Thursday, August 26, 2010

Adventures in Medicine - Part 4 (The Home Version)

It has been a few weeks since I was released from the hospital, but the adventure is far from over. Let me catch you up.

I left the hospital on Wednesday (Aug. 4) with prescriptions for 3 days worth of Lovenox injections and 10 days worth of Coumadin, and an appointment with my new GP on Friday. My first day home included errands to the hospital to get copies of my records (check) and my bill (not ready yet), Hastings to rent movies, and WalMart for vitamins (without K). It was a lot of walking for someone who had been in bed for five days, and I was tired when we got home.

I managed my injections with no trouble at all. I'm glad I didn't need any help, because the guys disappeared when I brought out the syringes. A little squeamish, perhaps?

I was sure that I had lost weight with all those "two bites and I'm done" hospital dinners, so I dug the bathroom scales out of the closet. I think I last weighed myself was in April or May. Anyway, the results... I had lost 13 pounds! Now, the trick will be keeping it off without the hospital diet plan.

On Friday morning, I met my new GP. He is short, red-haired and had received no information about me from the hospital.  Good thing I brought the records with me.  My PT/INR was 1.9, so the doc decided we would stop the Lovenox after the remaining three injections. Yay!  He scheduled blood work for the following Wednesday and told me I could go back to work on Monday.

After my blood work appointment on Wednesday, I stopped by the doctor's office to see what the next step would be. The doc obviously didn't remember me. He asked me if I had a history of blood clots (no, just the one I was hospitalized for last week) and later commented that we did not know what caused the clots (actually, we're pretty sure that it was the injury to my leg muscles combined with the birth control pills I was taking). They checked my PT/INR - still 1.9. The doc modified my Coumadin dosage - added another 1/2 tablet every Wednesday. I thought this was a bit strange, but later learned that these tiny adjustments are pretty standard. He recommended that I get support stockings to help with the swelling in my ankle and calf. (Yeah, that's not happening.) I scheduled a two-week follow up appointment.

I've started getting the bills for my little adventure. The hospital bill was over $30,000 and I've only started getting the various lab and consultant bills - looks like that will be another thousand. I am so glad I have good insurance. Even so, it's going to take a bite out of the old bank account.

The two-week follow up appointment was yesterday morning, and I was reminded of why I stopped using this practice for my son many years ago. After my name was called, I sat in the exam room and waited for the doctor... for an hour. When he finally arrived, I had to repeat my history for him. (I now have a serious lack of confidence in this doctor.) My PT/INR was at 1.3, so the doctor changed my dosage again. First, he told me to take 1-1/2 tablets for the next three days (to give it a boost) and then he wanted me to take 1-1/2 tablets on Sundays and Wednesdays and 1 tablet on all the other days. He drew a little calendar on a prescription form to explain it.

I asked about my blood work and he was surprised that no one had called me with the results. (I wasn't.) As of two weeks ago, my hormones were all normal, I had iron deficiency anemia, my cholesterol was high (215 which is below average for me), I had a high platelet count (no big surprise), my C reactive protein count was above average, and I needed more vitamin D. None of this was surprising, but I will be interested to see what changes in 4 weeks when we run it all again.  In the meantime, we have added calcium supplements to my daily pill collection.

I have another appointment to check my PT/INR in 2 weeks. 

I can't wait.

Thursday, August 12, 2010

Adventures in Medicine - Part 3

Tuesday, August 3
Last night, I slept! I remember waking at midnight when the tech came to take vitals, then again at 4:00 (more vitals), at 4:40 for the vampire, who collected four more vials (total - 37), and finally at 7:30 when breakfast arrived. Nine hours of sleep (more or less) does not make up for the previous 3 nights, but it helps.

Today's PT/INR is 1.22 - still just barely creeping up. The doctor doubles my dosage of Coumadin.

I have no morning visitors, so I spend time on Facebook. I am terribly amused by a friend's analogy comparing blood clots to loud drunks tubing down the Guadalupe river toward his favorite fishing spot.

I take another shower (a long one) and wait for the pulmonary specialist... who never shows. I visit with a dietitian who instructs me on which foods to avoid while taking Coumadin. Evidently all of those wonderful leafy green veggies that are so good for you, are now off my diet. They have vitamin K and that reduces the effectiveness of Coumadin. No more spinach salads or broccoli for a while.

I scare the staff when my telemetry monitor makes strange noises. They come running into my room to check on me and find me calmly writing in my planner. I wish I knew what I did to cause this... I could try it again later when I get bored. 

There is talk of sending me home, but I still need the twice daily shots of Lovenox. Patient services checks on the cost of the prescription.  It is almost $1100 for 7 days ($220 after insurance). At 4:00 I realize that I will not be going home today, and am disappointed.

Afternoon visitors arrive - family and a friend. It's a slightly smaller crowd this time, only 6 people at once. They stay until dinner time. Then it is just me and Mike - until he leaves for dinner. Jimmy stops by on his way home from a Scout meeting and stays until 9:00.

I have a male nurse tonight. Something new and different. 

I stay up late playing on Facebook. I realize that I have forgotten to order breakfast.  I hope they send something good. I am not worried, because I know that breakfast is the one meal that they do really well at this hospital. Even the eggs are good. Lunch is usually good as long as you stick to soups and salads. Dinner is tricky. If you order items from the grill (chicken strips or burgers) you are fine, but stay away from the dinner entrees.  They have three different choices each night, and so far they've all been disappointing. I can tell that I have lost weight during my stay here.

Wednesday, August 4
The vampire is late today. She arrives at 6:00 (better watch out for that sun!) - total vials collected now at 41. I watch TV until breakfast arrives.  I am pleased with the selection, but there is too much food and I don't eat everything.

My PT/INR is 1.52. It has jumped 0.3 in one day. I am encouraged.

The pulmonary specialist arrives to tell me my echo cardiogram was normal. He can do nothing more for me and is signing off my case. I am overjoyed. This improves my chances for going home today... and I am no longer stuck in bed!!

A financial services rep stops by to ask how I plan to pay my deductible and (estimated) co-pay. I dutifully hand over my credit card. I expect to be doing a lot more of this as the bills start rolling in. Now, I am sure that I will get to go home today.   

I take a long shower (bliss) and "forget" to have the tech reconnect the telemetry monitor.

My doctor stops by. She wants to send me home, but is concerned about the Lovenox. I assure her that I can administer the injections myself. I convince her to write a prescription for three days instead of seven, to reduce the cost. If my PT/INR is still below 2.0 after three days, my doctor can prescribe more. This solution works for her and she begins the discharge process.

I gather all my things and prepare to check out, then I wander down the hall to fill my water mug - feeling almost guilty for being out of bed.  A friend stops by with a gift of puzzle books. She is happy that I am going home and stays to keep me company while I wait.

The doctor moves my evening injection up to 6:00 (instead of 9:00), so I can leave. I receive instructions on how to administer the Lovenox and am surprised at how easy it is to stick myself with a needle.

I call Mike to come pick me up.  He has 30 minutes to get there before shift change. If he is late, we will have to wait another hour. He and Jimmy arrive with 10 minutes to spare.  The nurse has stashed a wheelchair in my room (smart woman), and we are loaded and out the door in less than five minutes. 

Our first stop is Pizza Shack, where I have some of the most delicious pizza I have ever tasted. My hospital diet has given me a new appreciation for good food. Our next stop is the drug store, where we fill my prescriptions for Coumadin and Lovenox. The bill is almost $100.  Yikes!

Finally, we head home. I am so happy to be back home. I unpack my bag and settle in.

The cats take a full day to recognize me. Darn cats.

Sunday, August 8, 2010

Adventures in Medicine - Part 2

Saturday, July 31
The phlebotomist arrives at 4:45 AM to collect more blood samples. I have started referring to the phlebotomists as vampires. I am not the only one... the nurses do it too. 

I give up on trying to sleep, turn on the TV and wait for breakfast. Breakfast arrives at 7:30 and it is surprisingly good. My husband arrives with more stuff from home - things to keep me busy. A friend from work stops by for a visit. She was recently in the hospital, so we compare notes.

I am hooked up to a telemetry monitor, so they can keep tabs on me, and now the IV has to stay in. It's in the bend of my left arm - uncomfortable. I am not happy. Fortunately, the telemetry monitor is wireless, so I can still get out of bed without assistance.

After lunch (decent food), more visitors - family and friends all arrive at the same time.  My room is crowded with seven visitors. It's hard to keep up with what everyone is saying.

My doctor stops by and tells me it's okay to walk around a bit if I want to. Then the pulmonologist arrives and asks all the visitors to step outside. He tells me that they have found a clot in my lung and wants me to stay in bed for 5 days. He uses strong, scary language - tells me that I am lucky to be alive and if another clot goes to my lung I might not be so lucky. He schedules an echo cardiogram.

The vampire comes and collects 8 more vials of blood.  (Total vials - 25)

Interesting fact about hospital stays: Your nurse and tech team changes every 12 hours. Sometimes you get a different team each day.
Most nurses and techs are great, but some are not so great. Tonight I have one of those not so great teams. The nurse injects the Lovenox so quickly that it burns for half an hour afterwards. (Future shots will be preceded by instructions to inject the medicine slowly.) I ask the tech for more water at midnight. At 7:30 she remembers to bring the water.  I wish I was at home.

Sunday, August 1
No vampires this morning. Surprised, since they are supposed to check my PT/INR levels every day. PT/INR measures the length of time it takes for the blood to clot. Normal is 1, they want my number to be between 2 and 3.

I want a shower, and spent most of the night formulating a plan to convince the nurse and tech to let me have one. I am surprised when the tech arrives and asks me if I would like a shower. Just like that... no negotiations required.  It is amazing just how much better I feel after a shower.

My boss and her husband stop by for a visit in the morning and my family shows up in the afternoon. Having the visitors spaced out is much better than everyone showing up all at once.

The vampire shows up after dinner and collects four more samples. (Total vials - 29) Later I learn that my PT/INR is 1.0, yesterday it was less than 1.

I'm still not sleeping well.  I can't get used to all the noises, the people in and out of my room every hour, and the bed that is constantly adjusting. I am enjoying the novelty of having television, though.

Monday, August 2
Vampire's running a little late this morning, she showed up at 5:00, collected 4 more samples. (Total vials - 33)  At 6:00, the tech arrives with the echo cardiogram machine. Finally, we get to see if my heart is still functioning properly. The tech arranges my bed so that I can see the monitor. Very cool pictures and sounds. The tech keeps me laughing the whole time. What a great way to start the day.

Breakfast is good. This is the one meal that they consistently do well. I have learned that sandwiches and salads are a safe bet, and to stay away from the dinner entrees.

My PT/INR is 1.1 today. The number is just barely moving up. I want it to move faster so that the shots can stop... so that I can go home.

Not many visitors today - most everyone has to work.  Mike comes by for a few hours during the day, then he and Jimmy come back in the evening. I receive a lovely bouquet of flowers from work. They make me smile.
I watch TV until 10PM.  I am so tired that I can't hold my head up.  I shut off the lights and go to sleep.

Yes, sleep.

Tuesday, August 3, 2010

Adventures in Medicine - Part 1

Friday, July 30
While I was at summer camp, I strained a muscle in my leg. A month later, the muscle is still sore and swollen and I'm hurting, so I follow the advice of concerned family and friends, and make a 9:00 appointment with my orthopedic doctor.  The doctor tells me I've definitely strained and probably even torn the muscle. He schedules me for a venous doppler (ultrasound) to make sure that I don't have any blood clots in my leg, and tells me that he doesn't expect they will find anything.

I arrive at radiology half an hour early for my 1:30 appointment.  Good thing, since the nurse has sent me to the wrong place. I am directed to the cardio-pulmonary unit... at the other end of the hospital.  No problem - walking helps stretch that sore muscle. Cardio sends me to the registration desk, where I learn that the doctor's office has not yet sent any orders. A few phone calls takes care of the problem and I am registered as an out-patient. I arrive back at the cardio-pulmonary unit... exactly on time.

After only five minutes in the waiting room, I am led to the exam room.  The scan takes only a few minutes. The results take a bit longer. Fortunately this hospital firmly believes in a TV for every room, so I watch and wait. The tech returns with the news... "You are positive for DVT (deep vein thrombosis)." I am stunned.

I am no longer allowed to walk. The tech and her student assistant load me into a wheelchair and take me to the emergency room. (Next door to radiology, where I started). I wait while they try to contact my doctor - who has left for the weekend. I start making phone calls to notify family, friends and work. After an hour or so, a nurse tells me that they are going to admit me. A tech will take me to registration.

We arrive back at registration and, again, they do not have any orders. We learn that I should have been registered at the ER registration desk, not the outpatient desk. No worries - paperwork is faxed and the registration is completed. I am given an armband and taken to my room on the fourth floor. 

I am greeted by my day nurse, who has a list of questions for me, and my technician. The interview process is lengthy and peppered with amusing comments and laughter. I am instantly at ease with this fiesty lady from New York. After all the questions have been answered and my vitals have been checked, I call Mike (my husband) with my room number and a list of things to bring from home.

Mike and Jimmy (my son) arrive with my necessities (laptop) and we discuss all that has happened. They leave briefly for dinner. My own dinner is delivered - typical hospital food. Fortunately, I don't have much of an appetite. I get a chest x-ray while sitting in bed (didn't expect that!) and a new nurse and tech. I also get my meds - Coumadin and Lovenox, which is delivered by injection - in the abdomen - twice a day. Ouch!

Mike and Jimmy return quickly followed by the phlebotomist, who collects 13 blood samples - enough to allow for all the tests that might be ordered.

After my family leaves for the evening, I keep myself entertained with e-mail, Facebook and Twitter until I learn that I have been scheduled for a CT scan. I get an IV line and take a wheelchair ride to radiology. The radiology tech is handsome and gentle. He'd fit right in on Grey's Anatomy. (I am later berated by a single friend for not doing a wedding ring check.) I have never had a CT scan before, so he tells me what to expect and warns me of some of the strange sensations that I might experience. The scan only takes a few minutes and I am on my way back to my room.

At midnight, I turn off the light and try to sleep. My bed has an air mattress and is designed to aleviate pressure points. It is contantly adjusting - inflating and deflating - and it's noisy. At 3:00, my nurse unplugs the bed so I can sleep. She is certain that it will not fully deflate. I wake up an hour later on a flat mattress. She plugs the bed back in. Between hourly checks, I try to nap, without bending my left arm, until morning.