Fun and Games with the Emergency Room

So, last Friday (a week ago today) I sat around from around 11 am on toying with the idea of calling 911. I was having what I guess is best identified as shortness of breath. I could breathe fairly deeply and rapidly, but still did not feel like I was getting enough to breathe. If that isn't "shortness of breath", then call it what you want; but, that's what I had. Also, it felt like someone had a wide belt around me just at the end of my breastbone and was gently pulling backward. This was not the classic elephant on the chest syndrome, just a minor discomfort. Finally, I had an ache, quite akin to and later attributed by my doctor as being due to a pulled muscle, from under my left ear down the carotid/jugular region to the clavicle, across the clavicle to the ac joint (achromioclavicular, if you wish) and down the front and middle of the bicep to my elbow. Not a shooting, yes mildly warm and somewhat characterizable as burning, mostly an aching. Periodically from 11 on I felt a bit woozy, and I don't think my brain was clicking on all cylinders through there.

So, when Peg called at 5:30 to see if she needed to stop at the store I told her no, but I'm about to call 911 unless you think you want to take me.

On the way out to Methodist West, she asked why I had not called 911 or her earlier. Here my sarcastic, skeptical, cynical (true?) nature came out. Quote: "Every time I go with symptoms like this, they put me in the little room, give me an IV, give me nitroglycerin, do some tests, tell me they don't know what's going on and send me home. I thought I'd skip the middle man this time and stay home."

Then, too, in 2001 I went in, they even did an angiogram, told me they couldn't find anything wrong. They did not, in retrospect, do an ultrasound of my gall bladder, like the one they did only 2 weeks later in Orlando where I ended up in the hospital for 8 days and never saw Disneyworld. So, skepticism and cynicism? Yeah, maybe¿

So we got out to Methodist West, they did an EKG, blood tests including cardiac enzymes, hung an IV, had me chew baby aspirin (still as  yucky as they were when I was a kid), and put a nitroglycerin under my tongue. Then they asked if the nitro helped, and I was foolish enough to respond "maybe", so they wrote in my chart that nitroglycerin had made a big difference in relieving pain. Since, at the time, I had not been in pain and had noticed little if any effect, I find that a remarkable comment. The cardiac enzymes said none of the muscles had been beaten up yet. But, there was this thing called a d-dimer. I always thought that would be somebody who saved 10-cent coins made at the Denver mint. Lo and behold, we significantly increased the sum total of man's knowledge with a quick trip to Wikipedia:

• "D-dimer is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrinogen protein. D-dimer concentration may be determined by a blood test to help diagnose thrombosis. Since its introduction in the 1990s, it has become an important test performed in patients suspected of thrombotic disorders. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis but does not rule out other potential causes."

 So, I had a positive d-dimer, and they did a spiral cat scan to check for a pulmonary embolism or thrombosis, aka a blood clot in the lungs, like Captain Phil on "Deadliest Catch".

Nope. Couldn't see anything.

But, they decided I should be their guest for the evening, ran me upstairs, wired me up and then did another round of blood tests at midnight, just after I was asleep (of course). I fooled them in the morning though - I was already awake when they came in to poke me at 6.

My doctor was actually the duty doc for Iowa Clinic, so she came in, and we agreed that after they finished negative enzymes I should go home, since cardio don't work weekends unless it's like an emergency bypass or whatever, and get set for a stress and an echo outpatient. But, then slightly after noon I turned white as a sheet, apparently, and my telemetry showed junctional rhythm phasing in and out of sinus bradycardia (look em up if you want to) and a low pulse rate and blood pressure. Great. What-e'ver. The nurse didn't want to send me home; Dr. Taylor told her send me home anyway. I came home.

So this time it was more than 4 hours, the hospital food was pretty much OK but nothing to write home about, and I knew very little if anything more about my health after than I did before.

They said cardio would call on Monday. I'm still waiting. I have felt poopy about half the time this week. Who knows what's going on? We'll see next time.