Angie & Jim

It’s a Rainy Day in Palo Altoby Jim

On Saturday, one of the neurologists asked Angie to repeat back to her the phrase, “It’s a sunny day in Palo Alto.” It was a test to check for slurred speech and see the language processing centers are still working normally. I commented that it definitely wasn’t sunny, and he said, “Oh, yeah, well that phrase normally is accurate,” so he modified it and had her say it was a rainy day. She passed the test. Today is another rainy day in Palo Alto, and it’s really beautiful. Angie loves cloudy, rainy days, so she’s commented on how beautiful it is from our window many times today.

Well, none of the imaging was done yesterday, so they’re planning on doing it today. They have an echo, an MRI, and a CT scan they want to do and Angie is so special that they want to bring in all the teams to monitor her as they happen. The arrhythmia team doesn’t come in on the weekends (but apparently they come in on holidays), so we had to wait until today. The echo is planned for 12:30 and the MRI at 2:30. The CT scan probably can’t happen today, so they’ll keep us until tomorrow. (Update! The CT scan is done! After I wrote this paragraph transport showed up to take her away for the CT scan. The doctor from the congenital heart team came and said they put in the order first thing this morning to get the CT scan, which means we might get to go home tonight. Yay!)

This morning they did another pacer interrogation. Before the MRI they have to put her pacemaker into “safemode” but they will do that just before they start the procedure. It uses magnetic induction to communicate to the outside world (programming and reading for data), so understandably an MRI could potentially do bad things to a pacer. Obviously, this will be safe, but they will take all the necessary precautions.

They are doing the MRI so they can characterize the infarctions in her brain and see how old they are. With the CT scan of her head from Saturday, they don’t have the same resolution and it’s harder to see the age of the damage, but with the MRI, not only can the see them but they can tell how long they’ve been there. If they are all new from the procedure last week, it means the risk is lower that it’ll happen again spontaneously. If some are older, we may need to make some adjustments to her medication and take some other precautions. They don’t anticipate finding old ones, but they need to check just in case. They will scan her head to image her brain and her neck to image the vessels there.

Angie has some clots in her heart that have been there for a long time. A clot in the heart is called a thrombus (plural is thrombi). They formed because the anatomy of her heart has some areas or pockets where blood doesn’t flow as freely as most people, so a clot has formed. It isn’t necessarily dangerous so long as the clot stays where they are. This is why she’s been on blood thinning medication for years. The CT scan is looking for the thrombi in her heart to see if they have changed at all, if there are new ones, or if any are gone (dislodged, which would be the most worrisome).

The echo she’s getting is looking for the same thing as the CT scan. CT scans are x-rays (which are in the nanometer wavelength) and echoes are ultrasound (in the sub-millimeter wavelength). They do both because neither one has really great resolution, but together they help to see things a little better. X-rays are really good at looking at densities and ultrasound is really good at seeing function. X-ray is just a static image, but ultrasound can record movies, so they can see different things. Each team has a different preferred imaging method. From the echo they will also measure basic function and flow of her heart.

So, one down, two more to go. Echo is next, and the MRI should be done by 4 and that means there is a good chance we can come home tonight. Hopefully our next post will be from home letting you know the results of the tests. Thanks for tuning in.