The Trauma of Treatment
Edith Cook
Miss Edith
(Dr. Edith Cook)
Published November 21, 2024. Editor’s Headline” Heart Felt.”
When you go to a specialized physician you haven’t met before, you assume he’ll be competent and rational when deciding your treatment. He’ll select the best approach for you and follow through.
Such was my assumption when, early this year, I began struggling with shortness of breath. My primary-care attendant recommended I consult a Wyoming cardiac group. They ordered an echocardiogram, a procedure I’d undergone before. The cardiologist who reviewed it said it showed considerable degeneration from the earlier one: The leakage from my mitral valve had gotten substantially worse.
For the past thirty years, I have known of the mitral-valve leakage or “regurgitation” within my heart. With regurgitation, the mitral valve doesn't close tightly; as a result, some blood leaks back through the valve. The heart has to work harder to get blood to the body. When the blood is regurgitated backward, it increases the pressure within the heart. This can lead to muscle damage as well as high blood pressure in the lungs.
“In your case, the leakage is minimal,” said a Tennessee cardiologist thirty years ago. “It causes a heart murmur, but lots of people walk around with a heart murmur. You won’t have to worry about it until you’re eighty, if then.”
As I crossed that age milestone, however, symptoms appeared beyond the murmur. I learned that mitral valve regurgitation can increase the risk for other heart problems, such as atrial fibrillation (AFib), which results in a fast and irregular heartbeat. AFib can also lower the heart's pumping ability and increase the risk of stroke. Mitral valve regurgitation can be acute or chronic. My case is chronic now, meaning the valve has leaked more and more over time.
“We can fix this with a mitral clip” said the Wyoming cardiac surgeon early in 2024. “It’s ‘minimally invasive’; that is to say, it’s heart surgery but not the old-fashioned open-heart surgery. I’ll insert a wand through an artery or vein at the groin, whence it wends its way to the heart.”
He explained that the “wand” is pushed forward by an outside contraption. At the foremost end of the wand, a tiny set of pincers carries the precious clip that will seal the mitral valve where it leaks.
“We need one more test,” he said. “To determine whether your arteries and veins are free of obstruction. At the same time, we’ll examine your esophagus, to make sure it can accommodate the tiny camera which my colleague manipulates on the computer to make sure the clip goes where it’s needed.”
Another cardiologist from the group performed the vein-and-esophagus tests while I was under anesthesia. At conclusion, he said, “I looked at your mitral valve from another angle, The regurgitation isn’t that bad.” He added, “It won’t need correction.”
“I was under sedation,” I said. “With anesthesia and additional oxygen, my heart got a respite from having to work hard.” When I rested at home, I explained, my heart didn’t act up.
The cardiac guru did not take kindly to my objections. He became testy, not taking kindly to a layperson’s challenge of his expert opinion. Later I realized, had he taken a look at the blood test results, he would have understood the problem. Only months later, at a visit to the Emergency clinic of the local hospital, was I informed that a certain value, which should have hovered around 49, had spiked to 352.
Mitral valve regurgitation can increase the risk for other heart problems, such as atrial fibrillation (AFib) which results in fast and irregular heartbeats. AFib can also lower the heart's pumping ability and increase the risk of stroke. If left untreated, the condition can lead to heart failure—and I was having atrial fibrillation now and then, I knew, with “moderate-severe” mitral disease, the quicker the surgeon stops the leakage, the better the outcome.
On the FollowMyHealth client portal, I found the remark, “Moderate to severe mitral regurgitation; mitral valve moderate prolapse.” Yet, even though the transesophageal and vein tests showed no restrictions, treatment came to a standstill.
I sent a letter to the first cardiac surgeon, reminding him he had found “significant” mitral regurgitation, along with attendant edema; his echocardiogram had revealed “a moderate bileaflet prolapse with moderate-to-severe mitral regurgitation.”
He ordered more tests, the outcomes of which no one ever explained. Each time, a different cardiologist within the group did the tests; I was never informed of the outcome. Although I found the results on my client portal, my partner and I couldn’t make sense of them.
My primary-care attendant urged a second opinion. The first surgeon responded, saying he would recommend me to a specialist in Colorado, and that he’d forward the records and test results the Wyoming group had gathered. Despite the marvels of modern-day communication, sending huge files of information took time.
By now it was late summer. Obtaining an evaluation date with the Colorado group was difficult; everyone was booked three months out. One time I got so sick, my partner drove me to the Emergency clinic at the local hospital. The team there expressed strong concerns as a result of the blood tests they’d ordered.
“I have a consultation date in early November with a cardiac surgeon in Colorado,” I told them.
“Be sure to keep the appointment,” they urged me as they handed me their findings.
“I will,” I said. I knew people who died of heart failure.. At fifty, a friend in Germany died alone at home; unable to crawl to the telephone. In California, a young woman who was on our lids’ swim team, collapsed and died after a jog at the beach. She was twenty-eight.
The Colorado surgery team met with me after they’d ordered (and obtained) their own echocardiogram. It showed my heart existing along the lines of “congestive heart failure.” In the meeting with my partner and me, they said surgery was urgently needed. Luckily, they had a cancellation for November 15, 2024. Did we want to return to Colorado on that date?
“By all means,” I said.
The rest is history. My heart is alive and well, although some minimal regurgitation remains. One clip wasn’t quite enough, yet there was no room for a second one. Still, my partner and I are happy. It’s good to look forward to a future together even if, at our age, that future may not stretch very long.
Kudos to our host in Fort Collins, who went beyond the call of duty as he opened his home to us on short notice. Kudos also to my partner and sweetheart: Could I have managed without him, repeatedly running after test results? I’m so glad I didn’t have to find out.
Why did the first surgeon change his stance late last spring? Was he the newcomer bullied by senior colleagues? I’ll never know.
Patti Sherlock
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