Cardiology Consult for Right Atrial Thrombus - March 23 2012

Jan Martin drove me to UCH for my Cardiology Consult with Eugene Wolfel, MD, Cardiology at UCH. Short history: On Day 40 after my 13 September 2011 autologous stem cell transplant, I had an echocardiogram where a large right atrial thrombus (blood clot) was discovered in my heart. At the time, I had both a Trifusion Hickman catheter in my left chest and a Bard Power Port in my right chest. The following day, 3 November 2011, I had an MRI of my Heart which confirmed the right atrial thrombus. I was put on daily Fragmin injections 12,500 units and had both the Trifusion Hickman catheter and the Bard Power Port Removed.

I have been followed with monthly echocardiograms and the right atrial thrombus has decreased some in size, but PERSISTS. 

Concern now as I had a PICC Line placed on 16 March 2012 for my VDT-PACE treatments and it terminates at the right atrium of my heart. Hence, the consult to Dr. Wolfel at UCH.

Jan and I waited for our visit, but not too long.

Dr. Wolfel came in and was well aware of my neutropenic (low white blood cell count) state. He told me that he works with heart transplant patients. Dr. Wolfel was especially kind and was genuinely concerned for my well-being. 

I shared with him my history and I had copies of all my cardiac tests which was a good thing since they did not have a copy of my MRI of the Heart Results.

Dr. Wolfel examined me and listened carefully to my heart. I have a slight systolic murmur.

He wants me to get another echocardiogram and then he will evaluate if I can have pulmonary function tests (part of the pre-autologous stem cell transplant authorization process). I am not a candidate for a trans-esophageal echocardiogram because of my low white count and MRI of the Heart is LONG (2 hours) test that was very hard on me the first time.

I need to continue on Fragmin even though my platelets are low because I still have the potential of clotting even with almost no platelets. He had me sign a release of information so he could get my pre-transplant echocardiograms from Poudre Valley Hospital in Ft. Collins for a baseline done 23 June 2011 and 9 August 2011.

All in all, it was a very good appointment and I trust that Dr. Wolfel will have my best interests at heart.

Okay...the Skinny On My Heart - January 19 2012

The cardiologist's office called yesterday and made an appointment for me at 2 PM today with Patrick Gorman, MD in Idaho Falls, Idaho.


Woke this morning to about 1 inch of new snow.

So, I decided to leave a tad early for my 100 mile drive across the high country desert to Idaho Falls. Gratefully, the snow covered road turned dry just below Mackay. Once out of the Big Lost River Valley, the wind was blowing a GALE!

I had to wait more than 2 hours for Dr. Gorman because he had been called to an emergency at the hospital. 

When, Dr. Gorman got back to the office he spent well over an hour with me!

Okay...now the skinny on my heart. Dr. Gorman said I am NOT A TICKING TIME BOMB! The blood clot in the right atrium of my heart is most probably NOT going to MOVE - if it were to move - it would have already moved. Although the echocardiogram reveals that the blood clot is "Mobile", it is tethered too. If the blood clot were to detach and go to my lung, it is "marble sized" and would not cause that much damage - but, again Dr. Gorman stressed that the clot was not going anywhere. I may have this blood clot forever.

Most importantly, I DO NOT NEED TO LIMIT MY ACTIVITY in any way. I can walk, hike, and even shovel snow!

As for the right sided chest pain that had me in the emergency room on January 17 2012, Dr. Gorman said that might have been a very small clot from an IV stick that went to my right lung and caused the pain - even though I had a negative (normal) CT Pulmonary Angiogram. 

I told Dr. Gorman that the right sided chest pain radiating to my neck continued until I took 8 mg of dexamethasone by mouth January 18 2012 (I had some from my pre-stem cell transplant). So, I now have a gut ache, but the pain in my chest, although not gone, is much better.

I told Dr. Gorman that the pain might have been from the Zometa that I received on January 16 2012. I've only had Zometa 2 times prior and both of those times, I also received 20 to 40 mg of IV Dex with it. Both of the prior times, I ached all over for a couple of days after, but never a pain like I had after this last dose.

Dr. Gorman felt like the 12,500 mg Fragmin was adequate to continue on for at least 6 months. After 6 months, he will take me off the Fragmin and see how I do. I'll have to continue some blood thinner even after the Fragmin since I'll be on Revlimid which can cause blood clots.

Dr. Gorman would like to follow my blood clot with echocardiograms every month - so, I'll get my next one on February 5 2012.

We discussed the need for intravenous access down the road if my veins don't hold up. He thought a pic-line that terminated above the heart and not in the heart would be the best option for me....but, I wondered to myself if they have buried port that would terminate above the heart...less chance of infection.

I left Idaho Falls on a real HIGH - I am so relieved!