Cath Lab Digest - September 2007 - (Page 40)

40 PERSONAL ESSAY SEPTEMBER 2007 The next day, I ended up in another ER where I was given a spinal tap and an MRI. The MRI showed that I had dissected my left vertebral artery. After being stabilized, I was sent back to the first hospital I had been to because that is where my primary physician was on staff. By this time I had the “worst headache of my life.” Beading on carotid ultrasound Courtesy of Dr. Jeffrey Olin Medial Fibroplasia Courtesy of Dr. Jeffrey Olin Medial Courtesy of Dr. Jeffrey Olin The rest of my story involves almost being sent home again. Being a nurse, I challenged the physician’s knowledge and he re-evaluated my case. Had I been sent home, I would have had a massive stroke and died. Even after that I was misdiagnosed again. If it weren’t for my nursing training, I most likely would not have survived this ordeal. I ended up dissecting my left vertebral and bilateral carotid arteries. Months later, I continued to be symptomatic and went to see a vascular doctor at The Cleveland Clinic. My physician decided they should do an angiogram to look at the arteries. It showed areas of stenosis and a “classic string of beads” appearance, which is characteristic for fibromuscular dysplasia (FMD). My physician also looked at my renal arteries. My right renal artery was also affected, which explains the sudden onset of hypertension. From the dissections, I formed carotid aneurysms and needed to have stents placed in my carotid arteries. In 2001, a Multi-Link Tetra stent was placed in my right carotid and a year later, I received a JOSTENT in my left carotid. Since the second stent, I have been doing great. The stents really made the difference for me. (Unfortunately, I learned an FMD patient who was stented the same day and who received two stents in her left carotid artery had an episode last July. Both her carotid arteries collapsed and she had a severe stroke.) I go in for yearly checkups on my carotid and renal arteries. My carotid arteries look great and it appears my right renal artery has more stenosis now than a year ago. For now, I will continue taking blood pressure medication and diuretics. At some point, I will need to have a angioplasty on the renal artery. As a result of my experience, I have changed my focus and am doing everything I can to raise awareness of FMD. FMD is more common in women and is a cause of stroke. It was only last year that the National Stroke Association listed FMD as a cause of stroke. FMD can appear in any arterial bed, but is more common in the renal and carotid arteries. I know of several patients with mesenteric and subclavian FMD. Most of my physicians were not familiar with FMD. Everywhere I go, I need to educate my physicians, but this is changing. I survived with no permanent disabilities — I am one of the lucky ones! ■ Pam Mace is a registered nurse with 14 years of experience. She currently lives in Milton, MA and works in the emergency room at Milton Hospital. Pam has also worked as the Clinical Director of Emergency Services at Lincoln Park Hospital in Chicago. She has worked in the cardiac cath lab, critical care transport, ICU, and CCU. She is currently the President of FMDSA and is dedicated to raising awareness of fibromuscular dysplasia. The University of Michigan has also gotten involved with the FMDSA organization and is working out the details of a patient registry for fibromuscular dysplasia. Pam can be contacted at pam.mace@ fmdsa.org. More information is available at The Fibromuscular Dysplasia Society of www. America (online at fmdsa.org). Letter to the Editor Dear Cath Lab Digest, My name is Dave Hartman. Although I have been a licensed paramedic for 25 years, I have worked as an invasive cardiology special procedures technologist for St. Joseph Mercy Hospital in Ann Arbor, Michigan for the past 7 years. Dr. Mansoor Qureshi of the Michigan Heart and Vascular Institute is planning a project to initiate cath lab services in Rabwah, Pakistan in November 2007. I plan on accompanying him to assist with medical procedures and training of staff. The project will take place at the Tahir Heart Institute of Fazl-e-Omar hospital. F.e.O. is a 90-bed hospital with complete Toshiba 5-Axis digital angiography system, but as of yet, no trained staff or materials to perform diagnostic or interventional procedures. A consulting cardiologist will arrive in August to begin seeing patients. We plan to arrive the last week of October and stay for 4 weeks. In addition to performing patient procedures, we plan to train resident staff in BLS CPR, sterile technique and invasive procedure assistance. On our departure, staff will be capable to assist visiting interventional cardiologists. Eventually the plan is for a permanent interventional capability. Fazl-e-Omar and Tahir Heart Institute are both non-profit organizations that were paid for with donations and built by volunteers. Rabwah currently has a population of around 11 million within a 60kilometer radius. There is 1 CCU bed per 70,000 people. There are no cardiology services available. We hope to initiate the infrastructure to bring better health care to the people of Pakistan. While I have not worked in this part of the world before, I have done projects in Central and South America. The largest was design and implementation of BERT, the NGO designated by the government of Belize as responsible for Emergency Medical Services. I feel confident that we can bring the Pakistan project to fruition. Our project costs are estimated at $10,000 U.S. Accordingly, we are seeking grant monies and donations. Any and all gifts will be gratefully accepted and acknowledged. Any excess funds will be left in place for material acquisition. Please feel free to contact me at wdh@acd.net with any and all questions. Thank you for your time. Sincerely, W.D. (Dave) Hartman BS EMTP I/C. St. Joseph Mercy Hospital Ann Arbor, Michigan wdh@acd.net ■ http://www.fmdsa.org http://www.fmdsa.org

Table of Contents Feed for the Digital Edition of Cath Lab Digest - September 2007

St. Dominic Hospital The Genous Bio-engineered R Stent Percutaneous Treatment of Peripheral Arterial Chronic Total Occlusions: Device Options and Clinical Outcomes Contents Clinical Editor’s Corner Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How? Myocardial Infarction and Syncope: A Manifestation of the “Raynaud-Prinzmetal Syndrome”? Essential Technical Components of the Transradial Approach If You Build It, Will They Come? Evidence-Based Medicine with Drug-Eluting Stents Back to School: The Value of Education in Cardiovascular Services The ACVP Standards and Competencies: Are You Using Them Effectively? What Do You Think? My Experience with Fibromuscular Dysplasia and Stroke A Brief Review of Fibromuscular Dysplasia Letter to the Editor A Look at On-the-Job Training: Perceptions, Reality and Our Profession Doing the Wave: Inventory Management with RFID The Ten-Minute Interview with… Paul Pinsker, RCIS CLD’s Annual Salary Survey Harrisburg Area Community College Volunteer Survey CEU Education Center SICP* Section Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Clinical & Industry News

Cath Lab Digest - September 2007

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