2 months post-op complications

17 years 3 weeks ago #4211 by skypilot
Replied by skypilot on topic 2 months post-op complications
I love the way you said that becouse thats how I feel but have never writing out. Thansk from skypilot Don

Hanging in there!

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17 years 3 weeks ago #4209 by Patricia
Replied by Patricia on topic 2 months post-op complications
Good advise Karen.......an arterial blood gas is not something they do routinely.....make them do it. Its definitive.........Pat

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17 years 3 weeks ago #4207 by KarenE
Replied by KarenE on topic 2 months post-op complications
That's exactly like my Dad - Go to ER - On an IV - Fluids made him re-hydrated, whatever else they gave him to reduce the high potassium - Ate great in ER, Hospital - went home and within days was back to being dehyrdated, not eating, tired, etc...

High Potassium is very dangerous! Please make sure the doctor does the correct tests and does not dismiss the Metabolic Acidosis. My Dad's surgeon was one of the best in our area for neobladders, but when my Mom called again and again and told the surgeon's nurse how my Dad wasn't eating, lethargic, etc... and they even saw him two days before he was admitted to the Hospital for dehydration - they didn't catch this. When I spoke to the nurse about the Metabolic Acidosis, she said that she had worked for the surgeon for 10 years and this never was a condition that came up!!!!!!!! So.... make sure they get your Mom the care she needs. This could be damaging her kidneys and heart! That's why my Dad had to see a Cardiologist as well as a Nephrologist to get everything under control and treated.

Good luck and let us know what the outcome is.

Karen E.

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17 years 3 weeks ago #4205 by talon13
Replied by talon13 on topic 2 months post-op complications
Thanks to so many for your quick response... I'm going to copy everything out and take it to the specialist appoint I have for tommorrow. It's with the surgeon, he's quite worried too as he's looking for answers as to why and whats going on, but everything he tries doesn't seem to help. He's done these surgeries for a super long time, in fact he was the first surgeon in B.C., or even Canada possibly, I can't remember that ddid the neobladder styles and internal pouches.
I'm sorry I didn't give the bit more info on personal stats.
I'm writing this on behalf of my Mom, she's 61 - the cancer diagnosis took way too long - she started having blood in the urine last Jan. 2006 - they put it down to a urinary infection - up until October she was just put on a series of antibiotics. Of course the pain was terrible. Someone finally took a look at blood work that was done months ago and found enough info to have an exploratory in November, she was found to have an invasive tumor and was then scheduled for the removal of the bladder Jan.11 - close to a year from when it all started. I'm a big mouth these days about any women who have a lil' blood in the urine to push for more tests - instead of just allowing the doctors to say - "oh, that's just a bladder or urinary tract infection!" They tend to just ignore signs in women that are a red light for men. I'm going with her to her specialist appointment tommorrow and he can go over evrything I've found on-line - maybe re-take a look at the tests that were last done in the ER - possibly re-do them if the right ones haven't been done.
She's doing pretty good when she gets re-hydrated via an IV for a day or so and then within 4 days, she just starts sleeping all day, not eating and then back to the ER.
I come back here on Friday and let you know what cam of the meeting.
Thanks for all your quick response - it's a great place to come and get some direction and not feel like you are alone going through this scary world.
Thanks!! :)

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17 years 3 weeks ago #4204 by KarenE
Replied by KarenE on topic 2 months post-op complications
The information below is all about Metabolic Acidosis and is from the Wikipedia site: en.wikipedia.org/wiki/Metabolic_acidosis

It may help .... Please get checked immediately if you think you have this!
Karen E.


Signs and symptoms
Symptoms are aspecific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite (either loss of or increased) and weight loss (longer term), muscle weakness and bone pains. Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in a compensatory respiratory alkalosis.

Extreme acidosis leads to neurological and cardiac complications:

Neurological: lethargy, stupor, coma, seizures.
Cardiac: arrhythmias (ventricular tachycardia), decreased response to epinephrine; both lead to hypotension (low blood pressure).
Physical examination occasionally reveals signs of disease, but is otherwise normal. Cranial nerve abnormalities are reported in ethylene glycol poisoning, and retinal edema can be a sign of methanol (methyl alcohol) intoxication. Longstanding chronic metabolic acidosis leads to osteoporosis and can cause fractures.


[edit] Diagnosis
Arterial blood gas sampling is essential for the diagnosis. The pH is low (under 7.35) and the bicarbonate levels are decreased (<12 mmol/l). In respiratory acidosis (low blood pH due to decreased clearance of carbon dioxide by the lungs), the bicarbonate is elevated, due to increased conversion from H2CO3. An ECG can be useful to anticipate cardiac complications.

Other tests that are relevant in this context are electrolytes (including chloride), glucose, renal function and a full blood count. Urinalysis can reveal acidity (salicylate poisoning) or alkalinity (renal tubular acidosis type I). In addition, it can show ketones in ketoacidosis.

To distinguish between the main types of metabolic acidosis, a clinical tool called the anion gap is considered very useful. It is calculated by subtracting the chloride and bicarbonate levels from the sodium plus potassium levels.

Anion gap = ( [Na+]+[K+] ) - ( [Cl-]+[HCO3-] )

As sodium is the main extracellular cation, and chloride and bicarbonate are the main anions, the result should reflect the remaining anions. Normally, this concentration is about 8-16 mmol/l. An elevated anion gap (i.e. > 16 mmol/l) can indicate particular types of metabolic acidosis, particularly certain poisons, lactate acidosis and ketoacidosis.

As the differential diagnosis is narrowed down, certain other tests may be necessary, including toxicological screening and imaging of the kidneys.


[edit] Causes
The causes are best grouped by their influence on the anion gap:


[edit] Increased anion gap
Causes incluce:

lactic acidosis
ketoacidosis
chronic renal failure (accumulation of sulfates, phosphates, uric acid)
intoxication:
organic acids (salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, INH, toluene)
sulfates, metformin (Glucophage®)
massive rhabdomyolysis
The Mnemomic MUDPILES is commonly used to remember the causes of Increased anion gap metabolic acidosis.[1][2]

M-Methanol
U-Uremia
D-Diabetic Ketoacidosis
P-Paraldehyde
I-Infection, Iron, Isoniazid
L-lactic acidosis
E-Ethylene Glycol, Ethanol
S-Salicylates

[edit] Normal anion gap
Causes include:[3]

longstanding diarrhea (bicarbonate loss)
pancreatic fistula
uretero-sigmoidostomy
RTA
intoxication:
ammonium chloride
acetazolamide (Diamox®)
bile acid sequestrants
renal failure (occasionally)
It bears noting that the anion gap can be spuriously normal in sampling errors of the sodium level, e.g. in extreme hypertriglyceridemia. The anion gap can be increased due to relatively low levels of cations other than sodium and potassium (e.g. calcium or magnesium).


[edit] Pathophysiology

[edit] Compensatory mechanisms
Metabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate. The body regulates the acidity of the blood by four buffering mechanisms.

bicarbonate buffering system
Intracellular buffering by absorption of hydrogen atoms by various molecules, including proteins, phosphates and carbonate in bone.
Respiratory compensation
Renal compensation

[edit] Buffer
The decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes: the buffer (from water and carbon dioxide) and additional renal generation. The buffer reactions are:

H+ + HCO3- <--> H2CO3 <--> CO2 + H2O
The Henderson-Hasselbalch equation mathematically describes the relationship between blood pH and the components of the bicarbonate buffering system:

pH=pKa + log [HCO3-]/[CO2]
Using Henry's Law, we can say that [CO2]=0.03xPaCO2
(PaCO2 is the pressure of CO2 in arterial blood)
Adding the other normal values, we get
pH = 6.1 + log (24/0.03x40)
= 6.1 + 1.3
= 7.4

[edit] Treatment
A pH under 7.1 is an emergency, due to the risk of cardiac arrhythmias, and may warrant treatment with intravenous bicarbonate. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention however, is not effective in case of lactic acidosis.

If the acidosis is particularly severe and/or there may be intoxication, consultation with the nephrology team is considered useful, as dialysis may clear both the intoxication and the acidosis.

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17 years 3 weeks ago #4201 by Beth
Replied by Beth on topic 2 months post-op complications
Dear Talon,
I apologize for not having any answers for you except that almost everybody else says he/she went through this and came out to a normal active life.
How old are you? Are you ..a girl or a boy? And...weren't you released too soon?
I am writing in behalf of my husband and who is 71 years old.H is to have a much similar surgery like yours at the end of March.I am very worried and I would like to exchange information and share experiences in the hope all will end well eventually.
Be strong and, if you don't mind,please answer me.
Beth

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