HORIZON HEALTH PULSE Hak Ko, MD Residents of Horizon Village now have another opportunity to help turn theirlives around while staying at the Village: a GED program available throughNiagara/Orleans BOCES Continuing Education. “The GED program, which is funded by Niagara County Social Services, is designed to helpour residents become less dependent on social services and re-enter so
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Accident.dviBicycle Accident 12/21/11 and Consequences S. J. Peale In riding my bicycle to work, I have a choice between two routes: 1. Over Fairview overpassfor a distance of about 4 miles. 2: On a bikeway under both the freeway and Hollister Avefor a distance of about 6.7 miles. The latter is safer with less traffic. On the morning ofDec. 21, 2011, I decided to take the shorter route because it was cold. This turned out tobe a bad decision.
I remember crossing Hollister Ave, but nothing else until I was being put into an ambulancefor transport to Cottage Hospital Trauma Center. From the accident report submitted bythe CHP and kindly brought to us by a CHP officer, we deduced the following events thatled to the collision of me and the car. I was approaching the bridge over Goleta Slough bythe airport, probably doing about 18 MPH. when a woman proceeded from the 217 off-rampstop sign directly across the road and struck my front wheel with her right front bumper.
She was going into a small parking area for the Goleta Slough overlook, which was on theairport side of the bikeway. My front wheel was turned sideways, and I slammed into herpassenger side door as she had kept moving. The day was clear with the Sun at her back,so there was no excuse for her not seeing me.
I was knocked unconscious, which implies a concussion. I broke six ribs, the sacrum at thebase of the spine, and several vertebrae were damaged. My left kidney was damaged and myleft lung severely bruised. The damaged kidney was bleeding badly, which bleeding is verydifficult to stop. I think a CAT scan was done to determine the extent of the damage. If thebleeding of the kidney cannot be stopped, it must be removed. The bleeding was apparentlystopped with an angioplastic technique, where I think an artery in my leg was entered witha probe, the probe was threaded to the kidney artery that was bleeding, where the latterwas plugged with several small coils. Success was not clear, as my hemoglobin readings keptdropping. A reading of 14 (grams/100 ml) is at the lower end of the normal range. Minewas initially 13.7, which is normal for me. It dropped to 11 then 10, 9, 8 and finally 7.2, atwhich point I was given two units of blood several days after I entered the hospital (Dec.
24). Part of the reduction in hemoglobin level may have been due to the continued salinedrip that was given to me. I gained 15 pounds of fluid, as it was not being eliminated, andthat may have diluted my blood and reduced the hemoglobin level.
I was initially in SICU, where I spent the most miserable night of my life. I was given two 1mg doses of morphine that allowed me to maybe sleep a total of two hours. My left back ribcage was extremely painful, so much so, that I did not notice the much lesser pain near myspine. I was moved from SICU to a regular room in 5 Central after the first night. In thatprocess, I had to be shifted from a gurney to a bed in the room after the transport. I hada catheter inserted in my penis. The Foley bag was attached to the gurney, so when theypulled me over to the bed, the catheter was pulled out with the balloon still inflated. Myurethra was severely traumatized and proceeded to bleed profusely. However, the bleedingwas stopped, and I was able to pee normally for several days into a urinal. I have a habitof pressing on my urethra to empty my penis of residual urine, and I made the mistake ofdoing that after the trauma. The clot was disturbed, and I bled again during urination. I had one time of urination which did not bleed, but the next one did, and a catheter had tobe reinserted to allow the urethra to heal. It had to remain in place two weeks, I was told.
My problems kept multiplying. My digestive system shut down, so I could eat nothing. Ithink the doctors called it ilius or something similar, where the abdomen becomes bloated,and material stops moving through the intestines. There are pockets of gas. My stomachwas bloated, and I was nauseous, because fluid deposited in the stomach was not passinginto the intestines. I had xrays of my abdomen to verify the diagnosis, and a tube waspassed through my nose to my stomach to draw off the accumulating fluid. That relievedthe nausea, but the tube insertion by the nurses was painful, and my throat was irritated inthe back. After two days, the pressure in my abdomen subsided, and my stomach area andabdomen became softer. The stomach tube was removed, and I was given a meal of clearliquids–chicken broth, jello, juice, etc, which I kept down. After another meal of clear liquid,I was asked to eat solid food. I chose oatmeal with a banana, brown sugar and raisins. But Istill had zero appetite, and had to force myself to eat it. That and subsequent meals stayeddown, but I had to force feed myself every time because of total lack of appetite. Even withthe small portions that I chose, it was difficult to get the stuff down. I had gone almost aweek without food before the first clear liquids stayed down. I got that capability just intime, as I was threatened with inter venous feeding, which involves significant surgery to setit up. Since, I was eating again, the inter venous saline solution was halted. This was aboutthe time of the transfusion, which brought my hemoglobin up to 9.1, which later stabilizedat 8.9 and proceeded to climb slowly. Makes me think the saline solution had something todo with the low hemoglobin. All this time, my blood pressure was reasonably stable, butmy pulse has been between 80 and 100/min compared with a normal of 55 to 60/min. Thismay be due to the low hemoglobin, the pulmonary embolisms, discovered later that day, orboth. I will know I am mending when my pulse returns to normal.
Things got worse. My blood pressure, pulse and the percentage of oxygen saturation of myhemoglobin were checked every 4 hours or less. To keep the oxygen saturation above 90%,I was put on oxygen at 2 liters per minute. I had oxygen for most of the time I was inthe hospital, but am home now without oxygen. The criterion for allowing me to go homewas that the oxygen saturation remain above 90% without supplementary oxygen while Iwas walking around. After sitting up all morning without oxygen on Dec. 28, talking withvisitors, reading the paper, etc. I was given the test and flunked. The nature of the drop,I think made Dr. Daniel suspicious, and a CAT scan was ordered, which discovered bloodclots in my lungs. I assume this was the reason for the drop in oxygen saturation, but I amnot sure. In addition, a pool of bloody fluid was found in the cavity between my injured leftlung and chest wall. It was a good thing that I was not allowed to go home. A wire filterwas inserted into the major vein coming from the legs and groin to catch any further clotsthat formed there. The filter was to be removed eventually. I was also started on a drugcalled Lovenox that thins the blood. This had to be injected into my belly fat, which I hadto do myself after coming home. This was to be replaced later by coumadin (warfarin). Ashunt was inserted in my left side to drain the 300 ml of fluid from my plural cavity. Theshunt was removed after a couple of days and several xrays verifying that no more fluid wascollecting. Now I was on blood thinner, when I had a shredded urethra that was supposed I came home on Jan. 1, 2012 a lot worse for wear. My oxygenation was about 96%, so I didnot need the oxygen that had been ordered for home, when I was first going home prior tothe failure of the test. I slept intermittently with persistent discomfort using a foam wedgethat raised my shoulders and head. I tried once without that wedge, and my back ached somuch I had to reinstall the wedge. The rib pain has largely subsided now, but I have a hugebruise on my left side where I struck the car. My back is weak and a little painful when Imove, as in sitting down in a chair. Initially, I could not walk without supporting some ofmy weight with my arms on a walker, but as of today, Friday, Jan. 6, I can walk withoutthe walker or cane, although slowly. I walked with Robert down to the end of the streetand back, yesterday and the day before. Doug had come down for Christmas, so was hereto help Priscilla until I came home from the hospital on Sunday, Jan. 1. Robert came fromFlorida to help on the following Tuesday night and stayed until Sunday. Priscilla was verystressed, so the boys’ presence was, I think, a great comfort.
A couple of days after I came home I started having painful bladder spasms that forcedurine around the catheter so I dribbled outside. The urologist, Dr. Curhan, says that urinepassage is normal and not to worry, but I do. Will I be incontinent in the end? It turnsout that Curhan was wrong. The bladder spasms causing the leakage were due to a Proteusurinary track infection. The spasms were becoming more frequent with a persistent urge topee in spite of the catheter. I saw Dr. Daniel on Thursday, Jan. 5, and he referred me toUrology when I told him of the bladder spasms.
The night before, I was convinced that I had an infection, with T = 100◦, called the clinic, gotDr. Rhodes, and he told me to go to the Goleta Valley Emergency room for a culture or waituntil my visit to the clinic to see Daniel the next day. I chose to go to the emergency roombecause of temperature and the cloudy nature of the urine with floating debris. The bladderspasms were severe, but infrequent at the time, and I associated them with a misplacedcatheter instead of the infection. A urine sample was taken and a culture begun. I wasadvised not to start antibiotics, as the nature of the infection was not defined, but I wasgiven one pill to take if my temperature got above 100.5◦. It was a good thing I went tothe emergency room, as the results of the urine culture with a Proteus infection diagnosiswere available to Dr. Rhodes the next day. He prescribed Amoxicillin for the infection andUribel for immediate reduction of the bladder spasms. The first drug was obtainable, butthe second had to be ordered. By this time the bladder spasms were almost continuous, andit was all I could to to suppress them as advised by Dr. Rhodes. I took the first antibioticpill at about 6:00 pm on Jan. 5, but the bladder spasms were not reduced initially. Not formore than about 4 hours after the first pill, did the bladder contractions wane, but I wasable to sleep much of the night, with no further bladder pain. When I really needed theuribel the first night, I did not have it. The next day I decided not to get the uribel thathad been ordered, because the bladder spasms have subsided from the antibiotic alone, andI felt pretty well.
Today is Friday, Jan. 6, and the unused oxygen equipment and associated tanks are to be picked up this afternoon. Later, we meet with our lawyer team headed by Josh Lynn.
Today is Saturday, Jan. 7. I have had four Amoxicillin pills, and the urinary track infectionseems to have stabilized. At least the bladder contractions have mostly ceased, and my urinehas a better color and clarity. Eight more days of the antibiotic. My stool was loose today,which is probably the result of the antibiotic killing the intestinal bacteria. I slept poorlylast night, and had to leave the bed with the wedge for the recliner chair. That relieved theback pain that I had with the wedge, and I was able to sleep some.
After dinner on Saturday, I had a severe pain in the left kidney region on my back. Therewas no position I could assume that would change the pain. A Dr. Vallee advised me togo to the emergency room to check it out, as it could be a serious complication. So Robertand Priscilla transported me to the SB Cottage hospital emergency at about 9:00 PM.
where another CAT scan was done. Fortunately, there was no further internal bleeding, andeverything seemed to be ok. The pain may have been caused by an infection in the damagedkidney. I was given an inter venous dose of antibiotic, and several administrations of painmedicine. That made me nauseous, and I vomited my dinner sometime after midnight. Ilater had dry heaves as I was waiting for the car to be returned to us. I was also given someoral narcotic to control the pain. It was after 2:00 am before we left the emergency room.
The pain medicine I was given allowed me to sleep fitfully until about 7:30 am. I got up andhad breakfast along with my Amoxicillin for the urinary track infection. I had another painpill at 10:00 am and proceeded to sleep the rest of the day. I woke up at 5:00 pm with noappetite, but I forced myself to eat through my semi nausea. Another Amoxicillin pill takenwith my dinner; all stayed down and I felt a little better. I decided not to take another painpill, as the pain seemed to be under some control. I think the pill was the cause of my feelingawful. It is now 12:20 am on Monday, Jan. 9, and I am wide awake from sleeping all day.
No sleep the rest of the night.
On Tuesday, Jan. 10, I had the stitches removed where the tube was inserted to drain mychest cavity. This was done by a very pretty and smart nurse practitioner, Eileen, whohad been watching over me when I was in the hospital. I had another appointment withan orthopedist that afternoon related to the cracked sacrum. All he did was asked me if Iwas having any problems there, which there were none. I think he spent only about twominutes with me, but I suppose the check was necessary. No appointments on Wednesday,but Thursday, Jan. 12, I had the catheter removed. I could pee again, but that night, Jan.
12-13, I was up six times to pee. I do not know where the huge volume of urine was comingfrom (1500 ml) as I had not drunk that much. Maybe I am eliminating accumulated fluids.
Between bathroom excursions, I was actually sleeping soundly. But the interruptions meantI was really not that rested in the morning.
Today is Friday, Jan. 13, and other than being somewhat sleepy, I do not feel badly. Theback pain is mild and I am able to sit at my desktop for limited time periods. I see Dr.
Daniel on Monday. In the meantime, the coagulation rate of my blood is being monitoredwith frequent blood tests, and the coumadin dose adjusted to keep an INR index between2 and 3. The index is just the ratio of the time to coagulation compared to normal, so 2 means it takes twice as long to coagulate as it would normally. I will apparently be on thecoumadin for six months. I have one other appointment next week with a neurologist relatedto the damage to my spinal column. I think it will be about as eventful as my visit to theorthopedist.
The visit to Daniel on Monday, Jan. 16 was uneventful, except he was on hospital duty thenight before and was one hour late for my appointment. I had another coumadin blood testalso and the visit and test meant we spent the entire morning at the clinic. My walking hasimproved, and Priscilla and I walked for about 30 minutes after lunch, after which I took a1.5 hour nap. My back pain has eased so I will try sitting at the desktop tomorrow.
This is Tuesday Jan 17. Back too uncomfortable to sit at the desktop. Only place my backis comfortable when sitting is in a recliner. I see a neurologist tomorrow after an x-ray,so I should be better informed about my back tomorrow. On Jan. 18, after 8 more highintensity xrays of my spine, the neurologist said that my collapsed vertebra was worse thanit was when I was in the hospital. That probably meant that it more crushed than it wasinitially. That is probably because I spent more time upright after going home which causedthe further collapse. The neurologist, Dr. Connor, also pointed out that I have a lateralcurvature of the spine, which looked pretty bad on the X-ray. This curvature preceded theaccident. I have to see him again on Feb. 29 with more X-rays, when I will ask about theseriousness of the curvature and whether there are exercises that will correct it.
On Friday Jan. 20, I had the wire filter removed from the large vein from my legs. Thefilter was to catch any clots formed in my legs before they reached the lungs. Since I wasnow on coumadin to prevent further clots from forming, the filter was no longer needed. Toremove the filter, a vein near my collar bone was entered and a probe pushed straight downthrough my heart to the leg vein. the filter is like an umbrella with six ribs facing down. Thefilter was grasped by the probe and pulled into a cylinder to collapse the ribs of the filter. Itwas then pulled out with the probe. The whole procedure took about an hour. There wasactually a blood clot caught in the filter, so it apparently did serve a useful purpose. Theappointment was for 9:00 am, but we sat in the reception area until 10:30 am, where somepaperwork was completed. The reason for the delay was that there was no bed availableuntil that time. I transferred into a hospital gown and waited until 12:30 pm before I wastaken to the place where the filter was to be removed. I got back to the room at 1:30pm andfinally got some lunch at about 2:00 pm. I had to stay until 4:30pm while my vital signswere monitored. All day in the hospital was no fun.
I have absorbed huge amounts of radiation during the course of treatment. In the followingthe unit of radiation used is the rem (R¨ontgen equivalent Man) which is weighted by theeffect of various types of radiation have on a person. The only measure I have of what isexcessive is that I think 5000 mrem is the upper bound on radiation absorption per yearfor nuclear workers. I had three sessions of CT scans, with I think at least two scans persession that covered various parts of my body. From a document “Doses from Medical X-RayProcedures,” each CT has the following dosage: CT head 200 mrem, CT chest 800 mrem, CTabdomen 1000 mrem, CT pelvis 1000 mrem. In the first session I had all of these CT scans, which may have been done multiple times. Later, I had additional CT scans of the abdomenand chest each with 1000 mrem exposure. I had enumerable X-Rays of my abdomen, chestand spine. The chest xrays are minor exposures, but those of the spin, and abdomen areseveral 10s of mrem according to the chart–some approaching 100 mrem. Finally, duringthe angioplastic procedure to plug the artery in my kidney, I was subject to continuousxray fluorescence for an undetermined time that must have exceeded several minutes. Thexray fluorescence was repeated during the insertion of the filter into the vein from my legs,and for 4.9 minutes during its removal. I may have had a total exposure exceeding 15000mrem, which is more than three times the maximum yearly dose for nuclear workers. Sothe radiation that was necessary to make the necessary diagnostics to keep me alive mayultimately shorten my life from what it would have been had there been no accident.
On Tuesday and Wednesday Jan. 24-25, I developed flu like symptoms. Dry unproductivecough, temperature that reached 101.6◦, but then hovered near 100.7◦ for most of the night.
It was down slightly on Wednesday, but was above 100 several times during the day. Thelast symptom was a dripping nose with violent sneezing. But my nasal passages remainedopen–unlike the behavior with a cold. By Tuesday, Jan. 31, my cough and runny nose wereconsiderably reduce and I was apparently nearly over the cold.
On Friday, Jan. 27, I had a sense of well being for the first time. Probably because of lessback pain, I slept pretty well last night, and I was recovering from the cold. On Tuesday,Jan. 31, I went to work for the first time. My desk chair is reasonably comfortable, but Iam not sure my back will last all day.
Zusammenfassung der Merkmale eines Arzneimittels (FACHINFORMATION)da dies die Freisetzung und Resorption ausder Vaginaltablette beeinflussen kann. Bei Verdacht auf eine der folgenden Erkran-abgebrochen werden: Myokardinfarkt, zere-brovaskuläre Störungen, arterielle oder ve-LUTINUS ® Vaginaltabletten sind nur im ers-1 Vaginaltablette enthält 100 mg Progeste-ten Trimester der Schwanger