Tom has had a PICC line and been on antibiotics since 12/5, to control persistent strep/staph infection on the plate holding a bone graft. Hoping it can be removed within another 30 days, but no guarantees. The whole situation is causing atypical side effects, primarily extreme fatigue and GI pain/occasional bleeding. But no one can explain these deficiencies. He got a big oral dose of potassium two weeks ago, which brought that level up, and it seems to be holding. But last week's renal panel results came in today's mail, showing phosphorus level at 1.5 (from what I can determine, the low end of "moderately low," just above dangerously low) with orders for a re-check next month. Nothing I have found online (malnutrition, malabsorption, fluid loss, alcoholism, etc.) really explains any of this--nothing associated with abx. He is eating OK, has some increased D, but nothing too extreme. Any wisdom or experience out there?
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Gee, I'm stumped Connie. Kidneys check out OK? If I find anything, I'll let you know.
Jan
Jan
I don't know about the phosphorus means but it is in the normal level, which is better than below.
I do know from my dad having MRSA and worse infections that having a foreign body, such as my dad has with his hip implants, is a difficult thing to deal with. Hopefully when the plate comes off of Thomas you will see a remarkable infection improvement. My father has had low blood counts and out of wack D, B12 and I can't remember what all the levels. He's 82 so has all the aging going against him as well.
I've had vitamin D problems and do not get much sun. I am currently taking 5-10,000 units a day. Doctor's are glad when we get in the normal range, which I think is 39. My nutritionist says above 80 is optimal. My last reading was 62 so we bumped it up to 10,000 from 5,000 for winter. I also have other health problems, besides my J-pouch, and we are all different.
I take a lot of other supplements and told you about my D as an example of how wide some ranges can be.
I do know from my dad having MRSA and worse infections that having a foreign body, such as my dad has with his hip implants, is a difficult thing to deal with. Hopefully when the plate comes off of Thomas you will see a remarkable infection improvement. My father has had low blood counts and out of wack D, B12 and I can't remember what all the levels. He's 82 so has all the aging going against him as well.
I've had vitamin D problems and do not get much sun. I am currently taking 5-10,000 units a day. Doctor's are glad when we get in the normal range, which I think is 39. My nutritionist says above 80 is optimal. My last reading was 62 so we bumped it up to 10,000 from 5,000 for winter. I also have other health problems, besides my J-pouch, and we are all different.
I take a lot of other supplements and told you about my D as an example of how wide some ranges can be.
Normal phosphorus level is 2.4-4.1 mg/dL. 1.5 is pretty low.
Have they looked into parathyroid disturbance? Maybe the antibiotic is having an endocrine effect? Just a thought.
http://en.wikipedia.org/wiki/Hyperparathyroidism
Jan
http://en.wikipedia.org/wiki/Hyperparathyroidism
Jan
Interesting, but not in a good way. I'll keep it in mind and ask. I guess time will tell.
I'm sorry, I thought you meant he was in the at the bottom but still in the range.
Thanks for the link Jan. I knew D was associated with calcium and now I know more. I take D with calcium and at a different time of day than my multi vitamin as well. Most calcium comes with D for absorption. You need to know your calcium level as well. You don't want to over do it...I think because of your kidneys. I knew why when I adjusted my supplement regime.
Thanks for the link Jan. I knew D was associated with calcium and now I know more. I take D with calcium and at a different time of day than my multi vitamin as well. Most calcium comes with D for absorption. You need to know your calcium level as well. You don't want to over do it...I think because of your kidneys. I knew why when I adjusted my supplement regime.
Connie, the puzzling thing is the low phosphate without abnormal calcium levels. It could just be a blip, when repeated, be back to normal. Since he has been having GI symptoms, perhaps there was a malabsorption/malnourishment factor going on.
What caused the potassium depletion? Diarrhea? Diuretics?
Logically, you'd think all these things were all related to one root cause, like the prolonged bone healing issue, not a single drug, like the antibiotic. Plus, if he's taking antidepressants and other things, there could be a metabolic interaction going on. I guess that is why they are monitoring these things.
Jan
What caused the potassium depletion? Diarrhea? Diuretics?
Logically, you'd think all these things were all related to one root cause, like the prolonged bone healing issue, not a single drug, like the antibiotic. Plus, if he's taking antidepressants and other things, there could be a metabolic interaction going on. I guess that is why they are monitoring these things.
Jan
That's an understatement for many Jan. There can be several problems causing what looks like one thing wrong. I wonder sometimes how they feed off of each other in making a condition worse......
Going back to my accounting background, looking at one account or problem. The balance could be off a dollar but that dollar difference could be caused by several mistakes. For example a $999,000 mistake one way and a million dollar mistake another. This is an over simplification but in the debit and credit world things are not always black or red.
Going back to my accounting background, looking at one account or problem. The balance could be off a dollar but that dollar difference could be caused by several mistakes. For example a $999,000 mistake one way and a million dollar mistake another. This is an over simplification but in the debit and credit world things are not always black or red.
We don't know what caused the potassium depletion, either. Since it has remained stable, maybe just another "blip"? White cell count also was slightly elevated a week ago. So maybe the antibiotic is barely keeping infection in check, and that along with all the other meds (pain meds and psychotropics), and some pouch effects means everything else follows.
Sometimes I think we underestimate drug interactions. When we see a side effect shortly after starting something new, we assume it is the new drug. But, it could be something taken for a long time, but now interacting with the new "cocktail." It can bring forth side effects that were not an issue before. Plus, sometimes it is only after a duration that an effect is seen. On top of that, chronic inflammation has systemic effects. This is partially due to constant flooding of stress hormones into the system and how the body responds to that. Then you have consider his probable variable diet, activity level, yada, yada. What a mess!
Is there a light at the end of this tunnel? Hard to imagine so much grief from a single toe...
Jan
Is there a light at the end of this tunnel? Hard to imagine so much grief from a single toe...
Jan
CT scan next week to check the healing progress. If or when it's far enough along, they will remove the infected plate. Then hopefully the pain meds will end sometime after that.
It has been an unbelievably long haul--three years. The orthopedic surgeons claim it's "worth it" to save the toe, but no one has any idea of the extent of the psychological toll--on all of us, really. I did get through to the executive level at Blue Shield of CA. They did another peer review, the results of which are confidential "for legal reasons" (I'm not sure what those are, since it's nearly impossible to sue)--but the outcome is obvious, since she continues to be a provider. The VP/medical director called me earlier this week. He was very apologetic and said they need a better process for oversight and decision-making, but otherwise tap-danced around my questions about the meaning of "standard of care" and the lack of any consequences for the podiatrist. Basically said she's young, lacked experience, "may well have a lot of regret" and have learned from this, and that drug companies often lobby doctors hard to try new products, use them off label, blah, blah, blah. So basically they aren't going to do anything, but I can call him directly if we have any problems with authorizations, etc.
Thomas' Mom
Foot Surgery Nightmare
It has been an unbelievably long haul--three years. The orthopedic surgeons claim it's "worth it" to save the toe, but no one has any idea of the extent of the psychological toll--on all of us, really. I did get through to the executive level at Blue Shield of CA. They did another peer review, the results of which are confidential "for legal reasons" (I'm not sure what those are, since it's nearly impossible to sue)--but the outcome is obvious, since she continues to be a provider. The VP/medical director called me earlier this week. He was very apologetic and said they need a better process for oversight and decision-making, but otherwise tap-danced around my questions about the meaning of "standard of care" and the lack of any consequences for the podiatrist. Basically said she's young, lacked experience, "may well have a lot of regret" and have learned from this, and that drug companies often lobby doctors hard to try new products, use them off label, blah, blah, blah. So basically they aren't going to do anything, but I can call him directly if we have any problems with authorizations, etc.
Thomas' Mom
Foot Surgery Nightmare
quote:He got a big oral dose of potassium two weeks ago, which brought that level up, and it seems to be holding.
I had to have this immediately after my colectomy when my potassium shot down to alarmingly low levels. In those days (1992) Mount Sinai of NYC did not administer potassium by IV because of the risk of inducing cardiac arrest (in fact, potassium chloride is the critical ingredient in lethal injections in states which administer it as a death penalty punishment).
As I recall liquid potassium is blood red and has a taste that gives vile a new meaning.
I am puzzled as to the reason for the potassium depletion. In my case it was explained to me that removal of the colon causes initial electrolyte imbalances while the body adjusts to its removal. But my understanding is your son had his colectomy long ago and now has infection issues. I suppose if there is a blood loss, then replenishment at the right ratio could be an issue but you have not mentioned that here.
I had very low potassium coupled with a very high white blood cell count right after my ileus, and that could have been a factor, but they told me at that time that I had a low grade infection from surgery. I remember when the nurse ran in my room with a dixie cup filled with the liquid potassium and she had a look filled with urgency and commanded me to drink it immediately with the gravest imaginable expression on her face. They had been running daily blood tests on me and obviously the one that came back that day must have shown the very low potassium level.
When potassium is very low or very high it can cause quite dangerous heart rhythm problems. Of all the electrolytes, potassium is the one most likely to be treated as a very urgent matter, with no time to lose.