Rush University Medical Center is part of an international effort to evaluate the effectiveness of a screening test that may provide early detection of lung cancer. Known as the International Early Lung Cancer Action Project (I-ELCAP), the collaboration brings together 48 major academic medical centers in nine countries. 

Physicians at Rush will study the use of spiral computerized tomography (CT) scanning to detect tiny nodules in the lungs that could be cancer in its earliest stages.  CT scans can detect tumors that are smaller than a pea and previous research has shown CT scans can detect lung cancer growths that are often not visible on a chest x-ray.  Unfortunately, by the time tumors are large enough to be viewed on a chest x-ray, the cancer is often too advanced to be cured.

The CT lung screening means to lung cancer what mammogram screening means to breast cancer,” said Dr. Mark Yoder, the lead investigator of the study and assistant professor of pulmonary and critical care at Rush. 

Dr. Mark Yoder, pulmonologist and study lead investigator, and Dr. Palmi Shah, study radiologist, Rush University Medical Center, reviewing lung scans.

“The goal of this study is to see if we can detect and diagnose lung cancers in the very earliest stage.  Stage one is the only stage at which cure by surgery is highly likely,”  said Yoder.

Physicians across the country have been debating the effectiveness of using CT scans for early detection of lung cancer, but recent research studies have provided promising evidence that CT screening for lung cancer could offer new hope for millions of people at risk for this disease.  Two recent modeling studies have shown that low-dose CT screening of a high-risk population may result in a reduction of lung cancer deaths comparable to what mammography screening has done to reduce deaths from breast cancer.  The technology is not an approved modality for lung cancer screening, but has proven to be a potent visualization tool.

“Lung cancer is a very common and deadly disease and the way it is treated now is very disappointing. This study evaluates how safely we can deliver lung cancer screening care,” said Yoder.  “We want to optimally manage early lung cancer.”

According to Yoder, Rush researchers are also looking at the relationship of developing lung cancer in individuals with COPD (chronic obstructive lung disease), a disorder that usually indicates a person is particularly sensitive to the damaging effects of cigarette smoke. 

“This technology may help cut down on the number of lung cancer deaths by allowing physicians to catch the disease early and surgically remove the lesions before they grow and spread through the body,” said Dr. Philip Bonomi, director of the division of hematology and oncology at Rush University Medical Center.  “This test could possibly be an important tool in fighting lung cancer, which has a dismal five year survival rate of only 15 percent.”

If the study radiologist at Rush, Dr. Palmi Shah, detects an abnormal looking nodule, the multi-disciplinary lung cancer screening team will determine the appropriate next step.  Most often, that means a repeat CT scan in 3-12 months.  Very rarely, a sample of the nodule will be obtained by specially trained radiologists or thoracic surgeons on the team. 

One of the ongoing goals of the study is to continue to refine the screening process in order to minimize the number of unnecessary biopsies that are performed.  Patients identified as having an abnormal CT will receive follow-up care with a study physician at Rush, and those with normal scans will be invited to continue screening on an annual basis. 

Lung cancer is the leading cause of cancer deaths in the United States, accounting for nearly 30 percent of all cancer deaths, according to the American Cancer Society.  An estimated 215,000 new cases of lung cancer were diagnosed in the U.S. in 2008.  Unlike breast, prostate and other cancers, there are no tools to diagnose lung cancer early. 

Rush is seeking participants who are current or former smokers and who are 50 years of age or older.  For more information about the study, please contact Josephine Volgi, study coordinator, at 312-563-2741.

Friends,

The capitalist, American system of healthcare may not need fixing, however certain hospitals, especially Riverside Hospital in Newport News, Va., are in need of a major system overhaul.  The following are my list of complaints about my recent treatment at the Riverside emergency room:

1. Upon entering, with an non-urgent complaint of chest pains, the staff admitted me with considerable swiftness, never mentioning the municipal health clinic next door, which could have potentially offered some of the non-essential services under its relegated services.

2. The doctor ordered an EKG, a chest X-ray, and multiple blood tests and could not find any circulation problems, despite the fact that heart disease has been present in my tissue since March of this year.  I told the doctor I had been smoking about 3 packs of cigarettes a day for quite some years, however, he made no mention or thought of heart disease.

3. I overheard the doctor discussing my case with one of the nurses, describing his search for drug metabolites in my blood. I heard the nurse ask him if he looked for “crystal meth.”

4. After being laid up in an emergency room bed for 6 hours, I grew restless and wanting of a cigarette. I asked an orderly or nurse or some employee if I could go out for a cigarette.  The Riverside employee told me that my discharge papers were being processed and would soon be given over to me.  She directed me to a counter at which to ask for them. However, the Riverside employee behind the inner-emergency room counter told me that the doctor was not finished with me yet.

5. Knowing the costs of uninsured hospital visits, I refused further tests as I did not want to “rack up thousands” of dollars on a doctor who doesn’t even know what he is looking for.

6. Now, I’m getting 3 separate bills from three separate companies all using “Riverside” in their name. Which one am I supposed to pay?

The argument is thus: Hospitals are treating patients as if they are regulars there. The employees of Riverside Hospital in Newport News, Virginia do not take into account the interests of those who only resort to hospitals when danger is threatening.

That’s it.

Truly yours,

Rice Cutgrass

Posted Jul 9, 2009 2:43pm

Posted Jul 1, 2009 9:15am

I will suggest few basic things to carry with you if you are flying to UK for the first time. Some of them are generic, whereas few of them are very much situation/person specific. I have tried to make the list as exhaustive as possible. Please choose items depending on your requirement. Also feel free to write to me in case you think I have missed anything.

1)  Some basic utensils in case you are planning to cook or not sure if you would like or can afford eating out everyday. Though the british food is little bland, thanks to all cosmopolitan environment, you will find different cuisines. If you are going to stay in London or some big town then you will prominently find Indian/Asian restaurants and take-aways for spice lovers. If you are going to a small size town or country side then I will strongly recommend you to be prepapred to cook your own food as you might not find many multi-cultured cuisines.

For those who dont know cooking, I will suggest to take some basic lessons of cooking, at least  some easy dishes. For Indians/Pakistanis learning some rice, dal and currys might help you for some days till you find an alternative.

Utensils can contain -

A Pressure cooker

– a must, as it is not very common in UK, you might get one in some Asian area but quite costly.

Kadhai

– Depends on personal choice

Frying pan

– good to have.

1/2 dishes, bowls, glasses – Depends on personal choice. Though houses in UK have these things if you rent complete house, in shared houses you will need your own. Else you will have to rush for shopping the day you land.

2)

Ready to eat

packets – Nowadays, there are lots of brands with multiple ready-to-eat/ready-to-cook dishes. I will be a good idea to carry 8-10 packets with you, so that you dont have to worry or spend too much time in grocery shopping and cooking on the day you land. It keeps you sorted till you settle down and find shops in your area. Please note that though shops in London are open for most of the day, shops in small towns and country side remain open only till 5 p.m. or 6 p.m. So you might have to wait till weekend to go shopping, in case you are going to be busy from next day you land in UK.

3)  Depending on your food habits, it is a good idea to carry some basic groceries like rice, dal, noodles, spices, some sugar, ketchup/tomato sauce, coffee sachets, pickle and chutney. Also include maggi noodles packets if you like.

4) I would also suggest you to carry some basic medicines with consultation from your doctor and appropriate prescription. As healthcare in UK is very much different than other countries. UK has NHS (). Click on the link to know more about NHS.

5)  Some books or ipod, songs loaded in your mobile phone for entertainment. You may also want to include entertaining things depending on your hobbies and interests like musical instruments etc. This is a must epsecially if you are arriving in UK for the first time in any month between September and March. During this period day light is less and weather is cold and rainy, which makes life dull and boring.

6)  Thermal wears, winter clothes and jackets are must if you are traveling in between September and March.

7) Necessary day-to-day clothes. UK has different clothing styles depending on the season, i.e. summer, winter etc.  I will be writing briefly about the same soon.

‘8)’ Good quality trainers/Sports shoes are good to have, especially during winter months. In case you are travelling during months of March to September, then remember to carry a pair of sandals or chappals as heat wave makes it painful to wear shoes or trainers.

9) Iron – If you are travelling on a short trip, then you might not need to carry an iron. Just a word of caution – Laundries are quite costly in this country even to get your clothes ironed. So you might want to consider carrying an iron.

10)

Chest X-Ray

– A must have. Make sure that you get done chest x-ray, which is no older than 7 calendar days before you fly. This is a must have at the immigration desk when you land. Not having one, might delay your immigration process.

Make sure that you have arranged for an accommodation and booked a taxi/bus or mode of travelling to your designation from the airport you are landing. Taking a taxi after landing might turn out to be costlier than you think.

That’s what a healthy lung looks like under an x-ray.  Not often you see a healthy lung x-ray.

I haven’t given an update on my health in a while, so . . .

Last Tuesday I had a chest x-ray and a bone scan.  They were scheduled because the doctor knows that my kind of advanced breast cancer has a tendancy to migrate and metastasize to other areas, particularly the bones and lungs in my case.  GOOD NEWS:  both the x-ray and the bone scan were negative!  The cancer has not spread beyond the left breast and bone marrow.  For this, I give thanks!!!

On Wednesday, I saw my oncologist and had another chemo treatment.  The blood work showed that my platelets had fallen to 59.  This, of course, was not the news we had hoped to see considering last week they were 67.  However, this fall is not uncommon as we found out last summer during the first round of chemo when it seemed that almost every other week we’d have a decrease in the platelet count.  Then the following week, there would be an increase.  A little bit like the old saying, “One step forward and two steps back.”  Eventually, we made it into the normal range, which we anticipate this time around too.  The doctor has decided not to continue checking the blood work every week though.  Seems my hemoglobin count is falling due to all the blood taken for these lab readings, and because I continue to have nose bleeds – some of them quite difficult to stop.  Hopefully taking blood work only every other week will give me a chance to get stronger, make more blood, and feel a little better. 

This round of chemo has been far more difficult than the last one.  More nausea and more weakness.  I’ve had to lean on John more which I hate, but he is my rock and always encouraging me to do what I need to do.  What would I ever do without him?  He was God’s gift to me almost 29 years ago, and it’s the gift that has gotten better every year that we’ve been together.  I love him so much.

The Lord is good.  He is merciful.  He is seeing me through this every single day with a love that I have only come to be more and more completely awed by.  His love is perfect in every way, and tailored specifically for what He knows I need at just the moment I need it most. 

By Calvin Palmer

A Minnesota judge today ruled that 13-year-old boy suffering from cancer must seek conventional medical treatment instead of the parents’ choice of alternative medicines based on their religious beliefs.

In a 58-page ruling, Brown Brown County District Judge John Rodenberg found that Daniel Hauser, of Sleepy Eye in southwestern Minnesota, has been “medically neglected” and is in need of child protection services.

He allowed Daniel to remain in the custody of his parents, Colleen and Anthony Hauser, but only if they get a chest X-ray for their son and select an oncologist. The judge set a deadline of May 19.

Daniel’s court-appointed attorney, Philip Elbert, called the decision unfortunate.

“I feel it’s a blow to families,” he said. “It marginalizes the decisions that parents face every day in regard to their children’s medical care. It really affirms the role that big government is better at making our decisions for us.”

Elbert said he had not spoken to his client yet.

The parents’ attorney, Calvin Johnson, said they will comply for now but are considering an appeal.

In a written statement Johnson said: “The Hausers believe that the injection of chemotherapy into Danny Hauser amounts to an assault upon his body, and torture when it occurs over a long period of time.

“They believe that it is against the spiritual law to invade the consciousness of another person without their permission. Danny feels healthy, and is anxious to continue on with his present course of healing.”

Daniel was diagnosed with Hodgkin’s lymphoma and stopped chemotherapy in February after a single treatment. He and his parents opted instead for “alternative medicines” favored by the Nemenhah Band, a Missouri-based religious group that believes in natural healing methods advocated by some American Indians.

At a court hearing in New Ulm last week, Daniel’s mother insisted the boy would not submit to chemotherapy for religious reasons and she said she would not comply if the court orders it.

“My son is not in any medical danger at this point,” Colleen Hauser told the court hearing. She also testified that Daniel is a medicine man and elder in the Nemenhah Band.

Cancer specialists from Children’s Hospitals & Clinics of Minnesota and the Mayo Clinic testified that Daniel had a 90 percent chance of surviving with chemotherapy and radiation, but likely will die within five years without it.

After the first chemotherapy treatment, the family said they wanted a second opinion, said Dr. Bruce Bostrom, a pediatric oncologist who recommended Daniel undergo chemotherapy and radiation. They later informed him that Daniel would not undergo any more chemotherapy.

Bostrom said Daniel’s tumor shrunk after the first chemotherapy session, but X-rays show it has grown since he stopped the chemotherapy.

Johnson said Daniel made the decision himself to refuse chemotherapy, but Brown County said he did not have an understanding of what it meant to be a medicine man or an elder.

Court filings also indicate Daniel has a learning disability and cannot read.

The Hausers have eight children. Colleen Hauser said that the family’s Catholicism and adherence to the Nemenhah Band are not in conflict and she has used natural remedies to treat illness.

Nemenhah was founded in the 1990s by Philip Cloudpiler Landis, who said yesterday he once served four months in prison in Idaho for fraud related to advocating natural remedies.

Landis said he founded the faith after facing his diagnosis of a cancer similar to Daniel Hauser. He said he treated it with diet choices, visits to a sweat lodge and other natural remedies.

[Based on reports by the Associated Press and Minneapolis Star Tribune.]

***SCUT REPORT: CHEST X-RAY (Updated 04/29/09)***

I like chest x-rays. They make me feel warm and fuzzy inside. So much so, in fact, that I’ve created this nifty little reference sheet. Please note, however, that I am not a radiologist nor do I play one on TV. In fact, at the time I am writing this, I’m not technically a doctor yet. One more month. But that’s beside the point. I’ve made this “scut report” mainly for medical students. If you’re a resident or smarter, than this probably isn’t much use for you. Also, if you’re a medical student, you really need to have some basic understanding of chest x-rays to make the most of this. You should also realize that there are many different methods to read a chest x-ray. This “scut report” only describes the one that I currently use.

To be clear, there are gobs of chest x-ray resources online. There are also these antique things called “books” that contain useful information. If you really want to learn chest x-rays, first try some of the resources below. After that, come back here and download my quick reference sheet if you want.

Chest X-Ray Resources:

• Chest Radiography: A Systematic Approach to Interpretation
• Approach to Reading a Chest Radiograph
• Approach to the CXR
• The Medical Student’s Guide to the Plain Chest Film
• ChestX-ray.com
• LearningRadiology.com – Fundamentals of Roentgenology
• Chest Radiograph Evaluation and Interpretation
• Interpreting Chest X-Rays
• Basics of Chest X-Ray Interpretation
• Differential Diagnosis in Conventional Radiology
• And a… *grasp*… book: Felson’s Principles of Chest Roentgenology

And now what you’ve all been waiting for:

***SCUT REPORT: CHEST X-RAY (Updated 04/29/09)***

I plan to continue occasionally updating this reference sheet as needed, or rather as smarter people tell me to change something.

Lastly, as with anything of mine, if you have any suggestions on how to improve this “scut report”, please let me know. I am grateful for any constructive feedback.

My journey for radical nephrectomy at Mumbai in India was just amazing!!!! Three years before, I went there for my surgical removal of kidney. Nephrectomy is surgical removal of kidney, along with its collecting system i.e. renal pelvis and ureter. It is a surgical procedure for the removal of a kidney or section of a kidney. It is performed on patients with severe kidney damage from disease, injury, or congenital conditions. These include cancer of the kidney; polycystic kidney disease; and serious kidney infections. It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation. It may involve removing a small portion of the kidney or the entire organ and surrounding tissues. In partial nephrectomy, only the diseased or infected portion of the kidney is removed. Radical nephrectomy involves removing the entire kidney, a section of the tube leading to the bladder, the gland that sits atop the kidney, and the fatty tissue surrounding the kidney. A simple nephrectomy performed for living donor transplant purposes requires removal of the kidney and a section of the attached ureter.

My doctor told me that I will be heavily charged for this surgery in UAE as the medical infrastructure is so costly. He suggested me to go India for radical nephrectomy as the medical healthcare groups over there are providing surgeries at a very affordable cost. Having heard much of India, both as a great vacation destination and a place where excellent dental and other medical services are extensively available at a reasonable cost, India became my choice. I researched several websites based in India. Two healthcare groups in India caught my attention, I was particularly drawn to Forerunners Healthcare Consultants, a medical healthcare group because the website answered most of my questions and I liked the fact that my point of contact was with an English person.  Furthermore, there was information about flights from the UK; pick up’s from the airport and hotel accommodation reservations.  These things, along with some of the comments of former clients, gave me the confidence to proceed. And found their site to be the most sophisticated and informative. Why, because their website visually was presented in a very analytical, (the way scientists think), typo free, easy to navigate, informative way. I e-mailed Dr. Dheeraj Bojwani. I reported the extent of my problems and also that I only had about a week to get the work completed. Was it possible? My answer came back the next day as a very friendly and helpful reply from Dr Dheeraj Bojwani. Not only was it possible, he suggested who to contact for accommodations and assured me concerning other issues. Radical nephrectomy at Mumbai in India is becoming very popular among international patients just because of cost consideration.  

I arrived in India and was scheduled to be picked up at my hotel. The wonderful representative of that medical healthcare group was there promptly with a brand new mini van to whisk me away and he quickly dispersed any nervousness I had with his cheerful personality. On the drive from the airport I noticed that parts of the city were covered in graffiti. I was worried about cleanliness and hygiene. I told myself that if I wasn’t happy with the situation when I reached the surgeon’s I would not have any treatment. My fears on arriving at the clinic were quickly alleviated. It was so clean, professional and empathetic. From the time of my arrival to my departure, the time elapsed was 9 days. During that period I was picked up at my hotel every day. This company seemed to provide the most suitable and professional package, which included a lovely hotel in the middle of City; taking less than 2 hours to get there. The clinic was located near the hotel and has the latest technical equipment and the most professional staff.  I was scheduled for treatment. On arrival at the clinic, the work started almost immediately. My first observation on day one was the harmony between doctor and his staff of doctors and assistants. In a very short time I felt that harmony extended to me; I felt more like a family member than a patient.

During my post operative operations, it was extremely crucial for mysurgeon to assess my kidney function before radical nephrectomy. A thorough physical examination, ECG, chest x-ray, complete blood profile, complete kidney profile, pulmonary function tests, blood gas analysis, blood typing and cross matching was done in case transfusion was required. Specialized tests like intravenous pyelography, Cystoscopy / Ureteroscopy, retrograde pyelography, cystourethrography, CT scan, ultrasonography, MRI, renal angiography and renal venography was performed for complete anatomic assessment. I was hospitalized at least one day before the surgery. I informed my surgeon about my other health conditions and medications. I refrained from taking aspirin or Ibuprofen at least 2 weeks before the surgery. I do not ate or drink any thing for at least 10 – 12 hours before the surgery.

My surgery was performed under general anesthesia. Abdominal approach was anterior subcostal, thoracoabdominal, or flank approach. The kidney was dissected free of its attachments. The renal artery and vein were dissected and cut, ureter was cut and the adrenal gland was freed and removed along with the kidney. A drain was left in and the wound was closed. It was a minimally invasive procedure in which the kidney was removed by making four small incisions. Surgical instruments were used to free the kidney from its surrounding structures and the kidney was removed through an incision in the front of the abdominal wall below the navel. The renal artery, renal vein and the ureter are then tied off and the incision was sutured. It took up to three hours.

Following radical nephrectomy, I spend the next few hours in the recovery room to monitor my heart and lung function and also to check for any immediate post operative complications like excessive bleeding. I was hospitalized for about 5 – 7 days and those days were quite painful and uncomfortable. I was prescribed pain medication to cope with the pain. As with all other major surgeries, I was encouraged to do deep breathing and coughing exercises following the surgery. I avoided strenuous activities, heavy lifting and playing sports for 2 – 3 weeks after radical nephrectomy. I was able to return to my daily activities in 4 – 6 weeks. My renal function was monitored closely to make sure that one kidney can take over and compensate for the loss of the removed kidney.

Everyone involved in my treatment exhibited a high degree of professionalism, which demonstrated the pride and joy they have in their chosen professions. The end result was very much above my expectations. They changed my life, gave me my smile back, and the experience of a life time with their warm hearted generosity and care. I consider them friends for life. They organized a tour which included Agra and Goa.   Even if I could have afforded to have the treatment in the UAE I wouldn’t have been as happy as I am with the whole service and experience that I had in India at Mumbai for my radical nephrectomy. High quality and affordable surgery were my priority and these were provided to me complete satisfaction by Forerunners Healthcare. Although I live in UAE, I preferred to have the treatment in India because it costed me much less compare to UAE prices. I’m admired by surgeon’s work, Indian work environment and professional staff. Good weather, costs and love of Indian food were the deciding factors to get my radical nephrectomy at Mumbai in India.

I’ve been absent. 

For some crazy reason, I decided to make all our gifts this Christmas.  So I’ve been busy, busy, busy sewing, baking, concocting, and knitting.   

Norah turned three this month and with the grand old age of three years, she also turned chatterbox.  Seriously.  We obliged her wish for a “blueberry birthday” and celebrated with our family.  Thank you Zach for the amazing blueberry smoothies.  Thank you Broomes for the incredible blueberry bush.  Thank you mom and dad for letting us use your house.  Thank you everyone for the precious time together and of course, Norah thanks you for her gifts!

One quick story before I get back to the gift making:  Norah had her very first sick visit to the doctor.  I was furious because our oh-so-carefully-selected-for-this-very-reason family doctor could not fit her in and told us to go to urgent care.  !!$&*#&@!!  Incidentally, earlier this year, they could not see my husband when we thought he smashed his face in a kayak accident.  That was an urgent care trip, too.  I thought this is why we HAD a family doctor!   

At urgent care, we were honored by the extraordinarily brief presence of a doctor who had consumed way too much coffee and barely looked at Norah before ordering a chest x-ray.  

After the chest x-ray (which was clear), the not-on-a-caffeine-buzz technician showed Norah her heart.  Norah squinted at the x-rays, paused a moment, then asked “But where is Jesus?”   

Yesterday (Nov. 17, 2008) I spent the morning at St. Vincents Carmel hospital getting my pre-operative testing done for the upcoming December 2nd Roux-en-Y surgery.  Of course this meant that I was not allowed to have had anything to eat or drink after midnight… typically standard.  I got there about a half hour earlier (8:15) than when I really needed to be there (8:45).  Went through the check-in and pre-registration process for the surgery then prepared to sit and wait. Oh… and they gave me a very neat Itinerary that laid out everything that had to be done and when approximately they would do each one.  I was thoroughly impressed with that.

I am right now thinking about how I can imagine (since I haven’t really talked to her yet) how my mom would comment that I am like my Dad… as while reading a book and waiting to be called back I found myself in the mix of a conversation with two other people in the waiting room regarding where the closest Wal-mart was.  I just sat there watching and listening as the other 2 were seeing if they could find it on the GPS and waited just in case they did so I could write down the directions for her.  Ah… it was just something to do to pass the time.  Discovered by asking someone who worked there that it is just north of the hospital on U.S. 31 about a half a mile to a mile.  I actually thought that was valuable information to know… just in case I need to relay it to Jason next month while I am there for those few days and I need to send him out for some strange reason. LOL  Rather funny… No matter where you go that may be unfamiliar territory it is always good to know where the closest Wal-mart is.

So I get called to start my little process, to which they were right on time… if not a little early.  Around 9 am I was in getting my labs done. Eight vials of blood and the cup thingy…. and that is all I have to say about that.  From there I was escorted down to Radiology… we walked… where I sat for about 5 minutes in another waiting room.  Went back at around 9:30 to change (from the waiste up) into a gown that truly was one-size fits all.  Went to go sit in another little waiting section… oh… cool… someone familiar!  Talked to the “GPS lady” (I can’t remember her name… I am wanting to say it was Brenda but I am not sure… so I am sticking with GPS lady at the moment) from earlier.  I think that that familiarity made both of us feel a little better about the immediate forthcoming unknown of these tests.  So they come out and get me first.  I go and do my Chest X-ray.

I have never had a Chest X-ray done and what was going through my mind??? Yep… the horror stories that women all hear of the dreaded Mammogram.  But, that is not what they did. LOL… funny though. :O)  I was rather happy.. no mammogram.  LOL.  (OHHHH… side thought… I would have, and could have, just wrote exactly what tests that I had done, but I am giving more detail because there are people who are considering this procedure and have that “need” to have details… I’ll “try” not be too gross though. :O) )  For those who have never had a Chest X-ray done and wonder about how it is done I actually found a fairly good YouTube video for you (See below).  Not too painful. :O)  (Please let me know if by chance the videos below become “inoperable”.  That way I can find a different one to take its place.)

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When finished with that I was then taken to my next location…. just down the hall to do the Upper GI X-ray.  When I get in there (and unfortunately I did not find a very good video for this one… wish I had as it would cut down on the typing a little) they have these two little bitty 1 oz cups with stuff in them.  One of the cups had about an ounce worth of water in it and the other had these little white crystals that reminded me a lot of PopRocks candy.  I had to put the Crystals in my mouth first and then add the water.  This causes the Crystals to fizz up quickly and you are forced to swallow it, BUT you cannot belch (which they do make you wish you could do).  Next thing… I am given this cup with about 1 cup worth of white Pepto looking and smelling liquid… if you want to call it liquid… it was super thick and well… I won’t lie to you…. it was gross.  The stuff is very hard to keep down and you are told you cannot belch, even though you really want to.  Standing on this little platform thingy that has a back I am then told that they are going to flip this thing over to where I will go from standing on it to laying on it (in other words it is a table that is mechanically moved into a side up-right standing position and they mechanically flip it backwards where you are then laying on it).  I closed my eyes on that one.  I have problems with vertigo and I was anticipating that it would make me dizzy… it wasn’t too bad though.  When in this laying down position I am then instructed to roll over completely so that they could have that Barium liquid completely coat the inside of the stomach giving them better pictures.  So I roll in several different positions for picture taking.  THEN… the other nurse comes in and gives me yet another cup (this time with a straw in it) and tells me that I have to drink more Barium liquid… of which is not as thick but still as nasty.  I had to take one BIG gulp and then swallow that one big gulp in three times.  Finally they tell me to lay flat with my back against the table again and they set the table back in it’s upright position. (Kind of felt like I was giving details of a plane flight just then… lol.)  I am then told I can finally belch.  I am then escorted back to the dressing room then off to the waiting room

At around 10:30 am I am picked up from the waiting room by another nurse (who reminded me sooo much of a friend of mine) and am taken back to have an EKG and breathing test done.  Guess what??? I am still breathing… LOL. Sorry can’t get rid of me THAT easy. hehe.  The first test is the EKG test (AKA: ECG test).  I have attached a very good YouTube video below that shows you how this test is done.

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After the EKG (or ECG) test the nurse (or technician) had me do a breath test (or a Pulmonary Function Test).  Since I was not able to find a good video as to how this was done by them I’ll just say… it is easy to do.  Alright!  I’ll tell you the best I can.  I had to sit on the edge of the chair with my back straight, I had to put this tube next to my cheek, in-hale for about 3 seconds and then blow all the air out in one full sweep, then in-hale again while this tube was still in my mouth.  I had to do this a few times in order to get the hang of it, but it really was VERY simple to do.

After the Pulmonary Function Test (PFT) the nurse / technician showed me how to use what is called the Incentive Spirometer.  I think this is rather interesting.  Starting today (Nov. 18th) I will have to do this test four times / day and will have to mark my chart each time.  I found an interesting link that will give you a video demonstration on how to do this and what it is used for.  In addition I found a very informative pdf link: http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/dis-cond/respirat/in-sp-mouth.pdf and also: http://www.rcjournal.com/cpgs/ispircpg.html.

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When I go in to have the surgery on Dec. 2nd I have to bring back with me this Spirometer that they have given as I will have to use it every hour I am awake in the hospital.  I was told that this will help prevent any upper respiratory infection including pneumonia.

After these tests were complete I had to meet with yet one more nurse / technician / what ever her job is.  Walk into her little room and… hey… it’s the GPS lady again. :O)  We both had a good little chuckle.  Here we were given a booklet titled “Patient Surgery Guide” that has information about what we need to do before the surgery, information about the waiting rooms for who ever goes with you so they know where to go for the cafeteria and sorts, the Anesthesia, pain management techniques, etc., etc.  She told me that since my surgery is at 2 pm I can have clear liquids up until, and no later than, 9 am on the morning of the surgery.  She discussed what they were going to do in prep for the surgery and talked briefly about the Nutrition class that ironically both the GPS lady and I have together next week on November 25th.  GPS lady mentioned her surgery is with Dr. Jones and she is scheduled for surgery on December 4th first thing in the morning.  I was done with my testing by 11:30 am.  Because I have had my gallbladder already removed (in 2002) I did not have to have an Ultra Sound test, but usually this is also one of the tests that are performed from what I have been told.

Left there, came home and picked up Jason, went and got a bite to eat, went to Wal-mart and ran into an old friend from grade school who I have seen throughout the years as we used to go to church together.  We saw each other and I think I heard a sigh from both of our husbands, who kind of went off on their own accord briefly knowing we were going to talk.  (A lot of us that went to school together have mentioned how we cannot seem to not run into someone we grew up with at the Wal-mart in College Park… and the worse part is… we always seem to “think” we look like hell worn over every time we go in there and never without fail run into someone.)  LOL… Ironically we ran into each other in the vitamin & supplements aisle.  Come to find out she had this same surgery done 3 weeks ago.  She is doing okay but says that she has found that she does not tolerate milk that well and doesn’t like the protein shots is hoping that this next beverage thing she was getting would help with the protein that is needed.  We talked about myspace and facebook, which she is not on… yet.  Talked more about the procedure though.  She told me that her surgeon was Dr. Evanson… to which I couldn’t help but tell her MacKenzie’s little stunt of telling him that he was “hot” at one of the support group meetings we went to.  She chuckled and said that she agreed with that thought.  We exchanged contact information and I look forward to talking to her more later.  Holley, if you read this… thanks for the advice and I am so glad I ran into you.

Okay… so.. now… that leave me with today. Today is the start of the pre-op diet that they start us on 2 weeks prior to surgery.  So… high protein (80 g / day), low carbs (no more than 20 g of carbs / day), lots of water, no caffeine, no carbonated beverages, no sugar, multi-vitamins, additional vitamin B complex, additional vitamin B-12, Calcium citrate, fat-free (or Skim) Milk (which reminds me I need to go out and find some packets of non-fat creamer, has to have no carbs, for my coffee when I am out with friends… if anyone finds some tell me brand and place, please).  Next week I am going to go buy a digital food scale.  I am going to take a break on Thanksgiving day though.  I won’t hord the carbs, but I will enjoy a little more than 20g… and I will stay away from the caffeine and carbonated beverages.  Oh… and no alcohol… not allowed to have any alocohol… unless it is rubbing alcohol and then that is only for a wound.  Fun, fun, joy, joy.

Goodness!  I wrote a lot this morning.  So “everyone” should be satisfied and should know what to be expected at this point.  One side thought though… I am surprised at how many people that I have talked to whose Doctor’s are NOT apart of Carmel Surgical Specialists, but are apart of the St. Vincent Carmel Bariatric Center of Excellence system have not recommended that patients get online and go check out obesityhelp.com.  If you are considering this surgery, have someone you know that is considering this surgery, or just want to learn more about this surgery please go check out this site, which includes a discussion board, at:  http://www.obesityhelp.com.  You will be so glad that you did.

I’ll update again soon.  Talk to you later.

~Tammy~

my fever is gone.  i can almost take a full, pain-free, deep breath.  i might get to go home tomorrow.  it will depend upon my chest x-ray, a conversation between my oncologist and pulmonologist about the true necessity of a lung biopsy and the availability of take-home oxygen tanks on sundays.  happy thoughts!  good night.

Ok, so I decided to keep this post separate from the wedding post because I want to keep this medical stuff separate just in case someone stumbles upon this wanting thyroid surgery information.  I know I read a lot of blogs and discussions and just want the meat and potatoes :)  My random observation for the day about the cancer/surgery process is that it is a pain in the rear!  Not in any way that I can’t handle, but just a general pain.  I got my packet from the doctor today about my surgery and I need to get blood work done and a chest x-ray here in town before I go next week.  So that will mean calling my doctors office to get the x-ray scheduled and making sure that everything ends up where it is supposed to!  This is of course much easier than having to drive to Indy to take care of everything, but it is still time out and off work, and it is a busy week for me with a conference on Tuesday, taking students to the SGA conference on Friday and Saturday and getting everything ready for me to be out.  I will be glad to rest the week after surgery.  

While this is a pain, it makes me stop to think about all that I have to be thankful for even as it relates to this situation:

1. I have good health insurance

2. I have a doctor that I like and office staff that will help me

3. I have transportation and don’t have to worry about how I am going to get to the extra stuff

4. i have the “brain power” and coping skills to handle all of the steps that lead up to surgery

5. I feel well while I am dealing with the prelim stuff 

6. I have a job that allows me time to do what I need to do

7. I have saved over 12 weeks of sick time, so I will be in full pay status while I am out

The list could go on and on and on and on…  I am one blessed woman!

What are the routine tests before surgery?

Visit this page for my experience of gastric bypass in India. Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. All patients but the very young get a chest X-ray and an electrocardiogram. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus. Many surgeons ask for a gallbladder ultrasound to look for gallstones. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated.

What is the purpose of all these tests?

An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels. To make gastric bypass in India easier, medical tourism of India offer package deals, arranging for visas, transportation, and translators.