Feb 11


I thought I should write a brief post about the days immediately after my catheterization. The temptation to make the title a pun was too much for me to resist, I’m afraid. (It’s a play on “aftermath,” you see. Sorry.)

In my previous post, I mentioned that my post-procedure instructions included some restrictions, like not driving, avoiding stairs, and not lifting more than five pounds. The ban on driving was in case I was still impaired by the anaesthesia (I wasn’t, as far as I could tell), but all the other restrictions were intended to prevent me from causing the spot where they inserted the catheter (referred to with the charming term “puncture site”) to bleed. The instructions also included warnings not to strain during bowel movements or engage in sexual activity. (That last one wasn’t really a problem for a divorced man who isn’t in a relationship and is not looking for one.)

In addition, I was told that the morning after the procedure, I was to remove the dressing from the puncture site and then shower, gently washing the site with soap and water. I didn’t exactly obey that instruction. I did not have to go anywhere or see anyone on Tuesday (the day after the procedure), and I was doing my best to take it as easy. So I chose to leave the site alone. I left the dressing on, and I didn’t shower.

But I had a dental appointment on Wednesday morning, and plans to meet Bob and Miles for dinner that evening. A shower was mandatory. I carefully peeled off the dressing and examined it. Not a speck of blood on the gauze — clearly, there had been no post-procedure bleeding. So far, so good.

But before getting in the shower, I wanted to take a look at the puncture site to see how well it was healing. I couldn’t find it! I had been expecting a puncture something like the one you get when you donate blood, but clearly it had been smaller than that. And in the two days since, it had apparently closed completely. I am not limber enough to bend double and take a close look at my own groin, but I couldn’t see it in the bathroom mirror, and my attempts to snap a picture of it with my phone were unsuccessful. So I shrugged and got in the shower.

Washing the area with soap and water didn’t provoke any discomfort. I wasn’t terribly surprised, because I had experienced no pain whatsoever during or after the catheterization. No soreness or tenderness, nothing at all. This is typical for me; in the past, following surgical procedures, I have had little or no post-operative pain. My gallbladder surgery, for instance, had left me with four new holes in my abdomen, which didn’t hurt at all. They were little holes, but so is a paper cut, and those hurt like hell. Surgical incisions don’t, not for me. I don’t know why.

The instructions said to put a Band-Aid on the puncture site after washing and drying it. But with only the vaguest idea where it might be, that seemed pointless. I didn’t bother.

After having avoided driving on Tuesday, I did an unusual amount of it on Wednesday. First I went to Apex and back (12 minutes each way) for my dental appointment. Then, in the afternoon, I drove to Fuquay-Varina and back (half an hour each way) to pick up a new work computer. And in the evening, I went to the restaurant and back for dinner (about ten minutes each way). I had no trouble at all driving.

In short, I recovered quickly and easily. My only problem is that, between missing a whole day of work for the procedure, and most of Wednesday morning for a dental appointment, I am short on hours for this week. Which is why I will be working on Saturday. But things are finally calming down. After a steady barrage of medical tests and appointments during all of January and the first half of February, I don’t have another one scheduled until March 7. And after that, nothing until late April. That will probably change, since I was told that Dr. Desai would want to see me again about two weeks after the catheterization. But things are definitely getting back to normal.

One more thing that I forgot to mention in an earlier post: The primary measure of heart function is ejection fraction (EF), which measures the percentage of blood inside the heart that is pushed out when it beats. A healthy heart typically has an EF of 50-65%. When I was admitted to the hospital on December 29, my ejection fraction was in the 20-30% range. (That’s why I was diagnosed with heart failure.) Shortly before the catheterization, Dr. Desai told me that the MRI on January 24 had measured my EF in the 40-50% range. So it’s not quite back up to normal, but it’s improved a great deal. My heart is getting stronger. He was very pleased, and so am I.

Feb 08


When I revived this blog, I had thought that I would use it to tell the story of my heart failure experience in chronological order. But it’s taking too long for me to do that, and I don’t think it makes sense to delay updates on recent events just because I haven’t finished describing earlier ones. So today’s post is about what happened today. I’ll catch up on the earlier events when I can.

Today, February 7, I had a heart catheterization at WakeMed Cary Hospital, where I was an inpatient a month ago. This was a procedure scheduled by my cardiologist, Dr. Desai, to look for blockages in my coronary arteries. If any blockages existed, that could be the cause of my heart failure. Procedures for doing this vary, but in my case, the catheter was inserted into my femoral artery in my groin, and then maneuvered through blood vessels to the heart, where it was used to examine the blood flow in the coronary arteries. X-ray imaging is use to track the location of the catheter and aid its navigation. The catheter can also release small amounts of a radiocontrast agent, also known as an x-ray dye, which makes the blood flow visible to the x-ray cameras for a few seconds. By analyzing this imagery, the catheterization team can determine whether blood is flowing normally in a particular location, or is restricted by a blockage.

My preparation for this procedure required me to stop taking Xarelto, the anticoagulant (or “blood thinner”) that I normally take to treat the deep vein thrombosis in my lower legs. I was instructed to stop the Xarelto two days before the catheterization. I was also told not to eat or drink anything after midnight on the day of the procedure. Other than that, I just had to show up at the appointed time, which in this case was 8:00 a.m. I was not allowed to drive myself to or from the hospital, so Ruth agreed to provide transportation. I would be there all day, so she wasn’t required to wait at the hospital while the procedure was happening.

After I checked in, answered a few questions, and signed some consent forms, I was taken to a room in Observation. I went through the familiar process of changing into a hospital gown and putting my clothes and other belongings into a plastic bag for storage until I was ready to reclaim them. (This was part of the preliminaries for my gallbladder and eye surgeries, as well as every colonoscopy I have had, so I know the drill.) Intravenous lines were installed in my right arm and left hand. (I didn’t ask why they needed two of them.) Then I was taken to the “cath lab,” which the equipment required for the procedure. In particular, it has an manueverable x-ray camera that can move around the patient’s body to get the best images of the catheter’s current location.

I was given a sedative and local anaesthesia in the groin area, and the catheter was inserted. I had expected to the sedation to make me groggy or sleepy, but I remained conscious and alert during the whole experience, although I was very relaxed. The local anaesthetic was administered so expertly that I wasn’t even sure when it happened; I didn’t feel a needle. Perhaps they used a topical numbing agent on the skin first? Anyway, the entire process didn’t demand anything of me other than being relaxed and keeping still. At one point I was asked to take a deep breath and hold it for a few seconds. That was my only participation.

I knew that if blockages were found, the plan was to correct them with stents, which would probably be installed by the catheter as part of the same procedure. But I didn’t have any blockages, so no stents were needed. After the procedure was complete, I was taken back to my room for recovery and observation. The main concern was to make sure that I didn’t start bleeding at the site where the catheter had been inserted. I was required to lie on my back and rest for several hours. By this point it was 10:30 or 11:00 a.m., and I was pretty hungry, not having had breakfast. A nurse brought me a turkey sandwich and some graham crackers, which I was able to eat while flat on my back. She also helped me drink some ginger ale through a straw. After that I dozed. I wasn’t able to sleep very well, because I normally sleep on my back, and my neck wasn’t really comfortable despite some fiddling with the pillow. But I just had to put up with it for a few hours, so I drifted in and out while I waited for the required time to pass.

Some time between 2:30 and 3:00, I was allowed to sit up in bed, then stand and walk to the bathroom. Then a nurse took me for a brief walk in the hallway while she observed me to make sure I was moving well. When it was clear that my balance was good and I wasn’t dizzy or lightheaded, she took me back to my room and canceled my Fall Risk status (which is automatic for anyone undergoing anaesthesia). After that, a lunch tray was brought in and placed on the overbed table, and I ate lunch while sitting on the side of the bed. (It was the same kind of meal that I had been served while I was an inpatient a month ago, so I felt a bit of nostalgia as I ate.) Another nurse went over my discharge instructions, and then left me alone to change into my clothes and get ready to leave.

I sent Ruth a text message to let her know that I was ready for pickup. Both of my IVs were removed. A wheelchair had been parked outside the door of my room, so I sat in it and reviewed my printed discharge instructions while I waited. The main point of them was to avoid straining the insertion site and causing it to bleed. I was told to avoid going up and down stairs for 24 hours, which would mean that after getting home, I would be confined to my apartment for a day or so, which would be no hardship for me. (Since I work from home, I sometimes don’t leave the apartment for several days at a time.) I was not to drive or operate machinery for 24 hours as well. The main limitation was that I shouldn’t lift anything heavier than five pounds for three days.

When Ruth arrived, a nurse wheeled me out to the curb where her car was waiting. I explained the restrictions to her, and mentioned that a prescription had also been sent to the Harris Teeter pharmacy that I sometimes use. She agreed to take me there to pick it up, and to get a few grocery items as well (since I wouldn’t be able to go grocery shopping for a while.) Then she took me home and carried the groceries up the stairs for me, since they definitely weighed more than five pounds. After making sure that I felt fine, Ruth left.

I did feel fine. I wasn’t in any pain, and not dizzy or lightheaded. But I was kind of tired, so after a light supper, I took a nap for several hours. But I wanted to get this entry written and posted today, so here I am finishing it up at half past midnight.

I don’t have any blockages in the blood vessels serving my heart. That is both good and bad news. It’s good because blockages are certainly not a good thing, and you’re better off without them. But it’s bad news in the sense that we still don’t know what caused my heart failure. We’ve eliminated blockages as a possible cause, though. So that’s progress.

I’m progressing in other ways. Dr. Desai told me that my heart function is continuing to improve. And he surprised me by telling me to stop taking furosemide, the diuretic that I’ve been on for over a month, and which enabled me to lose forty pounds of excess fluid, restoring my breathing to normal and allowing me to resume my normal life. When I was an inpatient, I was being given furosemide intravenously, so I don’t know what the dosage was. But I was given a prescription for the oral form of it when I was discharged. At first, I was taking one tablet twice a day. At my first follow-up appointment, Dr. Desai reduced it to one tablet per day, and at my second, he cut it again to half a tablet. Now he’s stopping it altogether. It seems that my heart is functioning well enough that my body can eliminate excess fluid without it the diuretic. I continue to weigh myself every day, and if I see a weight gain of 2-3 pounds or more per day over a two-day period, or five pounds in a week, I am to call his office. (He’ll probably put me back on furosemide if that happens.)

I was told that Dr. Desai will want to see me again in a couple of weeks. I expect that we’ll talk about what comes next. In the meantime, I’m going back to work. I took all of Monday off for the catheterization, so I have some catching up to do.