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Archive for October, 2015

There is a Hawaiian saying that I love… i mua (pronouced ee mooh-ah). It means to go forward with strength, courage, and strong spirit.

I wish that for all of you.

Today is about moving forward for me as well.

I finally have a plan of action from my cardiologist. Dr. J.’s patient coordinator, K., and I have worked out a plan after several calls and emails back and forth. He doesn’t want to see me before I do another Cardiolite Exercise Test which will happen two weeks from now. It means I have to get up at the crack of stupid but what runner doesn’t do that—I’ll be running and even if it is only for a test, I’ll embrace every wonderful moment!

This time around, Dr. J. doesn’t want to consult with me after and instead he’ll let K. know if I can start running and going to the gym again. She said she’ll just wait for my call after the test but to give her 24 hours—apparently I have a bit of a reputation as the exuberant runner who calls the very next morning for results. Even though we both feel that I can be back to regular activities by early November Dr. J. just wants to be thorough given my history of surprises. The treadmill test with the cardiolite scans will show what is going on under the duress of exercise. It uses something called the Bruce Protocol which increases speed and elevation in timed increments. Generally it reaches an intensity that is above my norm. Think of a really steep hill that never ends and then, as you go higher, a grizzly bear starts to chase you so you have to run all out. It’s difficult but wonderful because it means I get to run even if it is for about ten to twelve minutes. From this testing the technicians and doctor can see many aspects of my heart function before, during and after the exertion.

I already have a follow-up echocardiogram and consult booked for December because of what transpired in August and we decided that I should continue with that appointment. I’m not at all surprised that Dr. J. doesn’t need to see me before then. I suspect this is because he knows that I am a very proactive patient that will do what’s best for my health by taking the necessary steps if an issue arises.

The best part is that if everything goes well I will be back to running in the next two to three weeks!

Yes… i mua seems to be the most fitting of sayings—moving forward with grace. 

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Here we are again with yet another of my post-hospital updates and I am hoping that this is the last one for a very long time. This was quite the adventure so you might want to get comfy for the long read. I’m going to start off by thanking my family and friends who were such a big support last week while I was in hospital and Bryan was stuck in Germany. I am grateful to have such wonderful people in my life.

You are likely wondering what happened seeing as I had an extremely mild heart attack in August and everything seemed to be going quite well. Things went a little haywire and I’m posting my story to illustrate how imperative it is that we advocate for our health—to realize that not all physicians know our bodies as well as we do.

I was back to running and feeling better than I had in a very long time. I had the all-clear to train for events again but I needed to build my base first. A Spring half-marathon was on my mind and my Cardiologist, Dr. J. was on-board with that as well. I went for a run on the trails with my teenaged son on the Sunday and then to the gym on Thursday. There was lots of walking on the days inbetween. It was almost 35K in a week which was more than I had done in some time but I was very cautious about not overdoing things. Friday evening I was tired but I figured that was because I was getting up really early every day and reading late into the night. Saturday I started to have warmth on the back of my neck, shoulder and arm. I went out to the camp gathering we were hosting and came home early. By Sunday it had worsened. My husband Bryan was heading to Germany for an important work project so I sugar-coated how I felt and he flew out Sunday on schedule. By Monday morning the pain was so horrible that I made the decision to go to the Emergency Room at Brantford General Hospital (BGH). I was sent home as the doctor felt it was muscle strain. Tuesday morning I walked my daughter to school and I also walked her home at the end of the day. The pain was worsening. About an hour after she went to bed it was as bad as it was before I went to the hospital back in August. I tried the Nitroglycerin spray that I had been prescribed and, after the third dose didn’t provide any relief,  my son helped me get ready for the hospital. I was on the verge of collapse so an ambulance was called.

Once in the ambulance the paramedics were having a tough time deciding if I should go to Hamilton or Brantford. My ECG wasn’t bad enough for them to take me straight to Hamilton General so BGH it was. I was taken immediately into the ER and my Troponin levels were tested repeatedly… they came back negative for heart attack. During the last round of blood work the technician couldn’t even get a teaspoon of blood from my right arm which was strange. The fact that I wasn’t having a heart attack was a relief however there was still gripping pain like someone was squeezing my heart. Sometime in the wee hours Wednesday morning I had relief from the pain because of a multitude of nitroglycerin doses and pain medications. I finally saw an Internist who told me he had a strong background in cardiology. We’ll call him Dr. A for now. We talked about my horrendous family history of heart disease, what I had been through, and then he said “I’m not accepting patients right now but I’d like to take your case on in my private practice.” Then he went on to say that he felt this was unstable angina and that he thought my cardiologist gave me false hope about the collateral artery business. Dr. A. acted as if Dr. J. was clueless. He wanted to send me home with an increased dosage of blood pressure medication, a nitroglycerin patch, and a pain medicine that I believe he said is normally used for gout so I wouldn’t feel the symptoms. I don’t have gout so I wasn’t sure how that would help but maybe I was missing something. I asked if I would be able to exercise. He bluntly said “no”. I asked if I would be able to walk Kaia to school. He said “no” again. So there it was… his solution was to cover the pain and have me become completely sedentary—a couch potato.

Not acceptable!!

My intuition told me I was heading for another heart attack. I knew I had a blockage… after all I’ve been in this position before and remember all too well what it felt like. I told him that I have a cardiologist that I quite like and that I live an active lifestyle that I am not about to give up on that easily. I insisted that he send me to Hamilton General for an angioplasty. Dr. A. told me that this idea was “ridiculous” as I had just had one in August. He said I “would be wasting everyone’s time” and that I just “need to learn to live with this unstable angina”. He told me I had done this to myself and I had to take my lumps. I let him know that if he discharged me I would go above his head at BGH or straight to Hamilton General’s emergency department. I mentioned that I know my body and that this felt just like it did the last two times. I asserted myself and he reluctantly relented. Dr. A. learned just what a strong advocate I am for my health. I told him that it seemed to me his policy was to wait until the patient has a heart attack rather than try and prevent it while my cardiologist’s approach is prevention. I reiterated that I was not about to go home and sit on my ass and wait for something more serious to happen.

Unbelievable!

Finally, after I protested quite strongly, Dr. A. gave in and said he’d call Hamilton General to see what they thought but that they would not likely take me in for an angiogram. He felt that they would deem it as useless as he did. He was being very pompous and clearly didn’t like that I dared question his judgement. He seemed very frustrated with my denial that his first choice of treatment was the right course of action. I didn’t care because this was my life hanging in the balance.

Come Thursday morning Bryan was still trying to get a flight home but I insisted that he stay and finish his work. Everything here was under control. I was booked to go to Hamilton for 10 am with the procedure to be done at 1 pm. Dr. A. came into see me before the transport and said “You can still stop this and save everyone a lot of resources. They will not find anything!” I retorted “You’ll find out today just how much I know my body.” I was upset that he would even say this to a cardiac patient before an invasive procedure. He was quite snotty about the whole thing and seemed aggravated that I even questioned his diagnosis and treatment plan.

I was transported to Hamilton shortly after the doctor left. The nurses remembered me from last time and were shocked to see me back. One of the nurses left my file where I could reach it so I decided to read through the report from the doctors in Brantford. Dr. A. and the doctor from Monday’s ER visit had put in my file that I suffer from acid reflux among other falsehoods. I think the only time I’ve had anything remotely similar to that is when I was in my last weeks of pregnancy and when I had the heart problems in August… that was my heart not reflux. It was also stated that I saw Dr. J. in September because of continued chest pain. More BS. I saw him because I underwent testing to see if I could get back to running and the gym. The notes painted an incorrect picture which I assume was because the staff didn’t pay attention to the history I was giving them or perhaps it was to cover someone’s ass. Who knows? Still, it was incorrect. The nurse reprimanded me for reading my file when I drew this to her attention. Oops. Apparently I am not allowed to see my medical file without permission even though it is about my health. Go figure.

The angiogram started right on schedule which is quite unusual—it’s a busy place. This time I had Dr. T. who is the same surgeon I had for the first angioplasty in March 2014 when I also had a similar battle about getting checked out. He is a fabulous surgeon and back then had found a blockage that many doctors would have overlooked as it appeared to be a shadow on the imaging more so than a blockage. This was due to it being near an abnormal bend in the artery. I was conscious, as always, during the procedure which is rather freaky. I couldn’t feel my body but my I was lucid and aware of what was going on. He accessed the heart through my right wrist and found a blockage, with the similar shadowing issues at a bend—this time in the other side of my heart. He looked at my right coronary (RCA), for what seemed like an awfully long time. He called in another surgeon to look as well. The contrast dye was increased and sure enough my RCA had a 90% blockage. He used a balloon and a stent to repair the issue. The investigation and procedure took just under two hours. It went flawlessly and I was sent to recovery. I had a slight hematoma starting in my wrist as the clamp was loosened but the nurse was right on top of things unlike last time with my leg.

Later Dr. T. came to see me and I asked if this was a new blockage. He said that was somewhat unlikely for a blockage of that size to pop up in less than two months but it can happen. He also told me that I have a myocardial bridge. That’s something I would have been likely born with but, despite two previous PCIs no one has ever mentioned it. Dr. T. said it was brilliant that I knew my body so well and advocated for the angiogram because had I not this would have resulted in a heart attack causing a great deal of tissue death or, even worse, my demise.

Gulp!

I was transported back to BGH at 7 pm. I got settled back into my room and Nurse Judy came to see me. I told her what had happened and that I wanted to see Dr. A. in the morning to talk with him. She said that she already saw the report and of course he would see me… after all he would be the one releasing me so it wouldn’t be an issue.

Fast forward to last Friday morning. Nurse Judy came with my release papers and they had already been signed by a doctor without anyone coming to see me. I signed everything and reiterated that I would like to speak with to Dr. A. I could hear his voice down the hallway. Two hours passed and Dr. H. came to see me instead. She got quite the earful albeit very politely as it wasn’t her fault that Dr. A. put her in this awkward position. Dr. H. also saw me back in August and knew a bit about my situation. I explained to her that I was upset with what had transpired and that I planned to pursue the matter of his unprofessional behaviour with the proper governing authorities.

What angers and scares me about this is that some most patients would have just accepted what he said to be the right course of action because he is, after all, the Doctor. I can’t fathom that Dr. A. was going to put me at risk for a potentially fatal heart attack so he could drum up business for his practice and how much he was belittling me in the process. I’m upset that he didn’t take my symptoms seriously and treated me like I was wasting resources. I’m appalled that he didn’t have the integrity to come and face me when it turned out he was very wrong. He could have at least apologized but I suspect this is a case of ego. What an… insert whatever expletive comes to your mind.

The bottom line and the reason I share this is to remind all of us that we need to advocate for ourselves because sometimes doctors are driven by agendas other than doing the best for their patients. We have to educate ourselves and be assertive about our care because, in many cases, the reality is that we are just another number. I was “bed 1 in room 558 on the 5th floor”.

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