Diary of a Crohn’s Flare: Get thee to the Hospital!

My last post covered sepsis, there’s a reason why I inserted that topic between my statuses :) .

I hadn’t been feeling well the Sunday of 6/8 and my abdominal pain prevented me from falling asleep until around 3 am, even after taking a full Norco pain pill (7.5 mg hydrocodone).  I awoke several times through the night and each time was awake for an hour or more.  In total I slept only 2-3 hours through the whole night.  In the morning (on 6/9), I hurt even more, had a fever (over 100 F), had a rapid heart rate (estimated at 110 BPM to 120 BPM), and I felt really crummy.

My wife called the GI doctor and reported my condition.  They asked that we keep them apprised of my condition and get to the hospital immediately if my temperature spiked over 102 F.  My fever eventually got up to 101 and at this point my wife packed me into the car and took me to the hospital emergency room.  She notified the doctor that we were going.

At the hospital they took blood, urine, vitals, etc.  They concurred with my assessment on the heart rate and respiration (both in the elevated range).  My temperature had dropped to around 99.8 F.  My urine sample was extremely dark (darker than a dark beer) almost orange in color.  Later I learned that there was no blood or bacteria in the urine.  The blood test showed several numbers out of standard range, perhaps the most important of these was my white blood cells which indicated an active infection.  My doctor decided to admit me to the hospital and they immediately began IV antibiotics.

Later in the day I saw my doctor and we decided to try to get the abscess aspirated.  When I got to the room I discovered someone suspected I might have a C. Diff infection (I never found out who) and so I was quarantined for the duration of my hospital stay (but found out after discharge that they found no evidence of that infection in the various cultures they did).

I hate staying at the hospital; however, the one nice part of a hospital stay is that they can give me pain medication powerful enough to almost completely eliminate pain.  During this stay, the medication I was permitted to take was dilaudid (hydromorphone) which for me was more effective at controlling abdominal pain than morphine (but ironically worked less well at controlling headache pain as simple ibuprofen).  Anyway, when I’m in the hospital I’m no longer shy about asking for my pain mediation when I’m hurting and for several doses took it as frequently as I was permitted (about ½ the time).

The dilaudid gave me a strange sensation in my muscles.  It made them feel taxed and slightly sore for about 20-30 minutes after IV administration of the drug.  It also made me feel loopy and drowsy during that time and perhaps for up to 60 minutes after a dose.  After that time, I felt somewhat normal but either pain free or pain significantly reduced.  On a pain scale of 1-10, the dilaudid knocked the pain back 4-5 steps, so a 7 pain scale might be bumped down to under a 3.  On both Monday evening and Tuesday evening I felt really good with fever under control, my pain under control and able to eat.

Anyway, Tuesday morning they sent me down to interventional radiology.  They took a CT scan, found a “window” through the loops of my bowel large enough to insert a large needle.  They dosed me with some “waking” sedation (versed and fentanyl) and a local (lidocaine).  I remained conscious and was able to talk to the person performing the aspiration (who happened to be one of my daughter's former soccer coaches!).

He inserted about 3 3/4 inches of a 5 - 6 inch needle, attached a syringe, and aspirated all the fluid he could get from my abscess.  They pulled a bit more than 2 cc worth of what I can only describe as “pus”.  The entire process took maybe 30-40 minutes (but may have been less).

We kept waiting for the results of my stool culture, urine culture, and aspiration culture through the evening of Tuesday but didn’t get any lab results back (they had a hardware problem).  Because of the delay, the hospital held onto me through the night.

Wednesday was more of the same, except I chose to transition off the dilaudid and resume the use of Norco for my abdominal pain.  The oral Norco does seem to keep the pain controlled for a longer period of time even though it didn’t control the pain as thoroughly.  The hospital released me late Wednesday afternoon even though we hadn’t gotten any of the lab cultures back.  Also the blood tests from Wednesday showed my white blood cells had returned to normal.  I found out a couple of weeks later that my hemoglobin dropped from 15.5 or so down to 12.5 during my stay.  No one told me about this and I only found out by looking through my on line records.

By Thursday I got the results of the various cultures.  My urine was clean and had no blood or anything else questionable.  My stool culture was clean of the nasty bacteria types.  The fluid aspirated from the abscess found pretty typical gut infection bacteria (nothing like MRSA or C Diff) but they also found yeast (fungus) cells.  So they introduced an antifungal drug too (diflucan – flouraconazole?) into the mix of drugs I am taking.

One thing that I was very pleased with: I asked the nursing staff to try to time all activity to occur at the same time (blood tests, vitals, IV bag changes, etc.).  They were able to honor this both nights of my stay.  They did the last evening activity around midnight and that kept me going until I needed an IV antibiotic at 5 am.