I’ve been trying to write a blog post for the past few weeks. I’ve started at least five posts, gotten a paragraph or two in, and then stopped. My brain just won’t work long enough to keep going. So since I can’t think of anything creative to write, I’ll just write the facts regarding my angiogram last month. I can do facts, right? Maybe that’ll be interesting to some people?
If you’ve been following my blog for at least a year, you may remember the incident prior to my brain surgery when I was having my pre-op scanning and an incidental aneurysm was found on my CT scan and MRI. An unpleasant surprise to say the least. So in November 2016, about two months after my brain surgery, I had a stent placed to close off the aneurysm. I was put on aspirin and Plavix for six months. I came off the Plavix in May, but need to continue the aspirin 325 mg probably indefinitely to prevent a stroke. The plan was to have an angiogram at the one-year mark to check on the aneurysm.
In late October, I got a call from my neurovascular surgeon’s office to schedule the angiogram. The nurse said she couldn’t believe it had already been a year since my procedure and that she doesn’t remember every patient, but she remembered me. (Well, how many 31-year old patients do you think need neurovascular surgery? I don’t exactly fall into the most common demographic for that.) The nurse said a different surgeon performs the diagnostic angiograms and he had the angio suite on Fridays. Thankfully, I was able to get scheduled for Friday, November 17th, which was the only Friday my husband had off that month. I was given the 11 am slot, although I had hoped for something earlier. But at least we got to sleep in and miss rush hour getting to the hospital.
I was told to report to the admissions desk at 10 am, which involved 10 minutes of sitting around so my information could be verified. Luckily, I already knew how to get to outpatient/interventional radiology since I’ve been there half a dozen times in the past year and a half. But the medical facility I go to is rather…sprawling, shall we say? (It has its own zip code.) So the walk nearly killed me since I decided to forego my wheelchair. When I was handed a clipboard to fill out forms, I was never so happy to see a chair. This was where hubby caught up with me after parking the car.
I was finally called back to the preparation area around 10:40 am. (11 am procedure time? Not likely.) I changed into the gown and did the ever-necessary pregnancy test. Then we just sat around. And sat. And sat. A nurse finally came in at 11:15 am asking me if my IV had been placed yet. Nope.
Right after this, the fellow came in to discuss the angiogram procedure with me and obtain consent. She was a super sweet woman who said to call her Dr. Jenny. She explained the procedure in detail and that she would be performing it under the direction of her staff. She mentioned that she had plenty of numbing agents at her disposal to make the procedure as painless as possible, so I was to speak up if I was in pain. (So much for me thinking I was actually going to be sedated during this angiogram like I was last time!) Dr. Jenny said the room was being cleaned and prepped and they should be coming to get me shortly.
An hour and twenty minutes passed.
Around 12:40 pm, just as I was about to literally start banging my head on the bed out of sheer boredom, a woman in surgical scrubs and cap appeared at the door. I told hubby I’d see him in a little while and off I went. Down the same hallways as last year, to the angio suite right across from the elevators.
As soon as my gurney was backed into the room, it was so cold (remember, nakey under a thin hospital gown) I thought all my leg hair immediately grew back. I’m fairly certain that if I would have stuck my tongue to the gurney rails, this would have happened:
Compared to last year, when the room was swarming with people, at first there was no one in there except the woman who transported me. Then one other woman came in. I got onto the table and they explained what was going to happen and what to expect. The staff surgeon came in to introduce himself and asked me how I handled the angiogram last year. I told him I was sedated for it because the angiogram was followed immediately by the stent placement. So he told the nurse to do my sedation at “half and half.” I assumed that meant fentanyl 25 mcg and perhaps midazolam 1 mg. I knew that wouldn’t touch me. Sure enough, a nurse administered the meds as another nurse started prepping both sides of my groin (COLD!) and putting up the sterile drapes. (I was right about the fentanyl, but the midazolam was only 0.5 mg. HA.) I was awake as I had been all day. I suppose in this circumstance it was the thought that counted. (In the pharmacy world, we’d call it “lick the vial” dosing.) But I wasn’t panicking at all, so I figured I wouldn’t worry about it.
After about 20 minutes, when all was ready, Dr. Jenny came in. Since my right groin was used last time, they wanted to use it again this time. Dr. Jenny found a great pulse in my right femoral artery and said she was going to numb me up. I felt a few little pricks as she injected lidocaine around the area she was going to access. Due to the blowers in the room, I didn’t hear what she said next. But I suddenly felt a big, deep, dull PINCH that I wasn’t expecting and made me involuntarily grimace. It was only a few seconds later, when by her hand motions and a slight…sliding sensation at the insertion site, I realized she was threading the catheter up towards my head. I realized the big pinch had been Dr. Jenny accessing my femoral artery with a giant needle. Ok then.
The staff doctor was present the whole time, but had enough trust in Dr. Jenny that he decided not to scrub in. Once it was time to inject the dye and take images, Dr. Jenny told me, “Take a deep breath in and exhale…now don’t breathe, don’t move, don’t swallow. Don’t breathe, don’t move, don’t swallow. Now breathe.” I have to admit I almost started laughing because her words made me think of this iconic moment in television history:
I felt warmth on the left side of my face when the dye was injected. Then I saw lights flashing across my eyes when the x-rays were blasting my head with radiation three inches from my face. Luckily, I only had to go through that twice. From the time my femoral artery was accessed to the time the catheter was removed, it was probably only about 20 minutes.
Dr. Jenny had to hold pressure on my groin for 20 minutes to get the bleeding to stop. While she was doing this, the staff doctor brought my images up on the screen (which was conveniently located right next to my head). He said the aneurysm was “about 90% gone”. I saw the tiny blip he meant, which ended up measuring 1.3 x 1.1 mm in size.
Now my instructions were to lay flat for the next four hours, until 5:30 pm. I started out in interventional radiology recovery, but then two hours later, I was transferred upstairs to the short-stay unit. I was bored out of my mind. There isn’t much you can do when you’re laying flat on your back with no pillows to support your head. Luckily, since I was in the same building as my sort-of place of employment, my BF Holly came up to visit me for awhile! Her visit cheered me up and helped pass the time.
After what seemed an eternity, I was allowed to sit up part way. Once it was determined I wasn’t bleeding, I sat up a bit more. Then it was time to sit me on the side of the bed and do vitals sitting and standing. I knew this could be a bit hairy. Since I really didn’t want to use a bedpan, I hadn’t drank anything except a few ounces of apple juice right after the procedure. Since I had been NPO prior to the procedure since 9 am, by the time 6 pm rolled around, my POTSie body was in full rebellion. My heart rate was in the 90s sitting up and went up into the 120s when I stood up. My blood pressure was a bit high, but my nurse took it again once I had been allowed to pee (which I had been holding for about three hours) and then it was a little better. (I didn’t tell her I chugged half a liter of Propel before the second measurement, which also helped my heart rate come down a bit).
My transport guy finally arrived around 6:15 pm and we peaced out. This guy was an angel. When we told him we were parked in the employee parking garage, he said he would roll me out there. He sat with me on the first floor of the garage while David got the car from the 7th floor, then rolled me right up to the car. Unlike with other patients, who are discharged from the main lobby, he braved the cold and windy night to wheel me that far because we were “family.” David and I were amazed and so thankful.
So how did everything really turn out? My neurovascular surgeon reviewed my images and told me about the small remnant (which is only left in about 20% of patients at the one-year mark, hmmph). I’m to continue on aspirin 325 mg and have an MRA in a year. So not another angiogram, thank goodness! The whole aneurysm thing isn’t really behind me yet, but hopefully it will be next year!