February 6, 2011 - 12 noon

Yesterday's mail included the letter from Sarah's cardiologist to her primary care physician reporting on her October 26, 2010 follow-up visit to the cardiology clinic.  It was a little daunting to read how well she was doing and how stable she was from a cardiac point-of-view as well as the recommendation that "SBE prophylaxis is not indicated as per AHA 2007 guidelines."  That was then, this is now.  Also, one hopes that communication to the primary care physician about her current problems occurs in a more timely manner since the stakes for everyone being on the same page are now much higher.  Of course, if everyone used in-operable electronic health records (electronic records that can talk to each other), then the information in Sarah's primary care record would be updated during or immediately after her most recent visit to her cardiologist, or her most recent lab test, etc.

Sarah's continued knee/leg and chest/incision pains prompted the nurse practitioner on the cardiothoracic surgery team to add a new medication.  Amitriptylene is an old antidepressant medication that has proven helpful for certain kinds of "neuropathic pain" (pain due to nerve injury).  Since nerve injury may be playing a role in both pain locations for Sarah, this seemed like a good idea.  So far, it seems to be very helpful with her knee/leg pain which has nearly disappeared.  It is less clear that it is helping with the chest wall/incisional pain.  Pain remains the primary limiting factor in Sarah's recovery process - though it is intertwined with anxiety, fear, and post-trauma stress in complicated ways I am sure.

I am not sure how helpful her "cardiac rehab" consultation at the local hospital was on Friday.  Sarah is not exactly the typical cardiac rehab client in many ways.  The assessment amounted to seeing how fast she could walk around the perimeter of the room six times.  There was no checking of pulse or blood pressure.  Return visits were scheduled, but Sarah is doubtful that this is what she'd like to do.  We may need to look for a physical therapist, exercise physiologist, or personal trainer with a combination of experiences in their background.

We are working on a consultation with a local physiatrist (physician specializing in physical medicine and rehabilitation) here in Concord who is also a chronic pain management colleague of Seddon's.  His advice may be helpful on a number of fronts such as those I just described.

Does anyone find that their body waits for the right moment to succumb to acute illnesses - usually colds or the flu?  This has always been true for me and probably accounts for the fact that I had plenty of accrued sick time to devote to Sarah's needs over the past 6 weeks.  I practically never use sick time, but I can depend upon a 24 hour illness at the beginning of a planned vacations or during some long holiday weekends.  So after starting to feel it coming on Friday morning, I was sick in bed, mostly sleeping, for all of Saturday.  Blown kisses had to suffice for Sarah for 24 hours.  I'm not sure what I would have done with an illness like this three weeks ago.  Thursday afternoon I called into a meeting in Washington that I was unable to attend.  Someone familiar with Sarah's story said, presciently, "How are mom and dad doing?  You need to be sure to take care of your own health at times like these."