think that the answer is much simpler. When I had the pancreatits, I was fat, and due to the pancreatitis, my abdomen was swole up like a dirigible. So my diaphragm didn't move much. I could feel it not moving, and it hurt a lot to breathe.
Ahh... could be. We call this "splinting", and it could account for decreased lung expansion and transient atelectasis (or, temporarily collapsed areas of the alveoli in the lung) that continue to get a blood supply despite not being inflated. This area of "perfused but not ventilated" lung causes what's called a temporary V/Q shunt, and the result is that the blood going through your lung in that area does not get to dump it's CO2 and pick-up fresh O2. As a result, the amount of hemoglobin circulating through your body that is oxygenated is slightly lower, and this is reflected in your SpO2, which again is the percentage of hemoglobin that is fully "saturated" with oxygen.
epepke said:
The liver biopsy is becuase an MRI showed an anomalous mass. The CT scans didn't show it. Now, this is probably inflammatory, but they want to make sure that it isn't malignant.
As for the removal of the gall bladder, as far as I can tell, it's because they can't figure out why I was admitted the second time, without alcohol. Also, they did an endoscopic (if that's the right word) examination and found that the output of the gall bladder was, in their words, "sludgy." No actual stones, but as far as I can tell, something like a pre-stone condition. So I think it's really more prophylactic than anything else.
Well, first off, sounds like you had an ERCP, which stands for endoscopic retrograde cholangiopancreatography, that can measure the function of the ducts within the biliary tree. It is still fairly commonly done in pancreatitis, but a lot of centers have begun replacing it with MRCP (an MRI version of the same test - less invasive). It is a good test and is indicated to see if you have an outflow problem. Sounds like you have some issues with your GB and it seems that these guys are suggesting the right course of action (but, please don't construe that as a second opinion
). Plus, if you have a laproscopic cholecystetomy (which is what I'm sure they're suggesting) and the lesion in your liver is amenable to biopsy via that route, then it's probably best just to be sure what's going on. Solitary liver nodules are actually fairly common and, unless there is a high-suspicion of occult malignancy in the absence of other findings, they usually prove to be nothing serious. Of course, the biopsy is the definintive test to rule that out. Did they do some blood marker tests as well, specifically CEA and CA 19-9? Would just be curious to know what those results are, if done. (If not, I wouldn't worry about it. The biopsy will tell you everything you need to know.)
epepke said:
No, not at all. I feel great. Except, of course, for the muscle mass that I lost in the hospital, but I was also in bad shape for a couple of years.
That's great. And, good to know you're losing weight. Very important to feeling better and, in fact, just being better and more healthy. Once you're 100% back up to speed, keep up whatever you've been doing that's made you feel better.
epepke said:
I really appreciate your information, and I reassure you that I'm not going to interpret it as medical advice or get sue-happy or anything like that.
No problem. And, I'm not really worried about
you suing me. But, unfortuntately, a lot of people are "sue happy" and it's just part of our training to be perhaps overly cautious when presenting information that can be interepreted and construed by
anyone as "advice" upon which they then rely. So, the caveats are there despite the fact that I'm not personally aware of anyone who's been successfully sued based on information presented on an Internet forum. Still, I don't want to be the first.
-TT
(edit: fix code)
