S
South Sound Sailor
Well it's been quite a week. I wanted to share this info with others and I apologize, it's a long story.
This past weekend several of you responded to my questions about abdominal bloating. Some of you suggested periocardiac tamponade (sorry... sp? or I may have got the term wrong). I was checked by my surgeon's PA on Sunday. He did not have any concerns. By Tuesday morning, the bloating seemed to be minimal but I noticed by body temp was consistently under 97.5. Then I started seeing readings around 97 and lower.
By Monday evening I was having SOB, high level of fatigue and dropping BP (approx 100/70). Tuesday night my temp dropped to 95.5, I got very nauseated (dry heaves), BP dropped to 75/60. I immediately called 911 and paramedics arrived in minutes. Unfortunately upon arrival, my temp bounced back up to 96 and my BP increased to 100/70. Parameds spent about 20 minutes with me but we made the decision that I did not need to be transported to hospital. Big mistake.
Within a couple of hours, same symptoms returned; lowered BP, decreased body temp, dry heaving, poor coordination, blurred vision... and I started to panic. Fortunately my visiting sister was here and on Wednesday morning, around 4:30 am she immediately drove me to the E/R (10 minutes from home). In a nutshell, I was told I was having periocardial effusion that was rapidly turning into tamponade. All the symptoms I listed above were clearly evident in E/R. Within a couple of hours, I was having blood pumped out of my pericardial cavity; total about 650 - 700 CCs. It filled up a medium sized (bigger than sandhwich) zip-lock bag. Surgeon commented that the blood was clearly "old" blood and had been accumulating for several days/hours. I received 6 units of frozen plasma plus several units of saline.
All of this took place early Wednesday morning. Before the blood was pulled out, I came very close to going into a panic attack. My breathing was very difficult and I knew something serious was happening. Within minutes after the initial pull of blood out of my cavity, I started feeling relief or at least the feeling of having a panic attack subside. I had to go into the CT machine several times to complete the needle insertion procedure and that was the worst part... waiting and not being able to take a breath because of my SOB.
After that initial procedure was over, I had a central line inserted (yes, now I have "twin" central line scars right next to each other!) and a gravity pump was hooked up to me to pull more blood out of my cavity. The collection pod on the pump held about 3/4 cup and they had to empty it several times. I subsequently had 2 chest x-rays and 2 ultrasounds. Blood flow into the gravity pump stopped about 24 hours ago. Everyone is feeling very confident that all blood has been removed and any further leakage has stopped plus no sign of clotted blood remaining in the cavity. I asked for and received extra attention to be given to my lungs because now I was concerned about pleural effusion; not related to the above problem but I figured they might as well watch this closely too. Fortunately no problems there and I'm rapidly regaining my deep breathing ability.
Yesterday, about 24 hours after I had been worked over on Wednesday, I started to feel better and walked the halls for about 25 minutes. I walked this morning for 35 minutes and felt a WHOLE LOT better. Also got my appetite back late last evening. I still have some abdominal bloat and asked for the ultrasound to take a view and was told that there is no indication of inappropriate fluid collection. Cardio doc (not the surgeon) advised me he sees no sign of pleural effusion. I'm confident the abdominal bloat is just what happens to me when I become inactive for a long period of time plus I know I've had a lot of fluid and water in-take these past 3 days. So that's what I've been up to since Tuesday night. I did comment to one of the nurses (not in ICU) that I was very impressed with how calm everyone was in the E/R. She told me that she had heard about my situation and then she told me that it was actually a very serious situation and the more severe the situation, the more E/R docs, nurses and technicians are programmed to act calmly. At the risk of sounding over-dramatic, what happened to me is about as close as a life/death situation as I've ever been in. Even when I was at my worst Wednesday morning, I still doubted that I needed to go in to the hospital. But when I saw my temp was well below 96, I knew something bad was happening. Cardio tells me he's confident I'll now resume recovery from AVR (which I'm having zero to very minimal issues with). My coumadin dosage has been reduced 5 mg/day to 2.5 mg/day. When I was admitted to the hospital on Wednesday, my INR was 7.2. No one would commit to saying that my elevated INR contributed to the problems I had this week but I will be checking my INR daily for a couple of weeks. For those of you who initially gave me advice about tamponade, thank you. For 24 hours, my BP has been running 110/70 (and that's without Metropolol), body temp 98.2 to 99.0, weight amazingly has not changed very much and I received great medical care this week as I did last week. Bottom line - do not second-guess symptoms after VR surgery. If I had to do it over again, I would have had the paramedics transport me to the hospital instead of waiting 4 hours. I'm back on the road to recovery and hopefully no more speed bumps. This is one bump in the road I will never forget.
This past weekend several of you responded to my questions about abdominal bloating. Some of you suggested periocardiac tamponade (sorry... sp? or I may have got the term wrong). I was checked by my surgeon's PA on Sunday. He did not have any concerns. By Tuesday morning, the bloating seemed to be minimal but I noticed by body temp was consistently under 97.5. Then I started seeing readings around 97 and lower.
By Monday evening I was having SOB, high level of fatigue and dropping BP (approx 100/70). Tuesday night my temp dropped to 95.5, I got very nauseated (dry heaves), BP dropped to 75/60. I immediately called 911 and paramedics arrived in minutes. Unfortunately upon arrival, my temp bounced back up to 96 and my BP increased to 100/70. Parameds spent about 20 minutes with me but we made the decision that I did not need to be transported to hospital. Big mistake.
Within a couple of hours, same symptoms returned; lowered BP, decreased body temp, dry heaving, poor coordination, blurred vision... and I started to panic. Fortunately my visiting sister was here and on Wednesday morning, around 4:30 am she immediately drove me to the E/R (10 minutes from home). In a nutshell, I was told I was having periocardial effusion that was rapidly turning into tamponade. All the symptoms I listed above were clearly evident in E/R. Within a couple of hours, I was having blood pumped out of my pericardial cavity; total about 650 - 700 CCs. It filled up a medium sized (bigger than sandhwich) zip-lock bag. Surgeon commented that the blood was clearly "old" blood and had been accumulating for several days/hours. I received 6 units of frozen plasma plus several units of saline.
All of this took place early Wednesday morning. Before the blood was pulled out, I came very close to going into a panic attack. My breathing was very difficult and I knew something serious was happening. Within minutes after the initial pull of blood out of my cavity, I started feeling relief or at least the feeling of having a panic attack subside. I had to go into the CT machine several times to complete the needle insertion procedure and that was the worst part... waiting and not being able to take a breath because of my SOB.
After that initial procedure was over, I had a central line inserted (yes, now I have "twin" central line scars right next to each other!) and a gravity pump was hooked up to me to pull more blood out of my cavity. The collection pod on the pump held about 3/4 cup and they had to empty it several times. I subsequently had 2 chest x-rays and 2 ultrasounds. Blood flow into the gravity pump stopped about 24 hours ago. Everyone is feeling very confident that all blood has been removed and any further leakage has stopped plus no sign of clotted blood remaining in the cavity. I asked for and received extra attention to be given to my lungs because now I was concerned about pleural effusion; not related to the above problem but I figured they might as well watch this closely too. Fortunately no problems there and I'm rapidly regaining my deep breathing ability.
Yesterday, about 24 hours after I had been worked over on Wednesday, I started to feel better and walked the halls for about 25 minutes. I walked this morning for 35 minutes and felt a WHOLE LOT better. Also got my appetite back late last evening. I still have some abdominal bloat and asked for the ultrasound to take a view and was told that there is no indication of inappropriate fluid collection. Cardio doc (not the surgeon) advised me he sees no sign of pleural effusion. I'm confident the abdominal bloat is just what happens to me when I become inactive for a long period of time plus I know I've had a lot of fluid and water in-take these past 3 days. So that's what I've been up to since Tuesday night. I did comment to one of the nurses (not in ICU) that I was very impressed with how calm everyone was in the E/R. She told me that she had heard about my situation and then she told me that it was actually a very serious situation and the more severe the situation, the more E/R docs, nurses and technicians are programmed to act calmly. At the risk of sounding over-dramatic, what happened to me is about as close as a life/death situation as I've ever been in. Even when I was at my worst Wednesday morning, I still doubted that I needed to go in to the hospital. But when I saw my temp was well below 96, I knew something bad was happening. Cardio tells me he's confident I'll now resume recovery from AVR (which I'm having zero to very minimal issues with). My coumadin dosage has been reduced 5 mg/day to 2.5 mg/day. When I was admitted to the hospital on Wednesday, my INR was 7.2. No one would commit to saying that my elevated INR contributed to the problems I had this week but I will be checking my INR daily for a couple of weeks. For those of you who initially gave me advice about tamponade, thank you. For 24 hours, my BP has been running 110/70 (and that's without Metropolol), body temp 98.2 to 99.0, weight amazingly has not changed very much and I received great medical care this week as I did last week. Bottom line - do not second-guess symptoms after VR surgery. If I had to do it over again, I would have had the paramedics transport me to the hospital instead of waiting 4 hours. I'm back on the road to recovery and hopefully no more speed bumps. This is one bump in the road I will never forget.
