Wednesday, July 18, 2018

Five Years, Ten Doctors, Countless Appointments and Tests: The Diagnosis Is POTS

My middle daughter, Lexi has gotten migraines for as long as I can remember. I think they started back when she was in 6th or 7th grade. They've gotten progressively worse over the years in frequency, duration, and intensity. As a sophomore, she missed so much school that I finally withdrew her so she could finish out the year by taking online virtual classes. It's heart-breaking seeing someone you love suffer especially when there's nothing you can do to help her. Sure, I've taken her to a plethora of doctors. She's had a barrage of tests. We've tried several different medications to both help prevent and to treat her headaches. But it's not only the headaches that have plagued her.

As a freshman in high school, she passed out during PE a few times. After the 3rd time, I made an appointment for her with the pediatrician to make sure there wasn't anything serious wrong and it was just the exercise in the intense Florida heat that had caused the fainting. The pediatrician sent us to a cardiologist to rule out any dangerous heart conditions that might have lead to the syncope. After an EKG and an echocardiogram, the doctor determined that nothing was wrong with Lexi's heart and the fainting was likely due to overheating and dehydration. Her recommendation was for Lexi to drink 2 liters of water a day, and to increase her salt intake by drinking Gatorade and snacking on salty foods like pretzels in order to increase her blood volume and therefore help prevent more episodes of fainting.

Because of the migraines, Lexi was seeing a neurologist who ordered an EEG and an MRI of Lexi's brain to make sure nothing scary was causing the headaches. The EEG was normal, and the MRI was basically normal other than a finding of an enlarged pineal gland. The neurologist admitted she didn't really know what that meant, and referred us to an endocrinologist.

The endocrinologist basically looked at us like we were crazy for seeing her, and told us that an enlarged pineal gland didn't mean anything and they dealt with diabetes and actual problems, and we should just leave. Thanks to the neurologist for wasting our time and money there.

Meanwhile, Lexi was still having frequent migraines. On one (of many) trips to the ER for medication to help stop a migraine that had lasted for 3 days with no relief from any of the prescriptions she had on hand, the doctor commented that Lexi was markedly anemic. He suggested taking an iron supplement and consulting with a hematologist right away. We did. After considerable bloodwork, the hematologist diagnosed her with iron deficiency anemia likely due to her heavy and frequent periods, and referred her to a pediatric gynecologist.

The gynecologist suggested getting an IUD placed to help with the anemia. The doctor also theorized that this treatment could help decrease the frequency of Lexi's migraines. So Lexi agreed, despite how uncomfortable she was with the whole idea. Honestly, at this point I think she would've smeared peanut butter on her head and danced with snakes around a fire if there was even the slightest chance it would make her feel better.

As all of this is going on, Lexi started dealing with depression. I suppose it's hard to stay positive when you lose 2-3 days a week because you can't get up and function. It's pretty easy to get down when you deal with a chronic condition that makes you feel like garbage more often than not. So we added a psychiatrist and some antidepressant medication to the mix.

one of Lexi's SFX creations
My daughter who had a bunch of friends, enjoyed going out and doing things, and was a cheerleader, had a hard time getting out of bed and functioning some days. Cheer made her dizzy and gave her headaches. She missed practice and games. She missed school. She missed life. She was in a kind of pain you can't see. That's when she really started practicing her SFX makeup. Instead of cutting herself to somehow show the pain she was feeling, she turned to makeup as an outlet, creating gruesome and painful-looking designs. Plus, she was able to utilize her artistic talent in an activity she could do while sitting or lying on her floor; one that didn't make her heart pound or her head spin.

The neurologist Lexi was seeing for her migraines had come up with a concoction of meds that had significantly cut down on the frequency and duration of the headaches. Lexi still got them, but instead of weekly, they were now maybe twice a month. Having a debilitating headache for 2-3 days twice a month still stinks, but it's better than losing 3 days every week to headache pain.

Then one day, the summer before her junior year, Lexi and I were running errands. She saw a Big Red Bus and asked to stop so she could donate blood for the first time. When the technician assessed her, Lexi's heart rate was over 100 (you must have a heart rate under 100 in order to donate) so she was deferred. Lexi tried to donate blood two more times over the following months and both times she was deferred because her heart rate was too high. The last time, the technician informed her that her heart rate was 154. "A young, fit girl like you shouldn't have a heart rate of 154. No one should have a resting heart rate of 154. You really need to get that checked out."

So we went back to the cardiologist we'd seen a couple years prior. She did another EKG and then the doctor had the nurse take a set of blood pressure and heart rate readings while Lexi was lying down, sitting up, and finally standing. Her heart rate went from 80 to 144 when she stood up. Upon those findings, the doctor ordered another echocardiogram which didn't show any abnormalities. She also equipped Lexi with a Holter monitor which Lexi wore for 24 hours to monitor her heart rate.

A few days later, the doctor called us and seemed surprised at the Holtor monitor's results. There were some curious findings that prompted her to refer us to an electrophysiologist. So we met with an electrophysiologist who explained his suspicion that Lexi had an arrhythmia based on the Holter monitor findings. He proclaimed that she would probably require an ablation to fix it, but in the meantime, he put her on beta blockers to help with her tachycardia.

The beta blockers instantly gave her a migraine which continued nonstop for several days until we ended back in the ER (after a year with no ER trips for headaches) to get some relief. We met with the neurologist who confirmed our suspicions that the beta blockers could worsen migraines so I stopped giving them to her. The electrophysiologist argued that beta blockers helped migraines, and we were wrong. Let's see here. Lexi hasn't had to go to the ER in a year. The day she starts a new medication, she develops a migraine that doesn't gone away in a week despite all the recovery meds she's taken. Yep, clearly I'm wrong. I mean, what do I know, right? I'm not the one with the MD after my name.

The electrophysiologist ordered an exercise stress test with pulmonary function. It was normal. He had Lexi wear an event heart monitor for 30 days, and it recorded over 150 incidences where her heart rate went abnormally high. The electrophysiologist who originally talked about an ablation because he thought Lexi had an arrhythmia changed his mind and said she doesn't have an arrhythmia after all. He insisted her heart was fine and suggested her high heart rate was all in her head. 

"But I thought the monitor picked up a bunch of abnormal heartbeats," I asked, confused.
"Yes, but it's probably anxiety causing it."
"Nope. She doesn't have anxiety."
"She should just exercise more. She's out of shape."
"Nope. She's thin, fit, healthy, and  she's been in sports her whole life."
"Her heart itself is fine. You should take her to a psychiatrist."

Her legs turn a mottled purple when she stands up. Her heart races. she has palpitations and chest pain. She gets dizzy and sometimes passes out. She has chronic headaches. She missed 41 days of school this year. FORTY-ONE days. That's 8 weeks. A quarter of the school year. Yep, all in her head.

Even though I knew it wasn't "all in her head," there was a little part of me that began to doubt. Could it just be anxiety? She never sleeps well at night. Could it be anxiety causing all of this? She doesn't seem like an anxious person.

After another trip to the ER because Lexi's heart rate shot up to  213 while roller skating, we got a referral to another cardiologist; this time one at Nemours. We met with him, went through her medical history once more.  I ended with this: :We have seen a pediatrician, a cardiologist, a neurologist, a psychiatrist, a hematologist, an endocrinologist, a gynecologist, and an electrophysiologist. It has now been several years of searching for an answer and some relief. And her diagnosis currently stands as - it's probably in her head.

This new cardiologist answered, "It's not in her head. There is no it's in her head here. We'll figure it out."

He did a tilt table test (they monitored Lexi's heart rate and blood pressure and how it changed when she was maneuvered from lying down to an almost completely upright position.) Based on this one, noninvasive, simple test, he was able to give her a diagnosis - POTS (Postural Orthostatic Tachycardia Syndrome.)

Finally, there's a definitive answer! An answer that should not have taken years to obtain! This is why you shouldn't automatically take someone's word, even if that someone has a medical degree. No doctor knows your kid as well as you do. If you feel that something is wrong, keep searching until you find someone who will listen and do what it takes to get an answer.

Now that we have a diagnosis, we can move on to searching for a cause or underlying problems, and treating her symptoms.

Friday, July 6, 2018

My Colectomy - Day Two

I had my partial colectomy yesterday. The nurse in pre-op was very nice. She got me all set up for surgery - pretty gown and matching blue hat, hospital socks, IV, a bunch of medicine. When the anesthesiologist came in, I pleaded with him, "Anesthesia makes me violently ill. Pleeeeeease do whatever you can so I don't get sick. Please. I'll name my first-born kid . . ., oh wait, I'm done having kids. I'll name my first cat after you. I have lofty plans of becoming a cat lady, and if you keep me from throwing up, I'll name my first cat after you."

I knew I was rambling like a crazy person, but I really wanted to impress upon him how scared I was of getting sick from the anesthesia. He promised to load me up with anti-nausea drugs before and during surgery. I got a patch behind my ear and another pill under my tongue before I even went in. Still, I gave him a dubious look and told him I didn't believe him, and I thought I'd still get sick no matter what he said. Then he gave me what he called my "morning cocktail" in my IV. He said it was to relax me, but I'm pretty sure it was to get me to shut up about cats and vomit. I don't remember anything after that. I don't remember being in recovery either, but apparently I was there for an hour. I was groggy all day and didn't really wake up until last night.

But praise the Lord, I did not get sick at all! Now I need to get a cat and name him Vikram.

My surgery took more than 3 hours and I had a breathing tube down my throat the whole time so now I sound like an 80 year old chain smoker. The surgery went well and I have 5 incisions. (The video was right - they went up through my butt to staple the two ends of my intestines together!) My doctor removed about a foot of diseased colon. He said there was a hole in it which confirmed his presumption that it had perforated during my last bout of diverticulitis, and my body had contained it. I'm glad I had this done because it probably would have resulted in an emergency situation when I had my next flare-up.

They injected this numbing  medicine called Exparel all over my abdomen. It's supposed to last for three days so right now I'm getting by on muscle relaxers, nerve blockers and IV Tylenol, which is fantastic because I hate the way narcotics make me feel. Plus narcotics cause constipation which I imagine is less than pleasant when you just had surgery on your bowel. I was told the effects of this numbing agent will start wearing off this evening (and they are) so I may need something stronger for pain tomorrow.

My catheter was taken out this morning so I can pee like a normal person now. I was also given clear liquids to try today. Unfortunately I started pooping blood so I'm back to nothing by mouth again, I'm off blood thinners, and I'm having extra bloodwork to make sure I'm not losing too much blood. Or at least I'm supposed to be having more bloodwork, however 3 different nurses have stuck me in 3 places and missed the veins each time. I'm currently waiting for nurse #4 to come give it a try.

But, on the bright side, I have a lovely view outside. I alternate between the picturesque landscape and The Food Network on TV which is really kind masochistic since I can't eat.

Oh and I have learned that coughing HURTS!

Wednesday, July 4, 2018

My Fun-Filled Colectomy

In 2010 I developed abdominal pain and discovered I had diverticulitis. You can read all about that fun-filled ER trip where I had a pelvic exam. By a 20 year old male doctor. In a curtained room in the ER. When I had my period. Yeah, I know, but what can I say? Not everyone is as lucky as me.

Fast-forward to 2018. I've had multiple diverticulitis attacks. I'm tired of being hospitalized at inconvenient times. Or you know, any time. The bout I had last month was especially severe, almost necessitating emergency surgery, so after consulting with two surgeons, I decided it was time for surgery to eliminate the problem before it became a life-threatening emergency.

Here's a quick run-down if you aren't familiar with it. Diverticulosis or diverticular disease is when little bulging pouches form in your colon (large intestine.) According to research, about half of all people over the age of 60 have it and for most, it causes no problems. For some people, however, these pouches can become infected (diverticulitis.) Diverticulitis can usually be cleared up with a clear liquid diet and antibiotics. Sometimes, the infection causes perforation of the colon or other complications that necessitate emergency surgery.

So, to that end, I head to the hospital tomorrow for a laparoscopic bowel resection. I'm super-looking forward to it, and I'll tell you why.

1.  The colonoscopy-like prep involved. Today, the 4th of July will not include a BBQ for me. I'll be partaking of delicious foods like broth and jello instead. There won't be fireworks for me tonight, but never you worry. I will have my own explosives. Out of my butt. Locked in my bathroom all evening. You can read those enchanting details here. Into the Tunnel of Darkness: My Colonoscopy

2.  The weight loss. Not eating for a few days and consuming only clear liquids for a few others should garner me a loss of a couple pounds. It's probably unrealistic to hope that my sigmoid colon weighs 30 pounds, huh? But any loss is a loss, amiright?

3.  No cancer. When I wake up from the anesthesia, I don't have to worry if the doctor was able to get all the cancer like so many people who have this surgery for colon cancer. This is why it's so important to get regular colonoscopy screenings. Just do it!

4.  Being lazy. I can lie in my hospital bed (which is as comfy as a slab of cement or a bed of nails) all day watching SpongeBob without feeling guilty.

5.  The surgery itself. Because I am completely stupid was curious, I watched six one videos of the surgical procedure on YouTube. I understand that they'll make 4 or so incisions to do the laparoscopic surgery. I'm down with that. Once the diseased portion of bowel is removed, they have to attach the two ends of healthy colon together some way. I get that. What I did not know until I was enlightened by this video is that they attach the two ends together by going through your butt. Just another added layer of fun!

6.  The possibility of a poop bag. Although, because this is a scheduled surgery and not an emergency one, the doctor doesn't anticipate me needing a colostomy, he did caution me it was a possibility. Sure, life will go on if I have to empty my bowels into a bag instead of the toilet. This little gem will just be one more reason for single men to line up around the corner for the chance to date me.

7.  The tubes. I was told I'd have a catheter in my bladder that would stay there for a day after surgery. I was also told I'd have a tube down my nose into my stomach that would be removed after surgery, but is oftentimes reinserted because of vomiting. And let's not forgot the IV for fluids and medicine. I'm thinking with all these strings attached, I can pretend to be a marionette. That'll be fun.

7.  The possibility of clots. Because I have a clotting disorder and a history of blood clots in my leg and lung, I'm at greater risk for this complication after surgery. But, I do get to wear super-sexy compression devices that will squeeze my legs as I lie there watching cartoons and reruns of The Office.

8.  The vacation. No kids to care for. No dinners to make. No errands to run. No groceries to buy. No bathrooms to clean. I mean, why do you think I had 6 kids? For the mini hospital vacations, of course! 

9.  The visit with my parents. Little do they know this surgery is just a ploy to get them to come visit us!

10.  Vomiting of epic proportions. Anesthesia makes me sick. Let me clarify. Anesthesia makes me so violently ill that I retch from the tips of my toes. You guys know how I feel about throwing up. I mean, I'm sure no one really LIKES to vomit, but I absolutely detest it! I pray fervently whenever I get that stomachache that tells me its contents are about to be evacuated. "Please God, I beg of you, keep me from throwing up! Pleeeeeaaaaassssseeee! I'll do anything! I'll move to Africa and be a missionary. I'll give up chocolate, wine, and guacamole forever! I'll stop yelling at idiot drivers! Just say the word, God!'

Now imagine doing it while you're completely groggy and in pain from abdominal surgery. Of course I'll talk to the anesthesiologist before the surgery. But I know what's going to happen. He'll promise to give me top-of-the-line, heavy-duty, anti-nausea drugs. He'll swear I won't get sick this time. He'll assure me he'll take care of me so I don't get violently ill. In other words, he'll lie. And after my surgery, when I'm forcefully expelling my intestines into the ridiculously small barf tray they give you, he'll ask if he can include me in his article about weird anesthesia reactions.

So there you have it. Honestly, for a good week I was waking up every night, my heart racing with anxiety about the whole thing. But I've been praying and I feel peaceful about it now. There's no reason to worry because God is with me. :)

Still, if you're the praying sort, say a prayer that I don't throw up. I don't care about pain or needing a colostomy. I just don't want to vomit!

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