June 24: Beginning a new week

It's Sunday and I'm on call.  This was the only day it was possible to not be out of the house, so once again I decided against going to Fellowship and just staying home all day.  This has been one of the silver linings of the last eight years: doing nothing absolutely guilt-free!  That being said, there is a third laundry in and some light vacuuming to be done. 

Made it through last week without too many problems.  Found that after about six hours, plus getting ready and driving in, so more like eight hours, that I really pooped out.  Just got very tired, aching more, drained, less mentally alert.  You know, exactly how you should feel before getting into a car and driving....

The chest area continues to improve, although the right shoulder is still quite sensitive.  Some things are fine, but then little things will sometimes cause a problem, like pushing in the metal seat belt tongue into the fixed part.  It will still ache after a few hours, although now much more contained to just the 'ground zero' part. 

Bruising has been surprisingly undramatic, after the first amount came out.  Over the past week there has been some extension into the right breast and around to front, but nothing new along the side or chest area.  It is still quite tender on the lateral (outside) of the breast, hurts with any touch.  Went out yesterday and got new bras to accommodate, will be wearing those and a loose top of the days I see patients, which this next week only looks to be Monday and Wednesday, the rest of the time sports bra and scrub tops.  Got the CT result, and the measurement of the blood collection (not including it being in other places) was 7.7 x 7.2 x 3.4 cms, which is a lot of blood in the chest.  The depth of 3.4 cms was pretty impressive.  Supposed to get another one in 3 months to be sure of absorption.

While working all five days is tiring to me under normal circumstances, and even more so now, I'm trying to be smart about things.  Not staying late, doing little else outside of work.  Expecting that this week will be a little better. 

Just today noticed that Zerla isn't eating well. She usually sucks down her food without even chewing it, this morning she didn't finish all her dry food and during the second feeding (split because Tabitha would eat to fast and vomit, so they got used to it) that she was chewing and seemed to be having some problems.  I'm hoping it will be something minor, liker her teeth needing to be cleaned.  She is otherwise normal and her weight is the same, but will try to get a vet appointment this week.  That is a benefit to doing the charts--more time flexibility.

So I won't post unless there is something dramatic, just will shoot for next week.

Thanks for checking in,   Laurie

June 19: Back to work

Just a quick note.....

Returned to work yesterday.  Sore, but not too bad by the end of the day.  Only went in for 3 1/2 hours today, then left as I was meeting new cleaning people at the house.  Got home and felt totally washed out.  Not sure why.  Rested on the couch for a while as the two ladies scrubbed, dusted and etc. around me.  Started in with the dizziness and nausea.  Even though I've done nothing since they left still not feeling great.

Bruising now into left breast, but seems to be clearing up much more quickly than anticipated.  That being said, wearing sports bra and scrub tops for the foreseeable future.

Doing all charts, as two doctors are now switching over to 100% EMR, in addition to the one that already had.  It's looking as if I'll never see a patient again.....  The good news is that ME, who will never give me a compliment directly, has told the office manager to move everyone else around so that it's me doing his charts.  Gotta love job security.

Have to cook lunch for tomorrow, hoping a full night's sleep will leave me better.

Thanks for checking,   Laurie

June 13: Definitely recovering

Not sure if this is something to be proud of, but I've managed to do absolutely nothing for several days now.  A finely honed skill that comes in handy at times.

Went into the office on Monday and had blood drawn.  After getting up and dressed, then out to the car I was already tired.  By the time I got into my office my color was waxy and I felt wretched.  Came home and stayed on the couch.  Repeated this yesterday.  My hemoglobin came back at a respectable 12.4; lower than my norm, but not nearly as low as expected.  Not sure why I'm so utterly exhausted, although this is still considered a major bleed. 

The bruising hasn't gotten much more dramatic.  There is still the lump below the mid-clavicle area that is the firmest and most tender site still, along with the swelling along the side of the chest and into the right breast, which is somewhat painful.  But on the whole isn't nearly as bad as was expected.

Over the weekend, when the weather was warm but still nice, the swing and a book was the extent of my exertion, although in all fairness I also dressed and fed myself daily.   The Help had been sitting on my kitchen table since January, provided a good distraction.  When the weather got very hot it drove me indoors, leading to my only accomplishment of the past two days being a Friends marathon.  I'd treated myself to the whole 10 seasons (courtesy of a very reasonable winning bid on eBay) during the last foot fracture, hadn't made it past Season 3 since it didn't arrive until late in the stay-at-home recovery portion.   Today I'm going to try and make it through some of the magazines that have been piling up. 

Shannon came over yesterday, mostly visited, but also cleaned out litter boxes and cut some food up for me; these two things remain somewhat painful.  Just going through some of the bags and containers with my crystal stuff with her was enough to start the right side hurting, and even typing on the computer isn't entirely pleasant.  There is something about the angle and extension of the arm that makes it uncomfortable after a while, so much less time on-line than anticipated. 

My cousin Fernando was scheduled to come down this weekend, but he hasn't responded back to me since this happened.  I wouldn't be able to do much since my movement is supposed to be severely curtailed for a full two weeks.  Appointment on Tuesday with the new cardiologist.  (Spoke Monday to the one who is moving, updating him on the latest drama.  RG's comment on the next cardiologist's taking me on was 'That poor guy has no idea what he's getting himself into!') 

I'm debating making another appearance at work tomorrow for a few hours, just to do charts.  It's not so much my dedication to the job as the awareness of not losing my stamina.  If I do go in it would be with the knowledge that Friday and the weekend would be mostly at home and resting. 

Will try now to get a couple of house chores done, maybe some coupons clipped and a little picking up.  There is a lovely breeze and nice temperatures outside again, so the swing is looking mighty tempting.....

Thanks for checking in,   Laurie

June 9: calmer still

So, it's 9:00 PM.  Woke this morning and texted my next-door neighbor Jessica that I was still alive.  She's been just fabulous the last few days.  Definitely less pain, what is there is still that spot below the clavicle that seems to be the 'ground zero', still firm.  Significant swelling in the outside chest wall area from top of armpit area to right breast.  Everything a little tender, pressure seems less.  Still feel even the smallest movements with some pain.  But overall better.

Body check revealed an extension of the deep purple bruise on the outside of right breast, which has gone around to the front and is extending towards the mid-line of the axillae.  More along the sternal scar than yesterday. 

I took a shower today, first one since Tuesday night.  I did feel a 'pop' at one point in the right shoulder area, but nothing afterwards.  Maybe it was just muscle movement through old blood.  Things feel the same now, many hours later, so OK.

Kim came over and spent the day with me, Rick had to work.  She went to the farmer's market for me, changed my sheets and towels, did wash, cleaned out kitty litter pans....  She's been beyond busy the last several months and hasn't been able to get together, so lots of chatting and catching up.  She inspected my colorful areas when she came and again on leaving 8 hours later and felt they'd gotten worse, but of course this is only the beginning. 

Despite the fact that, again, I did virtually nothing today, found myself quite tired.  The guess was that my hemoglobin was going to fall more.  Despite the coumadin I generally run in the mid-14 area, the last one Thursday am in the hospital was 11.8, so may be as low as 10, which would be a significant sudden drop.  This means that it's logical for me to be tired.  I'm going to increase my intake of red meat, usually very sparse.  Fortunately I have some buffalo meat in the freezer which should make for nice steak salads this week.  (Yes, buffalo.  Regular seller at the farmer's market--I love that place!) 

Tomorrow on my own, although Jessica is next door and my friend Shannon is on stand-by.  I think I'll do a repeat of yesterday and see how little I can do, just go from couch to swing.  At some point I'll have to decide if work is an option on Monday.  My suspicion is that I could do part of the day, but will be too tired to stay until the end.  Will discuss with my bosses tomorrow. 

Being a female, of course I'm thinking what to wear.  An underwire bra is not an option, especially since the worst area is right under where a bra strap goes.  Much to my surprise it was fairly easy to locate a bag full of old scrub tops in three colors: mostly that hospital green, 2 nice blue ones and one maroon.  So it will be sports bra and scrub tops at least for next week, if not the following as well.  Fashion be damned.

Thanks for checking,    Laurie

June 8: Calmer

As planned, went to the couch after posting with ice pack for a while, staying absolutely still.  Decided to only take Tylenol, although I put the codeine tablets in the bathroom for easy access.  Woke once about 4:30 in moderate pain, went back to sleep until 8:30.  While there is some pain, the main feeling is an uncomfortable pressure across my right chest and into my axillae.  It's a constant awareness, but not all that painful.  Movement, however, changes that.  Any movement.  Raising my arm to brush my teeth, washing a glass, twisting something open, even the button on my denim shorts.  Bending over is really bad, but I've been working on crouching and balance in yoga, so it's easier now than it's been in the past. 

My goal is to take as few pain pills as possible, because of the constipation.  Those who were reading in the aftermath of the thoracotomy (Sept 2006 postings, into Oct) will remember this was a major problem, to the extent that straining caused all the internal sutures in the back to pop, which is why when I cough there's an unnatural undulating movement around the scar.  In fact, I'm even wondering if that could have caused this blood vessel to break open, because for some reason I had a lot of problems over the weekend.  Colace is now my best friend.  I had multiple fruit cups in the hospital, ate an apple last night and had several fresh strawberries for breakfast.  ML was very generous with the pain meds at discharge, telling me I could have as much of whatever I wanted.  He shook his head when I said only codeine and insisted on 15 mg instead of 30 mg tablets.  I don't like narcotics.  Just in case he gave me a few percocet, but I'm hoping not to need them.  It can never be said that I'm drug seeking. 

It's with great relief that I report nothing new on my body this morning.  Yesterday, waking in the hospital, there was more swelling around the armpit and into the back.  While that's still there, it's not worse and feels softer than it did, which is a good sign.  The swelling on my chest no longer extends to my sternum, although is clearly along the outside of the breast and chest wall.  The worst place is where I think it started: just below my clavicle, a little to the lateral of center.  It's still very firm there, and the most painful.  But I'm certain that the bleeding has stopped.

Yesterday morning the nurse noticed a bruise on my right breast, on the lateral side, just below where I could easily have seen it.  I suddenly remembered that at some point over the weekend I bumped pretty hard into a corner of the wood cover for the radiator, thinking to myself at the time 'Well, that's going to leave a bruise', but totally forgot about it.  I think it's incidental to the bleed, however, because it's below by several inches.  By this morning, however, it's expanded and is a deep purple and blue, somewhat tender.  My neighbor, Jessica, gasped and said 'Oh My God' when she saw it, so it's more impressive to others than to me.  I told her it was nothing compared to what was coming.  The only bruising on my chest is just to the left of the sternum and a couple inches down, so I can only guess that the blood is starting to settle.  It's pretty faint right now.

Having gotten through the night without incident and feeling very stable this morning I'm much more relaxed.  But I know that even if the bleeding has actively stopped it could still be oozing, and that any clot there is probably pretty delicate.  So, plan for the day: as little movement as possible.  They told me absolutely no exercise, not even walking, just to stay still.  Fortunately, I'm pretty rehearsed in that! 

So, I'll sign off and get a book, take the cell and house phone, then out to the swing before it gets too hot.  My swing is wonderful, two seats facing each other with a roof, so I can put my foot on the other side, swing with little effort and be blocked from the sun's rays while still enjoying the weather and the breeze.  It's right next to my lavender plant, which has been discovered by several honey bees.  It's neat to watch them going from stem to stem, quietly buzzing in a way that sounds like contented purring, insect style. 

More later, thanks for checking in.   Laurie

June 7: Hospitalized again....wish this wasn't happening

So, nothing much in the past month.  Exercising increased.  Up to walking 2 miles when weather and time permits.  Doing at least 10 minutes of yoga almost every day, some days more.  Watching my diet, finally seeing the needle move down, ever so slowly.  Getting more excited about feeling better, taking some strain off my heart, fitting into clothes not worn in a few years......

You know something bad is coming, right?

Monday I woke with a headache, figured it was the weather front moving in.  I've only had one migraine in my life, more than 20 years ago, this seemed to be #2.  It got to the point that I had to leave work by 11:00, came home and straight to the couch.  The headache gradually resolved by the evening, then I noticed my right shoulder was hurting, but in a different spot than usual.  Instead of the usual place in the back of the shoulder this was the front.  Damn it, now something else is getting worse and I just don't want to cope with another physical problem.

Went to bed, woke Tuesday feeling better, a little sore.  But I walked for over two miles, although I needed to hold my right arm at my side.  Went to work, did more than 4 hours of charts with no problems or pain, but on the way home the shoulder got worse.  As the evening progressed the pain escalated.  Boy, I must have really pulled a muscle.  I wracked my brain, only different thing was more yoga Sunday night.  By the end of the night there was a vertical 'stripe' down the front of the right chest, between the breastbone and edge of the chest, tender and swollen.  Put on ice, took a codeine (mild narcotic), Tylenol, even Advil and went to bed. 

Woke Wednesday for work and knew immediately something was wrong. The swelling now extended a couple inches from the sternum (breastbone) to the edge of my right chest, so large an area that my whole hand barely covered all the swelling.  And it hurt, even worse with movement.  I got ready for work and ran the options through my head.  Clearly something was definitely wrong and it wasn't a muscle,  but I really didn't know what.  Truthfully, I blocked out more than that, but was concerned enough to separate the cats, set food timers on their food and pack an overnight bag.  In a daze I drove to work, thinking only that we were short staffed and I couldn't go to the ER until about noon.  Yup, I really can be that stupid, although perhaps 'blocking' is the better word.

The hospitals were quiet, so one of the PAs came over before 11:00 to relieve me.  At my last cardiologist's appointment my doctor broke the news to me that he was leaving the practice and moving to Connecticut in June.  Since my report had been so good I figured I had a couple months before establishing with another cardiologist.  With no obvious place to go, I headed to Bryn Mawr, one of the hospitals my group is on staff at.  As I drove the reality finally sunk in, my hands were trembling and the tears were starting.  Over a few hours the swelling had gotten worse, now going from the edge of my sternum, across the upper chest, down into the outside of my right breast and into the armpit.  There are only two things that spread inside the body this quickly: air or blood, neither a good thing to have pouring into your chest.  I started realizing that a chest tube was a distinct possibility in the near future.  And with the mesh from the lung surgery in place and my blood so thin it would mean another surgery and the threat of complications.

Emily, one of our PAs, met me in the ER soon after my arrival.  I thought I was hiding my anxiety, but she told me later that it was difficult to look at me because I was so clearly terrified.  We calmly discussed the possibilities, including that if surgery was needed I'd have to be transferred to Lankenau.  Things moved slowly, I didn't call anyone, except I had notified my mom on the way over so the first call she got wasn't the hospital with an emergency.  The swelling was very obvious at this point, large and firm but with no color to it. 

The nurse (who was wonderful) kept asking me what my pain was on a 1-10 scale and I doggedly stuck to a 3, at worst a 4.  She kept offering me narcotics, I kept refusing.  She got very frustrated after a couple hours of this and said 'Look, you HAVE to be in a lot of pain.  You're telling me a 3-4, but I bet anyone else would say a 7-8.  Why won't you admit how much pain you're in?'  My reply was that my perspective of pain was based on three open heart surgeries and a thoracotomy, and this pain was nowhere close to those.  She couldn't argue with that.  My second comment was that things had a distinct possibility of deteriorating and since I had to stay cogent enough to explain my complicated medical history, make decisions and sign anything.  And, honestly, my anxiety level was way worse than the pain.  My BP, usually nice and low, was 160/90.  My pulse ox made wild swings between 92-98%.  And my temperature started going up, getting to over 101.  They wouldn't allow me to eat or drink in case I needed surgery. 

I really was beyond terrified. 

Blood work normal, my INR (measure of how thin my blood is) was 3.1, in the range I'm supposed to be but that means extremely thin and with little ability to clot. The chest x-ray said probable pneumonia and lower right lung changes consistent with heart failure, but I knew the 'pneumonia' was where the mesh was keeping my lungs in place and that the changes in the lower part were chronic damage. MH, the newest of our group (although it's been about 3 years now) and who I really like and respect, caught up with me coming out of the CT scanner. More questions, exam where he agreed it was very strange (yup, used to hearing it, but that doesn't make it any easier). And off he & Emily went to look at the scans with the radiologist.  (This is the best thing about being in a hospital where you are on staff and with doctors who know you--a cardiologist going personally would guarantee a detailed, rapid analysis.) 

An incredibly long 20 minutes or so later, MH came back in and announced "Well, good news: it's not air.  The not-so-good-news: it's blood."  Good news: no chest tube.  My BP went down to 113/56 in less than 5 minutes just from the relief of that news alone.  As I've said, the thoracotomy was worse pain than any of the heart surgeries, the larger chest tube that time stuck in my right side for that surgery excruciating then and painful for years afterwards. 

So, at some point before Monday night a blood vessel in my chest burst open and it's been bleeding into my chest cavity.   There is an impressive amount of blood in there, according to the CT scan, between the outer part of my lungs and the muscles of my chest wall.  There is no sign of bruising because it's so deep under the muscles.  The measurement of the main part of blood collection is 7 cm x 3 cm, although the blood is down in the breast and axillae (armpit).  All the swollen areas are blood filling my right chest cavity under the muscles.  You know me: if something is going wrong it's going to be big.

The chest surgeon came down and confirmed MH's opinion, that there isn't anything that can be done.  The coumadin can't be reversed because of the stroke risk from clots forming on the mechanical valve and the surgeon said he'd cause more damage trying to get the blood out than just leaving it there.  Good news, bad news. 

So, was admitted to be able evaluate if it was growing faster. The concern would be if my lung started to get compressed and caused breathing problems.   Emily managed to get a private room for me, everyone was wonderful.  Slept fitfully.  Blood work again in the morning.  My hemoglobin was down 2 grams, an indication of how much blood is in my chest. 

ML, who I also totally trust, saw me this morning.  I'd already texted to MH and they both agreed: there isn't anything to do.  Hold the coumadin for a couple days, get INR down to 2.5, stop the aspirin, follow the hemoglobin, which they both tell me will go down more.  They said there wasn't anything to be gained by my staying in the hospital.  So I'm home.  If things get worse, then I go back to the ER. 

Honestly, I'm kind of scared.  Knowing as I'm sitting here that I'm bleeding into my chest isn't a really fun thought.  I've cancelled all plans for the weekend as the next few days are the most important.  Ironically, it's the bleeding that will cure, because as the blood increases the pressure on the area bleeding increases, which will then tamponade it off--just like putting pressure on a cut.  At this point the treatment is 'watchful waiting'.   MH is on call this weekend, obviously a good thing if something more happens. 

Right now (10:00 pm) the pain meds are wearing off, so I'm going to stop typing, go to the couch and put ice on, then go to bed.  Sorry this is so long, just wanted to get it the information on here but not up to editing.

Thanks for checking in,   Laurie