Differential Diagnosis II

More Medical Adventures

This week brought some good news and some interesting twists regarding our health status.

Odd how, with age, this topic becomes more and more the subject of conversation.  I remember how I used to dread asking certain members of our family how they were, lest the inquiry unleash a torrent of unwelcome detail about their various ailments. Ah, well, so here goes......

We returned to Doctor Burnworth's office for the results of the bone density test. The good doctor shall be referred to hereinafter as Dr. B, having so named himself in his comments to my first post on Differential Diagnosis. You might want to read those in his lively exchange with Tom below.  The happy news was that Tom had passed the test. He is dense--from head to toe.  This is actually no surprise to me. He eats well and has been an exercise fanatic as long as I have known him, so seemed an unlikely candidate for osteoporosis.

 Dr. B's diagnosis, a differential one now, having eliminated the first possibility, is that Tom's second fracture was caused by his total inability to obey doctor's orders to stay off the foot as much as possible, to walk carefully whenever walking is necessary, to elevate it often, etc., etc. This too is no surprise to me.  He doesn't ever follow my advice either. Tom marches to his own drummer. His x-ray showed the fractures healing well and he will be out of the boot in three weeks.

My own medical adventures began on Saturday, when I decided to take a nap, and was thunderbolted awake from a deep sleep by a whole-body jolt that threw me straight up, slap out of my chair.  It was like I had been hit with a defibrillator! Well, since I've never been hit by one, I guess I need to say it felt like what I imagine it would be like. Before I could even begin to process what had happened, I had an asthma spasm and couldn't breath!  For about 8 seconds I stood there, realizing that it would do me no good to find my inhaler--the attack was too severe to have been helped by such a puny rescue device.  Suddenly it let up, thank God. I could breathe again! Just as I began to feel safe, another spasm grabbed me and lasted for an awful 10 seconds. Long enough to make me wish I had cleaned the house that morning, or at least straightened up and emptied the trash.

Way shaken up, I sat down in the chair and tried to decide if I should wake Tom up from his nap to ask him to take me to the hospital.  While I was trying to decide, I thought I would test to see if I had had a stroke--possible cause of the body bolt, maybe.  So, standing in front of the bathroom mirror I tried to remember the three- part test to identify a stroke. Smile.  Is it crooked? Well, mine already kinda is anyway, but I looked to see if it was a lot more one sided. Stick your tongue out. (Was that one of the tests? What about your tongue? Was the test if you could move it in and out easy?  Well, I could) Hold your arms up over your head  I totally could not remember what about your arms you were supposed to look for.  I resolved to review and really learn the tests, cause sorta knowing doesn't help.  My diagnosis, maybe really my wishful thinking, was that I had not suffered a stroke.  Nothing seemed amiss, except that I was weak and scared.

Not long after, I was recounting the events to Tom, now awake from his nap. To his insistent plea for me to go to the hospital, I said no.  After all, nothing weird had happened since.  And now I felt fine.  Besides, what would I say when they asked me about my symptoms?  I got hit with a thunderbolt? How foolish does that sound. I know that women's heart attack symptoms are unusual, but that's a little over the edge isn't it?  It seemed just embarrassing to have had such a weird body experience--and I didn't want to have to try to explain it in case folks would think I was a crazy old lady.  I just wonder how many women don't go to the hospital when they should because their symptoms are unusual or vague.  Maybe they are afraid folks will think they are foolish or they are just complainers or that their symptoms are imaginary.

After a perfectly normal Sunday, on Monday I stopped at the drug store on the way to work and, while there, decided to let Jason, our pharmacist give me my flu shot. It briefly crossed my mind that it might be a bad idea, considering the unusual goings on from the day before, but, not really.... Jason did say he would call to check on me in a little while, to be sure there was no adverse reaction.

I was at the office by 10. In the middle of a busy day about 2:30 I was hit with a wave of nausea and dizziness. I felt myself fading away into a faint, so stood up and began walking around, announcing in a calm voice, that I did not feel at all well.  I went into Tom's office to lie on his couch and call Jason, who found no such side effects mentioned in the flu literature. Lie down, drink water and call me back in 10 minutes, Jason had said. As I lay there, with the room spinning and sick as I could be, and with folk fluttering around trying to be helpful,  I finally called my primary physician.  When I recounted my worsening symptoms, and those from Saturday---she told me to go immediately to Providence Emergency Room to explore if I might be having a heart attack.

Finally convinced, I told Tom, who grabbed me and ran, as fast as a man in a boot with a cane can move. 

If you want to avoid waiting in the emergency room, as we have done many times, go in bleeding heavily, or with asthma or any other condition which renders you unable to breath, or appear having heart attack symptoms.  You will be rushed right in for examination and treatment, as I was Monday afternoon. The doctor administered an EKG while he took a medical history and listened to my thunderbolt/defibrillator story, with only an occasional Humph. First good news was that it was not a heart attack, or at least the kind revealed by an EKG  (and I had already eliminated stroke right on my own!) Now began a series of tests--urine, 4 vials of blood, x-rays, another kind of heart monitor, and on and  on--all this to  eliminate other possibilities.  The doctor came in to talk-- a different one, who told me that the clues did not add up to anything--especially the thunderbolt thing--perhaps a first in the annals of medicine.  Maybe it was just the way I described it!  

While we waited for some of the tests to come back (she was pursuing some educated guesses with specific assessments), she taught me the three tests for a stroke--important for everybody to know for the sake of yourself or a loved one. 1) The crooked smile was the only one I had remembered right. 2) The arms. Hold them straight out in front, not over your head.  Watch to see if you can hold them steady.  If one drifts down, that is a bad sign. 3) The say-a-sentence test.  If you can say a slightly complex sentence without difficulty, then you are probably in the clear. For instance, "You can't teach an old dog new tricks" would be better than "See Spot run."  If you slur, or can't form the words at all, then clearly, something is wrong.





About 7pm all the tests had run their course and the final differential diagnosis was in.  The doctor pronounced that I was super deficient in  potassium, cause unknown. The cure--replenish the body's potassium through a slow drip, drip, drip 


into my arm for 4 1/2 hours. It was boring; It was painful--maybe because potassium is thick and doesn't want to go into the vein (I am guessing here).  Tom stayed by my side, holding my hand almost the whole time, alert and sympathetic to my pain.  When he could bear to see me suffer no more and had to take a break,he would slip out for a beer at the local bar. He could bear it no longer a lot. He had to take a break a lot. He drank some beer a lot.  He did stay alert by my side a lot during that long 4 1/2 hours, and he did drive me home at 12:30 that night.

The doctor's further diagnosis was that it had been coming on for awhile. Part of the cause was dehydration, from not drinking enough liquids. She sent me home with directions to see my doctor for follow up. I feel great;  obviously my recent tiredness was a symptom--as was dizziness, nausea, shortness of breath--everything I had had, except thunderbolts. My doctor found that my potassium level is holding fine. She did not put me on any medication, just ordered me to drink lots of water. I have had 37 other consultants, mostly friends, some folks I hardly know, prescribe the consumption of bananas on a regular basis. I am now eating 6 bananas and trying to drink 64 ozs of water every day.

I have had no recurrence of thunderbolts.