Category: Diagnosis

Setback? Nah.

I really need to fix my header area.  But I digress, already.  *sigh*

Anyway, things have been going well.  Astonishingly well.  I feel good.  I feel better.  I can do more now than before the surgery.  That’s all good.  Then this past week I hit what I thought might be a speed bump.  Around last Monday I started having some chest… not pain, per se, but… discomfort.  It wasn’t bad, but I was a little concerned.  As the week went on it remained, but it lessened.  Ok, I thought, it’ll go away.  I spoke to some people at rehab about it on Monday, and we agreed it might be natural long-term side-effect of recovery, but to still keep it in mind to have it looked in to if I thought it necessary.

Fast forward to Thursday, and I’m home from work for another reason, but I’m really not feeling well, either.  The discomfort in my chest has suddenly increased, and is very uncomfortable.  It was in the center of my chest and my upper chest in front of my shoulders.  I describe the pressure as standing against a wall, trying to take in a deep breath, and feeling pressure on my chest because the wall will not give way.  I also felt pain/pressure when I would move suddenly and/or turn abruptly to either side.

But at the same time I don’t *know* what it is.  I’m also constantly told, “If you feel anything bad have it checked immediately.”, so I did.  Later in the afternoon, Missy and I headed down to the ER again.

I am again whisked into a room in the back… I later learn they have 36! rooms in the ER and that it’s not common, but not unusual, for them all to be occupied at the same time… and am asked a slew of question, the usual poking and prodding, and so on.  But because this is heart related they do an EKG, which came out fine.  The doctor was afraid of a possible blood clot, which is not unheard of for people after heart surgery, so they do an X-ray and a CT Scan.  Those both came back negative.  It is decided to have me stay overnight for observation… which I had kind of predicted would happen before I even went in… to do some more tests in the morning and to consult with the day’s cardiologist.

I felt gypped because, during my surgery, I had a very small broom closet-like room that was very sterile and cramped.  This time I had a very nice and spacious room that was actually comfortable.  But I digress, again.

The next day I have another EKG, an Echocardogram, and a treadmill stress test.  The EKG (which might have been the night before, I forget), was even better than the first time.  The Echo was fine.  The stress test was fine.  Interspersed between these tests is consultations with the Hospitalist (on-call doctor of the hospital), an on-call cardiologist and his nurse practitioner, pretty much everything heart-related is ruled out.

As coincidence would have it, I already had an Echocardiogram scheduled for the next Monday, which I now no longer needed.  In talking with the on-call cardiologist, he wants to keep me for a second night of observation “juuuuust to be safe”… where have I heard that before?… and because my regular cardiologist was on-call the next day, but Missy and I quashed that pretty quickly, and he backed off, though I sensed grudgingly.  It was after this that the treadmill stress test was done.

The cardio nurse practitioner was present during my treadmill stress test, and afterward she saw that I was not suffering any heart ill-effects.  Bottom line, through an incredible series of process of elimination, it was determined that it was most likely just inflation in my chest cavity and/or around my lungs.  I have some anti-infamatory medication for the next 30 days and instructions to take ibuprofen as needed.  I’ve been out for two days and I feel much better.  In my non-medically trained opinion, the inflammation makes the most sense.  So here I am, telling another story, and I hope it helps someone down the line.  We shall see.

As a last point, I want to reiterate again what amazing and stellar care I was given by everyone at my local hospital, especially the nurses.  I said it before and I’ll say it again, the nurses make or break the entire experience.

Uh oh!

…I woke up on a Wednesday morning, August 22nd, and didn’t feel right.  Discomfort in my chest, shortness of breath, and the slightest exertion such as tying my shoes wore me out.  People always ask me about chest *pain*, and maybe one’s personal definition of pain applies here, but I’ve never felt chest pain, only discomfort.  Which I normally blow off as acid reflux, which I have too, and which mimics the same symptoms.

Anyway, I get ready for work, and am sitting on the side of the bed contemplating what to do.  I finally decide that I’m going to call in and go back to bed.  I can sleep it off, I tell myself.  So, I do that, and also text Missy to let her know.

Missy is suddenly worried.  The doctors said after the angioplasty that if I experience ANY signs of pain or discomfort to get myself to the ER, either by ride or 911.  She tries to call.  No answer.  Keeps trying.  No answers at all.  (I was sleeping.)  Fearing the worst, the worry gets to be too much so she leaves work and heads home.

I wake up about 9:30am as she’s crawling into bed with me.  I eventually wake up fully, and she asks me whats going on.  I figure there’s no way I can my usual uncommunicative self, so I fill her in.  She’s now riding that fine line between feeling relief that I’m “ok”, and feeling upset because I worried her so much.  She also insists that I go the the ER… so we get dress and I go to the ER.

We get to the ER… she drove… and I walk up to the window and am greeted by three ladies.  One asks what I’m there for.  I say that I’m having chest discomfort and am going to have by-pass surgery in 2 to 4 weeks.  They immediately burst into action.  The one takes my info, another one offers me a wheelchair, and a third speaks into a microphone on her chest, something that was all code but obviously about me to get people in the back into action.  And action it was.  I didn’t even have a chance to sit down even if I wanted to.  I am escorted to a room where they begin to undress me from the waist up, and start poking and prodding and asking questions, about four people total, if I recall correctly, and even more enter and do their thing and leave at various times afterward.  I bet I was worked on and talked to by over a dozen people just in the ER.  It was actually kind of impressive in its efficiency.

I get my chest x-rayed.  There are various tests, many involving the drawing of blood, I take my first ever nitro glycerine pill, more questions, and I swear every person who wondered within a 100′ radius felt the need to break out their stethoscope and listen to my lungs and heart.

I going to have to apologize because I don’t always remember all the technical terms and names of the tests, but they did one checking for some anti-body or something in my blood, and it checked out fine, but they had to wait I think three or four hours to do again, which checked out fine.  Meanwhile, my cardiologists partner was on duty that day, and I met her and she was helping to try and figure out what might be wrong, and whether or not I might have to stay.

At the end of it all, she says that she’s not comfortable with my lack of diagnosis, she can’t rule out anything, so she’d like to keep me overnight for observation.  Ok, I suppose.  (I always wonder what they’d do if someone refused.  I’m sure it happens.)  They get some paperwork done, and wheel me, in my bed, upstairs to my room for the night.  For this trip, and my x-ray trip, they always seem to have the most petite young women wheeling my and my huge NASCAR-looking bed around the place, yet they seem to be used to it and aren’t struggling too much.

Anyway, I get the most awesome room.  For a hospital and in Cedar Rapids, anyway.  It’s a corner room, with a clear view of the s-curve of the adjoining freeway, and lots of light and a very airy feeling.  I ask if I can request the same room for after my surgery… they laugh.  My new assigned main nurse asks me to tell something about myself so she can put something on my white board to help people connect.  I say that I’m very sarcastic, and it works, because that little tidbit does help spur conversation during my stay.

Missy and I settle in for the night.  Missy goes home to take care of a couple things.  My son and my sister visit, and we have the most wonderful conversation for about an hour, just catching up.  It almost feels like a night out at a hotel, except for the constant checking on my breathing… I’m tellin’ ya, every person that walks by.

After the diagnosis

So, where were we?

Oh yeah, I’ve been diagnosed.  As I mentioned the surgeon wants me to get my blood sugars down below an A1C of 8.0.  It was 10.5.  Not good, I know.  (No lectures, please.)  So that’s where my focus is going to be the next few weeks.  I begin a stringent regimen of tracking my blood sugar numbers and eating less and better.  In true nerd engineer-like geeky fashion I created a spreadsheet to help me.  Those of you who remember Arlo Guthrie’s Alice’s Restaurant will remember the twenty seven eight-by-ten color glossy pictures “…with the circles and arrows and a paragraph on the back of each one explaining what each one was to be used as evidence against us.”  Well, I created a spreadsheet with rows and columns and colors and a key chart to be used to keep me straight.  Here’s an image of the actual spreadsheet, so far…

My endocrinologist today said that I have provided too much information.  It’s overwhelming and hard to narrow anything down, but that’s jumping ahead a bit.

Anyway, with my meter and my chart I track myself morning, noon, and night.  I have two appointments later in the month, the 28th with my endocrinologist, and the 30th with the surgeon where we will set the surgery date, providing my blood sugar numbers are down to being reasonable.  Today, as I write this, it’s the 28th.  Had my endocrinologist appointment this morning.  Two days to the surgeon’s appointment.  I’m just a little anxious, I want to get it scheduled and done, but I digress.

A couple days later my endocrinologist’s office calls and wants to see me for some diabetes education, so I set an appointment and we meet.  Ends up being two appointments over two weeks and some good information is exchanged.  The nurse marvels at my out-of-date glucose meter… she had to go look for the program to download it, it had been so long… so she gives me a new one.  Then, we’re both perplexed because the new meter’s smart phone app to track for me won’t download onto my phone.  Ya see, I have an Android v5.0.1 and the minimum version number is v5.1.  Figures.

Long story short, things are going  well and the next two and a half weeks go by fine without incident, until…

How did I get here?, Part 3… The Great Leap to the next step

The doctor (my cardiologist) gets my attention, and pulls me out of LaLa Land, and tells me the procedure is over.  I’m just a little taken aback… when did they start?  He then proceeds to tell me, very matter-of-factly, that I need to have heart by-pass surgery.

My reaction:  😐  Oh.  Ok.

I had to absorb this a bit.  The whole process up to this point from the tennis elbow up to this moment has been pretty mundane, almost kind of funny.  “Juuust to be safe”, now took on a whole new meaning.  It was serious.  We talk for a bit, they show me the photos they took, and explain that they went in, found several near-blockages (four or five, something like that), knew a stent or two wasn’t going to cut it, took the photos, and got right back out.  Took all of twelve minutes.

I listen.  It all makes sense.  Somewhat shocking, but it makes sense.  come back to the moment and ask the doctor directly, “Ok, so why haven’t I had a heart attack already?”

Without missing a beat (no pun intended), he says, “You’re lucky.”

I can buy that.  I also like his sincerity and forthrightness.  Just tell me straight up.

Fast forward a few minutes and, after they put this inflatable device on my wrist to ensure the artery does bleed out, they wheel me and my bed back to my room.  I’m reunited with Missy, and for reasons that are blindingly obvious, she’s upset.  Or, rather, was upset.  She has spoken with the doctor, called her mom, but has calmed down now.  When I see her she has sort of a “We have work to do, but we’re going to get through it.” resolve, which is exactly what I needed at that moment.

Most of the rest of the afternoon is somewhat relaxing.  I’m still in bed.  Still wearing the stylish hospital gown.  Almost kind of ‘chummy’, as we’ve gotten along quite well with our nurses.  My primary nurse comes in every so often to let some pressure off the wrist device and check up on me.  Another nurse comes in and does some sonic listening of my heart that I forget the name of.  Another nurse comes in and checks out the veins in my left arm.  This is where they will get the veins for my by-pass.  The nurse also checks my legs for the same reason, as a Plan B.  All this is unplanned, of course, but they’ve been through the drill before and are clearly competent at what they do.  It’s actually impressive at how they can keep their spirits up working in an environment where there is so much potential for disappointment and grief, not to mention that your ‘clients’ keep changing on a daily basis.

Anyway, a couple more hours pass as things are done, I’m eventually disconnected from all the wires, get some more information and explanations.  I meet the surgeon who will perform the actual operation.  Very serious man, but also has a very good reputation.  He says prognosis looks good, but since my blood glucose numbers have been up lately he wants them to come down a bit before he schedules the surgery (which has been going well), otherwise it would have been done in just a few days from then, almost immediately.  They want my A1C down to 8 or less, and it had been a bit above that.  An appointment is set for about four weeks away, and I should get a date scheduled then.  It will probably be pretty soon after that.  Until the, I wait… though it is nice to have some time beforehand to get things in order instead of having life take a sudden turn with no warning.

How did I get here?, Part 2… The Angioplasty

Actually, the nurse was trying frantically to call me late Friday afternoon.  And I’m the kind of person that rarely hears their phone, and I was driving anyway, so I missed the call.  They also called Missy, and she missed it, but she did hear the voice mail.  After an hour of phone tag we settled in with the notion that I would call Monday morning.

I finally get a hold of the nurse on Monday morning, and she’s kind of upset.  Says it’s urgent that I go in for an angioplasty as soon as possible.  She told me what was up, but most of it I didn’t catch.  I knew they wanted to possibly… probably… put in a stent.  We schedule for that Thursday.  I arrange to take the day off as I’m told the whole process will take about five-ish hours.

No eating after midnight the night before.  Only clear liquids… which includes coffee, soda, tea, etc., caffeine was ok this time, who knew?… only up until three hours prior to the procedure, which was scheduled for 1030 am.

We get to the hospital and sign in.  It was as if everyone was expecting me.  haha  I get a room and nurse… I’m going to call everyone except the doctors a nurse as I have no idea which ones were and which ones weren’t… and am told to undress to a certain point and put a gown on.  And let me say that hospital gowns have not changed for at least the last 50 years.  Anyway, eventually a second nurse comes in, who I believe was my primary nurse, and they poke and prod and hook stuff up and get all kinds of vital signs.  Everyone is super friendly, and professional at the same time.

Come time for the procedure they wheel my, still in my bed, out into the hall and down the hallway, around a couple corners, and into a room that looks like a surgery room.  It’s very sterile looking, but also very large and has an enormous set of equipment.  I have an IV in my left arm that was put there in my room.  The nurses… I must have seen a dozen different nurses that day, except for a couple they all seemed to have a single purpose… are all doing various prep-type things to get ready for the procedure.

Time for the procedure comes, and I had been paying attention to my surroundings and all the bustle up until then, and one of the nurses tells me they’re going to inject the anesthesia into my IV now.  I say, “Ok.”, and off we go.

And I mean “off we go” very literally.  This is the same kind of anesthesia that they use for procedures like colonoscopies.  You’re ‘out’, but not out cold.  It’s kind of hard to explain.  Anyway, I say “Ok.”, and they keep bustling around, and my mind wanders a bit.  I think I’m still with it.  Before long I’m no longer aware of my surroundings, though I think I am.  They did tell me when they were going to insert the tube into my artery in my right wrist, I do remember that.

As a side note they go through the wrist now, preferably the right, instead of the groin, though the groin is sort of a ‘Plan B’, if necessary.  And it strikes me as odd that they have to go through an artery, though maybe that’s the only place big enough for the tube, I don’t know.

So there I am with my mind wandering… and wandering… and wandering… thinking I’m aware… and wandering… when they suddenly get my attention.

To be continued.

How did I get here?, Part 1

This has been an interesting journey, so far.  It started around Memorial Day weekend, I was experiencing some sharp pain in my left elbow.  It would at times radiate down to my wrist and/or up to my shoulder.  I lived with it for over two weeks trying ibuprofen to keep it in check.  It was affecting my sleep, keeping me awake at night.  After a couple weeks of no discernible improvement, I finally gave in and went to the doctor.  Urgent care, on a weekend.

The doctor diagnosed me as having tennis elbow.  I was not expecting this, but it made sense.  It felt muscular, not heart related.  Got some advice to take lots of Alieve and use occasional cold compresses.  I also got a rest pad for my elbow at work.  Over time my tennis elbow improved, and is very manageable now.

Anyway, while there, juuust to be safe, the doctor wanted to do an EKG.  We get the EKG done, and he has it read by an on-call cardiologist downtown.  The results come back normal, except a small abnormality that he has concerns with.  They think that maybe I had had a heart attack previously and never knew it.  The set-up an appointment with a cardiologist for a better exam the about five weeks later.

I get to the cardiologist appointment and he essentially says the other cardiologist didn’t know what he was talking about.  I had definitely not had a heart attack previously.  Everything was fine.  However, juuuust to be safe, we’re going to do a treadmill stress test… a nuclear stress test.  So we set it up for the net week.

This nuclear stress test is a two-day stress test.  The first day is a resting stress test.  They take my vital signs.  They inject me with the nuclear stuff.  I go eat a light meal… I ask what the meal is for and they say it’s to ‘push’ the nuclear stuff through to the heart and kidneys, or something like that… then I go in and get pictures taken of my heart from a very expensive looking piece of equipment.  Then I go home.  No caffeine for 24 hrs, btw, for the next test.

The next day I get more vital signs.  I get hooked up to ten electrode things, and they put me on a treadmill.  It starts somewhat fast, I thought, and increases speed and incline as I go along.  Once I get to a certain point they inject more nuclear stuff and keep increasing the speed and incline.  No meal necessary this time, as the higher heart rate pushes the nuclear stuff through just fine.  This did not go well.  I am very out-of-shape.  Once finished I did calm down fairly quickly.  Then for more photos of my heart, for comparison.

The next day I get a phone call from the nurse.  They did not like the photos.  There was a dark area near the bottom of my heart.  I am told I need to go in for an angioplasty, and maybe get a stent, or two.  It’s scheduled for later that week.  At this point, Missy is worried.  I’m, somehow, unconcerned.

To be continued.