This saga is still playing itself out so check back for updates.
Last updated: Sep. 28 - Karen filled in some additional details and made numerous corrections.
I now understand why they say they 'practice' medicine.
Karen brought Heather to Medemerge for some burns she received at work the night before. They had blistered quite badly and we wanted to make sure they were treated properly. While there, Karen had them look at her fingernail which she had detached while doing some yard work over the weekend. Before examining her they took her vitals and found her blood pressure was high. They gave her an EKG which showed non-specific abnormalities. He gave her a prescription for something to control the high blood pressure (Norvasc). She started taking the medicine that night.
Karen experienced about 10 minutes of minor chest, upper back, and stomach pain around 10:30 in the morning.
Karen again experienced about 10 minutes of minor chest, upper back, and stomach pain around 10:30 in the morning.
Karen's chest pains started again between 10 and 10:30 but continued to get progressively worse. The pains were also felt in her abdomen and back. She was driven to Medemerge where they took another EKG which showed 'non-specific changes' from the previous one. My guess is 'non-specific changes' means a change that doesn't fit the pattern for any known heart problem. This change worried them, however, so they administered two nitro-glycerin tablets, did blood work for cardio enzymes, and sent her to the emergency room by ambulance with paramedics. On the trip to the emergency room, two more nitro glycerin tablets were administered and a nitro patch was applied. She went to Robert Wood Johnson University Hospital since it is closer to our home than Somerset Medical Center which was their preference since that's where they all hold admitting privileges and where the cardiologist they wanted her to see was.
Karen was at RWJUH from about 2:30pm until after 1:00am. During this time she had blood tests, a continuous heart monitor, two chest X-rays to look for heart damage, an ultrasound and CT scan to look for gall stones or kidney stones. All tests came back negative so they blamed her pains on musculo-skeletel issues and prescribed some pain killers (Percoset and Ibuprofen).
Karen was feeling pretty good today. Medemerge wanted to see her for a follow up so I took her in. The doctor prescribed a different high blood pressure medication (Toprol). She started on the new medicine that night. We went out to dinner after leaving the doctor and she felt fine.
Karen had bad pain in the morning again. Karen was brought to Medemerge in the afternoon. Another EKG was run. The results looked better than the previous one. The doctor told her that the second blood pressure medication could cause chest pain as a side effect but he didn't tell her this beforehand hoping to avoid psychological effects. He also prescribed Nexium in case her pain was from reflux and recommended taking Maalox or Mylanta before bed.
Karen was scheduled for a stress test at Medicor Cardiology Group. She experienced the pain while on the treadmill and the doctor did not like what he saw on the monitor. They also did an echo cardiogram. Again it sounds like what he saw did not fit any known pattern but he didn't like what he saw and wanted her admitted to Somerset Medical Center for an angiogram. She was admitted that afternoon. Since it was near dinner time, they got her a meal tray.
Karen had her angiogram in the morning. She came through it well. The doctor said her arteries were clear so his theory of a partial blockage or a clot intermittently shutting off an artery was shot. During the procedure they applied a nitro patch.
I believe it was around this time that someone mentioned that she had an elevated count for some enzyme related to the liver. This might indicate a gall bladder problem. I have no idea why this wasn't detected at Medemerge or RWJUH. She was supposed to have an ultrasound to take a closer look at her gall bladder later in the afternoon.
About 12:00 she was complaining of pain in her right abdomen which the doctors thought was some internal bleeding from the angiogram. Sometimes the artery leaks where they insert the catheter and the only place for the blood to go is into the abdomen where it interferes with the operation of the intestines causing pain. She was scheduled for a CT scan to confirm this. She was given dilaudin for the pain. This caused her heart rate to fall to 20 (the hospital considers this flatline) and her blood pressure dropped dramatically. Another injection was administered to counteract the pain killer. They were moments away from hooking her up to an external pacemaker to keep her heart going. From this time on, she was given morphine for the pain.
For some reason, it took three hours to get any progress on the CT scan. She was given barium to drink for the test at 3:30. A second bottle arrived at 4:15. She didn't actually get the CT scan until nearly 6:00. Just before going in, she was given two large glasses of water to drink. Due to the pain, having to drink the water so quickly, and a slight bit of nausea, she ended up vomiting as they were setting her up for the scan. As a result of this, she started feeling better. She had been very miserable all day up to that point.
Due to the ingestion of barium which would affect her digestive tract, the ultrasound was scheduled for Friday morning so she had to stay another day. She couldn't eat anything all day due to a requirement for the ultrasound test. The doctors are ruling out heart problems and blaming her gall bladder.
The ultrasound was put off again. A nuclear test was scheduled. This involves injecting some radioactive substance into her and taking some X-rays. Just before the X-rays are taken, another substance is injected that should cause the gall bladder to work as during digestion. She was warned that this second injection might cause abdominal cramping or pain but she didn't experience this. Later in the afternoon, she finally got her ultrasound.
At this point, the doctors said she couldn't leave because her hemoglobin tests showed a decreasing blood count. They attributed this to the internal bleeding. At this point, we persuaded Karen's nurse to talk to the doctor about getting her some food. She hadn't taken anything by mouth except the barium and small amounts of water to swallow pills since that meal tray Wednesday night when she was admitted. The doctors are still blaming her gall bladder which they want to take out. She is too tender to do it now so they want her back in two to three weeks. They will remove it, keep her overnight, and send her home the next day if there are no complications.
Karen's blood counts were down again. We were told that if they were down again tomorrow they would send her for another CT scan to check on the bleeding. Otherwise, Karen got through the day with only some discomfort in her right abdomen.
Karen's blood counts were down again. They didn't do the CT scan since she was feeling well and thought that was a sign of recovery. They seem to be playing it day by day. If her counts go down to some level or if she starts to feel worse I guess they'll do the CT scan. Otherwise, we just wait for the counts to go up at which time she can go home. She has lost nearly a unit of blood just to blood tests so that can't be helping either.
I called Karen in the morning and she said her blood counts have gone up so she can go home this afternoon. They still want to do one more ultrasound.
Earlier I described the nuclear test that sometimes caused abdominal cramps. The doctors are now telling her that the fact that she didn't experience those pains pretty much indicates that her gall bladder is working properly. They are now blaming the high blood pressure medication for her initial chest pains. Day 10 and they're still guessing.
Later in the afternoon, Karen called home to say that they might want to keep her overnight again. A vascular ultrasound was done that can view veins and arteries. This revealed a minor leakage around the site of the angiogram.
Late in the day they ran one more hemoglobin test. Although her blood count was still low, it was improving and Karen was able to convince them to release her. We left the hospital at 8pm.
They thought she might have cardiac problems but her heart has now been declared to be in good health. They have gone from being ready to take out her gall bladder to declaring it normal. They are now falling back on the 'simple' explanation: it's a reaction to the new medication she was put on. To get to this point she has had a chest X-ray, two CT scans, a test involving injected radioactive material, an angiogram, a pain killer that nearly killed her, and has had nearly a unit of blood drawn. Our guess when all this started was that she was having a bad reaction to the high blood pressure medicine but an accelerated program of testing was started without testing the simple things. She could have just come off the medicine for a couple of days to see if the pains would go away.
According to www.drugs.com, chest pain appears to be a known side effect of Norvasc and Toprol. They should also not be taken by patients that have liver disease.