My Foray into the Health Care System
So....
In December and January, when sitting my recliner reading or watching TV, as I am sometimes want to do, if I relaxed and breath deeply I could feel my heart kinda flutter. "Palpitations" that felt like the engine was misfiring a couple cyclinders and would then go back to normal. I experienced it before during my training for IMCDA. Typical guy, not missing a limb = no need to see a doc and I have zero issues when cycling and running.
But, I am now almost 42, figured I should have it checked out. I saw a heart dude in January. I told him I noticed it when I would start to ramp up my training and thought it might have something to do with my heart making adaptations to a sudden jump in training load. He described something that was similar, said he thought I was probably right (yay me) and ordered up some tests.
So yesterday I went to a lab to have them slap on a fancy HR monitor dealio. About 6 leads on my chest, wires, a cool sony walkman looking thing on my hip that would record my heart for a day. In retrospect I should have waited to do my Thurs ride with that thing on cuz I TT'ed for about 1:10 of a 1:50 ride. Would have made for an interesting file 
.
Then today I went in for 3hrs of tests:
- Plugged in more wires and did an ultrasound kinda thing. Brought up pictures of my heart and the tech is doing ALL kinds of things with the images. Taking measurements, creating this file, that range...like WKO on crack.
- Shot me up with some radioactive stuff and did 2x imaging/scanning dealios. I noted that the lead box that contained whatever they shot into me was on a counter next to a window that overlooked a busy street. Seems someone could smash the window, grab the stuff and have the makings of a Tom Clancy terrorist plot...
- Between the scans they hook up more wires and a different recorder dealio, hooked into a PC. Put me on treadmill and did a stress test. Started out walking and then increased the grade and speed of the treadmill in 3' increments. When they started they said I was going to go until I got tired....I had visions of walking until 5pm, begging for something to eat and to read
but they stopped the test when I got to what felt like about 8% grade at 7:45 pace. It was tough, about 8.5 out of 10, as I'm not fit at all right now. I'm glad they did cuz there was no way in hell I was going to "quit" the test before they shut it off . I could only imagine what kinda show P or Mancona could put on for them on that thing.
Anyway, here are my questions and observations:
- I'm no med-person, but I have a pretty good idea that this was NOT cheap. This was likely the most expensive 3hrs of my life...at least expensive for someone because we have very good health insurance and I didn't pay of any of it (at least not yet).
- Is this the best allocation of health resources? I mean, 41-42yo very fit dude shows up with a flutter in his heart. Next thing I know I'm doing a round of very expensive tests at the same time that some REALLY unhealthy people are doing them. I was decades younger and light years more healthy than anyone else in there, including the staff.
I guess, in retrospect and with the health care debates, etc in my head, I'm kinda suprised at how quickly and easily I was prescribed what appear to be a very expensive battery of tests. Surely there could be another course of action that the doc could have used, given my age, health, risk factors, etc. That said, my dad's side has a history of heart problems, but also a history of heavy drinking, smoking, etc. so there you go.
Comments
What if there was something seriously wrong? People in great shape drop dead all the time because of an underlying condition they did not know about. Think about some of the sports stars that have died from problems with there heart. Yes very expensive and most of the time you are okay but a doctor is about helping and saving lifes, they would probably feel pretty bad if they dismissed it and the next day POW, forget the lawsuit they are human too and would be questioning themselves for the rest of there lives.
Rich I also had a similar problem years ago, complained about something, given my job and family history next day I was outlasting the test as well.
Good Luck
before this turns into a health care system roast over costs, insurance, and whether doctors are out to get you...
(and mind you, I'm not a cardiologist) just wanted to point out that the physical/nuclear stress test that you had is one of the least expensive and invasive technique there is to assess cardiac vessel integrity. had the doctor suspected something more serious or found oddities when you had the Halter monitor on, he might have ordered a more aggresive test like an angiogram or cardiac US. he also could have easily looked at the monitor results, looked at your age and slapped you out on the street with a clean bill of health because of your fitness level.
So if it were me, I'd be pumped I actually got the test. that's why we pay for insurance right?
I did some consulting work in the nuclear medicine world a while back. Leigh's right. Just because there's a lot of electrodes doesn't mean it was expensive. Total bill for that test is pretty cheap (and centers like that have to do a lot of them to make a profit). So don't feel guilty.
Now, the MRI-arthrogram I got for my hip... that's an expensive test!
Mike
Once you have "entered" the system, the MD is obligated to a certain standard of care, based on your presentation. Let's say they hadn't worked you up and you DID have some vessel/electrical abnormality and drop dead. Then Joanne could sue for "failure" to diagnose.
Ditto to what Leigh, Steve, and Mike said.
Mark- Have ya ever had PF??? I suffered for about 2 years, wanted the lithotripsy to my foot, but insurance would not cover it. That is, until 18 months later when I was better.
Gina - sorry to hear about the PF - my wife has battled it on and off for about a year, so I have some appreciation of how debilitating and demotivating it can be for an athlete. We ultimately paid for the ultrasonic stuff - it gave her temporary relief, but I think for her, lots of stretching and the passage of time turned out to be the most effective path. Did you find a solution that kept you running through it?
Mark- Didn't run for ~ 1 year. I think what ultimately helped was wearing a night splint and improving calf flexibility. Loved the irony of finally being better and then being called to tell insurance had approved procedure!
I was chuckling over the images of Rich and Steve intent on outlasting the treadmill. I can totally see me doing the same thing, although not sure my legs could hold that kind of pace. You guys crack me up.
Being female having a history of syncope and a recent case of increased, sustained balance issues and nausea 10 months after blacking out, falling and shattering my face. I reluctantly decided go in to the doctor's office yesterday because I'm having trouble just doing my days' work (workouts have been a relative non-starter). Just as has been the case EVERY TIME I'VE PASSED OUT, the doctor orders a pregnancy test! The Doc doesn't even sit down with me first to refresh himself with my history or discuss my current symptoms! AND he was the one who I saw to get my referral to the craniofacial surgeon who fixed me. I'm not offended by having had to take the test, because it's all in the name of ruling stuff out. I took offense with the apparent SOP for dealing with a female patient who presents with nausea. Let's just try treating each patient as an individual case first....After he read my file again, confirmed that I'm not pregnant (which I could have told him had he asked!) he said, "Ohhh, now I remember you." "Man, how could I forget that! What a horrible accident that was!" He was sorry. I think he may have felt my tacit disgust at the way my visit started out.
Sorry...that's rather rant-like. I'm on a short fuse, I guess.
Proceed as you were, team.
Rich--look up the links between caffeine and heart irregularities. Dude, you gotta cut back. Says mom.
Rich, it's your heart, dude. Do you really want them to cut corners?
I experienced some heart palpitations during exercise last summer. Because they didn't make me feel bad or short of breath I discounted them, but my partner and sister badgered me into seeing a cardiologist. I'm not as fit as you, but I was easily the youngest and fittest person in that office, staff (and cardiologist) included. I so badly wanted a stress test to blow their minds
but was instead given a monitor for a month to wear just during exercise, since that's the only time I had a problem, and an echo. Long story short I was diagnosed with sinus tachycardia, which is benign, and a small patent foramen ovale, which is a hole between the chambers of the heart. I asked the doc point blank if I could do another Ironman (she knows what that entails) and she said yes, and signed up for EN the next day. 
Anyway, the point of the story is that many diagnostics are relevant and important, no matter what the cost.
Rich,
I had the same test done earlier this month; what a production!
Just like you I figured I'd be there on the treadmill for hours; but nooooo. 14 minutes and I was begging for mercy, done, cooked. The staff was still impressed that a 55 YO dude could go that long. Their best ever? A pro hockey player!
Despite all you knuckleheadedness I'm glad you're seeing fit to take care of yourself; you're loved here.
Rich I am with Linda, you got to cut out the coffee or at least cut it back. caffine is a stimulant in the same family as amphetimines I believe just much weaker. Causes palpitations and other heart irregularities in many people. Still worth getting it checked out for more serious problems though.
Makes your choices, takes your chances.
Glad you went in and had it checked out. Not many men do...me being one. I am self-insured until recently when I remarried. To avoid the costs associated with raising healthcare coverage I chilled for a year after 2008 IM Moo where I also developed what you mentioned and had palps during the marathon leg that required me to walk and occasionally sit, shortness of breath and coughing during training along with the amazing fatigue leading up to the IM event.
I did a treadmill test in Dec for life insurance and they said I was the best they've seen in 11 years. Sad as I am not a Mancona by any means. They must see some sick people. The cardiologist told me that even with a stellar test like mine that there was still a 30% chance that I could have up to 69% blockage of one of the major arteries of the heart. They recommended I do a heart scan (CT of the heart) so they could look at cross sections of the arteries and look for blockage...as I also have a family health history of sudden death due to MI, smoking and diabetes.
If you are willing I'd like to hear more about your diagnosis.
I did recently start taking Zyrtec for my allergies and noticed difficulty with hitting my FTP durations (although my pVO2 is at an all time high) and TSS rides of 200 or more leave me sapped. Is that from 16 weeks of drilling the OS? Falling testosterone levels?
Vince
My mother was a nurse so having grown up listening to all of the stories from the hospital I tend to go to the hospital only when my options have been severly limited. Having said that good on you Rich for having it checked out. If my wife finds out I'll be doing that stress test.
Hey, maybe we've discovered a new "Haus Virus". "Flutter".
Seriously, Rich I'd be interested in hearing the diagnosis should one become available that you don't mind sharing (HIPAA notwithstanding). Thanks for sharing your hospital experience. Always a treat to hear the heatlhcare adventures. I tend to agree that seems like a lot of money spent running all those tests. So my question remains are all of those tests really needed for someone who is obviously fit as a fiddle?
Jay
Got me interested so, for what it's worth, I went and read up at http://www.emedicinehealth.com/palpitations/article_em.htm
Jay
Unfortunately us doc's tend to succumb to 2 things when overordering tests:
1. Malpractice/defensive medicine: We don't want to get sued too much. I've not been sued in 12+yrs of practice ( an attorney friend of mine said Im on borrowed time....) We'd rather go into a trial overtesting as a defense than failure to diagnose (funny the Health Care Debate is not addressing this)
2. Anectodal Medicine: we all have rare/unusual case where something out of the ordinary happens and we unfortunately tend to sometimes over utilize these test so not to miss those unusual cases.
You can always as a patient refuse to do tests, procedures as long as you get informed consent.
NEVER go thru a test if your not going to do something with the results. I often ask before a Shoulder or Knee MRI that are your symptoms bad enough to need surgery...if the answer is NO...then ordering a test is less likely.
I guess I should chime in a little being a doc also. I agree with above about the over utilization of tests due to malpractice risks. In my experience, patient's tend to fall to either extreme. One patient thinks all the tests are not worth it, until something is missed and the lawyer calls. Another patient wants every test in the world, but wont do anything with the results. So I try to strike a middle ground and make sure all my patients are informed when it comes to testing.
I dont want to really get into the health care debate on costs, but there are some things that do irritate me from a doctor's point of view. The first and foremost is having to negotiate for a test I want on a patient. I once had to talk to three different insurance physicians on the phone to get a simple test approved. Its really frustrating when somone across the country thinks they have a better idea of a patient sitting in your clinic than you do. The insurance companies says they do this to save healthcare money, but dont forget, they are also trying to save as much of their money also.
Second big point is that the reason tests are so expensive is a combination of overutilization , as Rich pointed out, as well as insurance companies desire to drive up profit. If you couple this with decreased payment to physicians for procedures and increasing mal practice costs, you have a situation in which doctors cant afford to not order ever more expensive tests. The cost of materials in a stress test are significantly much smaller than the bill people get.
I have no idea what the answer is. Hopefully someone much smarter will think of something. Or I will just give up medicine and raise Taro in Hawaii.
GV
Sometimes the insurance companies are a problem in other ways. I have recently had 2 different patient's being told by an insurance adjuster that they need to see this (or that) specialist since "...she [me] is just a general nurse practitioner". Unknown to me, one guy was seeing an MD through his private insurance, getting a 2nd opinion on everything I suggested, to make sure that I was treating him properly ( I was). So when the insurance adjuster started trying to get him switched to an MD of their choice, he refused and explained the whole story to both of us. (I found it amusing, the adjuster? well... not so much.) The patient is aware that I can not fix his problem. But he trusts me to choose the best specialist for his case, not the insurance company. The other young man, I sent him to the specialist that the insurance company was insisting upon. When the specialist didn't give the insurance company the answer that they wanted (the specialist agreed with me), the insurance company was left with no where to go. I had a good laugh at their expense. This will never change. But it does drive up the cost. I always check carefully to determine the credentials of the insurance person that is questioning me. More often than not, they have no medical training but are following a "cook book" handed out by the insurance company. And believe me, no 2 patients are alike.
Yes, I am of the opinion that we need to change the justice system in order to obtain meaningful health care reform. But folks still want to be fixed as of yesterday. When I give them the average time line for recovery, I get a lot of disbelief. People have this perception that in the U.S. we can fix anything in days, not weeks or months.
Ohh- I better stop. I can see an even bigger rant starting.
Hey folks,
Very cool, thanks for the dialogue. About the only time I talk to other people (never civilians, only athletes) is on a bike so...tough to have a conversation
.
I'll absolutely post whatever they come up with, especially any cool pictures, graphs, etc.
Good to know I didn't break the bank with those tests...maybe they'll send me an invoice (marked PAID).
Coffee: not sure I'm "that" bad. AM = either a big cup of coffee (20oz, pretty strong) or a 3-shot mocha from Cafe Sonny', made by barrista Joanne. I'll then have another cup or coffee or tea no later than 1pm. As I quickly approach Steve's age...or even Linda's...I've noticed that it affects me longer and I can't sleep if I have coffee after about 3pm. So, all in, I'm probably at the equivalant of 5x shots of espresso all day? I went dry for the morning of the test and I was HURTIN' bad. Bad. BAD.
Bill, in top fitness I think I coulda gone 1, maybe 2 more "steps." The steps were pretty severe and I think 2 more woulda had me at like 7' pace at 8-9%. I would NOT last too long...but sure as hell would not quit.
Steve's age...or even Linda's
Dude I think you are older than me, thats why they really sent you.
I had a similar thing in the summer of 2007 when I was ramping up my training. Ending up doing 2 ECGs, a stress test, a heart ultrasound and wore a HR monitor/recorder thingie for 24 hours to track my abnormal beats. I also didn't have to pay, but I did get copies of the receipts and it was only a few hundred US dollars. Of course you can probably multiply that by 10 to get American prices.