Doesn't PVC Have Something to Do With Plumbing?

The last few days have been... well... surreal. I guess that's about the best way to describe it. At the least, the events of the past couple of days have given me a change to reflect on some simple truths, some things that need to be a bit more prioritized, some things political, and some things just down right frightening.

It started on Tuesday. Just another ordinary Tuesday. I was sitting at my desk when the belly pain started. I've had this pain before: imagine a labor contraction, only high on your abdomen, right below the rib cage. But instead of the cramp going away it gets tighter and tighter and tighter. The tighter it gets, the shorter and shallower the breaths come. The more the shoulders start hunching forward and the legs drawing in, causing pain across the shoulder blades and tension in the quads. I tried to ignore it. My boss asks if I'm alright. Apparently I've turned three shades of white. Of course I'm alright. This has happened before and it always resolves itself within about 10 minutes. But this isn't ending. Finally, the nausea begins that I know will end the pain. My stomach heaves, and the pain vanishes. Just as quickly as it began it was gone. I told my boss, "I told you so." And resumed my work.

About 15 minutes later it began again. Never has it happened twice in a single day - not even in a single week. And so I headed off to Immediate Care to find out what was going on. I'd been told previously that it could be gallstones and that if it became a recurrent issue I could have an ultrasound to determine if more intervention might be needed, so I naively thought this was probably the issue. Of course by the time I saw the doctor (about 20 minutes after the 2nd onset) the pain was completely gone again. The doctor reviewed my records, asked me to describe the pain in more detail and to be more specific about the location. Nothing was fitting a case of problematic gallstones. A deeper probe into medical history and the GERD that was diagnosed years ago was discussed. Immediately the doc felt this was the cause of the pain. Huh? I haven't been having heartburn. I haven't been having any signs of the GERD. How is this pain related? Apparently you don't have to have heartburn with GERD. Good to know I guess. So let's draw some lab work, make sure there's nothing going on there. We'll schedule an ultrasound for later to rule out the gallbladder. Take some acid pump inhibitors and follow up with primary care physician. By the way, is there any family history of heart attack or coronary artery disease? Ummmm yeah! The adult men in my family have all had heart attacks by age 50. My father much earlier than that. No, the women in my family have never had heart trouble. Yeah, sure. OK, I'll consent to an EKG just to make sure that pain isn't heart related.

"I don't think this machine is working right. The tech is actually here now working on the other one so let me see what he has to say."

Two nurses later. A doctor recheck. A 2nd doctor opinion. A change in the EKG machine. And the next thing I know I'm being told that we're going to play it safe and give me a ride to the Emergency Room because I'm having an irregular heart beat. Ventricular Trigeminy. AKA Premature Ventricular Contraction (PVC). Am I sure I feel alright? Yes, I feel fine. Really. An 18 gauge IV is started in the left arm (ER protocol), baby aspirins are shoved in my mouth with instructions to chew (I never did ask about the aspartame issue related to so many chewables), a medical transport service is called and I'm hooked to oxygen and telemetry to wait for my ride. Holy cow, batman! Is this real?

I try getting ahold of my boss, but only get the voice mail - hmmm how do you leave the kind of message I would have to leave? Instead I tell him that they want to run some tests and I probably wouldn't be back to the office that day. I'll call later or have my friend call him if it starts to get too late. Of course, my friend doesn't know where I am. Why would I call anyone to say I'm going to the doctor for a belly ache? And when I did try to reach her, again all I got was voice mail. Nope. Not going to leave that kind of message. I managed to reach another friend from church - please make some calls. At a minimum I need a priesthood blessing and hopefully I need a ride home. And then off we go. Lights, sirens, horn blaring because apparently stupid idiots don't realize that you're supposed to yield the right of way to emergency vehicles.

The Emergency Room is a much calmer place. Other than an urgent need to draw blood for cardiac enzymes and the need for me to repeat the day about a million times, they pretty much leave me alone - still on telemetry of course. I'm x-rayed and taken to ultra sound. They confirm there are gallstones but no blockages or irritations noted, the liver enzymes are higher than normal but not alarmingly high, the cardiac enzymes are normal. No heart attack. Thank God! In the midst of all of this, the heartburn - you know the stuff I haven't been having for almost a year? - starts up with a vengeance. But that they treat with antacid and lidocaine. Nasty tasting stuff that lidocaine, but it worked well at calming down all things gastric. So what to do with me?

Both ER docs are inclined to admit me overnight and get a cardiologist to see me inpatient in the morning. But they have to defer to Family Medicine since I wouldn't be admitted to cardiac care with the symptoms - or lack thereof - I was having. I was fine. My heart just wasn't beating right, but it wasn't a life threatening rhythm either. The Family Med doc is nice enough - thorough but quick. Brisk almost fits her attitude. And it was about at this time that I wished I had not made that call. Because now my best friend was sitting at my bedside and basically taking charge of all things related to Stephanie. And I was in no mood to argue. I was also, however, in no mood to go home with a bunch of unknowns, knowing that the minute I left that hospital I was going to enter the never ending world of medical politics and bureaucratic nightmares.

So who is at home with you? No one. Is there anyone...? Oh I can stay with her, comes the volunteered offer. I really wanted to kick her. Not out of meanness but out of frustration. She meant well, she just wasn't thinking things through from my perspective. So the Family Med doc decides to send me home and says, we'll call you in the morning and get you back in here for a Cardiac Stress test tomorrow - just to make sure that the PVC's are benign.

So I wait for the phone call the next morning. It doesn't come and hence begins the game. I call. I get transferred here and there. I try to explain why I'm calling, my records are called up by multiple receptionists. No one seems to know anything or be willing to do anything but finally someone transferred me to Cardiac Prevention and I get ahold of the first helpful person of the day. She promises to call me back within 30 minutes after reviewing the records and making some inquiries. Surprise!! She actually does. The cardiologist who would be in charge of the procedure that was ordered reviewed the order and the notes and suggested that the wrong test was being ordered (nuclear stress test versus echocardio stress test) and that it was now in the hands of my primary care physician to review the cardiologist recommendation and then make a call to schedule one of the two stress tests. And hence the game begins again. After waiting an hour to hear from the primary care office, I call them - the day is ticking away after all and other than being stressed out from not knowing what is going on, I still feel fine and really should be at work if nothing is going to happen. The receptionist tells me that the earliest my doc can see me to follow up is later next week. Not acceptable, I say. And they manage to find me a spot in the schedule at the very end of the day on Friday of this week. So what about the stress test that the ER doc wanted done that day? Oh it's our practice not to schedule tests unless our doc has seen you first. What?? I'm livid at this point. It was YOUR DOC that saw me in the ER. The notes are all in my record of what has happened and what is recommended and you've had a cardiologist basically call and give you advice on what to schedule and now you're telling me that you won't schedule a test that a doc ordered because you have not seen me in your own office instead of the ER? They'll get back to me.

An hour later the nurse calls and says that they can't get me in for a stress test until the Friday after Thanksgiving. And so I tell her that they may as well go ahead and schedule it for mid-December when my boss returns from his trip instead. Don't you care about your health? Of course I care about my health. Why would I spend the day on the phone with you people trying to arrange things that were supposedly urgent enough to warrant a trip to the ER, an ambulance ride and supervision overnight in my own home? Why would I try to be getting you people to follow the orders that were written to get this test done right away? If it can wait a month then it can wait 6 weeks until it's convenient for me to not have to close the office. After all, apparently it's not an emergency, right? She'll call me back.

Another hour passes with no word. By now it's 3:30 and I know they're going to be leaving for the day soon, or at least rolling phones. I know I'm not getting the test that day. But is it going to happen this week? I really need to communicate something to my boss who is planning to leave town on Friday night unless something presents itself as emergent before then. So I call her back. They have a call into the cardiologist but the consensus is that I can wait until mid-December since there appears to be nothing available on any cardiac schedule for this week. She says to me, they should have just kept you overnight because that's the only way to get these tests that fast. No kidding?? Gee, I wonder why I didn't want to go home from the ER with my babysitter/friend.

Finally I get a call and am told to report to the cardiologist office on Friday morning - the same office and cardiologist who's nurse was so helpful earlier that morning and who said the wrong test was being ordered in his opinion. OK, got the time, got the place. Any special instructions? Bring all of your medications. I don't have any. Anything else? No, this is just a consult, you won't actually be having a procedure done that day unless the cardiologist feels it is absolutely necessary. Literally I'm ready to bang my head on the wall.

So now I have an appointment at the very beginning of the day and an appointment at the very end of the day and maybe something in between if the good doctor feels like going along with his colleagues' orders. In the meantime, I'm back to work and fully functional even if I am stressed out. But I've learned a few things:

1) It IS better to be safe than sorry. As much as I was embarrassed about putting people out and having to ride in an ambulance when I felt fine and as much as I was scared to death to think about the possibility of what that irregular rhythm could imply, I would much rather be embarrassed and scared than dead because I had ignored good common sense to check things out.

2) Women are a mystery to the medical profession as it relates to heart attack and heart disease. No one seems to know what to do with you if you have a problem that might be a problem or might not be a problem but since you're a woman and women are different than men we better be over cautious... except that once we've sent you home we're not so cautious anymore because obviously if you're breathing and vertical and pain free you must be healthy, right?? Tell that to the beat, beat, beat, pause... beat, beat, beat, pause... beat, beat, beat, pause... ok?

3) Good friends are hard to come by but sometimes friend pop out of places you didn't realize. And there's always someone willing to help you if you just ask. It might not be the first person asked, but someone will be there. Literally I had no less than 4 offers of rides home if I needed one and transportation for appointments if needed. Is there anything else I need? No... but thank you. I do feel loved.

4) Don't be afraid to stand up for yourself with medical providers. I could have and I should have expressed my fears and concerns to the Family Med doc. She may have decided to keep me even though my friend was willing to babysit me overnight knowing that I was ubber stressed about getting this testing out of the way before bossman departs. Or she may have sent me home anyway but with the reassurance that it needs to be followed up but it's ok if it takes awhile as long as I feel fine. I also learned that receptionists don't know squat when it comes to what the doc will and won't do. Get the news from the nurse, not the appointment scheduler.

5) Yeah, ok. I know. I've been tackling one health issue at a time - I quit smoking. I increased my physical activity. I dealt with the oral issues that prevented me from eating healthy fresh fruits and vegetables and from properly chewing food to provide proper nutrition in general. I'm learning to use these new teeth and still have a way to go but things are better. I've started drinking more water and can identify when I haven't had enough. I've started to cut the caffeine but is definitely still an issue. And while I finally managed to find out and deal with the underlying causes of my weight issue (yes, I know it's food, but why food???... ) and been able to maintain my weight instead of steadily increasing, it's definitely time to get more serious about losing instead of "not gaining". It would sure be nice to make sure my heart is sound enough to handle the physical activity it's going to require to take off the weight, right?

I called my ex. He doesn't know the cardiologist. He's filled in on the basics of what is going on - with very specific instructions to not tell the children anything. I hope he keeps his word on that. I'll have many more answers by the time I see them next and can fill them in IF anything needs to be said at all.

I called the sister who is listed as my "relative emergency contact" - although because of her distance from me she is the secondary contact only if my friend cannot be reached through her various numbers. I figure she needed to know what was happening in case anything were to happen. It's not going to, but I'm learning you just never know.

Of course I've talked to and updated anyone who was involved with making calls and arranging blessings, etc. I've also vented my frustrations about the medical profession and it's bureaucracy.

I've read just about everything I can get my hands on about the procedures being debated and about Ventricular Trigeminy. You'd be surprised how common and benign it can be.

And I've had a good long heart to heart with my boss. Assured him that I would be honest and tell him if there is any reason at all that he should probably not leave for this part of his winter hiatus. He trusts me. And I definitely will share with him anything that he wants to know after my appointments tomorrow so that he can change any travel plans that he wishes. His wife wouldn't be happy, but I'm not worried about her being happy. I do hope that he keeps his plans though. I believe in positive thinking so I'm just going to keep saying that things are fine until I'm presented with evidence to the contrary.

Prayers are welcome and encouraged. It's been a long week, and tomorrow is going to be a long day. But at least now I know that PVC isn't just for plumbing.