Fri 10/25/13 – Back to the ER - Possible Stroke

When Breck woke up Friday morning the tingling in her face (right side cheek, lips and tongue) were still present along with tingling in the fingertips on her right hand.  At this point I didn’t know quite what to think.  But I figured I would do as the ER Doctor Beck said and let someone know. 

At 10am I spoke to a nurse at Dr Albuquerque’s office.  He was in charge of the Specialized WADA test.  The nurse told me that she didn’t think the tingling had anything to do with the procedure and to make sure we called her neurologist. I then called and left message with Connie (Dr Schusse’s nurse – who is Breck’s neurologist) 

A little before 4pm I received a call from St Joseph’s 4^th floor.  A nurse was checking up on Breck and asking me how she was doing.  I said “You do know she was admitted to the ER yesterday – that we never made it to the car?”  She sounded very surprised and said “no” – that there was nothing in her file stating that.  At this point I restated what had gone on the day before and how disappointed I was in the ER Docter (Dr Lauer) whom I had specifically asked to call up there.  As the nurse was talking – her fellow nurse mentioned to her that they were aware of the seizure – that the two volunteers with the wheel chair had informed them and they had called Dr. Park & Dr. Albuquerque.  I do not know if they knew Breck was in the ER.

After this call I was really steaming! 

At 4pm I then left another message for Connie at Dr. Schusse’s office.  At this point I called Dr Schusse’s office right back to find out if Connie was even working today.  They told me she was and asked what was going on.  I told them that Breck still had tingling and that we were told it should be gone by now.  She found Connie and told me that Connie would be calling me on my cell right then. 

I still had to work at the ranch so I headed back down to my office. 

At 5pm I received a call from Dr. Albuquerque’s office.  The nurse said she reached the Dr. and his message to me was to take Breck to the ER if it wasn’t gone the next day.  I said ok.

5:15 – I received a call from Connie (Dr Schusse nurse) We discussed increasing Breck’s medicine but then after hearing more and my continuing concern about a stroke – she decided we needed to speak with Dr. Schusse.  She put me on hold and tried to reach her.  After about 10 minutes she came back and said she couldn’t seem to get a hold of her and that she wanted to call Dr. Varma.  I was put on hold again.  When she came back on she said that Dr. Varma was very concerned and that he was going to call me directly. 

At 6pm Dr Varma called.  He asked me to repeat what had happened.  I did.  Then he said that we needed to go to the ER that night.  He said it sounded like a stroke and that unfortunately the time to administer meds to stop the stroke was long past.  He explained that when a person has a stroke if they get help within the first 2 hours they can give meds to stop the stroke.  He also explained that he didn’t think the tingling was seizure related because she hasn’t had the feeling before.  See once someone starts having seizures they are pretty predictable.  Most people have the same kind of seizures.  And although Breck has several different kinds they still follow a recognizable pattern.  He told me to let the ER know that Dr. Varma requested a CT Angiogram.  And that the best test would be an MRI but it was highly unlikely to receive this test… that it is a hard test to get from the ER due to the time constraint.  Usually takes 12 hours to get one ordered.  He also warned us that if they find a stroke then Breck would automatically fall under a “stroke victim” status and be given many different tests that probably are not exactly needed.  This is because St Joseph’s hospital has been named a comprehensive stroke center by the Florida Agency for Health Care Administration which certifies that St. Joseph’s Hospital is recognized for its delivery of the highest quality care to stroke patients.  In order to have this designation they have to follow National Guidelines and procedures for ALL stroke victims.  This includes many tests to determine what has caused the stroke, even if they would know that the stroke was caused by her procedure the day before. 

Dr. Varma also said that the other thing it could be is a vasospasm, spasm or narrowing of the blood vessels.  This also would only show thru the CT scan or MRI. 

Depending on stroke or the spasms would determine which meds would be given.  If a stroke then aspirin and if the spasms some other drug (don’t know the name).  Either way it was important to go in and in either case we could not reverse what has already happened.  Also – either way the tingling should go away in a week or so.

Breck and I arrived at St Joseph’s ER at 7pm.  We chose to go there as all of her testing was done there the day before and I wanted her records to be easily accessed.

Once admitted to ER – they performed a CT Angiogram which came back showing nothing.  The resident neurologist was still concerned and decided to go ahead with an MRI.  This would mean many more hours in the ER.  He did warn us that it most likely wouldn’t show anything but at least it would put our minds to ease. 

It wasn’t until the next morning Saturday 10/26/13– around 8am – after being moved to 4 rooms within the ER that a nurse came in and informed Breck that she was being admitted to the hospital.  We were really confused. 

Soon after the Resident neurologist came back in the room and said “ I am sorry to have to give you the bad news but Breck has had several – at least 5 strokes.  And because of her seizure history she will most likely start having more seizures of a different nature”.  Breck started to cry.  He also said they would need to many more tests as now she falls under a “new” stroke victim even though the stroke is well past the 2 hour mark.  He ordered another MRI to look more closely at the arteries and and Echocardiogram to look at her heart.  They also started taking blood samples checking her cholesterol & blood sugar along with other things I am sure. 

Now even though Breck was told she was being admitted at 9am she did not make it to her room on the 5^th floor until 4pm.  That means we were in the ER for 21 hours.  We were exhausted!!!  This ER has you share rooms and only has recliners – no beds. 

Grandma Bevell, Aunt Judy and my mom came by to see Breck and bring food. This helped to make the last few hours move along for us. 

Once up in her room Breck relaxed by doing homework.  We had emailed her teacher but Breck couldn’t rest until her homework was done and emailed in.  What a diligent student!

Things slowed down from here.  My mom stayed with Breck and I.  John came up as soon as he could get away from the ranch.  Breck’s Bishop Woodruff and his wife came by to see Breck as well. 

It was very strange to look back on and realize that Breck was never once connected to a monitor for her heart and pulse.  She is have an IV and bag – but even that she had to carry her bag around with her. Usually they have it on a pole… but not this time.  They did intermittently check her blood pressure and continue to take blood samples. 

Sunday 10/27

Breck was told that many “experts” had reviewed her tests and that in fact she did NOT HAVE a stroke but instead it looked as if she had experienced the vasospasm, spasm or narrowing of the blood vessels.  This was good news as the brain heals much better and that we can relax about the ongoing fear of strokes.  They didn’t prescribe any meds for that though.

AND when the actual discharge came the nurse stated that Breck’s diagnosis from the hospital stay was a “seizure”.  I was very surprised and not happy!  I questioned the stroke and / or spasms.  I was told again that Breck DID NOT HAVE a stroke and that they couldn’t be 100% sure about the spasms so seizure was the diagnosis.  Breck was given her discharge papers and she WALKED out of the hospital about 5pm. 

 Notice - we are leaving with more than we came in with!  Thanks to a friend of Brecks.  

After getting home I wanted to review her discharge papers and noticed that page 3 was torn out of the packet and missing!  This has raised many questions in my mind.  I will have to wait until we can see Breck’s neurologist.

At this point we were just glad to be home.

Smiles

Sean A’lee

Thurs 10/24/13 – Specialized WADA – Discharge – straight to ER

St Joseph's Hospital 4th Floor to Parking Lot to St Joseph's ER!

Approx 1pm… After Breck signed her discharge papers – Looking great – I headed to get the car.  Two volunteers wheeled her down to the pick up zone.  As I drove up I could see her being wheeled out of the main lobby towards me.  “Oh, No… she doesn’t look good!”  I quickly ran over to her.  She whispered “I don’t feel good”  Then her head went back, mouth turned up on the right side, right hand clenches in a distorted fist.  I quickly tell one of the girls to go get help – “She is having a seizure!”  Was very short – maybe a minute.  Breck whispers “Mmmomm”.  I can tell she is coming out of it.  But she still couldn’t lift her head and her top lip is pure white, with the bottom lip turning blue.  She is also turning blue around the nose.  We wheel her back into the lobby where a respiratory therapist runs over and slips on a device to monitor her oxygen level.  She too loudly calls over to security “This mom needs some help here… her daughter is still blue!”  Another nurse comes over – then we start pushing Breck towards the ER – I am holding her head while they push.  They are talking to her.  “Breck!!  Stay with me!  Are you here?  Breck?”  Once we made it to the ER they quickly transfer her to a gurney – they were headed out the door coming at us.   

Once she was in her ER room and connected to the Monitor – she soon started looking better.  I left to go back and re-park my car.  One of the volunteers was sweet enough to stay with my car as I had left my purse and keys on the front seat with the windows down.  How nice of her!

As soon as I got back to the ER – a young nurse came in and stated “Ok, I guess you’re being released.  You can go home.”  I looked at her and said “They just put her in the bed?”  She stated again, “No, it says right here that after resting for 2.5 hours she can go home.”  I tried to patiently explain to her that those discharge orders were from upstairs where we had just come from.  She looked at me and said “ I am confused.  Let me go look again”.

The ER Doctor was Dr. Donald J Lauer.  He asked the basic questions concerning seizures and what had happened.  I explained Breck had just had a procedure on the 4^th floor – a “specialized WADA” test and that she never made it out of the wheel chair – she went into a seizure and was turning blue.  He then asked me “Do you always take her to the ER when she has a seizure?”.  I stated “No, but she just had a procedure, was turning blue and the number one risk is a stroke”  I strongly asked him to just call upstairs to Dr. Park or Dr. Albuquerque and they would tell him.  During this time – the young nurse or assistant came back in and said “Ok, you will be getting blood…”  I looked at her and said “What?  I don’t understand!?”  She then pointed to the blue band on Breck’s arm and said – “that blue band means you are getting blood”.  I explained again, “No – that blue band was put on upstairs just in case she needed blood from her procedure.”  She again stated she was confused and would go look at the chart! 

Another nurse then came and I repeated everything to her.  I asked her to please check with the 4^th floor.  Especially worried about a stroke.  She left and I never saw any of them again. 

About 4:30 we met Dr Brian Beck.  At this time Breck mentioned that the right side of her cheek, lip and half of her tongue felt very strange.  Tingly.  I again repeated what transpired from the WADA test, parking lot and my worry of a stroke.  I actually said “I don’t want to take her home only to find out that we have to come back and that she had a stroke!  I want her checked out while we are here!”  He agreed.  He did the normal physical neurological testing.  Hold up your hands, palms up.  Keep them there.  Can you stick out your tongue?  Can you spell the word “world” backwards?  What’s this? A pen.  Good.  What’s this?  A watch.  Good.  What day is it?  Where are you?  Can you feel this?  How about over here?  Lift your leg… don’t let me push it down.  Point your toes.  Good.  Flex your toes.  Good.  Can you see which had is moving? (from the sides of her eyes).  Good.  Then Dr. Beck states “Well, outside of the tingling, I don’t see any evidence of a stroke. The tingling could be just a side effect of her seizure.  Has she experience this before?”  Breck tells him “no”.  He then says it will most likely go away by morning and if not to be sure to let someone know.  But for now –can go home. 

I guess there was a shift change.  Dr. Lauer had gone home – the new attending ER Doctor – don’t remember his name came in and discharged us.

At 5:30 pm after 4.5 hours She is exhausted.  I am exhausted.  I go and get the car.  Breck is wheeled out of the hospital a second time and we arrive home by 6:30pm. 

I had Breck sleep with me.  We were in bed by 8pm and slept great all night.