The Nielson Family: 7/1/11

OK, I know it has been months since we've posted anything. We offer our apologies. Now, with that out of the way, I have three things I would like to update everybody on.

First, I finished my second year of medical school and my boards last month. I took both the USMLE (MD licensing) and COMLEX (DO licensing). I have heard many people say that the COMLEX is easier. I just wanted to say, from personal experience that I don't think that is true. I found both tests to be a quick punch to the stomach. I do think the USMLE required more depth of knowledge, but the COMLEX seemed to cover a broader knowledge base. Both made me feel fairly stupid, which I think may be the ultimate goal of the test writers.

Second, Christina is pregnant! The back story on that is too long to blog, but I will say this: We found out in an urgent care clinic...

Third, and most important, the blood clot -- or brain clot, as Christina often calls it. Sometime around the middle of June, Christina got a headache. But not just any "ache." More like an elephant sitting directly on her brain. We tried to manage it ourselves for a few days, but nothing seemed to help and we gave up and went to the ER. After a mind-numbing four-hour waiting room sit, we finally saw a doctor who thought it was a combination of dehydration and pregnancy hormones. He gave Christina IV fluids, and even though the headache seemed to get worse with the fluids, he sent us home with a prescription to treat the UTI he found incidentally.

About this time, Christina noticed she wasn't seeing as well as she is accustomed to, so she convinced me to take her the eye doctor. He found the her vision was only slightly less than perfect, but because the headache persisted, we decided to get a pair of glasses and try it anyway.

Fortunately, Christina seemed to feel slightly better for a few days. Unfortunately, the headache came back ferociously the day before she had planned to fly to Utah. We discussed cancelling her trip, but she couldn't let go of the credit card miles we used to book the ticket, so she and McKay boarded the plane. During the flight, the elephant got tired of sitting and started dancing around on Christina's brain.

The first day and a half of her vacation consisted of an extra dose of couch-laying, while trying to figure out why the people on TV seemed to be somewhat blurry and horrendously out-of-proportion. Eventually, Christina's sister Melissa drove her to the ER and dropped her off so she (Melissa) could watch McKay while Christina got checked out. While the waiting room visit was much shorter, the doctor took the same course. He chalked up the symptoms to pregnancy-onset migraines and sent her home with Lortab.

The Lortab did not help much, and desperation began to set in as the first elephant recruited some friends to continue the dance. Everybody she knows offered a solution to handle migraines. Christina tried most of them (but dodged some, because she hadn't told anybody she was pregnant yet). She even drank half a generic cola -- her first-ever caffeinated beverage.

She got some minor relief from Excedrin, but it was short-lived.

The next day, Christina got a priesthood blessing from her dad, and an interesting thing happened: the headache moved -- but did not go away. All of the elephants seemed to team up to stomp on the area directly behind her ear. And her vision seemed to get worse. After another day like this, and a tearful phone call to her husband, she made the decision to return to the ER again.

This time, the doctor listened to her symptoms, especially the pain behind her ear and the visual changes. The doctor suggested a CT scan, but told Christina she wasn't sure it was the best thing to do, because of the pregnancy. Christina opted for the scan, which led to a MRI and a free ticket to the Neuroscience Intensive Care Unit. I got the word at 2:30 a.m. and left Phoenix for Salt Lake at 6 a.m.

Official diagnosis: dural venous thrombosis in the right transverse sinus. Interpretation: a blood clot blocking the venous drainage from her brain. The good news was that her arteries were not blocked, so her brain was still receiving the oxygen it needed. That means there should be no lasting damage. The headache and visual changes were caused by an increase of pressure inside her head.

I arrived in Salt Lake City around 7 p.m. I sat with Christina for a couple hours, trying to piece together all the details from a somewhat foggy recollection of the previous 24 hours. Since Christina seemed to be doing very well, I decided to go to my in-laws for a good night's sleep (as I had gotten less than three hours the night before). Unfortunately, nearly as soon as I hit the pillow, I was rocked back awake by my phone ringing. It was a nurse at the hospital. My blood turned very, very cold. Why couldn't Christina call? What was so important that a nurse had to call in the middle of the night?

It turns out that Christina had had a seizure. Less than 40 minutes after I left the hospital. I did eventually get to talk to her over the phone. She said she was fine and told me to wait until morning to come down. She doesn't remember talking to me at all.

As best as she remembers it: a nurse came in, insisting on starting a second IV (ICU policy). While the nurse was working, Christina remembers feeling very hungry, then she had a strange sensation similar to receiving some kind of strong drug through an IV line. It hit her whole body at the same time. Then the headache returned -- stronger than ever. She tried to explain her feelings to the people in her room (three people at this point). One of the people pulled down an overhead light and turned it onto Christina's face. That is the last thing she remembers, except hearing someone asking if she was OK, to which she tried to say "No. No. Help me." -- only nothing came out.

I didn't return to the hospital until about 8 a.m. the next morning, at which time I miss-communicated information from the previous night, leading to several people thinking Christina had two seizures. She only had one.

An EEG performed the next day was normal. An EEG is a test that measures the electrical activity in the brain, and is the best predictor of the recurrence of seizures. The doctor said he thought the seizure may have been caused by Perkoset, which she was taking for pain, and switched her to Lortab.

Christina spent the next four days in the hospital, and (thankfully) they were rather uneventful. During that time, Christina was switched from the IV blood thinner Heparin to injections of Lovonox. She will stay on the Lovonox for the rest of the pregnancy -- two shots every day, given either by me or her. The blood clot will take months to fully resolve, meaning the headaches and visual changes will be with us for awhile longer.

The first MRI showed what the doctors described as a "small area of possible cortical infarction", or a small area of her brain that had died. The second MRI showed no such lesion, and the doctors renamed the questionable area on the first MRI "artifact," meaning the "possible" infarction most likely never existed. Her latest MRI still showed fluid in her optic nerve, which can be caused by increased pressure, can cause the visual symptoms she has described and, most importantly, should completely resolve.

So, after a some very scary nights, we came out with this: everything will be OK, as long as Christina can muster up the courage to continue giving herself two injections a day. Apparently, they are quite painful. And, because of the seizure, her driving will be restricted for awhile. That may prove to be quite challenging, as she will have to follow up with doctors in Arizona, but cannot drive herself to appointments -- and I start rotations next week.

And, to the few valiant ones who held on through this very, very long post, I reward you with this: the priesthood blessing proved to be pivotal. It didn't directly cure her headaches, but it gave her the courage to return to the ER, and emphasized the "red flag" symptoms that helped the doctor to finally make the tough call to send Christina to the CT scan. And, as for the previous two ER visits, where it seemed the doctors didn't catch something important? Both -- BOTH -- of those ER visits came on the day/night before one of my previously mentioned boards. Perhaps it all had to go the way it did, just so I could get through it all... And, maybe, just so Christina would be in Salt Lake City, surrounded by family, when we would need the most help.

Whatever the reasons, I am sure of one thing: Heavenly Father never stopped watching over us.