Sunday, April 28, 2013

Hearts, Moons, Stars and Clovers

We have been having a crazy month. Blogging has not been on the radar. So a little catch up is in order...

CPA Boy started having pains in his legs starting several months ago. At first the pain was just annoying, like when you pull a muscle. But the pulled muscle eventually heals. This pain got worse. So painful that even swimming was too difficult.

This caused CPA Boy's first doctor's appointment in more than 15 years!

The doc checked him out and scheduled an ultrasound of his legs. At the follow-up appointment we learned that CPA Boy had some sort of blockages in the veins (or arteries? or both?). This was almost two months ago and we still aren't really clear about the cause or nature of the blockages.

Except this: blockages = bad.

CPA Boy was referred to a vascular surgeon for the next step. But before he left his doc's office the nurse ran an EKG and sent the doc back in. Since CPA Boy was getting ready to fly to the East Coast for an audit (and a hockey game in Philadelphia) he was IMMEDIATELY referred to a cardiologist so they could clear him to travel the following Monday.

He was NOT cleared and the trip was cancelled.

After having a few more tests --- ultrasound (no blockages in the carotid arteries, which is good), angiogram (which showed no heart blockages, which is good) and a chest x-ray --- we have learned that CPA Boy suffers from atrial fibrillation and he also has a very low heart ejection fraction.

For a-fib cardiologists generally prescribe meds to lower the heart rate and the blood pressure since most cases of it cause fast heart rate and higher blood pressure. Since CPA Boy is the opposite --- very low heart rate and low blood pressure --- they can't treat him with meds.

As for the ejection fraction, healthy people generally have a rate of 60 to 70. Between 50-60 they keep an eye on you. Between 40-50 they may start some sort of treatment. Between 30-40 is VERY serious.

CPA Boy has an ejection fraction of 25.

He also had a CAT scan this past Monday. We have no idea what it showed (the appointment to get the results from the vascular surgeon is scheduled for next Wednesday) but it did prompt his regular doctor to schedule an MRI due to leg "muscle atrophy" (we don't know if this is serious or minor).

Meanwhile, based on the other tests, the cardiologist had recommended that CPA Boy get a pacemaker to help some of the heart issues because there is nothing they can do with meds to treat him for a-fib or the ejection fraction. It seems an extreme step --- CPA Boy is only 48 --- and you need to get then replaced every 5-10 years as long as you live. But it seems to be the best option.

All of this has converged to this past Friday. The pacemaker is scheduled for Monday morning but we don't know if the MRI is a critical test that must be performed first or if it can wait for a few weeks. No doctor was available Friday to answer any questions leaving us confused.

Nowadays you can get pacemakers that are safe in case you need an MRI but you need to wait several weeks after its insertion first.

So we will go to the hospital on Monday morning and the nurse in the cardiac department said she would coordinate with the doctors to see what needs to be done. MRI first, then pacemaker the following week? Pacemaker Monday and MRI somewhere down the line?

And to complicate issues, insurance needs to approve any procedures first. We just got pacemaker approval but don't have MRI approval yet.

And CPA Boy has to have blood work done each time he has a procedure. He feels like a human pin cushion.

The crazy thing is, ignoring all the leg and MRI stuff, there is still one more heart procedure that needs to happen AFTER the pacemaker is implanted: a trans-esophageal echo-cardiogram (aka TEE). That is supposed to take place a week after the pacemaker.

We will know more on Monday. We hope. I guess that's one of the issues when you have several doctors working on your case; they don't always coordinate with each other.

So pull out all of your lucky charms and think good thoughts for CPA Boy's health!

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