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

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