Grumpy

A different GI doctor made rounds this morning.  He said he reviewed the procedure and case notes of his partner, as well as E.'s labs.  It looked to him like the bleeding was under control since E. hadn't vomited any more blood and the labs (specifically, his H & H) were looking good.  He said that it wasn't clear if the bleeding was coming from the esophageal varice or from the mass.  He actually said that it would be better if the bleeding was from the varice rather than from the mass as it would be less likely to bleed again.  If the bleeding was coming from the mass, it could start bleeding again at any time without warning.  (Yet after reading a bit on the internet, it sounds as if once you have a bleeding esophageal varice, you are prone to more bleeding esophageal varices.)  Either way, bleeding varices and masses don't sound good.

They gave E. some a medication to stimulate his appetite today called Megace.  He managed to eat a small container of pudding before they informed him that he was scheduled for an Upper GI at 7:00 tonight (now postponed to 8:30 or 9:00 pm) and was allowed nothing more to eat or drink.  So much for that!  They increased the IV fluids as they are concerned about the low output.  Despite the high volume of hydration they've already pumped into E., he's only peed a very minimal amount.  I'm hoping this is only due to the fact that he was so dehydrated and once he gets caught up, input and output will be more proportional to each other.

The Internal Medicine doctor is concerned that there might be an obstruction affecting his eating, which is why she ordered the Upper GI.  The concern is that the mass in the small intestines (at the base of the stomach) has possibly grown larger, thereby blocking food from going any further.  So, for today's Upper GI, E. will drink some Barium (a thick, chalky white substance) and then they'll take a series of x-rays as they watch it move through his system.

E. dozed on and off throughout the day.  He grimaced in pain frequently, but will no longer even tell me what his pain level is on the pain scale because he is sick of me suggesting pain medication.  He's taken none today.  He's watching a little Monday Night Football, excited to see local UNR boy Colin Kaepernick as the starting quarterback.  His bilirubin went UP from 3.8 yesterday to 3.9 today. Not up a lot, but still the wrong direction.  It sounds like he may get to move to a regular room on the oncology floor tomorrow.  He's very sick of being in the hospital and getting quite grumpy about it.  Grumpy is good.  It means he's still full of piss and vinegar.  We can work with that.