the internist

[piranha]

on friday i finally had my appointment with the internist, dr w. this is the same internist the hospital was going to refer me to, but apparently that idea got lost between the ER doc and whoever else was involved in that game of telephone. then my GP was gonna make an appointment with another internist, and i don't know what happened there, but it never came about. finally, he said he'd call this one, and *whew*, this time it happened.

boy, am i glad, too. this is my kind of doctor. he's eager to find out what is wrong, he's curious, he does research (and as my luck has it, research on atrial fibrillation), he's gung-ho. he asked all the questions i thought from reading he should be asking (but which other doctors had only asked a subset of), and then some. he called the hospital to request my ECGs pronto (the ones taken while i was actually in afib). he took one right there. he was excited about my record keeping (i take my blood pressure twice and my blood glucose once a day and graph the data), he wanted to keep the graphs i brought. he was critical of some prior treatment where i had had questions (without me prompting it). he said i made the right decisions about low carbs, salt, and aspirin, and added anti-inflammatories and anti-histamines to the list of things i should stay away from. i did forget to ask how careful i have to be about caffeine; i'll ask that next time.

so now we're cooking -- i have more lab tests to do, and on thursday i do a stress test, and get a holter monitor and possibly another spiffy new machine he has, to measure stuff about my heart for a week. i am lucky, i found a fellow research geek. he might be able to use me for one of his studies; i'm fine with that.

i like him. he said "weight loss" but also said "i know, easier said than done, i am the posterchild for that" (he's chubby), so there was no particular stupid pressure, and i think i can get him away from that phrasing. i really like how engaged he was, and that he's not laid back about finding a cause -- even if we might not find one, he's not assuming that from the start, he wants to know.

generally healthwise i am ... mixed. my blood glucose levels were perfectly normal for several weeks, but this last week have been slightly above 6.1 and i am not sure why. my blood pressure is also not as low in the mornings as it was in the period before my last tach attack. but i have more energy, and i am doing more things. it all feels quietly precarious though, and any new attack will knock me over again. i am not sleeping in my room (because that's where i get these attacks -- i know this is pure superstition, but i feel better sleeping on the couch and just don't want to bother fighting it right now). the celexa still makes me mildly nauseated, so now i am taking it just before i go to sleep. no change in dosages, except for aspirin (halved it): metoprolol 50mg x 2, micardis HCT 80mg, celexa 20mg, aspirin 81mg.

Comments

[brooksmoses]

i am not sleeping in my room (because that's where i get these attacks -- i know this is pure superstition, but i feel better sleeping on the couch and just don't want to bother fighting it right now)

And, besides which, just because the only problems it might result in might only be psychosomatic, that doesn't make them not-real or not-problems. Bodies are liable to do strange things when their minds expect them to go wrong.

I'm glad to hear you've found someone good to work with!

[pir-anha.livejournal.com]

i generally prefer to not treat psychosomatic stuff as real, but to get over it because it is utterly not helpful to my life in general to give in to bullshit. heck, there isn't even any evidence that this _is_ psychosomatic, i am pretty sure it is not. it's just that this is an easy thing to be wimpy about because it doesn't really matter, and i have enough things to fight right now.

after getting the holter monitor, i will sleep in my room. :)

[brooksmoses]

That makes a lot of sense.

I didn't mean that this itself was psychosomatic, but that any additional effects that you might have from sleeping in the bedroom would be. (And I also meant that in the broader meaning of physical symptoms resulting from mind stimuli, not just the narrower meaning where the symptoms are also mental.)

[janetmk.livejournal.com]

That's very welcome news about the internist.

[platonios.livejournal.com]

I'm so happy to hear of your new doctor!
He sounds very promising...I hope he'll keep up to your expectations!

He reminds me a little of Dr. House, you know the part where he's eager to find the cause for your symptoms...minus the snarkiness ofcourse...

Be well, my friend...
and do ask about the caffeine I'm curious!

[aquaeri.livejournal.com]

I think a certain degree of superstition is okay as long as it's not harmful. I had problems with nausea recently which put me off my usual breakfast. I'm eating a nutritionally nearly identical breakfast for now.

[firecat]

What did he say about salt, and did he say why to avoid anti-inflammatories?

NSAIDS, salt

[pir-anha.livejournal.com]

no putting salt on food (which i had already decided on and implemented). greater care about consuming high-sodium foods -- but he didn't put me on a low-sodium diet. i've pretty much dropped all salty snacks, except for occasional peanuts, and i think i'll drop those too and make my own with no-salt spices instead.

NSAIDs provoke salt-water retention which is partly responsible for edema, and implied in an increase in blood pressure and decompensation of heart failure. this seems well-known though nobody said it to me before; when i looked it up i found lots of references.

i had edema quite some time before the first afib attack; i hadn't even realized how bad it was because it had been coming on gradually. the diuretic and diet changes seem to have taken care of it; my feet are back to normal, and i don't feel like my lungs are congested anymore either.

Re: NSAIDS, salt

[selki.livejournal.com]

Could you speak a little more on the diet-lung congestion thing?

I am glad this doctor suited your needs so well!

Re superstition: I'd say go with it for now. I wonder if the air quality could be worse in your bedroom, and lower oxygen could be affecting you? (sheer speculation)

[hmms-sio.livejournal.com]

my blood glucose levels were perfectly normal for several weeks, but this last week have been slightly above 6.1

You have seen this?:
http://www.nytimes.com/2008/02/07/health/07diabetes.html

(you probably have and I don't know enough about your background to know what I'm talking about)

[lorres.livejournal.com]

this is my kind of doctor.

Yay!!!

And psychosomatic head games just have to play themselves out, IMO. If you do what you think is going to be healthy for yourself, or relieve stress, or just psyche yourself out, it's a good thing.

I think James Hillman is useful reading for dealing with mind-body issues. Have you tried him ever?

[1ginko.livejournal.com]

Sounds like you have a good doctor, for which I am happy to hear. Sleep where you are comfortable, and do not bring guilt along. Hugs and better health wishes to you.

Doctors

[betonica.livejournal.com]

How excellent that you've found a new doctor who's an expert and works so well with you. He sounds like he really knows is stuff and, even more importantly, is enthusiastic and will get all the right stuff done. I'm also impressed with how much control you're taking of the whole thing - all those little details! Excellent.

[prairierabbit.livejournal.com]

This all sounds excellent--a good doctor can make all the difference in figuring out what is going on. I didn't know about the edema/NSAIDS link, and I find it very interesting. Go YOU!