What a scare

Image courtesy of emaxhealth.com

I visited Dr. Rody Sy, my cardiologist, last week. He told me to see him 3 weeks after my angioplasty. I’m happy to say that he gave me a clean bill of health from the cardiac standpoint. My next follow up with him is 6-8 weeks. He said if all goes well, he can give me clearance for the KT(kidney transplant). I just need to continue the meds he prescribed so as to make sure the stents in place will not get occluded. As I mentioned, I am on blood thinners, clopidogrel and Aspilet EC. And due to this, we cannot have the KT this early. Again, if all goes well, maybe July. Dr. Sy is such a kind-hearted man. I really appreciate everything that he has done and is doing for me. I wish I can repay his generosity one way or another. Even when I saw him last week, he looked under his desk to give me physician’s sample meds.

Since it could be possible that the KT will be in 3 months, I have to start with the work-ups again. About a month ago, I underwent an abdominal ultrasound and one of the results gave me some cause for concern. It said: Prostrate is enlarged with concretions. This was quite alarming, and I dilly-dallied on having it checked fearing the worse. Usually, men my age start to have enlarged prostrates and some develop cancer. To think that my mom passed on with cancer not 8 months ago. But, what the heck, I’m gonna do it anyway, so why not right now? So I went to NKTI and got inside the door of the first urologist’s clinic I found. 

I showed him my results. After telling me his interpretation of the same, he told me there will be 2 tests that I have to undergo. The first one was done right there at the clinic. He told me to drop my pants, and then gloved his hand. Oh my, a DRE! For those who do not now what DRE is, it’s the acronym for Digital-Rectal Exam. And I’m sure you now know what happened next. 

The other test is the PSA(Prostrate-Specific Antigen) Test. The test measures the blood level of PSA, a protein that is produced by the prostrate gland. The higher one’s PSA level, the more likely he has prostrate cancer. The urologist told me that if the result is normal PSA, then he can give clearance for the KT. So off to the laboratory I go. 

Yesterday before my dialysis session, I went to claim the result. And for a while, I was stunned. The paper I was holding said that the reference range for normal PSA is < 2 ng/mL, and my PSA level was at 2.440 ng/mL. Not knowing what it meant, I just sat there for a few minutes trying to decide how to feel. I texted Ninette(my wife) to ask her to go online to see what it meant. I couldn’t help but think that I, most probably, have prostrate cancer too... That I was not only on the big D but also have the big C. I became panicky and irritable waiting for Ninette’s reply. I also asked her, being a mathematician, if the symbol “ < “ is really the “less than” symbol. I couldn’t think straight. 

Then she replied: “...most doctors consider PSA levels less than 4.0 as normal.”

Whew! What a scare. During my dialysis session, the nephro fellow came and I showed her the result. She said, yes it is slightly elevated but she believes there’s nothing to worry about. It was only then that I started to relax. And after a few minutes, Dr. Celestial(my nephrologist) also came to see me. And I showed him the result as well. He believes my PSA is within normal levels for my age. He even said that the DRE right before blood extraction might have contributed in elevating my PSA. Whew again!

I went online to do some reading when I got home last night. And this table from zerocancer.org is one of the things I found.

Any day this coming week, I’m gonna see that urologist again and get that clearance. Well, I hope he does clear me. Hmmm, I don’t even remember his name. But I will never forget what he did to me.

     

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Angioplasty

Have you ever stayed immobile for 24 hours? That's what I just went through. Just laid in bed, not allowed any movement for that period of time. Well, I was allowed to move 1 leg and my arms but that's it. I'm telling you... it's such a pain in the behind! I'm at the Cardinal Santos Medical Center again. This time for an angioplasty. 

I was told to be at the Cardiac Catheterization Lab at 6:00am yesterday. To save on cost, my doctor suggested that we do the procedure as an out-patient, then just get admitted after the procedure. That was just one of Dr. Rody Sy's and Dr. Harim Santos' ideas to help help me get the necessary treatment for my heart. The other was that he negotiated with the stent company to give a buy-one-take-one discount for the 2 stents that were used for the procedure. I am so thankful to Dr. Sy and Dr. Santos and the cath lab team for really taking care of me.

As I understood, 2 stents were placed; 1 in a major artery and in 1 one of it's branches. I did not feel a thing. They gave me a Valium and a Benadryl and I slept through the whole thing. Next thing I knew, the doctor was waking me to say that everything went well. Everything went smoothly and took just about an hour. Next, I was sent to hemodialysis to filter the dye that was used just as how they did it last week after the angiogram. The dye increases creatinine levels especially for ESRD patients. Hemodialysis was for 3 hours instead of 4 and no heparin was used since I was already given blood thinners so as not to clot during stenting.

After dialysis, I was wheeled back to the cath lab, again as a cost saving measure. I needed close monitoring so instead of sending me to ICU or to a room with a special nurse, the doctors just had me stay in the cath lab recovery area where I was well cared for by Dr. Santos and nurses Jay and Nanah. A big and tight dressing was placed upon the catheter insertion site in my groin area. But only after about 20 minutes of continuous manual hand pressure by Dr. Santos. The dressing was really tight. Then again, a 5-pound sandbag was placed on top of the dressing to increase the pressure. That went on for 8 grueling hours. I was not allowed to move my right leg.

They finally took away the sandbag at 9 o'clock last night. But still, I wasn't allowed to move. Only when they took away the cardiac monitor this morning, was I allowed some movement in the right leg. That's why I am able to sit up and type this. And you know, move other things as well ;)

Dr. Sy came to see me just now. I'm good to go home. Next step is to wait a couple of months, then see if we can do the transplant already. I am really thankful for persons like Dr. Sy and Dr. Santos. They really went out of their way to help me out. To all my friends, colleagues, relatives who sent their support and prayers. To Xavier School, Fr. Johnny, Fr. Ari and Fred.

This is just one one hurdle. We'll get there.

Setback

Image courtesy of harrisonmedical.org

They woke me at 4 o’clock this morning. A nursing aide with a razor and a towel. So I lay there exposed while she shaved away. She took them all off. This was part of the preparation for my procedure today. They also started an IV line and extracted some blood as well as a finger prick to check my blood sugar. I’m at Cardinal Santos Medical Center where I had an angiogram. A diagnostic procedure to identify obstructions in the arteries of the heart. My cardiologist’s original plan was to do a stenting/angioplasty if they found occlusions. Stenting is an intervention where a splint is placed inside a blood vessel to relieve an obstruction. But since I wasn’t financially ready(see last post) for the cost of an angioplasty, the procedure today was purely diagnostic.

They gave me a Valium at 6:00am just a few moments before they wheeled me out to the cath lab. Upon reaching the procedure room, more preparations were done. I am not sure what they are since the Valium started to take its effect. I remember joking around with Robynne(my niece & today’s hospital companion), telling her I was high. The doctors came and told me that they are hoping the ischemia seen in my recent nuclear profusion imaging stress test was a false positive. 

It was a short procedure. Maybe about half an hour. I was asleep and awake at the same time. I could hear their voices. They did confirm an occlusion, possibly two. They told me that I needed to be brought to hemodialysis. This is due to the dye that was introduced to my bloodstream increased my creatinine levels and needed to be flushed out. So I was brought to the ICU recovery room with a dialysis machine. They packed my groin/femoral area(where the catheter was inserted) with pressure dressing. It was so tightly packed. Like a hand was continuously pressed on the area to stop the bleeding. On top of that, a heavy sandbag was placed on top of the dressing to add pressure. It was so heavy. I felt that my thigh was pinned under a very heavy object. What’s worse, I was given strict instructions not to move that leg... FOR 6 TO 8 HOURS! More than all the preparations, more than all the needle insertions, more than the procedure itself, the 6-hour stay in the recovery room was hell. That sandbag weighed like a log.

The doctors were very kind. I have told them before hand that I could not afford an angioplasty at this point. They told me they would help find alternatives. Maybe arrange the procedure to be done at the Philippine General Hospital(PGH) where it is cheaper. Dr. Rody Sy, my cardiologist, said he will try to seek help from some sources. Dr. Choa(interventional cardiologist) said he was going to talk to the stent supplier to give a discounted price. God bless these compassionate souls. They said that I needed the angioplasty before they could give me clearance for a kidney transplant. 

If the angioplasty will be done, this will set back the schedule for the transplant. Maybe even up to 6 months. After stenting, I would be given blood thinners to make sure that the blockage will not recur in the same area. They will not be able to perform the transplant on someone who is on blood thinners. The transplant will have to wait. That is how it is. We try to do the best we can. But we shall never know what is to come. So one step at a time. Maybe this is a blessing in disguise. Of course I have asked the question, countless times, why me? Why this? Then this again? Countless times. But that is how it is. 

Still ‘round the corner, there may wait, a new door or secret gate. -J.R.R. Tolkien

Cardiac Stress Test: Nuclear Myocardial Perfusion Imaging

Dr. Rody Sy is one of the top cardiologists in the country. When I called his secretary requesting for an appointment not more than 2 weeks ago, I was informed that due to the huge number of patients under the doctor’s care, he does not accept new patients anymore. I was insistent and tried to convince her. After all, our late grandma was Rody Sy’s patient for several years. Also, i dropped the name of the company/organization where I work for just for good measure. Luckily, I got a call back from the secretary. I was ordered to submit my latest labs as well as undergo a 2-Dimensional Echocardiogram(2D Echo) with Doppler. The procedure uses ultrasound to picture out the heart. It provides a cross sectional image of the beating heart including its chambers, valves and blood vessels. Doppler assesses blood flow in and out of the heart.

I went to my appointment at the Cardinal Santos Medical Center(CSMC) with results in hand. Also, Electrocardiogram(ECG) was performed in his clinic. As his initial findings, Dr. Sy told me that it appears that I, for my age, still had a strong heart. He asked me what physical/athletic activities I engaged in before because he guessed that I did. It’s just that my pulse rate was a little bit on the high side. So he ordered another procedure and to see him in 2 weeks or when I have the new results in hand. he was so nice he even gave me discount cards and several free samples of my maintenance medication.

2 days ago, I underwent the Myocardial Perfusion Imaging with Technetium-99m Sestamibi at the National Kidney and Transplant Institute. NKTI Diagnostic Center is the newest building the the sprawling compound with modern equipment and facilities. The courteous and efficient staff made this long and difficult procedure seem pleasant. 2 days before the test, I was given a list of instructions that included a 4-hour fast before my scheduled procedure. The instructions also indicated that any and all medication that pertains to cardiac function be on hold for 24 hours before the procedure as well, and to be in comfortable clothing especially rubber shoes as the test involves running on a treadmill. There is a choice of which agent to use, either Thallium or Sestamibi. Dr. Sy did not specify. He wrote Thallium ‘or’ Sestamibi in his order. I was told Thallium is the ideal one since the image during the scan is easier to produce and you spend less time in the ‘bed’, and because of the shorter period, is actually cheaper. But the hospital’s Thallium supply was delayed overseas as this is imported from some other country. Therefore I was left with the other alternative, Sestamibi. I was told that I needed to set aside half a day to complete the test. It was really expensive too. They asked me to bring water and soda crackers. Which is the only food I can take after the exercise phase of the test.

Upon arriving, I was interviewed by a medical intern. It was a 4-page questionnaire covering family history of illnesses to present pain felt and current medication. They then asked me to change into a hospital gown. I was in shorts and running shoes. I should’ve asked someone to take my picture. I guess I looked ridiculous. Then an intravenous line was started by the technologist. This will be where the agent will be introduced before I lie down on the scanner. After half an hour, I was called into a room where the imaging equipment was located. It consisted of a flat, narrow bed and sort of a hollow sphere similar to the picture above. I was told to lie down with arms raised overhead and told not to move for 20 minutes.The bed started moving and in a few seconds the bed was halfway inside the spherical machine. A moving object came whirring very close to my chest. Moving laterally as if taking pictures from all angles.

It was so uncomfortable that I couldn’t hold my arms in that position any longer and they began to stray from its original position. I tried adjusting my arms back slowly thinking that it might not affect the scanning. After that episode, I was told to wait for about half an hour. Water was allowed and they encouraged walking around the corridors. I did that, unmindful of the stares I got because of my ridiculous outfit. Then it was time to repeat the scan. The technologist said that because of the small movement of my arms, the scanner failed to get a clear, isolated image. So into the tube I went again. Another uncomfortable 20 minutes. It helped that the staff, doctors and technologists were positive and encouraging. An hour’s wait  and more walking up and down the corridors, and I was called to the treadmill room. 

A harness of electrodes similar to an ECG was hooked up and we started to see the blipping image of my heart rate on the monitor. Baseline blood pressure(BP) was taken and it was at 140/80. Baseline resting heart rate was around 70 beats per minute(BPM). We waited a while for the cardiology fellow to arrive before the treadmill started to turn. I was told to take long steps. It really wasn’t running but more of a brisk walk. Also I was told that the target heart rate to reach is 145 BPM. After a few minutes in a comfortable pace, I heard a beep to indicate that it was time to take my BP. Same at 140/80. Then the treadmill shifted gears to a faster pace as well as raising the incline. The beep came, 90 BPM and 150/80. After each minute the angle and speed of the treadmill changed into a more challenging pace. When I reached the target 145 BPM, they gave me a choice to stop or to continue on. I opted to continue since the discomfort I felt was minimal. When I finally quit, I think it was 153 BPM, BP 190/100. The staff were all praises and told me that I have tolerated and finished the exercise phase well. After a minute or 2, BP was back to 140/80.

Now that surprised me because about 10 years ago, i did not finish a similar stress test. Utilizing the Bruce Protocol(the gradual increasing of pace and incline on a treadmill) then, my heart rate was still moderate but my BP was already high. I did not get to finish that test and I did not undergo that again until now.

After the ‘run’ I was told I can already eat my soda crackers and drink water. An hour of waiting and it was time to take the scan again. So back to the disagreeable position for another 20 minutes. Then again for the last time. Results will be released between 3 - 5 days. Hopefully, they are positive. But that little sequence of brisk walking made me realize how I miss regular physical activity. Again hopefully, I can get back to it.