Heart Doctors – enter No.3

I’m at the hospital for a Heart Echo scan and a follow-up consultation to my short stay back in February.  Now this is where it gets complicated; I had two short stays in February – during the first I met Consultant Number 1 and during the second I met Consultant Number 2 (AKA Dr Heart-Less).  Their strategies for dealing with my heart problems were quite different; Consultant 1 was sympathetic to the complications caused by Warfarin therapy and my pending voice procedure while Dr H-L thought it all stuff and nonsense.

As a consequence, their respective drug regimes were quite different; Consultant 1 prescribed Amiodarone (bad move) and Aspirin (good); Dr H-L prescribed Beta-Blockers (good) and Warfarin (bad).  Furthermore, Dr H-L decided that Cardio-Ablation therapy was the only sure way of dealing with Atrial Flutter and referred me to Oxford for ‘urgent’ treatment.  If you’ve read the entry for March 19th you’ll recall that he forgot to write the letter and there is now a 3-month waiting list.  So I’ve been looking forward to this consultation, because there are lots and lots of questions that need answering.

I am surprised to find that this particular clinic is being run by Consultant 1 and his team.  I had assumed that Dr H-L was now in charge of my case.  Indeed as we walk into the hospital we see him in the corridor talking to someone; he’s fidgeting, swinging his stethoscope around giving an impression of impatience and boredom.  Then a few moments later he walks through the waiting room, one hand in his trouser pocket, the other still swinging the stethoscope. Annie’s never met him, although they’ve had a robust phone conversation, and from her years of teaching quickly identifies him as a potential ‘naughty boy’.

I don’t actually see Consultant 1, but one of his Registrars instead.  She is, in a word, brilliant.  Her manner and recognition of the process we’ve been through, suggest that this is someone we can have a serious talk with.  She begins by recapping my medical history but soon becomes lost – I’m not surprised she’s confused.  I had anticipated a moment like this.  Each time I end up in hospital I have to recite a list of dates and procedures; difficult because they go back over 5 years and because speaking at length is such an effort.  So I produce a document, a complete chronology of every procedure, consultation, treatment and outcome since initial diagnosis in December 2005.  She is mightily impressed and grateful and suggests scanning this in to my notes.

Just prior to seeing her I’ve had an ECG and a Heart Echo scan; the results show a heart that appears just hunky dory.  No sign of the Left Ventricular Failure identified in a similar scan last December.  And a steady, Flutter-free ECG printout.  The Beta-Blockers are clearly doing their job.  “Do you really want to go through another procedure?” I do the old ‘whatever it takes/it can’t be any worse’ routine.

She goes through a risk checklist; have I’ve ever had a stroke? Smoked? Diabetic? Chest pains? A history of heart problems? “And you’re not a woman”. (Pregnant women with AF are at risk of heart problems).  She identifies me as low-risk as far as strokes are concerned. “Ablation is not really appropriate for someone like you”. I wonder why it was suggested then.

I show her a copy of the referral letter to Oxford.  Her first response; “Why was this written on the 8th March if you were seen in the middle of February?” Why indeed.  Is this the time to be indiscreet about a colleague?  It gets better (or worse depending on your point of view); “hmm – that’s not right” and finally, “there’s no record of this letter on the hospital system.” I look at Annie and smile.  Why are we not surprised by this?  Perhaps this is the only copy in existence – the one supposedly sent to Oxford, a fiction.  Could there be a Black Hole over the hospital where referral letters, having lost their battle with gravity, are never seen again?

And then I envisage a frown and sucking of teeth from Dr H-L when she asks what I actually want.  What is it that I want to happen next?  I explain that a few days after lung surgery I was riding an exercise bike – and before that I could cycle 20 miles in just over an hour, while now …..  I make it clear that I do not expect life to be exactly as it was before; but I was reasonably fit and healthy – I could move around without huffing and puffing all the time – and just want to get back to some semblance of that life.  (I also mention the singing but she thinks that’s a “lifestyle thing” and so we don’t pursue it).

Without actually saying as much, she concludes that the chest pains and breathlessness may not be related to the heart at all (something I have often wondered myself).  Perhaps it’s the lungs?  Sounds a bit radical to me.  Or what, in modern parlance, is called ‘thinking outside the box’.  What we used to call holistic or systems thinking – the bigger picture.

She comes up with a new plan; I should have the voice procedure as soon as possible because the failure of the vocal chords to close properly is exacerbating the breathlessness.  The catheter ablation therapy is to be postponed until they can establish whether or not I do have a major heart problem, rather than what now appear to be inconvenient, post-cancer treatment, fluctuations.  She will refer me to a Respiratory consultant to assess the state of my lungs.  I will stay on the Beta-Blockers for the time being and as soon as my INR drops to less than 1.5, stop the Warfarin and take Aspirin instead.  This sounds like a good plan.  But as she goes off to check it out with Consultant 1, I see a potential flaw.

All of this is predicated on my answers to her questions; that my understanding and interpretation of my medical history is accurate.  Some questions are easy – “have you ever smoked?” No.  Others are more difficult.  I say “no” to Diabetes because I assume I’m not.  But I’ve never been tested.  Does ‘chest pain’ only refer to the sort of pain that results in a dramatic clutching of hands on heart, in a manner much favoured by film and television, or can it also include a dull ache around the chest area but seemingly from nowhere in particular?  I own up to the latter – and assume there’s a difference between the two.

And there are some things I just don’t know the answer to:  “Is there a history of family heart problems?” My father died over 40 years ago from the consequences of Progressive Muscular Atrophy.  Perhaps he didn’t live long enough to acquire a heart problem.  And all his relatives are long gone.  My mother died over 20 years ago so she’s not around to ask.

The Registrar returns – Consultant 1 has approved her plan.  In addition to the above, I get to wear another 24-hour heart monitor, just to be sure.  She will write to Mr ENT asking if I can have the voice procedure before my next Cardio appointment in 3 months time so that they can try and eliminate vocal breathlessness from the equation.  Quite a change from when we first walked in.  I hope she’s right.  And I wonder if they’ll give Dr H-L a detention.

And then two coincidences – so coincidental as to be spooky – as if the fate fairies are at work.  First, a phone call from L, the speech therapist I saw last year.  I’m at work so she talks to Annie who fills her in on recent events.  L is convinced that lung function is at the heart of all this so makes an appointment for me to see her to sort out some breathing exercises and breath control.  You’d think we all know how to breathe properly as we do it each day, but not so.  Well not efficiently anyway.

And then a call from the lovely admissions lady at the hospital offering me a new date for the Voice Op – in just X weeks time.  (I’m being deliberately coy about the date in case it doesn’t work again – expectations were so high last time).  She rings before the Registrar has even had time to write to Mr ENT.  It appears they had a cancellation and wondered if I was off the Warfarin yet.  So I have (X-1) weeks to get my current INR of 3.3 down to less than 1.5.

And with that last paragraph, dear reader, I have not only conveyed the drama and excitement of the next few weeks, but also provided you with an answer to your children when they say “why should I study Algebra at school because I’ll never use it once I’ve left?”


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1 Response to Heart Doctors – enter No.3

  1. Frank says:

    I can’t begin to imagine how exhausting your life must be. I struggle to keep track of meetings, gym sessions, occasional theatre trips, and a bit of shopping. And I’ve got an iPad!
    Just to keep you in the loop, my current favourite phrase is ‘following discussions’. this appeared in a recent email from the VC announcing the departure of a senior person to ‘pursue other interests’. Translated, this appears to mean, ‘I’ve told X to piss off out of here’. Cheering and chilling at the same time. Impressive that he puts the boot in at the top though.
    Anyway, here’s wishing you all the best for the vocal op. Interesting that one medic’s ‘lifestyle choice’ is another’s key to the kingdom, or lungdom.
    Keep well!


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