Hello, all!
In the last few weeks, I’ve seen both of my transplant pulmonologists at UPMC and Cleveland Clinic. I was somewhat alarmed to be informed at a routine visit that I’d become the subject of their Sunday night conversation, two medical directors of transplant pulmonology commiserating about a mutual patient. Both physicians were concerned about a recent near-fainting episode I had that resulted in an overnight hospitalization. The surrounding circumstances, fatigue, slight dehydration, and a recent medication change, were certainly sufficient to account for the event. On the other hand, nothing like this ever happened before. The doctors assumed this was a symptom of worsening underlying disease but wanted more data. Their plan was a right heart catheterization, the gold standard for diagnosis and evaluation of pulmonary hypertension (RHC). This test evaluates the health of the heart muscle and valves, and measures pressures within the heart and lungs. First, a physician inserts an introducer sheath, similar to the elongated part of an IV that stays inside the vein. Then, a pulmonary artery catheter passes from the internal jugular in the neck to the superior vena cava to the right atrium and right ventricle of the heart to the pulmonary artery, measuring pressures and blood flow as it progresses from one chamber to the next. Typically the test is performed while the patient lies supine on an operating table, relaxed but motionless. However a simulation of the exertional dyspnea (shortness of breath with activity) that I experience when mobile can document more accurately how much resistance the heart is working against when pumping blood to the lungs. To assess the effects of physical activity on pulmonary hypertension, the patient additionally pedals a cycle ergometer while a physician continues to take measurements.
In the last few weeks, I’ve seen both of my transplant pulmonologists at UPMC and Cleveland Clinic. I was somewhat alarmed to be informed at a routine visit that I’d become the subject of their Sunday night conversation, two medical directors of transplant pulmonology commiserating about a mutual patient. Both physicians were concerned about a recent near-fainting episode I had that resulted in an overnight hospitalization. The surrounding circumstances, fatigue, slight dehydration, and a recent medication change, were certainly sufficient to account for the event. On the other hand, nothing like this ever happened before. The doctors assumed this was a symptom of worsening underlying disease but wanted more data. Their plan was a right heart catheterization, the gold standard for diagnosis and evaluation of pulmonary hypertension (RHC). This test evaluates the health of the heart muscle and valves, and measures pressures within the heart and lungs. First, a physician inserts an introducer sheath, similar to the elongated part of an IV that stays inside the vein. Then, a pulmonary artery catheter passes from the internal jugular in the neck to the superior vena cava to the right atrium and right ventricle of the heart to the pulmonary artery, measuring pressures and blood flow as it progresses from one chamber to the next. Typically the test is performed while the patient lies supine on an operating table, relaxed but motionless. However a simulation of the exertional dyspnea (shortness of breath with activity) that I experience when mobile can document more accurately how much resistance the heart is working against when pumping blood to the lungs. To assess the effects of physical activity on pulmonary hypertension, the patient additionally pedals a cycle ergometer while a physician continues to take measurements.
In preparation for the catheterization, I juggled three sets of pre-procedure bloodwork orders, two on paper and
one sent electronically. When I left the lab last Tuesday, I assumed all appropriate tests were drawn. Unfortunately, the cardiac nurse practitioner found no record
that clotting studies were drawn, so I needed a second set to be redrawn on the
day of my RHC. After following instructions to fast from all food and liquids
after midnight, I didn’t have much to offer in the way of veins or blood. The
first vein, one in the bend of my left arm, looked promising initially but the
IV wouldn’t thread. The second one vanished as soon as the needle went in and
never reappeared. For the third attempt, I made an executive decision to direct
the medical assistant to utilize the basilic vein on the back of my forearm;
it’s in an odd position but a really easy IV insertion.
In the cardiac catheterization lab, despite initial palpitations
(PVCs) from the curve of the catheter, the first part of the procedure was
straightforward, all pressures and volumes measured and recorded. Then, the
pulmonary vascular nurse scooted me down the procedure table to strap my feet
into the cycle ergomer pedals. The timer started, accompanied by a beep to keep
my cycling rate at sixty rotations per minute. The cycle resistance gradually
intensified to a maximum of 3.2 mets after almost eight minutes. Huffing and
puffing with pulse flying, I was relieved to slump against the table while my
heart slowly, slowly quieted to one hundred beats per minute, just above my
typical heart rate.
Ironically, the testing results will have little impact on my
daily life. My doctors will tweak a few medications. I’ll start seeing the
doctor who did the catheterization for closer pulmonary hypertension monitoring.
The results will be entered into the algorithm that calculates my lung
allocation score, and my LAS might even rise a few points. But overall things
will stay about the same, and I’m content with that. So much has changed in the
last half year: the friends I grab for a spontaneous pedicure, the doctors who manage
my health most closely, my go-to hot chocolate and tea shops, the distance I
can walk in six minutes, the place I call home. The rhythm of daily life has
changed as well, now structured by Tuesday/Thursday pulmonary rehab and once
weekly mentoring. Most of these changes have been beneficial, contributing
greatly to my happiness in Pittsburgh, but all change, even good change, can be
stressful. I’m gratefully relieved to recognize my treasured constants: my
community of family and friends, and my faith. Most days, my body repeatedly
lets me down, failing to deliver enough oxygen or energy to accomplish all the
tasks I’ve proposed, and progressively destroying my remaining healthy lung
tissue. Yet aside from that immense, inescapably disruptive change, most everything
else remains reassuringly monotonous. The IV that took three attempts to place never got used after a ten cc flush. The range of motion of my neck is back to normal. I finally replaced my “flesh tone” 4”x3” bandage with a Doc McStuffins band-aid. My weekly routine can continue with
minimal interruption. After facing down all the other changes, I’m grateful for every serenely uneventful day that brings me closer to my transplant.
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| In the recovery room with Peter post-procedure |
