Journal

Journal entry by Ricky Teachey

This is Rick- wanted to update everyone on the- sort of- final chapter of this late journey I have been on.

We did receive the genetic testing results back a couple weeks ago, and I have tested negative for all known Brugada Syndrome genetic markers, or for any other markers known to cause sudden cardiac death. This is good news in the sense that I don't have any additional genetic conditions that could have contributed to my collapse and SCD.

This is not all "good news", though. It has been confirmed- via the "procainamide challenge" of my heart during the EP study- that I definitely have Brugada. The genetic testing result just means that I do not have the known markers that cause it. The current belief is that Brugada is always genetic, they simply have not discovered all the markers. So I probably have markers that haven't been discovered yet.

This means that, since there are no known markers to find, we cannot genetically test family members (including our 3 kids, my sister and brother, and my parents) to determine if any of them may have Brugada. Instead, we can only wonder.

We will of course pursue this health issue with regards to the kids down the road. My understanding at this point is that pediatric Brugada cases are extremely, vanishingly rare, and it will only be later in the kids' lives that it will become a concern. At that point it will probably be recommended that they undergo regular ECGs, looking for the electrical patterns that indicate Brugada. If these are found, an ICD such as I have now might be a good option.

I very much thank everyone who has taken this journey with me. We are not at the end- the pile of medical bills on our kitchen counter remind me of that every day!, haha, my incisions are still healing, and I will have to have my device swapped out every 6 or 7 years. But I'm grateful to be alive and to be able to see my kids grow up, and to hold my wife's hand.

Rick.
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Journal entry by Jacqueline Teachey

Rick was released from the hospital around 1:15 today. We got home to Dayton a couple hours ago and are EXHAUSTED (and props to our awesome friend who literally made us an Egyptian feast to enjoy upon our return!). Everyone was in their pajamas and in bed by 8pm. We could sleep for days. Rick is sore but feeling normal otherwise - he will probably even go back to work on Monday.

Next step is genetic testing for Brugada markers (of which only about 40% are known), followed by testing the kids, siblings, and parents to see if they are also at risk for SCD.

At this point there will really not be much to update, so I think this will be my last journal entry. Thank you for your prayers and constant support during these few months - we are so blessed to have the community we have. Merry Christmas, everyone!

Love,
Jacqueline

Journal entry by Jacqueline Teachey

Rick is officially out of surgery and recovering at Central Baptist (which is now called Baptist Health, apparently). The ICD is in and everything went well.

Visitors are welcome - he is in the North Tower, floor 6A, room N611. The doctor anticipates releasing him before noon tomorrow (Saturday).

Good. Night.

Journal entry by Jacqueline Teachey

The doctor just completed the EP study and called me in for a consultation. Forgive the awkwardly worded language, it's hard to get all the medical jargon straight in my head.

Rick shows no indication of Long QT Syndrome, so the doctor has ruled that condition out completely (this is the condition Rick's doctor in Dayton originally thought he might have). Rick did show a strong presentation of Brugada Syndrome during the study today, when they did the procainamide challenge. Type 1 Brugada is a condition that causes an abnormal rhythm within the sodium chambers of the heart. There is no single test to confirm Brugada, so instead they have to look for markers by running a series of tests, such as the following:
  1. EKG: On November 28 the doctor saw an irregular heartbeat during Rick's electrocardiogram (EKG) that indicated Brugada.
  2. EP: Today the doctor saw a"strong marker" for Brugada during the electrophysiology (EP) study.
  3. Genetic Testing: The next step is to run a genetic test for Brugada Syndrome.
If Rick tests positive for the genetic markers for Brugada, the step after that will be having the kids (and his parents and siblings) tested for it. Generally this syndrome does not present until adulthood - it is known in layman's terms as the "Drop Dead at 40" disease. This condition can skip generations (it can present randomly, but that's less likely than inheriting it), which explains why he's unaware of any family history of it. If any of our kids has this disease they will need to be closely monitored once they reach adulthood.

The doctor is putting in the subcutaneous ICD as I type this. Thank you for the continued prayers. I will post again tonight once he is out of surgery and stable.

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Journal entry by Jacqueline Teachey

They just wheeled Rick into surgery. The doctor is going to do an EP study first, which tests the electrical system of his heart. There is a *slight* chance that the doctor will see the problem that caused his SCD, fix it, and then he won't need the defibrillator after all. More likely, however, is that they will do the EP study and then implant the ICD. Assuming there are no issues when they go in, the plan is to put in a subcutaneous ICD (less restrictive, which is optimal for younger patients). It is the size of a person's palm and will go in his left side.

We've been sitting around the prep area since 12:30 so to kill the time we watched the first two Back to the Future movies. As they wheeled him out I told him not to screw it up - his favorite thing to tell people when they are about to experience an important moment, haha.

(Also, anyone who knows us well would be aware that if Rick or I ever say something you don't "get," we are probably quoting Seinfeld.)

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Journal entry by Jacqueline Teachey

Yesterday Rick had his doctor appointment in Lexington (it ended up being Wednesday, not Tuesday, for reasons I won't bore you with). The doctor is extremely skeptical that the Sudden Cardiac Death (SCD) was simply a perfect storm event, particularly since his potassium level was at 2.9 (if it were 1.9, or even 2.3, he could see possibly dismissing it as a one-time event, but the fact that Rick's potassium level was as high as it was - and he nearly died - points to another underlying problem). The doctor said there is a possibility that Rick has something called Brugada Syndrome, which is a genetic disorder that causes arrhythmia. He wants to do genetic testing to look for markers for that as well as other disorders.

The doctor in Lexington was able to schedule Rick for an earlier surgery, so he will be having his ICD implanted a week from tomorrow, the morning of Friday, December 7. They will do an EP study at the same time to further identify the underlying cause of Rick's SCD, whether it is Brugada, Long QT, or something else. Rick will stay in the hospital overnight and go home to recover the next day. Recovery isn't too bad, from what I've read. He'll be on pain medication and the incision will be tender for awhile, and for 6 weeks he won't be able to lift more than 20 lbs, but other than that he can return to normal life. His permanent defibrillator battery will need to be checked every 6 months and completely replaced every 10 years.

All I have to say is: Thank God for modern medicine! Without it I would be a basket case any time Rick skipped a meal or got a little sick. As it is, he has been sick with a stomach bug since Sunday, and I had a hard time not panicking about it even with the Life Vest. REALLY stressful, so I can't imagine not having that safety net available. I don't think I could let him leave the house without having a panic attack.

Needless to say we were especially grateful this Thanksgiving as we celebrated together a week ago. That weekend Cal also turned 2. As we prayed together, visited family at the farm, celebrated with friends, and sang happy birthday to our son, all I could think about is how grateful I am to have my husband around. And my favorite quote with regard to thankfulness flooded my mind:

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.” —author Melody Beattie

Journal entry by Jacqueline Teachey

On Saturday we drove to Lexington to celebrate Rick's twin cousins Isaiah and Eliana's 1st birthdays (his cousin Chelsea's youngest kids). During the celebration, Rick got to talking with Chelsea's mother-in-law, who happens to be a cardiologist. She informed us of the following:
  1. The limitations with the transvenous ICD (the defibrillator that's implanted in the chest) are only TEMPORARY. Both Rick and I were under the impression that a transvenous ICD meant he could never raise his arm above his head or lift more than 20 lbs ever again (we attribute this miscommunication to a language barrier, as his current doctor has a very thick accent and can be hard to understand sometimes). So Dr. Hollingsworth assured us that the restrictions are only for about 6 weeks after surgery. This changes EVERYTHING about which ICD (transvenous or subcutaneous) Rick will choose to get!
  2. Chelsea's mother-in-law told us she could get Rick in to see an electrophysiologist in her practice next week, and that he could have the surgery at the beginning of December. Hooray!
Chelsea's mother-in-law arranged everything for us, so Rick's appointment with the new doctor is a week from tomorrow (November 27). Had we not gone to Lexington on Saturday we might not have learned that the restrictions with the transvenous ICD are only for 6 weeks, and we would have had to wait until the end of December for Rick to have surgery. Now, if all goes well, he will have it much earlier in December and we will still be able to go to Chicago to see my family.

So praise God for cousins' birthdays and mother-in-laws!

Journal entry by Jacqueline Teachey

We met with the electrophysiologist today to discuss next steps for Rick's heart condition. The doctor was quite frustrated to hear that Rick has not been taking his prescribed medicine. When the nurse asked him whether he'd been taking his beta blockers, he said "I've been reading online that they don't really do much..." at which point I whispered "But you're not a doctor..." and the nurse giggled. I love the man to pieces, but.... *shakes fist at the sky*  =) So. Even though the readings from Rick's Life Vest are concerning, the doctor can't legally or medically make the decision to put in an ICD until he has enough accurate data, and he can't get accurate data unless Rick is consistently taking the beta-adrenergic blocking agents.

Long story short: We have to wait 3 more weeks and then have another consultation. The doctor was gracious enough to go ahead and schedule the ICD procedure so we can get it done before the year turns over, but we won't know for sure for 3 more weeks. It is tentatively scheduled for December 20.

If I sound frustrated, I am. This has been an incredibly trying few months, and the stress of regular life has not ceased, so we are all feeling the anxiety here in the Teachey house. We need prayer regarding the following:
  1. That my husband will remember to take his pills.
  2. That the doctor is able to get enough accurate readings from Rick's Life Vest.
  3. Once the doctor has given the okay for the ICD (which it sounds like he certainly will, thank God!), we have to decide which kind of ICD to put in. One kind goes in his side and is quite obtrusive, but other than that there are no limitations. The other kind goes in his chest and will also help regulate his heart's rhythm, but it limits him to never lifting that arm above his head or lifting anything above 50 lbs. This is a hard decision and we need prayer for wisdom with regard to which ICD to implant.
In the meantime we've decided to go ahead with the genetic testing. Even though we won't have the results back in time for the consultation, it will be good to know if part of this is the result of a genetic disorder.

Journal entry by Jacqueline Teachey

Tomorrow is our appointment with the electrophysiologist to discuss next steps in this whole situation. The heart catheterization (Oct. 2) and the cardiac MRI (Oct. 25) showed nothing - Rick has a healthy heart with no blockages or significant abnormalities. If we understood our current doctor correctly, he has the attitude that if the tests show nothing, the Sudden Cardiac Death was just a fluke - a perfect storm of exhaustion, illness, and stress - and that Rick could probably go on with his life and have no further heart incidents. My issue is the "probably" part - I am not willing to take the risk that my husband will "probably" be fine. Our cardiac surgeon friend is skeptical, too. He said if Rick were his patient, he would not let Rick leave his hospital without a subcutaneous ICD. There are plenty of 37 year old men walking around who are stressed out, sleep-deprived, and sick, yet they are not dropping from SCD. There has to be something else wrong and it's not worth the risk of chalking it up to a "fluke" incident.

Furthermore, Rick's vest alarm has gone off multiple times (three times alone on Saturday!). Some of those alarms could be false readings, but perhaps not. All of the data is being sent to the doctor each time Rick changes out his battery. We are praying - and we ask all of our church-going friends and family to pray along with us - for wisdom in these next steps (wisdom for the doctor and for us). If the doctor will not put in a subcutaneous ICD, we will go for a second opinion, which will take more time. And his Life Vest is costing us $3,000/month, so we want to get this resolved as quickly as possible.

In the meantime, life has continued as usual. Rick is back to work, the kids are back to school, and "normal" has mostly returned. Cleaning up the house the other day I found this slip of paper that an emergency response worker handed to me in the emergency room. I was in complete shock, waiting in the lobby with Rick's brother and coworkers. After what felt like an eternity they let me see my husband. He was strapped to a gurney ready for transport, with a tube down this throat and blood all over his face. This sweet red-headed lady handed me a slip of paper with Rick's room number at Miami Valley (the hospital they were about to transport him to). I think I'll keep that paper as a reminder of that day. This Thanksgiving will be particularly overwhelming as I think about how much I have to be grateful for!

Journal entry by Jacqueline Teachey

Today Rick and family went over to Station 41 in Centerville to thank the EMS team who saved his life. They told us the story from their perspective, how at first it appeared he was having seizures, but then they realized his heart kept stopping and they used the CPR machine on him. They had to shock him 4 times and each time his heart would start beating and he would breath again, and then it would stop. We went there to thank them for saving his life - the kids brought candy and they got to walk around inside the truck that took their daddy from work to the hospital. It was a blessing to get to thank them in person.

In addition, we spoke to our heart surgeon friend yesterday (Rick had the facility send the MRI results to him) and basically the MRI showed nothing. There was one tiny observation, but he called it non-specific and something they see in normal patients all the time with no real risk associated with it (if it were more a pronounced of a finding it could be a risk factor for Sudden Cardiac Death, but again he said that it was non-specific). So the mystery continues.

Next step is genetic testing followed by implanting an ICD.

Journal entry by Jacqueline Teachey

Dear Becky,
Mitch told me that you were the one who ran into Rick's office and started doing CPR on Rick . . . and I am overcome with gratitude. The doctor has said multiple times that you literally saved his life. Had you not done what you did, he would have died. 
Sending a simple "thank you" email feels trite, but at this point, as I'm sitting next to Rick's hospital bed typing on my laptop, listening to him breathe, a simple email is all I can manage. Thank you for saving my husband's life. Thank you for running in there so that I would not be a widow at 36 with 3 small children. When he recovers we will find a better way to say thank you, but this is all I can manage now.  God bless you.
With Love & Gratitude,
Jacqueline Teachey

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Rick’s Story

Site created on October 1, 2018

Rick was at work on the morning of Thursday, Sept. 27 when his heart failed and he fell over onto his desk. Several of his coworkers heard the thud and rushed in to help him. One of them, Becky, began giving CPR. She saved his life - the doctor said had she not been there, Rick would have died, so praise God for amazing coworkers! We later learned that he experienced ventricular fibrillation and ventricular tachycardia, and he also had asystole. They brought him to the ICU where they cooled his body down to 92 degrees for 24 hours to prevent further damage to his brain and other organs, after which they warmed him up and as of Saturday, September 29 he is awake, breathing on his own. They determined that he experienced something called "Sudden Cardiac Death" (not a heart attack - he had no warning signs that anything was wrong, his heart just stopped suddenly and he blacked out). Most people simply die from SCD without warning, but thanks to his wonderful coworkers he is alive and walking around today.

His short term memory was shaky at first: He kept asking me the same questions over and over, and forgot conversations he just had and even forgot about people visiting. Thankfully his memory is improving as his body recovers from the trauma. Brain scans came back normal, so they know the problem is with his heart. He was released from the ICU on Tuesday, Oct. 2.

On Thursday, Oct. 4 (a week after he collapsed at work) they released him from the hospital wearing a Life Vest - a device he wore under his clothes that monitored his heart and, if necessary, would shock him if his heart stopped again. In December we decided to seek a second opinion with a more aggressive doctor to figure out why a healthy 37 year old man with no family history of heart problems would suddenly have heart failure. On December 7 we drove down to Lexington and Rick's new doctor did an EP study and then implanted a subcutaneous implantable cardioverter defibrillator (ICD). Rick was ultimately diagnosed with Brugada Syndrome, a rare genetic disorder affecting the electrical workings of the heart.

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