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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