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It's Not Lupus

  • Sunday, March 15 2015 @ 12:18 MDT
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Chantelle Rants As the two or three of you who read my blog probably already know, I've been in hospital. It's been quite the week and I'm starting to feel like myself again. That said, I've been warned that I'm far from recovered and I have some long weeks ahead of me. Surprisingly, I'm feeling generally pretty positive.

This whole mess started last Wednesday evening. I got home from cadets, got ready for bed and then found that my back was aching so badly that I couldn't sleep. Specifically, the left side of my back. I eventually took a robax and got a few hours of sleep. I thought it odd that I hadn't fallen or done anything weird at the gym but I chalked it up to being 40 and being on the heavier side at the moment. By Thursday night, robax wasn't working anymore and I was curled up into a little ball. I called my dad to ask what his kidney stones felt like and then on his advice, had Jason drop me off at emergency. They couldn't find anything in my blood and urine to indicate kidney stones, so they sent me home with T3s and told me to see my GP. The pain was still terrible and the T3s didn't seem to be helping so my dad came down from Red Deer to take me to the doctor. My doctor also suspected kidney stones and gave me a new prescription and booked an ultra-sound for the next day. Dad took Simon back to Red Deer with him (it had originally been my plan to go to Red Deer for a visit but I was in no shape for it).

By 0100 hrs in the morning, the pain was getting worse and no combination of medication was helping in even the smallest way. Jason took me back to emergency at PLC. By this time, I was vomiting and they were able to get me in faster. They gave me a heavy painkiller and set up the second of what would be endless IV sites on my arms. More blood and urine was taken and a CT scan done. Just as the pain meds wore off, the doctor released me saying that it had to be muscular because they could find nothing. He gave me percocet. It did nothing.

Two hours later at around 0900 hrs on Saturday, Jason called the ambulance to take me back to PLC. The EMTs gassed me up and gave me morphine. It was my first ambulance ride as a patient. I noted to myself that ambulances had got very roomy since I was I kid and pondered if people got annoyed when the EMTs didn't use the sirens. The gas was working well.

I spent the afternoon curled up in a chair at PLC. My right side at least gave me some relief. Another IV, more samples. The doctor they sent me was a senior intern who also had her PHD in pathology, which I thought was neat. She took a more complete medical history (which for me was pretty short) and then headed back to try and figure out where all the pain was coming from. It was a crowded Saturday afternoon so Jason spent his time coming back to visit and going out to update my parents and other concerned friends. By the evening, the doctors had decided that as near they could tell, I had a kidney infection. They gave me some intravenous antibiotics and sent me home with more painkillers and a chit to go to out-patient at Foothills the next day for more antibiotics. I was starting to feel better and slept reasonably well.

Sunday, Jason and I expected to be at Foothills for a couple of hours and then head to Red Deer to get Simon. We showed up for appointment and when we were seen by the doctor, she informed us that they didn't think that it was a kidney infection and they wanted to do further testing. I was getting frustrated. The antibiotics were actually helping and I wasn't going to be getting them. The pain was starting to come back. The day passed at out-patient and I gave more blood and urine. At 1400 hrs, I was sent for another CT scan, this time one that required me to drink liquid every 15 minutes for two hours. I called my mom to let her know that they'd need to keep Simon for another day. The pain was now back and worse than before. I was getting annoyed and scared and it was made 100 times worse by the pain. Out-patient would be closed by the time we were done and we would have to go to Foothills emergency and wait to get in there. By the time I was having the CT scan done, lying on my back was excruciating and I sobbed through the whole test.

We checked in at emergency and Nadine kindly brought us food. Then we got called back. Another doctor informed me that they still hadn't seen anything on the CT scan but the one thing that kept showing up was that my white blood cell count was sky high, indicating some kind of infection but not in the kidneys. The next test was a blood culture test. “Have you had a blood culture test before”, asked Mary, the blood tech. “I don't think so,” I replied. “Oh, you'd know if you had,” she said, pulling out a bag that had what looked like four mini-bar bottles half filled with goo. The samples needed to come from two different locations. I think my arms had gone numb from needle pokes at this point.

The wait for an MRI seemed to take forever because my pain seemed to be getting even worse. We got to the lab and I was seriously wondering how I was going to manage to stay still for the test. The answer: I wasn't. I cried, I sobbed, I desperately tried not to move but in the end they had no choice but to put me out with painkillers and Ativan. Or maybe it was horse tranquilizers. I couldn't have cared less I just wanted the pain to stop. I remember very little from the hours that followed. We were in one room and I vaguely recall Jason trying to sleep in a chair and then I was in another room waiting to be admitted to my room.

Once admitted to a (thankfully) private room. I was told that I was suffering from a spinal epidural abscess and would be having surgery as soon as possible. You can check out the full details here:

https://www.youtube.com/watch?v=do-K1VWYhi4

http://www.cjem-online.ca/v7/n5/p351

From the linked article above:

“Spinal epidural abscess (SEA) occurs at an incidence rate of 0.22.8 cases per 10 000 hospital admissions.1-4 Predisposing factors include spinal surgery, recent trauma, immunosuppression, a distal site of infection and intravenous drug use;1-3,5-7 however, 20% of patients will have no clear predisposing factor.2 The typical symptoms of back pain and fever are common daily presenting complaints in the emergency department (ED); therefore the condition is easily missed if physicians fail to consider it in the differential diagnosis. Multiple ED visits and diagnostic delays occur in 68% of patients, contributing to a 45% morbidity rate and 15% mortality.1,7 We describe a patient with no significant predisposing factors who presented with the unusual chief complaint of urinary retention.”

I was in terrible pain again by the time my surgery arrived and I couldn't wait for them to put me under. I stood until the surgical team absolutely needed me to lie down and then quickly succumbed to the anesthesiologist.

In short, a show about a difficult differential diagnosis may be entertaining, but when you become the subject of an actual difficult differential diagnosis, it's a whole lot less so.

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