We all do some medical intuitive work at some time or another, which is a form of intuition attuned to physical health and vitality.
My dad's family has good health, but tend to develop heart circulatory issu...es, when blood vessels oxygenating the heart become narrow -- affecting tissue directly responsible for cardiac rhythm and full contractions.
And so my dad's symptoms suddenly appeared, a rapid heart beat, shortness of breath, increased blood pressure, but no pain. He felt so atypical, that he sought a cardiologist.
Through tests we knew his heart was not getting enough oxygen, which explained why his cardiac function had deteriorated over time. I should note that the circulatory system's compensatory mechanisms had kicked in to keep blood pressure up, but this did put additional strain on a heart already in need of oxygen. Fortunately, my dad was health conscious and not one to self-deny.
Based on test results, his heart suffered no irreversible damaged, but because his physician was reticent to admit it, I filled my dad in on that conclusion.
The doctor advised my dad very conservatively, informing that his heart was "bad" and that its function would worsen over time. Also, he said that dad would require surgery to open his heart vessels with stints and that medication would manage his condition from here on out.
I was okay with that, but still felt his age was an important factor (almost 80). We all die and a decline in systems' function is a normal part of the aging process before we die. Quality of life is more important as we age and die.
After stint surgery, he was put on a regimen of pills.
During our follow-up visit after surgery, the doctor performed more tests, but was not pleased, and wanted to achieve better cardiac performance, and so a 'beta-receptor' class drug was added to correct this -- a drug that would keep stress off the heart by slowing down its rhythm, while theoretically increasing ejection fraction rate by allowing more blood in the heart between contractions. In this way the heart gets to work less under less stress and by pumping more blood per contraction.
I read medical literature and noted that the dosage should be increased incrementally until the target ejection fraction rate were achieved. Unfortunately, this standard approach was ineffective, although we had already hit the maximum daily dose.
After no improvement, and at the maximum dose, I thought this drug should now be decreased, because the heart slowing side effects would eventually become more prominent, which is cardiac suppression, which could at worst lead to cardiac failure. My intuitive question was: "When is this all coming to head?" and "Will my dad have access to emergency medicine when this happens?"
I mentioned this to my mom, a retired registered nurse (first a cardiac nurse, then quality assurance, and finally retiring after developing the hospital's and medical college's first risk management program as risk manager).
I also told my dad of my concern with this drug.
Although there were no symptoms, I knew as a medical intuitive, what was coming around the corner. This was a waiting game I did not want to play.
You see, as a pharmacist, I hated the idea of loosing credibility with my family and his doctor by blowing the whistle or crying, "Wolf," too soon with no symptoms, only to be characterized as "an overly concerned relative with some knowledge about drugs;" and, yes, pharmacists and physicians are historically on good terms, because doctors do call upon pharmacist for drug therapy consults.
This is not translatable when I am interacting on the other side of the pharmacy counter.
Two months later my dad calls me, explaining he can't sleep at night, because laying flat he's drowning...suffocating, and also when climbing a short flight of stairs, he is breathless.
I sensed he thought he was about to die, and wanting to relieve his concern so, I told him, "Remember that drug I told you about?" He did not remember the drug.
I told my mother, because he did not want to concern her. In reminding her I said, "It is the beta-blocker drug...it's too high and he is in cardiac failure..."
I'm still not sure my mother gave my detailed concern much credence, after all, why or how should I know...I ran no tests and I can't see through people..."
I told my dad to go the doctor's office immediately, that he would be taken off the drug and put on another to strengthen the heart performance, not telling him he'd be admitted to the hospital to begin with, because that would stress him more.
He went from his doctor's office directly to the hospital.
My father was admitted and cared for by another doctor on call, which assessed him, re-dosed his meds, and put him on medical watch. I came into the picture on day two of father's in-patient stay.
My dad was put on another drug, just as I said, the culprit drug (the long-acting beta-blocker) was cut in half. In a several hours, he could lay flat on his back again, "...ready to return home," as he put it - but, "not before we talk with the doctor..." I forewarned dad.
I wasn't happy, he knew it and was uncertain about a confrontation over his hospital bed.
Well, his regular doctor visited the next day, telling my dad that his heart had worsened unfurling a report that had my dad thinking more pills and a possible surgical procedure were in order.
Here was my moment...
"Doctor," I said, "my father's heart isn't failing. It was the beta-blocker drug left at maximum dosage, never improving ejection fraction rate, which finally caused cardiac failure. "
He said, "I don't agree. Now, here is what we will do."
I said, "Doctor, it would be easy to assume that my father has left ventricular heart failure and that his heart condition worsened; but this is purely a drug-related incident." I began reciting from memory, what I had been deducing over the past several months, waiting for all this to unfold:
1. This drug suppresses heart function by default especially at the maximum dose, while yielding no therapeutic benefit (ejection fraction rate had not improved)
2. There is no pulmonary edema (fluid in the lungs due to back up of heart circulation -- a symptom associated with chronic congestive failure)
3. There is no pulmonary hypertension (see number two)
4. This drug you have him on has no intrinsic activity (meaning it does not empower the heart, while slowing it down...some beta-blockers do both)
5. My dad has no peripheral edema (swelling at extremities)
6. His peripheral pulse is strong (pulse at wrists and ankles)
7. He has no left ventricular hypertrophy (muscle inner growth due to stress, decreasing the hearts available volume to draw in and hold blood before pumping it out), but that his muscles were stretched or dilated, meaning the muscle change that happened is still in the reversible stage. I saw the imaging results from the doctor's office myself, by asking to view them.
After I finished my list of points, the doctor was obviously livid and said condescendingly, "Why am I arguing with you?" still firing specific clinical details trying to intimidate me into backing down, while declaring that he intended to raise the very same culprit drug (long-acting beta blocker) back up to its maximum dose.
This to me was a mortal threat on my father's health and well-being; and I wasn't standing for it!
I said, "You are right, in that we don't have to argue. No need for that, but, instead, why don't you go look to the computer just outside our room to see what your colleague assessed and then left on record for you upon admitting my dad?"
Personally, I did not see what the on call doctor wrote down. I already knew.
The doctor spun out and sat at the computer situated right outside my dad's room. We watched him as he looked into the screen to view my dad's record -- we could see him there since the wall at that point is tinted glass. There he sat typing, reading, and conversing with the medical interns, which flanked him.
While we observed the doctor, I repeated aloud, but under my breath to my dad and aunt, his sister who were both sitting there in awe of my abstinence, "Oh, yeah...,you' re right, doctor. We don't have to argue, and you won't be increasing that drug dosage ever again....because you're fired!"
Some time had passed, before my dad's cardiologist got up from the computer and reentered our room. I don't know what he specifically read at the computer, because he never mentioned it, however, he came in a different person with a brand new attitude.
"Dear Bryan," he said, "how about this?"
"Yes?" I said leaning inward just as super-intrigued as my father and aunt were.
"We will leave the drug dosage right where the doctor on-called reduced it...at one-half the maximum dose; and I will not increase the dose until I okay it with you first. Is that okay? We will monitor him over night."
"Why certainly, doctor!" I said. I was finally free to play the role of a caretaker, promising to ensure nothing but compliance per the physician's orders, "but," I asserted, "my dad wants to return home today."
"Okay! So, be it!" the physician sung melodically throwing up his hands as if to playfully give in.
My mother had not arrived, and somehow I feel that it was best, because as registered nurse, she may have deferred in favor of the cardiologist in order to squelch our heated debate. She was also a hospital risk manager (before retiring) and so, again her relationship with physicians was different.
My mother had not arrived, and somehow I feel that it was best, because as registered nurse, she may have deferred in favor of the cardiologist in order to squelch our heated debate. She was also a hospital risk manager (before retiring) and so, again her relationship with physicians was different.
In any event, I was relieved that this had finally passed, understanding the importance of following your heart
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Making It All Click
October 2009 
Bryan
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