Heartbeat

It started when I happen to look down and notice my left ankle was swollen. I hadn’t fallen or twisted it. There was no pain. I had range of motion. There was no redness or rash or heat. I showed my wife Maureen, a registered nurse, the next night. She asked if I could breathe okay and pee okay. Her feared it was a DVT, a deep vein thrombosis, a blood clot. She was anxious to have me seen. She knew I didn’t want to see my family doctor because his office was a longer drive away, and pushed me to see my rheumatologist who is closer. I knew this would mean getting sucked into a process of phone calls, seeing different doctors, and tests. I would become one of those old people whose life is regulated by appointments. I called my rheumatologist who treats me for arthritis. I was secretly hoping that was the cause of the swelling. But I knew I was looking for an easy explanation. The nurse practitioner said let’s try elevating the ankle and icing it for a couple of days and see what happens. The swelling did go down a little, but not completely. After a couple of days, I called her. She suggested I come in and get it checked, appointment number one.

I went in the next day. The nurse practitioner examined me and asked all the usual questions. She tried to draw fluid out with a needle. Nothing. She suggested I get an x-ray to check for arthritis and an ultra sound called a Doppler to check for a clot, appointment number two. I went to an out patient facility. First, a very friendly technician took me in for the ankle x-ray. They never tell you right away what it shows because a radiologist has to read it and then tell your doctor who then tells you. I returned to the waiting room. A second friendly technician came out and took me in for the ultra sound. The first sign that this test was a little more than I expected was when she told me to remove my pants while she left the room and get up on the table and cover myself with a blanket. When she returned, she first asked if I wanted the gel heated or room temperature. Heated gel just made me feel uncomfortable, as if I was looking forward to this. I opted for room temperature gel.

I then found out that she needed to gel me and run that ultra sound gizmo starting at the very top of my leg meaning my groin. She delicately tried to fold my boxers back so she could get the right starting point. No luck. Then she said what no man wants to here from a female technician. I’ll step out while you remove your underwear. I was really starting to regret this just wasn’t just a little arthritis. I did what I was told. Of course, you have to stay still while she’s doing this. I griped the side of the table to steady myself as she stared the long journey down my leg from an area that is one of our most sensitive. After just a few minutes, it was done. She handed me two towels to clean off the gel and left the room. I didn’t even know her last name.

It went back out to the waiting room to wait for the radiologist to read the test. Then for them to call the nurse practitioner and for her to notify me. They finally got the nurse practitioner on the phone and called me over to take the call. It was a different physician’s assistant who sounded very young. She said, “You have a blood clot and you need to go to the emergency room right away.” When someone says go to the emergency room right away, it tells you this is serious. When I asked what they would do for me when I got to the emergency room, she sounded unsure and said they would treat it. I was not very comforted.

I picked up Maureen and we went to the emergency room. They did a cursory check and took blood to run tests. They started me on blood thinner medication and a case manager called ahead to a pharmacy to make sure I could pick up a prescription. She told me the cost which was ridiculously expense but said she had a coupon to get the first three weeks free. They told me to make a follow up appointment with my family doctor, appointment number three.

I got to see the doctor right away. At first he said didn’t I fit the profile of someone who would have a blood clot. I wasn’t overweight. I didn’t have any other medical issues. I hadn’t just taken a long plane ride which can cause clots from inactivity. But when he put his stethoscope on my chest and listened to my heart, everything changed. He said with a slight bit of surprise, “You have an irregular heartbeat.” I thought “Wait, what”?He had his nurse come in and administer an EKG which confirmed an irregular heartbeat. The doctor said it could be atrial fibrillation. During a regular heartbeat the upper and lower chambers of the heart work together to pump blood to the rest of the body. A-fib occurs when the upper chambers of the heart beat irregularly, and all the blood is not pumped into the lower chamber. This causes the blood to pool and potentially form clots. Clots can break away and cause strokes or even death if they hit the lungs or brain.

It’s a strange feeling when something happens inside your body that you can’t feel or control, and we’re talking about the most important part of your body. It feels like a sneak attack that I didn’t realize was happening until my swollen ankle tipped me off. My family has a history of aortic aneurysms, a bulging of the the main artery to the heart that can burst and cause almost immediate death. I’ve been checked and fortunately  I don’t have it. I was the exception. Now, I have my own special heart issue. I have an appointment for a transthoracic echo test, appointment number four. Followed by an appointment with a cardiologist, appointment number five. I still have many questions about the secrets locked in my beating heart.