Dreaming in Iambic Pentameter

I’m starting to think I need my own spin-off series.

I went back to see my cardiologist at Jefferson today, and discovered there were a few complications of which I hadn’t been aware. The key one to note is that in October 2006 the FDA rescinded their endorsement of PFO closure using trans-catheter devices, on the grounds that there had been insufficient medical trials.

Strangely enough, they have had difficulty enrolling patients in these trials. The patients seem to think that they should get a choice as to whether they have their PFOs closed or simply trust to blood-thinner medication. Strangely enough, so do I. The procedure is already recommended in Europe. I’m not sure it’s sensible to attempt to perform a trial when there is a belief that one of the therapies under assessment offers significantly more protection than the other. It is still possible to get trans-catheter closure using devices ‘off-label’ provided one gets (of course!) clearance from one’s insurance company or pays oneself. My cardiologist is going to Washington this coming Friday to argue the point with the FDA.

So where does this leave me? Well my cardiologist was keen to close the PFO before the ovary removal, but wanted me to make my OB-GYN aware that this would necessitate delaying the ovary removal for 6 months. Now I have had enough of being treated like a go-between by these disinterested professionals. After all, I would not ask my cardiologist to take notes on a lecture about prosody by Donald Hall and paraphrase them for Stephen Dunn. So I asked him respectfully if he would mind contacting my OB-GYN directly and having a discussion with her about the priorities. Who would expect it to be the poet whose common sense prevails? In that discussion they agreed I should get the ovary taken care of first, which means I needn’t worry about the FDA just yet, and indeed, their somewhat insular stance may be taken care of by the time I need to make that decision.

So, the only slight complication with this is that I am not allowed to stop taking blood-thinning medication before the ovarian surgery. However, there is an alternative treatment in the form of a self-administered injection I can perform for the few days leading up to the surgery. (Oh joy! Because I just love needles…) This will confer the same benefits as aspirin on a daily basis but will not remain in my system to interfere with healing after surgery.

NOW how does Patient A feel about this? Actually not too bad. At least we have a way forward and some degree of consensus between my medical professionals. Although, House? Are you around? Got any thoughts?

For those who don’t know, House is an excellent TV show on Fox, which stars Hugh Laurie as Doctor House, a genius at diagnosing tricky diseases who is also selfish, rude and obnoxious to the point of minor sociopathy. Apart from the fascinating character, devious plot lines and a pithy script, one of the things I admire most on the show is Laurie himself. American audiences may not know (especially given his stellar mid-Atlantic accent) that he is an English actor known primarily on the other side of the pond as a comedian. But I digress.

Every week in the show, House is presented with one or more puzzling cases where the immediate diagnosis is not clear. Over the course of the hour long episode, the patient(s) typically present more and more mystifying symptoms, with his/her/their condition deteriorating until they are close to death, before House has a Eureka moment and pulls the correct diagnosis out of the hat like a rabid bunny.

Let us consider then, the strange case of Patient A, a 38 year old woman in apparently good health with no obvious risk factors. In January of 2006, Patient A is diagnosed with hypothyroidism, which is treated with levothyroxine in standard dosage. All seems well until September 2006 when Patient A suffers a Transient Ischemic Attack and is hospitalized. After undergoing countless tests which all prove normal Patient A is released, but in follow up testing a Trans Esophagal Echo determines the presence of a 5 mm Patent Foramen Ovale (Hole in the Heart). Further testing demonstrates that this PFO is Grade IV and Patient A is told she will probably need to have it closed. Meanwhile Patient A has stopped taking the Birth Control Pill Yasmin and is suffering horrible symptoms from hormonal fluctuations including dizziness, palpitations, restless leg syndrome, insomnia etc. The abrupt cessation of hormones has also led to Patient A experiencing acute abdominal pains during her menstrual cycle. She reports these to her doctor, concerned that the pains might be indicative of endometriosis, the presence of which has been masked by the pill. An ultrasound followed by an MRI in early 2007 determine that Patient A’s left ovary has in fact been entirely taken over by a Dermoid Cyst, which will need to be removed. Surgery is tentatively scheduled for late February.

On February 13th 2007 Patient A finally gets in to see the Cardiologist at Jefferson Hospital. He appears concerned by an anomaly in her charts no one else has picked up on previously, namely an irregularity in the right vertebral artery. He decides she needs conventional angiography to evaluate this before proceding with the PFO closure, and also that the ovarian surgery cannot proceed until more is known, because of the risk of taking Patient A off the blood thinner (standard aspirin, 325mg per day.)

Oops. This particular episode appears to have run over an hour, and no one can find Doctor House to deliver the masterful diagnosis. I guess we’ll have to slap up the “To be continued” sign.

I wonder how Patient A is feeling about all of this. Would anyone like to take a guess?