More Healthcare, Better News

(Continued from previous post)

On Wednesday I duly fasted and then headed to the clinic. I immediately saw the cardiologist, Dr. Salas, who reviewed my current health and family history. He took one look at my previous ECG and discarded it, saying that device was notoriously inexact. He even showed me on the computer print out where it said left ventricle when the data it showed as abnormal was about the right side of my heart.  He told me based on my physical condition, he really doubted I had any heart issue, but he had his own ECG machine with him, so he wired me up and ran the test.  He said it looked very normal, with just one reading slightly “off.” He suggested I come up to the hospital on Monday for a stress test, to put the issue to rest. I agreed, and he reiterated he felt confident the test would find nothing.

Next I popped into the surgeon’s office, who gave me another ultrasound. Sure enough, you could see my gallbladder very clearly. It is supposed to be a long oval; mine looked like a pair of connected golf balls. The surgeon told me this was probably a condition I was born with, but the small connection between the two parts of my gallbladder was probably closing from the gunk (my word) that goes through your gallbladder. This was causing the inflammation and other results noted in my blood tests. He said he has seen this condition many times, and most such patients eventually have their gallbladder removed.  He said I could wait until I have severe pain, or I could just have laparoscopic surgery anytime.  I scheduled the surgery and went home.

It didn’t take long for doubts to set in. I was so relieved by the cardiologist’s demeanor I probably would have agreed to a prefrontal lobotomy. Then I started to research gallbladder surgery, and I learned it is controversial NOB, as so many are being performed.  Most gallbladder removal is related to gallstones, which are very painful, but could be treated by preventive measures and lifestyle changes. I had no physical symptoms, just blood work and an ultrasound showing an apparently congenital condition. No one had suggested any diet or lifestyles changes. While the laparoscopic surgery is fairly routine, it is still surgery with a potential for complications. Friends reminded me that doctors here are used to older patients with adequate resources, so there is a tendency to over test and quickly resort to surgery.

I e-mailed my surgeon and asked for a written diagnosis so I could get a second opinion via my insurance, and cancelled my surgery. I will send a detailed e-mail to the Cleveland Clinic, which has a program to give second opinions on surgery for my insurance program.

On Monday, I headed to Guadalajara for my stress test. At the Angeles del Carmen hospital, I met with a cardio technician (Carlos) and a nurse (Edna) who would administer a sonogram and then a stress test induced by Douramine.  Basically they hook you up for a sonogram and an ECG, then administer a stimulant through an IV which causes your heart to accelerate up to your maximum heart rate. They monitor your vitals throughout, and constantly ask you to describe anything you feel. It was quite odd to feel one’s heart beating rapidly, without feeling the need to breathe quickly or pant, and while laying completely still.  Other than that, I felt fine. It took about 30 minutes total time, and cost 5500 MXP (about $300 USD).

After they gave me a decelerant to get my heart rate back down, I went back to the waiting room. Carlos came out and handed me a portfolio with written reports on all my heart data, an annotated ECG chart, and a DVD with all the numeric and visual data (in case I want to entertain my friends?). I went back to Dr. Salas office, where he reviewed the data. He said my heart is perfectly normal! The unusual result that the earlier ECGs showed is something my heart consistently does, so while it is not textbook, it is normal for me.  In my records, I had found another stress test done on me at National War College 20 years ago, and when I showed that to the Doctor, he pointed out even that result was consistent with the current ones. He told me to cut back on bad cholesterol, improve the good type, or he will prescribe statins for me. Other than that, all good.

So in the course of a single week, I went from feeling fine/eating whatever, to sick heart/bad gallbladder, to questionable heart/gallbladder, and back to healthy heart/need better diet. It was quite a ride, and a great dry run for dealing with doctors and hospitals in a foreign land, which is a major expat challenge. Lessons learned: be an educated patient, and research whatever your diagnosis is. Ask questions! Know what the doctors in your area are used to; it affects what they see and how they respond. There is an old adage for medical diagnosis: “when you hear hoofbeats, look for horses, not zebras.” It means look for usual causes first, not unusual ones. But what your doctor thinks is normal will be influenced by where they are and type of patients they see.

Sorry for the long post(s) and the unusual delay, but as you can see, I have been busy. Thanks for all the thoughts and prayers!

 

4 thoughts on “More Healthcare, Better News”

  1. Wow! Sounds like you got great care overall, but demonstrates that an informed patient is her/his own best advocate. I remember the War College stress test, including plunging your arm up to the elbow into a vat of ice water. Don’t give up beer!

  2. Glad to hear you are in good shape and rethinking the gallbladder surgery. Also glad that you subscribe to the philosophy of being an educated patient and asking a lot of questions. Muy bien amigo.

  3. Pat, I read your “sick” blog with great interest. Glad to hear all has worked out. In Dec. 2013, I ended up in St Barnabas Hospital in NJ not feeling well and some discomfort in my abdominal area. Long story, short-
    Spent Christmas recovering from gall bladder removal. Amazing thing is I actually felt better than I had in months. (BTW, surgery was very easy)
    Keep the faith- love reading your posts.

    Joe

  4. Tom and I are glad everything turned out okay for you! I think being an educated patient is important whether you are based in the US or an expat!

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