General Update #30

1:05 p.m. - Dusty was attempting to depart room to visit hospital commissary for lunch when Dr. Brown arrived with report from radiologists. There appear to be no blockages and no internal damage seen, Joyce just has a lot of backed up poop. It appears that Joyce also has a kidney stone (and has "had it for some time"). Dr. Brown suggested that the kidney stone might have been (and currently could be) be causing Joyce some pain, especially in her back area, and requested permission to contact the Gritman urology department to see if they could break it up as a step toward additional pain relief for Joyce. Dusty assented to urology team being contacted. Dr. Brown departed to contact urology. 

2:02 p.m. - Nurse's aides checked on Joyce to see if she needed to use bathroom and Joyce confirmed "probably." Joyce did not have a bowel movement. 

2:07 p.m. - Dr. Keizur (urologist) arrived to talk with Joyce, but as she was in the bathroom, said he would return later.

2:12 p.m. - Joyce was returned to her recliner by nurse's aides. Keizur returned as this was being done, informing Joyce that after reviewing the radiology scan taken this morning he can confirm that she has "a pretty big kidney stone" in her left kidney. 

Keizur asked if Joyce had kidney stones in the past and Joyce reported that she had none in the past. Joyce reported pain in the left-side of her back for the past month at least when asked. Keizur guesses that if she has been complaining about back pain off and on for the past few months then they might have been related to this kidney stone. Joyce confirmed she has been sick to her stomach and thrown up recently. No blood in urine when using bathroom at home (pre-fall down the stairs accident) was reported by Joyce. Keizur asked if anyone in her family had history of kidney stones, Joyce responded that no one had. Keizur asked about status of colon cancer, Joyce reported that she thought they were still working on it, citing recent message left on phone answering machine at farm. Dusty clarified that they are still monitoring her and Dr. Morgan is her oncologist for that and the kidney spot which was cryoablated by Dr. Ho. 

The kidney stone Joyce currently has won't pass on its own due to its size, and it is probably bouncing around. When it bounces down it causes pain, when it bounces up it is relieved. Treatment is minimally invasive surgery where stone is broken up with a laser (no incisions, microscope and laser go up through bladder to kidney). Joyce would be asleep through the procedure. If surgery is not done, Keizur is concerned that the pain will persist and possibly get worse. There is small risk of bladder infection from doing this procedure, some blood will be passed in urine (to be expected), and potentially the temporary tube from procedure would be left for 7-10 days after procedure and then removed. Keizur plans to do the procedure tomorrow morning. Doesn't anticipate any issues. Should not hold up transfer to Good Samaritan.

Keizur noted that the initial scan done on Joyce on Tuesday evening didn't include a report of the kidney stone being present (but he confirmed that it was there when he looked at the file image today). The radiologists have since added an addendum to that scan report, noting the kidney stone's presence even though they did not on the first viewing. The kidney stone was noted in today's scan, of course. 

Keizur asked about which kidney was treated for Joyce by Dr. Ho and if it was biopsied. Keizur is guessing that if the kidney stone was present last time Joyce was scanned in preparation for the cryoablation for her right kidney, then they [Dr. Ho or Dr. Morgan] would have seen it. Keizur assuming then that it has developed since whatever most recent scans Dr. Ho or Dr. Morgan ordered in regard to Joyce's treatment plan for the cancers. Dusty could not provide dates for most recent scans taken off the top of his head to Keizur but noted that they should be in Joyce's file as they were most likely done at Gritman. This large kidney stone must have formed since as it was not noted or visually present in the files Keizur looked at regarding the colon and kidney treatments.

Keizur asked if Joyce uses oxygen at home and Joyce responded in the affirmative. Keizur asked Joyce if the bruises he was seeing on her as he visually inspected her body were related to her fall at home and Joyce responded in the affirmative. Keizur asked if Joyce had an appetite and she said that she did not have appetite. Keizur asked Joyce if she was feeling up for surgery tomorrow to remove the kidney stone. Joyce asked if the kidney stone removal would alleviate "the pain she has been feeling lately." Keizur stated that the kidney stone removal would help alleviate some pain, but as Joyce has fallen down the stairs at home she has pains from all of that (fractured vertebrae, fractured ribs, bruises) and it would not remove that pain but would help lessen her overall pain. Keizur confirmed that the surgery is fairly non-invasive when Joyce asked. "Will it make me feel better?" Asked Joyce. "I think so," said Keizur. Following a long silence as Joyce stared wide-eyed at the bed, she agreed to the procedure. Dr. Keizur went over the paperwork and Joyce signed for consent.

Keizur says normally patients are fully sedated for the procedure, but he might try to do local only to reduce risk to Joyce's pulmonary functions as she is having difficulty breathing. NPO order temporarily lifted from Joyce, even though she is not feeling up to eating right now. She can order anything from the room service menu and drink all the fluids she wants, but no foods or fluids after midnight as the plan will be to have the procedure occur at around 9 a.m. tomorrow. 

Dr. Keizur departed at 2:35 p.m. to begin scheduling the procedure. 

At 2:37 p.m., after a noted silence following Dr. Keizur's departure, Dusty looked up from composing General Update #30 expecting to see Joyce asleep in her recliner. Instead, Joyce was staring wide-eyed at him, head tilted forward. When eye contact was made, Joyce whispered in a hushed and creaky tone to Dusty "We are in Gritman...not in a fancy hospital." When asked if that bothered her, Joyce glanced at the room door and back. "It does!" She said. "I'm going to have to have faith that they can do this and not screw something up." Joyce went on to discuss cousin Tom's issues with kidney stones and his lack of successful outcomes in getting positive results when the Gritman doctors tried to help him. Dusty attempted to reassure her that Keizur was good and had previously helped him. Joyce was unimpressed and went back to dozing in her chair. 

2:52 p.m. - Kandi, nurse's aide, made a return and stopped by to visit Joyce and see if she is comfortable. Notified Dusty that Callie is Joyce's day shift nurse as Kandi was moved to staffing the desk. Kandi updated Joyce's room information board to reflect the names for reference. 

3:05 p.m. - Oxygen levels at 96%. Physical therapy team (Mark and Tristan) arrived to offer to take Joyce on a walk. Joyce declined as she was "so comfortable right now." Mark stated they would check back later.

Message(s) from Joyce:

None.

Current location:

Gritman Medical Center, Room 202.

Current pain level:
"I have a little pain in my back, but I'm not doing too bad." - 1:34 p.m.

5 out 10 as of 3:08 p.m.

Visiting information:

No change from previous post.

Confirmed with nurse's station shift leader at 11:05 a.m. (on 6/6/2020) - currently only 1 visitor per day for Joyce, no exceptions. Once current visitor departs Joyce's room, no further visits for the rest of the day. No swapping out visitors (example, Dusty cannot remain on hospital grounds while Craig goes to sit with Joyce for an hour and then Dusty returns to room).