Talked to Dr. Weiss, the internist. He agrees with Dr. Sulica’s suggestion that the heart disease could be a side-effect of the previous radiation treatment. Likely diagnosis is atherosclerosis. Needs to be dealt with, but in the absence of current symptoms we can be patient. Suggested I go back on a statin, which I’d discontinued since my cholesterol numbers were OK and I was worried about short-term memory effects. Agreed with Dr. Bomback that I should cut back my allopurinol dosage from 300 mg. to 100 mg., to reduce the kidney load. I suggested that –since I hadn’t had a gout episode in more than a decade and was now on a low-meat diet –we consider dropping it entirely, but he thinks cutting back is enough until we see if those symptoms come back at the lower dose.
Next question was whether it’s possible to get the heart diagnosed without going on dialysis first. My friend Dr. Susie Lew, a nephrologist at GW, tells me there are ways of doing catheterization with little or no contrast, and with other preparations to minimize the kidney burden; in the best case, the kidney-function measurements don’t move.
That discussion led to my first health-care-policy insight of this episode. It turns out that New York State does very careful tracking of the outcomes of some surgical procedures. That sounds like a reasonable venture in quality assurance and consumer protection. However (there’s always a “however” in these things) that means that cardiologist who does a catheterization after which the patient needs dialysis gets a black mark on his or her record. On the other hand, if the patient is started on dialysis before the catheterization, then it doesn’t count as a bad outcome. Conclusion: We should look for a cardiologist in New York willing to run the risk, but be open to the possibility of going out-of-state.
Footnote: Some of the responses to my first email –for which I’m grateful –suggested to me that the medical picture I’d painted was overly grim. There’s no doubt that I’m what’s called an “interesting” case, but as far as I can tell I’m more likely than not to be alive and reasonably healthy ten years from now.