Author Topic: Trip to the ER (long post)  (Read 776 times)

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Offline daniel1948

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Trip to the ER (long post)
« on: December 15, 2016, 10:25:24 AM »
Yesterday morning I suddenly started feeling very confused. I walked a NetFlix disc out to the mailbox to return, and I fond myself thinking, "Is this really what I'm supposed to do with it?" Back in the house, things didn't seem right. I tried reading and couldn't concentrate. My pulse went way up and I was shaking uncontrollably. The pulse and shaking were probably a panic reaction to the confusion. I tried lying down but was frightened of what was happening. Maybe 20 minutes after first noticing a problem I called 911. I was lucid enough to unlock the front door and gather my things for a trip to the ER. I got dressed, got my keys and my phone and my iPad and my Kindle, knowing I'd likely have a lot of time sitting there waiting. I even had the presence of mind to get my insurance card, ID, and some money.

A fire truck and ambulance came. I had told the 911 operator that my problem was mental confusion, but I guess the first responders always travel by fire truck. They did an EKG, but I was shaking so badly by then that they couldn't get a clear reading. I was able to answer some questions coherently, but could not answer others at all. After some thinking, I managed to name Obama as the President, but could not name my doctor or the president-elect. I could not remember whether it was 2006 or 2016, and had to do the math in my head to figure out that I am 68 years old, not 66. The guy apparently in charge of the responders recommended I go to the ER but would not make a recommendation as to whether I should take the ambulance or an Uber, though he did say that some Uber or taxi drivers won't take you to the ER for fear of liability. I ended up taking the ambulance. I was having a hard time thinking clearly, but was able to answer some questions, though not others.

At the ER I apparently bypassed the usual check-in. I don't know if that's because I arrived by ambulance, or because the responders had phoned in my symptoms and they considered them too serious to delay. They got me into bed and put in an IV and drew blood, and after a short wait they did an MRI, which came back normal, as did the blood work. The diagnosis was acute transient confusion. They told me it could have been something in my brain that left no residual effect (I don't remember if they used the word stroke), or any of a hundred different things. They arranged for me to see my regular doctor today (no waiting for an appointment) and they'll probably do an echo of my heart and put me on a heart monitor for a week, just to make sure it's not my heart.

By the time they got me to the MRI I was feeling normal again. The shaking had stopped and I no longer felt confused. Writing this has got me shaking again, but no confusion. I guess telling the story is getting to me. So I'll stop here.
Daniel
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Re: Trip to the ER (long post)
« Reply #1 on: December 15, 2016, 10:49:17 AM »
Oh honey, how very frightening.  Did you get some good sleep?  Let us know how today's doctor visit goes.
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Re: Trip to the ER (long post)
« Reply #2 on: December 15, 2016, 11:18:00 AM »
That's scary. Did they mention TIA as a possibility? I understand that some blood clots can cause temporary oxygen deprivation in the brain without causing permanent damage.  With your history of arrhythmia, I'm guessing they're going to put you on anticoagulants if you're not on them already.
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Re: Trip to the ER (long post)
« Reply #3 on: December 15, 2016, 12:18:32 PM »
Wow, scary!  Was your blood glucose low?  That sounds a lot like what happens when my glucose goes really low, and would explain why there's no lasting effects from it.

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Re: Trip to the ER (long post)
« Reply #4 on: December 15, 2016, 01:13:35 PM »
The body is fucking crazy and if anyone really knew how much was going wrong at any given time they would never want to leave the house.

Glad you were able to get help!

Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #5 on: December 15, 2016, 01:29:18 PM »
Oh honey, how very frightening.  Did you get some good sleep?  Let us know how today's doctor visit goes.

Actually, I slept very well last night. The symptoms were all gone, and because of going to the ER without having eaten breakfast, and being there until mid-afternoon, I ate much less than normal. I always sleep better when I eat less.

They called a little bit ago to put my doctor visit back from 12:30 to 4:00, but I'll post how it goes tomorrow if I don't get around to it this evening. But it's going to be some tests, and probably no results right away.

That's scary. Did they mention TIA as a possibility? I understand that some blood clots can cause temporary oxygen deprivation in the brain without causing permanent damage.  With your history of arrhythmia, I'm guessing they're going to put you on anticoagulants if you're not on them already.

I think they might have mentioned TIA, but what I remember is her telling me that it's possible I had a minor event that left no trace. I don't remember the actual term used. What she did say is that it's possible it was any of a hundred things. A stroke or TIA is not the only possible cause of acute transient confusion.

She also said they might put me on anticoagulants or other drugs, but those have side-effects, so there's a good chance they won't. In any case, the ER did not see fit to give me any prescriptions, which I'm happy with. I'll take drugs if they tell me to, but if my doctor gives me a choice, I'll opt for no drugs.

I've printed out all the EKGs I've taken since I bought the BodiMetric gadget, so if my arrhythmia is a problem they should be able to see. Basically, based on what my friend the cardiac rehabilitation nurse said, I don't think my a-fib is coming back, and the PACs are supposed to be of no concern. But I'm expecting them to put me on a King of Hearts monitor for a week.

Wow, scary!  Was your blood glucose low?  That sounds a lot like what happens when my glucose goes really low, and would explain why there's no lasting effects from it.

I've never had low blood sugar before, and I had not exercised yet when it happened, so it seems unlikely. The blood work came back normal, so I did not have low blood sugar at the time they drew the blood.

This morning a nurse called me from the ER for a follow-up, to make sure I'm feeling okay, which I am other than having a new thing to be hypochondriac about. She said this kind of thing can be a one-time thing that never repeats itself.

And this morning I did 30 minutes of cardio on the NordicTrack machine and felt pretty good. A few PACs, but that's normal for me. The arm didn't bother at all.

The day before yesterday I had a late lunch of Chinese take-out. Once upon a time I'd have blamed the MSG. I think Steve has said that MSG is not the evil that the woo crowd thinks. But perhaps the overdose of salt? I had sweet & sour prawns and veggie egg rolls, and ate way too much food. That was roughly 18 hours before my event happened. It will likely be a while before I eat Chinese food again. Irrational, but hey, you get a scare, you stay away from anything you did different in the preceding week.
Daniel
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #6 on: December 15, 2016, 01:30:48 PM »
The body is fucking crazy and if anyone really knew how much was going wrong at any given time they would never want to leave the house.

Either that, or get out right away and enjoy the five minutes you figure you've probably got left. ;D
Daniel
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Re: Trip to the ER (long post)
« Reply #7 on: December 15, 2016, 01:32:23 PM »
Dude, no shame in any of this.  I had my first real panic attack earlier this year.  Fucking crazy that shit is.  I can only imagine if my memory had been fucking up to.  I'd have gone to the ER too.
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #8 on: December 15, 2016, 03:30:21 PM »
Oh, I get panic attacks all the time. I just take an aspirin and lie down. This was different enough for me to call 911. I find the idea of a stroke much more frightening than a heart attack. A heart attack can kill you, but a stroke can change your entire personality. And the only two cases of people I knew, it turned them into very unpleasant people.
Daniel
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Re: Trip to the ER (long post)
« Reply #9 on: December 15, 2016, 03:50:48 PM »
Yeah scary!

I was going to guess stroke, but EMTs ought to be real good at recognizing that.
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #10 on: December 16, 2016, 09:15:41 AM »
Yeah scary!

I was going to guess stroke, but EMTs ought to be real good at recognizing that.

Apparently a TIA is a kind of micro-stroke.

My visit with my regular doctor went as expected: I described what happened. He explained some likely causes and recommended some tests. Since the tests involve the heart (checking for things that might have caused a mini-clot) we agreed that I'll phone my cardiologist this morning (it's still too early) and see if he can see me soon to order the tests. If he cannot get me in, my doctor will order the tests. These are: An echo of the heart, an echo of the carotid artery, and a King of Hearts monitor. (That's a portable EKG that records constantly, and when you press the button it remembers the last minute and the following minute, and then you can transmit the information over the phone.)

They think I had a TIA, but its cause could be any of many things. A micro-clot, a spasm of a blood vessel that momentarily cuts off blood flow, or who knows what. They'll be more concerned if it happens a second time. Sometimes it's a one-time thing and never repeats. I've been told not to worry, but of course I'm human. So now I have one more thing to be hypochondriac about. If you managed to convince me that a feeling of cold in the right pinkie toe was a symptom of heart attack, I guarantee that before very long I would have a feeling of cold in my right pinkie toe.

One way or another, I expect to get the tests next week and the results within a few days of that. Assuming I don't have a full-on stroke and die before then. Or a heart attack. Or get hit by a bus. Or shot by a lunatic. Or we all die from a gamma ray burst or a CME. Or kidnapped by Lithuanian volcano worshippers, taken to Hawai'i, and dropped from a helicopter into an open caldera of Kilauea. ...
Daniel
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Re: Trip to the ER (long post)
« Reply #11 on: December 17, 2016, 04:05:49 PM »
Yeah, a Transient Ischemic Attack is basically anything that temporarily stops or reduces blood flow to a portion of the brain without causing permanent damage.  As your doctor said, it can be caused by lots of things; the worry with your history is of course that it could be caused by clotting secondary to the arrhythmia.

(Note: I'm not a doctor, but I've got my own history of arrhythmia, which runs in my family, and my father, who was otherwise in great shape died suddenly of what was probably a stroke secondary to his intermittent atrial fibrillation.)
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #12 on: December 17, 2016, 06:15:06 PM »
I get premature atrial contractions. I get them often and frequently in series where every second or third or fourth beat is premature. Sometimes I get tachycardia lasting from a few seconds to ten minutes or so. But the a-fib stopped when I had an ablation nearly a decade ago. They're going to do some tests, including probably a King of Hearts monitor, to make sure the a-fib has not returned. But if it has, it never lasts very long. My understanding is that there is a risk of a clot forming when a-fib lasts for a couple of hours, due to blood pooling in the atria.

A separate concern is if a chunk breaks loose from the wall of a blood vessel, but that's not related to the arrhythmia. They're going to do an ultrasound of my carotid artery for that reason.

One problem is that they want me to call 911 and go right to the hospital if I have another episode of confusion, but as a hypochondriac I have episodes frequently where I think something is wrong. I've learned to ignore them, rather than going to the ER ten to fifteen times a year (or much more often if I went in for every bout of tachycardia). But yesterday when I had a brief bout of tachycardia that lasted for a minute or so, I had to think hard to decide, "Am I lucid, or is this a TIA that calls for a trip to the ER?" I decided that I was just scared, but still lucid, and the episode passed. The tachycardia is very scary when it happens, but I don't want to be that guy who goes into the ER twice a month.
Daniel
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #13 on: December 28, 2016, 05:11:15 PM »
The echo of the carotid arteries came back normal, as did the echocardiogram. I'm wearing the Holter monitor now, which arrived by UPS a little while ago. I was expecting a King of Hearts monitor, which only remembers the last minute or two until you press the button, then stores the past minute or two and the next minute. Then you phone them and it transmits the signal as audio over the phone.

Instead they sent a Holter monitor, which remembers everything, 24 hours a day, and has its own cell phone to upload the data periodically. If you press the button it sets a bookmark for them to look at that part of the trace. The Holter monitor I wore a decade ago was big. This one is tiny, with a separate cell phone unit.

I didn't think to ask how long they want me to keep it.
Daniel
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Offline Desert Fox

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Re: Trip to the ER (long post)
« Reply #14 on: December 28, 2016, 05:17:11 PM »
My roommate knee is hurting really bad but has no medical (not working)
Barely able to walk. I have been trying to tell him that he should go to the ER anyway.
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