Cardiac Catheterization: Fabgrandpa’s Heart Surgery

When we were called and asked to come in to Dr. Rouse’s office just a couple of days after Fabgrandpa’s stress test, I knew it would not be good news. Doctors don’t call you that quick when it is happy or good news. So, when we went in and heard that Fabgrandpa needed to go for a Cardiac Catheterization, I was not surprised. The stress test was on Monday, August 8, the counsultation in Dr. Rouse’s office was on August 11, and his procedure was scheduled for August 18. Dr. Rouse told us that they would do the catheterization, and if they found any blockages, they would insert stents into those arteries. Fabgrandpa would be in recovery for 6-8 hours, and then we would go home. It didn’t happen exactly like that, but we are now back home after a three day, two night stay in the hospital. NOTE: Graphic photos are ahead, if you are squeamish, don’t click to read more. 

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Fabgrandpa: Scheduled For A Cardiac Catheterization

 Cardiac catheterization

Fabgrandpa

In the ongoing circle of going to doctors, trying to figure out what is wrong with the man of the house, we have now seen Dr. Howell, the primary care physician; Dr. G, the Ear/Nose/Throat doctor; Dr. Mikolides, the neurologist; Dr. Whitney, The vascular surgeon; Dr. Robinson, the pulmonologist, and now Dr. Rouse, the cardiologist. 

 Cardiac catheterization

Me and Fabgrandpa in 2011

The first time we went to see Dr. Robinson was June 22. She took a medical history, and sheduled Fabgrandpa for a lung function test. He has had lung function tests before at the VA, but those were very simple, easy tests compared to what Dr. Robinson did. This lung function test was very sophisticated, with ultra modern equipment. Fabgrandpa sat in what looked like a modern telephone booth, and the breaths he took were recorded electronically. This machine gave Dr. Robinson a ton of information about Fabgrandpa’s lung function. Quite a contrast with the plastic tube that the VA used, which only showed how far he could blow the marker up the tube. 

Next, Dr. Robinson changed the medication he was using to see if there would be any change in breathing ability. She also took blood to run a bunch of tests. We were referred to Dr. Rouse, a cardiologist, for a stress test. 

With our granddaughter, Sarah at her school play last year.

With our granddaughter, Sarah at her school play last year.

On Monday last week, Fabgrandpa went to Dr. Rouse’s office for the stress test. Because he can not walk for very long without getting out of breath, they did the chemical stress test, where they inject Fabgrandpa with the chemical, and then monitor his heart function.

On Wednesday, we went back to Dr. Robinson’s office for results of his testing. She told us that he has Alpha1 Antitrypsin Deficiency, which is an inherited condition that raises your risk for lung and liver disease. She said that even if he had never smoked a cigarette in his life, with Alpha-1, he could still get COPD. Dr. Robinson is setting up a home health nurse who will come to our house once a week and give Fabgrandpa an Alpha-1 injection. 

When we got home from the pulmonologist’s office, we got a call from Dr. Rouse’s office, asking if we could come in the next day at 8:00 a.m. We took that appointment and got up bright and early to get there on time. 

Dr. Rouse said that the stress test came back as “abnormal”, and he is scheduling a Cardiac catheterization for Thursday, August 18. Next week. All of this is happening so quickly that we are wondering why we didn’t start with the pulmonologist and cardiologist, instead of taking this round about journey to get here.  If Dr. Rouse finds a blockage, he will go ahead an insert stents while he is in there with the catheter.

I am nervous, worried, scared, but also hopeful that the things these two doctors aare doing will make my sweetheart feel better. I hope that getting stents will allow Fabgrandpa to feel good enough to go on day trips, and go out and have some fun. All we have done for about two years now is go to doctors. It gets to be depressing, and disheartening, to go from one doctor to another and still feel bad. I’ll let you all know how things go with the Cardiac catheterization on Thursday.

Fabgrandpa's Surgery: Endarterectomy For an Ulcerated Carotid Artery

one week after carotid artery surgery

Fabgrandpa with our daughter, Emily, one week after his surgery.

So, after going to doctors since September 3, 2014, the vascular surgeon we saw at the end of March performed an endarterectomy .  Endarterectomy is is the general term for the surgical removal of plaque from an artery that has become narrowed or blocked. Normally, they don’t do surgery until the artery is blocked 90%.

Fabgrandpa with Becky three weeks after surgery.

Fabgrandpa with Becky three weeks after surgery.

Fabgrandpa’s artery was only about 65% blocked, but it had ulcerated. This means that part of the plaque had broken loose, and left a hole where it had been. Blood could pool in the hole, and form a clot. If that happened, and the clot then broke loose from the hole, it could cause a massive stroke.  Dr. Whitney said that the risks of NOT having the surgery were greater than the risk of having the surgery.

April 2 was surgery day. We arrived at the hospital around 12:30 and checked in. They took Fabgrandpa back to prep him for surgery, and then Becky and I were allowed to sit with him until they took him back to the operating room.

Prepped and ready to go

Prepped and ready to go

They took him back to begin surgery around 2:00 p.m. They kept Becky and me informed about the progress of the surgery every hour or so. The surgery took about four hours to complete.  When it was over, Dr. Whitney talked to us and explained what he did. He had to cut out a section of the artery, and replace it with a synthetic artery made of bovine pericardium tissue. The incision in Fabgrandpa’s neck was about 8″ to 10″ long.

carotid ulcer

This is the carotid ulcer that was removed. That hole is pretty big

That hole in the lining of the carotid artery was the culprit. If it had not been removed, Fabgrandpa would still be at risk of a massive stroke. He spent one night in the hospital, then was released to come home. The discharge instructions included no lifting over five pounds for two weeks; wear the support hose until the follow up with Dr. Whitney; and no driving until after the follow up.

Fabgrandpa has recuperated very well, and is doing fine. We went to a concert in Atlanta over the past weekend. While he was tired out after more than he normally would be, he was a happy man to still be here to see his favorite band perform.

Today, we had the three week follow up with the doctor. Dr. Whitney said he is doing excellent, and said that Fabgrandpa should be the “Poster Boy” for this type of surgery. We go back in six weeks for the last follow up.

We still haven’t found the reason for Fabgrandpa being off balance, but we are thankful that we kept looking for a reason, and that the doctors found this problem and were able to correct it. I hope that it means a healthier husband for me, and many more years for him to be around.

I will repeat what I have been saying for the last few posts about this: Don’t Ignore The Symptoms When You Are Just A Little “Off”. Your doctor may not find the cause for your symptom immediately, but they may just accidently find something that will save your life.

 

Don’t Ignore The Symptoms When You Are Just A Little “Off”

Me and Fabgrandpa in June 2014

Me and Fabgrandpa in June 2014

The first appointment with the neurologist, Dr. M, was on January 8, 2015. He had us bring in a CD of the MRI that Dr. G, the ENT, had done. He spent some time listening to Fabgrandpa’s symptoms, looking at the records from the recent visits to the primary care and ear/nose/throat doctors. Then he looked at the MRI and said it looks like Fabgrandpa had had a TIA some time in the past.

Dr. M decided to do several tests, most of which were done in his office. I am not sure what all of the tests were for, but one was to check for nerve damage in Fabgrandpa’s legs and feet. One was to test balance. One was done at the hospital, a CTA. Computed Tomography Angiography is used to diagnose and evaluate many diseases of blood vessels and related conditions.

After all the testing was done, Dr. M was on vacation for three weeks, while we sat and worried about Fabgrandpa having another stroke. Finally, we had our last visit with the neurologist on March 19, 2015. At that visit, we still did not have an answer for why Fabgrandpa was feeling off balance. However, Dr. M said that the CTA showed a blockage in the left Carotid Artery. Normally, they don’t worry about a blockage until it is about 90% blocked. But, this blockage also came with an ulcer in the plaque that was blocking the artery.

An ulcerated plaque is where some of the plaque has broken off, and gone with the blood flow through the artery to the brain. The place where the plaque broke off left a hole, or ulcer, in the plaque. The danger in that ulcerated plaque is that blood could settle in the hole, and form a clot, then come out of the ulcer and go to the brain, causing a massive stroke. He said he was referring us to Dr. Whitney, a vascular surgeon.

Our appointment with Dr. Whitney was on March 25, 2015. Dr. Whitney had already looked over Fabgrandpa’s medical records from all the other doctors we had seen. He was very blunt but to the point. Fabgrandpa needed surgery to remove the ulcer and clean out the carotid artery. We talked about the risks involved, what would happen during surgery, and how long he would be in the hospital. Then, Dr. Whitney scheduled surgery for April 2, 2015.

We went home from that visit with Dr. Whitney stunned. We had no idea that the surgery was that urgent. We also discussed how we have been going to doctors since September 3, 2014, looking for the cause for feeling off balance and stumbling when walking, and the doctors accidently found this other thing that could be life threatening. THAT is scarey.

So, I will repeat what I have said before: Don’t Ignore The Symptoms When You Are Just A Little “Off”. Your doctor may not find the cause for your symptom immediately, but they may just accidently find something that will save your life.

Don’t Ignore The Symptoms When You Are Just A Little “Off”: Let Your Doctor Ignore Them For You

In my last post about Fabgrandpa’s health issues, I left off when we were referred to the Ear, Nose, and Throat Specialist, Dr. G. Dr. G was quite pleasant and to the point. We went in telling her that Fabgrandpa had been having some issues with being off balance, and other symptoms like tingling on the top of his head, lots of cramps (in his neck, chest, legs and feet), numbness in his legs and feet, and other things.

Me and Fabgrandpa in 2001

Me and Fabgrandpa in 2001

Dr. G said that a lot of patients have dizziness or vertigo due to problems with their inner ear, so she would be checking his inner ear for any abnormality or infection. Although Fabgrandpa has never called what he has been experiencing “dizziness”, every doctor we have seen so far has called it that. It is very aggravating to say “I’m feeling off balance” and have the doctor interpret that as saying “I’m feeling dizzy.”

So, on the first visit to Dr. G., she did a very thorough examination of Fabgrandpa’s ears, sinus cavities, and throat. After she was finished looking in all the holes in his head, she did an air and bone conduction assessment of hearing loss and speech recognition. In other words, she tested his hearing. He has some hearing loss, but he is a 65 year old man. That seems to be a normal thing.

Next, on the same visit, she did an assessment of eardrum and muscle function. This test is to measure how well the parts of the inner ear are working. None of these tests showed any reason why Fabgrandpa would be having a feeling of being off balance, or dizziness. So, Dr. G. scheduled an MRI.

We went to the hospital in Carrollton to have the MRI done, and a few days later we were again sitting in Dr. G’s. office. She told us she did not see anything abnormal about the MRI, and could find no reason for Fabgrandpa’s dizziness, or vertigo. She said she was sending us to another office to have some more testing done.

About a week or so later, we were in yet another doctor’s office, having another round of testing done. These tests were doe abnormal eye movement; assessment and recording of balance system during irrigation of both ears; and use of vertical electrodes during eye or balance evaluation. I think by now they have done every test in the medical encyclopedia of ear testing. We had to go back to Dr. G’s. office for results of those tests. Again, she found nothing to indicate why Fabgrandpa should be feeling dizzy, off balance, have vertigo, or anything else they want to call it. While we were at that last office visit with Dr. G., she did an x-ray of his sinus cavities. Still nothing.

Just in case you haven’t been counting, we were now up to nine doctor visits, two medications, six tests, an MRI, and an X-ray, and still had no answer to why the man is feeling off balance. The first doctor visit was on September3, 2014, and the last one up to this point was on November 26, 2014.

Next time: We meet the neurologist.

Don’t Ignore The Symptoms When You Are Just A Little "Off"

Here we are, in 1992

Here we are, in 1992

YOU are your own best advocate.

YOU know when something isn’t just right. YOU are the one who has to keep telling your symptoms to another doctor when the one you are seeing is just not listening or just not getting it.

It’s hard to know where to begin, because I don’t know where the beginning is. So let’s just start in March, 2014. Fabgrandpa decided to quit smoking and drinking beer, and he did it cold turkey. He just laid them down and hasn’t picked them back up.

This was something that I have wanted to happen for a long time. He has COPD, and every cigarette he smoked made me sad. Sad for time I knew was being slashed off of his life. Time of his life that he would have to spend with me. So, yes, it was a selfish wish that I wanted him to stop smoking and drinking.

About a month or so after he stopped smoking and drinking, he started telling me that he felt “off balance”. Not dizzy, not like vertigo, just that he was having trouble with balancing his body. He started sort of “lurching” when he walked, a little bit of a veering off to one side or the other when he took the first step.

Other things he told me about were a tingling on the top of his head, a little numbness in his legs, cramps. Lots of cramps. In his chest, in his neck, in his legs, in his feet. Not being able to remember things. This man who could remember verbatim a conversation he had with someone in 1992 would forget to put his glasses on his face when we were going out to eat.

Then the anger started. He was angry about everything and anything. He screamed at me right in my face over the smallest things. I made a sandwich for him before he asked for it, and that made him so mad he pushed me.

That was the day I told him I was making an appointment for him to go to the doctor. Something had to change. I was not going to wait for him to hit me.  The first doctor appointment was with the Physician’s Assistant at my doctor’s office. The PA told Fabgrandpa that he was depressed, and prescribed an anti-depressant.

After about a week on the anti-depressant, Fabgrandpa was calling the doctor to tell her that the medication wasn’t working, and that he did not think that he was depressed. She told him that it would take about a month for the medication to show any effect on the depression, and that he should continue to take it as prescribed. She told him to come back in three weeks.

At the four week mark on the medication, we went back and saw the PA again. She asked Fabgrandpa if the medication was working, and he said no, he didn’t think it was, and that he did not think he was depressed. He was still flying off the handle at times, but I thought I saw an improvement. I told the PA that I thought it was working some but maybe he needed a higher dose of the medication. Sometime during this appointment, the PA looked at Fabgrandpa and said “I thought you said you were better.” And Fabgrandpa said “NO! I did NOT say I was better. My wife said that, but she is not the patient.” She told him to try the meds she prescribed for a little while longer.

We left, and Fabgrandpa said he was not going to go to that PA again. He wanted me to make an appointment with my doctor, who we both like. So, I did. The Dr. told us that sometimes that medication that the PA prescribed just doesn’t work for some people, and she changed the prescription to a different medication, Dilantin. Dilantin is a drug used to help prevent seizures, but it can have the effect of calming a person who has anger problems. She said that she has some other patients, all older men, who have responded well to Dilantin for their anger. So, Fabgrandpa came home and started taking the Dilantin.

My doctor also referred Fabgrandpa to an Ear Nose and Throat specialist, because the ears play an integral part in balancing your body. She wanted to make sure there was no problem with his inner ear that would be causing Fabgrandpa to be off balance.

Next: We go to the ENT.