Thursday, March 16, 2017

Searching for the Causes of Syncope

This week has been one of tests - the kind that I don't know how to study for.

Tuesday morning I had a light breakfast around 7am, and arrived at the hospital around 11:15am for round one of tests. After checking in at the main desk I was taken back to registration where a sweet lady named Lorraine asked me to present my ID and insurance cards, make a payment on my balance, and sign a bunch of forms. Eventually I was sent out to the waiting room to wait until they were ready to take me back. A short time later, a young woman in blue scrubs and her blond hair in a ponytail came in and called my name. She introduced herself as Jesslyn, and I followed her down a hall, through a locked door that she had to open with a key card, and down another short hall through the last door on the right to the room where the tests would be done.

If you stood in the doorway we entered, on the right there were a wall with a few hooks where I was told to hang my purse. Straight ahead along that wall, but facing the door, there was a computer monitor on a cart (I discovered later it was an ultrasound machine). To the left of the cart was a low bed, with the head at the far wall and the feet towards the door. Standing to the left of the head of the bed was an IV stand. To the left of the stand there was a treadmill facing the far wall. On that wall above the treadmill, there was a long horizontal photograph of a park with a lake and downtown Denver's skyline and the mountains in the background. The view looked fairly familiar, and I think it might have been a park near the Denver Zoo. Below the photograph on the wall there was a bunch of medical equipment. To the left of the treadmill was another cart with a computer screen, and a printer below it. (This was the EKG machine.) To the left of that computer screen was the far wall, with a large door that they could wheel a bed through if they wanted to. To the left of that door, and to my left as I stood in the doorway I entered, there was a long desk covered in papers, equipment and a desktop computer. There was also a trash bin and some other gadgets on that wall.

When I entered, I was asked to change my shirt for a hospital gown with the opening in the back. She left while I did that, and then returned. She explained the procedure for the tests I would be doing and asked if I had any questions, then she put the blood pressure cuff on my right arm and proceeded to attach a bunch of adhesive circles with snap attachments to various spots on my chest. Then she connected wires to each of those snap attachments. Each wire was connected to a small box (about the size of a paperback book), which she strapped around my waist. Then she made a couple phone calls - one to have someone do an IV, and the other to my doctor. The lady for the IV arrived first. She chatted with a pleasant eastern European accent as she had me lay down on the bed and inserted the needle into a vein in the back of my right hand. She was just finishing when my doctor arrived.

They made sure I was laying on the bed comfortably with my feet against a board at the base of the bed. Then Jesslyn strapped me in, with one strap across my legs a little above my knees, and the other strap across my chest, below my arms. Then they pushed a button and the head of the bed began to swing up so I was standing at about an 80° angle. The lady who had put in the IV sat in a chair directly in front of me and chatted comfortably. Doctor Haffey stood by the EKG machine, monitoring the zigzag lines as they tracked across the screen measuring the electrical impulses in my chest. Jesslyn sat at the desk or stood. And I stood there, strapped to the bed for twenty five minutes as the blood pressure cuff gave my arm a squeeze every three minutes and occasionally the IV lady or someone else would ask how I was feeling, or if I was feeling nauseous or dizzy. (They hadn't wanted me to eat for four hours before the test so I wouldn't throw up.) It wasn't incredibly comfortable, but I wasn't feeling sick or dizzy or anything. Finally the twenty five minutes were up and they lowered the top of the bed down again and they unfastened the straps. The IV lady left at that point and I was allowed to stand up.

As they were printing out the EKG pages and preparing for the treadmill test, they asked how I was feeling and I mentioned that it seemed like all my blood was pooling in my right hand. It was looking purple and puffy and felt weird. Jesslyn and Doctor Haffey said something about it being the blood pressure, and Jesslyn moved the cuff to my left arm instead, easing it over the needle which was still embedded in my right hand.

Then I was told to get on the treadmill. They started it slowly and horizontally, but every few minutes it would go faster and rise to a higher elevation. Every three minutes the blood pressure cuff would give my arm a squeeze, and the lines on the EKG machine would bounce along regularly. My heart rate got up to its target 157 bpm, and continued for a while, until I had been on the treadmill for about 12 minutes, my hands were sweaty and I was worried about keeping my grip on the bar in front of me. At last they stopped it and I was allowed to sit down and let my heart rate return to normal. It slowed down slowly but surely, and then the doctor left and Jesslyn removed the blood pressure cuff, the IV needle, and the electrode wires and stickers on my chest. She left so I could change back into my shirt, and then I was allowed to go home.

Tuesday, March 14, 2017

Vandalism and a New Car

Friday morning, Hannah and John went out to the car to go to seminary, only to return back inside saying, "I think someone broke into our car!"

When we went out to check, the van - our 2004 Toyota Sienna that we have owned and loved for the last eight years looked like it had been hit by a tornado on the inside. Every compartment that could have been opened had been opened, and its contents were strewn all over the seats and dash. Steven ended up driving them to seminary while I called the police to file a report.

After further inspection, we realized how thoroughly they had vandalized our car. Besides making a huge mess, they had attacked the rear speakers with a small file, and a broken off part of that file was jammed into one of the speaker holes. Probably that same file was used to stab and scratch the DVD player screen. The knob on the gear shift lever was missing entirely. Something had been jammed into the ignition keyhole and then broken off inside so we couldn't even turn on the car to roll down the windows to relieve the overwhelming odor of pot that permeated the car. To top it all off, the vandal(s) appeared to have urinated on the front passenger seat. (As well as on a couple of CDs and stuff that had been in the glove compartment, but were sopping wet on the seat when I found them.) Interestingly, the only thing that was missing - besides the gear shift knob - was the bag that the jumper cables had been in. The jumper cables were on the back seat, and other straps and things that had been with them were up by the front seat, but the bag was gone. Also a screwdriver may have been taken.

The very thought of sitting on the front passenger seat after some junkie had peed on it grossed me out so thoroughly that Steven and I decided it wasn't worth even trying to salvage it. I emptied the car of all our stuff, while holding my breath as much as possible. I still got a horrible headache. That evening, Steven and I started looking at used cars online. We wanted something that would hold seven comfortably, and still get decent gas mileage. I decided I wanted either another Sienna or possibly a Honda Odyssey. We're planning a long trip this summer, so a rear entertainment system was a priority. We found a couple that were within what we were willing to spend.

Saturday morning Steven dropped me off at our stake Women's Conference, and then went to look at cars. Three hours later he came to pick me up in a dark grey/blue 2007 Toyota Sienna that he was test driving. After I had driven it a little ways, I decided I liked it and we ended up going back to the dealership and buying it.

Our new car has a fancy touch screen navigation system, a rear entertainment system, a sun/moon roof, leather seats and something like fourteen cup holders in various spots. The kids seem to like it, although Hannah has mentioned that the navigation screen is distracting when she's driving. I assume we'll get used to it eventually. The car didn't come with an owners manual, so I looked one up online, and I'm trying to figure out the ins and outs of programming things and getting them set up for us. Who knew new cars could be so complicated?

At the moment, our old car is still sitting on the street where it was parked when it was vandalized. Steven is arranging to donate it to someone who will come pick it up and tow it away (so we don't have to get a locksmith to clear the ignition so we can start it.) It was a good car, and I'm sorry to see it go, but I'm also looking forward to more adventures in our new car.

Wednesday, March 1, 2017

The Encroaching Blackness aka Syncope

The first time in my life that I ever passed out completely was during a choir concert in high school. We were dressed in the red polyester choir robes, packed onto risers like sardines into a can, made to stand there under the hot spotlights on the stage and sing, At some point, the blood drained from my head and darkness crept from the sides of my vision until my sight was filled with blackness, and I sunk down onto the riser for a short nap. I woke up a little while later confused and disoriented, wondering why I was napping - dreaming even- in the middle of a choir concert.

Six or seven years later, I was pregnant with my first child, but not far enough along to show. I was kneeling in worship, and once again I felt the darkness come creeping in. I tried to stave it off, shifting my weight, concentrating on breathing, but nothing helped. Again, I fell into an unexpected sleep, and awoke in another room, with no memory of having been carried there.

About five or six years ago, at a time when we had no health insurance and I didn't have a car during the day, I was home alone, sitting at the computer, when I had a very strange experience. I began to remember a dream that I'd had a long time before. This memory sucked me in, and I felt the need to take a nap - right then. I laid my head down on the desk, and was instantly asleep. I woke some time later, remembering that I had been dreaming, but no longer able to remember the dream. I was a little dazed and confused, but soon began to wonder if I should do something about the event. By that time, I felt perfectly fine, and the idea of calling an ambulance or even a friend to take me to the emergency room seemed stupid. I hadn't talked to a doctor about the other two times I passed out - although the reasons for passing out those times were more understandable, and during those I had experienced the encroaching blackness, while this time I did not... but it was easier to try to forget the entire experience, so I did.

Maybe nine months or a year later, it happened again. I was at home alone again. I was sitting at the computer again. (I tended to spend a lot of time on the computer.) Once again, the memory of the dream invaded my mind, and I took an unexpected nap. This time when I awoke the computer was shutting down. Somehow, I had managed to push the button on the computer tower to tell it to turn off - while I was unconscious. This event scared me a little more than the one before. My sister had been suffering from seizures. Was this a seizure? I did some looking around on WebMD and other sites, and even tried to casually ask my sister what it felt like to have a seizure, but in the end, I did nothing.

Two years ago, I was playing wiffle ball with the family in the front yard on a Monday evening. I honestly don't know if that was another "passing out" event but it is a real possibility. One minute I was chasing after the ball, and then the sidewalk was coming towards me, and the next thing I knew, Steven was at my side and my shoulder was in a world of pain. Talking to Steven later, it sounded like I had tripped, and it wasn't until I didn't get up immediately that he came to my side to see if I was okay. As we went to the emergency room to have my dislocated shoulder put back in place, through my pain I remember wondering, "Should I tell them that I might have passed out?" I didn't. At this point, it kind of felt like a deep, dark secret that I should have told a long time ago, and since I hadn't, it was now too late.

Some time later, I was visiting with a couple friends. We were sitting in chairs around a table in a dimly lit room. One friend was talking - telling a long story about something I don't remember now. Once again, I felt the dream take over my mind. This time, however, I didn't even put my head down. When I awoke, I was still sitting in the same position, my friend was still talking, and no one in the room had noticed a thing. This confused me even more, and I pondered it as I drove home from my friend's house a short while later. My sister wasn't allowed to drive because of her seizures. Should I be driving? Was it a seizure? I hadn't been shaking or moving enough for anyone to notice. Was it real? Or was I just imagining it?

Monday, February 13th was a busy day for me. I exercised. I washed laundry. I went grocery shopping. I cleaned house. I did Relief Society stuff. That night I was sitting at the dinner table with the family, telling Steven about something that had happened that day, when I was distracted with memories of  "the dream". Unable to push the thoughts away, I succumbed to it, resting my head on the table (luckily not in my half-eaten dinner.) Steven says I was out for about 30 seconds, during which I was unresponsive. Someone got me a drink. I awoke and tried to continue the tale I had been telling before, but I was confused and disoriented. I remained in that "cloudy" state the rest of the evening, and I had a headache. It was during a discussion with Steven that night that I decided I would *finally* see a doctor about it.

You should understand, I hate going to the doctor. I don't have a regular family doctor. I went to my OB/GYN during the years I was having babies, but only 3-4 times since then for birth control purposes and the like. This didn't seem like something an OB would know much about.

I looked up our health insurance website to find a list of primary care physicians that took our insurance. I selected one that wasn't too far away that said it was accepting new patients, and gave them a call. The soonest they could see me was in three or four weeks. Surely someone could see me earlier than that! Maybe? I didn't bother making an appointment.

There is an urgent care up the street that we occasionally go to for physicals for scout camp, strep throat, or stitches, and they take walk-ins. I decided to go there. I'd ask them to do a physical, and just see if there was anything generally wrong. I arrived and signed in, and then the receptionist asked what reason brought me there. I casually mentioned I had passed out the evening before, and after consulting with the doctor on duty, she told me to go to the emergency room within the hour. They wouldn't see me at the urgent care.

Seriously? The emergency room? For passing out over 12 hours before? How is my insurance going to like that?

I returned home and called the insurance's nurse hotline. When I told her what was going on, she confirmed what I had been told by the urgent care. I should go to the emergency room. Ugh. So, feeling quite a bit foolish, I climbed in the car and drove myself to the emergency room.

Two hours later, I had provided them with a urine sample, they had listened to my heart, taken my blood pressure, and stuck a clip on my finger that measures oxygen levels.They had attached several stickers to my chest and attached wires to them and watched a bunch of lines jump around on a computer monitor. They had taken chest x-rays. They had taken samples of my blood. Finally a doctor came in with their final diagnosis. I have syncope. (AKA fainting... I could have told them that...) He told me that all the tests they had done had come back negative/ normal and they sent me home with a referral to a cardiologist and an injunction to find myself a primary care doctor.

Back at home, I found a doctor who could see me in just one week, and I visited him on President's Day. This doctor is about 80 years old, a bit hard of hearing, and his big, black Labrador followed him into the examination room. He has little to no appreciation for emergency rooms. ("They don't know anything, and I just have to fix people up after they've been there...") but he does have some respect for the cardiologist I had been referred to. He explained to me that syncope is difficult because it is hard for doctors to know what is going on unless they "catch it in the act". Considering I only experience it once a year or so, the chance of that happening is very slim. They would probably give me some sort of monitor. He took a drop of blood to make sure I'm not diabetic (I'm not), listened to my heart a bit, and sent me on my way.

Two days ago I met with the cardiologist. He asked for my entire history of fainting - from the very first time. It seemed strange to me because in my mind the first two times were "normal" fainting while the more recent times were not the typical "black outs." But he's the doctor. Again, it was explained how they have to catch it in the act to find out what is causing the fainting spells. He told me (I think he was joking... but it was hard to tell) that they could put me in the hospital for the next year or two so they could keep me on the monitor just in case it happened again. Or, they had different gadgets that could keep track of my heart rate for varying amounts of time - from a big thing I'd have to attach to my chest for 24 hours, to a tiny one that could be surgically implanted over my heart and last for three years. He said they could also do a series of tests that would attempt to "cause" a fainting spell: a tilt table, an exercise stress test, and some others, as well as an EEG that would determine (for sure) whether I'm fainting or having seizures. I told him I'd rather do the easy tests before I have anything surgically implanted, so I'm scheduled to do the tilt table and stress test in a couple weeks. They are still working on scheduling the other tests. While I was there on Monday, they took more blood to check my cholesterol levels. They also took my blood pressure (which was quite a bit higher than normal, but some of that could be from the stress of being in a doctor's office) and listened to my heart.

Part of my is relieved that I've gotten this condition into the open and that I have people with experience helping me figure out what it is. The other part of me is stressed about the expense and everything that is going to be involved in figuring this out, and wondering if it is really worth it. I asked the cardiologist as much when I talked with him on Monday.

"How dangerous is it that I pass out randomly once a year or so? I mean, is this serious, or can I just ignore it?"

The answer I got was, "I treated a woman a couple weeks ago who had a similar condition, and when she passed out, her heart stopped for six seconds. That is serious."

I gathered that there is a possibility that it could be something very serious, even life threatening. On the other hand, it could be harmless. It might happen some day while I'm driving (and I'm driving more these days than ever before in my life due to my current church responsibilities) and that could be devastating not only to me but to others as well. So yeah, I'm going through with it, and hoping they figure out what is causing it.