Monday, June 01, 2009

Justifiably worried...or just foolish?

Hi everyone:

Well, perhaps in my last post I was a little too cavalier about Patty's low blood pressure, and as a consequence left Patty open to the whims of the fates, furies, gremlins or any other forces that toy with the well-being of seemingly "recovered" heart failure patients. Or perhaps I'm just being a worrywort again, and crafting colossal molehills. But as I sit at my computer this morning, I'm fretting about Patty's health.

I'm always on the lookout for signs the sky is falling, and have worried too much about too little in these matters in the past. Yet this is the first time in years that real tendrils of worry are starting to creep in. We've promised to keep everyone in the loop, so welcome to my tendrils. Patty, thus far, is not as worried as I am, so please don't read too much into my take on all of this.

For several days running now, our patient has been under the weather--functioning, but with few reserves of energy. To a certain extent, this was to be expected. As mentioned in my last post, she (and Levaquin) have been doing battle with a kidney infection and, although I've never had one, I've seen them enough and they don't appear to be a lot of fun. However, Patty responded quickly to the antibiotics and, based on what we've seen with her and previous infections, she's showing none of those symptoms anymore. Here's where my worry comes in.

For the past week or so, Patty has been showing symptoms of heart failure--symptoms that we hadn't noticed in a very long time. She has been breathless, especially after climbing stairs. When she lies flat, she starts to cough. Whereas for several weeks she was feeling energetic, she's now sometimes so fatigued after minimal efforts that she needs to sit down to recharge. She can grab a nap in the afternoon and then struggle to stay awake early in the evening. The muscles and joints through her shoulders, arms, back and feet ache regularly and, at times, intensely, even though she's done nothing to aggravate them.

She is sporadically nauseous. At times, her hands shake. Her blood pressure has dipped so low at times that she's dizzy even when sitting down, and she seldom rises from a chair without some concern about passing out. At one point yesterday, her blood pressure reading was in the 55/35 neighborhood, which is ridiculously low even for Patty. She spent most of the day and evening yesterday on the sofa. To be fair, she's not faring so poorly that I think she needs to be hospitalized, but she is certainly showing me enough that I'm watching her like a hawk.

The most unsettling "symptom" is one that I think only I see, and therefore could just be imagining. When Patty struggled with heart failure before, she bore what I call the "crazed rabbit" look--her eyes seemed less alive, her skin had an unnaturally pale tone and her mouth was positioned differently, with more of her upper teeth showing. I realize this all probably sounds stupid, but I don't think I've ever pointed out the look without Patty admitting she was feeling especially poorly at that moment. I hadn't seen the look in several years; I've seen it a handful of times over the past week.

At first, we thought that Patty's lifestyle changes might be the culprit; she's been cutting back on calories, and exercising often, so we thought she might be missing out on some vitamin or mineral, or that she was experiencing some symptoms of overtraining. We also considered the possibility that a long, busy school year, worries about Kathleen and the stresses of today's economy were taking a toll. However, over the past several days she's been eating more, taking a daily multivitamin and not exercising at all, and none of the symptoms have improved. And this has been a happy week for Patty, in part because P.J. just graduated from high school, so her current stresses are certainly not overwhelming. So we're perplexed.

Patty has an appointment with her heart failure specialist on Wednesday to try to find some answers--or, as Patty says, so they can "just fix it." In the meantime, her doc down-titrated some of her medicines that lower blood pressure (lisinopril and metoprolol), with little effect.

Our hope is that these recent symptoms are a temporary residual effect of either her back injury or the kidney infection, and that doctors will be able to prescribe something that will magically restore her to better health. I don't really think this is an unreasonable hope, given how long Patty has been faring well. I'll even happily pillory myself here for causing such a fuss over nothing, if it turns out I'm wrong. But until I see her better, it's in my nature to anticipate the worst.

Anyway, thanks for reading this. It keeps you in the loop and is good therapy for me. Keep your fingers crossed. I'll keep you posted.



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