And that’s why they always check your vitals

Sciatica brought Jim Leuenberger to UCHealth Primary Care – Lone Tree. The routine clinical workup found a serious problem with his heart.
March 7th, 2019

 

Jim Leuenberger on the trail near his and wife Susan’s home in January, where they walk several times a week.
Jim Leuenberger on the trail near his and wife Susan’s home in January, where they walk several times a week. Photo courtesy of Jim Leuenberger.

You know the drill: no sooner have you gone from waiting room to exam room for a doctor’s appointment – for a fever or a tweaked ankle or lower back pain or whatever – than they’re weighing and measuring you and listening to your heart and checking your pulse oxygen levels and blood pressure.

What does any of this have to do with a fever or a tweaked ankle or lower back pain or whatever? In Jim Leuenberger’s case (as with yours, most likely), nothing at all. But those routine checks can point the way to serious health problems. So it was with Leuenberger.

Last May, Leuenberger’s sciatic pain spiked to the point that he had his wife Susan make the short drive from their home to UCHealth Primary Care – Lone Tree. The Navy senior chief petty officer turned Colorado Department of Transportation leadership trainer might well have grimaced through that pain and driven himself, but there was numbness all down his right leg, too.

The UCHealth team in Lone Tree brought him back to an exam room and, as is standard practice, took various vital signs. His body temperature, blood pressure and pulse-oxygen levels were fine. But his heart thumped along at 145 beats per minute. That’s a normal resting heart rate for a baby; for a fit 60-year-old such as Leuenberger, maintaining such a rate would normally take strenuous exercise. Medically speaking, that sort of an elevated heart rate is called tachycardia.

Slow it down

Perhaps the pain from his sciatic episode had masked it, but Leuenberger hadn’t noticed his abnormal heartbeat. Dr. Luke Miller, assistant professor of Family Medicine at the CU School of Medicine, told him that, while this wasn’t an emergency, Leuenberger should get to a hospital for a more thorough workup. Susan drove him straight to UCHealth University of Colorado Hospital at the Anschutz Medical Campus (UCH).

Leuenberger checked in and had some additional tests done in the UCH Emergency Department before being admitted to the hospital’s Coronary Care Unit with fast atrial fibrillation (AFib) and heart failure symptoms. Once upstairs, Dr. Karen Moulton , a UCHealth physician and associate professor Medicine-Cardiology at the CU School of Medicine, took over his care.

“He was surprisingly tolerant of his fast heart rate, which was not easy to suppress with common medications such as beta blockers,” Moulton said. “He was in a lot of pain from his sciatic, which was his biggest complaint.”

A photo of Dr. Dilip Raghuveer
Dr. Dilip Raghuveer
Photo courtesy UCHealth

Moulton consulted with UCHealth rheumatology specialists, who gave Leuenberger an injection to quell the sciatic inflammation. For his heart, they did a cardioversion – an electric shock to jolt the heart back into a normal rhythm.

The cardioversion slowed down Leuenberger’s heart, but there were, as Moulton put it, “some extra beats, and we suspected he would easily go back into AFib.”

Cardiac cath

Which happened overnight, albeit with a slower rate of AFib. A second cardioversion also failed to return his heartbeat to normal. Moulton referred him to UCHealth’s Cardiac Electrophysiology team, the largest in the region, which specializes in minimally invasive cardiac ablation surgeries for heart arrythmias. These procedures involve interventional cardiologists snaking thin catheters through the femoral artery near the groin up into the heart. Diagnostic catheters help isolate heart tissue whose faulty signaling is causing the irregular heartbeat. With the offending area located, a catheter delivering either heat or extreme cold modify the offending heart tissue to isolate or ablate away the tissue in question.

Meanwhile, Leuenberger’s sciatic pain persisted through the injection and the muscle relaxants prescribed by the UCHealth Rheumatology and Pain Management teams.

“I couldn’t even walk to the bathroom. I couldn’t put any pressure on my leg,” Leuenberger said.

Through his five days in UCHealth Cardiac and Vascular Center, Pain Management and Physical Therapy staff kept working on his sciatic. They inked spots on his back, rump, and legs to show Susan where key pressure points were so she could continue to work on her husband after discharge, which happened after the cardiac ablation.

Back in – and back outside

Cardiologist Dr. Michael Rosenberg, assistant professor Medicine-Cardiology at the CU School of Medicine, and internal medicine specialist Dr. Dilip Raghuveer, instructor of internal medicine at the CU School of Medicine,  kept tabs on Leuenberger’s heart and sciatic at UCHealth’s Lone Tree clinic. As had been done at UCH, Rosenberg and Raghuveer coordinated to make sure that the medications used to treat the sciatic problem didn’t interact with heart medications. Such coordination of care is common, Raghuveer says, given that perhaps one-third of the patients he sees have complex medical issues requiring collaboration among providers in Lone Tree or between those in Lone Tree and the specialists at UCH, UCHealth’s academic medical center.

With physical therapy and Susan’s pressure-point massaging, the sciatic gradually improved. Leuenberger’s AFib, though, returned. In late August, he was back at UCH for a second cardioversion, which again didn’t quell the extra heartbeats, and then another cardiac ablation. That one seems to have solved the problem, he said.

Months later, Leuenberger is back to feeling more like his former self again. His heart beats normally; his sciatic is much better, too – though, he adds, it’s still a work in progress. He and Susan take advantage of sunny – and less-sunny – winter days and walk two-and-a-half to four miles on trails near their home in Lone Tree several times a week. He’s grateful for the work UCHealth has done, he says.

“I can say that I’ve had the best help – thorough in explanation, in follow-through, and in follow-up – and as far as just being honest with me,” Leuenberger said. “I said, ‘Just let me know everything. I just need to know.’ It was honest, sincere, professional care.”

https://www.uchealth.org/provider/wendy-tzou–md-clinical-cardiac-electrophysiology/