Thursday, January 26, 2012

Mayo Appointment 1/25/12

We met with a new cardiologist at the Mayo yesterday.  There's definitely something to be said for continuity of care!  I totally understand why my patients want to mainly see one provider.  I think it's a little more important though, in this situation.  Having seen two new cardiologists in the past two weeks instead of Dr Steidley has been a bit frustrating.  I feel like he has been able to watch Carlos change over the past couple months.  It's easier to see the decline when you know what he looked like last year, 3 months ago, and now.  People are often fooled by Carlos' appearance.  He just has never looked as sick as he actually is.  But I know.  I know what he looked like 10 years ago, last year, last September, and 3 days ago.  I can tell when he feels worse.  So it's definitely frustrating when I feel like these new doctors aren't listening to me.  They ask Carlos how he feels and Carlos is pretty understated.  "I'm ok".  That's the typical response.  But because he can sleep on two pillows and doesn't cough at night (instead of the horrible cough he has all day long, the coughing when he tries to eat, the coughing when talking - new symptom), he's stable enough to not rush into anything.  'But call us if he gets worse'.  Ughggh!  I'm telling you he is worse.  He even told them he is definitely more tired, and the coughing is very obnoxious.

Anywho.  He has a right heart cath Monday morning.  I'm about 95% sure they will find he has worsened.  Specifically the pulmonary hypertension that's a by product of the severe heart failure.  While I don't have a huge desire to see him moving to the next step (probably IV medication) as that is not without concerns, I don't want him to get to weak to be able to undergo the transplant nor do I want damage to occur to his lungs.  I believe that he will be admitted on Monday to start IV medication.  But we shall see.

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