A Medical Summary post:
This guy and me had quite the 2 days. Yesterday he saw Nephrology who watched a video of Tomas' pain episodes and promptly sent him for a renal ultrasound to check for kidney stones. She also had some ideas on what could be causing his anemia and puffiness; awaiting labs for those.
The largest challenge is his blood pressure. His dilated root means Cardiology has set tight limits for his systolic pressure, and T is outside of them now. The nephrologis ... t said she could lower Tomas' blood pressure with a second BP med but wants Neurology's clearance first. Why?
Well, with the resurgence of the Intracranial Hypertension she needs to make sure she leaves his bp high enough to overcome the pressure in his head. If his blood pressure isn't higher than the pressure in his brain the blood wouldn't flow in.
So to be clear, the nephrologist has the challenge of bringing his blood pressure low enough to keep his aorta from dilating any further, and high enough to make sure that there is enough blood pressure to overcome the high intracranial pressure and get blood into his brain. I asked her how on earth she was going to walk that fine a line and she said, "With a lot of help."
That brings me to today. Good news is no stones, bad news is no idea what is going on. The urologist doesn't know, but also wants to talk with neuro. He wants to make sure T's intracranial pressure is well controlled (to rule that out as the source of pain), then trial Ditropan again. First as an enteral med, then if it works, we'll cath it straight into his bladder. That way it will only have an effect on the bladder (vs. a systemic anti-spasmodic). If it still works then we'll know it's bladder spasms and if it stops working then we'll know the Ditropan is working on some other muscle to control T's pain. If it never works in the first place then the whole shebang gets kicked over to GI in order to pull the J tube as a last ditch effort to stop the spasms. budget-saving homecoming wear that is below 50
The monkey wrench in all of this is that the pain might not be a GU or GI issue, but seeing as it started after the September surgery that's where were looking first and second.
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