After my "incident" last Monday, I spent the bulk of Tuesday wrangling follow-up care. Not an easy task, mind you. Being rather a rookie in the world of medicine and doctors and health coverage and whatnot, I was amazed at the hoops through which I was forced to jump. After about five hours on the phone to various sources, I managed an ER follow up appointment at KUMed (my initial visit had been at Shawnee Mission Medical Center) on Wednesday.
The doctor was interested in my story and lack of risk factors. She was looking forward to presenting it the following morning, but was honest in explaining that the upcoming tests that I would be taking would doubtfully provide much for answers. The diagnosed TIA was likely a fluke and my life would probably go on normally with little more than a faint memory of those garbled words and a decent bog post.
The next morning, I returned to give them a few vials of blood and the following Monday I had cardiac tests. They checked my carotid artery for plaque -- none to be found, and then ran an echocardiogram (I was told my arteries are very photogenic) and a bubble study to see if I had a PFO. After the nurse injected saline in my bulbous vein (my arms read like a road map -- "I could stand across the room with a dart and draw blood," one tickled nurse chortled), a whoosh of bubbles crossed from my right atrium to my left. There's a hole in that thar heart! No biggie. Lotsa folks have them (20-30% of adults, it's believed). But it could be a reason as to the TIA, so it was good to have more information than we thought we'd gather.
Tuesday morning, the ER follow up doc called. She'd seen the results of the heart test and was surprised to be gaining ground on finding a reason for my event. She mentioned the PFO, which I knew about, but also said there was a potential atrial septal defect. She scheduled another heart test -- a transesophageal echocardiogram -- to get a better look at the hole(s) in my heart and to see if further treatment is necessitated.
Now, that same morning I woke with an odd achiness in my left arm. I figured I had slept on it wrong and it would come back to life after awhile. But it kept nagging. It felt tingly and occasionally hurt, and now and then I felt a pang just below my left clavicle. Now, I have ignored many pains for many years, but on the day a doctor tells you that there is at least one hole in your heart and to "keep taking that aspirin to prevent clotting," an ache in or around the heart certainly gives you pause. I ignored it the best of my abilities, arguing that I was over thinking and just needed to chill. But it continued to nag at me. The doctor had told me to watch for any interesting symptoms and I knew a whole slew of folks who would ream me if I experienced another mini-stroke that my body warned me was coming.
So after I had successfully tackled much of my to-do list for the day, my arm continued to fuss and I reluctantly listened. At about 4:30 I headed to KUMed's ER and hesitantly told them my story, acknowledging that there was probably nothing wrong, but I had to cover my arse. They agreed, gleefully drew more blood and sent me to a room. Where I waited. For a very, very long time.
And of course, once the doc arrived, I couldn't really describe my symptoms. "It's sorta like icy-hot is running through my veins." "Kinda achy, but kinda not a real pain." "I didn't drop anything today because I didn't use that arm today...but I don't have any decreased strength either." I know he was loving me...not. But he wanted to err on the side of caution, and a neurologist was on staff for the evening, so...more waiting. And then I got to tell the story again. After a bit of internal debate on his part, he ordered an MRI. I was wheeled down to the dark, dank basement where they keep the magnetic fields and radiation tucked away from the masses...and...I waited. But not before a tech delivered the news that an extra test had been ordered and I was looking at about an hour and forty five minutes in a cozy tube.
By the time that was done, it was nearing midnight and I was well-past hungry. As I emerged from the basement, I had visions of a quick signing of release papers and a short drive home to feed the cat and drag the trash to the curb, but there was more waiting to be done. Eventually the neurologist returned, saying he didn't see anything abnormal on the scans, but he'd have them read by a radiologist. And shortly before 1 a.m., they took the uncomfortable hep-lock out of my arm and I wearily left.
Just after 9 this morning I got a call. The neurologist. Though yesterday's arm fuss was neither here nor there, last week's so-called TIA was not, in fact, a TIA at all. The radiologist saw what indicates the event was a sub-acute stroke, complete with permanent brain damage (on a very small scale). So though yesterday's trip wasn't merited as per my symptoms, it got me in with the neurology department a full three months earlier than my upcoming appointment and uncovered yet another important piece of my puzzling ailment.
For the lessons learned portion of today's post:
- You get faster service at the ER if you garble your words.
- Bring a book.
- Throw a tangerine and a gluten free granola bar in your bag too.
- No nose rings for an MRI -- so bring a plastic shunt for the hole, 'cause it's a major drag to get it back in after two hours.
- Veiny arms are as good as porn for nurses.
- KUMed is hands-down the finest ER in the city.