Saturday, September 1, 2012

It’s Not the Annual Physical, It’s the Tests

My primary care provider is a fine doctor; she is intelligent, kind, and a good listener; I enjoy talking with her when I have my annual physical each year.  What I dread are the tests, not because I mind being punctured or scanned or even having a certain amount of my time wasted, but because they sometimes force me to fend off unwanted medical interventions. 

Twelve years ago, when a previous doctor offered statins to lower my cholesterol, I said that I would try diet and exercise instead.  Diet and exercise worked, end of discussion.  A couple of years later when a bone scan revealed osteopenia (low bone density), Fosamax was pressed upon me.  I have never broken a bone and I think there is still a lot that medical science doesn’t know about bone quality so I said, “No, thanks.”  My doctor was a little offended.

The real fun started two years ago when a radiologist looking at my current mammogram thought he saw signs that might indicate cancer and recommended a biopsy.  (See the whole story in “Mammograms and the Cost Conundrum,” 8/22/2011.)  In my family cancer is almost unheard of and I am generally quite healthy so I opted for a second opinion, a move that clearly annoyed him.  The second radiologist found nothing wrong and still hasn’t.

This year the issue was heart disease, a matter I take very seriously because strokes and heart attacks are what kill most people in my family.  My PCP thought she heard a heart murmur so she sent me for an echocardiogram.  My doctor said it might be nothing:  apparently in very fit people a strong, vigorous heartbeat can sound like something wrong.  So I went for an echocardiogram.  As a side note, the technician took my blood pressure while I was sitting up talking to him.  When I saw on the screen that it was 140 over 80-something I said, “That’s much too high, let’s do it again.”  I lay quietly for a few minutes and my bp came out 118 over 63, still higher than my true number of 106/58, but at least within the normal range.  I’ve noticed a lot of medical personnel doing this:  not letting you sit quietly for a few minutes before taking your blood pressure.  Surely they know that the reading won’t be accurate; most people’s bp is higher in a doctor’s office and this just makes it worse. 

A doctor in Indianapolis read the echo and sent back a report saying that I had a “’pseudonormal’ filling pattern of the left ventricle for age (Stage 2 diastolic dysfunction).”  My PCP asked me to see a cardiologist.  My first move was to pick up a copy of the report from her office and try to learn more about what it meant.  According to several online sources, Stage 2 diastolic dysfunction is when you get shortness of breath, chest pain, and exercise intolerance.  This sounded like my father a few years before his death; it did not sound like me, with my P90X and cardio workouts.  

So I went to the cardiologist, a man widely respected for his medical expertise and his philanthropic work.  I was a little intimidated by his reputation and worried that perhaps there really was something wrong with my heart after all.  His waiting room was reassuring.  There were beautiful photographs on the wall (his work?) and a friendly receptionist.  In the examination room was his medical degree, from a university I had also attended (at the same time, it turned out).  The cardiologist was my age and a fitness buff like me.  He listened to pulses from head to foot, prodded my abs, and told me he didn’t hear a heart murmur.  Of the report he said, “I don’t know where he got this!”  Of my list of supplements he said that some of them probably weren’t doing me any good but there was nothing that would hurt me.  His recommendation:  “Don’t change a thing; just keep doing what you’re doing.” 

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