May 17: Cardiology appointment

Maybe shorter and more often....

A couple more people have told me that they are still reading, so it's at least 5 of you. And, of course, a few people over the years have admitted to being 'lurkers', which sounds much worse than it is!

Had my routine cardiology appointment. Need to get my cholesterol checked on the Crestor, had too many myalgias on the Zocor. Haven't lost weight. Sigh. Will be getting a monitor soon to check the dysrhythmias. I told Dr RG that my suspicion is that there are two areas which are sending out the extra electrical impulses: one in the atria (top chamber) and the one we know about in the ventricle (lower chamber). I don't get them daily, sometimes only once a week, but then will get several in a 24 hour period. No commonalities that I've identified. Will wear the monitor for three weeks unless we get lucky and I have a bunch in the first week. So it will probably be a month or so before there is any news. And chances are it will only be 'watchful waiting' at that point, because treatment options are limited.

I noticed something a few weeks ago that I didn't discuss with anyone until there was independent correlation, and that was today. (It should be addressed with my internist, although she doesn't really impress me but does prescribe whatever I ask for without seeing me, so until someone better comes along she'll do.) Anyway, I've developed a hernia in my upper abdomen, right around where the xiphoid is (where the ribs come up and meet in the middle). This is a very strange place for a hernia to develop, they usually appear around the navel area or below. But this one is right over where the chest tubes were repeatedly put in, so an area which was cut open over and over. I know they were there for the second and third surgeries, can't remember the first, although everything is pretty hazy after that one. It hurts, especially after the exam where he's pushing in and saying 'Does this hurt? How about this?' and also hurts sometimes when exercising. Sometimes it doesn't bother me for days, other days frequently.

There is only one treatment for a hernia, which is to put mesh under the muscle wall to keep the intestines from getting through the opening, in addition to trying to close the opening. This, you may recall, was the point of the thoracotomy for the lung hernia, although that's keeping my lung in my chest. (Yes, I still feel it hitting against the mesh.) So that's surgery, a type that is relatively minor, generally only an overnight stay. But no surgery is minor when you are on coumadin. Getting this fixed would mean going into the hospital at least two days in advance, having stopped coumadin before that, and being put on IV heparin to keep blood clots from forming on the valve. There are other drugs which can be used (Lovenox) but they are not approved for mechanical valve patients who, you have read here, are at the highest risk for blood clots. The heparin, which only stays in your system for 6 hours, is then stopped 6 hours before the surgery and would be restarted about 24 hours after, along with the coumadin, which takes several days to hit therapeutic levels (INR). And, of course, that increases the risk of bleeding from the surgical site. So, for a mechanical valve patient, this simple surgery turns into about a week in the hospital, especially since I need such high levels of the coumadin, which therefore takes longer to hit therapeutic levels.

So this is why it needed to be discussed with my cardiologist, who is adamant that I be hospitalized on heparin, especially as he points out the obvious, with my complicated history. As much of a pain as it is I wouldn't risk it any other way, because of the stroke risk, not to mention the risk of a blockage in a retinal (eye) artery, kidney area, or peripheral circulation (toes & fingers). For all the people who kept saying 'why didn't they just replace it during the first surgery?'--this is why. I'm very grateful that my cardiologist is so firm on the heparin, because that gives me the support I need for what the safest course is.

With the weather in it's current pattern it's been a tough day pain wise, although sometimes there doesn't seem to be a reason for the pain to flair. My sternum is particularly bad, I have to remind myself every hour or so to take a very painful deep breath to expand the lungs, otherwise my breathing is quite shallow so as not to move the chest wall as much. And the right shoulder/scapula area hurts. And the foot is flaring up. And my lower back with all the collapsed discs is killing me, also radiating down into the left hip. I feel about 90, possible more. Makes me understand the suggestion to old people to move to dry Arizona.

Will address mood next time. The cats are all lined up staring at me because it's 15 minutes past supper time. To their credit, no noise has been made, although KC will start up as soon as I head towards the kitchen. It's amazing how much racket a 13 pound bundle of fur can make when he feels his food schedule is being unfairly tampered with.

Gee, not so short! Thanks for checking in, Laurie