Tuesday, May 13, 2008
Neither Ill Nor Nuts
I had a doubly reassuring doctor's visit yesterday.
To understand the emotional background here, you have to know that I have a long history of vague-but-mildly-alarming-symptoms that persist despite batteries of expensive tests showing that nothing's wrong. As a result, several of my doctors have, I believe, come to the conclusion either that I'm a hypochondriac or that all of my symptoms can be chalked up to my depression. This history has made me a little reluctant to go to the doctor (although I'm also, certainly, very glad that I keep getting excellent bills of health).
The most recent such fiasco was my second stress-echo test in three years: as longtime readers will recall, the tech was very unnerved by my EKG and said I might have to go straight upstairs for an angiogram, but the echo was normal and my exercise tolerance was great, so the cardiologist dismissed the EKG results as a false positive without even seeing me. (The same thing had happened during my first stress-echo, although I gather that the EKG results there were a little less dramatic.) My primary-care doc sided with the cardiologist and seemed somewhat less than sympathetic to my anxiety. Rightly or wrongly, I read into her response an eye-rolling "oh, here she goes again" reaction.
We'd been having other communication problems, and I finally realized that I was no longer very comfortable talking to her about symptoms, so I decided to switch primaries. I went back to the doctor Gary and I had seen before the most recent primary; he'd left that medical group to start his own practice.
I saw him last Wednesday. I'd asked for a physical but got a very perfunctory exam without even bloodwork; now I think this may have been because he thought the appointment was simply an establish-new-patient visit, not an actual exam. I asked him about the stress-echo situation -- he was the doctor who'd sent me for the first one -- and got a brisk, "Chalk it up to individual variation."
Thursday I started having mild fluttery heart symptoms for a few seconds every hour or so. I tried to ignore this: I had no shortness of breath or dizziness, and the end of the semester is stressful, and the last thing I wanted to do was go right back to my doctor with new heart symptoms and then be told they were nothing, thereby further eroding my credibility. So I waited it out. The palpitations kept on through the weekend, brief and sporadic but stubbornly persistent. Yesterday, during my final workshop party, I had one during which I got very dizzy and also started sweating a lot, although these symptoms didn't last long either.
Still no shortness of breath, and negative for nausea, chest pain, or radiating pain to the neck, shoulder or arm. But it was a little worrisome, and Gary and I are leaving on a long trip tomorrow, and the last thing I wanted was to be sitting on an airplane fretting about my heart.
So at 4:00 yesterday, I decided to go to Urgent Care. That way, I'd be seeing a new doc, who'd give me an EKG and undoubtedly tell me everything was fine; word of this would only get back to my new primary if something needed follow-up. It seemed like a reasonable compromise.
I went to Urgent Care armed with my knitting, two books, a bottle of water and a power bar. I expected to have to wait for hours. Amazingly, I was the only person in the waiting room, and I got taken back to an exam room immediately. I talked to a very nice nurse and then to a very nice doctor, who took an admirably thorough history and did a careful exam, and then sent me to another room for an EKG.
Which was, of course, absolutely normal. Both the nurse and the doctor had told me that they wouldn't be able to figure anything out unless I had an episode while I was hooked up to the leads. Naturally, that didn't happen. "This is the opposite of white-coat syndrome," I said glumly to the nurse, who laughed and agreed. But the minute she unhooked the leads, I felt the flutter again.
"There. I just felt one."
"Hmmmm. Let's hook you up to a monitor and see if one shows up, okay? I'll be right outside. Call me if something happens."
She hooked me up to the monitor and left. Nothing happened. I lay there feeling foolish. The doctor came in and told me that my EKG was "splendidly normal," and began explaining that my palpitations were probably -- although he couldn't know for sure without seeing something on a test -- premature atrial contractions, which are common, benign, and nothing to worry about. He told me that he's had them since he was sixteen. He carefully described how these happen, what they feel like, and under what conditions one should worry about them, and then told me that he suspected I was absolutely safe to travel, although it would be a good idea to follow up with my primary and have bloodwork done to make sure nothing's going on with my thyroid.
As I was lying on the table listening to him, I felt a flutter. "There!" I said.
"I saw it! I saw it!" He sounded like a birdwatcher who'd just spotted a particularly rare and handsome specimen. "Let's see if I can get it on a printout."
"It was a PAC?"
"Yes, it was definitely a PAC."
As it turned out, he didn't get it on the printout from the monitor, but at least I had official confirmation that my symptoms were legit. "I'm not crazy!" I told the nurse when she came back in to unhook me.
She gave me an odd look. "I never thought you were."
That's because you haven't seen me often enough, I thought. I got dressed, thanked her and the doctor copiously, and went back home, feeling much relieved. I'm not really sick, but I also wasn't hallucinating my symptoms. Given my state of mind when I went to Urgent Care, that's the equivalent of having my cake and eating it too.
And now I'm going to call my new primary and see if I can get the thyroid workup today.