He's Home!

Mom and Dad in Vail, CO celebrating 60 years of marriage in July, 2013

When my dad went to the Emergency Room on the evening of February 3rd, he was experiencing pain on the right side of his chest and under his right arm. When he arrived, they did an EKG which showed that he wasn't having a heart attack but they found that he was in Atrial Fibrillation with Rapid Ventricular Response. He was given Cardizem to bring his heart back into normal rhythm and it worked. His heart has since been in Sinus (normal) rhythm. Blood was drawn and they did a Blood Panel, also known as a CBC (complete blood count), or FBC (full blood count). This test gave an overview of his overall health status.

As part of that blood draw, they looked for Cardiac Enzymes that could have leaked into his blood. This was done 3 times over a period of 18 hours (every 6 hours) and if the enzymes were present, that would indicate that he had had a heart attack and that there was possible injury to his heart. Fortunately, those tests came back negative so it was definitive that he did not have a heart attack.

After the EKG and blood draw, he was taken to have a chest x-ray and a contrast CT scan which showed multiple small blood clots in both lungs. There are clots in his lower and middle right lung and in his lower left lung. He was diagnosed with Bi-lateral Pulmonary Embolism and was immediately given an injection of Lovenox. This is a fast-acting blood thinner and they have continued to give him 70mg of Lovenox twice daily. At the same time, he was given 5mg of Coumadin which is also a blood thinner but it will take several days to build up in his system.

Using a Pulse Oximeter (a device clipped onto his finger), his Oxygen Saturation Level (called Sats or Lung Profusion) was tested and it was at 95%, which was great! Normal Sats are between 95-100% at sea level and on Tuesday morning, his Sats were at 96% on room air. This is a good indication that the clots in his lungs are not keeping his blood from being oxygenated as it travels from his heart, through his pulmonary artery, into his lungs and then back through his circulatory system. 

Because he was stable, Dad was transferred to a high-level care room within the hospital rather than having to be placed in ICU. He was continually monitored there and given narcotics to lessen the pain he was experiencing as a result of the blood clots in this right lung. This medication made him very drowsy but it relieved him of his pain and allowed him to rest peacefully.

An Echocardiogram (an ultrasound of the heart) was performed on Monday morning. His doctor was exploring the atrial fibrillation that had been discovered in the ER. Also, it is not uncommon for the heart to be damaged after a PE because the heart is often stressed as it pumps harder (because of the blood clots) to get blood into and back out of the lungs. What was found is that he had a mildly dilated right atrium, but his valves looked good and his heart continued to be in Sinus (normal) rhythm. His heart rate has consistently been in the 60's over the past couple of days which is very good.

The PE that Dad experienced as a result of clots in his lungs most likely originated from a blood clot (or clots) in his leg(s). He has traveled extensively by plane over the past 12 months and has spent a lot of time in his office sitting at his desk getting everything in order in preparation for their upcoming move to Minnesota. These factors definitely contribute to the development of blood clots, but between the Coumadin and the fact that he's going to get into the routine of getting up and moving around more frequently, we shouldn't have to worry about more clots developing.

The clots that he currently has in his lungs and likely in his legs will gradually dissolve and be reabsorbed into his bloodstream. This will take several months. His doctor wants him to have an ultrasound of his legs in three months to determine if the clots have dissolved and if they have, he will probably be taken off Coumadin. My friend, Patti Heaps who is a Palliative Care Nurse told me that tests are being done on the risk-benefit ratio of elderly patients being on Coumadin. It's not uncommon for them to stumble and fall, usually hitting their heads and being on Coumadin frequently leads to head bleeds. So more and more, patients are taken off Coumadin and put on a low-dose aspirin regimen.

Dad was released from the hospital on Monday, February 5th around 5:00 pm. His discharge diagnosis was 1) Bilateral Pulmonary Embolism and 2) Atrial Fibrillation with Rapid Ventricular Response. He was sent home with an order to have his blood drawn to test his PT/INR (Prothrombin Time/International Normalized Ratio) level every day for seven days. Prothrombin Time (PT) is a blood test that measures how long it takes blood to clot. It is also used to check whether medicine to prevent blood clots is working. The PT laboratory test includes mixing a commercially available reagent with the patients blood plasma and measuring the clotting time. However, PT time shows great variations, depending on the type of reagent used and the way it is measured. To standardize these PT results, the World Health Organization introduced International Normalized Ratio (INR), which allows a doctor anywhere in the world to treat a patient with blood clotting issues.

For most people, their INR should be around 1, and their PT (clotting time) should be around 10-12 seconds. A person on Coumadin typically needs to be in an INR range of 2-3 (which is my dad's goal range) and their PT (blood clotting time) should range from 22-30 seconds. The challenge is to make sure their blood is thin enough to prevent clots from forming yet not so thin that it causes excessive bleeding. He will gradually reduce the frequency of his blood draws from daily to weekly to bi-weekly(every two weeks) to monthly.

Mom and I are also giving Dad twice-daily Lovenox injections until his INR is (and remains) in his goal range. He doesn't seem to mind them but he has some very attractive bruises on his stomach! The pain medication that was prescribed for him is a pretty strong narcotic that makes him drowsy and a bit confused, so he's been taking Tylenol for his chest pain and that seems to be working well.

We will meet with his Primary Care Doctor on Friday for a follow-up visit. I have a few questions for him that I wasn't able to get answered in the hospital and also some questions regarding his follow-up care. I feel bad for the poor nurse and doctor in the hospital who were subject to my copious list of questions yesterday, but they were both great about answering them and giving us so much information and clarity!

The "curse" of my Massive Pulmonary Emboli in December of 2010 has proven to be a blessing these past couple of days. Because of what I went through, I understand all of the medical terminology and have been able to communicate effectively with the Doctors, Nurses and Lab Technicians with confidence and understanding that I would not have possessed otherwise. I knew which questions were important to ask, was familiar with the information they gave us and feel confident that my dad is receiving the care that he needs.

I want to thank everyone for your prayers and well-wishes, notes of compassion and concern, e-mails, texts and phone calls. Our family has been through so many serious medical emergencies in the past 2 1/2 years but God has been gracious and has had His healing hand on all of us. Please pray for my dad's continued speedy recovery and for clarity and peace of mind for both of my parents as they navigate through this new medical terminology, medication and change of lifestyle.

Also, please pray for God's guiding hand on them as they prepare to move from Oklahoma to Minnesota around the first week of April. They have a lot on their plate right now and it can feel daunting at times, but I know they will be fine and will settle into their new home quickly. My brother, Ken lives in Minnesota and it's great that he will be so close to them. I am very thankful for all he has done to help them find a Retirement Community in which to live, and the bonus is that it is fairly close to his home and work. I will be here in Oklahoma through next Monday and then will travel to Minnesota in April to help them unpack and settle in. Hopefully, my next blog post will be an update on how they are thriving in their new home in Eden Prairie, Minnesota!