December 27th, 2008 by Dr. Val Jones in Announcements
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My dear friend Seton Holt passed away on Christmas eve. She was 42 years old, and surrounded by family at home. I wrote about Seton’s battle with cancer – and how she faced adversity with an inspirational courage.*
When you lose someone you immediately wish you’d had the chance for one last conversation – to make sure they knew how much you loved them, and what they meant in your life. I didn’t have that final conversation with Seton, but I suspect that she knew how I felt.
Seton was a devout Catholic. She leaves behind a nearly two-year-old son, Damian, her husband David, and a large loving extended family.
I’ll be attending her wake tomorrow. May she rest in peace.
*These are some of my previous posts about Seton:
Cancer Isn’t Fair
Unencumbered By Prognosis
Strawberry Shortcake In Central Park
The Lucky One
December 27th, 2008 by Dr. Val Jones in True Stories
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Fortunately for me, my recent brush with the healthcare system was not as frightening as Dr. Dappen’s (he blogs here every Wednesday and recently had a mild heart attack). However, it was provided me with some amusing blog fodder.
Last week I was minding my own business, planning to purchase a new batch of contact lenses from a local optometrist, when I was required (under threat of withholding my lenses) to undergo a vision exam. Much to my disappointment, my right eye was not behaving itself, and refused to correct to 20/20 despite a good deal of lens fiddling on the part of the doctor. A slit lamp retinal evaluation followed, and the optometrist concluded that my right eye’s macula “looked like an 85-year-old’s.”
Well, that was not the most welcome of observations. I asked for the differential diagnosis (being that I’m quite a few years away from 85) and wondered how I’d developed macular degernation. He suggested that it could also be a “central serous” which is (apparently) a stress-related swelling of the macula that requires no treatment and usually resolves on its own.
“So basically you’re saying that my eye could be ‘bugging out’ because of stress.” I said. “And you’d like me to see an ophthalmologist just in case it’s something worse and equally untreatable?”
“Right.”
So I made an appointment with a local ophthalmologist – one of the few working on Christmas Eve – and was sorry to have him confirm that there was indeed something wrong with my retina. He even ordered an eye angiogram (I didn’t know those existed, but it makes perfect sense) and I was injected with a vegetable dye. Photographs were taken through my dilated pupils at regular intervals as the dye wound its way through my retinal vasculature.
“It’s not a central serous.” He said with a serious tone. “And you can see the macular defect here on this photograph.”
“So my right eye is like an 85-year-old’s?” I asked, wondering how I’d been so fortunate to have one part of my body on the aging fast-track.
“Well, not exactly. I think it’s unlikely to be age-related macular degeneration. You probably have retinal thinning caused by your nearsightedness.”
“You mean all that straining to see the chalk board wore out my retina?”
“No. What I mean is that your eye is supposed to be shaped like a baseball, but yours is an egg shape. So your retina is stretched thin and is starting to wear in your macula area.”
“Well can you suck out some of the vitreous gel and shape my egg back into a baseball?”
“No. Unfortunately that doesn’t work.”
“How do you know?”
“The Russians tried it in the 1960s.”
“Ok, well how do I take some of the tension off my stretched out retina?”
“You can’t.”
“Well if I lose weight or eat carrots or exercise, or stop wearing contacts, or get lasik… would any of that help?”
“No.”
“So there’s nothing I can do to prevent further damage, and nothing to repair or treat it.”
“Right.”
Pause.
“I don’t like this condition.”
“Well, you’ll have to come and see me once a year so I can monitor the progression. Sometimes the body responds to the retinal damage by growing blood vessels in the area, and that can cause further visual deficits. But we can zap those new vessels with a laser and decrease the damage.”
“So my eye might overgrow with blood vessels like weeds in a garden.”
“It might. But it also may stay exactly the same for the rest of your life.”
“Well, the uncertainty is anxiety-provoking.”
“I’ll see you in a year. You’ll probably be fine. Don’t worry. Oh, and if you see any ‘floaters’ or flashes of light, come in to see me immediately.”
“What would that indicate?”
“A retinal tear that would need laser therapy right away. People with thin retinas can have spontaneous tears. Just keep that in mind.”
“Um… ok.” I said, smiling feebly.
So here I am, with one wonky eye, not knowing if it will get worse or remain the same indefinitely. There’s nothing I can do but watch the progression once a year with an ophthalmologist. Like so many patients, I’m in a gray zone where prognostication is a challenge and reversal of disease is not possible. I have one 85- year-old eye. May it bring me wisdom, courage, and more empathy for patients.
December 25th, 2008 by Dr. Val Jones in Announcements, Humor
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I’m visiting my husband’s family in Rochester, New York. If you don’t see any new blog posts in the next few days, you can assume that I’m actively digging my way out of their home to get back to DC.
Please check out this winter video to get a feel for life in snowy Rochester. It’s hilarious.
For more Christmas cheer, check out The Christmas Miracle story.
I wish you all a merry Christmas… and happy holidays!
See you on the flip side! (Don’t forget to sign up for my healthcare reform party on the 30th).
December 24th, 2008 by Dr. Val Jones in True Stories
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By Alan Dappen, MD
Twas days before Christmas and all through the house
The doctor was pacing, not telling his spouse.
“It can’t be my heart for it’s healthy and strong;
I exercise, eat right and do nothing wrong.
I’m hurting, I’m worried, have lingering doubt
I guess that I really should check this thing out.”
I did and the doc said, “Sadly it’s true,
That nobody’s perfect and that includes you…”
So starts my tale about life’s infinite ironies. This past week, I, “the doctor,” became “the patient.” My story is classic, mundane, full of denial, of physician and male hubris that it merits telling again. Like Christmas tales, there are stories that are told over and over again hoping that lessons will be learned, knowing they might not. I was lucky. I was granted a pass from catastrophe and this favor was handed to me by my medical colleagues and all who supported me.
My story began six months ago while playing doubles tennis with friends. Suddenly I felt the classic symptoms of chest pain. “This is ‘textbook’ heart pain,” I thought. “A squeezing/pressure sensation dead center in the chest.” Running for shots made the pain worse and stalling between points helped. My friends soon noticed a change in my behavior.
To my chagrin, they refused to keep playing. Instead, they wanted to call for help. Indignant, I informed them that the chest pain was caused by my binge-eating potato chips before the match – a fact only a doctor could know. The sweating was clearly from playing. I was younger and healthier than anyone there. The pain subsided while we relaxed and joked about “the silly doctor who thinks he doesn’t need help.”
In the next week, the discomfort returned often when I exercised, which I regularly do, including jogging, biking, swimming, and weekly ice hockey and tennis matches. Every activity provoked the pain. “Stupid acid reflux!” I thought, contemplating giving up my favorite vice –coffee. Keeping the secret from my wife was easy; she was traveling for business.
Over the next several days I started aspirin, checked my blood pressure (BP) regularly, drew my cholesterol, rechecked my weight. All were normal. Finally I plugged myself into an electrocardiogram (EKG), with the “nonspecific changes” results not reassuring me. I went to a colleague for a stress echocardiogram, and passed. “See!” I congratulated myself. “It was just reflux.”
For five months, all went well, with no memorable pain. But on December 10 “the reflux” came back. On the sly, I restarted aspirin, pulled out the home BP monitor again, and considered cholesterol-lowering drugs “just in case.”
Saturday night into early Sunday morning I played ice hockey. This time the pain was worse. With my team short on substitutes, I played the entire game. I dropped into bed exhausted and pain free at 2 a.m., only to be nagged throughout the night with persistent discomfort. I nearly slept through a morning meeting with a medical colleague at Starbucks. To avoid increasing my “reflux” pain, I passed on coffee.
By noon, a feeling of overwhelming inadequacy enveloped me. I withdrew, and my wife, Sara, asked what was wrong. I had to confess to her – and myself – of the reality of the pain in my chest. Sara coaxed my answers from me with non-judgmental techniques learned from years of experience.
“What advice would you give a patient calling you with these symptoms?” she asked.
“If it was anyone else, I’d send them to the ER,” I responded, wanting to stall longer. “I want to check my EKG at the office.”
Once there, she helped me with the wires, hooked up the machine. She turned the screen toward me with the interpretation to read: “anterior myocardial infarction, age undetermined, ST- T wave changes lateral leads suggestive of ischemia.”
“Stupid machine,” I thought, “there must be something wrong with it.” I insisted Sara redo the EKG. The second reading was the same. I leaned my head into my hand, not willing to believe what I saw. “Sara, let’s do it one more time…please.”
She asked, “What would you tell your patient to do?”
“Call 911.” I said quietly. The words hung there. At last I handed her the keys, saying, “Drive me to the ER.”
So went the gradual erosion of my denial, emerging into a new reckoning. After a catheterization, the cardiologist used a stent to open my 95% blocked coronary artery. Despite all I did to ruin my chances, modern medicine delivered me a “healthy” heart. This holiday season I got a second chance.
Eating healthy, exercising regularly, sleeping well, being happy, praying regularly, even being a doctor does not save us from the inevitable… sooner or later we are all patients. Healthcare is a critical social asset that must be done right, must be affordable, must offer as many of us in America a second, even a third chance. May we all be thoughtful and willing to compromise to achieve this end. Amen.
