Friday, December 12, 2008

This Week's Adventure

Well, it's been an interesting week, although it's ending pretty much the way it started, with no new answers.

This week's adventure started with a toothache. I assumed I had a cavity since I've always had lousy teeth, and my dentist kindly worked me into her schedule on Wednesday despite being fully booked. After x-rays, a dental exam and even looking at my teeth with an ultraviolet light to see if there were any cracks, my dentist told me that my severe toothache was not caused by any damage to my teeth. However, she warned, tooth and/or jaw pain are often an early sign of a heart attack in women, who frequently don't get the more typical pain radiating to their left shoulder. So she recommended, especially with my history of tachycardia (which has been getting worse again), that I follow up with my internist.

Unfortunately, I couldn't get in to see my internist on Wednesday because it was her half day and she was totally booked. So I talked to her by phone, and she told me I could go to the ER if I was really worried or I could wait until Thursday morning and come see her in the office. I went back and forth, both in my own head and with Scott, and ultimately decided to wait until Thursday morning. There came a point Wednesday night when I regretted that decision, but by that point, Ellie was already in bed and there was no one to take me and I wasn't bad enough off to call an ambulance.

Thursday morning, I continued to feel worse, but at that point it seemed just as easy to wait for my 10:45 a.m. appointment. It helped a lot that Ellie stayed home from school that day with a cough so Scott was available to drive me to the doctor.

My EKG came back normal, as always, but my heart rate hit 120 beats per minute during a very slow ambulation and was 108 while sitting still. My internist also did bloodwork, which unfortunately would have gotten results much sooner if I'd gone to the ER but took all day from her office.

So she called me at home around 5:30 p.m. and told me that my D-dimer results were abnormal. Normal levels should be below 0.5, but abnormal results can range from 0.5 to 4.0. Mine was 1.25, not excessively high but enough to want to get checked out. According to, "
D-dimer is normally undetectable in the blood and is produced only after a clot has formed and is in the process of being broken down. Measurement of D-dimer can tell your doctor that something has increased above normal the body's clotting mechanisms."

Off to the emergency room we went, with me wondering if I should pack an overnight bag or not first. Scott and Ellie waited with me for a little while in the waiting room, which was the busiest I've seen, before I sent them home so Ellie could get a good night's sleep. I figured at least one of us should, and I could take a cab ride home. (I'm glad I did that since they didn't finish with me until past 11 p.m.)

So I had a CT scan looking for a pulmonary embolism. I believe they also looked at my legs since they had me going in and out of the scanner repeatedly. The ER doc says my lungs are beautiful, which is always nice to hear. :) No signs of a clot anywhere. But to do the scan, they injected my IV with gell-like iodine, which caused my chest pain to worsen considerably.

But he said that one cause of chest pain like mine can be from esophageal spasms, so they gave me a nitroglycerin tablet to dissolve under my tongue. And apparently, it was a good, fresh, strong nitro tablet because within a minute or two, my head felt like it was going to explode. And I still have a headache from it more than 12 hours later. Made the chest pain feel different, but not better.

Meanwhile, I noticed that while I reclined on the stretcher in the ER, my heart rate dropped to the upper 90s and my pulse ox was a good 98 percent. But if I even just sat up fully, my heart rate would climb to 130 and my pulse ox dropped to the low 90s. Both better stats than when I was admitted to the hospital from the ER in July 2007, but definitely not normal.

But apparently I was the only one concerned about that because not long after I noticed, I was discharged, without even being asked to walk around the ER to see what happened to my heart rate and pulse ox then.

So, I bet you're wondering what's next. Good question!

My internist is seeking pre-authorization from my insurance company to run a stress test on me. Because of my bum knee (which I'm still limping on) and my fatigue and other issues, she wants to do a chemical stress test instead of the more typical variety.

And I am already scheduled for an endoscopy for Dec. 22 to do biopsies for celiac disease as well as for any new ulcer developments. The ER doc thought it would be good for checking out my esophagus as well, and I know my gastroenterologist looks there on his way up and down.

Meanwhile, I'm feeling incredibly lousy, worse than when I went to the ER last night. But I think I'm happy I didn't get admitted since it seems like my hospital experiences are all pretty negative in that I come home in worse shape than I started.

But I'm grateful that they didn't find any blood clots and that I didn't have a heart attack.


Sherril said...

I'm having awful tooth and jaw pain today, so in addition to being not glad that you are having to go through all this, now I have one more thing to worry about. But I'm pretty sure my probs are from TMJD and the fact that I wore out my night guard a couple of months ago...

drewandkatie said...

Not really sure how I stumbled upon your blog, but wondering if any of your many doctors or your own research has brought you to look at Postural Orthostatic Tachycardia Syndrome (or a related disorder) as a potential part of your troubles. I was just recently diagnosed and understand that you're probably tired of people throwing ideas your way, but also may want something to help. So, hope this is in the helpful category. If it is here are a couple links you can check out if you haven't already. Hope you find a diagnosis soon!
Katie also

Aviva said...

Aw, Sherril! I definitely hope it's not your problem. For me, if it had been molars that hurt to start, I would have assumed it was from grinding my teeth. But my initial pain was between my bottom front teeth, and that was just bizarre all around.

Hope you're feeling better.

Aviva said...

Hi Katie,

However you found me, I appreciate you reading and commenting! I don't think what I have is POTS or related because my tachycardia happens while lying down. It does get worse when I stand or move or even just sit up, but it's been high while lying down since I got sick too. :(

I'm printing out some pages from the sites you referred me to, though, and I'm going to bring them to my doc to ask, just in case. Can I ask what kind of doc it was who diagnosed you finally?

Thanks!! And I never get tired of people throwing ideas my way, and even my internist likes it when I bring suggestions to consider for her to check out.

drewandkatie said...

Your internist sounds like a good doctor--always helpful to have a listening physician. Technically, a neurologist diagnosed me first after a 'tilt-table test', but i didn't respond to the typical drug protocol for POTS so it was another year before my internist came back to the diagnosis. So, both get credit [the internist slightly more]. Oh, and the internist finally diagnosed me officially in his office just by checking my heart rate lying down, sitting up, and then standing (after five minutes), if it's over 120 and 30bpm more than when lying down that is the very basic definition of POTS and the cheapest medical test you'll ever have to have. :)
If you're taking things to your doctor here is one more from my list of bookmarks. The third paragraph, second to last sentence is one to pay attention. Hope something good comes soon! Patience and peace to you and your family. -Katie

Aviva said...

Hi Katie,

Wow -- I know I shouldn't try to self diagnose because I don't have a medical degree, but this article actually makes it sound like a possibility. Thanks for the additional resources, and I will definitely let you know after I talk to my doctor about it.

I have to say that the photo of the upright tilt table testing looks really uncomfortable!!