As discussed a month ago, the top-down and the bottom up searches for a gaping, bleeding, pus-filled wound as the reason for my fall in haemoglobin came up with a fat zero. So, being nothing if not thorough, my Gastroenterologist ordered one more test to explore where no probe had gone before: the undiscovered country of my small intestine and the upper and lower reaches of my large intestine.
Naturally, he ordered the latest no-strings-attached technology – the Pill Cam, or Pill Camera to the uninitiated (are there any uninitiated anymore?). It’s a simple and painless device that consists of a camera, a flashing light (it’s darker than black inside our guts) and a wireless transmitter, all packed into a capsule about the size of a jumbo jelly bean. During its journey through me, the Pill sent a constant stream of pictures to a receiver unit strapped to my hip.
The receiver was a lot like the Sam Browne belt that British officers wore during WW1 and WW2: a thick belt around the waist with a thinner strap across the shoulder. Rather than a sword, this time the thin strap held the antenna for the wireless signal draped across my chest; the thick strap held the receiver, a nifty unit about the size of a two iPhones taped together, with a screen showing the live feed from the camera.
There was more preparation than I expected, but no great challenge from a dialysis viewpoint. My small bowel had to be empty so the camera could look at its walls, so no iron supplements five days before; no food except clear fluids after lunch the day before; nothing to eat or drink from 10pm, until I swallowed the pill. Once swallowed, nothing for two hours after, and then clear fluids only for two hours after that. By that time the pill would have moved from the small intestine to the large one, and on its journey to a wider world.
Initially, I was fixated on the screen. I found that if I wriggled and moved my stomach in and out, I could move the camera and the view would change. Though I really couldn’t interpret what I was seeing very well, and I saw no gaping, bleeding, pus-filled wounds (a good thing).
It reminded me of the movie Fantastic Voyage, where four men and a woman are reduced to microscopic size and sent in a miniaturized atomic sub through a dying man’s carotid artery to destroy a blood clot in his brain. I remember it starred Raquel Welch (I forget who the guys were). Isaac Asimov also did great things with the story when he wrote the novel from the movie. He made sure it was as technically accurate as possible (the body bit, not the microscopic sub). Somehow what I saw in the movie made a lot more sense to me that what I saw from my Pill Cam, but hey, that’s show biz.
Still, the small intestine was well worth a look. Its where all the nutrients from the food we eat are absorbed and carried by our blood vessels to different organs, where they are used to build the proteins, etc needed by our body. The non-nutritious stuff that remains undigested and unabsorbed passes into the large intestine (which contains several body bits most of us have heard of, including the colon, rectum, and anal canal). Its extracts water and salt from the solid wastes, which then exit the building. That area was also interesting to look at, though it was filled with stuff so I couldn’t see the walls.
I swallowed the Pill Cam at about 8:30am and returned to the doctor’s surgery at about 5pm to give back the receiver unit and have a quick check. All was well. I handed over the unit, we had a quick look at the signal to confirm it had reached the bowel and I departed.
I had some vague plan about watching for the pill when it emerged into the light of day. I looked a couple of times, but either it wasn’t there, or it was hiding. Either way, I lost interest on the third day and stopped searching. I don’t know what I would have done if I had found it. Very limited market for used Pill Cams. Replacing the battery could be tricky… Anyway, its gone now (or at least I hope is has).
So, all clear on the bleeding front; it must have been holding back the EPO for too long, as I suspected. A lesson for next time.