Faith Under Stress
To say yesterday afternoon was stressful is an understatement. Dean and I were looking forward to my much anticipated consultation appointment with the cardiologist Dr. Carroll at the University of Denver Hospital. Traveling from Cheyenne, we made a list of the questions I had regarding the procedure and recovery. We stopped for lunch at Chipotle, even eating outside as it was 70 degrees!
Once we found a parking spot on the gigantic hospital campus, we walked to the Anshutz Inpatient Pavilion. After winding our way through many long hallways, we finally found the cardiology and vascular wing on the 3rd floor. Here we checked in and waited.
Once all the basics including vitals were taken care of, I was finally put into a room and was able to meet Dr. Carroll's nurse and nurse practitioner. Finally, he arrived.
Needless to say, the appointment didn't go as I had envisioned.
First, the disc that I picked up from Sage West the day before, did not contain the content that the team needed. We had requested my transthoracic echocardiogram (TTE). The disk instead contained a CT scan. This was not even of me. Second, I learned that Dr. Carroll had not even received nor was aware that I had had shunt study completed in Casper in early December. Third and most shocking, Dr. Carroll explained that as of then, he did not have the objective information needed to justify the closure of my holes.
"WHAT?" I though. I had a pretty hard time hiding my surprise. All I could think was, "Why are we here then? What is the alternative? AND How can I continue to feel like this the rest of my life?" I couldn't even fathom being limited to brisk walks for the rest of my life. I am 35 years old! Am I just going to wait for a stroke or heart attack to occur? I should not be feeling this crappy. I should not breathe hard during a brisk walk. Needless to say, I am pretty proud of myself for not bursting into to tears that minute.
So, the plan was to have another TTE and bubble study and repeat all lab work. Also, the nurses were to take me for a walk and measure my oxygen levels to check if there was a change from sitting to light exercise. Dr. Carroll needed an objective measure that the holes in my heart where not an incidental finding and are actually causing problems in the function of the heart. He stated, if the right ventricle is enlarged, it will mean extra stress is being placed on the heart and this will warrant closure.
I had been told by the cardiologist in Casper the right atrium is enlarged, but nothing about the right ventricle. I got very nervous that we wouldn't find what we needed to find in order to keep the procedure scheduled. Most of all I was worried that I would not be feeling better any time soon.
"Ok," I said, "but what if we can't find a reason to need to close these holes? What then?" Dr. Carroll said that then we will need to continue to investigate what is causing my symptoms.
Thank goodness my rock Dean was right there with me the entire time. It is amazing how long 45 min-1 hour can feel when you are stressed.
Soon after we returned to the room, Dr. Carroll returned. He came back shut the door with authority and said, "We will absolutely move ahead with closure on Thursday morning."
"Thank God!" I said my shoulders dropping several inches.
He explained that the TTE showed that my right ventricle is enlarged and also that I have bilateral shunting. This would explain why I feel so terrible. He said my oxygenated blood and deoxygenated blood are mixing together. He used the words aneurysmal and fenestrated.
Later Dean explained to me in normal people language that basically my septum is like a thin piece of swiss cheese. It has several holes and is a thin flap. (The exact number of holes will be determined on Thursday. The Dr. thinks at least 3.) He described it as plastic blowing in the wind.....
Seriously, I still can't believe it. But I did see it flapping around on the screen with my own eyes. I also saw the bubbles go right through right to left instead of left to right like they are supposed to do.
Editor's Note (Written by Dean): A bubble study is where bubbles are injected into the veins which are delivered to the right atrium where they are supposed to go to the right ventricle and then the lungs. In a normal system, the bubbles are filtered by the lungs and do not return to the heart. If there are bubbles on the left side of the heart, it means something is wrong.
The bubble study wasn't just "positive", it was shocking. When you can impress the cardiologist (who has done 600+ of these procedures) you know that there's something really wrong.
Most shunting (blood flow through the leaky heart wall) will go from left to right as the left side of the heart is higher pressure than the right side. This causes the right side of the heart to have to process some blood twice, effectively increasing its workload and causing the heart muscle to get bigger and stronger due to the stress. Ann's shunting is the opposite of what is expected, her deoxygenated blood has been passing through the holes in the atrial septum and then being pumped directly out to the body, effectively skipping the lungs and their required oxygen. Even though the majority of the flow is right to left, there was still enough left to right shunting to cause increase in the size of the right side chambers of the heart. Whether or not blood is going right to left or left to right is dependent upon what Ann happens to be doing and the position that she's in at any given time. (end Dean) All of this apparently makes for me feeling pretty cruddy.
Editor's Note (Written by Dean): A bubble study is where bubbles are injected into the veins which are delivered to the right atrium where they are supposed to go to the right ventricle and then the lungs. In a normal system, the bubbles are filtered by the lungs and do not return to the heart. If there are bubbles on the left side of the heart, it means something is wrong.
The bubble study wasn't just "positive", it was shocking. When you can impress the cardiologist (who has done 600+ of these procedures) you know that there's something really wrong.
Most shunting (blood flow through the leaky heart wall) will go from left to right as the left side of the heart is higher pressure than the right side. This causes the right side of the heart to have to process some blood twice, effectively increasing its workload and causing the heart muscle to get bigger and stronger due to the stress. Ann's shunting is the opposite of what is expected, her deoxygenated blood has been passing through the holes in the atrial septum and then being pumped directly out to the body, effectively skipping the lungs and their required oxygen. Even though the majority of the flow is right to left, there was still enough left to right shunting to cause increase in the size of the right side chambers of the heart. Whether or not blood is going right to left or left to right is dependent upon what Ann happens to be doing and the position that she's in at any given time. (end Dean) All of this apparently makes for me feeling pretty cruddy.
I have continued to pray all day today that all goes well, and I will not be that 5%. Either way, I know with faith, all things will be okay. Thank you all for your continued love and support.