It has been impossible for me not to continue...
...musing about my mother's lab results. I continued a search on WebMD and discovered that the low range reference for IgG is 640 there (with the caveat that lab reference range values may be different) so I guess that's why Mom's hematologist didn't mention anything about it.
    Regarding her elevated RDW, after more thinking I remembered that as anemia alleviates blood numbers do not snap into place like stretched rubber bands. It takes awhile for blood numbers to normalize. My guess, looking at the rest of her numbers, some of which are just over the range border, is that he is not concerned about this one as he expects it to settle into normal reference range.
    What I read about protein in the urine, though, puzzled me. It is typical of, among other things (none of which apply to my mother), damaged kidneys. This is not the first time protein has appeared in her urine and at much higher levels, almost three times today's level in January. Yet in other urinalyses to which he referred (of which I do not yet have copies) she has bounced back and forth between negative and positive. According to his records, her last test for protein/urine/random was negative. As well, all her kidney numbers are showing no indication of kidney damage and haven't, even as they have signified her anemia.
    My mind boggled from lack of sleep and working these curiosities over so, when my mother laid down I decided to do the same. Within minutes a possible answer to the mystery of protein in her urine came to me: She has never had a clean urine test. Unless she were to be catheterized it is virtually impossible to get a clean urine test from her for more than a few reasons. Let me describe the process of what has happened every time a urine sample has been required of her since she began seeing PCPs from this particular office:

1. Into the bathroom we go, where ever we're at (this has also happened at home where we're often, finally, sent to collect the sample). Invariably, if she pees alone, regardless of where she is, she holds the cup in her hand and forgets to take the sample. I've learned that I have to take the sample.
2. She claims she can't pee. While she is claiming this her urine stream begins, often unbeknownst to her.
3. I shove the cup (which she has trouble managing) between her legs, usually grazing her skin at least a few times, hunting for the stream, finding it and getting what I can.
4. As far as the wipes provided for cleaning the area around one's urethra and, for women, the entire genital area are concerned, every time we've attempted to use them, by the time she is or I am done "wiping" she has peed out any urine she was holding. We don't bother with that, anymore.
5. If I've only been able to get a little urine and we are at a medical facility I take the sample out to show a lab tech and ask if that is enough (depending on the type of urine tests requested sometimes it is).
6. When, for whatever reason, we have no luck, we take a sample cup home.
7. The process described above occurs at home with one difference: I follow her around until she alights on the toilet and quickly shove the cup under before her bare butt has hit the seat in order to gather what has already begun to flow.
8. If we are unsuccessful we keep trying but, typically, there is a time limit on how long the lab will wait for a urine sample if they already have the blood. We have, on occasion, been told "a urine sample is no longer needed", which is polite medical code for, "forget it, maybe next time, or, maybe the blood work will show that a urine sample is unnecessary."
9. As far as the technique for guaranteeing a "clean" urine sample flowing through her body is concerned, which consists of one emptying one's bladder completely, drinking several ounces of water and waiting for it to flow through then allowing a bit of the stream to be voided before filling the sample cup, well, medicine can forget that we'll ever again be able to do this.

    As I was mulling over these details and trying to drop into Nap Waves it occurred to me, considering all the skin cells, vaginal secretions and whatever is in her underwear that leaves its mark on her genitalia, probably some of that stuff contains protein. I wonder if this is where her curious protein readings, which never show with any kind of regularity, come from.
    I wish I had thought of this when I was talking to Mom's hematologist. I know that he would not have dismissed my idea out of hand without explaining to me why this couldn't possibly be the problem, if it couldn't. Although I remain dedicated to her PCP he tends to get himself into overbooking frenzies and doesn't consider my questions. Sometimes he doesn't even answer them with a mere, curt "yes" or "no". If I catch him on an easy day I can carry on a reasonable medical conversation with him. If not, he has a tendency to pooh-pooh anything I say. Sometimes, though, I find out later that I am right or my ideas have merit, usually from another doctor and in arrears, as with the colonoscopy. I'll see what he says when I talk to him on Thursday. I may go back to her hematologist with this idea, later.
    Something I forgot to record that is important: I mentioned to Mom's hematologist that she responded with amazingly restored vitality to the accidental colonic preceding the colonoscopy and that the effects, although somewhat modified, have lasted. "I'm thinking," I said [as I had mentioned to her PCP during one of his high frenzy days] that when lethargy returns for more than a few days and I can't seem to revive her by other methods, of administering light, modified bowel cleansing from time to time."
    When I mentioned this he was hunched, head down, over my mother's numbers. By the time I finished he had fixed me with bright eyes, was smiling and responded, "Absolutely! Good policy!" and lifted an upturned thumb in the air, which is a bit out of character for him being that he is a reserved man.
    I guess I'm right on that one, too. I wonder how many other of my ideas have been right but haven't been acknowledged as such because other doctors (her PCP isn't the only violator here) simply haven't had the inclination to listen to and consider what I have to say.
    Doctors and patience. That's where this post needs to go. I had originally intended a free standing essay on this topic. Perhaps I'll collect all this stuff onto one page for convenience, adding what I have already written. The story never seems to end. Maybe I shouldn't be writing an essay but a free flowing litany on this subject with it's own page.
    Dinner time is approaching so I continue not to have time to concentrate on my second posting regarding the beliefnet article. Maybe later tonight. Maybe early tomorrow. We'll see.
- posted by gail rae @ 18:13   email...this post