On April 3, 2011...

Hi Jim - So glad to hear that you're resting and getting stronger in Panama, Yeah, sure, e.i your cement worker (where would he be without your reaching out to him literally), but that's you!

I have a story to tell that I don't tell to many because it's hurtful. My brother at age 43 had a massive heart attach (no prior warning) and my Mom and I had to watch him be denied a approved heart transplant because his attachment "places" were mulch and they had nothing to attach it to. Dr. Albright at Millard Fillmore Gates (a wonderful, compassiponate & informative Doctor) used the balloon to keep him alive for the next day but we had to "pull the plug". You can see how this relates to Sharon's friend, who is also in my prayers.

I'm sharing this with you because you sought help as soon as you knew your prior prognosis was invalid and that probably saved your life. My prayers have been with you throughout.

Get well, don't worry, be happy.

Hope to see ya soon, Dee

On March 20, 2011...

To Jim and all re the docs and not discovering stuff. For what it is worth here's some of my lessons for sharing. When looking for a doc in the 80s, I chose one mostly on the basis our neighbor good friend, a GP (DO...I prefer DOs, actually) used the doc for his family...rational was if a doc would choose a GP for his family, probably he feels confident in the doc and should be good for me/my family. And, the doc was, for a long time. Some time after this doc diagnosed and started treatment of my hypertension, after I became involved in running, I discovered the doc was not capable, i.e., he just didn't know/have experience to manage hypertension in a master athlete. So, searched for one that did. Went to one to advertized to be an expert iin Sports Medicine, a GP. It wasn't true, but I was taken care of by one of his CNPs, Julie, who has taken care of us ever since except for a short time we lost her when she moved to work somewhere else and we didn't know where. I tried another DO GP, actaully an Ironman (that means super athlete), but he, and his office group, were lacking. My wife got on a quest and found Julie again, damn, right down the road in our mtn community, how convenient. Now, here's the thing about Julie. She takes time, unbelievable time with us, and she is quick to recognize when it is appropriate to refer to a specialist, and selective/careful with the specialist selection. Because of her I have a cardiologist. Selection of the cardiologist is another story. I was referred to a specialty cardiology practice and when I made my first appointment I told the lady I wanted a doc who is an athlete, please find out which of the docs might be an athlete, take your time, and call me back. Well, seems the practice at many groups is the docs kinda take turns with the new patients that come and my request did't fit their practice for assigning new patients. I was assigned a doc with a super reputation...in fact...wife...the retired nurse...told me he was one of the best, perhaps the best in the area. Well, after a serious (to me, serious) issue with experiencing dehydration and hypotension (I don't like having vision that is like an over exposed black and white photo and I don't like loosing consciousnous, even a second, when I'm packing up my stuff in the transition area) during my first triathon in Austin, I asked him a simple question about a med he had me on...3 or 4 times at that appointment asked him that question. He ignored me...he didn't know the answer and should have..last time I saw him...then I got a new young cardiologist, also an athlete. He understands, and, being somewhat of a new doc, he's fresh with the latest, more up-to-date training than the older guys that who knows how much continuing ed they get. Lesson summary: CNPs are often more thorough than the actual MDs or DOs. Research, check backgrounds. Be quick to recruit specialists. I have my first follow-up after valve repair appointment tomorrow. The CNP at the GP's office is gonna be checking my wound and managing the X-Ray the discharge people said to get to be sure I'm not retaining undo fluid in my thoracic cavity..and that's it. My cardiologist in conjunction with the professional cardiac rehab folks are gonna manage my heart. It was my cardiologist that on my routine 6 mos follow-up, ordered the echo to be done b4 just I saw him on that day in Nov, the echo that showed him my b4 benign prolapse had becoome a seriously leaky valve. Another lesson for me. So many times I called to see him before my 6 mos follow-up was due. For this last one I had made a deal with my self I was not gonna bother him for anything, but be patient and not see him sooner. Dumb me. Hind sight tells me he would have discovered my leaky valve situation if I just had called him back in August when I had trouble swiming the distance in that lake in VT. Dumb me should have told I had trouble breathing and got towed from a lake by a kayak. Geeezzze, I'm so dumb sometimes...but, a lesson, when somethings not quite right re health...docs should be told, docs that find out the cause. ...Barry

On March 8, 2011...

Hi Jim, Yes . . . your misdiagnosis gives plenty of food for thought. You will have to think about its impact on your relationship with you primary, but please don't be too hard on yourself. For one thing, we live in a culture where doctors are seen to be close to gods, and they aren't. . . but we aren't given many examples of how to deal with our health differently, and, yes, more pro-actively. Clearly it would be a good thing if we would get that message at least as much as those from the drug companies telling us about all the new medicines they have on the market.

I don't want to get into the state of our medical/health care system right now, but I do want to say that the RELATIONSHIP we have with our bodies (well our minds too!) is of utmost importance . . . because our bodies have an intelligence and ability to communicate when things aren't going well (as well as when they are!) As in any relationship its important to listen and not tune out to what is being communicated. (And YES, alas, we also have the abilityto accept what could be symptoms as the norm and go on with our lives! Sometimes that ability serves us well . . . but it isn't an ability we should rely on . . .)
And then there are the relationships we have with our medical practitioners. I've been amazed recently how much they rely on tests over some common sense good listening & diagnostic skills, their knowledge and even intuition.

So finally . . . I'd like to say that the responsibility rests not with the doctor OR the patient - it is rather BOTH/AND, its a shared one, and that is why the quality of the relationships between our selves, and our bodies, our mind, AND our medical practitioners are so important. The practice of medicine/health care is as much an Art as a Science.

Are you are feeling, in a funny way, a bit thankful to that hip of yours that called out for surgery!? One more way you could look at it all is that your body (or for that matter YOU) did find a(nother) way to get your attention and then get you to another doctor for the right diagnosis. We are much more complex beings than we give ourselves credit for: our unconscious can work in mysterious ways!

Feeling gratitude is a good thing . . . its also good all around for your much happier heart. :-) see you soon! Sandy

On March 8, 2011...

I'm glad to hear you are recovering with no complications and on your way to a healthier life. I find your last entry very interesting because when Smitty and I made our first trip to Panama in March of 2006 I came into contact with parasites and went back to the states with the little pests crawling throughout my intestines. When I started having sharp pains in my abdonmen area my primary doctor sent me to a GYN, he thought maybe I had a cyst on my ovaries because that was where the pain was the worst. Long story short I told them I had been out of the country, no one seemed interested, in fact the doctors hardly take the time to listen to you tell them how you really feel. I went through an ultra sound, cat scan, lower GI, all kinds of blood work. Finally I said enough, none of the doctors knew what was wrong with me and kept sending me to another specialist. We moved to Panama Feb. of 2007. In March I was so weak I could hardly get out of bed. Someone here told me their doctors name so I called him and they got me right in. He actually sat with me in his office and listen to me tell about all my tests, but most of all how I was feeling and what my body was doing. I never had to wait in an examination room with a white gown on for 30 minutes freezing, he didn't keep looking at his watch to see if my 15 minutes was up, he really seemed concerned about me. He told me then I probably had parasites and gave me the pills to kill them but went ahead and ordered the lab work to see if it was positive. I was better in a matter of weeks. I spent several thousand dollars and went through tests I did not need. In the states it feels like an assembly line when you go to the doctor, they have 15 minutes for each patient and they seem to want you out of the office as quickly as possible. I realize not all doctors are like this, but has our insurance made going to the doctor more like a production line and is it all about money now instead of real health care. When you know something is wrong with your body do not ignore it. The doctors in the states kept telling me they could find nothing wrong. By the time I saw the doctor here I was close to being hospitalized. I will look forward to hearing about your docotr visit.