Well, here we go again. As expected, our visit with the cardiologists led to Tami being admitted to Duke University Hospital this afternoon. Here are some of the important details…
Tami’s symptoms of fatigue and shortness of breath could be due either to side effects of the interferon (HepC injection) or to heart failure (possibly related to the weakness of her heart and possibly made worse by the afib). So all they can do to try to sort it out, then, is to try to treat the afib and see if anything improves and to see what condition her heart is in (compared to what it was when we were here in October).
So, they want to start Tami on a medicine called dofetilide. It is supposed to help correct the afib. It may (though they think it’s unlikely) correct it on its own. Or, after she has had a few doses, they will try to shock her heart back into a normal rhythm, and the medicine hopefully will help it to stay that way. Again, they are not optimistic that any of this will be successful given the weakness of Tami’s heart. But, before they can start the meds, they have to verify that there are no clots in her heart that might come loose when the heart starts beating normally. If they had documentation that she has been therapeutic with her coumadin for the last 6 weeks, they could proceed (since on anti-coagulation (“blood thinners”) you wouldn’t have any clots). But, more likely, since they don’t have that at hand, they will probably verify the absence of clots in her heart by a TEE. In this lovely procedure (that Tami had once at McLeod Hospital in Florence), they put a probe down your throat so that they can get an echocardiogram (essentially an ultrasound) of the heart. Interestingly, from that perspective, you can get a clearer picture of all 4 chambers of the heart. OK, all that, and a little blood work, too, and they can start the dofetilide. After that, she gets a pill at 9am and 9pm every day and EKG’s at 11am and 11pm. The EKG’s and some blood work help decide if it’s working and if the dose needs to be reduced. Some time later (Monday it seems most likely to us) they will do the electrical shock to correct the afib and get the heart back in rhythm if it isn’t yet by then.
The other big thing they want to do is a right heart cath. This will, among other things, measure the output of the heart. If the output is essentially the same as in October, then most of what she is experiencing is related to the interferon therapy. She doesn’t seem to be having any other new or worsening symptoms of heart failure, so this would be the best result – it’s the interferon, we’re sorry, stick it out 8 weeks, and see how you feel. Oh, but she has to come off her coumadin for the cath. Arrrrgh! That’s what takes forever. That’s why we were here 8 days the last time… 3 days for the INR to come down, wait through the weekend, procedure, then 3 days to get the INR back up.
Oh, wait, she has to be ON the coumadin for the new meds, but she has to be OFF the coumadin for the cath. Hmmmm. So, they are starting her right now on heparin. That way she can be anti-coagulated while she starts the dofetilide but they can stop it quickly to do the cath whenever that is.
So, at some point, maybe Friday, more likely Monday, they’ll do the heart cath. Not painful, no big deal, Tami had that done here in October. Nothing to be afraid of in advance. (On second thought, there is nothing to be afraid of afterwards either. Either her heart is the same or better or worse. That’s what it is. We’ll just know, that’s all.)
But, since she will be anti-coagulated (and, therefore, prepared for “procedures” – one of our least favorite words…), we are guessing that they will also want to talk about doing the liver biopsy that Tami has kept avoiding. More on that topic when we see a hepatologist some time.
Then, after all the procedures are done and however long it takes to get the coumadin back up to therapeutic, and we’ll be home.
Simple, huh?
Thanks for the prayers. We’ll keep posting as we know more specifically.
Meagan Maxson- Mims 3:20 pm on September 4, 2009 Permalink |
I’m glad Clabo is liking school. We miss you all SO much. And pray everyday for you all! have a blessed weekend. Love, The Mims (Meagan, Phillip, the twins & Aubree)