Angie & Jim

Catching Upby Jim

I’m sorry I haven’t posted anything new today.  There has been a little back-and-forth between the doctors involved, so I wasn’t sure what to say yet.  Now that the day is nearly over, I think things are at least set for tomorrow.  So, here is the latest:

Dr. Dubin (a pediatric electrocardiologist, and one of the first heart doctors we met here at Stanford/Lucile Packard) came by and told us that she’s will helping with Angie’s arrhythmia.  She remembered us, even though we hadn’t seen her for about 6 years.  She told us that she wants Angie to start on an anticoagulant (blood thinner) because of the atrial flutter she’s experiencing and also because of the clot that they saw during her CT scan.  We hadn’t heard much about that clot, so that was a surprise to us.  It isn’t related to the flutter she’s having since that was before she got into tachycardia, and we don’t know how long it has been there, but they are concerned nonetheless.  Dr. Dubin also wants to get Angie on some medication that treats tachycardia called Sotalol.  While it is unlikely that the drug will get her out of the flutter, it is a possibility.  Regardless, they didn’t want to start that until she was on the anticoagulant, which she now gets via IV.  Last week, they had given her Heparin in shot form every 8 hours.  If you hate getting shots in the arm, try getting them 3 times a day in the stomach.  Yuck.  Now that it is delivered in her IV as a drip, it means she has to get another IV for other medicine — so she still has to be stuck again.  Not fun.

Dr. Dubin also wants to do a transesophageal echocardiogram (or TEE) to have a better look at the clot in her ventricle.  TEEs are basically an ultrasound from inside your throat.  It involves being put to sleep and having a breathing tube down your throat.  Usually, they also take it out while you’re asleep.  Angie has woken up with them still in and it is about the most unpleasant experience you can imagine coming out of a procedure.  Dr. Dubin’s plan is to deal with the fluid problem first and then get her on anticoagulation for a month and then bring her back in for another TEE and a cardioversion (a shock to stop the arrhythmia).  We’re not thrilled with the idea of atrial flutter for a month, but with the current state of things (fluid, clot, etc.) that is probably the best option.

Dr. Lui came in later and said he didn’t want the TEE (which made Angie pleased) since it wouldn’t change what they end up doing and it means another procedure for Angie.  We trust them both and know they are both experts, but it is hard for a patient when the doctors disagree.  If Angie has the TEE, she’s supposed to be off of food and water for a few hours beforehand, but we’re already worried about her losing her strength and when you can’t eat, it doesn’t help.

So things went back and forth and the latest from the nurse is that she can eat after midnight, which means that she will not be doing the TEE tomorrow.  Of course, that may change tomorrow, but it won’t be until after breakfast (probably).

Today has been a bit emotional and difficult as we see the doctors struggle to figure out what to do next.  Angie had an x-ray this afternoon that didn’t look markedly better than yesterday, which means the fluid isn’t draining very fast.  We hope that that changes because we would prefer not having another chest tube.  I’m hoping that they will give her another day tomorrow to shed as much as she can before they decide what to do next.

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Thank you all for your love and concern.