Wednesday, June 18, 2008

PICC a line, any line

I want to live, I want to give

I’ve been a miner for a heart of gold. It’s these expressions I never give

That keeps me searching for a heart of gold

Neil Young

Got the good news late today that since my donor matches my blood type, they don’t need to wash his life giving haematopoetic stem cell. We are both type A Rhesus (Rh) negative. There will be no Rhesus monkey business or battles between Rh & ABO antigens and antibodies in my blood stream. A ( for my Canadian family and friends read "eh") - negative rocks!. Only 6% of the population are that so nearly perfect (but not full of themselves like the 35% who think they are so special with their A+) blood type. Yet I have never been happier with an A minus on a report record. Saves me a lot of tsoriss (read aggravation) as my docs plan how they will send all that I need to live on a direct course to my heart, and from there to where it need to go. Go stem cells, go. Find some cozy corner in my freshly evacuated bone marrow. We've been expecting you. But that is still two weeks away. First you need a secure road in and mine just got simpler, if a foot or two longer. Here's the story.

Because of the match and no need for a fancy catheter, I can get by with a bedside under local (just a lidocaine shot) procedure. When I am admitted, they will be inserting a PICC, a peripherally inserted central catheter that is threaded up my arm and only stops when it gets it gets snuggly with my right atrium. Dylan would call it a tight connection with my heart.

Way easier on my wife and me. My transplant nurse called me today so I got to cancel two clinic appointments tomorrow. And you know what trouble I have being a good patent and a silent doctor, especially when I am with other doctors or nurses. Can I help if my doctor gene is dominant? I need to up-regulate my compliant patient gene. But I digress, for what that phone call meant is that I am not getting an under the collarbone double lumen, better keep this puppy sterile and free of clot Hickman catheter that requires a trip to the OR and constant care. I will already be high maintenance. You see they don’t trust a one -armed doctor to care for his own tubing, so my wife is the most happy, as the PICC is much simpler.

Still no hot tubs or swimming or even baths while it is in place. Don’t worry friends, I can shower, but only with water that been bottled in France and blessed by very well connected leaders from three warring religions. That shouldn’t be hard to find and I can’t be too careful.

And the worst part is I have to give up pumping iron (at least with that one arm). At my present utter dominance over the 15 pound dumbbell, I am only 305 pounds short of the world record for single arm preacher curls held my trainer, Dan Judge. And I was planning to run for governor when this was all over.

Be well. More on  “conditioning” soon. Now that is a strange choice of words.


Anonymous Anonymous said...

Dr. Koffman,

I'm happy to see such a display of your great sense of humor! I'm also happy to hear the news about the "PICC" and hope it makes things a bit easier for you.

Best Wishes,

Charles De Long

June 18, 2008 at 6:52 AM  
Blogger Howard said...

Green lights all the way bu-be-leh.

It's clear from the tone of this entry there are a few stones that got kicked out of your path. As it should, and continue to be.


June 18, 2008 at 11:19 AM  
Blogger Barry B. said...

I'm sure you are aware of the latest efforts to end nosocomial infections. There is a recent New York Times article on the Michigan effort to keep catheters problem-free. It was very successful. There are five guidelines, and of course I can't remember all of them, but they include a sterile drape on the patient, using antiseptic on the patient, etc.

This isn't the article I saw, but it probably has the same advice in it:

Here's the NEJM article:

As I've said, you probably know all of that, but...

June 18, 2008 at 11:28 PM  
Blogger Unknown said...

I am dreading that nasty thing being in my chest. I have put that part of my therapy off for over three year, but this time is drawing near. Dr., do I have too? What are my options? How do I ensure that it will not cause any issues post transplant?

June 29, 2008 at 2:22 AM  

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