|This stone is in the left ureter, but the overall idea is the same. Wuss patient.|
I'm spending the night at Uncle Steve's house because he knows I was up late and he doesn't want repeat performance of a car rollover because of the driver falling sleep at the wheel. I'm not devoid of common sense, Even if he were not insisting, I would ask to stay over another night. I know when I'm too tired to risk driving further than a few minutes.
I practiced violin for an hour right after I finished working, because I suspected I'd fall asleep and sleep until late at night, when it would be too late to practice because the rest of the family, or at least the children would be asleep. My Aunt heather is awake, and she did ask me to play one song for her that she especially liked, but one song is different than practicing for an hour or longer.
The family had Hawaiian chicken for dinner. I sleep through dinner, but Aunt heather made a plate for me, which I just finished. It was tasty, and I was hungry enough to eat all of it. My parents and most of my adults now know that I will eat when the time is right, so they don't nag me so much. There are times when my stomach cannot hold much food for whatever reason, and there are times when I can find room for a full meal. Fighting nature accomplishes nothing.
I did a white blood cell count. The pathologist did the count on thedendritic cell. the pathologist said differentiating with ease will coe with exxperince. same patient with another slide, as my results at this stage of the game cannot be considered reliable. The procedure is done by placing a drop of blood on a slide, then taking another slide ad using it to push the blood and smear it across the slide. Then the blood must dry. Once it is dry, first a "Diffquick" solution (it's a brand name for a differentiating liquid) is applied and the slide is looked at under the microscope using a grid to count the number of total white blood cells. Next, different solutions are added so that the types of white blood cells present may be counted. I did well on the overall count, but not quite so well on the differentiating part. To me, a mycrophage looks a whole lot like a dendritic cell. The pathologist said differentiating with ease will come with experience. f/or practical purposes for this particular test the total count was what mattered. Appendicitis was being ruled out. the total WBC count was within the normal range. The pathologist repeated the procedure himself, as he always does to be certain, and came up with results even closer to mine the second time. The pathologist was able to determine that if appendicitis was present, it was in its extremely early stages. (The report sent from the ER also said that the patient was afebrile, further lending credence to the absence of appendicitis.) The pathologist asked me what test I thought should be run next. Relying on my own experience, I said that first I would obtain a urine sample if one had not been obtained and check for blood, which would be indicative of a urinary calculus. the pathologist agreed. In this procedure, urine is spun at a rapid rate to separate any blood that is in the urine from the urine itself. Sometimes it is present, maybe even just in trace amounts, but cannot be detected just by looking at the sample. /I suggested also a dipstick test for presence of nitrites and WBCs in the urine to determine the possible presence of a urinary tract infection. The pathologist agreed. We found nitrites, WBCs, and red blood cells, indicating probable urinary tract infection and possible urinary calculi. The absence of WBCs in the blood would indicate that the infection was at the lower level of the urinary tract and had not yet reached the kidneys.
The pathologist asked what we should do next. I said that other than reporting our findings, basically nothing. Our job was finished. It was now up to the examining physician to order some form of radiological procedure- most likely a CT scan, though possibly a simple kidney-ureter-bladder X-ray or maybe an ultrasound if indication was that the stone, if there really was a stone, was obstructing the ureter and causing any backup urine into the kidney. KUB plus ultrasound is less expensive if that's an issue, and there's also less radiation to which the patient is exposed.
The pathologist said I got an A for the day. Of course it was figurative, as we don't receive daily grades.
He texted me after I was gone to tell me that the patient has a 9-millimeter by 5-millimeter partially obstructing stone in his right ureter. A stent will be placed in the ureter, and as soon as possible, it will be blasted with lithotripsy if it cannot be moved along simply by increasing IV fluids and possibly giving the patient tamsulosin, which increase the flow of urine. (Often known by the major brand name Flo-max, its primary use is to help men with prostate problems pass urine.) . I texted back that the patient is a wuss because I passed a much larger (13 by 8.5 mm calculus) all by myself with nothing but a little soda and lemonade. The pathologist texted back to ask if I wanted a medal or a trophy. I said either would be fine.
We're having a thunder storm. I shall turn off the lights to enjoy it, while hoping that everyone has been able to seek shelter.