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Friday, October 18, 2002

Implosion

The doctor removed the stethoscope from his ears and casually remarked, "you know you've got a murmur?" No I didn't, but at the age of 31 I must have had 20 doctors listen to my heart and none of them ever mentioned a murmur. So what were they hearing? A bunch of animated "good bacteria" singing "Dem Bones"?

"You'd better see a cardiologist and have it checked out", said doctor number 21.

Dr Sangeev Ramachundren (not his real name) consulting cardiologist, peered at the monitor of the ecocardiograph machine. There on the screen was the fascinating muscular pump that I had taken for granted all these years. And there was that aortic valve, almost but not completely closing on each contraction of the left ventricle.

Murmurs can be caused by several different dysfunctions of the heart, all with varying levels of seriousness. Some people will require valve replacements at some stage in their lives; others will live out their entire lives with no symptoms being manifested.

Surprisingly, Ramachundren was writing out what appeared to be a prescription. Apart from a packet of jelly beans I could not imagine what medicine a figure of athletic prowess like me could possibly need.

"Take one of these daily with food", I heard him say, as I swung into panic.

"HEART DRUGS!!!!!!!"

The words exploded in my brain like a burst capillary, but the words that came out of my mouth revealed an instinctual awareness that I was in some kind of danger, and it wasn't necessarily due to my health.

"What do I need those for", I asked pointedly.

They were "Calcium channel blockers" called nifedipine, designed to reduce the extra work that my heart was apparently having to do due to the murmur.

"Do they have side-effects", I asked.

"Everything has side effects! Water has side effects!" he stammered impatiently. With this he clapped his hands together to indicate the end of our meeting and ushered me to the door.

I found myself alone in a florescent corridor clutching a script for heart drugs if not for the end game in a tragedy that had seen my self image of sparkling good health annihilated without explanation. My first confrontation with mortality had been handled by a man with an IQ of 150 and an EQ of an imbecile.

Very upset, I stumbled along that hall toward a glaring light and out into a different world.

"Can I have your pharmacological manual please?"

The Chemist looked at me with a combination of amusement and suspicion.

"Are you a doctor?", he said as he reached down and pulled a large black tome from under the counter.

"No, but I would like to know a bit more about nifedipine, is that against the rules?"

"No, go for your life".

"I generally do" I said, as the reference book sat me down on a chair.

I leafed through to the relevant section: "Nifedipine - Side Effects".

Possible side effects were a list of 15 worrying symptoms including breathing difficulties, swelling of the hands and feet, irregular heart beat and, there it was, a rather surprising little side effect - "death".

Call me a spoil-sport but I stopped wanting to play. This definitely called for a second opinion.

Dr Nick Santini (not his real name) agreed that he would put the time in and explain my condition to me. However, he could not explain why I had been prescribed nifedipine. Both specialists had 13 years of medical study under their belts but one couldn't understand the other. Of course I didn't need it, I had no symptoms, and if doctor number 21 hadn't discovered the murmur I would be out running and jumping, oblivious to this weird world of heart valves and clapping cardiologists.

But Santini did think I would need lisinapril, another HEART DRUG!!!!

Lisinapril is an "A.C.E. inhibitor" designed to take pressure off the heart and to help prevent ventricle dilation.

Were there any side-effects? Yes, a light cough, but only one percent of patients got it. Well that's an improvement. So far so good. But did I really need to take them?

Dr Henry Anderson (not his real name) smiled expansively. "Santini's a junior", he was saying, "I remember him at the college, a few classes beneath me". Having located Santini in the pecking order he moved on to the business at hand.

"This lisinopril is somewhat experimental, they are still tracking the long term results".

"So I'm a guinea pig?" I said.

"Well, I wouldn't put it quite like that" he said, revealing his other speciality as spin doctor.

"But do I really need it?", I asked.

"Let me put it like this: if I had to convince 300 of the worlds top cardiologists that you needed to take this drug, I couldn't do it."

What about 400 cardiologists?

He pretended not to hear.

Holy wholistic! Drug free at last! I skipped down the corridor towards a warm, luminous light and out into the world I once knew.

Ten years later and still no symptoms. I sometimes wonder if I shopped for the result I wanted and got it; should I really be taking some kind of HEART DRUG!!!!?  I suppose only time will tell.

In the meantime, when I drink a glass of water I wait cautiously for the aforementioned side effects. So far my only observation is that I no longer feel thirsty, which is more the intended effect than a side-effect, wouldn't you say?