Angie & Jim

Good News, We’re Headed Home!by Jim

All scans and imaging is now done and Angie is back in the room. She’s a little tired, but in good spirits. The first thing she told me was, “Why didn’t you warn me that MRIs are so loud?!” I remember thinking the same thing after mine.

Grace Oppenheim, the nurse practitioner from the neurology team that did the MRI this afternoon, came in to give us the news that the MRI looked good. They could see that the infarctions were not hemorrhagic, they are ischemic, which is good news. She didn’t see any evidence that they will convert to hemorrhagic and turn into a secondary bleed, which is always a risk. So that’s good to hear.

She also said that all the infarctions look about the same age and they are less than a week old. Apparently once they get over 30 days, they can’t tell how old they are, but all of the ones from the CT scan are new. They did say they saw a couple tiny old ones, but they were not really anything to be worried about. They’re pretty confident that the “shower of clots” happened at the same time and is probably from the catheterization. What they can’t tell is where they came from. It could have been the procedure or it could have come from the thrombi. We’ll never know. The good part is everything they saw in the MRI was what they expected. Another really good thing about this MRI is that now Angie has a baseline in case we need to do another MRI in the future.

The most important thing Grace said was that there will be no lasting deficits, no higher risk for bleeding in the future, no reason to delay her place on the transplant list, and no major change to medications. I asked about prognosis for recovery and she told us she believes Angie can expect to be back to normal in a month. She said from the neurology team’s perspective, she’s good to go home. We need cardiology’s green light before we’re discharged.

Only a few minutes after Grace left, Alison Leibold, nurse practitioner from the congenital cardiology team, stopped by with the official word, we’re going home! Yay! She gave us the rundown on the CT scan and echo. They did a CT scan of her body from neck to pelvis to take a closer look at her thrombi (clots) and see if there is anything else going on. They said her ventricular thrombus they’ve been watching is about the same as in 2024. It’s bigger than it was a few years ago, but not enough to be concerned. Angie’s target anticoagulation level is 2-2.5 (INR), but they’re thinking of putting it back to 2-3. She had some GI bleeds back in 2012, which is why they went to a lower INR, but they think now with the risk of stroke, they want to go back to the more typical 2-3. There is a risk of another GI bleed, but between that and a stroke, we’d take the GI bleed. However, she hasn’t had any problems with it since 2012, so they don’t think it’ll be an issue. Dr. Lui, Angie’s main cardiologist, will have the final say.

Alison also said that the CT scan also showed some minor clots that made their way into Angie’s kidneys. She said her kidney function still appears to be good, but they did catch some of the “shower” that happened last week. Alison also talked about the source of the infarctions, which they don’t know if it is from the occluded collaterals in her catheterization or if it is from her ventricular thrombus. Regardless, they want to make a small adjustment to her anticoagulation medication, but besides that, probably nothing else will change. She’ll be meeting with her primary cardiologist, Dr. Lui, next week instead of just the nurse practitioner like she was scheduled before all this happened. Alison also said the echo looked good: function was good and valves were good.

So, we’ve learned the hard way that you’re not going home until they take out the IV and order transport. Working on discharge papers doesn’t mean anything until after you are actually discharged. I will post this when we’re on our way out so we don’t have a false alarm. So if you’re reading this, we’re headed home.

Thank you so much for following along. We truly appreciate all your love and prayers and support during this time.