7 HOURS IN THE EMERGENCY DEPARTMENT & KELLY COMES HOME WITH A NEW DIAGNOSIS & TREATMENT

THIS PHOTO KIND OF SUMS UP THE WAITING FRUSTRATION
I wasn't able to make it all the way around the trail Wednesday morning but Kelly & Pheebs did. By the time they made it back to the house Kelly was worn out & the rest of her morning was spent laying on her bed & stretched out in her recliner. It was about 1:30 in the afternoon when Kelly came outside to where I was working on a little project & told me she felt sick & maybe it was time to head for the emergency room at the hospital. Minutes later we were on the road.

PHEEBS LOOKS LONGINGLY DOWN THE TRAIL BUT WE JUST COULDN’T MAKE IT THIS MORNING
The emergency room at the Goderich hospital was busy as we checked in. Took our seats & waited our turn which we knew was going to be quite awhile. Little did we know it would be after 9 p.m before we left that hospital for a second time. The first time came only an hour after we had been there when Kelly didn't want to wait any longer & just wanted to go home. She got up & informed the emergency desk lady she would come back the next day & headed out the door for the Jeep. Sitting in the parking lot across the road with my hand on the ignition key we had ourselves a 'little discussion'. Minutes later we were back inside only to learn Kelly's name had just been called while we were outside.

SPENT THE FIRST HOUR OF OUR WAIT IN THE MAIN WAITING ROOM
The check-in lady quickly slipped away from her desk for a minute, returned & told us to come right in. Kelly's blood pressure was checked & it was determined she still had a low grade fever. Questions were asked & we were immediately taken to one of the small examining rooms inside of the emergency room complex. Here, Kelly was at least able to lay down. It was just after 3 p.m. & we sat quietly in that room for the next 4 hours before things began to happen. It was a very, very, long wait. We both felt bad for Pheebe because her supper time is usually around 4:30 in the afternoon & it was now approaching 7. When we left home in the early afternoon we had no idea it was going to be dark out by the time we got home so we hadn't left any lights on & we knew the little Pheebs would be sitting there alone in the dark.
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Sometime between 6 & 7 Kelly was given an EKG test.  She was then wheeled out & taken for a chest X-ray. At last something was happening. That chest X-ray turned out to be the beginning of some flurried activity. A young Doctor in training with the Emergency room Doctor first came in carrying a clipboard & more medical questions. She was very pleasant & we had a feeling she was sincerely concerned. She left the room & conferred with her Doctor. Minutes later the emergency room Doctor entered & things began to happen. I recall at one point we had 5 medical people in the room. We liked Doctor SAMUEL APPAVOO right off the bat because we could tell he was a man of knowledgeable action, had a sense of humor, a caring way, & was determined to find out what was going on in Kelly's chest.

IV APPARATUS ALREADY IN KELLY’S ARM AS SHE AWAITS HER CAT SCAN
Vials of blood were immediately drawn & Doctor Appavoo did an ULTRA-SOUND with a small portable device he had with him. Obviously not satisfied with the results he returned a few minutes later wheeling in a much larger Ultra-Sound machine. Fluid around Kelly's heart was detected & he also told us the X-ray had revealed a widening of the problem compared to an X-ray taken a month ago. Kelly's suspected Pericarditis had grown from mild to moderate. Possibly a slightly enlarged heart as well. We had mentioned VALLEY FEVER to the trainee Doctor but she had never heard of Valley Fever. But Doctor Appavoo sure had. Turns out his Mother lives in Green Valley, Arizona. Blood was drawn a second time to be specifically tested for Valley Fever.
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Having seen fluid around the heart Kelly was immediately prepped for a CT Scan. An intravenous device was placed in her arm & she was wheeled out of the room, & down the hall for a scan in the big round donut machine. Twenty minutes later she was back where a second more in depth blood pressure test was conducted by a specialist. It was cold in the examining room & a nurse brought in a warm blanket for Kelly.

THE LARGER ULTRA-SOUND MACHINE WHERE WE COULD SEE INSIDE KELLY’S CHEST
It was sometime after 8 when the results from the CT Scan came in & Doctor Appavoo re-diagnosed Kelly's condition as a PLEURAL EFFUSION.   It had been Doctor Appavoo’s intention right from the start to determine if Kelly's condition was life threatening. The CT Scan showed Kelly's THORAX containing the heart & lungs to be OK & that put into action the Doctor's plan of treatment. It also meant Kelly would not have to be taken by ambulance to London or Stratford. Doctor Appavoo also contacted the Stratford Hospital & tracked down an Internist to set up an appointment for Kelly as soon as possible. Ironically when we arrived home later Thursday night there was a phone message from Kelly's Doctor saying they had finally set up an appointment with a Stratford Internist as well.

THE CLOCK ON THE WALL IN THESE PHOTOS KIND OF TELLS THE TALE
Although greatly discouraged by the long waiting time at the hospital we were very pleased by the caring staff & especially the 'take charge' Doctor. Today Kelly started on a drug called COLCHICINE as well as large doses of Ibuprofen.  Also a third pill prescription to protect her stomach lining.  Doctor Appavoo’s prognosis for Kelly's health improving is good & he feels a follow up with an Internist will be able to determine the initial cause of the problem, is anything else going on, & further tests if necessary. (* see bottom of post) At last we are at the root of Kelly's condition which has had her down since late March.  Originally thought to be a pulmonary embolism, then Pericarditis we are hoping we now have the correct diagnosis.  And we can't put all the blame on Canada's health care system for the long appointment waits. We have to share that blame with ourselves for not being more assertive, more forward, & more forceful with our concerns. But hey, we're Canadians eh:))

By late afternoon we were getting hungry sitting in that waiting room so figured as soon as we got out of there we would head for SWISS CHALET for supper.  By 8 Thursday night Kelly had lost her appetite & we realized it was way too late to be eating a big supper anyway.  Luckily for me I remembered where the cafeteria was in the hospital from my Town & Country mobility van driving days.  Knew it would be closed but maybe, just maybe……..  Headed myself down the hall to the darkened room.  Door was open & there in the corner sat a large food machine.  I stealthily entered & made my way up to the side of the huge whirring behemoth.  Peering around the corner I spied a lone turkey sandwich hiding within.  With a quick & calculated thrust into my pocket I came up with the right coinage & slipped it into the money slot before the dozing machine even realized I was there.  Pressed # 7, slid open a plastic door, firmly snagged the Turkey before it had time to bolt & quickly exited the area with prize in hand, soon to be prize in tummy.   And the turkey sandwich even had a sprig of lettuce & a slab of cheese on it.  Mission accomplished:))
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We sure had a big happy welcome home Wednesday night. Pheebs had been waiting patiently in the dark sitting at the living room window. Soon as we got out of the Jeep we could hear her racing around inside knocking all our furniture asunder with her furiously wagging tail. It had been a looooooong 7+ hours for her. So nice to be home with the Pheebs & so nice to be home with a diagnosis & treatment plan for Kelly under our belts. But OMG can you just imagine what this is going to do to our travel health insurance this Fall.   And they don’t even know about my hip problem yet.  We might have to sell the Winnie Wagon just to pay for the travel insurance.  That didn’t make much sense did it.  But, we'll cross that bridge when we get there. Right now we are just happy to be most of the way across a medical bridge that had been standing in our way since the end of last March.
 
BEST PALS:))
And it wasn’t until after Kelly looked up DR. APPAVOO'S PROFILE today that we realized how truly fortunate she was Wednesday to have been seen by the right Doctor. A shift change had occurred at the hospital while we were waiting & the hospital’s Chief of Staff, Dr. Appavoo was the man who walked into the examining room & got the ball rolling:))

DOCTOR SAMUEL APPAVOO, CHIEF OF STAFF AT THE GODERICH ALEXANDRIA MARINE HOSPITAL…AVID PILOT, BOATER, & MARTIAL ARTS FELLOW (no, I did not take this photo)
A quick update on today…… A cold drizzle made for a short morning walk.  Kelly was also feeling tiredly sick & I didn’t want to agitate my hip so it was just to the end of the Goose pond & back for both of us.  Soon as the Bayfield Pharmacy opened, Kelly was there to fill her prescriptions & get started on her Pleural Effusion treatment plan.  She also stopped in to her Doctor’s office & the earliest Internist appointment time they had set up was mid July & that was not acceptable.  Fortunately Dr. Appavoo’s call Wednesday night had produced results & with an affirmation phone call from Kelly to Stratford today Kelly has an appointment with Internist Dr. Tom Haffner at the Stratford General Hospital this coming Monday at 1:30 p.m.  We will be there:))  At the time of publishing this tonight at 8 p.m. Kelly was still feeling pretty rough with coughing & trouble breathing.  Hopefully by morning the medications will have begun turning things around for her………………………………

ALWAYS AMAZES ME HOW A PHARMACIST CAN READ A DOCTOR’S SCRATCHINGS
Soon as Kelly returned from the Pharmacy this morning she wolfed down her handful of pills & headed for her recliner.  Couldn’t stretch out on her bed because of the pain in her chest.   It wasn’t even 9:30 yet & she was already exhausted for the day.  Certainly not normal for the Energizer Bunny girl.  My hip was feeling good so I was able to whack some weeds outside plus do a little grass trimming for a neighbor before my Whacker’s battery ran out of juice.  All 4 spare batteries were juiced out as well.  I was also able to take Pheebs for a short walk in the afternoon & I finished the day free of any pain in my hip. 
KELLY CHECKS HER PRESCRIPTION INSTRUCTIONS >>>
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Below is Wednesday's post which I had started earlier in the day before we whisked ourselves off to the Goderich hospital's emergency department.......
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Upon my return from the movies Tuesday night I noticed some concern in my Shout Box about RV SUE'S site being down & suddenly not accessible. Folks were concerned as to Sue's well being. Also in the Shout Box was a note from Sue herself which stated, RVSue “I appreciate your concern. I've got an email in to WordPress for clarification. I suspect WP wants me to self-host which I've meant to do. So I signed up with Hostgator. I hope to have my blog up and running again soon”!------ Thanks for clearing that one up Sue. Not to sure what all that hosting stuff is about but it's good to see RV Sue is alive & well with a solution to her blogsite problem well under way. See, readers & fellow Bloggers do care:))

AW COME ON MOM, GET FEELING BETTER SO WE CAN HAVE A GAME OF TOYS
DARYL SCHULTZ from way down yonder in that Australia place has become our latest Blog Follower.  We welcome you aboard Daryl & thanks for tuning into us way over here on the other side of the world.

NICE TO SEE OUR ‘RED BUD’ TREE IN BLOOM ONCE AGAIN THIS SPRING
John Hatch had a Facebook question wondering if the motorcycle seen in Tuesday night's post is the one I now currently have. No, that was my second motorcycle which was a Yamaha Virago 750. Nice bike & I had it for over 10 years.

KELLY, MAX & I AT THE OLD FARM HOUSE WITH OUR 1984 VIRAGO 750 MOTORCYCLE … 2001
Right from the opening scenes of the Star Trek Into Darkness movie Tuesday night I & had a feeling it was not going to be the type of movie I had hoped it would be. And it wasn't. Hollywood has a standard formula for it's movies & knows what will bring hordes of young movie goers flooding to the box office. Simply pack as much violence into a movie as is possible & people will fill theater seats. Load the movie with fiery explosions, big noise, numerous tacky fight scenes, lots of guns whether they be bullets or lasers, & soap opera dialogue. For the masses it's a winning combination every time. People love this stuff & Hollywood just keeps turning up the schlock meter & laughing all the way to the bank. Might be a very long time before I take myself out to the movies again. I did think the actors playing Spock & Scotty did a very admirable job with their characters & of course I did like the Star Trek theme at the end as the credits came down. Best part of the night was getting myself out of the house for 3 hours & the nice moonlit drive home though the countryside after the movie. And was I thinking about the movie on the way home? Nope, I was just driving along thinking how much I really liked my little Jeep Wrangler:))

GROANER'S CORNER:(( If you think women are the weaker sex, try pulling the blankets back to your side!!
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- Tourists see the world, travelers experience it.
- Home is where your pet is:))
- "If having a soul means being able to feel
love and loyalty and gratitude, then animals
are better off than a lot of humans."
(James Herriot)
- The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails -William Arthur Ward
- The only thing better than right now will someday be the memories of right now...AL.
- It is not so much having nothing to do as it is not having the interest to do something....AL.
* Possible further tests… 
Thoracentesis should be performed in all patients with more than a minimal pleural effusion unless clinically evident heart failure is present.
Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with a needle (and sometimes a plastic catheter) inserted through the chest wall. Ultrasound pictures are often used to guide the placement of the needle. This pleural fluid may be sent to a lab to determine what may be causing the fluid to build up in the pleural space.
Normally only a small amount of pleural fluid is present in the pleural space. A build-up of excess pleural fluid (pleural effusion ) may be caused by many conditions, such as infection, inflammation, heart failure, or cancer. If a large amount of fluid is present, it may be hard to breathe. Fluid inside the pleural space may be found during a physical examination and is usually confirmed by a chest X-ray.

Why It Is Done

Thoracentesis may be done to:

• Find the cause of excess pleural fluid (pleural effusion).
• Relieve shortness of breath and pain caused by a pleural effusion.

Additional Info…
The first step in the evaluation of patients with pleural effusion is to determine whether the effusion is a transudate or an exudate. An exudative effusion is diagnosed if the patient meets Light’s criteria. The serum to pleural fluid protein or albumin gradients may help better categorize the occasional transudate misidentified as an exudate by these criteria. If the patient has a transudative effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative effusion, attempts should be made to define the etiology. Pneumonia, cancer, tuberculosis, and pulmonary embolism account for most exudative effusions. Many pleural fluid tests are useful in the differential diagnosis of exudative effusions. Other tests helpful for diagnosis include helical computed tomography and thoracoscopy.
Pleural effusion develops when morel fluid enters the pleural space than is removed. Potential mechanisms of fluid increased interstitial fluid in the lungs secondary to increased pulmonary capillary pressure (i.e., heart failure) or permeability (i.e., pneumonia); decreased intrapleural pressure (i.e., atelectasis); decreased plasma oncotic pressure (i.e., hypoalbuminemia); increased pleural membrane permeability and obstructed lymphatic flow (e.g., pleural malignancy or infection); diaphragmatic defects (i.e., hepatic hydrothorax); and thoracic duct rupture (i.e., chylothorax). Although many different diseases may cause pleural effusion, the most common causes in adults are heart failure, malignancy, pneumonia, tuberculosis, and pulmonary embolism, whereas pneumonia is the leading etiology in children.1,2
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