Tuesday, July 10, 2007

Too Much Drama

I am going to apologize in advance for the length of this post. There is really no way to describe how horrible it is to think that you might die after just having a new baby. I am hoping that maybe someone in the same situation will do a Google search for some of the symptoms listed here and get to the hospital right away.

Last Thursday morning, my daughter Katie was distressed to find that I was not in the house. Later she said, “I thought somebody stoled you. Because I missed you.”

I was not planning on having to leave the night of July 4th. I had just finished feeding the baby and went outside to see the remainder of the firework display when I noticed that my heart felt like it was beating too slowly and skipping beats. I had felt that a little bit the night before but ignored it and it went away a little later. This time I was prepared to ignore it as well but then I started to notice that I was also short of breath.

It was about then that I started to become concerned since I also had a lot of swelling in my legs and ankles. I had called my O.B.’s office two days prior to talk to them about the extreme swelling that had developed after the baby was born. The nurse talked to the doctor, called me back and said it was normal and not to worry. I actually suspected that it was beyond normal but was happy enough to just put it out of my mind. After all, it’s a symptom of postpartum cardiomyopathy and I certainly did not want that.

So the shortness of breath along with the edema and bradycardia (heart rate under 60) was something that I could not ignore. I called the answering service for my O.B. and was waiting for a call back and then decided that waiting was not really the best plan. I packed up the diaper bag and got ready to go to the E.R. Just as I was ready to leave, the on-call doctor called back and suggested that an EKG might be a good idea.

Twenty minutes later the triage nurse was evaluating me. After reviewing my vital signs and questioning me about my symptoms, she told me I was next. The waiting room was not completely full but full enough that I thought it might be a while. The emergency room is not a place where you want to be a priority. That usually means you are pretty sick.

I was taken into a room, instructed to put on the gown and the nurse immediately drew blood, hooked me up to an EKG and an I.V. line. My heart rate was staying between 38 and 43 beats per minute and I was not feeling good. They decided to move me to a room close to the desk with constant cardiac monitoring.

Next stop was for a chest film. The chest film showed evidence of pulmonary edema, which means that there was fluid in my lungs. The doctor was discussing this as well as some of the lab results and explained that now we had to check for a pulmonary embolism. Pregnancy and birth raise your risk of clots so it had to be ruled out. Pulmonary embolism is a very bad thing to have that is commonly fatal. The next test was a chest CT with contrast dye.

They informed me that I would not be walking for that one. I was now in the gurney hooked up to a portable monitor with an attached defibrillator. This was a little nerve-wracking, along with the fact that I was scared that is was an embolism.

I made the journey to radiology without any excitement. I had a CT scan years ago but things have changed. I had not been subjected to the contrast agent with my previous CT but I knew I did not like the idea of being injected with it. In rare cases people can have serious allergic reactions and I had enough problems without that.

The tech came in and told me I was getting the test dose and that it would probably burn a little. It was worse than a little burning but was over with quickly. Then he was back saying that it was time for the full dose and that I probably wouldn’t like it. It felt like it had a density much greater than regular liquids, more like hot molten metal. It is quite painful, but the tech had warned me that the I.V. placed in my hand would make it worse than if it had been in my arm. Immediately there was a hot feeling all over my body and a strange taste in my mouth. This was in addition to fact that I was now flat on my back and it had become very difficult to breath in that position.

The CT was read fairly quickly. Evidently they have a deal where it is sent to radiologists in Australia to read so that the local radiologists can sleep through the night. My results were negative for pulmonary embolism, which was a huge relief. The problem was that they still were not exactly sure of what was wrong.

The doctor ordered some more lab work and we waited. The results for a test called BNP were back quickly and that showed an elevated level. Normal range is less than 100 and mine was 200. The doctor consulted with the O.B. on call as well as the cardiologist and decided to admit me for constant monitoring with more tests ordered during the day. The working diagnosis was congestive heart failure secondary to postpartum cardiomyopathy. Scary stuff.

The good thing was that they decided to give me some drugs to get rid of some of the fluid. I was given I.V. Lasix, which is a strong diuretic. Within 30 minutes a lot of the fluid was gone out of my legs and my lungs. I started to feel better immediately.

I was moved to a postpartum room (so I could keep the baby with me) and hooked up by the telemetry nurse. I had just had enough time to sleep for 10 minutes when they brought in breakfast. Then the cardiologist was in, followed by nurse after nurse, lab techs, etc. Then they decided to move me again due to trouble with monitoring, this time to a unit called “Progressive”. That is the equivalent of being banished to old people land. That unit is filled with really sick people, all wearing oxygen masks. I was happy to not be hooked up to that. My blood pressure was higher than it had ever been and was compensating for my low heart rate. The result was that I still had normal perfusion with plenty of O2 reaching my tissues.

I spent the next few hours getting an echocardiogram and a Doppler of my legs to rule out clots. Everything was looking normal. It was then decided that I did not have cardiomyopathy at all. I was diagnosed with fluid overload, which means that the large amounts of I.V. fluid that I had been given during labor along with the increased blood volume from pregnancy was more than my body could tolerate. That explained the symptoms that I was having with the edema, shortness of breath, etc.

My doctor finally came in around noon. The first words out of her mouth were, “I’m so sorry.” When I called about the edema originally, she thought it was nothing, because that is usually the case. I was at fault for being too willing to believe that it was nothing.

I was released with a little EKG monitor that I have to use for 30 days and instructions to check my weight and blood pressure daily. I am also on a low sodium diet, which is just as tasty as it sounds. I have continued to have some of the same symptoms, such as the bradycardia, but in general I feel better. I was not given a diuretic at discharge but hope to start one tomorrow when I see my doctor again. I think maybe then I will be able to get back to normal more quickly.

1 comment:

Anonymous said...

You are not alone. Have you stopped by the peripartum cardiomyopathy (PPCM) support site? http://www.amothersheart.org/members/index.php

I hope that you feel better soon. It's a hard trip.