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
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
2 Comments:
At 11:36 PM,
Tersha said…
Laurie-
I'm so sorry to hear this happened to you and I do hope that you will be feeling better soon. If you ever need to talk or just need someone one to lean on, please feel free to give me a call or shoot me a text. I'm always here for you.
Sending good thoughts and healing energy your way,
Tersha
At 3:45 AM,
Anonymous said…
Hi Laurie,
This sucks! Hope by now you are feeling better,,,,,,
We are missing you here!
Deneen
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