Day two in Rio de Janeiro, day two in the hospital.
I landed at 10:30 am yesterday. Went first to Tavares Bastos to drop off the luggage, then headed to the CER Leblon (Coordenação de Emergencias Regionais).
Dad was moved here this past Tuesday, after a day of being taken to specialists, and eventually sent back to his local Posto de Saude. Wendy, the director of that public health clinic, on hearing of how he’d been shuffled from place to place without any resolution – this is a man who’s not been able to walk since December, who had not been able to go to urinate in a week, was dehydrated and had not had anything to eat since the morning when he was taken from home to the first clinic at 10AM – decided to escalate his case to the regional emergency level, summoned an ambulance, and then kept the staff from going home for three hours while they waited for dad to be evacuated to the hospital.
That is how Dad found himself at the CER Leblon. The complaint upon his arrival here was that he had not had a normal bm in 10 days, and had had progressively harder time with urinating, until by the fourth day of not effectively eliminating liquid waste, his legs were quite swollen.
The internment came just in time as he was getting very dehydrated – after days of retaining urine, he’d had a very hard time drinking fluids, and consequently, was dehydrated, despite retaining several liters of fluid in his tissues – but not in his blood stream, where they are needed.
Since his arrival he’s been on an IV to ensure hydration . The staff have taken blood and urine samples daily. The bed he’s in is very comfortable, but they are not turning him – which will eventually lead to bed sores (tomorrow is day 5).
While he’s been here the staff have keyed in on two indicators of kidney health – the reactive compound type C, would indicate infection of the kidneys, the second marker, creatinine, is used to measure the efficiency of kidney function, the higher the index of this protein in the blood the more compromised the kidneys are.
It seems, I’ve learned from speaking with one of the many attending Dr.’s, that Dad was here in early October of last year, when he’d needed urgent care for an infected leg wound and an associated larval infestation in his ear (how the two are related is another story). When he was here at that time, the hospital performed similar blood exams, and so had a prior “baseline” to work from. At that time, his creatinine levels were in the low 2’s. Healthy kidney functions lead to measured levels in the low 1’s. This told the CER doctors that Bill had a chronic kidney function problem before – what they encountered when he arrived here this time were creatinine levels in the high 3’s.
Speculating that the high creatinine readings were related to dehydration, and his incapacity to eliminate liquid wastes, they decided to hydrate him via IV, and keep monitoring for kidney function. The other index studied by blood work, the reactive compound type C, has not been worrisome after the first run of tests, eliminating the specter of kidney infection.
The issues with urinating have been relieved by catheter, and while not a permanent solution, has at least served to stabilize my father’s condition, permitted the body to evacuate excess fluids from his tissues (swollen legs no more) and allowed for the monitoring of the volume of urine produced, which has been normal.
The Dr. I spoke with this morning, a young woman by the name Renata (in Brazil the honorific is accompanied by the first name, not the surname), explained that they believe the urination problem was due to gallstones that literally stopped the flow of fluid down the urethra.
The gallstones, if correctly diagnosed, would have been exasperated by dehydration. If the situation was exactly as described to me, it quickly becomes a vicious cycle – gallstones impede the normal flow of urine, urine is retained causing discomfort and abdominal pain, leading to a diminution or cessation of ingestion of fluids, which in turn encourages the production of gallstones (because the fluid in the urinary tract is more concentrated), leading to even greater difficulty in eliminating liquid waste. The recommendation of this facility (which is strictly an emergency facility) will be to refer Bill to specialists who are better equipped to treat urological health issues.
We are presently hoping that today’s tests show that the creatinine levels have continued to drop (indicating that the acute condition is returning to a chronic condition) and that the hospital staff will release him to go home with follow up consultations indicated.
In speaking with Dra. Renata I asked whether there is any particular measure to be taken to alleviate kidney functioning, and if anything that could be done for the gallstones. For the prior, nothing is recommended. However, dehydration stresses the kidneys, and will further aggravate the existing lowered metabolisys of waste products. At some point, if kidney functions fall below a certain threshold, dialysis will be required. The gallstones, I was told by Dra. Renata, are best passed naturally by ensuring that Bill stays very hydrated, thereby passing the stones while they are still very small and don’t threaten the eliminatory functions.
Bill’s been on a liquid diet since his arrival, and has been able to eliminate solid wastes again. If he is not released tomorrow, I expect that his dietary regimen will return to solid food.