Friday, January 6, 2012
Well, today I have been reminded how many people anxiously anticipate the daily updates on Tami. After posting a couple of Facebook updates early in the day and sending a few people text messages with various and partial updates, the afternoon got a little hectic (it’s all good, just trust me and stayed tuned and don’t skip ahead…). I didn’t get everyone re-texted or Facebook re-updated, and I got a barrage of texts of the “is there any news/is she done yet/have you heard from the doctors?” type. Yes, yes, and yes. And I’m sorry it’s late getting blogged again tonight.
So it was a long and tedious morning. We saw the intern, they drew blood, the nurse checked everything, and we waited. And no one knew or could affect the schedule of the cath lab, so we waited. And Tami hadn’t eaten since midnight, and we waited. So you can tell how fast the time went. About 11:30 the doctor came and said that Tami was the next case and would be taken in about 10 minutes.
(Now I have to tell a side story here. When we first came to Duke 6 years ago, we, of course, knew no one here. So after arriving at 11:00 p.m. on Friday, we met our first Duke cardiologist at 7:00 a.m. on Saturday. He spent the entire day on Saturday – his day doing rounds at the hospital – running tests, explaining results, confirming the diagnosis, and generally reassuring us. After that amazing first impression and seeing him on follow-up clinic visits for the past 6 years, we have developed a great respect for him, and he has always been genuinely interested in Tami (and in Alexander, too). But we have never seen him in the hospital, except for dropping in to check on us a couple of times. His specialization is not congestive heart failure and congenital heart disease, it is adult catheterizations. So when we knew that Tami would actually be having a heart cath on this visit, she wanted nothing more than to have her favorite cardiologist, the one with whom we have the best personal relationship, to be able to do it. But in a hospital this big with as many cath proceduress as they do each day, what are the chances of that? Well, however big the odds, we are reminded that our God is bigger than that. So, the doctor who came in, personally checked Tami before the procedure, brought the consent forms to sign, and did the entire procedure himself, was Tami’s favorite doctor! That definitely made Tami’s day!! :-))
So they took Tami and had her back within an hour. Tami said that the doctor told every person individually how important Tami was and to do their absolute best and take complete care of her! She even had the opportunity to choose the music they listened to (someone can explain to me some time – a guest blogger or something – why doctors like to listen to music during surgeries and procedures). Of course she chose Christian music, so the entire cath lab staff got to listen to a contemporary Christian radio station for an hour!
When she got back, the doctor said that Tami had done well and that there weren’t any problems. (He made a point of saying that he doesn’t actually do many procedures any more since there are fellows (that’s doctors learning a specialty) to do them for him, but he did this one himself!) He said there were what he would call “good” results and “just ok” results. On the “good” side, the pressures inside the heart were completely normal (not something we usually hear about Tami’s heart!), and that means that the excess fluid has been completely removed by the IV diuretics the past 2 days. YAAAAY!!! The “just ok” news is that several other measurements that they did confirmed what the echocardiogram showed yesterday, that the “pumping ability” of Tami’s heart is less than it was before. That is not a surprising result, and it is not a dramatic or excessive or sudden decrease in pumping efficiency.
The transplant cardiologist that we are seeing in the hospital came in a few minutes later and explained about the same thing. He said the good part about the “ok” results is that this is only the first time that Tami has been hospitalized for congestive heart failure and excessive fluid retention. If this were happening every 2 or 3 months, then the situation would clearly be much worse and we would have to be thinking about much more aggressive therapies and solutions. (Yeah, as the transplant doctor we normally see said recently, “that same conversation we had once before.”) But, for now, we can do the easier and less complicated things first to keep the symptoms under control and to maintain as much normal activity as possible. So, we are going to go home and take the new diurectic that Tami started last week (torsemide) and see if that keeps the fluid off for a few weeks. If so (and under normal circumstances it should), then good. Keep doing what works and let them know again up here when it’s not working again. While she is still feeling well and the fluid is under control, they will want Tami to do the special treadmill test that she has done before that is one of the best indicators of the heart’s output and whether a transplant is coming into the picture again. That’s Plan A. That’s at least the way we understand it right now. Plan B is for if, in a couple of weeks, the fluid retention has become a problem again. Then they will probably do more IV diuretics again and tweak the other meds some more, and we will have to start talking about some stronger at-home meds to help support the heart’s ability to “squeeze.” But we are thinking that is still down the road some. As are some other things they like to mention a lot just so you aren’t surprised later…
Oh, yes, Tami was a little nauseous after the procedure, so between the anesthesia she had during the cath procedure and the meds for nausea they put into her IV (zofran), she was pretty groggy and out of it for pretty much the whole afternoon and evening. (So a lot of the ignored phone calls and not updated texts and Facebook were while I sat watching Tami rest not so restfully and hoping she wasn’t going to get sick any more… :-)) She slept off and on and felt woozy (is that a word? does it work in Scrabble?) when she got up. She finally had some applesauce and crackers and jello a couple of different times and finally came around to feeling almost normal just in time to go to bed.
So that’s the story as of now. I’m sorry again for being so, so, SO late blogging again, but in the hospital, there’s just not a good time to sit long and write for a while. As we have said a couple of times in the last couple of days, for as little as we actually do and for as much sitting around as we always do in the hospital, we are interrupted a lot any time we do try to get anything done! More tomorrow, I’m sure, as we clarify the “what’s next” and sit around waiting for Tami’s warfarin to become therapeutic. (Remember, I promised a lesson on INR! :-))