Life-threatening cardiac problems I tried to ignore
An infected pacemaker wire proved to be just the
beginning of Dr Peter Tate's ordeal as a patient
was too fat at 17 stone, and was concerned about my nagging angina-like pain, previously but dubiously diagnosed as oesophagitis. I decided to go on a diet which I hoped would improve my gout as well. Unfortunately, I have sick sinus syndrome and have been paced since 1977. Pacemaker wires are fragile with limited lifespans and are difficult to remove.
At the time of this saga I had four three broken and one live.
One was tied off below the skin in the upper right breast and as I lost weight and my fat evaporated, the wire began poking through the skin. I asked a friendly plastic surgeon to do the necessary.
Down to 14 stone now, I felt more energetic than I had for a decade but what were these night sweats and funny feelings in the chest?
After eight weeks of increasing lethargy and ineffective self-treatment the problem was clear. I knew I had an infected wire, but I also knew to treat it properly they would have to take the whole lot out. This was not an attractive prospect so I did nothing. Eventually my registrar decided for me.
She told me I would be dead if something was not done soon and checked my CRP which came back at 219 a normal measurement is less than 8. Paradoxically, this made me feel better as it proved I was not skiving.
They put an IV line in, warned my treatment would take six weeks and said I probably had endocarditis. First the old pacing system had to come out. After the operation I was greeted with the words: 'We thought we might lose you.'
'It was the IVC intravascular coagulation that really worried us.'
'Eh?' I said.
'Well it's like toxic shock. All those wires with toxins on them being stripped off. Too much and it all coagulates and that's it really.'
My ideas on informed consent were shaken to the core. Was I pleased I didn't know this risk beforehand? I decided I was as I sank further into passivity.
In the lull that followed, the specialist registrar said: 'Shame the wire snapped.' I felt like a stunned trout and let the fly dangle in front of me. 'You see there's a fragment we will need to take out.'
'Where?' was the best I could manage.
'Oh it's just in the pulmonary artery, no real problem. We had better put you on Fragmin blood thinner injections till we fish it out. The interventional radiologists are going to do it next week.'
So that was all right then. The 'fragment' turned out to be a euphemism for 2.5 inches of something that looked like barbed wire but was in fact a very frayed 25-year-old wire. I felt inexplicably better once it was out.
'Is that it?' I asked. I saw eyelids drop. My concernometer registered 'Oh shit.'
'Well there is another fragment....stuck in the right ventricle....would need open heart surgery... probably okay to leave it.'
While 'probably' might be a good word for doctors, it is not a good word for patients.
'Your creatinine is not too good, too much gentamycin. So we will have to keep an eye on the renal failure first anyway.'
This felt bad.
Weeks went by. I was allowed home to give the IV antibiotics myself, much to the chagrin of the wonderful nurses who were all firmly of the opinion that most doctors could not be trusted to wipe their noses, let alone do complicated injections. Then I just needed a quick exercise test.
Even I could see the ST segments were very wonky. The chest tightness was mild and I did do nine minutes but probably needed stents. I might still be able to get back to work soon.
Oh, but why is there very little white dye getting down that big artery on the left ventricle? It appeared that stenting would not be possible because of critical occlusion of the left main coronary artery, and the right system was not too good to boot.
All that red wine to no avail. I was fairly fit half an hour before, now I was an invalid facing another major heart operation.
So here I am writing this post-quadruple CABG and open heart surgery to remove the offending fragment, which was apparently not doing me any good. So the chest surgery could be construed as lucky in a perverse sort of way.
My registrar checked my CRP which came back
What have I learnt?
· Any interference with the status quo may have unpleasant unforeseen consequences
· Being a fairly sensible doctor does not make me a sensible patient
· If you suspect the worst you are probably right
· NHS staff are wonderful
· Severe illness knocks the stuffing out of you
· Ideas, concerns and expectations are for real
Has the way you practise been influenced by a condition affecting you
or a close relative?
Pulse wants to hear from GPs with a story to tell and advice to offer.
For details contact
Amanda Elliot, Pulse, CMP Information Ltd,
Ludgate House, 245 Blackfriars Road, London SE1 9UY