On Friday afternoon we received a call from a scheduler from The Mayo Clinic. It seems that our doctor would like Lee to repeat the exercise stress test. YAY! (There's no good way to express sarcasm so I'll just tell you ... that was sarcasm.) The commute, which was in the middle of rush hour, was amazingly smooth. We gave ourselves 90 minutes to travel and we reached our destination in just one hour! That was exciting. We have to take our excitement where we can find it!
9:00am -- Mayo Clinic Hospital -- CARDIOLOGY Exercise VO2 Max
The pre-appointment instructions say to arrive rested. OK. Done. When Lee got into the lab, taking his blood pressure is the first step. His initial reading: 84/59 The nurse/technician said she couldn't conduct the test with his bp that low (hmmmm Lee's been living with this bp for a long time) Lee told her to try the other arm but she still felt it was necessary to call for the doctor. Fortunately, our transplant doctor was right next door attending another procedure so he was able to come right in. Lee's bp was taken on the other arm with a reading of 94/70. With the doctor in attendance for the testing, Lee was able to hang in there for 10 minutes or so. This time, the treadmill was started a little slower and gradually increased.
Another test is now in the records. Lee was exhausted and we headed straight back home. He had a good nap but still felt the effects of the exertion for the rest of the evening.
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Anti-coagulation background: The VA is where Lee normally has all of his medical care, including the monthly monitoring of his INR, because he is on the anti-coagulant, warfarin (Coumadin.) The goal with warfarin therapy is to maintain a balance between preventing clots (Lee has A-fib & a mechanical aortic valve, both of which cause blood clots) and causing excessive bleeding. The INR is a lab test that measures the time it takes the blood to clot. A normal INR would be around 1.0 Lee's doctors like to see his INR between 2.5 and 3.5
When we got home from the exercise stress test, we got a call from the VA about the labs that were taken on Friday. Lee's INR was unusually high (for unknown reasons.) His reading was 4.1 and they were concerned. The instructions were to skip one dose and come back in for re-testing in 10 days.
Around 4:30pm, a Mayo Clinic nurse called. She was calling to confirm the heart cath procedure tomorrow and to review the protocol. She asked if Lee was taking his Warfarin. Well, of course he was. It seems that someone had forgotten to tell us that he should have stopped taking it for a couple of days prior to this procedure. Couple this fact with his high INR & we were thinking that the procedure would have to be postponed. I should insert here that twice before, Lee has had to postpone a surgery because his INR was too high (excessive bleeding during surgery is not a good thing.) The nurse told him to eat as much Vitamin K (a natural blood clotting agent) as he could tonight and they would check his INR in the morning. We enjoyed a couple of pounds of Vitamin K rich spinach for dinner, along with MANY cups of green tea.
Day Eight
7:30am -- Mayo Clinic Hospital -- Registration
We are both getting a little weary of the long commute in the dark.
7:45am -- Mayo Clinic Hospital -- LAB
Lee was not too convinced that his INR would be low enough for this procedure but away he went to have his blood drawn anyway.
9:00am -- Mayo Clinic Hospital -- Cardiology Cath Lab
As suspected, Lee's INR was high -- 4.2 Lee was pretty well convinced that they could not do the procedure. The doctor who was doing the procedure said, "I think we can still do this." I am SO glad I was not in the room when he said that .... you "THINK???" Oy! This test is essential for the determination of the health of the heart and therefore an essential part of the heart transplant evaluation. After some consideration and discussion, the procedure was performed without incident.
The transplant doctor wanted to see both the left and right sides (or INsides) of Lee's heart. The heart catheterization http://www.mayoclinic.com/health/cardiac-catheterization/MY00218/DSECTION=what-you-can-expect was done through 2 different entry points. The right of his heart side was accessed through an entry into the artery of his right wrist. The left side was done through an entry into the artery in the neck. Lee said the procedure was quite uncomfortable and one he hopes will not need to be repeated anytime soon (or ever.) Because of the danger of lack of clotting, he had to lay still for a number of hours after the procedure. He was sure glad to be done and on his way back home. As for me, I was a bit anxious because of the high INR but Lee behaved himself and didn't lift anything heavier than a fork for the rest of the night. There was no extra bleeding or problems. Praise the LORD!
I Peter 5:7 "cast all your cares on Him, for He cares for you."
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