Ocean
Frequent Contributor (1K+ posts)
Member # 3496
posted
OK,
So they are 'within normal limits', which is good, but after seeing Dr. Cheney on the CFS (which I was diagnosed with), it makes me wonder.
I'm wondering if anyone else had this happen... The tech lady kept saying how she doesn't get such thin people in and how I couldn't lay flat to get some of the reading because of my weight, ect.
So on the report it says, "Normal sinus rhythm, technically difficult due to patient's size"
and in the conclusion part it says, "Essentially normal M-mode-two-dimensional color-flow Doppler. Technically difficult study with no apical's"
There are 13 things they were looking at and they have blanks for 5 of mine that they apparently couldn't 'get' due to my 'size'.
So, they are just basing this 'normal' result on the ones they could get? Drives me crazy because I have gained 10 lbs and technically am no longer underweight! I know Geneal said ECHO's aren't as accurate if you are on the thinner side.
The only thing I can see is my ejection fraction is 55% which is on the low side of normal (55-70%), but still considered normal, I'm just wondering now if this is really saying my heart is OK since the report states I was a 'difficult' patient.
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
-
Did they also do the ECHO with you standing up? If not, if you have one done again, ask the doctor to order it that way, too.
It often shows different reading for fatigued patients with them standing.
--
However . . . I am so sorry to hear that you have the horrible label of 'difficult' patient. That pretty much means you will never be taken seriously.
When I saw that in my file once, I thought the doctor had meant to say "a difficult case" but then I discovered that it is a code term for patients whom the doctors think are hypochondriacs or "whiners". Doctors hate 'difficult' patients due to their insistence at finding answers. It's sad.
I am concerned that once that is in your chart you can pretty much forget any doctor really digging for the root cause of any symptom.
As I recall, you are a nurse (?) . . . that would give you an upper hand, I would think, to confront whomever put that 'difficult' patient in your chart.
You may need to find a different doctor if the doctor whom you are counting on thinks of you as a 'difficult' patient.
=================
Search the term " Difficult Patient" at Google and this is just one of many links:
Nov 15, 2005 ... The difficult patient: prevalence, psychopathology, and functional impairment
[ Published correction appears in J Gen Intern Med 1996;11:191] . . .
Excerpt:
All physicians must care for some patients who are perceived as difficult because of behavioral or emotional aspects that affect their care. Difficulties may be traced to patient, physician, or health care system factors.
Patient factors include psychiatric disorders, personality disorders, and subclinical behavior traits. Physician factors include overwork, poor communication skills, low level of experience, and discomfort with uncertainty.
Health care system factors include productivity pressures, changes in health care financing, fragmentation of visits, and the availability of outside information sources that challenge the physician's authority.
Patients should be assessed carefully for untreated psychopathology.
Physicians should seek professional care or support from peers. Specific communication techniques and greater patient involvement in the process of care may enhance the relationship.
(Am Fam Physician 2005;72:2063-8.
Copyright � 2005 American Academy of Family Physicians.)
. . .
The Difficult Patient
The illustrative case above is an example of a patient who may be considered difficult. Most practices include such patients; the prevalence is estimated to be 15 percent of patients.1,2
. . .
The difficult or frustrating patient, often a "distressed high utilizer of medical services,"9 often has unrecognized psychiatric problems.1,2,10 Patients with mood disorders may present with insomnia, back pain, headache, fatigue, or a persistent search for a medical explanation for distress.
. . .
A strong negative emotional reaction to the patient (in an otherwise caring physician) may suggest a personality disorder diagnosis in the patient. 29
. . .
. . . Cont'd.
- Full article at link above with a link to the full SIX-PAGE document.
feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
I think that Oceans report reads: Technically difficult.
Her report does not read "difficult patient" anywhere.
It was Ocean herself who labeled herself as a "difficult patient".
That being said, what were the 5 things that they were not able to measure? I will compare to my report and let you know what the diastolic disfunction is reported under.
Feelfit
Posts: 3975 | From usa | Registered: Aug 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
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She said at the end of the post: " . . .the report states I was a 'difficult' patient.
-
Clarification would help but if it the report actually stated that term, it can be a rough road from here and it would be important to know if that term had come with her file as can happen - and then it gets passed on as a label.
Hopefully, this is not the case, and it meant "technically difficult" to perform the tests.
feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
Right Keebler, but it was referring to her size and their inability to measure....correct me if I am wrong Ocean.
Otherwise, I would be very po'ed if that was in my record "dificult patient" and would take measures to get that removed as Keebler suggested!
Posts: 3975 | From usa | Registered: Aug 2007
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bettyg
Unregistered
posted
we do have 1-2 members who "read" things like this.
if you want their opinion, search them out by clicking on directory at top.
go to 2nd blank line, and put in the title of people who do this ... i can't remember right now!!
next line, use arrow and pick OCCUPATION click search
it will bring up all who SHOWED their job in their profile only!
click on their name and send them a PM with the direct link of your post. many will help folks privately vs. publicly due to giving "medical" advise. doesn't hurt to try them.
lyme patients helping lyme/co-infection patients ... reaching out to others in need xox
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Ocean
Frequent Contributor (1K+ posts)
Member # 3496
posted
Keebler,
Ooppsss, yes I'm sorry I should have put difficult sized patient. I actually didn't say anything to them about Lyme or CFS, I just said I was having heart palps that showed up as PAC's and PVC's on my 24 hour holter monitor.
But you are right, once you are labeled as hypochondriac, ugh! I remember in nursing school, the nurses would roll their eyes at the 'frequent flyer' patients as they called them. Made me mad.
So sorry about the confusion. My husband is often confused when I talk, I will say half of what I am thinking (and I honestly believe I said the other half, when I actually didn't).
Sorry =) Keebler, no I only did it laying. I didn't know about the standing up, I should have posted on the board first before I had it done! Maybe they will do another one (although then they probably will try to label me as difficult!)
I will post the numbers in the report, thanks Feelfit for being willing to fill me in on yours too!
IVS (ED) is 7 normal is 6-11
IVS Excursion is Blank normal is 3-8
LVP Wall (ED) is 7 normal is 6-11
LVP Wall Excursion is Blank normal is 9-14
LVID is 44 normal is 37-56
RV Dimension is Blank normal is 23
LA Diameter is 20 normal is 19-40
EF Slope is 120 normal is 50-160
E point to Septa is Blank normal is 5
AV Opening is 16 normal is 15-26
Aortic Root Diameter is 24 normal is 20-37
A Wave Depth of PV is Blank normal is 2-7
Fractional Shortening is 31, normal says 29%
Then it reads: 1. Normal Sinus rhythm. Technically difficult due to patient's size.
2 Normal aortic, mitral, tricuspid and pulmonic valves.
3. Normal right and left ventricular size and systollic function with 55% ejection fraction.
4. Normal atria.
5. Normal pericardium.
6. Normal color-flow Doppler.
CONCLUSION:
Essentially normal M-mode-two-dimensional color-flow Doppler. Technically difficult study with no apicals.
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
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Ocean,
Whew! I am so glad you cleared that up and you don't have that label.
I searched some for that and am shocked that a "difficult patient" label is TAUGHT to doctors. It's in the medical literature.
Here's a thread that grew out of my being reminded of the disaster - and years of my life lost - that label caused me. So that other's don't have to go though such experiences:
disturbedme
Frequent Contributor (1K+ posts)
Member # 12346
posted
Ocean, I'd think maybe getting a second opinion from a different cardiologist? My ejection fraction is also only 55%.
-------------------- One can never consent to creep when one feels an impulse to soar. ~ Helen Keller
My Lyme Story Posts: 2965 | From Land of Confusion (bitten in KS, moved to PA, now living in MD) | Registered: Jun 2007
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disturbedme
Frequent Contributor (1K+ posts)
Member # 12346
posted
Ocean, that's really interesting. I really would like to see what my echo says. I've only seen what my holter monitor has said.
Think I will ask my cardiologist for copies of it. Hmmm...
-------------------- One can never consent to creep when one feels an impulse to soar. ~ Helen Keller
My Lyme Story Posts: 2965 | From Land of Confusion (bitten in KS, moved to PA, now living in MD) | Registered: Jun 2007
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
The right and left ventricular assessment is where the diastolic function would be noted. Looks like they only commented on your systolic function. Your ejection fraction is normal but on the low side for a young person.....but everyone differs. My ejection fraction was 66%.
I am going to another cardiologist who is highly recommended for a second opinion, actually, a first opinion because this cardiology group did not address my abnormal results.
I would say that your ECHO is incomplete.
Feelfit
ps sorry for late comment had an appt. at 4:00
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Ocean
Frequent Contributor (1K+ posts)
Member # 3496
posted
Disturbedme,
Yes, definitely get a copy of your report. If you don't mind, I would also like to know what it says since our ejection fractions are the same.
Well, Feelfit...I don't know about the 'young' part, I'm not exactly a spring chicken anymore (I turned the big 3 0 last year) =)
Thank you for your interpretation. I've never seen an ECHO result. I asked (wait..I mean TOLD) hubby to call our PCP tomorrow and ask for his ECHO report (he passed out in Feb and had one done). Ugh...I was very interested in the diastolic function as well, I wish they had been able to do it. My husband is skinny and they didn't pick on him apparently. Not fair!
Let me know what your new Cardiologist thinks about your ECHO, maybe they will do another one. I've read that you can have a normal ejection fraction and you can still have heart problems. I want to see what my husband's report said for his.
Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
My echo said 45% ejection fraction rate.
Mitral valve regurgitation.
Some other things that really freaked me out.
Go get a nuclear stress test done.
My heart was "perfect" and all of those things
They thought they saw on skinny ol' me,
Weren't really there.
It would definitely ease your mind.
It certainly did mine. Especially since I have
A positive family history of heart disease.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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Ocean
Frequent Contributor (1K+ posts)
Member # 3496
posted
Hi Geneal,
Thanks hon, I will see if I can get another test ordered. I don't know if my PCP will though since the ECHO was WNL. I'll have to look up Nuclear stress test, it doesn't involve injecting one with something to speed up the heart does it, eek?
It's so silly because I am not even that skinny anymore, slender maybe, but gross looking, no way, the tech lady made me feel like a freak, I was very uncomfortable! I would think that they would have equipment for testing people that are on the lower end of normal weight/height. Like what do they do for skinny kids??
Heck, they did ECHO's all the time when I worked in the NICU to check for PDA and PFO closure. And THOSE babies are skinny (but oh so cute!).
I never drink enough, so today I poured our gallon container 3/4 full and am trying to finish it. I was getting a lot of heart palps later today, now I'm wondering if my body isn't used to being dehydrated, I'm gonna see if this will help my fatigue/low blood pressure too!
disturbedme
Frequent Contributor (1K+ posts)
Member # 12346
posted
quote:Disturbedme,
Yes, definitely get a copy of your report. If you don't mind, I would also like to know what it says since our ejection fractions are the same.
So I got a copy of my ECHO... though now I'm not so sure I wanted to see it. :\
Here's the results:
Left Atrium: 3.6 (normal: 1.8 to 4.0 cm) AO Root Diam: 1.9 (normal: 2.3 to 3.7 cm) LOW Right Vent (Diastole): 1.5 (normal 1.0 to 2.6 cm) Septal Thickness: 0.9 (normal: 0.6 to 1.1 cm) Post LV Wall Thickness: 0.8 (normal: 0.6 to 1.1 cm) LV INT Diam (Diastole): 4.0 (normal: 3.5 to 5.6 cm) LV INT Diam (Systole): 3.1 (normal: 2.5 to 4.0 cm)
Findings:
Normal trileaflet aortic valve.
No aortic inssufficiency.
Normal mitral valve leaflets.
Mitral regurgitation, trivial.
Normal diastolic compliance.
Normal tricuspid valve leaflets.
Tricuspid regurgitation, mild.
No pericardial effusion.
No pulmonary insufficiency.
Normal pulmonary artery pressure.
Estimated ejection fraction: 55%
Normal left and right ventricular size and systolic function.
Intraatrial septal aneurysm - WHAT?!?!?!?!?
Normal chamber sizes.
So, I have some tricuspid and mitral regurgitation... and the freakiest that I was NEVER told: intra atrial septal aneurysm. Okay...... It's nice to know that your doctors keep these things from you. LOL. My cardiologist never told me that. He told me I was a healthy young woman.
-------------------- One can never consent to creep when one feels an impulse to soar. ~ Helen Keller
My Lyme Story Posts: 2965 | From Land of Confusion (bitten in KS, moved to PA, now living in MD) | Registered: Jun 2007
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posted
I have had 5 echos and they can't see clearly on mine either. It always says "technically difficult study"..I am not thin, but not heavy, just about the right weight. The tech said it had something to do with the bones being too close together or something like that.
.I have PVC, PAC, tachycardia, mild mitral and tricuspid reg. I dont think they could even do the measurements on mine due to the fact they coudln't see very well.
They even injected me with a dye to make my heart show up better, but it didnt help any. BTW my ejection fraction was 50-55% each time.
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