Monday, May 12, 2014

Dad's ECG

Recently my dad experienced what is referred to in the medical realm as a TIA.  A slight stroke.  It affected his sense of balance, his control over his right leg, it made him experience dizziness, and his speech became thick and slurred.  At the time this occurred we were unclear as to whether he had a stroke.  By the time I learned about his symptoms and paid him a visit (about three hours later) his speech had improved, he was able to walk again, though unsteadily.

In questioning him I discovered that his physician had put him on some new blood pressure medication which he started taking two days ago. I also learned that he had taken a diuretic AND an allegra generic for some allergy symptoms he was having - all at the same time that morning.  He then proceeded to go out into what was a hot sunny day without drinking any water.  Since he had obviously done a foolish thing with all those meds and had basically dehydrated himself I treated him to a lecture on how he was going to have to be more careful.

I made him get up and walk around to prove to me that he was functional.  He did so.  I decided it was likely that he had overdone it with the deluxe med combo platter and his body was adjusting to his blood pressure medication more than anything else.  He still had his sense of humor and was mentally sharp.  My mom had an appointment in two days with their physician, he stated he would go in with her and see the doctor about his symptoms.  I told him to take is easy, rest, inform me if things got any worse.

Everything was OK.  Upon seeing my dad the doctor scheduled some tests were for two days after that.  I went into the hospital with my folks at 7AM that day and made sure that the orders were ready and that they had all the necessary information filled out and available.  Then I went to work and awaited the results, which I didn't expect until the next day.  A few hours later my sister called my desk and was livid.  They had scheduled dad to see a neurologist the next morning.  The MRI had shown that he had had a stroke.  My sister was pissed that the doctor had not ordered the tests immediately. She was afraid that since they were rushing to get him into a neurologist there was a chance of an impending major stroke, which actually happens in about 20% of the cases with initial TIA situations.

I tried to calm my sister and said we had done the best we could given all the circumstances and what we knew at the time.  Dad was seeing the best person for his situation the next day.  As long as he took it easy he should be fine. Unfortunately, my dad is an independent and active man.  So he didn't take it easy.  He did some light jobs in the warm weather and got out on his tractor.  He fell coming into the house.  I was out mowing my property at the time and Jennifer came running out into the field waving her arms. My brother had called and said that he thought my dad had had another stroke.

I phoned my brother.  He said dad was slurring his speech worse than ever.  I told my brother to immediately take dad to the emergency room. Both my brother and Jennifer did not believe my dad would go voluntarily.  I called my dad and gave him a very stern talking to, telling him that he could have a massive stroke and end up in a nursing home pissing all over himself for the rest of his life. Now was he going to go with my brother or did I have stop what I was doing and come over there and make him go myself?

A humorous sidebar (there is a lot of humor in my family) is that by the time I got dad on the phone he was sitting in his living room chair eating a barbecue sandwich for supper.  In firmly talking to him I heard that his speech was indeed much more slurred.  I chastised him for getting out and doing this to himself and mentioned that his speech was much worse now. "Well," he slurred, "that's because I'm eating my supper and my mouth's full of food."  Funny in hindsight but not at the time. At the time I wanted some direct action. Things had moved too slowly for too long and we could not allow any sort of new episode to pass without being dealt with immediately. My brother took my dad in. My dad complied willingly.  I finished my chores and changed clothes, racing to the ER without bathing and with only a protein shake for my supper.

My sister was on her way up for the weekend anyway (she lives about two hours away).  She arrived at the ER about a half hour after I did. Various family members showed up at various times.  Things don't really move very fast in the ER, unless you are having a heart attack I suppose.  The situation was this. The MRI of his brain from earlier that morning revealed that dad indeed had had a minor stroke earlier in the week. The pattern of the stroke was widely scattered so the embolism was not concentrated in any part of the brain to cause specific major damage.  It was dispersed and, as things stood at that time, it would ultimately be absorbed by the brain.  It would dissipate and so would his symptoms as long as he did not have another stroke.  The ultra sound on his carotid arteries showed no blockages or clots at all. So the best guess was that the clot that caused the stroke came from dad's heart, which now needed to be examined.

After about three hours only my sister and myself were with dad as a lady wheeled a rather large contraption (for the size of the room) to perform an Echocardiogram. The procedure took about 45 minutes.  My sister and I got to observe dad's heart as it was pumping.  Mostly it was just observing a lot of ultra sound images.  You could see chambers and walls and valves all beating in rather mechanical rhythm.  At one point the technician injected a saline solution through an artery in the back of my dad's hand while simultaneously asking my dad to "strain" with his buttocks to create force on the heart.  I watched as the solution entered one chamber of the heart (it appeared as white bubbles on the US) but did not seep through into the other chamber.  This was a good sign.  No unusual seepage.  The technologist proclaimed that there was nothing wrong with my dad's heart other than normal wear and tear.

The technologist continued explaining things to me and my dad while my sister went back to her car to fetch a bag for the night.  She would stay with dad so I could be set to go to work the next day.  The technologist explained that before we are born our heart does not pump blood to the lungs.  That would only drown the fetus inside the liquid womb. Instead the chamber wall hinges open and the heart circulates blood within itself, round and round and out into the fetal body. Upon birth, literally around a baby's first breath, the hinge slams shut, the heart stops recycling into itself and starts pulling oxygen in from the lungs.  An amazing evolutionary and biological fact.

Dad's heart was strong.  But by now everybody needed to be certain of where that clot might have come from.  So they wanted to look at a fourth chamber of the heart that could not be seen with the first echocardiogram.  This required transfer by ambulance to a larger nearby hospital.  It also required dad's sedation as they put a tube down his esophagus.  The only way to get an ultra sound of the fourth chamber is from inside the body.  It was fine.  The cardiologist there told dad he had the heart of a man twenty years younger.  I actually think that might be high point out of this whole ordeal.  Having a healthy heart of a 60 year old sounds pretty damn encouraging to a 78 year old man.  I'd that that kind of report.  I think it motivated my dad despite his temporary stroke. Maybe he will take better care of himself now. Although obviously I have to pay closer attention to these matters at least in the near future.

A physical therapist is coming into the house two times a week to work with Dad on his right leg and knee.  He has a walker to get up and down and walk around for now.  He walks well in it. I think his arms are strong enough to keep him up until his right knee gets situated.  Hopefully he won't do more unwise things with his meds.  But he is now on blood thinner medication for the rest of his life. He will soon be wearing a heart monitor for 30 days as a precaution. His ability to farm is completely gone for the moment.  All he is allowed to do is use his walker, dress and bathe himself, and he is allowed to drive short trips in the car. He can, in fact, drive himself to his battery of medical appointments in the coming weeks, although I will be sitting in on specific consultations to monitor what is said and explained by the various specialists.

It will also mean that I am going to have to get more personally involved in the maintenance of my parents' home.  I will have to help check on the small number of cattle.  My brother can keep their yard mowed but their swimming pool, used by all the grand kids in the summer, still has to be opened and purified and cleaned.  I will get the ball rolling on that soon. My daughter's  boyfriend cleaned pools last winter during Christmas break. He has the knowledge.  So hopefully he will work out as my dad is specifically forbidden by his physical therapist from cleaning the pool.  The most he can do is advise.  I hope he is ready to change his life dramatically, and my own to some degree.  The same man who four weeks earlier was dealing with a bull problem pretty much by himself in the middle of the night is, as of this post, not allowed to walk without a walker or a good cane.  How much things can change in the course of a single month.

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