Heading Back to the Cath Lab

Hey Friends,

After a few telemedicine appointments this week, my local cardiologist has decided that it is time to go back to the Cath Lab, so we have one scheduled for July 29th at Inova. Why?

The new medication, Ranexa, that we had been using to chest pain for had to be come off this week. Unfortunately, the rhythm change we had been watching for each week with an EKG, showed up on this week’s EKG.
The plan all along when we started Ranexa, at the end of June, was that we were just prolonging a Cath as long as possible. We were all in agreement that if symptoms continued to worsen or we had to pull off Ranexa, we would go back to the Cath lab.
Even more frustrating the vomiting returned Sunday night, which indicates to my local cardiologist that a Cath is clinically indicated, as it is how I have presented in the past. GI symptoms are also very common when the vessel we keep having problems with so my doctor suspects he will find something.
I am also in mild heart failure at the moment (gaining 7 lbs of fluid in one week), after not having an issue with that in over 2 years, so he will also be checking on what is going on in the right side of the heart as well.

Why Inova?

Truthfully, I am not thrilled about it. However, my PCP and my local cardiologist and I are all in agreement that we cannot consider more aggressive surgical options (like re-do bypass), without a new Cath.
Dr. K is pretty confident he will find something in my ‘problem’ vessel due to what he has seen previously in Caths, the rate at which I occlude and my symptoms. He also disagrees with Hopkins’ assessment with the CTA during the last admission. He explained because I have so many stents, it could cause the imaging to reflect off the stents and miss the plaque buildup.
Medstar reviewed my case a few weeks ago but declined to re-do the bypass off the last cath films. However the doctor told me to resend them as soon as we have a new Cath, as they do believe it could be an appropriate next step.
Dr. K is in agreement about considering a surgical next step if indicated, so he has agreed to work towards that end. Namely, he will be aggressive in the Cath lab if he can be, but not too aggressive to prevent a surgical intervention and put us back in this same spot in 3-6 months.
We are all in agreement that if he finds a small blockage he will reopen it and place a stent. He suspects he will find a large repeat occlusion within previously placed stents. To reopen and place another stent within a stent, with my history is just not favorable as it is highly likely to re-block. If it is a large blockage, it makes me a candidate for a re-do bypass.

What about Hopkins?

As of my telemedicine appointment today, they are still arguing that it is psych/anxiety induced pain and that the vomiting is strictly GI. However, they are the only ones to continue to believe so. They are pushing for a Gastric emptying study.
We disagree with them very strongly, so while we thank them for their opinion, all medical opinions are exactly that: opinions. Having 4 other opinions saying its Cardiac, makes us feel strongly that a Cath is a better solution so that we can talk about a more long term treatment option.

What next?

Cath Lab on the 29th
With that data Dr. K will make a game time decision in the lab on whether to intervene and place a stent or pull me off the table for surgical intervention based upon what he sees.
With that information, we will reach out to the medical institutions that offer re-do bypass to determine who will do the surgery, if its clinically indicated at this time.

What can we pray for?

Diuretics to continue to work to get the extra fluid off
All pre-op labs to look good
Negative Covid Test (pre-op covid testing is required for procedure)
For clear answers in the Cath and for wisdom for Dr. K
We are trying a different premedication regimen for my contrast allergy, due to breakthrough reactions the last few times, so that we would have no reaction with this new regimen
That things remain stable, until the Cath on the 29th.