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Monday, January 31, 2011

Mysterious symptoms

We’ve been trying to figure out the source of some mysterious symptoms that have dogged Susan for the past ten days or so. Her most persistent troubles are swollen and painful lower legs with pinkish skin that’s warm to the touch, along with the increased confusion that’s been a faithful sign something’s wrong. Her legs and feet were sore enough ten days ago to make walking painful. She also had some nausea and vomiting, rapid heart rate and slightly higher blood pressure, and no fever.
 
We saw her doctor last Monday, who ordered labs, a chest x-ray, prescribed antibiotics for suspected infection, and scheduled a follow-up for today. The x-ray ruled out pneumonia; blood work revealed a slightly low red count (anemia); and labs came back on Friday to reveal another urinary tract infection.
 
If she had an infection other than a mild UTI, we’d expect a fever. If she had kidney failure, we’d see it in her blood work. If she had congestive heart failure, we ought to see shortness of breath made worse when lying down (she’ll have an EKG next week to rule it out). Swollen legs and feet can accompany the steroid taper we’ve been trying, but her lower dose was too small a difference to cause such a withdrawal reaction. We haven’t ruled out blood clots; but she’s been too mobile for this to be likely.
 
Thankfully Susan’s nausea, heart rate and BP have normalized; and she’s feeling better in general – but leg swelling and confusion remain symptoms without a theme. We saw her GP again today, had a scheduled follow-up with one of her urologists at UCLA, and did another set of labs. With the new lab work, we’ll see her infectious disease specialist at UCLA on Wednesday and hope to know more about what’s going on. Meanwhile, we’re glad she’s improved and not worsened, and are always thankful to God for his love, grace, and presence with us.

Thursday, January 6, 2011

Caregiver stress?

They say if you ever want a hospital bed, a bloody car crash or chest pains will get you one. This is true. I did not have a bloody car crash but did have chest pains - though I did not have a heart attack and do not have a heart problem. Read on if you want the story.

I had an episode with chest pains and rapid heart rate Saturday about midnight with a pressure and a tightness I’d not felt before. It was more than indigestion. After tossing in bed for several hours and trying to sleep, I woke up sweating a few times and in the morning tried to reckon with what had happened. I still had a lingering pain in my chest toward the left of center. I Googled “chest pains” and was reminded I felt a bit dizzy the day before, adding another item to my unwanted list of symptoms along with website warnings to call 911 immediately if you think you’re having a heart attack.

I felt sort of okay in spite of everything, but was nagged by the idea of being a dead idiot if I ignored the signs. I don’t want to leave my family, especially now. This is the stuff of cardiac rationalization. I arranged for the boys to look after Susan, drove to Long Beach Memorial and checked in to ER. Like I said, you get a bed right away. The ER doctor said my initial EKG showed an abnormal rhythm – another cause for concern. Also, my grandfather died of a heart attack at age 68, so the case was building.

Then I entered into “hospital time,” an alternate universe. This is the experience of staying in one place and staring around for endless, sluggish moments only to wonder how six hours crept by so quickly. I’d had a blood test right away to check for the enzymes that are released when someone has a heart attack and was told they’d need two more at eight-hour intervals to follow any trend. I never knew enzymes have trends. (All blood tests showed no signs of a heart attack.) After seven hours in an ER bed, I was moved to the cardiac monitoring unit on the third floor. At least I had the wisdom of going in on a Sunday so I could watch football all day and night. If I were in charge, I’d have big-screen TVs and hard-wired NFL programming in the cardiac unit since it’s mostly men there anyway. And I’d add a cigar lounge.

Cardiac Monitoring Unit Cigar Lounge (concept)
They must have a subtle way of getting cardiac patients onto a crash diet or something, because I’d been there since about 8:30am and finally had food that evening. Then at midnight I had to go “NPO” which is abbreviated Latin for “nothing though the mouth” but also could stand for "no pizza order" and "nearly passing out." I would not eat or drink again until after my stress EKG, which turned out to be some 18 hours later. My body went into survival mode and consumed any lingering cholesterol and fat, effectively curing me of heart disease in case I had any.

Also, I think nurses must take a special class called “Waking People Up.” Mine were really good at it. One of them burst into my darkened room, flipped on the lights, and pretty well shouted “Good morning! I’m here to draw your blood!” If the light and noise don’t wake you, the needle will. These are professionals.

There must be another nursing class called “Tact.” One nurse needed to put a new set of EKG electrodes on me, noticed my hairy chest (I can’t help it if I’m manly), and took to scrubbing me with an alcohol wipe like my pecs were a cast iron pan coated with burnt scrambled eggs. Then she said in broken English, “You’re sensitive. Your skin is red.” I said, “Oh,” in perfect English, which means, “Really? You mean my red skin has nothing to do with your Brillo Pad treatment? Was your last patient a rhinoceros?”

Aside from getting some nutrition, my last in-patient event late Monday was a cardiac stress test that involves resting EKG and heart ultrasound, 5-10 minutes on a treadmill from a warm-up to a jog-walk, and then transfer back to a bed for EKG and ultrasound with rapid heat rate. I was able to reach 100% of my maximum heart rate with no trouble and little sweat. The cardiologist said I met and surpassed every aspect of the test, then gave my heart an A+ grade. While I haven’t exercised regularly since Susan’s brain tumor came along, evidently my prior years of lap swimming have paid off.

The cardiologist ruled out a heart problem, which was the point of getting hospitalized, but he could not say which of a list of things may have caused my chest pains. Stress can do it. Since I can’t eliminate stress, I may need to put up with chest pains now as well as the mid-life acne. Along with meeting my health insurance deductible about as early in the year as I could have, this episode reminds me that I need to take care of myself so I can take care of Susan and our family. I so admire Susan for how well she’s endured her many hospitalizations without going nuts or making me crazy. She’s a champ. And I’d rather be a caregiver than a patient.