Friday, January 11, 2013

Bleeding Heart

When Bruce came out of recovery he was wheeled to his room by a young and diminutive nurse's aide. As she was struggling to move him to his bed, he-ever the Southern gentleman-did most of the work. She told him if he noticed bleeding or felt moisture near the catheter site to tell the nurse. He said, "oh yes, I feel a lot of moisture." She said, "no, I mean a lot." (Didn't he just say that?)  At his insistence  she checked the area, exclaimed dramatically and went running out of the room.

A nurse quickly appeared, stripping off gloves as he ran in the door. He immediately put pressure on the site. There was quite a bit of blood already on the bed. He explained to us that from the femoral artery it is possible to bleed to death in a matter of minutes. Also, since it had happened this time, it was more likely to happen again. He told Bruce that he had to apply significant pressure while coughing, sneezing, laughing. (awkward!) If it happened again, no matter where he was Bruce was to apply pressure, drop to the ground and yell "Call 911!" (even more awkward!)

Of course, we had to see how that worked. Several nights after we returned home, Bruce was sitting in his chair with the laptop, catching up on work. He sneezed and could not get past the laptop in time to apply pressure to the procedure site. He knew immediately he had opened the artery. I had the phone to call 911 and Bruce said, "I can apply pressure! Just drive me to the walk in clinic."

We got there about 4 minutes before they closed. I ran in to warn them we were coming, ran out and grabbed Bruce. He was applying all the pressure he could as he walked in. They wordlessly pointed him back to the exam rooms. By the time they had him laying down, he could no longer apply pressure so I took over. I was scolded for not calling 911, but after 30 minutes they checked him and sent him home. You can imagine what pains we took in order to NOT repeat that experience.

Dr. M had put Bruce on strong antibiotics to fight the pericarditis. His weakness, pain and shortness of breath lasted for several weeks. When checked in February 2009 his ejection fraction had improved to 50%, close to the low end of normal. In March, he was still experiencing chest pain and shortness of breath so he was referred to a pulmonologist.

The pulmonologist was very thorough and patient at taking the history. He listened to both of us and offered a reasonable theory to explain Bruce's symptoms. He said Bruce has chronic pleurisy; the severity and duration of this most recent episode could possibly be linked to an acute allergic reaction to penicillin that Bruce experienced in August of 2008. The constant pleurisy pain over many months caused the Takotsubo. Once he recovered from both the heart even and the subsequent bleeding issues, we hoped that would be the end of our adventures in cardiology.

Scripture reference: Psalm 20:7Psalm 118:8Isaiah 26:4

Tuesday, January 8, 2013

Heartfelt

I mentioned in a previous post that my husband has serious health issues. He has suffered from what has been diagnosed as pleurisy for 35 years. He gets it every few winters and it hangs on for a week or two. The pain can be intense; the first time he felt it he thought he was having a heart attack, but he got used to the pain and knew it was temporary. In October 2008, he experienced a particularly severe bout that never went away.

In January 2009 he woke up with a very different chest pain, very focused and in the center front of his chest. He finally decided around midnight that we needed to seek help. We are nearly equidistant from two hospitals and since I was driving and I knew exactly where one was, that is where we went. When we arrived we found an overflowing ER and no hospital staff. I went in search of help and grabbed the first white coat I found. I told her my 56 year old husband had severe chest pain and she looked him up and down. "He looks fine to me, go sit down in the waiting room." There was a lot of yelling, crashing and swearing going on back behind the swinging doors and she whirled around and was gone.

Obviously, it was a bad night at the ER. Bruce said,"Let's go." I was in total agreement; the other hospital had to be the better choice. Once we were in the car and headed north he said, "Let's go home. I feel better." You can imagine my response. My arguments were to no avail. Bruce promised that if he had any chest pain in the morning we'd go to the nearby walk in clinic. I did not sleep.

In the morning, Bruce's pain was worse, not better. At the walk in clinic the chest x-ray and EKG appeared normal. The severe chest pain responded to nitro. Part of the chest pain work up is to take blood and check certain enzymes that can indicate myocardial infarction-heart attack. One of them is troponin; normal is 0.1. Normal troponin cannot even be detected by most blood tests.  Bruce's troponin was 0.9 and the doctor called an ambulance to take him to Providence Hospital. We were told that he would need an angiogram the next day. By 9 pm the level was 14.09. Excellent nurses took responsiblity that night and monitored him closely. By 6 am his troponin was 27.70 and they took him to the cath lab.

That was a difficult hour for me. Of course, they make you sign alot of papers that say things like, "a rare complication of cardiac angiography is bleeding to death..." I sat in the waiting room and texted our daughters, my parents, our friends. There were a lot of people talking to God about our situation and I found peace knowing that. When the cardiologist came to give me the report, he said that he had found almost nothing. Bruce's arteries were clear. There was one tiny, non crucial artery with blockage-so insignificant that they do not stent it. Bruce's ejection fraction was 40%; below 40% may indicate heart failure.  Dr. M's diagnosis: Takotsubo Cardiomyopathy which he believed it was due to pericarditis masquerading as pleurisy. The good news about this is that if you survive, the heart typically returns to normal. The bad news didn't matter anymore.

Scripture reference:  Romans 15:13; Philippians 4:6-7