Another convenient thing about being a doctor (see first post/Nov4/2nd paragraph) is that with a modern patient portal you can half-ways diagnose yourself from the results, even if it’s not your specialty.
I’m in the hotel room after my day of testing and I wonder, surely, they must have a patient portal. I check. They do. I don’t even need a token or an invitation. All I had to do was answer some questions of public record that weren’t even my own:–they were my firstborn’s, but I knew the answers anyway.
All the results were posted and available for review except the PET scan results, which wouldn’t be available for 36 hours, which makes sense because those can read kind of scary to a non-medical person, and often read scary to us medical types as well. I didn’t even look at the blood work because after seeing the echo-cardiogram results, I knew that it was more likely my heart than it was my lungs.
It’s now 2:00 AM, the night before my heart cath.
I couldn’t sleep, and since I’ll be sleeping a good portion of this later morning, why let this time go to waste, especially as I’m so much more interested in time these days. Before I saw the cardiologist, I saw the fellow, and she discussed how my shortness of breath seemed to be out of proportion to the results thus far. She mentioned the possiblity of a restrictive cardiomyopathy, a term I was not unfamiliar with, but didn’t know much about other than, like many things medical, I remembered it with somewhat of a shudder. That happens often enough. In medical school and residency, you learn everything, and then you forget most of that except for what you routinely use; however, you recognize it when you see it, if you did your job, and then you learn it all over again only it’s easier this time because you already learned it once.
A restrictive cardiomyopathy is a loss compliance, or the ability for the heart muscle to stretch, so the chamber doesn’t fill with as much blood and becomes less effective at pumping so you get short of breadth with exertion, and that’s not good. It is rare however, which I think brings us to another possibility, which I think the cardiologist alluded to obliquely when I saw him after the fellow; but, he didn’t mention restrictive cardiomyopathy, specifically, to me, which I chose to interpret as a positive although I don’t mention rare bad things to my patients unless I am fairly certain it is a reasonable possibility.
As above, another possibility is tricuspid and mitral valve regurgitation (leaking) that is flow related. At least that’s how I think of it. I didn’t look it up and don’t remember that specifically from medical school; so, this is merely an exercise in Euclidean logic, but I’m good at that, always have been. I learned it from my high school math teacher in an upper level geometry class that he let me into when I was a sophmore, his youngest student, and one of the brightest in the class, in that particular topic. I was lousy at calculus, but somewhat of a savant in geometry for some God only knows reason. R. H. passed away last year and was well-loved, a favorite teacher of thousands down through the ages.
My Euclidean theorem proof for my heart:
Givens: 1. Moderately lousy valves between the upper and lower chambers of the heart. 2. Severe SOB with moderate exertion. 3. A severe lousy valve between the upper and lower chamber of the heart, especially the right side/ tricuspid will cause elevated right heart pressures. 4. Elevated right heart pressures cause SOB.
If increased flow across the valve, from increased blood pressure and/or increased heart rate increases the regurgitation, relative to rest; then, a moderately lousy valve can become a severely lousy valve with increased flows.
Therefore, my functional impairment with exertion may not be secondary to a restrictive cardiomyopathy; rather, secondary to a flow-related regurgitation of the tricuspid valve with exertion, relative to rest.
In medicine, as much as we like to learn about the rare things, the zebras; it is the common things that allow us to seem smart because, well, common things are common, and if presented with a range of possibilities, in choosing the most common one you will be right more often than not; however, that is most applicable to real life, because in training there is that fondness for zebras and thus your success rate will skew accordingly.
That is my fork in the road, door number one, a rare cardiomyopathy leading to an eventual heart transplant; or, a relatively much more common valvular heart condition that is repairable, or means not exercising or working hard the rest of my life; or, lastly, I should probably list:–it’s all in my head, and I’m crazy, which is a distinct possibility at this point.