Picotte Has Flown

Dr. Picotte had been scheduled to do my next TACE procedure at Munson on Feb. 12.  We are flying home to T.C. on Feb. 10 for this procedure.

 It seems that Dr. Picotte has left Munson for greener pastures, and now there is no one in Northern Michigan who does this TACE procedure.  Now it will be done in Ann Arbor.

 We've decided that we'll still fly in as planned, and drive to Ann Arbor and stay in a motel for a couple of days before heading back to T.C.  Our return flight to Florida is scheduled for Feb. 20.

Best laid plans, etc., etc.

Paracentesis

This procedure is creepy, unbelievable, pain free and relieving all at the same time.  We knew that fluid was being retained in my abdomen and needed to be removed, but we had no idea what to expect. It's embarrassing for me to write down how much fluid was removed.  I'll just say that afterwards I was eleven pounds lighter.  Totally creepy and unbelievable - or am I repeating myself?

Martin Memorial Medical Center North in Stuart is undergoing some construction, so everybody has to enter through the main entrance, which is very far from where we needed to go.  Unlike Munson, they have a guard station at the entrance where your drivers license is scanned and turned into a name tag with your picture on it.  We got lost, but ran into a helpful employee who gave us good directions and a wheelchair for lucky Dick to push.  The check-in operation at outpatient registration is actually more efficient than Munson's - I was pleased.

After checking in, there was a visit to the lab for a blood draw, and then a wait, wait, wait for the procedure.

It's a great procedure - no need to disrobe, just lie down, expose your belly and lie still.  Chrissie and Tara were the ultrasound operators, and Gina was the student.  They were all very personable and fun - made things a lot less anxious for me.  After Chrissie marked me with an X for the best spot for the tube, Dr. Hillmann came in and did the needle insertion, which was painless.  He was in the room for about two and a half minutes! The chargw for the Doctor was $309.08!!  That 8 cents must be really important. Then Dick was allowed to come in, and we just sat and chatted with everyone while I drained.  (Creepy and weird - the draining, not the chatting.)

Came directly home afterwards to rest and recuperate.  You do get some odd feelings in the midsection.

Abdominal Paracentesis

John L. Zeller, MD, PhD, Writer; Alison E. Burke, MA, Illustrator; Richard M. Glass, MD, Editor

Ascites is an abnormal increase in fluid within the peritoneal (abdominal) cavity. The normal abdominal cavity has a small amount of fluid (usually less than 150 mL). Cirrhosis (chronic liver disease) with associated portal hypertension (blood pressure within the liver above the normal range of 5 to 8 mm Hg) is the most common cause of ascites. Other causes of ascites include cancer, heart failure, kidney failure, tuberculosis, and pancreatic disease. An abdominal paracentesis involves the surgical puncture of the abdominal cavity with a needle and placement of a catheter line for the removal of excess fluid. The procedure can be diagnostic in helping identify the cause of ascites or may be used as a therapeutic measure if a large volume of fluid can be removed to lessen discomfort and improve breathing. The March 12, 2008, issue of JAMA includes an article about paracentesis techniques. It identifies ways to decrease the risk of complications and to improve diagnostic accuracy.

PATIENTS WHO SHOULD UNDERGO DIAGNOSTIC PARACENTESIS

• Patients with new-onset ascites
• Patients with chronic ascites and at least one of the following symptoms:

• Fever
• Abdominal pain
• Increasing ascites volume—increasing abdominal girth
• Unexplained encephalopathy (confusion or disorientation)
• Declining liver function
• Kidney failure

RISKS AND COMPLICATIONS OF ABDOMINAL PARACENTESIS

With current techniques, diagnostic paracentesis is considered a safe procedure. Some coagulopathies (bleeding disorders) may make the procedure too risky to perform. Pregnancy, organomegaly (abnormally enlarged organs), severe bowel or bladder distention, and previous abdominal-pelvic surgery may increase the risk of the procedure. In those situations, an ultrasound-guided paracentesis should be considered. Procedural complications are rare but can include

• Persistent leakage of ascitic fluid
• Circulatory problems, such as lowered blood pressure
• Localized infection at the puncture site
• Abdominal wall blood clots or bruises
• Bleeding
• Injury to organs in the abdomen

ANALYSIS OF ASCITIC FLUID

Tests of the removed fluid help to establish the cause of the ascites and to rule out infection. These tests include counts of the numbers and types of cells in the fluid. Testing for albumin (a simple protein) should be done in cases of new ascites. Additional tests may be done depending on the patient's history and physical examination.