Untangling Everything

In retrospect, any single one the things that I had described in the previous posts about migraines over the course of a lifetime would be innocuous:

  • chronic persistence of worsening migraines
  • some occasional, mild discomfort with abdominal exertion
  • occasional remarks from various practitioners over the past two decades that my WBC was on the higher end of average
  • significant injury (in 2016) that presented as a rib fracture, but no bruising observed and Xray revealed nothing
  • infection — demonstrable, evidential

We still don’t understand what the exact cause of the infection was. It’s not resolved until we’re certain of the vector itself. So, the big question would be: how was it contracted? When? How long did I have it? Was it something that I’d had since the 1980s? Did I live through Basic Training in 1989 with it? Was it worsened from the 2016 injury? And did that lead to the fall in 2017?

Sure, it’s been identified and treated. Mitigated, perhaps. But not eliminated.

Yet, I find myself wondering whether the infection itself, and the periodic brief episodes of light-headedness — not quite a syncope episode, but brief periods (fleeting, much like PVCs) of a half-second or less experienced in October, November, and December of that year — perhaps in a light-headed moment when I was atop the ladder, I fell.

Apart from the fall itself, any one of the issues above, by themselves, would be insignificant. Yet, together, over a lifetime, they would combine to lead to a realization which ultimately stopped the migraines with which I was contending.

From one perspective, I suppose that it could be said that I had to nearly die in order to accidentally stumble into a cure for the life-long migraines.

⌨️

The End of the Chapter?

…on our last episode.


I mentioned antibiotics… I underwent an extraordinarily intense, many weeks-long IV antibiotic regimen to address what was determined to be a Streptococcus anginosus infection.

What’s curious, I think, is that Strep-a is typically an ENT infection — it’s that “strep throat” thing. Same species of bacteria. And, yet, there it was having taken up residence in my liver. One might wonder, how in the world such a thing could get there. There aren’t many plausible vectors. But, there it was.

Nearing the end of the primary antibiotics — about two weeks worth — it dawned on me that I didn’t have migraines anymore.

The migraines had ceased.

The assorted and worsening symptoms of the prodrome with which I had endured for so many years. The classic “migraine” headache.

Gone.

Completely.

Now, about 18 months later, I haven’t had any recurrence of a migraine. I had also not been aware of until it was gone, that I had some abdominal discomfort — that I thought was just normal — for decades. Since as far back as 1988 or so.

Did the aggressive antibiotics put a stop to them? Scientifically, I’d say they didn’t. But looking back at all of the small, overlooked, issues that’d I’d become accustomed and desensitized to, I’m rather confident that there’s a solid link between them.

My experience is little more than a single data point — and a single data point does not a trend make.

But it’s interesting and something of a curiosity, to me, that the life-long recurrence of migraines completely ceased after the intense IV antibiotic put quite an abrupt halt to the unperceived Streptococcus anginosus infection.

Obviously, we can’t subject everyone with migraines to full-body CT scans in pursuit of zebras, treat the symptoms. But I think it would be interesting to investigate and observe the WBC trend is in those otherwise healthy patients who suffer from frequent migraines. But it wouldn’t be unreasonable to consider that an infection may be contributing.

* A few days before posting this, I had shared this backstory tale with my physiologist. We both reviewed the abdominal CT scans from August 2018 and the scans captured on the date of the fall (December 2017). We’re in agreement that it’s simply inconclusive. The scans do not provide any visible indication of infection within any organs, liver or otherwise. Yes, the scans from 2018 absolutely make clear that there was a significant abscess. But from 2017, there wasn’t enough information to indicate “Yes, there is.” Nor “No, there isn’t”.

Further study is needed.

…🕸📜


A Boss Battle?

…on our last episode.


We then immediately turned and made the hour-long drive to Wenatchee, which would become my home of sorts for the next week while they worked to save me.

Again.

While Samaritan was registered as a Level III trauma center, Confluence in Wenatchee wasn’t even listed as a “trauma center”. It is, however, a much larger and far better-equipped facility.

There was a brief intake to its ER, a quick consultation with one of the residents, and I think they noted that my mental state was beginning a rapid decline.

They then immediately rolled me over to one of the CT rooms and began a CT-guided percutaneous aspiration and drainage.

More radiation from the CT. More IVs, admission as an inpatient, and my decline was halted, but it was still substantial. I’m told in retrospect that they were rather concerned because of what it was, where it was, how substantially my mental state had degraded.

But we absolutely had an explanation for the fever, and all of the ancillary medical issues that a significant liver abscess would include. Weakness, collapsed lung (yep, really significant infection distended my liver… so… a lung couldn’t do its lung thing, apparently).

And if I wasn’t already struggling with recovery from the severe TBI — sound, speech, balance, fatigue — I would be now.

A week, a few more CT scans — I think I’ve had my radiation dose for the next 12 years, thanks — I was well enough to discharge. I’d also have some significant antibiotics for the next month or so.

…🤒📜


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Referred Pain Refers to Something Else

…on our last episode.


Yes, having referred-pain in the left should is suggestive of heart-involvement. And I’m only 46, but the ticker’s still rather healthy, thankyouverymuch.

It’s not my heart.

And it’s not my left shoulder.

Referred pain in the right shoulder, on the other hand (heh, that was funny right there), is suggestive of liver-involvement. There aren’t any sensory nerves in the liver, as such. Much as the brain, lungs, and several other internal organs don’t have mechanoreceptors. Instead, discomfort or injury to the liver is referred pain elsewhere.

“I’d like a CT…”, he started.

“…of my liver,” I finished.

About a half hour later, I was across the street at Samaritan Healthcare getting another dose of radiation in the CT scan. Then I’d have to wait another hour for the radiologist to interpret and report back to my physician. So, I just went home and resumed shivering and waiting.

No sooner than I got home, the phone rang. “Well, I know why you have a fever. You have a liver abscess.”

I remarked, “Well, that would explain a few things.” Yet, at the time, I still hadn’t fully comprehended how many things it would explain.

“We don’t have what we need to treat you here.”

Moses Lake had only barely reached the Level III trauma center designation. Samaritan in ML can stabilize a patient then transport them off to Wenatchee or Spokane.

He helpfully added, “I’ve already called ahead to Confluence [Wenatchee] and they’re expecting you. I can have you taken there by ambulance…”

“Uh, no, thanks. My checkbook is still reeling from the last emergency trip the other direction,” I jokingly said. “I’ll have Daisy drive me there as soon as she gets back from the pharmacy.”

…🚑☢️📜


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Adjusting Focus

…on our last episode.


Then, he asked a question, “Do you have any pain or discomfort, of any kind, even minor or trivial, anywhere?”

“No, nothing… but honestly, I think I slept on my shoulder wrong… but it’s probably nothing at all…”

“What kind of discomfort? Burning? Pressure? Tearing?”

“None of that,” I’d said, “It’s just a common myalgia — a muscle pain from over-use…”

And then, the very moment when I clarified where it was “…in my right shoulder…” he and I both latched onto that one, single, clue.

…☢️📜


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