Monday, December 17, 2018
As per usual, I didn't finish this post in one go. The following paragraphs we're written yesterday. Looks like it's going to be another beautiful day here.
Just a smashingly beautiful day here in the southwest Panhandle of Nebraska. Fifty-six degrees and sunny as I write this at 1227L. Just a light southerly breeze. Right before I sat down I had a lovely romp including a dozen ascents of smokebong hill and I'm feeling pleasantly well used.
As you might expect from the title up there, it's been a bit busy around these parts.
We installed a permanent drain tube in my Dad's abdomen on Thursday. The idea is to allow him to drain the accumulating ascites fluid at home rather than journey into tow to visit the hospital for a weekly paracentesis.
Of course the world isn't as simple as all that. At least not so simple that putting in a permanent drain is like snapping a hose onto a fitting.
I'm not sure if I've explained the while abdominal fluid thing before...
The liver is a major player in just about everything your body does. It's a big part of the digestive system where it serves both as a filter and as a factory for production of a great many proteins and enzymes and hormones and stuff. When you eat food the food goes through the gut -- stomach and intestines. The gut breaks food down into molecules that the body can use for cellular metabolism, but those molecules have to go through the liver to be "tweaked" and sorted and refined. At the same time the liver filters the detritis of it's metabolic and catabolic efforts. To get from the gut to the liver, nutrients travel via the circulatory system. Oxygen and nutrient rich blood enters the gut via the aorta, the big central abdominal artery. As the blood flows through the intestines it picks up nutrients, then flows to and through the liver via the portal venous system.
When the liver is sick this blood flow is slowed and restricted by scar tissue. It backs up in the liver, increasing in volume and pressure. Eventually protein rich plasma begins to weep out of the liver and collect in the abdominal space. That's where the fluid comes from, and once in the abdominal space it has nowhere else to go, so it builds up there. If you don't do anything to remove fluid and reduce pressure, eventually the non-compressible fluid will make it impossible for the diaphragm to work. When the diaphragm can't work you can't breathe and that's the end of the tune.
Fortunately, the fluid can be removed relatively easily. Dad's been getting weekly paracentesis For about 10 months now and he's never had any problem. Other than having to have it done of course. I suppose some folks might see having a needle jabbed into your belly every week as somewhat of a problem. Butt I digress.
Placing the permanent tube went well but it was rather an ordeal for Dad. They wanted his abdomen to be very full of fluid to improve both ultrasound visualization and overall safety. Once the tube was in place they drained about 15 liters of fluid. That's about 33 pounds of mass, and for various reasons removing that much fluid at once -- even though it's taken from the belly and not the circulating volume -- induces a certain amount physiological shock from the change in overall fluid balance/dynamic. So he felt pretty small and weak for a good 24 hours.
The next day there was a great deal of fluid leaking from around the tube. This is to be expected. Dad's liver is weeping about a liter of fluid into the abdomen every day, and since water doesn't compress (the fluid is mostly water) his intra-abdominal pressure goes up. Having just placed a tube in there, there's an unhealed pathway from inside to outside and rising pressure forces fluid to flow through that pathway. As it heals in the flow will first slow, then hopefully stop. In the meantime we're doing a lot of dressing changes.
Things are looking up today, with very little leaking, so it looks like we're headed in the proper direction.
All the rest of life keeps going on of course, and Friday I had to gather cattle for shipping yesterday. The weather cooperated, as did the cattle, so the whole thing was quite enjoyable and satisfying.
If the weather guessers are correct, or even fairly close, we could even have a couple more days of lovely weather before the next front arrives with more seasonal conditions. This time of the year you kinda have squeeze all the lovely out of nice weather while it's here. It's ephemeral, which makes it a treasure.
By the time Friday morning rolls around we'll be starting the annual shortest day-longest night as winter solstice arrives. Thereafter the days will be getting longer and spring will be on the way. Rebirth is upon us. Time to enjoy a pagan sammich!