I received the call today that I will be having my PFO closure on 3/11/2024.
It is really hard to describe my emotions surrounding that date now that there is one. I am very nervous and freaking out. I know and people keep telling me that it is a procedure that the Structural Heart Cardiologist has done 1,000+ times but at the end of the day, it is still a heart procedure, and it is still a foreign object that will forever be inside my body, specifically my heart.
I want to try to stay positive and focused on other things, but my head just keeps jumping back to the “what ifs”. My dad had a heart attack less than 2 years ago and ended up having to have open heart surgery. What happens if the procedure cannot be done the way intended and I end up having to have open heart surgery. I have kids and I work full time; I don’t have the time for complications. I will do my best though to think positive and hope for the best.
Below is a video that explains the type of surgery I will be having.
The structural Cardiologist I saw at VCU wanted me to have a repeat EKG with Bubble Study done though Riverside (not really sure why VCU didn’t do it, but it is okay because Riverside is a lot closer) because the results of my first one when the stroke initially occurred and the TEE with bubble study were both inconclusive as to me having a PFO or an ASD.
The technologist that performed my EKG couldn’t have been nicer. She took the time to get to know me and seemed genuinely interested in my stroke story. She took her time and ensured she got the correct images. I felt very at ease during the procedure. Another technologist started my IV and was able to get me on the first time! This is a major win for me because I am a hard stick.
Results
• Left Ventricle: Normal wall motion. The ejection fraction by visual approximation is 60 – 65%. There is normal systolic function. • Normal pulmonary artery pressure. • Left Atrium: Positive bubble study without Valsalva with several bubbles crossing on third beat. Overall minimal to mild shunt. Compared to echocardiogram from June 2023, there is no significant change.
BSA 1.97 m2
LV EDV 73.50 cm3
LV ESV 25.40 cm3
IVSd 0.87 cm
LVIDD 4.43 cm Reference Range 4.81 – 6.67
LVIDS 2.90 cm Reference Range 2.83 – 4.28
PW 0.89 cm
e’ lat 12.40 cm/s
e’ med 7.40 cm/s
Left Ventricular EF by 2-D Biplane by Method of Disks 63.90 Percent
E/E’ Ratio (Averaged) 8.56
Fractional Shortening 2D 35 Percent
IVS/PW 2D 0.98
LV ESV Index BP 12.9 cm3
LA vol BP 39.70 cm3
LA size 3.70 cm
Left Atrium 3.70 cm
LA vol index 20.2 ml/m2
RA 2D Volume 37.6 cm3
Right Atrium Major Axis 4.64 cm
Right Atrium Minor Axis 3.05 cm
Right Atrium Minor Axis 3.05 cm
Ao Asc 2.40 cm
Inferior Vena Cava Diameter 1.57 cm
MV DT 181.00 ms
MV regurgitation pressure 1/2 time 53.00 ms
MVPKAVEL 60.90 cm/s
MV E Vel 84.70 cm/s
MV area PHT 4.15 cm2
MV E/A ratio 1.39
RVD1 3.53 cm
RVD3 6.45 cm
RVD2 2.35 cm
TR VMAX 180.00 cm/s
TR Peak Gradient 13.00 mmHg
LV biplane EF 65 %
LVEF (Teich) 64 %
LV EDV Index BP 37.3 mL/m2
LVRWT 0.40
LV mass 125.60 g
LV Mass Index 63.8 g/m2
Ascending Aorta Index 1.22 cm/m2
ZLVIDS -1.44
ZLVIDD -2.45
RA medial-lateral diam 3.05 cm
RA Volume Index A4C 19 mL/m2
Est. RA pres 5.0 mmHg
RV pk systolic pressure 18.0 mmHg
LV est EF 65.0 %
Basically, what all of this means is that I will be heading in for surgery to close the PFO (patent foramen ovale). I am now playing the waiting game with VCU to see when they will call and schedule an appointment for closure.
I have been waiting to see a Neurologist since my aborted stroke and today is the first Neurology appointment. I have 2 scheduled because I want a few opinions. My appointment with VCU Neurology is coming up in about a month.
Today I saw Dr. Maria Guina. When the appointment was made with the Neurologist, it was supposed to be for follow up care after the stroke, somehow, the Neurology office had me being seen for Headache. This is the first frustration I faced with this office.
The front desk assistant was very pleasant while checking me in. The office didn’t have both of my insurances on file so I got that updated.
I was called back a few minutes after I finished checking in. I wasn’t too impressed with the nurse. I was telling her all of what happened, and it seemed like she didn’t really have a lot of interest in listening to me. (I wish it ended with her not listening to me, but it didn’t). She left and after a few minutes, the Doctor came in.
Immediately the Doctor started in on me about why I didn’t follow up with their office a couple years ago after I was seen there. I told her because you prescribed a medication, and I kept calling to check on the status of the Prior Authorization and I would 1. never get an answer or a returned call or 2. I was told by the nurse that if I wanted the medication, I would need to call my insurance company myself. That really upset me. The Doctor didn’t respond.
Next, she starts talking to me about what happened. I started explaining and every time I would start talking, she would cut me off and try to put words in my mouth. This kept happening and I got irritated. She didn’t like what I was saying and wanted me to say what she wanted me to say. She asked why the Cardiologist didn’t put me on a certain medication and I kept trying to tell her that I am waiting for my follow up with my Cardiologist to see what he wants to do and that he wanted to wait for all of my test results to come back before he made any decisions. She clearly didn’t want to hear it because I was once again cut off several times while trying to tell her. At this point, I was growing more and more frustrating.
The Doctor refused to possibly consider that I had a stroke. She told me I was too young and that there was no way. She said without a doubt that I had the Hemipelagic migraine. I tried to ask her why the clot buster medication worked the exact way the Neurologist said it would work and why my symptoms continued to improve after being administered the medication. The TNK clot buster medication is not a medication they give to everyone with a migraine. In order to get the medication, you have to show symptoms of a true stroke. I told her that both my Cardiologist and PCP said it was an Aborted Stroke and she basically said they are idiots and that she is the Neurologist and not them. I proceeded to ask her “why are you making a medication decision for my Cardiologist then since you are just a Neurologist”. She did not respond. She then proceeded with my neurologic assessment. She was so distracted during my neurologic assessment that she ended up repeating it. I was very confused by this. Dr. Guina was so focused on what she wanted that she completely dismissed the stroke and just deemed it a migraine. She changed my preventative migraine medication and my rescue medication.
Once she was finally done, she asked me if I was happy with the appointment today and if I still wanted to see VCU. I told her, I was absolutely keeping my appointment with VCU and that I did not trust her, and I did not think she was professional. I also told her before I left, that I would never see her again.
This was a terrible experience. I normally give all doctors the benefit of the doubt, but this one is reckless and dangerous and should not be allowed to treat patients the way she did. I will never go back to see her, and I would encourage anyone else, not to see her.
Today is the day I finally get to see the Neurologist with VCU. One thing about VCU that is always fantastic, is you typically don’t have to wait long to be seen. They are very punctual, and this is so appreciated.
The nurse brought me back and took my vitals and let me know that the Neurologist that I am seeing today would have a student with her and wanted to ensure that I was okay with her being in the room during my appointment. I told her I didn’t mind at all, and she said they would be right in.
There was a knock on the door and in walked in Dr. Kerstin Bettermann and her Med. Student.
Dr. Bettermann asked me to walk her through everything of what happened on the day of June 9th. She wanted as much information as possible and proceeded to let me talk without interrupting me. This was a huge difference from the TPMG Neurologist.
Once we finished going over the episode of what happened, Dr. Betternmann proceeded with my Neurological Exam.
Neurological Exam
Mental Status: Patient is alert and fully oriented, no aphasia or dysarthria, normal attention and concentration span, intact short-term and long-term memory function, good fund of knowledge, appropriate affect.
Cranial Nerves: Full visual fields to confrontation, pupils are 4-5 mm BL and round with normal reaction to light and accommodation, full extraocular eye movements, normal facial sensation and strength, face is symmetric, hearing is intact, uvula and palate rise symmetrically, tongue is midline, full shoulder shrug bilaterally.
Motor examination: Normal muscle bulk and tone,full strength 5/5 throughout, no drift, intact fine motor skills.
Reflexes 2 and symmetric, plantar flexor responses.
Sensation: Intact to light touch, pin-prick. No paresthesias.
Coordination testing: Normal symmetric rapid alternating movements in upper and lower extremities. Romberg test negative.
Gait: Stable. Normal tandem gait.
ASSESSMENT AND PLAN:
Nicole J Freeland is a 36 y.o. lady with multiple vascular risk factors including HLD, cardiac shunt of unclear type and at the time use of OCDs.
Her cardiac shunt was described as either a PFO or ASD and she will need further evaluation by interventional cardiology for possible shunt closure.
1. Obtain recent discharge summary and neuroimaging studies from outside hospital.
2. Stroke prevention-Continue ASA and patient. Check ASA function assay.
3. Referral to cardiology to review echos and to discuss possible shunt closure.I asked patient to bring her TEE and TTE studies on a disc for review by cardiology.
4. Order LE dopplers to r/o DVT.
5. HLD-Continue statin, regular FLP with PCP.
6. Migaine: We have discusedd the concept of rebound headache on Fioricet. Due to her h/o stroke patient can only take limited types of abortive medications. I have prescribed Nurtec for severe break through headaches. Will continue Amitriptyline for HA prevention.
7. Detailed stroke education has been provided by our stroke nurse educator.
Follow up in about 3 months (around 1/24/2024).
I had a fantastic experience with Dr. Bettermann and it was nice to have someone who listed and actually seemed to care. She didn’t dismiss the stroke because I was “too young”. She also said that more and more younger people are having strokes and that more and more symptoms are now related to strokes.
Once she left the room, I had another Neurologist that come in and asked if I would be willing to participate in a study on the signs and symptoms of strokes and how likely I would be to notice the symptoms or dismiss them. I was very happy to participate in this study. If it could even contribute to saving 1 life, it would be making a difference.
Once I concluded the study, in came a stroke nurse educator. This nurse went over all the different signs and symptoms and a stroke and how to recognize them. She also gave me a list of support groups for people who have had strokes and different programs that I can join.
All of the additional care I received made a huge impact. I didn’t feel dismissed with this appointment, and I felt like the team truly cared about my health.
Taylor woke up begging to go to Busch today. Blake and I went last night for howl-o-scream (very disappointing) so we were not inclined to go today. We decided to head towards the mountains and see where the day took us.
Blake knows I like going to Carter Mountain Orchard and joked about going. He thinks it is pretty and likes it but doesn’t like how busy it is. I tend to have to agree. Plus they now charge you to go on the weekends. Plenty of other orchards in the area to go to that don’t charge entry and are far less crowded. We did not go there today.
We made our way to the Blue Ridge Parkway and started to see a couple of the trees, mostly the poison ivy was being to take on the fall foliage and decided to turn around to head towards Wear Virginia since the leaves in that area turn sooner.
Before turning around, I asked Blake to check to see if the Humpback Rocks visitor center was open since every time we tried to stop there in the past 5 years, it has been closed. Well, sure enough, this time it was open. Inside, Blake read all about the history and I went to the passport stamp and pin section. I got humpback rocks and blue ridge parkway lapel pins, stickers for my passport book, an ornament for our Christmas travel tree and Taylor had to get 2 of her favorite books.
Good Night Virginia
Hello, National Parks!
We loves the Hello books written by Martha Zschock and Good Night books written by Adam Gamble. We get them for Taylor whenever we visit a place that sells them.
During our stop, I was talking with the park ranger about the junior ranger program for the Blue Ridge Parkway and the cashier working, hear me mention Williamsburg and said he and his wife moved to the mountains 2 years ago after living in Williamsburg for 60 year. After talking a little more, we found out his mother in law taught Blake in grade school and his father worked at the same school as I do. It is such a small world. It was a really neat encounter.
Shenandoah Valley
We made our way towards West Virginia on route 250 towards Monterey, VA.
We take a quick stop at the Confederate Breast Works pull off. We read some of the historical signs and did a little bit of the trail. The trail is only 0.5 miles but we opted not to do it today. We wanted to see the fall foliage with the sunlight. We did get a pamphlet on the trail that talked about the area.
The TOT of course wanted some pictures taken of her.
Once we reached Monterey, we decided to stop at High’s Restaurant. This is our go to mom and pop restaurant whenever we venture out that way. As always, they did not disappoint. I got the smothered chicken and Blake got the hamburger steak. For dessert, we split a piece of maple berry cake. All of their cakes and desserts do not disappoint. Taylor was wound up in the restaurant and did not want to sit still. So it was a bit stressful but we made it through. The perks of having a 3.5 year old…….
We continued on journey on route 33 through West Virginia and then back into Virginia, taking in all of the sights and twisty roads along the way.
I didn’t take as many pictures as I typically do because I was, for once, just enjoying the scenery.
We didn’t make any stops along our drive back home. We are still on our way home. About 10 mins from home with Taylor asleep in the back. A fun day trip to escape the everyday norm.
I went to the Cardiologist to begin my 14 day event monitor. The original monitor that my Cardiologist wanted me to wear that did 24/7 monitoring and would alert both myself and my doctor with any cardiac issues that arise, was of course not approved by my insurance. Thanks Anthem! Anthem through the State of Virginia at that. Their claim was that “their expert Cardiologist” said it was not needed. Ya know, because their Cardiologist clearly is the Cardiologist that is my actual doctor and is monitoring my situation. But it is what it is and not really much I can do about it.
All of this meaning, the event monitor that I am to wear for 2 weeks is one that I have to walk around with a 2nd cellphone and keep it within 30 feet of me at all times and I report when I feel an abnormality. My doctor is able to see the results after 24 hours. This is very inconvenient on many levels. 1. I don’t wear a lot of clothes with pockets, and I do not carry a traditional purse and having to carry around an extra cell phone is a hassle. 2. The smartphone is an older Samsung smartphone, and it does not hold a charge. I basically have to charge it 3 times a day for it to keep a charge and one being shortly before I go to bed. If not, then the phone beeps loudly until I charge it. 3. The beeps are so loud, and I feel like it beeps for everything. There is 0 way to adjust the volume on the phone. 4. It has many steps to follow when you need to report a cardiac abnormality. This is frustrating when clearly, I already have something going on. (When I was pregnant and did a monitor, all I had to do double tape the sensor itself). 5. The sensor that attaches to my chest, is very heavy and requires changing and charging every few days.
But again, it is what it is. I did the monitor as directed and once the 14 days were up, I put all of the materials back in the original box, shipped it back to the company via the UPS prepaid label provided.
I have a follow up with my Cardiologist on 9/11/2023 and will discuss the results during the appointment.
Blake and I made our way to the trailhead of McWay falls. Unfortunately, you cannot complete the full trail due to sections being closed. It is also illegal to go to the base of the falls.
The weather during our trip was not the best and the views lacked their beauty but what we were able to see was breathtaking.
We hiked under the roadway to get to the falls overlook.
The hike to the overlook is very short and easy. I’m not sure how busy the area gets but during our time, it wasn’t busy at all.
Despite the overcast day, the falls and ocean water are beautiful.
Before heading back to the car, we wanted to explore some of the area.
We saw some of the river and the flowers.
McWay falls also has bathrooms.
We throughly enjoyed our time at the falls and if you are ever down that way, be sure to take a look for yourself. Pictures just don’t do it justice.
I saw Dr. DeRidder with Riverside Hematology/Oncology 7/19/2023. During the appointment, I had 12 vials of blood drawn to check for multiple Hypercoagulable conditions.
Per Dr. DeRidder, if the testing comes back showing that I have an underlying hypercoagulable state, then it would be discussed to add Eliquis to my medications in an effort to prevent further thrombosis. If the testing fails to reveal an underlying hypercoagulable state, then I would need to continue on the daily Aspirin and further management with Cardiology and Neurology.
My iron levels were the first results to come back. I do have an iron deficiency and was advised to begin taking an iron supplement.
Over the next 1-2 weeks, more results came back.
From the looks of things, it seems all of my bloodwork with the exception of the Iron levels are normal. I have a follow up in 2 weeks and I will go from there!
Today is the day! My 2nd attempt at having the TEE procedure done. I received a call the night before to confirm the appointment and to inform me that my appointment time changed. I needed to arrive at 11:00 am vs 10:30 am (2 hours before the procedure). I did call first thing in the morning to confirm the appointment due to arriving last time and the appointment had been cancelled and I never received a call.
I went to work for a few hours and then I went to my parents’ house to pick up my dad who would drive me home following the procedure due to having to have anesthesia.
My dad and I arrived at the hospital and got checked in. The check in process went smoothly and we were quickly back in a room. Within a few minutes a nurse came in and got things moving along. She explained everything that would occur and started looking for a vein for my IV. I explained to her that I am a very hard stick and not having anything to eat or drink since the night before that my veins were worse. She listened which is always nice because I have come across many that don’t believe you and do what they want just to turn around and have to go in the vein that I said all along would work. The nurse felt around for veins because with the type of procedure I am having, the anesthesiologist likes to have the IV in a certain area. The nurse had the charge nurse come in and she found a vein and got my IV started on the first try.
Around 12:30, I was rolled back to the recovery room. I did not have to go to the operating room because I was not having surgery and the procedure could be done in a recovery room. I met with the Anesthesiologist, Echo team and met Dr. Ward. Dr. Ward is the Cardiologist performing my procedure. Dr. Ward specializes in prenatal and younger woman’s cardiac care. I will say, it was nice being referred to her because I am a “younger female”.
Dr. Ward explained what she would do during the course of the procedure. The Anesthesiologist told me the type of anesthesia I would have. The anesthesia I received is one that gives you a more natural sleep vs medically induced sleep. I asked to have more so I could sleep longer haha.
I always try to see how long I can stay awake but like always I fell right to sleep.
Once I woke up, Dr. Ward came in to check on me and to explain her findings. She first told me that I woke up twice during the procedure and tried to fight. I thought this was funny, especially since I did not remember any of it. She then proceeded to tell me that all looked normal on the test with the exception of the Left to Right Shunt by Color Flow Doppler suggestive of an ASD or PFO.
ASD – Atrial septal defect – A congenital defect characterized by a hole in the wall between the atria, the two upper chambers of the heart.
PFO – Patent foramen ovale – A small opening between the two upper chambers of the heart, the right and the left atrium. Normally, a thin membranous wall made up of two connecting flaps separates these chambers.
It was nice to hear that the only thing found wrong was what we already knew. Still VERY scary but I am glad it was nothing more.
Doctor’s Narrative:
Now I just wait until I have my follow up with the Cardiologist to determine the next steps.
Nic of Time - Travel 