Ablation day

I slept horribly last night; I don’t think Amanda slept well, either. There was a tyrant charge nurse barking orders, you know, give some power, and they’ll wield it to the max. I heard her early in the evening but never pinpointed which one she was, but I could definitely hear her all night. Once five rolled around, the chosen EKG hour, there was no trying to sleep. The nurse left the door open, and you could hear the barking in HD. 

A doctor came in at seven, so I finally set up to listen. It was a fellow from the EP team. He went over things. They were going to work six people in the schedule today alone. The procedure is scheduled for 2:30, but who knows if it will be later. We’re still waiting for the PICC line to be placed, but have been since this time last week, so I’m not holding my breath.

The doctor asked if we had any questions; I did but was too groggy to ask. I’d already asked our cardiologist, but I wanted to know from the EP team. That question was how will they access the left ventricle. They can’t get to the left side as easily. The likely approach will be a transeptal puncture, a hole straight through the heart chambers. That scares me; it is very common with treating A-fib, but it still freaks me. I mean, a poking hole in the heart sounds crazy! We still don’t know precisely where the arrhythmia comes from, but the lead EP seemed to think it was on the left side. Going in and out of the heart for studies or ablations and causing scar tissue is why we are where we are today. Also, all the in and out and pacemaker leads led us to valve problems. So, needless to say, I’m uncomfortable with this. However, Amanda is really uncomfortable with a 150 heart rate, so we need a fix.

They ran another magnesium infusion, which made three bags and two oral doses since yesterday afternoon. The infusion makes Amanda get hot. I woke up freezing, and I was threatened if I tried to turn up the AC! In most hospitals, it’s either hot or cold; the air is constantly blowing, hot or cold, and there is no in-between. 

The primary immunosuppressant she has been on causes hypomagnesemia, or low magnesium in the blood, so she takes magnesium regularly. However, I think the extra immunosuppressants and the PLEX treatment have bottomed it out. The PLEX also causes hypocalcemia, or low calcium, which they have been treating immediately during the treatments, even adding more when her symptoms, such as finger tingling, increase. 

I was googling the main anti-rejection med and low magnesium correlation. I came across an article that was typical of the abstracts I read when researching. This one was relatively easy compared to many, but it gives you an idea of what it’s like to research medical conditions that are uncommon. It was from Kidney International Reports and reads: Tacrolimus can cause hypomagnesemia from downregulating TRPM6, the major active transport protein at the apical membrane of the distal renal tubule epithelial cells requiring magnesium reabsorption. In our patient, there was a temporal correlation between elevated tacrolimus level and low serum magnesium.

It’s just afternoon reading for me at the moment! Low magnesium levels also contribute to arrhythmias, so they are likely trying to keep the levels in check to ensure we don’t have any other rhythm issues. Researching medical journals as a layman can be daunting, but I like being informed of what is happening.

We finally received the cards many of you have sent, about 50 of them. I’d been asking if they delivered or if I should go get them. I made a wrong turn in the basement the other day and went by the mail room, so I wasn’t beyond going and knocking on their door! The doctor from the ICU team came in and handed me the stack of cards; I have no idea how he got them. I was telling a friend about that, and she said VIP treatment!

Later, the EP fellow came by to chat before the procedure. I opened the cards with a knife, bigger than a regular pocket knife but not huge, either As he went over the risks of the procedure, he kept staring at my knife as I continued to open the cards. I couldn’t help but wonder if he was afraid of what I’d do if we had any issues he was speaking of! 

Not long after, we had some visitors show up. A couple of years ago, our pastor’s niece went on the native American mission trip we go on every year. Amanda became close to her, and they have remained friends. They made a two-hour drive to see us; her husband emphasized they wouldn’t make that trip for just anybody! They came bearing gifts, in the way of snacks, too. She had messaged me yesterday and asked if we needed anything, and I said Amanda had been wanting more savory snacks. So they came bearing a bag full of Sprouts snacks; the plant based manager helped her stock up for us.

We had a surprise visitor come as well: YJ, our pastor. We were excited to see him. He is the only person I will let sit with me in a surgical waiting room. Throughout all the years, I’ve never liked anyone to sit with me. I banished my mother from waiting with me years ago because she was a worrywart. Until YJ, I had always waited alone; he’s been here for a few big surgeries before the transplant. He stayed a while after his niece left. If he hadn’t been heading home today, he’d likely have stayed through the ablation procedure. He did give us a good laugh when he came in. He had mismatched boots on! He was in a hurry and had one on and not the other. He got busy talking with someone, forgot to put the other, and didn’t notice until he was in the hospital lobby! If you know him, this won’t be a surprise, and you’ll understand. We needed a good laugh this morning anyway, even if it was at his cost!

Amanda went back to the cath lab not long after YJ left. When they came to get her, it woke me up. I was getting a little nap in after my crappy night of sleep. She’s still back, and I haven’t heard anything as of 4:30, but I imagine I’ll see someone soon. A security guard on a power trip just kicked me out of my comfy spot. I had been sitting at the volunteer desk typing. I often do this because the volunteers usually leave in the early afternoon, and it is a comfortable office chair and not a butt-grooved waiting chair. There are literally only two others in the huge waiting room. It is not like I was hurting anyone; I probably could have been more helpful than the volunteer, anyway! I’ll update you later tonight after she is out.  

Just as I was about to publish this post, the cath room nurse called to update me. The procedure was more involved and invasive than anticipated and will take a little longer. They said it would last until at least 6 p.m. Prayers please.