Monday, Oh Monday

While most people returned to work for the first full week of 2014, I had Monday off. I returned to the hospital for a followup EGD, esophagogastroduodenoscopy, and a colonoscopy. These long words are very much like the German language – where there is no longest word; they can build compound words from individual words. The etymology of the EGD is 4 words:  esophagus gastro duodenem endoscopy meaning – from the esophagus to the duodenem they’ll be looking with a scope. The gastro part might be because they add air, or because they’re GI doctors and add it where ever and whenever they can – like bathroom graffiti.

As follow-ups go, it was very routine. No more banding for the variceal bleeding and my colon looked remarkably good – even for someone who has Ulcerative Colitis and recent C. Diff issues. I don’t remember many negative diagnoses today, but lots of positives:

  • The variceal backup has moved from the esophagus to a safer place; which means it still could bleed, but not life threatening. I don’t have leaky pipe syndrome–my term–which is replacing one leaky pipe and finding out the next weakest pipe is now leaking. Instead, my pipes seem strong.
  • A good looking colon is a healthy colon. Anytime the doctor says ‘remarkably good’, it means they had set their expectations low and were pleasantly surprised.
  • The doctor was familiar enough with the proton pump inhibitors (PPI) connection with C. Diff and told me to stop taking the stomach acid medication. Whenever a doctor agrees with LDAF (Logan Derek and Friends) Research Associates it’s good. (I’m laughing so hard about this! We need t-shirts, business cards, the works. -Logan)
  • I didn’t feel sick after coming out of the hospital – this time they gave me Ondansetron (Zofran). This is unusual for me; even with medications that aren’t supposed to cause nausea, I still feel sick. I’m happy that there was no discomfort.
  • It appears C. Diff is on it’s way out. Clean colon + antibiotics = get out of there! The doctor mentioned some people end up being carriers of C. Diff, but as long as the symptoms don’t return, it’s not a concern.
  • Followup for varices is 3 months, 6 months, and then a year. I’m crossing my fingers there’s no GI followup until April!
Waking up from a propofol nap
Waking up from a propofol nap.

The doctor, along with Logan, said my eyes look whiter than usual. Less jaundiced looking equals lower bilirubin levels (see FAQ post here). I have unintentionally done this ‘scientific study’ before – my colitis flares up, or I have bowel issues, and my bilirubin levels go down. I’ll wait for actual data from the blood test on my next MELD score – I expect to see a drop in bilirubin levels.

Could I single-handedly–with my sample of two flareups–be corroborating this study?

One hypothesis is that enterohepatic circulation of (as of yet undetermined) bacterially derived molecules plays a critical role in eliciting pro-inflammatory, pro-fibrotic hepatobiliary responses that lead to the development of PSC (hereinafter ‘PSC microbiota hypothesis’).[15–17] The entry of such molecules into the enterohepatic circulation may, in some patients, be related to the enteric dysbiosis and increased intestinal permeability associated with inflammatory bowel disease (IBD), a condition diagnosed in 75% of those with PSC.[18–22] Further supporting the PSC microbiota hypothesis is the observation, for example, that patients with PSC often have a leucocyte differential exhibiting increased neutrophils, even in the absence of signs or symptoms of acute cholangitis, suggesting circulation of endotoxins or other immunoactive molecules.[23]Collectively, these and animal model[24, 25] findings point toward a role for bacteria and bacterially derived molecules in the aetiopathogenesis of PSC.[2][Source]

I interpret the preceding as saying: ‘The hypothesis is, PSC is related to bacteria and may be caused by backup/upstream flow into the bile ducts.’  Maybe a real specialist, instead of an electrical engineer, could better interpret the paper.

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