Monday, February 22, 2010

Pain, the ER, and other yucky things...

The emergency room is probably very good in emergency situations. However, in "maybe emergency" situations, or in "not quite emergency" situations, or in "we're not sure if it is an emergency or not" situations, they're generally less helpful than you might hope.

They're good at what they do; however, they're not so good at figuring out what's wrong with you if you're not about to drop dead from a heart attack.

It is Monday morning, following a very interesting weekend involving - yes - the emergency room. iivo and I spent all day Friday in both the ER and the doctor's office. The details of what has transpired so far, and of what is currently going on (as much as we know) are below, for those of you who care to read about such things.

As for my part, typing it all out, now that I have a moment, will be helpful for my processing of the whole thing, and for my ability to accurately remember details as more time passes.

I am quite certain no one in the world will ever actually read this post in its entirety, but here it is, blow-by-blow:

WEDNESDAY morning - iivo and I were awakened by EV's calling to us from her bedroom, "Mom, I can't move my neck." She awakened with severe stiffness and pain in her neck, and a rope-like band of muscle tightness running down the right side of her neck. We did some massage, ice, heat, soaking in a warm tub, and ibuprofen, and she basically took it easy that day, wearing a neck brace for support and to prevent movement, which was painful. That night she slept in our bed with me so as to have the better mattress support and to keep her from rolling into a weird position while sleeping. iivo slept in her room.

THURSDAY - EV attended classes with us at our homeschool co-op, but needed the ibuprofen all day to keep full range of motion and to be without pain. She slept - with the support roll in her pillow - in our bed with me again that night, and iivo again slept in her room.

FRIDAY morning - iivo awakened at 4:00 am with chest pains and difficulty breathing. He went to the bathroom, then spent some time trying to stretch and move about and get into different positions to alleviate the pain, to no avail. He came into the room where EV and I were sleeping to awaken me about 4:30. We gave him four low-dose aspirins to chew, then got online and researched about his symptoms, concluding after several trips through several "symptom checker" checklists, that we really should go the emergency room, just in case. We took the dogs out, put them back in their crates, left the kids a note, and I drove iivo to the ER at about 5:00.

At the ER, they took us to an evaluation room. They put in an iv line to draw blood and get base-level readings at about 5:15. (They want to check blood levels initially, and then again six hours later, since by six hours after the onset of pain, certain blood levels will be elevated in a cardiac emergency situation.) They then hooked iivo up to a bunch of monitors - heart rate, blood pressure, blood oxygen levels, etc. - and also did an EKG.

Soon after that they took him for a chest x-ray. I stayed in the room. They brought him back in a few minutes, but about a minute after the radiologist left from having wheeled him back, iivo declared, "I'm going to throw up."

"What?! Why didn't you tell the nurse before she left?"

"She was just a radiologist."

"Well, she might at least have known where a bag is, so you don't puke all over yourself!"

As I looked around the room for a barf bag, iivo's alarm monitors went off. I turned around, and iivo was a chalky shade of greyish tan (including his lips, which were the exact same color as his face). Needless to say, I was a little freaked out and surprised that no one was coming into the room to check on him. I went out into the hall to the nurses' station, asking, "Do we need to be concerned about those alarms going off?"

"Yeah, we're watching it," they said, staring at their screen at the nurses' station.

I indicated that iivo had said he was going to throw up, and a nurse sighed deeply and returned, irritated, to the room with me. She immediately walked over to turn off the sound portion of the alarm (wouldn't want the obnoxious wife coming out anymore, you know), then turned around and caught her first glimpse of iivo, who was still ashen and yellow-looking.

"OH!" she exclaimed, then said, "Just a minute!" and rushed from the room.

Hmmmm. Novel idea, to actually look at the patient, instead of just the patient's monitor screen at your nurses' station.

She returned with a doctor, and they did whatever-they-do for a while until he was normal-looking again. The obnoxious wife - that's me - was keeping an eye on the (silenced) alarm screen during all this, so I know that his heart rate dropped into the 30's, and his blood pressure into the 50's, during all this.

After this, they decided that the plan they had had - iv fluids and some nitrogylcerine under the tongue to see if that alleviated some of the chest pain - was unwise, since nitroglycerine will cause a lot of blood vessels everywhere to open up, a course of action unwise in someone barely hanging on to a normal blood pressure. So they simply got him comfortable (a scenario only possible in an upright position in the bed, and in which "comfortable" is loosely defined as able to breathe - however shallowly - without turning blue and able to manage the pain without wincing, grimacing, or actively crying, as long as I stay absolutely still.)

This "comfortable" waiting continued for four more hours, while they waited for it to be time to take the second blood draw. This second blood draw was normal, in that it did not have elevated levels of whatever-they-look-for, which indicate a heart attack.

The next course of action in the let's-eliminate-the-possibility-of-heart-attack protocol was to take him for a stress test. Yes, as in on the treadmill. So they got iivo up, made him put on his tennis shoes, and wheeled him away in a wheelchair. (I was not allowed to accompany him.)

When he got there, they indicated to him that they wanted him to get his heart rate up to 178. He indicated, in his usual humor, "Today is not the day for that, fellas... How about I just start out by walking without passing out?"

He walked - with the treadmill at an incline - until his heart rate was up to 150, then indicated that he couldn't continue. As soon as he stopped, he was very woozy and dizzy and lightheaded, couldn't really breathe, and was holding his very tight, painful chest. So the stress-test guys gave him some nitroglycerine - you know, the nitroglycerine he wasn't supposed to have - and wheeled him back down to his room.

As soon as he was brought back in, he had another turn-bluish-tan/sweat-profusely-and-be-unable-to-breathe episode, which the nurses handled by elevating his feet and dropping his head (which had always made him unable to breathe since 4:00 that morning) and patting him with wet cloths.

He was not yet hooked back up to his monitors, so I don't know what his blood pressure and heart rate actually did, but he went "greyish-white-without-lips" again.

I suggested they might raise the head of his bed, since being flat had made him go into breathing spasms since the beginning. Eventually they were able to get him a little better stabilized. At some point during all this, it came out that he'd been given nitroglycerine, which the nurses hadn't even realized.

{Really. At times, it was like watching a parody of a circus show.}

We were grateful, however, that the stress test, however wimpy for my run-several-miles-a-day husband, indicated that his heart was fine, and that he was not having, nor about to have, a heart attack.

So what was causing the pain and inability to breathe? "We're not sure. You'll have to follow up with your regular doctor."

"You mean, you have no idea what is wrong, except that it isn't a heart attack?" (Bear in mind that we've been there nearly twelve hours by now.)

"Well, at this point, there are all kinds of possibilities. It could be gastro-instestinal."

[As in indigestion. Oh, please! The man can't breathe or move for the past twelve hours over acid reflux?!]

"All of these symptoms could be associated with anxiety."

[Well, okay, I guess so. But generally panic attacks come on suddenly and last for a few minutes, never for an entire day. And this began in his sleep, at 4:00 am on a day off from work, before a three-day weekend of vacation at his folks' house, generally a place of great fun and delicious food and no domestic responsibilities of any kind. An anxiety attack in this context seems unlikely, don't you think?]

"It could be muscular."

[Well, okay, maybe, but he lifts weights and exercises and runs every day. He's done nothing out of the ordinary. He can't stretch or press his chest in any way that finds anything remotely resembling a sore muscle. The pain feels like it is deep inside. But, okay, having seen my shoulder thing several years ago, and having known people with terribly debilitating back pain, I guess we can try to buy this one. A little.]

"It could be an infection."

[He has no symptoms of illness and no fever at all, however. That'd be kind of weird, but certainly not impossible.]

At any rate, they sent us home with the suggestion that we take Tylenol for pain and follow-up with our regular doctor.

As soon as we started walking down the hall to exit the ER, he got slow and hunched over with pain; as soon as we walked outside and hit the cold air, his breathing became super-shallow and labored and he went into weird spasms during which he couldn't really talk.

I brought him home, gave him some Tylenol, and tried to get him to lie down in bed. He could not do so without being unable to breathe. He was agitated. He couldn't be still. Together with his parents (who had decided to come to us from NC when it became clear that we could not, in fact, travel there, and who arrived here about ten minutes after we did), I decided that we should do the "follow-up with your regular doctor" now, before they closed at 7pm on a Friday evening.

The GP on duty at the doctors' office was not iivo's usual one, but he was good to work with. He decided that he wanted another chest x-ray, concerned that the continuing severity and constancy of the pain, as well as the difficulty breathing, warranted another check on his lungs. He indicated that this second x-ray was warranted as things in the lungs can deteriorate very quickly, and the other one was done earlier that morning. He did not like some of what he saw in iivo's lungs, noting that there were indications of abnormality in the lower lungs that he wanted looked at more closely. He ordered us back to the ER for a CT scan of the lungs. (They have the necessary equipment and - I assume - the necessary personnel after 7:00 pm on a Friday night). He also gave us a prescription for vicodin, indicating that we should take that to alleviate pain over the weekend if the CT scan ended up being clean.

We arrived back at the ER for a CT scan (our GP had made arrangements with Heather, he said). They checked us in again the exact same way, gave iivo wrist bands again, and sent us to a room. (This time our "room" was a little alcove off the hubbub of activity, with a little curtain separating us from everyone else.) I had to go to the bathroom, so I excused myself for a moment, only to come back to find them sticking all the little monitor things all over iivo again, preparing to give him an iv and do another EKG. "What are you doing?" I asked, and was told of their plan. "Why do you need to do that, since we're only here for a CT scan of his lungs?" I asked. "His doctor arranged it with Heather."

"Well, since you are back with continued chest pain, we need to..."

"No, we're not 'back with continued chest pain.' Yes, his chest still hurts, but you have already ruled out that the pain is cardiac in nature, so we don't need another EKG. You sent us away from here, assuring us it wasn't his heart, and told us to follow up with his GP. We have done so, and he's sent us here for a CT scan of his lungs, based on some concerns he has. We would like you to just do the CT scan, please."

"Well, we'd like to monitor things while you wait," she responded, continuing to hook iivo up to the same monitors he'd been hooked up to all day. "You can certainly refuse the EKG if you'd like."

"I don't think he needs another EKG right now, thank you. We'll just wait for the CT scan."

At this point, the phone rang, and I was giving the director of our homeschool co-op an update for the prayer chain, when I realized that they were preparing to give iivo another chest x-ray. I excused myself from the phone call and asked, again, "What are you doing?" Again I was told of their plan. "He doesn't need another chest x-ray; he's had two already today, the last one just minutes ago. Here are the films, which they sent with us."

"I know, but we would like to do our own."

"You don't need to do your own. You may look at these if you'd like to see what's going on in his lungs right now. His doctor evaluated these films and is concerned enough to want a CT scan of his lungs. You can compare your x-rays from earlier today to these, if you'd like, or look at the CT scan when it is completed, but he doesn't need another chest x-ray right now."

"But we generally do a chest x-ray..."

"Ma'am, I appreciate that you are just following your protocol. I really do. But we are not here for you to evaluate my husband's chest pain. You have already done that, and assured us it is not cardiac in nature. You have also indicated that out regular doctor would have to do any further evaluation. So we are simply here for the CT scan he's ordered, which we'd like to have completed as quickly as possible."

The doctor eventually came along and looked at the chest x-ray films we had right there; she expressed concern that it indicated that iivo's shallow breathing was making his lungs "sticky," which was going to lead to pneumonia if he didn't start breathing more deeply soon. They gave him some morphine intravenously (they got to put in that second iv after all, this time in his hand), to try to ease the pain enough for him to breathe; the pain did not go away, even with the morphine. Eventually they did do the CT scan, which required a larger iv port than the one they'd put in his hand, so he was stuck for the third time that day and equipped with an iv port in his arm to handle the dye they had to administer for the CT scan. That scan was clear as far as indicating any life-threatening blood clots. (Blood clots in the lungs cause similar symptoms as the ones iivo is having.)

They once again released us, with only our GP doctor's prescription for vicodin for pain. We once again hobbled out of the ER in pain, once again went into breathing spasms upon hitting the cold air outside, and once again went weak and woozy upon trying to lie down. Finally, iivo and I got into a hot shower, hoping to rinse off the germs of the day and open up his breathing a little. He said it felt easier to breathe while we were in there, but immediately began the difficult breathing as soon as we got out. He indicated he would throw up after one bite of food, so I made him some hot tea and propped him upright in bed. He was only able to fall asleep with hot packs on his chest and 750 mg of vicodin coursing through his veins.

SATURDAY morning was no better, and we had to give him vicodin as soon as he woke up and tried to move, to ease his breathing spasms. He spent the day in bed, taking the vicodin as soon as it was time for the next dose. He did get up to try to eat a little something a couple of times, and to show his face. We opened Christmas gifts with his parents, with iivo sitting up in a chair in the den.

By evening, we got to talk to our doctor friend Matt, who advised that he add ibuprofen to the mix, since it is anti-inflammatory. Vicodin apparently has no anti-inflammatory properties in and of itself.

At any rate, iivo went to bed early, having taken a couple of doses of ibuprofen in addition to the vicodin. At 2 am he awakened soaking wet (as in I-went-into-the-pool-in-my-pajamas-and-then-got-into-bed kind of wet), and after he had changed and we were trying to go back to sleep, he said, "You know, my chest doesn't hurt for the first time since this whole thing started." I reminded him that he was regularly consuming over a thousand milligrams of pain killers, so we should be thankful but cautious about assuming we're out of the woods. He took advantage of a few deep breaths, and went back to sleep. (I had a harder time getting back to sleep, of course!)

SUNDAY: iivo felt significantly better than he had, so we spent the day trying to convince him to take it easy and not overdo it, as he was still masking all pain with pain killers. He was still pretty wiped out and lethargic, but clearly happy not to be in such horrible pain. He spent the afternoon in bed, but sat with us at the dinner table while we ate a celebratory dinner with his parents and mine for my father's birthday, which is today. iivo took his last vicodin at 9 am this morning, and his last ibuprofen at 3 pm. By the time he went to bed around 9 pm, he was in pain again, though not as bad as before.

MONDAY: iivo slept well through the night, though we were awakened at 2 am by the dogs barking at some policemen parked outside our house. Again, he was able to return to sleep quickly, while I had to move to the den. His breathing was still shallow and noisy and labored, and I was having difficulty getting to sleep with that going on. He slept until after 8 this morning, and awakened sore but not in excruciating pain. (He had had no pain killers overnight.) His parents left this morning, as his father is getting sick with some upper respiratory infection. So today, my father and I worked chauffeur duty around my mother's cataract surgery, my children's dentist appointments, and iivo's follow-up doctor appointment.

Our regular GP saw us this afternoon at 2:45. He wanted to draw blood again and do another chest x-ray (yes, that's three x-rays in the last three days, together with a CT scan) and indicated that he believes that it is most likely - given his elevated white blood cell count - that iivo has an infection in his lungs which has led to partial lung collapse and will lead to pneumonia if he continues to breathe in a shallow manner. (Apparently all the blood at the hospital they drew was checked for cardiac enzymes and stuff, but not for elevated white cell count, indicating infection?! Unbelievable!) He is unsure if it is viral or bacterial, but he thinks iivo should take antibiotics, just in case. He also thinks he should continue taking the iboprofen for inflammation and pain, since it has helped.

Basically, he indicated that, with chest pain, you rule out what it isn't, then take your best guess about what it is. We may never know for sure. And, as long as it goes away and doesn't return, that's okay, he says.

It is a little maddening to me, but I am glad that iivo is feeling somewhat better now. I would like to know for sure what was causing such significant pain and inability to function or breathe. But for now, steady progress toward improvement and feeling better will do.

That, and an early bedtime.

4 comments:

fldowns said...

Wow, poor Iivo! We'll pray for him!

Frank Downs

Kim Hammans said...

wow, Laurie, what a weekend. We have been praying for you guys and for Iivo and will continue to do so.
Oh, and I DID make it through the whole post! :)

Loralee Holiman said...

Laurie, Kudos to you for standing up strong for your husband against the zombies in the ER. Tell me what hospital you were at so that I can avoid it if possible!
We'll keep you and your family in prayer. How's EV? Is there any possibility of some contaminant in her bedroom that might link her neck stiffness and iivo's infection? Maybe I've watched too much of "House!"

Anonymous said...

Laurie & Family,
It sounds as though it has been an incredibly trying time for all of you. I am glad to hear Iivo is doing better and will be praying that he is back to his old self very quickly. Thanks for letting everyone know what happened.
Sincerely,
Brenda Hopper