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Thursday, December 03, 2009

This Time I Left Him In The Hospital

There is no doubt that if this continues the Chief will have a heart attack, although he hasn't had one yet. This is getting worse very rapidly, and today I could not get his blood pressure down at all. Plus his heart was pounding and his heart rate was going up and down very erratically; I felt some missed beats. Eventually I drove him to the hospital. After waiting with him for a few hours and confirming they would admit him I finally drove home around midnight.

The thing that killed me is that on Monday aspirin dropped his BP (which was much lower), and the chest pain appeared to have started on Sunday after he walked the dog up a hill. But today it started while he was resting, and the same dose of aspirin didn't slow the rise at all. I finally gave him the lisinopril, and that dropped his blood pressure for a while (although it also caused him to break out in red spots), but then his BP turned and started climbing again, so at 8:00 PM I pulled the plug and drove him in to a more local hospital. The high I measured at home was 194/98, and that was after a full aspirin and and hours of bed rest. His blood pressure on resting is normally in the 12~/7~ range. On arrival at the hospital his BP for the first 30 minutes averaged 178/92.

They were a bit snotty at the hospital, but I was firm. He had been having chest pain since the late morning; the dull ache and intensified and by 5:30 PM he was having occasional "electric shocks". The situation was escalating and escalating, and I have to sleep some time.

I have confirmed that the chest pains are associated with high blood pressure, but the problem is that every four days or so his condition worsens noticeably. Telling the guy to take nitro is fine, but he can't keep taking nitro all day. I also cannot continue giving him these high doses of aspirin, not that it is working any more.

The Imdur controversy has not been settled either; SuperDoc won't let him take it unless he is in the hospital for a few days for observation and the SuperHospitalDoc won't admit him. I will try again tomorrow at this hospital. SuperDoc was going to try something else tomorrow (Friday, now today), so I will probably drive over to SuperDoc's office at 7:30 AM to see if he wants to try the Chief on the Imdur now that that he's in the hospital. Or if not, what he recommends. Something funky is going on; I have a feeling this will end in a fatal arrythmia. The Chief does have an AV block. The other day he was experiencing dizziness; tonight he was short of breath and extremely tired even when lying down. These have got to be very serious warning signs.

The worst of it is that the Chief is very stoic, and they are treating him like a hysteric. He didn't even tell me about the pain this morning; fortunately the bulldog started following him around looking frantic, so I knew to harass the Chief with extra blood pressure readings. This is the guy who chopped up his finger on the lawnmower blade and refused to go to the doctor. Instead he did minor surgery on himself. It healed quite well, although we had a fight that lasted for days until he finally agreed to go get a tetanus shot.

See, writing this post has helped, because this was sudden onset after he had been struggling with the flu. I think they need to do a scan of the heart itself and see if anything looks funky; maybe he has an internal infection causing swelling and sometimes intensifying the block. Whatever it is, it is clearly progressive. Also, when he gets in these states the heart is shifting activity quite erratically almost as if it is struggling to compensate for something and reach a new balance.

You guys are in my prayers.
my prayers too.
Just prayed for y'all. Endocarditis does sound like a good guess. Twenty six years ago, when I was still in the ER, we took this sort f thing quite a bit more seriously. I don't know whether the medicos in the NE are different, or whether they are all a bit over confident, now that we can break up throbmoses and what not. Your anxiety about your best friend's health (OK, other than your dogs, he is) must be multiplied exponentially by their cavalier attitude.

Michael, writing on my wife's computer, so the ID is different.
Both of you are in my prayers.
This might be unrelated, but one of my Pilots recently developed symptoms which looked like he was having severe heart issues (he's 40 years old). They went round and round and finally got hold of a decent Cardiologist who determined it was a virus that had settled in the heart. Perhaps this is related to the Flu you both had experienced.
Very helpful, guys.

CF, it might well be that especially since it was sudden onset after the Chief had been going through multiple flu relapses and the propensity of the wild flu virus to colonize different tissues than normally. It is possible it first settled around the stent and then moved to the inner heart.

Michael, thanks. It does look like a disease process more than an oxygenation issue.
CF - don't take that employment number too seriously. I still feel like the economy is on the upswing for a couple of months, but the factor driving unemployment numbers may be more people looking than people working. I will look into the numbers more when I am sane.

The Treasury tax numbers were very disturbing last month. CIT crossed and fell very significantly lower than last year's.

WIET -9.7%. I was not surprised to see that Nov chain store sales fell; there is just not the money out there.
Maxed, has the Chief tried Catapresan? It's an old medicine that seems to work quite well and has few side effects (aside from being dangerous if you stop taking it).

I have been on lots of different medicines for hipertension and nothing comes close, that includes lisinopril. But if I hadn't suggested it to my doctor, I'd probably not be on it today (because of the effect if you go off it, pressure goes so high it becomes dangerous).

Maybe you ought to see if it's a good fit for the Chief !

My boss went through almost a 9-month period where his heart rate seemed to change up and down for seemingly no reason (activity-wise). By 9 months I mean going to different doctors trying to figure out what was going on and being on-and-off probably 5 or 6 different meds. A pacemaker helped for a while, then the same thing occurred a few months later. Experimental surgeries next (along the lines of changing the angles at which some of his arteries bend), nothing made much long-term difference. He has been fine for almost two years now but no one really knows exactly what thing was done that reversed the problems. They are speculating a virus was the ultimate cause. He's about 59.

Hang in there and be glad the Chief is stoic, it probably helps in the long run.
I have some of these symptoms and can attribute some of them to stress. Stress is a sneaky little thing...you can have it without being aware of it. From what I've read here, Chief, is stoic but sometimes, that just masks an underlying symptom of stress.

I certainly hope and pray, you will find the cause and get this taken care of. God bless you both.

Good luck with this. He's lucky to have you to nag him (speaking as one who benefits from the occasional nag).
Hang in there MOM.
I can do slightly better than just my prayers. As a third generation participant in the Framingham Heart Study I've been contributing data for a third of a century. Here's to all those pokes and prods and pints doing some good.
I am only an occasional reader

I am truly sorry to hear about your husband.

I truly hate how we are not permitted to give medical advice on blogs; it is the catch 22 of the world we live in.

I obviously don't know enough about the specifics of your husband's medical condition to comment intelligently. However, I will say the way you have framed his issues does seem rather odd... Can you explain why you so frequently focus on his blood pressure readings? Further what did the angiogram specifically show? Details to these questions matter greatly.

Why would you be concerned about endocarditis?

If you are, you need blood cultures taken. No other test is as useful.

I think I may be able to help you re-frame the issues the way a physician would think about them.

PS- I am working quite a bit right now and it may take me a while to get back to this blog.

Good luck
Anon - you know, I think that is a good rule. I have run across people so crazy that they will take three or four times the dose of prescribed medication just to make sure it works or something. You just can't tell from what a person says (or writes). People tell you what they want to believe about themselves sometimes. That is probably even more true when a person is talking or writing about a loved one; we have even less objectivity then.

On a blog you can't have the clinical observation, you have no idea who will read what you write, you don't know who you are talking to and whether they are reliable, and things may be misreported.

The "First, do no harm" motto may be frustrating but it probably saves a lot of lives.

I have read about a few cases of people stuck in remote areas (like polar research stations) who had to get long-distance medical treatment and always felt amazed that the person survived. Medicine without doctors and nurses is bad enough; without doctors, nurses and a tangible patient matters probably are even worse.
Rob - Framingham, huh? I have USED Framingham data myself, mostly to check my incidence calcs for mortgage defaults (which are highly related to severe medical conditions). It's not so much the treatment costs, but rather the working interruptions, i.e. the medium and long-term disability conditions.

My hat's off to you. It is no fun being stuck for the cause of medical science but we sure have learned a lot from the volunteers. Framingham was, I believe, the first study to turn up the link between AV blocks and later arrythmias.
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