Thursday, April 28, 2011

April Drama

Usually I love April... It's officially spring and even though there is usually a lot of rainy days, there are peeks of sun that keep getting more frequent. Except this year...

It's been a busy month. Let's see, starting April 4th, Mike started a round of doctor appointments that hasn't ended yet. In fact each appointment seems to spawn 2-3 more! Being insulin-dependent for 40+ years does take a toll and we knew this time would come eventually... but knowing that in the back of your head doesn't do justice to hearing the doctor say "Hmm.. we need to explore..." this or that possibility.

In January Mike had 2 doctors... a general primary care doc and an endocrinologist. Now he has at least 7! Now - I am NOT complaining - actually just the opposite. I want him to be healthy and to be with me a very long time.

So.. here it goes. Back on February 1st Mike's PCP (primary care physician) recommended having an updatd echocardiogram to see how his heart murmur was doing. No big deal, happens every few years. But, due to an impending blizzard, they wanted to do it ASAP - meaning that same day. As always, nothing remarkable is said during the test.

Winter continues. 5 weeks go by and Mike goes back for the next appointment. Dr. PCP says "When is your appointment with cardiology? I don't see it in the system." Mike says, "Don't know what you're talking about. I don't have an a cardiologist." Dr. PCP says, "Didn't they call you with results of your echocardiogram? You need to be seen by a cardiologist." Dr. PCP is very flustered and leaves the room. Mike broke the cardinal rule of doctor appts. and used his cell phone while the doctor was gone. He called me to say that Dr. PCP seems a little frantic and I'll let you know as soon as I find something out. Dr. PCP comes back and tells Mike he has an appt. scheduled for April 4th, a few weeks away. Okay.. so not too urgent...

We spend the rest of March waiting for spring weather to appear, go on a fabulous vacation for Spring Break to Washington DC and Virginia, and return home to the beginnings of spring thunderstorm season. Somewhere in there he also acquired a dermatologist and a podiatrist. The appointed day finally rolls around and we go to meet the cardiologist, Dr. P. She reviewed some records and asked some questions... and says she suspects the source of the heart murmur, the aortic valve, needs to be replaced... likely within a year.

Hmm... lots to think about. First order of business is a series of 4 tests to see more specifically how damagaed the valve is. Another echo, a Holter monitor, a Doppler on his legs, and a catheterization with dye. the first 4 are non-invasive and really don't entail anything on Mike's part except showing up for the appointments. The "cath" is planned for one day, outpatient procedure scheduled for Tuesday, April 19th. We know that if "something" is found during the procedure, they will attempt to fix it. All the pre-requisite worst-case scenarios are discussed and paperwork signed. Mike and I both were a little nervous, but my biggest prayer was that they would find something and be able to fix it.

Chalk that up to the "Be careful what you pray for" category. They did both halves of his blood vessels.. veins and arteries. Ultimately the dye showed that his aortic valve is not as damaged as feared, but the left descending artery was 80% blocked. The LAD is also sometimes called the "Widowmaker" as it feeds most of the blood to the lower heart muscle, and if 100% blocked there is too much damage to the heart muscle... that is, death is immediate.

They give me an update at the 90 minute mark to say that this is what they've found and per our signatures on the paperwork, they will be fixing it, which usually takes about 30 more minutes. I find my way to the cafeteria and back (without too much getting lost) and right at the 30 minute mark, the doctor comes to tell me Mike is in recovery and doing well.

Eventually I am shown the way to his room on the cardiac care unit. The procedure was done with wakeful sedation, so he was just a little bit tired. The surgery people weren't completely happy with his blood's ability to clot at that time so they left an IV sheath type thing in his vein for the cardiac nurses to take out. I wish I had a picture of how funny it was... Nurse 1 with her intern, Charge Nurse with another intern, and 1 more intern watching from the foot of the bed. Nurse 1 tests his clotting ability.. sample doesn't have enough blood. Intern #1 had watched and now begins to take sample #2. She does fine and the blood has cooperated... time to remove the sheath. However, there is some question as to whether this hole is the vein or the artery, and if it is the artery, it could spring a big leak and cause some problems. Mike points out that he remembers that they did the arterial portion first and it is the upper hole.. and the one in question is the venous one marked with V on the tape, which they have now removed & discarded. None of the nurses really believe him... "better safe than sorry" they say.

Now, 4 sets of nurse hands converge on Mike's groin to make sure there is enough pressure to cut off blood flow if indeed this is the apocalypse and Mike's femoral artery should burst while taking out the sheath. Mike looks at me and laughs... "If I were younger and SINGLE, this might be fun!" His slightly groggy brain finds this highly funny and he giggles to himself, which causes his whole body to move around and the nurses have to wait for him to be still... 20 minutes of lying perfectly still with 4 sets of hands pressing down along his groin & leg "just in case." All is accomplished without incident and he was adorned with those lovely plastic bandaids.

I brought the boys to see him Tuesday evening and we spent an hour together. Wednesday morning I got the boys to school, and then spent the morning with Mike, just waiting to be discharged. He decided the bed was not comfortable enough so he was in the recliner and I was in the bed watching House on tv. Kind of a strange show to watch while you are in a hospital.

They let him out after lunch and we drove carefully home. He missed 3 additional days of work on doctor's orders. On that Friday, Apr. 22nd, he sees endocrinologist Dr. K, who wants him to be on a continuous monitoring system with his insulin pump (read that as additional dollars per month). We are considering this and will likely do a 72 hour trial of it soon... but not sure we are ready for another expense.

On Wednesday, April 29th he saw a vascular doctor (who is in league with the cardiologist), who will work on the apparent lessening blood flow to his legs. She explains that the Dopper tests from earlier in the month show that he has a problem in both legs, but wants a little more detail... so more tests. Lo & behold they schedule him for the next day! I'm more nervous this time because of the immediate nature. It's supposed to take a month to get scheduled. However we finally now have a 3 week break from doctor appointments. Mike's next visit is May 19th for 1 month follow up on the stent. Here's to a quiet 3 weeks!