WARNING- this is a long one…..
Ok, confession time. Last Friday morning during Louie’s dobutamine stress echocardiogram (medication-induced stress test), they found an obstruction in his heart. It appears in the lower left ventricle and decreases his blood output significantly under stress, but they couldn’t get a clear view of the ventricle in question. Final results of the stress test were “apical myocardial ischemia”.
In speaking with Dr. Issa, the nephrologist (kidney doctor), this is normal in someone who has been on dialysis, as is the calcification they found in his heart, but he now needs to be reviewed by a cardiologist (heart doctor) to be cleared for transplant just to be sure. This only really affects the very tip of his heart (apical) and shouldn’t be anything to worry about, especially since he has no symptoms, even when working out. Dr. Issa scheduled the appointment with the cardiologist for today at 10:30 am and we didn’t want to worry anyone until we had some answers to give. He also ordered an abdominal CT with contrast to get a look at Louie’s kidneys, which we did at 7 am today.
During the abdominal CT, the radiologist got an unintentional view of the bottom of Louie’s lungs with contrast. They had done a chest CT without contrast on Monday and everything looked fine, but the contrast is what made the difference. She diagnosed him with “bilateral pulmonary embolism”, or blood clots in both lungs, and we were referred immediately to the emergency department for further testing and treatment. Admitting him to the hospital for a few days was discussed, pending the results of his further testing.
A chest CT with more contrast was performed and concluded there are moderate embolisms in both lungs, but again, he has no symptoms of any problems, even when working out. So after many hours spent in the ER, and a myriad of tests performed, he was released to come home with a new prescription of blood thinners that should dissolve the clots within 30 days. We were assured by Dr. Hunter, the ER doc, that this is common in dialysis patients and catching it now means the transplant team will take precautions so Louie will be safer after transplant when people are more prone to clotting issues.
We obviously missed the appointment with the cardiologist, so that was rescheduled for Wednesday at 3:30….. AFTER the review committee meets. Provided everything checks out with his heart and lungs now, he will be submitted to the review committee on August 20 at the earliest. He has to take 3 days off exercising to adjust to the blood thinners and we’ll have to be careful that he doesn’t fall or hit his head or have any of the long list of symptoms they gave us to watch for in case his blood gets too thin.
On a positive note- all his blood work looks beautiful, and he passed most of his tests exceedingly well. Everyone seems very optimistic and encouraging that neither of these issues will be more than little bumps in the road to transplant. They are delays, but minor ones. And it’s much better to have found them now the way we did than to have found out the much harder way on either of them.
Keep praying, and we’ll keep working on getting him stronger and healthier than before. Every day is a little better, a little closer to that finish line, even if they did move it backwards a couple times. Please don’t worry, but pray that the blood clots dissolve and the cardiologist clears him for transplant without further intervention. I’ll update again when we have more information, but we wanted to spare you all the ups and downs and stress we've experienced this week.