Over the past month, my dear wife, Glenda, has had a series of sudden falls. Twice, now, those have led to EMS response, treatment at the ER, and hospitalization. The first EMS call was on October 1, 2014. She had been on our bedroom patio, leaning against the spa, and simply crumpled to the concrete patio floor. At that point she was unresponsive, so I called 9-1-1. By then she was responsive but could not stand, so I got a towel under her head and unlocked the front door for the medics. They found her blood pressure to be really low but found all else normal. They helped me get her to the bed and advised us to see her primary care provider the next day. We did that. At the doctor's office at 9:30 the next morning, her BP was even lower, so they immediately put took her by ambulance to the nearest ER. There she was tested, monitored, and hospitalized overnight. We left the hospital on October 3, 2014, with a list of follow up and consultation appointments. One of those appointments, scheduled for noon on October 24, 2014, was in Cardiology for a "tilt table" evaluation to test the impact of various postures and positions on her BP. She was also given a "Holter" monitor to wear for two weeks. This is a cell-phone based EKG machine that constantly transmits her heart function information to a contractor (CardioNet) in Phoenix.
We never made that appointment. At about 4 AM on Friday the 24th of October, she got out of bed to go the bathroom and only made it far enough to go down face-first on our ceramic tile hallway floor. I found her responsive but dazed, laying with her hands twisted under her jaw and chest and in a huge (and spreading) puddle of blood. Hitting the tile had split her skin open above her right eye, and scalp wounds bleeeeeeed. I applied a compress, and, again, called 9-1-1. upon initial evaluation they found her disoriented with BP of about 66/24. This time they did transport her to the ER right away and she was again admitted. During her two day stay she was seen by every medical specialty you can think of, and, again, discharged with a list of appointments to keep.
As of today (October 29, 2014) stitches have been removed with no complications. It took forever to be seen because the stitches were put in by the ER so they had to be taken out by the ER, so no appointment, and she was triaged to the lowest priority known to medical science. The black eyes have reached their “purple” stage, but the twin bumps and the laceration on her forehead are beginning to look a bit better. The home health care nurse and the physical therapist will be at the house at three this afternoon. One of the things they will do is a “safety inspection” to help avoid future falls. I’m sure they’ll tell us to get rid of our coffee tables, throw rugs, and small pets. They already have her using a walker. The challenge here is she’s not been tripping – most of the falls happened while she was standing rock still and just crumpled.
We saw the electrocardiologist yesterday (October 28, 2014) and he diagnosed her with syncope (blackout) with collapse (fall) caused by orthostatic hypotension secondary to autonomic nervous system dysfunction. That means that when she stands up, her body does not regulate her blood pressure, which falls to around 80/40 or less and the brain becomes oxygen deficient leading to fainting. The doctor had seen the report from CardioNet and found nothing worrisome there. One of the keys in his diagnosis is that when her BP crashes, her pulse rate and respiration remain unchanged and normal, and that with a BP crash, the autonomic system should race the heart and respiration to keep things oxygenated. So some thermostat somewhere is disconnected or not registering. In the meantime, ensure hydration, increase sodium intake, and continue to use a walker when up.
She is scheduled for vascular surgery to open up the right carotid (85% blocked) on Monday, November 3rd. The left carotid is at 50-60% blocked, so they are going to leave it alone for now. They don’t think this is the cause of her syncope and falls, but that it does need to be taken care of, especially with her history of stroke in 2009. We’ve been advised to expect one day in ICU and 2-3 days on the ward post-surgery.
After this surgery is over, she has a consult with the neurology clinic on November 19th to rule out Parkinson’s. But, the diagnosis we’ve now been given is much the same as Parkinson’s in symptoms and impact, minus the tremors, and, from what I can find, there really is not much in the way of treatment for either problem. We are hoping that the vascular surgery on the carotid will actually fix this problem. The vascular surgeon has told us that there are nerves near the junction of carotid with brain that do play a role in regulating blood pressure, so there is a very small possibility the blockage has been her problem here, but he’s not optimistic about that, primarily because the blockage is not truly bilateral.
I think we are doing all we can do at this time, including prayers and priesthood blessings. We are appreciative of the care and prayers we have received from so very many.