Episode 41: My (Your) First Meeting With a New Cardiologist Post Unroofing Surgery.

SPEAKER_01 0:10

Welcome to Imperfect Heart, a place for you to join me, Jeff Holden, in conversations, discussions, and dialogue about our hearts and the impact myocardial bridges have on them. We'll talk with healthcare professionals, those in related fields that support our condition, and others just like us with stories of their myocardial bridge experiences. It's my intention for this content to inform, educate, entertain, and even motivate or inspire you in your personal journey on dealing with a myocardial bridge. Most importantly is to have you leave each episode with hope, knowing you're not alone and that what you're experiencing is real. So imagine you are going to see a new doctor, in this case, a new cardiologist you've never met before. He doesn't know you, you don't know him other than what you've been able to do a little research and homework online to vet him a little more properly. Well, that's the case of the story I'm going to share today, and it's the episode you're going to listen to in just a minute. But I thought it needed to be set up properly so that you understand the situation. I had my surgery on January 4th, 2022, at Stanford. And all my follow-up procedures were at Stanford. And so for the next year, that was all Stanford docs, Stanford Cardiologist, Stanford thoracic surgeon, Stanford testing for anything else that needed to be done. I probably should reach out and get somebody. So I ask a few people and identify a few opportunities. So I'm assigned a particular cardiologist at a particular cardiology group for the medical system that I'm in. Well, I figured what I would do is I would go in with a microphone since I'm new to him, he's new to me. We're going to see if we've made any progress with regard to the understanding of myocardial bridges. Now, can you imagine some new patient you've never met before, have no idea who he really is, walks in with this recording device and says, Can I record everything that we're doing? And I give him a little bit of an explanation on what we do. I record podcasts, I have a healthcare podcast on hearts, and I don't get too much into it because I wasn't sure where he was, and I didn't want to taint any of the conversation. He actually says yes, which I was very, very pleased with. I come to find out that my Stanford medical records had not been transferred to the healthcare system that I'm in locally. So they didn't know anything about the myocardial bridge treatment, the unroofing procedure, or anything that had been done other than what I left them with last, which was something's wrong. I'm going into ventricular tachycardia as a result of vasospasms. And I was wearing a life vest in November of 2021. And I don't offer all that up immediately, which you'll hear in the conversation as we're recording everything, because I really wanted to vet how he was in terms of his understanding of myocardial bridges. Well, we all wish this was the first cardiologist we saw because I was blown away by the fact that he not only was aware, he acknowledged it. He said, Oh, yeah, they're definitely symptomatic. We understand. We talk about this in many situations that we see come through the cardiology group. It's up on our wall to always be thinking, could this be a bridge? And you'll hear the conversation that Dr. Lingham and I have as we orient ourselves to each other as my new cardiologist. And I want to, in advance, thank Dr. Lingham for his willingness to do this because that's a pretty confident move to let some patient you don't know walk in with a microphone and record the first conversation of your journey. So, Dr. Lingham, again, thank you for your awareness of what our situation is. And for those of you who are new on this journey, this is what you're looking for at the very least. That your cardiologist understands the bridges, and then if you were presenting in a different situation, that he would work or she would work toward the goal of getting something taken care of because they do know that these are a symptomatic condition. So without wasting any more time, my first meeting with my new cardiologist, Dr. Lingham.

SPEAKER_02 4:51

I don't know what you know about me. About two years ago you saw Manon. Yes. And I scared him into teaching. Yeah, he couldn't do both. He couldn't uh multitask melt. So yeah, it was in literally not 2020.

SPEAKER_01 5:16

Correct.

SPEAKER_02 5:17

Had a few runs of lenticular tachycardia transferred you or did they transfer you to Stanford? Yes. Yes. Radiation and resource phasing. Correct. What was the outcome of the transfer? Myocardial bridge. Oh the LA LAD bridge chain. What did they do? I roofed it, yes. Right. So that's part of the question. So you recognize the condition, which is great. What's your understanding of it? It's a genetic thing. Yes. I don't remember on top of my head the incidence of my guide of aging. I had another case and uh and I was going over that angiogram with him. She is she was this guy, now she is a medical student. I was going over how that is done, and even though it's a simple thing, you still have to do surgery. Like you literally lifted off. Yeah, that's what they do. It's a simple surgery. But at least that's I mean, not everyone needs that keyfair. You had re T, so you more than needed it. Well the vasospasms, too, they were caused by the endovarial dysfunction, which was a symptom of the heart compressing the artery for so many years. Oh, how did you do since then? Fine. Perfect. Literally asymptomatic. And and and that's an unusual situation. Not everybody comes out of it so fortunate. I had a five-centimeter bridge. There was long that's a really long bridge. Hey, I should go back and look at that cat image. Yeah. Because usually we have barely one centimeter where you could see that small area and we kind of use nitrates or something and not really put it in the sage. Right. Probably VT was what called for surgery. Did they do minimally invasive from breaking everything? No, they couldn't. They had to go in. They had to cut it. And I also had pectascopy that was compressing the heart. So they said we're going to go in and fix that because we're not going to do all that work. Yeah, that kind of came in. So they had to they had to Right. So I had a thoracic surgeon come in after the heart surgeon. Let's fix it. Fix the uh the VE. And you and you went to the best place, so you know, it's down the less cost, yes. They they have a department that's been doing research on bridges. And what we find is that so many people have them and so many people get misdiagnosed. Right, right. Because my cardior bridging is not picking up that quickly. Right. Because you're concentrating on how is the movement, you're injecting the die, everything is good. All right, it's got to be 17. You know, you just have to have the dye. But lately the detection is pretty high. I mean, well, please tell me that because part of our emphasis is to raise the awareness in the cardiology community. No, even in our boards, you know, when we have the boats, we do have one myocardial pyngin so that people don't forget that. Yeah. Oh, and that's really sad. And then that's that's part of the training. I don't think an interventional cardiologist would ever miss a myocardial print. Because what happens is when let's say I'm doing a hagiogram for ventricle tachycardia, I'm already looking for a good reason for VTing. VT doesn't happen just like that. Right. Okay. Eight or ten times it is due to blocked out use. The other reasons could be infections, could be there on a few other conditions. But in general, eight or fifty times it's to plug that use. So you're looking for it, looking for it, and then wait a minute, Rob, this is the reason. Because you don't see the blockage. You don't see the blockage, that is obvious. Right. But then you're having an electrical disturbance that is due to that. Yeah. So that's when that gets picked up quickly. Yeah, and we found the CT is is the quickest way to catch it when you're not. The reason we don't do CT is we know, let's say you have a block battery. We need to fix it right away, right? To prevent your T. If I do a CT and then if I do an angiogram, you're getting two dialodes and you're getting radiation twice. Why bother putting you through that? I mean, if you are a non-diabetic, you can handle two contrasts, double the contrast load and double the radiation is without trouble. But if you're a diabetic, then you don't want to screw up your kidneys. Yeah, that's and that's helpful to know. That's the first time we've we've heard then we say that. No, that's the reason why we don't jump on it. Sometimes in the emergency room you have chest pain and it's not sounding like cardiac, we end up doing an angiogram to rule out lung pots.

SPEAKER_00 10:06

Yeah.

SPEAKER_02 10:07

And then it comes back as no lung clots and you're having chest pain, then we're still stuck with doing an angiogram. Right. Which means you're still getting twice the radiation, twice the contrast. But there we don't have a choice. Yeah. I mean, because of the story, depending on who is first to band hitting you in the emergency role and what their comfort level of moving this way or that way. Right. Okay. I mean, do I call cardiology right away or should I do this, do this, and then call? You know, all these things fade. Yeah, that's interesting. I didn't know that. Yeah, no, that question makes sense then. Right. Why you don't go into that process first. Why we don't do a CT. Yeah, make sure you've got a currently. There are always all these there are all these conditions where we call this triple rollout. Triple rule out means when somebody goes from the chest pain to the emergency room. Is it because the main tube that comes out of the heart to the your count? Yeah. Is that leaking or ruptured or dissected? That's a big thing. That's an emergency surgery. Or is it because of a lung up to pulmonary embolism? Or is it because of a plugged artery? Yeah. That CT scan can do, but but the IV contrast has to go through different phases. So the triple rollout is not that simple. The radiologists have to work on when the contrast is going, it should go into the arterial phase, it should go into the venous phase, all these things have to be looked at before you can totally call there's no clock, there's no dissection, you know, there's no hot clock. Right. And then we don't want to and then you're literally flying the patient. Yeah, right. If I if I have a hundred patients coming to the year with chest pain, if I put all of them through this, yeah, that's going to be a huge healthcare expense. Yeah. Okay, that that makes sense. That makes sense. Across the world, imagine that. It's like well, one one in four of us has this condition, so it's like yeah, but five centimeters is really large. I mean, you know. Yeah. I have to, I mean, obviously that's why you have the roof thing. Yeah. You know, one, I have seen two centimeters, too. Five I have never seen. Yeah. But I don't, I mean, cath is not my thing. Yeah. So we see people, so many of them, it just bears. Right. It just wears the it's the toss of the poem. There's no right answer. I wish we knew what caused so many people the trouble. When we don't have a good answer, we throw it on the genes, genes. Yes, yes. We blame it on the genes. So because yes. I I'm sure. This this, by the way, is a good doctor. Because so many doctors don't recognize it. They call it benign. And uh I mean, you know, if it uh in your case, it's obviously not. It's VT is like the final straw. You cannot ignore VT. Right. Because V T kills people. When somebody has a heart attack, yeah, VT is what kills them. And I did on the 26th of August. Three years ago, we had a heart attack. I ended up in with a myocardial infarction.

unknown 13:14

Right.

SPEAKER_02 13:15

And uh and they said your coordinates in a fight go on board what? Yeah. Yeah. Yeah, everything was fine. Oh, and then we detected this afterwards? This because they couldn't understand why I was still having the pain. And I kept coming back. I said, look, I'm and this is okay. I missed that part. Yeah, so this this pain will not go away and it's severe. And so they ended up, I had enough. Taking back to the taking you back to the cat lab? Yeah, and I had cardiac MRI, and then they they did everything, and then they said, Well, you have this bridge, but it's not bad enough or something. Yeah, they didn't really get into the bridge. They saw it as benign at the time. It wasn't so much Rishi, he was the electrophysiologist downtown. Yes, Isaacushnan or something. Yes. You saw him in November. And and so he he said, you know, we we could do some testing, but we don't do that type of testing. We suspect vasospasm, the vasospasms were triggering the BT. So I'd have these really severe episodes of vasospasm, which would create the pain. Wow. But you wouldn't see it because you can't see a vasospasm unless you're in there. You know, we have we have medical residents in training now. If you if you were here, I would have made them make a case report on this one. If you make, you know, this I'm happy to talk to anybody at this point. Now, and next year we're getting cardiology fellows. We could save this case as a oh please. As a discussion point, if you don't mind. Absolutely, yes. Okay, yeah. So the Mazospans were triggered to be T runs, would be on the LightFest because they weren't sure. Did that go off at the Nickline? Twice. But I didn't pass off. So I was awake, so I was able to shut it off. And we got a good guess today. And I don't want to dish it. All right, so let's trigger out what the problem is, and then that's when they said you need to get a provocative test to identify what's causing the vasospasms. And then of course I was forced sharing enough to get into Stanford. We used to send, I mean, you know, I was at Dr. Pitchkoff for kind of is to say, okay, go to MZS. And they trained in New York and then in that direction or so. You know, we used to have all these big places saying, okay, I'm gonna go there. It's like, okay, it's it's not too far away. Go ahead and give it a shot or something, you know. We actually had a doctor from Yale who is now doing a clinical trial on Inoke. He's trying to identify Inoka Inoka. It's just talking about the So why do people present with condition when they have clear arteries and of smalcardial bridges one and oh, sometimes you could have diffuse disease. There are years roll by with high LDL and you know it's it's a Inoka is a very I think it's more prevalent than what we give credit to. I think it's why the study is happening as well. So it's accumulating 500 patients over five years. Okay, where is the mayo? Is mayo doing it? Yale. Yale. Yale is doing. Yale's doing it. Males inclusive, males participating, Cleveland Clinics participating, Stanford's participating. Usually that's all the big brothers. Right, right. They have the bandwidth to do all these things because they have more people to work with and also the the bandwidth they have with enhancers and everything. Yeah. We we have him in there is as one of the episodes. Who is that? Who is that? His name is Dr. Samit Shaw. About your age, young guy. Sameet Shaw? Same shaw. Yeah. So what do you do? What do you do for a living? I produce podcasts. Coincidentally, I produce podcasts. Well, I go for walks and used to. Nowadays, so it is something called womedi in kinda in medicine. V-U-M-E-D-I? I don't know if people it's V-U-M-E-D-I, uh. That's a which has all the medical talks. Uh so you could uh custom that into cardiology or proentocardiology or something. And all the latest talks are all the latest talks you have, and even if it's a big guy, whoever you know. Yeah. In the academic circles, they they talks come on it. Yeah. So all my podcasts are gone, and now I just listen to those. Like as a patient, I'm happy about that because you're learning more about the conditions. That's the only way for me to catch up on than you can. Yeah. Well, and this is this is doctors and patients. So we alternate. Typically, we've had the top three robotic surgeons for the cardiac repair of the uh myocardiobridges, as well as the doctors who did meet, Dr. Boyd at Stanford, who's the number one surgeon in the world for the division because he's been doing it for 12 years. Okay. So he's probably down his probably cushy 300 cases now or my cardiovridges. Yeah, because you know, the the thing with the higher centers or centers of absence is all these end up going there. So that regular surgeons kind of say, okay, you know what? Surgery by itself is not that hard, correct? Except, you know, the volume is lacking. Yeah. So mayo clinic and Stanford, all these guys end up getting all their thank weave your insurance approvals and rights. All those other things also all day well. I compliment you guys in and the whole sutter system because once you realize the distributor wasn't the answer for me, I'm very active. I'm a cyclist, I was a truth man. Doesn't fix me. It just protects me. And everybody was willing to say, well, then let's take that next level for the test. And then the test was conclusive. It's okay. Yeah, you when I run into Manon, I let him know that you're back here and you don't mind that, right? No, please, please. He's he's the second episode. Yeah. Reese came out and we talked about the whole case. Oh, he did. Okay. He still does some podcasts, I know. Yeah. Wellness Sundays, like he's uh he's made the wellness director or something for something uh for all the residents and everyone. Yeah. And I spoke with the the ladies up at Cardiac Rehab. You could like to do an episode on that just to identify what it's like we do get repaired, yeah, what that process is. Just to and people get anxious, you know, that first time out. But what's happened is it's been two years now since I've been a year on Stanford's follow-up. And I figure I don't have a cardiologist. Yeah, I have a heart computer. You probably don't need one anymore because it's fixed. I want to keep it right. You need Jack is to get an echo, make sure everything is okay. Do you need nitrates or not? Depending on how you do. If you're biking and not having chest pain, I do fine. And uh and not uh really on any aspirin. Just baby aspirin. They said stay on that and they haven't unlipped to her. How much is your LDL? 51? Pretty just yeah, I've been I've been on that since I left, but I cut it to 20. They said 40. I said I'm and as long as your LDL is below 70, I'm okay. Yeah, there is a push for lowering the LDL below 55. Okay. For patients that are for patients who already had a stroke or a heart attack. Got it, okay. Or required stents or bypass. Okay, good. But a part of me is like, why do you have to wait until these things happen? Why not for everyone? Yeah. So it depends. If I'll take it, if I can push it. Yeah. Like I said, they had me at 40s, and and I I just I said, I'll don't cut it to 20s, too. I don't know why I need that's that's a maximum dose. I mean, it has other benefits too, but in your case, that is a congenital condition that's fixed, and otherwise your arteries are okay. So the one they did say because they handed to the bypass, because where the artery enters the heart, there's always some sort of blockage. Yeah, and I had some soft plaque there. Oh, okay. So you did have some Yes, yeah. And the at the point of entry only, everything else is fine, which is not unusual. And they said what we'd like to do is protect that. I guess the limventor does protect in some way the soft black from possibly rupturing. Right. So it softens the black. Oh, it softens it. It so if you have a hardened black that's prone for ricture, okay, because you have a calcification that is hard, and the bloodstream could rupture water. If it does if the black is soft, it cannot cut loose. It cannot come loose. So they want to keep it soft. Right. Or soften it more. Okay. There are multiple other advantages of improving the endothical function of the of the lining, okay, you know, that the statins can offer. Apart from lowering the idea. Okay. Okay. So that's an additional advantage of the statins.

SPEAKER_01 21:58

And I I'm gonna clarify that just

SPEAKER_02 22:00

For the benefit of people who are listening, that the statins can actually improve the endothelial total function. Not can, will. Does. Does okay. So big deal. And that is a big deal. So that's why even if your LDL is normal or below 55, anyone who had a vascular event, vascular event meaning mini stroke or TIE or a stroke, or heart attacks requiring stent or bypass. Yes. Or heart attacks not requiring any of these, but you have plaques. Which means, yes, you had a heart attack from minor branches where we did not have to revascularize, but you have a little bit of plaques that are seen on the images. That is reason enough to justify statins. Okay, good. Regardless of your LDL level. Okay. Or I feel better to that too. People get a lot of bad rap on statins, but they don't understand what they did over the last 40 years. The incidence of major vascular events have drastically come down due to statins. Even with the people who are experiencing, not everybody has endothelial dysfunction as a result of the bridge. But for those who do, so endothelium is a lining of the internal side of the arteries. Right. Any rupture of that endothelium at any point to the entire vascular tree can cause endothelial dysfunction. So it starts from the aorta. The minute the heart the aorta comes out to the arms, circles around, goes to the belly, to the legs. Wherever you have a rupture, wherever the plaque rupture happens, that means the endothelial lining is disrupted. Once the endothelial lining is disrupted, the nitric oxide that comes from the endothelium could be coming down in proportion. There it should be. And that's why you need to take care of the endothelium. More the nitric oxide that is emanated from the endothelium, the the smoother the vascular muscle is. And constriction chances are less. The spasm chances are less. With the stem to protect with the nitric oxide. Oh, with the nitric, okay. Right. And this helps. Yeah. Statins help, they'll keep the endothelial function. Got it. Okay. Then I'll be able to do that. So you're not gonna get off of the lipitor if you already said you had a cluck. I have to go back to the Stanford records and pull up your OPRP pot and paste it into my note because you did not see melon after the no after the report. So I could go back there somewhere and pull it out. I wish I can help. Yeah, anything I can do to help. So we could keep you for follow up once a year. Sure. And take it from there. Maybe at some point next year I couldn't have a reason to update your echocardiogram. You had one before you went there? Is that? I had several. Okay. After you were there, you had And then I did it again. I did everything again at Stanford. Okay, then we'll pull that up from there and then take a kid. I don't You had a monitor also in October of 22. So you did not have echocardiogram since discharge.

SPEAKER_01 25:30

Correct.

SPEAKER_02 25:31

Yeah, the monitor was just altered. To make sure you did not have a VT. Well, it was after the surgery what they wanted to do is just watch my I have an arrhythmia. Just from cycling long distances over time, they said it's not a big thing. Arrhythmia is a vague word. What arrhythmia did you have? That's a good question. It's my heartbeat is not 100% regular. Okay. But is it sinus arrhythmia or is it AFib? No, it's not AFib. As long as it's not AFib or AFib. Looking at the Holy Grammar from October 2022, and three episodes of SVT and no AFib, no flatter. Yeah. Overall. And those are three. That was October 2022. And surgery. Well, in November 2021. January 4th. Oh, January. I think January 4th. And you might even want to go, if you go to November, you'll see all the testing. That's where the provocative testing will show up. November of 21.

SPEAKER_01 26:32

Again, thank you to Dr. Lingham for his candid discussion with me, for his awareness of myocardial bridges and the fact that they are symptomatic. And for the fact that we can share this with any other cardiologist that you may be establishing a new relationship with. I would suggest if anybody has any questions to reach out to Dr. Lingham. And I will have his information in the show notes for this particular episode. Again, thank you. I hope you enjoyed it. I hope you get something out of it. And I hope it helps you on your journey as you try to identify proper diagnosis for the condition. Thank you for listening to Imperfect Heart. It's my hope that this information helped in some way to improve your situation or will help you better understand this condition. More importantly, that it gives you hope through stories that there is help and you most certainly are not alone. If you've been diagnosed with a myocardial bridge, please be sure to join the private Facebook group, Myocardial Bridge Support Group. For more information about our program or to reach me directly, visit the website, myimperfectheart.com. If you like what you heard today, please give a positive review, thumbs up, high five, whatever your app likes. And be sure to share with everyone important to you so they understand what it is you're dealing with. Please subscribe as well. Welcome each day with gratitude and positivity. Imperfect Heart is a production of Hear Me Now Studio.