CLINICAL MATTERS

As a doctor, I usually continue working through Christmas and the holidays unless we go out of town for vacation. This year, my last clinic day was Friday, Dec. 20 but I continued to work up to Dec. 25 since I still had patients in the hospital on which I needed to round. With my clinic on hiatus, I had a little bit of free time. My wife, who is also a doctor, proposed that we get our laboratory work and some tests done. It is almost a cliché that doctors are notoriously bad at taking care of their own health and I am not an exception. A year shy of going on 50, I am badly overweight and I have sleep apnea and hypertension. The last time I checked my labs was a couple of years ago. They looked okay then but I hadn’t really been living a healthy lifestyle or getting enough sleep. I get easily short of breath when I climb a couple of flights of steps, and my knees hurt when I stay on my feet for too long.

Getting executive checkups is common at this time of year since people have some free time and they use up what is left of their health insurance allotments. Contrary to popular belief, regular executive checkups below the age of 40 are not usually necessary unless someone has specific symptoms. Many of these are done anyway especially for those with health insurance since people feel it is good value for their money. For doctors, we usually have some benefits in the hospitals where we work but it is difficult to find time for the lab workup. Since we did have time now and I was feeling some symptoms, we decided to use these for the usual fasting lipids, sugar, and other basic tests. I also added a 12-lead ECG and a 2-D echocardiogram. The night before, we had a light snack at around 11 p.m. since we wanted to target a 7 a.m. blood draw. 

Fasting laboratories should be done within eight to 12 hours of the last meal. Going over 12 hours of fasting can result in stress hyperglycemia, a phenomenon where the blood sugar might be higher than usual. We woke up early that morning, with me being a little crankier than usual without breakfast or my morning coffee. Fortunately, there were very few people in the hospital this late in December so we got our blood drawn quickly. Despite having done many blood draws on other people, I hate having them done on me. The medical technologists in our hospital are very good and there was minimal pain when they extracted my blood, but it was still uncomfortable. After the bloodwork, we finally had breakfast and I was feeling much better.

Next up was the 12-lead ECG and the 2-D echo. These are done at the heart station and one needs to take one’sshirt off for this procedure. Being on the other end of the healthcare encounter is always disconcerting for doctors. As the ECG tech attached the electrodes, I found myself going over the procedure in my head. Attach the four limb leads, both wrists and ankles. Attach the precordial leads over the heart, one on the right side of the sternum and five on the left going further along down the ribcage. I tried my best to calmly breathe so that it wouldn’t distort the machine’s reading but I did worry that it might find something wrong.

As if reading my mind, the tech gave me a copy of the printout immediately after the test. A cardiologist will do a formal reading later on, but most doctors are taught the basics of reading an ECG. I looked at the squiggles in front of me and systematically went over the findings. Look at the P wave, the PR interval. Check for Q waves which can mean an old heart attack. Normal and no significant Q waves. QRS complex is narrow, which is normal and there were no unusual T wave inversions except in the usual leads. Look at limb lead one and AVF. If the vector is predominantly upright, then the heart axis is normal. Check, both were upright. Check the precordial leads, there was good R wave progression. A little bit of a slant on the ST segment, which is probably early repolarization since I am hypertensive, but not a true elevation – which would mean a heart attack. I heaved a sigh of relief and handed the paper to my wife who had the same interpretation of the ECG.

Next up was my 2-D echocardiogram, or 2-D echo for short. A 2-D echo is basically an ultrasound of the heart that looks at the muscle function of the heart and the structure of the heart valves between the different chambers. Since I was getting short of breath when going up flights of stairs, I was particularly concerned that the 2-D echo was going to show something abnormal. An abnormal 2-D echo is commonly caused by poor blood supply to the heart, and this was something that I was dreading. 2-D echos are very specialized and only cardiologists are competent to interpret them. However, the techs can usually see if something major is amiss, and the machine does give some estimates of numbers. As the 2-D echo probe moved across my chest, I found myself getting nervous. What if they find something bad? Will I have to undergo a major procedure? I tried to suppress my feelings because even that may cause some abnormality in the test. However, lying there helpless in the darkened (they darken the room to see the echo readings better) room with the cold conducting gel spread on my chest as the probe uncomfortably pressed between my ribs was nerve-racking. Finally, it was over. The tech casually said that she didn’t see any obvious problems and that my heart function looked normal. 

Normal results are always reassuring. Although our bodies will inevitably break down as we get older, and the risk of a major event such as a heart attack or stroke increases over time. Just a few days ago, one of my former residents who was much younger than myself died of a brain hemorrhage. While it is impossible to predict rare catastrophic events, it is important to realize that we can only abuse our body so much before it collapses. At the risk of sounding cliché, it is clear that my New Year’s resolution will be to live a healthier life starting next year. And if you are younger and healthier than I am, it never hurts to start early. May you have a meaningful and healthy 2025 and beyond.