And Then...And Then...Along Came the Rest of the Story

Well hello there. Good to see you again. I'm back, and using the neatest technology for typing: talk-to-text. So why am I using talk-to-text, you ask? Ah well, that's part of the rest of the story. Let's get started…

When last I wrote, Mr. T was headed for a cardiac ablation to correct an arrhythmia. (Please see the previous two posts to catch up with this part of the story.) The short version is it all went extremely well. The longer version? Of course, that's where the rest of the story begins!

We got to Wake Forest Baptist Hospital in Winston-Salem on Monday (2/16) before the 7 o'clock scheduled appointment time and followed the (excellent) directions we had found on the website. Those directions got us to the correct parking deck that serviced the Electrophysiology Lab. Unfortunately, we actually needed to be in Admissions...several floors below and one building over. It's like we were trying to collect (or rather SPEND!) our $200 without passing "Go." STOP! Retrace steps. Start over. Dear Readers, if any of you have ever been to WFBH (or any large, metropolitan University teaching hospital), you will know that "retracing your steps" is much easier said than done. Sigh.

How did this happen? You may remember from my last post, that the cardiac ablation procedure was planned late Friday (2/13) afternoon over the phone, in consultation with the electrophysiologist after he had read Mr. T's ultrasound. As it turned out, Dr. W is the head of the EP department. In other words, he makes the decisions, and he can make a procedure happen in three days rather than in three weeks. What he does not do, is enter information into the WFBH admissions system. And, even if the top doc has decreed you will have a procedure ASAP, you do NOT do anything until the (electronic) paperwork is in order. And it was definitely NOT in order.

Still, I must say, everyone we met at WFBH...everyone...did everything to make Mr. T's stay there the best it could be. The Admissions rep pulled in just the right person to finagle the system into admitting him. And more than one person called the EP Suite to keep them apprised of his progress. He got the ticket for admittance when they strapped the bracelet on his wrist (note the QR codes...more about those in an upcoming post).

When we got back to the place we had started, they wasted no time in getting him prepped for the procedure...but neither did they try to save time by neglecting to tell BOTH of us what to expect when. Then, as they wheeled Mr. T away, one of the nurses said to me "do you know where the Adult Surgery Family Waiting Center is?" When I said I didn't, she smiled and said, "well, let me take you there!" And she did! Two floors down and one building over. [I soon learned that was a theme: if you even appeared to be lost, a hospital employee (doctor, nurse, tech...didn't matter) would come to your rescue, and typically ask if you wanted him or her to take you there.]

I settled in for my long winter's wait, since Dr. B (who was the EP in charge of the procedure) had said he would call me in about 2-3 hours to let me know how things were going. Missy M had agreed to stay behind at home and make sure the pups were fed (it's all about the dogz, right?); then she'd come along to wait with me. I had started a raglan sweater (knit, knit, knit...round and round on circular needles) that seemed perfect for passing the time in the waiting room. Only two problems:

1) We were in the direct path of a winter storm, supposed to dump snow and ice on us starting at 4:00...almost the exact time Mr. T was to be discharged (if all went well with the 4-hour enforced flat-on-his-back recovery spent in the day hospital room); and

2) My left wrist was hurting worse than ever. But, I had an appointment with a WFB orthopedic doc that very afternoon, and Mr. T's doc had encouraged me to keep the appointment. Plus, his nurse told me not to even think about driving across the campus...there was a shuttle bus that would deliver me door-to-door! Well, alrighty then...knit on!

Meanwhile....up in the EP Suite...

Mr. T said he remembers the first part of the morning, when they put at least 16 electrode patches to determine whether he was in flutter (he was) and to begin what they called a TEE. Here's a bit about that:

"In a small number of patients, an ultrasound of the heart is needed to make sure that there is no blood clot present. This is called a transesophageal echocardiogram (TEE)...and involves a probe that goes down your throat to look at your heart. You will be given sedation during this test..."

Well, sort of. He remembers the lidocaine that was used to numb his throat. Then the foul-tasting benzocaine. And he had the impression that he had pulled into pit row in a NASCAR race: there were people all around him, with each one doing some portion of the procedure...all working in harmony. He thought he might hear the whirring of the air-jack at any moment! And then...and then...well, lights out.

Meanwhile, back in the Surgery Waiting Center...

I knitted. And I texted. And I watched the constant weather updates. And I waited. And before I knew it, Dr. B called me to say the procedure was over, and Mr. T was doing well. Hooray and hallelujah! He said his nurse would call me soon and tell me the room number in the Day Hospital, which was where Mr. T had to go for 4-6 hours of observation "flat on his back, no movements." (Right. I was wondering what they were going to use to tie him down.) Within 15 minutes, Nurse Mary called with the number...and detailed directions...but when I asked an employee for confirmation of the correct bank of elevators (I had changed Towers, so I wasn't sure whether I could use the first ones I came upon), she said "let me take you there." Then when I got to the nurses' station on 11, I asked if Mr. T had arrived in his room. "No, but you are welcome to wait in there. Let me take you to it." (Can you tell I'm going to give them the highest score on their follow up survey?)

Missy M arrived to the room just after Mr. T did. And she stayed with him while I caught the shuttle to the orthopedic surgeon's office. I got there way too early, but they took me right away: the weather was changing, and they wanted to make sure everyone was seen before the snow arrived. The doc came in, asked me lots of questions, and examined my left hand/wrist/thumb. He was just like everyone else we have met in this system: open, kind, and easy to talk with. (Not at all like the orthopedic surgeon I had for my back in Florida...but don't get me started...:-)

Turns out I have a tendon-and-nerve combo problem called deQuervain's Tenosynovitis. Dr. W says it's fairly common, but I've never known anyone with it, have you? Here's some more info for you: 

>>>"Definition

By Mayo Clinic Staff

De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt every time you turn your wrist, grasp anything or make a fist. Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis. 

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons normally glide unhampered through the small tunnel that connects them to the base of the thumb. If you repeat a particular motion day after day, it may irritate the sheath around the two tendons, causing thickening that restricts the movement of the tendons."<<<

What causes it? Repetitive motion, like with tennis or golf (don't play), lifting a baby (don't have one...anymore), gardening (uh oh), crocheting (double uh oh), and knitting (triple uh oh). What can you do about it? For starters, NSAIDS are prescribed...but I already take Celebrex for arthritis, so obviously I'm beyond Step 1. Next up, stop doing any/all of the above, which is accomplished by splinting 24/7...for 4-6 weeks (only removing the brace for showering and hand-washing) to limit use and to keep the wrist and thumb in proper alignment. In other words, NO KNITTING. Triple sigh. And lastly, a cortisone shot...in the wrist. If you know me at all, you KNOW how terrified of needles I am. So, when you hear I was practically begging him to give me that shot, you will KNOW where I was on the pain continuum that day. And if the above doesn't work? The last stop is surgery. And the website that Dr. W sent me to showed a video of that surgery, which is probably the best incentive I have at keeping the brace in place. Ahem.

So here's the fashion statement I'm making for the next few weeks. "Lovely" isn't the word...and in doesn't fit inside of a sweatshirt sleeve very well. Still...I want to do everything I can to avoid surgery. [Yes, I admit it. I am a big baby. And no, I wasn't knitting with that ball of yarn. I was wondering if it would make a good squeeze toy. I may have to keep my thumb still, but I need to provide some therapeutic movement for arthritic fingers...which were used to knitting.]

Meanwhile, back on the 11th floor...

Mr. T's observation period was ticking away, with just a small hitch. At the 4-hour mark, the nurse who changed the bandage decided he needed to stay a couple more hours. Of course, that timing coincided perfectly with the arrival of the winter storm we'd been hearing about all day. You knew that was coming didn't you?

No worries. We made it home just fine, following the salt trucks and snow ploughs all the way. Missy M took good care of us until she headed back down I-85. And Mr. T was a good patient, following his doctors' orders for a quiet recovery. 

So far, so good. His heart rate is consistently registering below 100, his blood pressure is staying in the normal limits, and there is no indication of the arrhythmia. I say again...hooray and hallelujah!

And me? Well, I may have to give up knitting for a few weeks; I may have to forego using a keyboard and stick to talk-to-text and single-digit typing on an iPad; and I may have to figure out how to make-do in the garden with just my right hand (using a hand trowel, yes; using a cultivator or hoe, no). But I can tell you I am doing better already.

And that is...as promised...the rest of this story.

Weekend Interlude

interlude

[in-ter-lood] 

noun

an intervening episode, period, space, etc.

First things first...Happy Valentine's Day! This is a special day for many folks, and we are no exception. Ah, memories...

Then there is this picture that seemed apropos:

[Couldnt resist. Chalk it up to my wacky sense of humor.]

Ok, on to the real reason you are probably here: an update on Mr. T. And that's why I titled this post "Weekend Interlude," as in an intervening couple of days before the action resumes in our adventure...big time. But first, allow me to digress...quite a lot...

Yesterday was beyond wacky. Wacky cubed, you might say. We started the day right after coffee (breakfast was a protein bar on the run), dashing off to the cardiologist's office on the west side of Winston-Salem. Mr. T was scheduled for a cardiac ultrasound (as mentioned in my last post). His heart rate has responded well over the past week to the higher dosage of meds, although he became aware of his blood pressure monitor lighting up the little red light for "irregular heartbeat." Still, things seemed to be more positive than the week before. 

After the test (which was a new and interesting experience for him), we decided to move our Valentine's meal out forward a day and try out a new spot for lunch (I mean, really...how many people actually celebrate Friday the 13th, I ask you?). Although the last thing Mr. T needs right now is to be exposed to all and sundry germs, you just can't help wanting to have a special time out together. I was wearing a red sweater (see picture) I knitted several years ago for Valentine's Day in the pattern called Minimalist Cardigan, plus a heart-shaped pin, so that counts, right?

We headed to downtown Winston and were the first folks in the door of The Old Fourth Street Filling Station (click here to go there: http://theoldfourthstreetfillingstation.com). We started with the hot, creamy Spinach Dip and pita chip appetizer and then polished off the day's special lunch offering, hot and crispy fish & chips. Excellent on both counts! By the time we left, we probably could have auctioned off our table to the gathering crowd.

Next up, a trip to the AT&T store in HPNC. Beat me, beat me with a stick. So why subject myself to this torture? My iPhone took a dunk in a cup of Diet Pepsi about a month ago and has not been the same since...imagine that. It finally refused to take a charge this past week, breathing its final gasp on Wednesday. The AT&T tech confirmed the demise, but guessed it might be a problem with the charger port...possibly including a bad battery. Repair the "old" one (which is only 14 months old) or buy a new one? That is only one of the many questions that consumed the next three hours of our lives.

[As you read the following, please remember that I am certainly capable of making choices between Choice A and Choice B. I help clients do this all of the time! I can even factor in Choice C, but I usually find adding a third consideration just muddies the waters without giving any greater returns. I'm all about narrowing it down to the manageable Magic Two. If options begin to balloon beyond three, I start getting downright twitchy...to use one word for it. So, to recap: having two options is ideal. Three can be dealt with. Four or more makes me crazy. ]

Wouldn't you know it, the phone was two months beyond warranty (which may or may not have covered a soda-swim). So, the AT&T tech hands us a card for a local (thank the good Lord) repair facility. Mr. T calls them and is told it could cost $75-125 to repair...and while the estimate visit was free, they were backed up and it may take 3 hours to be able to give us an estimate. Ok, Choice A to consider: take the dead phone to CPR (Cell Phone Repair...how clever...:-).

Next on the agenda was the discussion about a new phone. I am reasonably happy with both my iPhone and with AT&T, so I thought this part would be easy, since I was not entertaining other makes or other carriers. I was, however, thinking that if I had to buy a new iPhone, that I might go ahead and get a 6 like Mr. T has or a ginormous 6-plus like Missy M uses (upgrading from my current much-loved, pretty, petite, bright yellow...albeit dead 5c). 

Back in the analog days when I worked for Vanguard Cellular (which was eventually acquired by AT&T), you picked out a phone, you picked a rate plan, you paid for the phone and one month's bill in advance...and they activated it, hey presto! You've got cell! That was so 1996.

Now? Good grief. It seems they are all about financing the phone...which I did not want. And if I bought the phone outright (to get the best pricing), I had to sign up for a two-year contract (which my previous carrier Northstate, who was bought by AT&T, never required, so I'm grandfathered in), which I'd rather not do. And even if I agreed to the 2-year contract (which the Tech admitted was going away "soon"), I would be paying MORE per month...for the same minutes and data plan. So, Choice B was buy a newer model of iPhone from my current carrier and pay more per month...for nothing.

Putting some distance between ourselves and this daymare, we headed across town to CPR...to leave the dead phone for an estimate. Lo and behold, in the same shopping center was a Verizon store...and Missy M had just directed me (on a call on Mr. T's phone) to bite the bullet and get some competitors' (namely T-Mobile and Verizon) information. Enter Choice C. 

Blah, blah, blah...numbers basically the same, except an offer for a monthly "bounty" for leaving my current carrier. Nice guy, but still...I'm sinking fast. Heading to T-Mobile (back across town), I hit my wall. I asked Mr. T to head home, realizing I simply couldn't manage Choice D.

At home, we switched gears, moving back to the realm of arrhythmia. Mr. T's ultrasound had been read and he had a call from the Electrophysiologist (EP). They talked, discussed what would happen next, and before he had hung up the call for long, there was a message from the electronic patient record application used by Wake Forest Baptist Health that he had a cardiac  ablation scheduled for Zero Dark Thirty on Monday. Wow! 

What's a cardiac ablation, you ask? Here you go...from the National Insttute of Health: "Cardiac ablation is a procedure that is used to scar small areas in your heart that may be causing your heart rhythm problem. This can prevent the abnormal electrical signals or rhythms from moving through the heart."

Read more on the subject here: (http://www.nlm.nih.gov/medlineplus/ency/article/007368.htm) Cardiac Ablation Procedure

Then there was a call from the nurse who talked about what to expect (a 4-6 hour procedure, done in the hospital-based EP surgery suite) and told Mr. T about the blood thinner med he had to begin...now. 

Before we could dash out of the door to pick up the meds at the pharmacy, he received a call to say "his" iPhone was ready to pick up. Say what? Yep, they'd determined the problem was a faulty charger port ("good deal of rust in there") and had repaired it (for much less than quoted).

Well. Choice A it is then! That settled that...for now.

So we are enjoying the intervening space in the wackiness...also known as our Weekend Interlude. Missy M and the Grand dogs arrive tomorrow, and Monday morning will be here before we know it. And then?

We shall see. We shall see. Regardless, we shall be together. 

Stay tuned!

And the Diagnosis Is...

First, a picture. That should set the stage for this post.

A lovely Riesling from Mosel, Germany called Urban, I might add. Now, for the rest of the story...

It all started about this time last week, when Mr. T was trying to shake a head cold and cough. Then Thursday night, he noticed this golf ball-sized knot on his neck, left side, just below his jawline. He called our doctor's office first thing Friday morning and was able to get an appointment with the nurse practitioner in about fifteen minutes. So far, so good.

When he got to the office, they started taking his vitals and making notes about the reason for the visit. Only...the nurse kept coming back to his heart rate, which was bouncing around, up to a high in the 160's. They did not one, but two EKGs...and then they called the ambulance. Mr. T called me from the office to give me some brief background info and to ask that I meet him at the Emergency Room at High Point Regional. And off I went.

Several EKGs later, a CT scan (for the knot on his neck), plus two IVs, one of which was inserted by the EMT on the bumpy drive to the ER, followed by a couple of medications, and the ER doctor gave us a diagnosis: atrial fibrillation or A-fib. By mid-afternoon, the doc was confident the meds were working and that Mr. T was stable enough to go home. He wrote two prescriptions and advised a follow up with a cardiologist, sooner rather than later.

Easier said than done, apparently. Our family practice doctor is a member of a multi-discipline group that includes a cardiologist group, so that is who the referral went to. When Mr. T talked to them on Monday, he was told the first available appointment was February 25th. Over three weeks away. Really?

Plan B. We live a heartbeat away from one of the premier cardiac care centers in the USA, located at Wake Forest Baptist in Winston-Salem. We looked up cardiologists on our insurance website and located several in the Wake Forest Baptist Heart and Vascular Center; called the number; and had an appointment for Thursday (today). Excellent! Of course, there's always a little catch...this one involved having to fax 28 pages of testing documentation and background information (when we stay within our group, that isn't necessary since all the docs share records). Ah well, small price to pay for some peace of mind. 

We were further surprised this afternoon (in a good way!) when we met the cardiologist, Dr. Stacey. I'm not sure what I expected, but he is the nicest, kindest, most caring specialist I've met in a long, long time...maybe in forever! He took Mr. T's newest EKG printout (which the tech did today as he was checking in) and compared it to one of the ones from last Friday. He drew pictures to illustrate his points (oh yeah...right down T's alley there!) And he answered all of our questions without rushing us through the visit. 

And, based on the hills and valleys (or as T called them: divots) on the printout, he gave Mr. T a different diagnosis: atrial FLUTTER.  Here's what the Mayo Clinic says:

"Atrial flutter is a type of heart rhythm disorder (arrhythmia) caused by problems in (the) heart's electrical system."

Bottom line: FLUTTER seems to be easier to resolve than FIB. The next steps are finishing the course of antibiotics (prescribed by the ER doctor), increasing the new heart med, getting an ultrasound (next Friday)...and if all is okay, then scheduling with the electrophysiologist (or as Mr. T calls him...the electrician) for a procedure called an ablation (which won't be a walk in the park...but a bit easier than the procedure done for A-fib). And then...if all goes well...that should be it! Dr. S says the success rate for the flutter ablation is 90+%...and if it works as designed, then there shouldn't be a need for drug therapy (as there potentially would have been with A-fib). Best news we have had in a week!

So, we celebrated in great relief with a visit to the nearby fave New Town Bistro and Wine Bar (click here to go there: http://www.newtownbistro.com). Hence, that photo of the wine glass above.

Oh, and about that lump that started this ball rolling? It was diagnosed as an infected salivary gland and is responding to the antibiotic. And I have never been so thankful for a health problem in my life. For, if Mr. T hadn't gone to the doctor when he did, he might not have known about his heart problem (which was not showing any symptoms yet) until much more damage had been done...or he had suffered a stroke (which is the main danger with this type of heart irregularity).

So I'm raising my glass to good fortune...and better diagnoses!