Day 14 – Constant Improvement – Wednesday, April 19

Today has been a very good day for Sue. I didn’t get to stop by until after work, so I was only there a couple of hours, but Cyndie and Wade spent the night and half of the day, and Kim arrived early in the morning and was there for most of the day. When I arrived, Sue had just returned from a PT “field trip” where she was moved to a chair (with her helping as much as possible by balancing and using her good arm and leg to assist) and then pushed all around the floor’s hallways for a little change of scenery! After that, we watched OT come in and work with her on hand and arm movements, and the therapist instructed us on how to work with her to get the biggest benefit possible.

Aside from that, I will leave it to Sue’s daughters to tell the tales of the day (and previous night).

Cyndie’s Post:

The cardiologist came by last night around. He looked over mom’s file for quite some time and showed me a couple of her EKG’s to help me understand what her heart is currently doing. And then he explained fully with his drawing which made it much easier to process. He said it’s a little bit of who came first – the chicken or the egg – someone who has afib can have a stroke…..or someone who had a stroke can go into afib. In her case, he believes her afib caused a stroke and that she actually did not have afib longer than six months. She most likely had it only a couple of months. He said the reason he thinks it was this short is because by looking at her charts, she was going in and out of afib even while she was here the first couple of days. This means her heart was in transition of permanently going into afib these last couple of months. If all of her EKGs had shown afib that meant she would’ve likely had this for a much longer time- at least a year, possibly longer, and she probably never felt it. He had us feel her pulse on her wrist and asked, “You can feel it, can’t you? It’s completely irregular.” And I could. He said that every morning and throughout the day we should check her pulse to really connect to what he heart is doing. It’s the simplest way, especially when we leave the hospital and we won’t have monitors to rely on. The comforting thing he said is now that she is on Eloquis she will never have another clot again for the rest of her life. So what’s left to treat is this afib. That’s when he did this drawing to explain.

The right and left atriums should be of equal size. Mom’s left atrium is twice the size as her right. The sinus node, located in the right atrium, is the end all be all of the heart and is about the size of a pencil eraser. It is its conductor, the general…the thing that tells the heart what to do. In her case all of those little x’s in her left atrium decided to take over and told her heart to ignore the sinus node. Those little x’s have caused her heart to beat 400 bpm which is more like a quiver. The dot in the center, the AV node, sensed this quiver and put the brakes on the 400bmp from getting down to her right and left ventricles which is essentially saving her. Her right and left ventricles are reading at 120-130 bmp which still puts her in afib (she’s been in the 90s with her meds) but if the AV node hadn’t sensed this then she would’ve gone into cardiac arrest because her entire heart would’ve been at 400 bpm. When she had her stroke, the quivering of her muscle pooled blood into her left ventricle. When her heart had a stronger beat it pumped the clot out and into her brain stem.

I asked if the treatment for her is a pacemaker. He said no. Pacemakers are for hearts that completely stop. The next step is to “shock her heart”. It sounds way scarier than it actually is. It’s a mostly non invasive procedure and she will be sedated for it (this unfortunately is the bit that was fuzzy for me and I can’t remember the details of the procedure). In fact, I can’t believe I even remember this much considering I didn’t write anything down. Shocking the heart will reset the heart rate and then from there we have to see if it will maintain at the heart rate we want to see. Her peg tube was turned off at midnight with the hopes that she would get the procedure this morning but they couldn’t fit her in. Her feeding has been resumed until midnight tonight so that she can have the procedure tomorrow.

Kim’s Post:

Tomorrow she’s getting two things done. The first is a “TEE” – Transesophageal echocardiogram. This is a non-invasive procedure that will give the doctor the clearest picture of her heart and how it’s functioning. It will provide more conclusive info than what you can get from an EKG. It uses sound waves to get a picture of the heart and arteries. This is the test that they will use to see if any other clots exist.

The other is a “cardioversion”. This is the one where they “shock” the heart to try and establish a normal rhythm.

As Cyndie said, they will turn off her feeding at midnight since they plan to get her tested in the morning. We won’t be surprised if she ends up having a sleepy day. She will be sedated for the TEE and it’s common to be tired after this kind of procedure or anytime you’ve been sedated.

Speech therapist K came in today. She said that this is the best that she has seen mom. Although still not cleared for anything other than the water sponge, her movements are getting better. They are only slight improvements, but I’ll take it. I mentioned to Therapist K that it looks like she has less droop on the one side of her face and she agreed that she sees that too. Mom is starting to use both sides of her mouth and is starting to move her tongue around more which is great. We are still to practice vowel sounds and counting. Getting her to smile and exaggerate the vowel sounds will help strengthen the nerves and muscles in her face – hopefully eventually that will assist with a more symmetrical look and function (my thought – not the therapist’s).

The attending doctor seems to think that it’ll be Monday/Tuesday before she’s sent to rehab. If Health South admits patients over the weekend, I honestly would not be surprised if it was earlier.

Now that Sue is allowing select visitors, her friends B and R came in for a short visit and it was good. Pastor K and Pastor C also came in for a visit.

One other thing. Kim actually recorded Sue moving her arm. The movements are slight and small, but they are movements and far beyond where she was a week ago. We consider this another victory and another step in the right direction!  Watch the video by clicking here!

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