Tuesdays with Chandra: The matters of heart

What prompted my cardiologist friend to summon me to the hospital the next morning and repeat the ECG and Echo? Was it because he had access to these equipments and was qualified to examine the visuals and interpret the results? Was it because of the friendship we shared? What did the earlier ECHO report say that turn the cardiologist impatient to repeat the tests? I had no answer and Google gave me way too much information to assume and analyze.

I honored my friend’s summon, sacrificed my coffee and showed up the next morning. I was taken to emergency; there was no sweat on my forehead, no panic on my face and with laptop hanging from my shoulder. And for the emergency room staff I looked very normal and must have appeared to have walked into the wrong building. I had never been to an emergency room and not seen the mood of doctors and ambience in the room. Nevertheless, the doctor order for an ECG and within seconds I was disarmed of my belongings, made to lie on the examination table. I stared at the roof while the leads were connected to my left side of my chest and when everything was ready the ECG machine failed to work! Even the ECG machine seems to have breakdown in the emergency room. It looked like my waves from my heart short circuited the ECG machine!

Finally, another ECG machine was brought over to record the unheard messages from my heart on a paper. Wouldn’t every lover and spouse want to hear and see the unheard messages from the heart, not just around Valentine’s day, but even on other days? The technician and doctor stared intently at the paper and the tip of the pen recording communication from my heart. It didn’t take much time to fill the A4 sheet and it was all black and white!

I heard the doctor say “incomplete RA and RV” and nothing else. I didn’t know if this recording was good or bad, but the doctor looked pensive. Is that a common demeanor in the emergency room? Those set of 8 lines on the graph paper meant nothing to me. All I knew was that I was hardly 10 m away from the ICU, but the results from the ECG didn’t need me to go that side. While he waited for me to get dressed he called his colleague over the phone and asked him to come to the Echo room on the first floor. We took the stairs, and he raced like a doe, while I was struggling to keep pace with him and I had no room question the scribble on the paper filled with mirco checks.

He ordered the Echo technician to prepare for the procedure as we got into the room. This was my second experience with Echo and I knew the breathe-in, hold, breathe-out, and lying down on the side routine very well. And over the next 20 minutes the two cardiologists and the Echo technician were staring at the monitor that showed the contours of my heart. They were looking for the culprit(s) aka anomalies. I heard them search for evidences of congenital defects in my heart. One of the said, “show me the septum and the valves” and the other said, “let us rule out venous sinuous” and they kept searching for everything they learnt in their anatomy class. At times they turned up the volume on the machine to hear the symphony composed in my heart. Now there was music to go with the visuals. Was the symphony normal? Was there an extra beat? Did their monitors show the same result that was seen by the other technician yesterday? I heard the beat, I saw the contours and to me the visual on the monitor was hazy and beats had no rhythm. But from the diagnosis and the discussion I knew “matters of heart” for me are always hazy and difficult to understand.

At the end of the procedure the cardiologist and the technician independently and together validated the earlier finding “dilated RA and RV”, though they ruled out a few congenital defects, but they had no conclusive evidence of what was causing the dilatation of the right side of the heart. I was ahead of the diagnosis and asked them if I needed a surgery to correct the dilation. Since no one has ever gone this close to my heart, I was petrified.

To ascertain the exact reason for dilation they suggested that I undergo Trans Esophageal Echo (TEE). This would help them rule out other abnormalities and pin-point the exact cause. Now I was asked to show up again tomorrow morning in empty stomach. I felt like a lab rat and at times proud that my heart was a piece of puzzle to the cardiologists. But I was still smiling and energetic after the 14 hour fast and invited the doctors for a cup of coffee. While one of them took my offer, the other proceeded to attend other patients in the queue. Over the cup of coffee I asked the doctor about his gut feel on the diagnosis and preparation for tomorrow’s procedure.

I know matters of my heart must be equally confusing and sounding ominous to you. Next week will bring more clarity. So come back soon! Until then go easy on sugar, fat and carbs. Importantly learn to listen to your heart.

Tuesdays with Chandra: Revelation 04:04:2011

I woke up early on April4 (Ugadi – New Year) like any other day and I had traded my yoga class for a master health check-up at a nearby laboratory, but not my yoga attire. I was not anxious or afraid and my attire truly represented my attitude: shorts, tee and sandals; cool, calm and casual. I had been fasting since 7 pm the earlier night and at 7.30 am the laboratory was brimming with older people, who had come in empty stomach to give blood samples. I know it is dangerous to be around elderly who’ve not had their morning coffee, and hence I stayed away from picking up conversations with any of them :-).

There is crowd everywhere in India be it railway stations, malls, temples, cinema halls, hill stations, and sadly even in hospitals and jails. The last two categories represented the unhealthy population: physically and mentally who are temporarily locked till they get cured. Sadly even those get visitors :-)! Whether these people feel like criminals or not, while the world looks at that with both sympathy and scare. But I must appreciate that people followed the queue and there was method to madness in Madras. I paid the money for the tests and then moved on the floor above. And there I showed my receipt to the man behind the registration counter. Everything about him was fresh and large: smile, clothes, hair and even the viboothi on his forehead. Looking at this man I was reminded of Lord Ganesha, this man even had a mouse, but just the garland was missing. Aha, wait to see who gets diagnosed with "super-sized" body parts.

He handed over a printed sheet with the list of tests for the package I had subscribed for and the tests were arranged by the hour and room numbers written next to them. Now I had no reason to ask or talk and just walk to the right rooms and give samples, get tested and scanned. The rooms in the laboratory followed an assembly line arrangement and everything was process driven, I just hoped the results were of Six Sigma quality standard.

I know it was Monday morning and 7.30 – 9.00 AM was Rahu kalam, and all I could do was leave home at 7.20 AM. At 8.10am the hungry hypodermic needle punctured my subcutaneous tissue and sucked blood from my vein. After the first sample of blood was drawn I went into the pantry to have glass of glucose (75 gms of glucose dissolved in less than 100 ml of water) and I used the paper napkin in front of me to calculate the normality of the drink.

While I was waiting outside the room to get my abdominal scan (liver, kidney, gall bladder, etc.) the technician asked me to drink a few more glasses of water (inflate my abdominal assets?). While I was waiting for my turn, an elderly gentleman on his mobile was sharing a moment of pride and achievement with his friend. He has forced his son and daughter-in-law visiting from overseas for a master health check-up. Soon I got invited for my stripping and scanning session and I had to miss on the other details he shared with his friend.

The cold gel at the end of the probe gave me goose bumps as the technician went up and down, right and left. He asked me to fill my lungs with air and at times asked me to hold my breath as he scanned my abdomen. And as he scanned my appendix he asked me if I felt any pain and asked me if I carried any appendix to my health, family, lifestyle and eating habits. Finally there was a big smile on his face, probably from a big catch? Before he diagnosed he asked me if I consumed alcohol, I was ready to draw the chemical structure of an alcohol molecule with the bonds and swear that I know nothing about its taste, color, viscosity, and other chemical properties. My answer didn’t deter him from changing his diagnosis! Miranda in Sex and the City around the same age gets diagnosed with “Lazy ovary” and here I am at 35 diagnosed with “Fatty liver”. So 30’s reveals all that is large and lazy, huh?

As I dressed up the technician asked me if I had an “Echo” in my package and if I had scheduled for an appointment. I was not aware and showed him the sheet of paper, but then he asked me to get an echo immediately. His tone sounded ominous. I went to the Ganesha man at the registration counter and asked him if I can include “Echo” in my package. He said my name was already in the list but I had not paid for it. But he was kind enough to let me into the echo room and pay later.

For man whose stayed healthy and lived healthy all through, terms like “Fatty Liver” and getting recommended for an “Echo” didn’t mean a thing. I didn’t know if I should feel proud or let my eyebrows sag in worry. Without much wait I made it into the Echo room. The technician was tall, thin and looked like a kid right out of high school. I stripped and lay down on the table, the monitor was ready showing images from the last scan, the technician put for circular adhesive strips (size of a carom coin) in my left chest and leads were connected. He passed the same instructions: breath-in, breath-out and hold as he moved up and down, left and right to my diaphragm. Having missed my yoga class in the morning this almost was like a pranayama routine. During the echo he asked me about my last check-up and where it was done. Why should questions be one-way? I had to ask and I asked him how long he has been an echo technician and said his looks deceived his experience. And finally what he said suddenly shortened by prana and almost became a “yama” to my prana!

I could see him record a few findings, without any interpretation in the green register and he ended the sheet with a two big question marks (??). I asked him to explain his prognosis, while he was adamant that I meet a cardiologist and recommended for a TransEsophagealEcho (TEE). I peeped into the register the findings he had recorded and I came out of the room and I texted two of my close doctor friends: a pediatric cardiologist and another pediatric intensivist. What does that mean? Am I in for more surprises? In the meantime I received a call from my mother to check if everything was going fine. She said he had just sent the watchman to the Ganesha temple nearby to break a coconut. My Mother's way of bribing Ganesha!

While I waited for my doctor friends to respond or call, I finished giving my second and third blood samples and even got through the X-ray. The last hoop for this healthy dog was a physical exam with a physician. He went through the readily available questionnaire to record my replies, while I interrupted him to explain me the findings from the abdominal scan and Echo. He said he needed to see the results, but placed the Stet scope on my chest and asked me to perform the pranayama routine again. I felt the phone in my pocket vibrate, but I was absorbed in the physician’s examination and didn’t repond. From what his Stet scope could pick-up, he ruled out “murmur” in the heart. I came out of the room with a little smile and a puzzle to solve, and returned my doctor friend’s call.

What was recorded in the Echo? What did my friends, the Pediatric Cardiologist and Pediatric Intensivist  say?  Come back for more surprises and till next Tuesday stay healthy and eat healthy!

Tuesdays with Chandra

I am inspired by Mitch Albom’s Tuesday with Morrie and plan to make this post every Tuesday. There is no striking similarity between me, Mitch and Morrie, except the “Tuesdays”. Tuesdays with Chandra is just an interesting phase of life that I am going through. I am recording as I am experiencing and I will write till I am exhausted or turn breathless.

I am just a healthy human being both in mind and body (atleast I believe and feel that way). Well it is normal for everybody to feel healthy until and unless proved otherwise! And when proved or disproved, may be every Mitch has a possibility to turn into a Morrie? But don’t be sure of every Morrie to effuse the same wisdom.

For a man who has worked out 6 days a week for the past 11 years, practiced yoga for the past 4 years, indulged in physical activity of all kinds from swimming, cricket, skiing in New Hampshire bunjee jumping in Tennessee, to trekking at 18000 ft in Himalayas, and importantly one who ate healthy, a health check-up never featured on the priority list. A recent evaluation revealed that I was more fit and flexible than the trainers at the gym. Heard of health miles? If at all I could redeem these miles, I may just ask for an ailment, a repair and maintenance free old age with a peaceful and dignified end.

Given the genetic pre-disposition to heart ailments in the family, If there was an option I would have donated these health miles as heart miles (does the recipient needs to pay gift tax?). But for someone who has decided to stay single for this life, healthy lifestyle is an absolute non-negotiable. And today I understand that charity comes only after self sufficiency.

I may sound like a vampire if I said I love of blood. In reality, I loved donation aspect of blood. All of us have blood, but not many of us are healthy and happy to donate. And as a healthy citizen, I considered blood donation a way to service the man-kind and it was the only way I could share my health miles.

Ever since I turned 18, I would mark my calendar and would stop by the blood bank every three months to add to their diminishing supply. Sometimes I made donation at the hospital blood bank and got an opportunity to meet the recipient, but most of the times I had no clue about the recipient. The latest donation was the book fair in January and the very moment I saw the mobile blood van I jumped right in and even tried to brainwash my healthy friend who came along with me to donate. I failed to convince him, but nevertheless my donation continued with pride.

The first time I won 2 medals for my physical power and endurance was last year. One for bench press, another for squat in the 30-35 age group category. The first one certified my upper body power, while the second one testified my lower body strength. I still remember that Monday morning. I was swarmed by the trainers as soon as I entered the gym and within minutes without any warm up I was benching 120 kgs and squatting 90 kgs. I put the medal around her neck for giving birth to a healthy child and feeding me nutritious meals for 35 years. I felt proud and committed to my health and fitness levels, but never felt arrogant or over confident. Surprises do come without notice and that is what makes life unpredictable and interesting.

See you next Tuesday.....