"Writing is not necessarily something to be ashamed of, but do it in private and wash your hands afterwards." - Robert A. Heinlein

Sunday, December 11, 2011

Good News and a Stern Warning (Heart Sick, Pt. 4)

First allow me to apologize for taking longer than I had planned to write this. I genuinely didn’t mean for so much time to pass before continuing. All I can say is that it’s right near the end of the school year and I’ve been quite busy. And now…

To recap… the doctor who had first diagnosed me wasn’t even my own primary care physician. But I had called their office – unable to do anything but breathe very shallowly – and another doctor in the office saw me that day. It would be tough to complain about that level of quality service, and I won’t. The doctor realized there was something amiss with my heart, not my lungs, and took an x-ray of it.

Let me be clear. I saw it. It was huge. When I was referred to the cardiologist, he ordered an ultrasound. The ultrasound confirmed that I had an oversized heart and that there were going to be complications and problems.

I have an arrhythmia. In my case, it takes the form of an atrial flutter. This means that it might, for no good reason whatsoever, simply start racing. The risk of sudden death, of going into congestive heart failure is minimal. It can happen, but it would have to get up to about 300 beats per minute and stay there.

There is also an increased risk of stroke, which is why they’re pumping me full of Coumadin and trying to thin my blood out.

On its own, an atrial flutter can be managed by medication, which is the goal.

While the doctors were learning what was wrong with me, I encountered a situation and had to visit the emergency room (story told here). The ER doctor who took care of me (I think I’m going to have to call him Dr. Doug Ross because… well, he was handsome) made sure I stayed there until my heart slowed and the beat got stronger. Before I was discharged, my heart had slowed to 94 beats per minute – the lowest it had been since this whole blasted thing began. He said the rhythm was strong and the beat was steady, and it was safe for me to return home. And he also gave me some really shocking news.

I’ll get to that in a moment.

A few days later, after I’d spent time at home doing nothing but thinking, I went to the cardiologist’s office for a previously scheduled appointment. The first thing he did was order an EKG. I sat through it and waited until the results were in.

It beat at 75 beats per minute – strong, steady, and constant. He smiled at me and said with some real deserved pride, “We are now chemically maintaining your heart.”

It’s better than it sounds. It means that the various pills I’m taking had taken hold and started working. As of right then, we are able to count on having my heart working like it is supposed to. I’ll have to keep taking the various medications for some time, though he and my primary care physician both said I may not have to be on them for eternity.

There is always the chance that the atrial flutter will kick in again and my heart will start racing, but the experts say the chance of that is much less now, and will be even less in the future. Apparently a heart in rhythm wishes to stay in rhythm.

The one thing I haven’t mentioned is the first thing that I was told – about my enlarged heart. There’s a reason for that. In the emergency room, Dr. Doug Ross told us that my heart, actually, was not enlarged.

My jaw dropped, and my girl and I immediately started questioning him. He insisted that he could tell the heart wasn’t enlarged. In fact, he had the hospital’s tech take two separate x-rays of my chest, to make sure. I asked him about the first x-ray taken and described what I saw. He made a point of telling us that if a chest x-ray was taken at an angle, it could ‘shadow’ and make the heart and heart cavity look much larger.

Between leaving the ER and seeing the cardiologist, we wondered if a terrible mistake hadn’t been made. Was that first one nothing but a shadow? Why did I have a hard time breathing the first time? Was it a racing heart that sent me to the ER or just a mad, bad panic attack?

With a list of questions written up and ready to go, I waited until the cardiologist had given me all the good news and started to ask…

No. He was firm about that. The ER x-rays were not accurate. I have an enlarged heart, he insisted. I gave him the same spiel that Dr. Doug Ross gave me about angles and heart cavities and misrepresentations…

No, the cardiologist said. An x-ray is like a shadow animal made on a wall – you can see the outline and shape of what I’m doing, but you can’t actually see what’s wrong with my hands.

Assuming that’s right, I asked, what is the best way to see what’s wrong with my heart? An ultrasound, he answered. He’d already given me one.

He reminded me of the same thing that Dr. Doug Ross had reminded me – I could seek a second opinion. I decided that everything would wait until I saw my primary care physician and see what he said. I had a chance to do that a little less than a week later.

He strongly suggested that I listen to the cardiologist. This is what he does, he said. He is a cardiac interventionalist. It’s his job to intervene and save peoples’ lives.

Neither my primary care physician nor the cardiologist said anything nasty about Dr. Doug Ross’s findings. Instead, they pointed out as an emergency room physician he knew a lot about a lot of different things. But a cardiologist is a specialist who basically knows everything there is to know about his specialty – which I fell into.

I’m still considering getting a second opinion, but I haven’t yet. It’s not because of what they disagree about; it’s because of what they agree on. An atrial flutter can be managed by medication, and that’s what we’re doing. But it can also make a pre-existing situation worse… which is why I don’t think the second opinion matters that much.

I weigh too much. Up until mid-October, I was a somewhat-regular smoker of cigars. I don’t get enough sleep, I wallow in too much stress, and I’m not getting enough exercise. Oddly enough, I do eat pretty healthily, but that’s about all I’ve got going for me, healthwise.

Whether or not my heart is enlarged – and for the record, let me state that I suspect it is – it doesn’t really matter. I need to continue to make some sweeping changes in my life. Improving my heart health happens the same time that I improve my all-over health. The doctors all agree that the best way to shrink my heart is to improve everything. The more weight I carry, the harder my heart works. I’ve quit smoking entirely, so my lungs will begin to return to a like-new condition and I’ll get more oxygen into my system with less effort. Getting sleep, removing stress… these keep my heart beating well, strong, and slowly.

I received good news. It just happened to come alongside a very stern warning: fix this or nothing will change.

I’m fixing this. I’m making the changes.

More next time.