I don’t know if it was Annie’s ‘School-Marm’ manner, or perhaps he’d just had a bad day when they spoke, but Dr Heart-Less now appears to have had a change of heart. A copy of the referral letter arrives. It’s very chatty in style – he starts off by asking his colleague at the JR to put on the list for flutter ablation “this very pleasant gentleman”. (That’s me). Then some stuff about my medical history – not all incorrect – before the big one.
He explains I’m on the list for ENT surgery to try and improve my voice – “Mr Spratley was previously a very talented singer”. Hmm. I ask Annie – she says she never mentioned this. He goes on – as the voice procedure has been deferred because of the Warfarin, “he is keen to have the flutter ablation as soon as possible… enabling him to have further ENT surgery”.
I too have had a change of heart; the palpitations are back. It’s scary and unpleasant. And it presents me with something of a dilemma; what to do about it. Before I go any further I need to clarify the cast of characters. I decided a long time ago not to use real names, but to refer to people by the initial of their surname. However the two main protagonists in what comes next share the same initial. So I’ll just call them Consultant 1 and Consultant 2 (who just happens to be Dr Heart-Less).
Last month, when I was first admitted to hospital with palpitations, I saw Consultant 1 who prescribed Amiodarone. A few days later I was back and this time see Consultant 2 who says, quite forcefully, “Amiodarone doesn’t work for this” and prescribes beta-blockers instead.
Given that it’s now about a month later it strikes me that perhaps the beta-blockers are not working either, because my heart is racing like a car with its accelerator stuck to the floor. It’s about 130 beats per minute. I grip the kitchen worktop with both hands and face Annie; “I cannae hold her much longer Captain”.
So, do I tell Consultant 2 – who is now my ticket to flutter ablation – that I think he’s wrong?
My GP is very understanding and very good at explaining just what is going on. He draws a diagram to show the effect that Amiodarone and beta-blockers have on heart rate and explains that they do entirely different jobs – the former regulates an uneven beat while the latter slows down a faster beat.
My heart rate is back down to 80 bpm by the time I get to see him and he thinks the beta-blockers are working. He also thinks that as the days are getting longer, Amiodarone is best avoided because of its adverse reaction with sunlight. So I don’t need to tell Consultant 2 that I think he’s wrong.
But why the palpitations then? This time the episode has lasted four days – it makes me tired, breathless and sick. And scared. To put this in context – I get out of breath just brushing my teeth – I have to hold on to the washbasin – it’s that much of an effort. Other times I can run (albeit slowly) upstairs.
I explain to the doctor that this probably sounds daft but …. I’ve noticed that I seem to get these palpitations after a severe bout of coughing. Can a severe cough increase my heart rate?
I’ve also noticed something else that seems even stranger – if I put my finger in my left ear I cough. Oddly enough, I’ve noticed that if other people do this they often start singing folk songs.
This doesn’t happen with the right ear. And in case you’re wondering – I discovered this in the shower when I had water in my ears.
Apparently this is not as daft as it seems. According to my GP it’s all to do with the Vagus nerve. This nerve is remarkable – named from the Latin for wandering – because it meanders all the way from the brain stem to the colon. There’s one on each side of the body. Of particular interest to me is the discovery that the Vagus nerve affects heart rate and speech. It stimulates all the processes involved in the cough reflex. It also connects to the outer ear.
One of the main branches of the Vagus nerve is the recurrent laryngeal nerve – this passes down into the chest and then loops back up to the voice box. This is the nerve that was damaged during surgery to remove the tumour from my left lung.
Now it’s all beginning to make sense. Well, some sort of sense – it’s very complex and most of it is beyond me. But the gist (and comfort) – is that my observations of how my body is currently behaving can be explained. This wandering nerve is the key. It appears to provide an answer to my original question – a cough can cause the heart to beat faster. And it evens explains the finger in ear/cough business (although not the finger in ear/folk singing business).
I had originally gone to see my GP because I needed advice – I was convinced that either Consultant 1 or Consultant 2 had got it wrong and I needed to know whose judgment to trust. Of course this was the wrong question. The real question should have been – why do I still get palpitations if the drugs are apparently working? Now I know the answer – or at least, part of it.
A year ago it would never have occurred to me to question a doctor, let alone a consultant. With illness our confidence goes and we are left vulnerable and afraid – no more so than when lying in a hospital bed. It seems impossible to have a conversation of equals when one is horizontal and the other vertical.
How different the situation in the GP’s surgery; we face each across his desk. Eye contact is easy – he engages with me and I find it very easy to trust him. We agree that it’s a waste of time going back into the hospital each time it happens. The episodes appear to last for 3-4 days and then seem to settle down. If it gets really bad, he’ll refer me to the hospital for a modification to the beta-blocker dose (we don’t really define what ‘bad’ means, but I think I get the picture).
In the meantime I just need to try and avoid over stimulating the heart until the flutter ablation has been carried out. Annie and I have a trip to Paris in 2 weeks time – so easier said than done.
Viva Lost Vargus!
You are entering the zone Catholics call ‘mystery’ or Keats described as ‘negative capability’ – being in a state of apparent contradiction with no sense of discomfort. A happy place, if only it weren’t also connected to actual doctors doing actual things to your body. More negative than capability, mor missed err-y than mystery.
As to the pleasant gentleman, I am beginning to wonder whether his earlier question o Annie as to whether she was sure he had actually ever met you was actually correct. On the other hand, my iPod keeps randomly selecting your singing and so I have, in all fairness, to acknowledge that he indeed has.
All the best Ian!
Welcome to your new blog home Ian, I learn so much from your ongoing journey and continue to be inspired by you. You manage to demystify the most complex medical predicaments and not from the outside looking in but from the inside looking out- it’s a rare gift and a privilege to read.
BTW folk singers put their finger in the left ear either because the person on their left is tone deaf or they want to make that yelp/cough noise that is essential to a shanty. Proves your theory.
I was forced to read Alexander Pope at A level and hated most of it but its funny how, even after all this time, reading you entry brought some of it back:
“Who shall decide when doctors disagree,
And soundest casuists doubt, like you and me? ”
I think your GP is probably right. Keep away from hospitals if you can!