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Challenges never cease

Yesterday, I was looking forward to making the trip 2 1/2 hours south to go pick up my daughter who I haven’t seen in far too long. We miss each other terribly but its been nearly impossible to get up the money to get there as far behind as everything had fallen. Well, the thrill of having my daughter back has been taken away from me yet again as I have been in the hospital since Wednesday with a very sudden onset of right lower lobe pneumonia. I have been unresponsive to most of the breathing treatments, antibiotics and steroids that they have been pumping me with. I was in such respiratory distress yesterday that the doctor strongly suggested intubating me for 48 hours and waking me up after 2 days of ICU treatment. Of course I fought it tooth and nail. He diagnosed me with COPD. My blood pressure upon arrival was stroke level 236/120. My blood sugar is running in the 200’s so I’m shooting insulin three times a day. I’m an unholy trifecta of health problems right now. I had been praying for healing but certainly did not have to go through all this to achieve it. I think I was hoping for more of a miracle than missed child, missed work, missed home. I just hope to God my daughter understands that my being away is not by choice, that I want us together but that I am still financially destitute and severely ill. I still, after all the treatment, cannot get out of bed without taking ten minutes to catch my breath. I don’t know how long I will be in hospital, but I need to start responding NOW to treatment.

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PerBlog April 10, 2013

Trying to come up with some radical new idea (ok, maybe “radical” in this day and age was a bad term) – a BIG new idea for research for my next FME article.  With everything happening in the news, I should not be at a loss for a topic, however my fear is that I will just come across as repeating the same news we’ve been hearing every day.  What would YOU like to read about, or hear a fresh view on?  Tell me in the comments!

Just to drop an update on myself, ever since my boss passed away on December 28th and the company subsequently closed on January 2, I have been seeking work.  For 3 1/2 months, I have been living on my tax return and the grace of friends and charity however that is all running out quickly.  If I don’t find viable work *this month* I will be facing very dire circumstances.  

The stress of this has caused my blood pressure to shoot up as the worry is constantly there, 24/7, and I have rarely been able to sleep at night for the past couple months.  A week and a half ago, I ended up having to break down and go to the doctor with the joints in my right wrist severely inflamed – I was unable to move my wrist, hand or fingers at all.  The wrist was treated and cleared up in a matter of days with a brace and a prescription anti-inflammatory but we still don’t know the cause of it.  X-rays showed no fracture, blood tests showed no elevated uric acid and therefore no possibility of gout, and the doctor also ruled out arthritis.  It remains an excruciating mystery but at least I have leftover meds to treat it should it recur. 

While at that doctor visit, whereas the wrist was treated quickly enough, the focus of the visit quickly turned to my blood pressure when my vitals were taken.  Back to that – my BP was 210/140.  YIKES!  The doc immediately gave me a Clonidine and told me to go to the emergency room however if you’ve ever read my previous post about Lawnwood Regional, you’ll understand why I was loathe to even consider stopping in there.  In the end, I did not go to the ER, taking the prescription for Clonidine and hoping that would start to lower my numbers.

Like an idiot, I started right in on the full prescribed dose.  Had I remembered the problems I had when starting on another BP med several years ago (heart rate below 60, fainting, inability to walk more than a few feet without severe difficulty in breathing), I would have started small and worked my way up to the full dose.  The first 3 days of full-dosing this time, same thing.  I was fainting, could barely breathe due to very slow heart rate, and (thankfully this was over the weekend) was barely able to stay awake for more than a couple hours at a time.  My thinking and reaction times were very slow so driving anywhere was NOT an option.  By that Monday, I was vomiting and fainting and I stopped the med completely (another stupid thing, but I did consider how my BP would shoot up in doing so). I called my doctor and told him I *have* to do this my way.  By stepping the dose up slowly over the next few days, I was fine on the prescribed dose.  Hitting my system all at once though is something my body just couldn’t handle.  

In taking my BP every couple days over a week and a half, I saw the numbers were going down but not nearly enough.  I called the doc and reported the latest readings and he still *insisted* that I go to the ER.  It was either that or drop another $60 at his office to be seen for another reading and a dose adjustment.  I did not have $60, I’d just dropped my entire unemployment check at his office at the initial visit, so this time I had no choice – I had to go to Lawnwood. 

Checking into the ER, my initial reading put the staff on alert:  240/120 – Hypertensive Crisis.  The previous afternoon’s reading was around 203/116 – I am willing to bet that just the thought of having to go to this hospital spiked it.  Immediately, I was in a bed hooked up to a monitor, getting about a dozen vials of blood drawn, the works.  The odd thing is, I *felt* fine, but this is why they call hypertension “The Silent Killer.”  They ended up doing a chest X-ray on me and an EKG.  Bloodwork came up clear, X-ray came up clear, I don’t know what the EKG said.  After receiving additional medication, 3 hours later my BP had reduced to 174/91 – the lowest it’s been since this whole ordeal started.  That was enough for them to discharge me with two new medications in a combo pill to be added to my original one.  

Because of the urgency in getting those numbers down to stay, I have gone headfirst into the full dose of the new med(s).  Since I lack a way of checking my BP at home (can not afford a home device), I have to go to a pharmacy or a fire station to get it checked for free.  Driving right now is not an option, so it’ll have to wait until my head clears from the new med.  What a headache this has all been, especially thinking of all the medical bills when I’m trying to survive on a tiny unemployment check that pays my rent but nothing else 😦

 

Severe acute ear infection – The pain is intense…

Friday night began with my noticing swollen glands on both sides of my neck, under the ears.  They were roughly pea-sized and did not hurt.  Given a few hours however, they had quickly grown to small marble-sized and it became painful to turn my head all the way to the side.

By Saturday morning, the glands had grown even larger and more tender, with the area in front of my right ear now having a hard knot of swelling.  Now the real pain was starting to set in — so I thought.  At A.H.’s house for the day, the pain nearly had me in tears.  She gave me ear drops with Benzocaine in them.  They made the ear start hurting worse.  Not supposed to happen that way.

As the day progressed, I was nearly in tears.  The side of my face had started to swell and could not be even gently touched.  A.H. gave me an IB800 and an anti-biotic (I’d taken Biaxin prior for a bad sinus infection and from what I remember, it kicked the shit out of it — I now have a full 7-day course of it).  An hour later and with the pain still worsening, C.H. gave me a hot towel to put over the area.  I don’t know if the IB finally kicked in, or if the heat helped, but the pain finally started to lessen.

I got home and the IB wore off.  Oh my gods.  I had to go to bed early, I couldn’t take it.  My daughter was lovely enough to bed down herself, seeing how much obvious pain I was in, but first came to quietly rub my back asking me if there was anything she could do to take the pain away.  Oh I love her so much.  By then I was in tears with another hot towel, having taken another 600mg of Ibuprofen and another Biaxin before lying down.  She attempted her Reiki, but I could not stand even the slightest touch, so she let me be.

Every two hours, I woke up, the pain worse each time.  I have gotten scarcely any sleep.  The right side of my face feels like it is on fire from my eye to my jaw.  I could barely open my mouth enough this morning to take another 800 of IB and another antibiotic.  Talking and smoking a cigarette are out of the question.  Taking a drink of tea just about floored me.  Even putting my glasses on is painful.  The swelling can only be described as horrendous.  The pain – just flat out intense.  I had a lot of ear infections as a child, and have had surgery on both ears a total of 7 times as a child.  I don’t remember *any* of my ear infections causing this much swelling and pain though.

I hope to God the meds I took this morning start working soon.  It’s almost unbearable.

Confiding in a dear friend last night, he tells me it sounds bacterial, and that the antibiotics should start working within 48 hours.  He says if it’s the “right type of bacteria,” then the Biaxin will work.  He is near deaf in one ear because of all the ear infections he had as a kid.  I have about 40% hearing loss due to all my ear infections and subsequent operations (tubes, etc).

My official diagnosis and patient info-sheet states:

Otitis externa

Also known as external otitis and swimmer’s ear, otitis externa is an inflammation of the skin of the external ear canal and auricle. It may be acute or chronic, and it’s most common in the summer. With treatment, acute otitis externa usually subsides within 7 days (although it may become chronic) and tends to recur.

Causes

Otitis externa usually results from bacterial infection with an organism, such as Pseudomonas, Proteus vulgaris, streptococci, or Staphylococcus aureus; sometimes it stems from a fungus, such as Aspergillus niger or Candida albicans (fungal otitis externa is most common in the tropics). Occasionally, chronic otitis externa results from dermatologic conditions, such as seborrhea or psoriasis. Predisposing factors include:

❑  swimming in contaminated water (cerumen creates a culture medium for the waterborne organism)

❑  cleaning the ear canal with a cotton swab, bobby pin, finger, or other foreign objects (irritates the ear canal and may introduce the infecting microorganism)

❑  exposure to dust, hair care products, or other irritants (causes the patient to scratch his ear, excoriating the auricle and canal)

❑  regular use of earphones, earplugs, or earmuffs (traps moisture in the ear canal, creating a culture medium for infection)

❑  chronic drainage from a perforated tympanic membrane.

Signs and symptoms

Acute otitis externa characteristically produces moderate to severe pain that’s exacerbated by manipulation of the auricle or tragus, clenching of the teeth, opening of the mouth, or chewing. Other signs and symptoms include fever, foul-smelling aural discharge, regional cellulitis, and partial hearing loss.

Fungal otitis externa may be asymptomatic, although A. niger produces a black or gray blotting paper–like growth in the ear canal. With chronic otitis externa, pruritus replaces pain, which may lead to scaling and skin thickening with a resultant narrowing of the lumen. An aural discharge may also occur. Asteatosis (lack of cerumen) is common.

Diagnosis

Physical examination confirms otitis externa. With acute otitis externa, otoscopy reveals a swollen external ear canal (sometimes to the point of complete closure), periauricular lymphadenopathy (tender nodes in front of the tragus, behind the ear, or in the upper neck) and, occasionally, regional cellulitis.

With fungal otitis externa, removal of growth shows thick red epithelium. Microscopic examination or culture and sensitivity tests can identify the causative organism and determine antibiotic treatment. Pain on palpation of the tragus or auricle distinguishes acute otitis externa from otitis media.

With chronic otitis externa, physical examination shows thick red epithelium in the ear canal. Severe chronic otitis externa may reflect underlying diabetes mellitus, hypothyroidism, or nephritis.

Treatment

Treatment varies, depending on the type of otitis externa.

Acute otitis externa

To relieve the pain of acute otitis externa, treatment includes heat therapy to the periauricular region (heat lamp; hot, damp compresses; heating pad), aspirin or acetaminophen, and codeine. Instillation of antibiotic eardrops (with or without hydrocortisone) follows cleaning of the ear and removal of debris. If fever persists or regional cellulitis develops, a systemic antibiotic is necessary.

Fungal otitis externa

As with other forms of this disorder, fungal otitis externa necessitates careful cleaning of the ear. Application of a keratolytic or 2% salicylic acid in cream containing nystatin may help treat otitis externa resulting from candidal organisms.

Instillation of slightly acidic eardrops creates an unfavorable environment in the ear canal for most fungi as well as Pseudomonas.

Chronic otitis externa

Primary treatment involves cleaning the ear and removing debris. Supplemental therapy includes instillation of antibiotic eardrops or application of antibiotic ointment or cream (neomycin, bacitracin, or polymyxin, possibly combined with hydrocortisone). Another ointment contains phenol, salicylic acid, precipitated sulfur, and petroleum jelly and produces exfoliative and antipruritic effects.

For mild chronic otitis externa, treatment may include instilling antibiotic eardrops once or twice weekly and wearing specially fitted earplugs while showering, shampooing, or swimming.

Special considerations

If the patient has acute otitis externa:

❑  Monitor vital signs, particularly temperature. Watch for and record the type and amount of aural drainage.

❑  Remove debris, gently clean the ear canal, and then dry gently but thoroughly. (With severe otitis externa, cleaning may be delayed until after initial treatment with antibiotic eardrops.)

❑  To instill eardrops in an adult, pull the pinna upward and backward to straighten the canal. For children, pull the pinna downward and backward. To ensure that the drops reach the epithelium, insert a wisp of cotton moistened with eardrops.

To prevent otitis externa:

❑  Suggest that the patient use custom-fitted earplugs to keep water out of his ears when showering, shampooing, or swimming.

❑  Warn the patient against putting any objects in his ears, such as cleaning the ears with cotton swabs or other objects.

❑  Urge prompt treatment of otitis media to prevent perforation of the tympanic membrane.

❑  If the patient is diabetic or immunocompromised, evaluate him for malignant otitis externa (drainage, hearing loss, ear pain, itching, fever). Appropriate treatments include antibiotics and surgical debridement.