I'll be doing a book signing at Eagle Harbor Book Company on Bainbridge Island for "Complications: A Doctor's Love Story" on Thursday, June 10 from 7:30-8:30 p.m. The bookstore is located at 157 Winslow Way East; Bainbridge Island, WA. It's a one-of-a-kind independent bookstore, with a unique regional flavor.
Catch the 5:30 p.m. or 6:20 p.m. ferry to Bainbridge, leaving from Seattle's Coleman dock. The bookstore is walking distance from the ferry, and there are several great spots to eat and shop along the way.
"Complications: A Doctor's Love Story" takes Steve and me through our early days as a couple. I found him through my Internet ad: "I'd like to meet a nice Democrat."
What I didn't count on were the complications we encountered. Steve had full custody of then nine-year-old Brita -- who greeted me with "I hate every centimeter of you; get used to it!" Then, there were the complications of Steve's health. Known to have diabetes and high blood pressure for years, Steve descended rapidly into the abyss of Acute Renal Failure.
"Complications: A Doctor's Love Story" is one of the few books written about ESRD from a personal standpoint. It also provides an intimate view of Home Hemodialysis, and one family's journey through a major health change.
So, please come to Bainbridge Island on Thursday, June 10!. Take a lovely evening ferry ride to the other side of the sound, and learn more about our family's adventures along the way. I will also have copies of "Arranging Your Life When Dialysis Comes Home: The Underwear Factor" which I co-authored with Interior Designer Jane McClure.
Thank you for your support.
Take care. Linda Gromko, MD
Sunday, May 16, 2010
Sunday, May 9, 2010
"But I was only gone for two days!"
Steve has been recovering from his aortic valve replacement and coronary bypass surgery since early March. Slowly eeking towards a stint on Rehab, we have seen progress daily -- but it has been very slow. He hasn't been able to stand up. He can now sit up with help, and only last week he wiped his chin for the very first time!
I had a medical conference to attend in New Jersey Thursday and Friday of last week -- a training event offered only twice a year. I orchestrated my flights so I'd spend the least possible time away, leaving late Wednesday afternoon and returning Friday evening. Besides, I could speak to Steve on the phone.
When I spoke with him on Friday noon, he sounded fine.
But when I got to the hospital at midnight, he had a temperature of 101.5, his white blood cell count had doubled to 26, and he was disoriented.
And I mean really disoriented. The choppers were landing behind his sister Carole, and he was begging to get out of his birthday suit! He couldn't get comfortable, and the focus of his pain was his right upper abdomen.
While there were a number of possibilities, acute cholecyctitis was the leading differential diagnosis. Blood cultures were drawn -- and were growing bacteria (enterococci) by Sunday. A trio of heavy-duty antibiotics was started, and as I write this, Steve is in the Interventional Radiology Department having a drainage tube placed in his gall bladder. He's far too fragile for either a laparoscopic or open cholecystectomy; that will have to wait for a more stable time.
The trip to Interventional Radiology affords Steve another advantage: he needs more IV access. Already dialyzing through a tunneled subclavian catheter, Steve needs more lines for the raft of antibiotics needed to fight his sepsis. The right arm -- with its "curing" fistula-in-development -- isn't an option.
I'm pretty sure there's nothing I would have picked up if I hadn't gone to my conference - if I'd stayed in Seattle. But, a flash of guilt assuredly did pass through my mind.
Caregivers need clones. We can't be everywhere; we can't anticipate every bump in the road. But we somehow feel we should be able to protect our loved ones from fates beyond our control!
As I was reminded on the plane from Newark, "place your own oxygen mask on your face first, and THEN tend to your children or other passengers who need assistance." We have to give ourselves a break! And everything is simply NOT within our control.
Take care. Linda Gromko, MD
I had a medical conference to attend in New Jersey Thursday and Friday of last week -- a training event offered only twice a year. I orchestrated my flights so I'd spend the least possible time away, leaving late Wednesday afternoon and returning Friday evening. Besides, I could speak to Steve on the phone.
When I spoke with him on Friday noon, he sounded fine.
But when I got to the hospital at midnight, he had a temperature of 101.5, his white blood cell count had doubled to 26, and he was disoriented.
And I mean really disoriented. The choppers were landing behind his sister Carole, and he was begging to get out of his birthday suit! He couldn't get comfortable, and the focus of his pain was his right upper abdomen.
While there were a number of possibilities, acute cholecyctitis was the leading differential diagnosis. Blood cultures were drawn -- and were growing bacteria (enterococci) by Sunday. A trio of heavy-duty antibiotics was started, and as I write this, Steve is in the Interventional Radiology Department having a drainage tube placed in his gall bladder. He's far too fragile for either a laparoscopic or open cholecystectomy; that will have to wait for a more stable time.
The trip to Interventional Radiology affords Steve another advantage: he needs more IV access. Already dialyzing through a tunneled subclavian catheter, Steve needs more lines for the raft of antibiotics needed to fight his sepsis. The right arm -- with its "curing" fistula-in-development -- isn't an option.
I'm pretty sure there's nothing I would have picked up if I hadn't gone to my conference - if I'd stayed in Seattle. But, a flash of guilt assuredly did pass through my mind.
Caregivers need clones. We can't be everywhere; we can't anticipate every bump in the road. But we somehow feel we should be able to protect our loved ones from fates beyond our control!
As I was reminded on the plane from Newark, "place your own oxygen mask on your face first, and THEN tend to your children or other passengers who need assistance." We have to give ourselves a break! And everything is simply NOT within our control.
Take care. Linda Gromko, MD
Monday, April 26, 2010
What Price Advocacy? Discomfort!
As my husband Steve completes his seventh week in the hospital following his open heart surgery, it's fair to say that he's come a long way. Truly, by all rights, he should have died -- were it not for the courage of Dr. Joseph Tepley and Dr. Brad Tupper.
But this past week, Steve suffered a setback. For a variety of reasons, he became volume overloaded and suffered several sleepless nights with severe shortness of breath. Fluid was accumulating in his lungs. Because he is essentially bedridden, Steve accumulates edema fluid in his neck and back, and even under his chin -- but less so in the usually dependent areas like the feet.
Concerned that the volume overload would place undue strain on his heart, I approached his health care providers. My concerns were reasonable. Plus, Steve's symptoms of chest constriction and shortness of breath raised concern about other possible diagnoses such as pulmonary embolism and coronary artery ischemia.
Here I am, an MD with a Master of Nursing degree -- and over two years of experience with Home Hemodialysis. And I found it uncomfortable to ask his care providers about these problems!
Would they resent my "intrusion?" Would my comments be charted as "wife insists....?"
Fortunately, Steve's team was gracious. His cardiac enzymes and d-Dimer did not support the worrisome possibilities of bypass graft failure or blood clots in the lungs. His chest X-ray, however, showed classic signs of fluid overload -- signs any second year medical student would have recognized.
I was relieved; we were on the road to correcting the problem. But what would have happened if I hadn't spoken up? Could it have meant a detour back to the ICU -- or worse?
What if I had been elderly (or more elderly than I am)? What if English was a second language? What if I felt truly intimidated, not just uncomfortable?
No doubt about it: there are barriers to being a "mama lion" in the hospital! But I believe, as a wife and caregiver, we have an obligation to overcome our discomfort and step up. Not doing so really could make the difference between recovery and disaster.
Remember: good doctors don't get rattled when you ask them questions. They welcome your input. They don't want a bad outcome either.
Take care. Linda Gromko, MD
But this past week, Steve suffered a setback. For a variety of reasons, he became volume overloaded and suffered several sleepless nights with severe shortness of breath. Fluid was accumulating in his lungs. Because he is essentially bedridden, Steve accumulates edema fluid in his neck and back, and even under his chin -- but less so in the usually dependent areas like the feet.
Concerned that the volume overload would place undue strain on his heart, I approached his health care providers. My concerns were reasonable. Plus, Steve's symptoms of chest constriction and shortness of breath raised concern about other possible diagnoses such as pulmonary embolism and coronary artery ischemia.
Here I am, an MD with a Master of Nursing degree -- and over two years of experience with Home Hemodialysis. And I found it uncomfortable to ask his care providers about these problems!
Would they resent my "intrusion?" Would my comments be charted as "wife insists....?"
Fortunately, Steve's team was gracious. His cardiac enzymes and d-Dimer did not support the worrisome possibilities of bypass graft failure or blood clots in the lungs. His chest X-ray, however, showed classic signs of fluid overload -- signs any second year medical student would have recognized.
I was relieved; we were on the road to correcting the problem. But what would have happened if I hadn't spoken up? Could it have meant a detour back to the ICU -- or worse?
What if I had been elderly (or more elderly than I am)? What if English was a second language? What if I felt truly intimidated, not just uncomfortable?
No doubt about it: there are barriers to being a "mama lion" in the hospital! But I believe, as a wife and caregiver, we have an obligation to overcome our discomfort and step up. Not doing so really could make the difference between recovery and disaster.
Remember: good doctors don't get rattled when you ask them questions. They welcome your input. They don't want a bad outcome either.
Take care. Linda Gromko, MD
Monday, April 19, 2010
Obesity Conference: A Real Eye-Opener
Last week, I attended the Obesity Conference presented by the American Society of Bariatric Physicians. What an eye-opener!
Two thirds of all Americans are now considered overweight or obese! And the problem is "ever-expanding" in that more children are facing challenges with excess weight. At the conference, I learned that it is now predicted that the current generation will not outlive their parents!
How does excess weight impact the "Renal Community?"
Excess weight is directly related to the following conditions. Certainly, Diabetes, Hypertension, and Metabolic Syndrome increase risks for End Stage Renal Failure (CKD-5). But note how much overlap we see between ESRD and the other conditions listed.
The problems of excess weight have become so concerning that we will be offering a Weight Management Program in my Family Practice, Queen Anne Medical Associates, PLLC, beginning in June 2010. I feel we are at a point where it's irresponsible NOT to offer a Weight Management Program of some sort.
Link to http://www.QueenAnneMedicalWeightLoss.com/ for more information.
And, for our new Weight Loss blog, go to http://www.QAMedicalWeightLoss.blogspot.com/.
Take care. Linda Gromko, MD
IMPORTANT ADDENDUM: ESRD patients should attempt a weight reduction program ONLY with the approval of their nephrologist and renal dietician!
Two thirds of all Americans are now considered overweight or obese! And the problem is "ever-expanding" in that more children are facing challenges with excess weight. At the conference, I learned that it is now predicted that the current generation will not outlive their parents!
How does excess weight impact the "Renal Community?"
Excess weight is directly related to the following conditions. Certainly, Diabetes, Hypertension, and Metabolic Syndrome increase risks for End Stage Renal Failure (CKD-5). But note how much overlap we see between ESRD and the other conditions listed.
- Type II Diabetes
- Hypertension
- Metabolic Syndrome
- Obstructive Sleep Apnea
- Coronary Artery Disease
- Stroke
- Erectile Dysfunction
- Abnormal cholesterol
- Asthma
- Depression
- And ON!
The problems of excess weight have become so concerning that we will be offering a Weight Management Program in my Family Practice, Queen Anne Medical Associates, PLLC, beginning in June 2010. I feel we are at a point where it's irresponsible NOT to offer a Weight Management Program of some sort.
Link to http://www.QueenAnneMedicalWeightLoss.com/ for more information.
And, for our new Weight Loss blog, go to http://www.QAMedicalWeightLoss.blogspot.com/.
Take care. Linda Gromko, MD
IMPORTANT ADDENDUM: ESRD patients should attempt a weight reduction program ONLY with the approval of their nephrologist and renal dietician!
Thursday, April 15, 2010
The Inn At Cherry Hill -- Useful Recycling of Old Hospital Space
When I was a medical student at the University of Washington, we rotated through many of the hospitals in the Seattle area. I spent many months at Providence Medical Center, both in medical school and in residency..At the time, it was run by the Sisters of the Charity of Providence. Morning and evening prayers were broadcast over the PA system; there was a crucifix in every room.
Today, Providence has evolved into the "Cherry Hill Campus" of Swedish Medical Center. There's a Starbucks where the gift shop used to be, the chapel appears more "bland" -- even non-denominational, and the crucifixes are gone.
The fifth floor of the old hospital -- with its small private rooms and tiny bathrooms -- was retired from patient use some time ago. Today, it is "The Inn at Cherry Hill" -- with rooms rentable to families of patients at the medical center for a fee that isn't cheap ($70/night), but certainly beats any area hotel rate. The rooms are modest, but clean. Best of all, they are down the hall from your family member. The Inn features a communal washer and dryer, and hospital linen is provided.
For those of us who come a distance, it is a tremendous service. This week, for example, I've been attending a medical conference at the airport. But I still live on Bainbridge Island, and commute to Seattle for work -- and to spend time with Steve at Cherry Hill. Some nights, when there's been too little energy to go around, I've spent the night at the Inn.
I think every hospital should have sleeping rooms for patients' families. And if not full quarters, at least a "USO style" lounge with showers, recliners, desks, and phones. A place to wash up, and a place to calm down.
I applaud Swedish for using these old rooms for such a humane purpose. Undoubtedly, they wouldn't have met newer codes for patient care use. And remodeling would have been too expensive.
But someday, perhaps hospitals will be planned to include such areas for families! Someday, it will be recognized that it's simply the right thing to do.
Take care. Linda Gromko, MD
Today, Providence has evolved into the "Cherry Hill Campus" of Swedish Medical Center. There's a Starbucks where the gift shop used to be, the chapel appears more "bland" -- even non-denominational, and the crucifixes are gone.
The fifth floor of the old hospital -- with its small private rooms and tiny bathrooms -- was retired from patient use some time ago. Today, it is "The Inn at Cherry Hill" -- with rooms rentable to families of patients at the medical center for a fee that isn't cheap ($70/night), but certainly beats any area hotel rate. The rooms are modest, but clean. Best of all, they are down the hall from your family member. The Inn features a communal washer and dryer, and hospital linen is provided.
For those of us who come a distance, it is a tremendous service. This week, for example, I've been attending a medical conference at the airport. But I still live on Bainbridge Island, and commute to Seattle for work -- and to spend time with Steve at Cherry Hill. Some nights, when there's been too little energy to go around, I've spent the night at the Inn.
I think every hospital should have sleeping rooms for patients' families. And if not full quarters, at least a "USO style" lounge with showers, recliners, desks, and phones. A place to wash up, and a place to calm down.
I applaud Swedish for using these old rooms for such a humane purpose. Undoubtedly, they wouldn't have met newer codes for patient care use. And remodeling would have been too expensive.
But someday, perhaps hospitals will be planned to include such areas for families! Someday, it will be recognized that it's simply the right thing to do.
Take care. Linda Gromko, MD
Friday, April 9, 2010
Fistula First...or Second or Third!
My husband Steve has been in the ICU now since 3/5/2010. He's had an angioplasty, then a major open heart surgery to replace his severely stenotic aortic valve and bypass four coronary vessels. He was so unstable that his chest was left open -- to be closed in a second surgery five days later. I had never even heard of this before! We are so grateful he survived.
Steve's dialysis fistula in his forearm "went down" on the day of his surgery. His cardiac ejection fraction was only fifteen percent (normal is at least over 50 percent), so peripheral blood flow was sluggish. The fistula clotted -- and Steve's condition was so precarious that he required twenty-four-hour-a-day dialysis via an Internal Jugular central line.
Even though Steve has had two prior central lines for Home Hemodialysis, we know that a central line is an infection waiting to happen! They say it's not a matter of if there will be an infection, but rather, when!
(We have been very fortunate with Steve's central lines in the past -- even using them for many months without infections.)
But this time feels more critical. In Steve's already weakened state, we cannot risk a line infection. So, the current plan is to place a new dialysis fistula this coming week. We know it will take weeks to mature to the point where it's usable for dialysis.
All this brings me back to the point of the slogun "Fistula First!" In the best of circumstances, a person with End Stage Renal Failure starts Hemodialysis via a mature fistula, surgically created weeks to months in advance. This is why patients are referred to a vascular surgeon as their renal function nears the point of dialysis (as reflected by the eGFR- or estimated glomerular filtration rate). In general, dialysis would begin with an eGFR of 10, or 15 in a diabetic.
Back in September of 2007, Steve's initial presentation with acute-on-chronic renal failure was so rapid, he didn't have the luxury of getting a fistula placed ahead of time. Even then, he couldn't seem to catch a break. But, even then, he landed on his feet. We're counting on continued strength from this extraordinarily resilient man.
Take care. Linda Gromko, MD
Steve's dialysis fistula in his forearm "went down" on the day of his surgery. His cardiac ejection fraction was only fifteen percent (normal is at least over 50 percent), so peripheral blood flow was sluggish. The fistula clotted -- and Steve's condition was so precarious that he required twenty-four-hour-a-day dialysis via an Internal Jugular central line.
Even though Steve has had two prior central lines for Home Hemodialysis, we know that a central line is an infection waiting to happen! They say it's not a matter of if there will be an infection, but rather, when!
(We have been very fortunate with Steve's central lines in the past -- even using them for many months without infections.)
But this time feels more critical. In Steve's already weakened state, we cannot risk a line infection. So, the current plan is to place a new dialysis fistula this coming week. We know it will take weeks to mature to the point where it's usable for dialysis.
All this brings me back to the point of the slogun "Fistula First!" In the best of circumstances, a person with End Stage Renal Failure starts Hemodialysis via a mature fistula, surgically created weeks to months in advance. This is why patients are referred to a vascular surgeon as their renal function nears the point of dialysis (as reflected by the eGFR- or estimated glomerular filtration rate). In general, dialysis would begin with an eGFR of 10, or 15 in a diabetic.
Back in September of 2007, Steve's initial presentation with acute-on-chronic renal failure was so rapid, he didn't have the luxury of getting a fistula placed ahead of time. Even then, he couldn't seem to catch a break. But, even then, he landed on his feet. We're counting on continued strength from this extraordinarily resilient man.
Take care. Linda Gromko, MD
Wednesday, March 31, 2010
I Celebrate Doctors' Day!
Yesterday, twenty days after the lengthy surgery to replace his aortic valve and to perform a quadruple bypass, Steve got off the ventilator!
Steve, the Respiratory Therapist, prepared Steve, the patient, by saying:
"On the count of three, I want you to cough and spit. Ready? One, two, three, and OUT!"
And out came the endotracheal tube. Steve was off the vent. And little by little, he settled into the comfort of breathing on his own: his respiratory rate slowing while his oxygen saturation levels stayed at 100%.
About an hour later, Dr. Teply, the Heart Surgeon who spent nearly thirteen meticulous hours taking down the scar tissue from Steve's previous heart surgery, stopped in on his rounds. His face reflected the joy and relief we all felt.
"I am so grateful for the work you did, Dr. Teply. And for the courage you had to even do this surgery."
Dr. Teply smiled in an "Aw shucks" kind of way. "I'm glad we could help," he said. Dr. Tupper, the electrical engineer-turned-Anesthesiologist, also stopped by, acknowledging with a broad smile, "You made us work, Mr. Williams."
But it was really nothing short of a miracle. It was an amazing composite of medical/surgical artistry and skill. And we are so thankful.
Even Steve, his voice sounding like a baby frog, was able to squeak, "Thank you, Doctor" to Dr. Teply and "Appreciate it" to Dr. Tupper -- the two doctors whose marathon efforts had truly saved his life that long night.
Later in the evening, I stopped by the Doctors' Lounge on the way out of the hospital. A partly eaten chocolate cake was decorated with "Happy Doctors' Day." I never gave Doctors' Day any thought...until yesterday. The day I received the best possible gift from physicians of extraordinary skill.
Take care. Linda Gromko, MD
Steve, the Respiratory Therapist, prepared Steve, the patient, by saying:
"On the count of three, I want you to cough and spit. Ready? One, two, three, and OUT!"
And out came the endotracheal tube. Steve was off the vent. And little by little, he settled into the comfort of breathing on his own: his respiratory rate slowing while his oxygen saturation levels stayed at 100%.
About an hour later, Dr. Teply, the Heart Surgeon who spent nearly thirteen meticulous hours taking down the scar tissue from Steve's previous heart surgery, stopped in on his rounds. His face reflected the joy and relief we all felt.
"I am so grateful for the work you did, Dr. Teply. And for the courage you had to even do this surgery."
Dr. Teply smiled in an "Aw shucks" kind of way. "I'm glad we could help," he said. Dr. Tupper, the electrical engineer-turned-Anesthesiologist, also stopped by, acknowledging with a broad smile, "You made us work, Mr. Williams."
But it was really nothing short of a miracle. It was an amazing composite of medical/surgical artistry and skill. And we are so thankful.
Even Steve, his voice sounding like a baby frog, was able to squeak, "Thank you, Doctor" to Dr. Teply and "Appreciate it" to Dr. Tupper -- the two doctors whose marathon efforts had truly saved his life that long night.
Later in the evening, I stopped by the Doctors' Lounge on the way out of the hospital. A partly eaten chocolate cake was decorated with "Happy Doctors' Day." I never gave Doctors' Day any thought...until yesterday. The day I received the best possible gift from physicians of extraordinary skill.
Take care. Linda Gromko, MD
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