Wednesday, December 12, 2018

TEE and heart catheterization

I had a very fun and relaxing vacation to Morocco. I came home ready to get to the bottom of things going on with my heart.

In the two weeks leading up to the trip, Jim and I attended the Google School of Cardiac Medicine. We learned quite a bit. I think it also helped me come to terms with my situation. The first few days, the idea of open heart surgery scared the daylights out of me (it still does, to be completely fair). I researched techniques to repair the valve that don't require the traditional open heart surgery. I was desperately searching for a less invasive, less scary sounding fix. I discovered a high school friend actually works on developing valve repairs, and he has been a valuable resource to me. My research led me to conclude that if I want a long lasting, high performing fix, one that will let me backpack and run and do other crazy things, I want the invasive surgery. It shocked me to the core to realize that I'd prefer the cracked open chest to the venous repair. I want a true fix, not something that will just keep me alive.

Dr N ordered a TEE (trans esophogeal echocardiogram) and an angiogram (also known as a heart catheter) to obtain a better picture of what was going on. Due to the esophagus' close location to the heart, one can get much better images through a scope than through the chest wall. When heart surgery is being contemplated, doctors also like to do an angiogram to see if there are any blockages or stenosis (narrowing) of any of the vessels prior to surgery. That way if there are, they can repair those issues while they are in there. Since surprises during heart surgery sound like a very unfun thing, I was enthusiastically on board, if extremely anxious.

The TEE and the angiogram were scheduled to take place one right after the other. Because I would be sedated, I was to have nothing by mouth for 12 hours prior to the procedures. I was warned that there was a possibility of having to spend the night if there were unexpected findings or complications. I was also told I would not be able to drive home.

When I arrived at 8am, I signed an initial consent to treat. They took me back, had me take all my street clothes off and put on a hospital gown. They then put 6-8 stickers on to do a quick EKG. I was also asked about my advance directives. (I've printed out our state approved form, but haven't signed it. I really do need to do that) I was also asked if I had a uterus, but no follow up questions. I was also asked if I'd been out of the country in the past 30 days, but no followups to that question either. The RN then set an IV (truly the most painful thing about the whole day) and took a bunch of blood samples. Dr N was going to do the TEE and Dr H (who is listed online as a cardiologist and cardiac interventionist) was going to do the angiogram. They both came in, explained the risks and the why in very clear and easy to understand terms. I signed another consent that said I understood that I could die. Dr H told me that I could choose to have the angiogram go through my wrist or through my femoral artery (thigh). I told him that my personal preference was my wrist, but that getting really great pictures/video was paramount. He said it would be easier to get better images through the femoral artery, so that's the way we would go.

They wheeled me off to the procedure room, and this was when I said goodbye to Jim. Parked the bed outside because I asked if I could use the ladies' room first. I then wandered into that procedure room. There were half a dozen techs and nurses in there who were absolutely hilarious and fun. It felt more like a party than a life or death situation. I'm not sure they would have been that casual with everyone, but since I'd started the conversation by asked for a pole to pole vault onto the really high bed, I set a more casual tone. Because they wanted me as comfortable as possible, they wanted to numb my throat first. The throat numbing stuff was a very thick gelatinous substance in a big syringe. They had me sit with half of it on the back of my throat for two minutes. Then swallow. Dear Reader, it is not delicious. I then had to repeat the process. I told the nurse that she doesn't get to mix my cocktails. She promised if we ever got together at her house, the cocktails there were much better. While I was numbing my throat with the Very Nasty Goo, they were setting up this warm air bed tube thing around me. It was really nice to keep me toasty warm for the 8 minutes I was conscious enough to care. The mattress was also a very comfortable memory foam. 

Dr N came in and chatted for a bit. She had a numbing spray that she was going to spray as well, just in case. Gagging is not an ideal circumstance. She told me that GI doctors have a similar wand that goes down the throat, but it has a camera. It makes it easy to see if there's any anatomic abnormalities or blockages. Because they need the ultrasound wand, she has to go down the throat blind. She told me if she encountered any resistance, she would stop. However, if I am anatomically normal, it should be very easy.

They had me lay down and gave me a canula with oxygen for my nose. They also put a bite guard in my mouth. Then, they announced it was time to give me the sedation. They gave me the first push into my IV. Within about 15 seconds, I could feel it. I felt nice and dreamy. I took the mouth guard out to say that THAT was great and he could definitely make me coctails whenever he wanted and then stuck the mouth guard back in. They decided I was a bit too with it and gave me another hit. night night

When I came to (and remember it), it was 2.5 hours later. Evidently Dr N talked to me before this, but I have no memory of it. Because the incision in the femoral artery needs a few hours to heal, I had to lay flat on my back for 5 hours before they'd even consider releasing me. They had leg squeezy things on my legs to prevent clots, and they were kind of nice. I wished I could make them squeeze harder to really get a good massage in, but oh well. There was a tv in the room, which helped alleviate the boredom.

Now Gentle Reader, I bet you are wondering what happens if one has to go to the bathroom? I can't stand up or move. Well. They have a thing called a Pure Wick. I know this sounds like a plug in air freshener, but it's not. It's this weird She-wee thing with suction so that you put it along your vulva, nurse turns on the suction, and you just pee. It literally took me a half hour to relax enough to do that. All that toilet training as a toddler paid off, I guess. It worked though, and was a very strange experience that I have never read about before. So there's your TMI for the day.

After 5 hours, I was finally able to go for a walk around the floor. I think it was mainly to make sure that I wasn't a fall risk anymore. I was then able to sit down with Dr N. She told me that the angiogram showed my vessels were nice and clear, and no bypass is needed. The TEE showed more details on my valves. It looks like I will probably need to have both my mitral valve and my tricuspid valve repaired. She couldn't say for sure, but she felt like it was probably a birth defect that degraded over time. While sedated, the regurgitation wasn't as severe, and the pulmonary hypertension wasn't as bad. I still need surgery, but it's not immediately emergent.

I am going to have a bubble test done to see if there are any holes in my heart. I will also have a lung function test done, given the pulmonary hyptertension.

I have a consult with Surgeon G on Monday. I am also going to have a consult with Surgeon C, and then choose the doctor I feel best about.

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