21 February 2011 - Visiting the Doctor, Part 3

So with the last posting getting us up-to-speed on my history with the German medical establishment, allow me to continue to more recent events.

About a week ago, I woke up in the middle of the night with a hacking cough. Couldn't get back to sleep. Couldn't stop coughing. Not good. So even I know that this might mean a visit to the doctor was in order. The doctor basically has open office hours in the mornings, so you can just show up without an appointment, which is kind of a crazy idea to me. But that's what I did in this particular instance.

I wasn't quite as surprised this time when, in his office after I had explained my situation, the doctor asked me to pull up my shirt. He listened to my breathing in various spots (which deep breathing caused me to break out into an extemporaneous coughing fit) and then said he didn't want to give me antibiotics at this point. Instead, he gave me a prescription (I use the term loosely - not a controlled substance here in the way we might think in the US) for a "natural" remedy but also ordered some blood to be taken for testing and recommended an "injection" of vitamin C. Now I don't know about you, but the idea of a literal shot in the arm of vitamin C was a new thing and somewhat fascinating. Um, it's not when it amounts to an actual IV (yes, as in intravenous) that makes a hyperactive person like me try to be still for 30+ minutes as stuff is shooting into me and, of course, while I am still coughing like I am sure there is a lung ready to be forcibly ejected.

As the day wore on, I thought I was feeling better and proceeded with a trip to Switzerland later in the day. By that evening, I was quickly loosing energy and the ability to breathe, the latter of which is particularly troubling. I got very little sleep that night between long bouts of unabated coughing. Made it to my client meetings the next day, but that night was even worse. When I returned to Frankfurt the following morning, I went straight to the doctor as things clearly were getting worse, not better.

He told me at this point that it was a good thing they did that bloodwork as it seems I had a "lung infection." Now, if you're like me, hearing that term made me wonder whether gangrene was taking over my lung tissue or something. No, not so much. I guess it equates to "bronchitis" but the term "lung infection" still troubled me. He gave me a prescription for antibiotics, ordered (versus requesting, which clearly had had no impact earlier in the week) me to stay at home not only the rest of that day but also the following day. Grrrr.....

He also told me to go in the following day (Friday) for another (this would be my third) vitamin C IV. I was going to skip, but since I was not allowed to go to work, I figured I might as well go. Um, yeah, after the IV I was preparing to go back home, but the nurse said that I should return to the waiting room. Okay.... When they came back to get me, they said that I was to have an EKG. Ummm.... Seriously? Which they did right there. More of the "take off all your clothes from the waist up" that a year ago might have alarmed me, but which I was getting used to by this time. After that, I was told to come back the next week for a follow-up.

This is when I finally kinda figured out what was going on. While I had forgotten that my heart had an asymptomatic long QT syndrome that could be exacerbated/made symptomatic by antibiotics, he had not. Hence his trying a bunch of natural remedies first. And when it became clear I needed antibiotics, he did an EKG after the antibiotics had been in my system 24 hours and then again after the treatment was over to determine whether the antibiotics were having any adverse impact on my heart. All good. Just might've been nice for him to say this a bit earlier on when all I wanted him to do was give me the German version of NyQuil so I could just sleep through the night. But in the end, I lived to fight another day, so all is good. And he gave me a whole bunch of reports on the bloodwork and EKGs for my own use (and to scan and send to my awesome doc in the US).

15 February 2011 - Visiting the doctor, Part 2

(Perhaps the theme music for E.R., House or even Trapper John, MD)

This is a far overdue posting, which is finally only making it because I want to add part 3 to the saga, which happened today. But much happened in between my trip to the doctor today and the one from the posting of May 2010. So some backfilling is in order....

Last summer, I seemed to be having a consistently high (for me) heart rate. I suspect it was primarily related to stress, but I finally decided to visit the doctor. Given that nothing ever came out of the failed attempt in May, I decided to look for a new doctor. The firm has an arrangement with International SOS which, in addition to being able to find medical care for me when I am in the middle of nowhere and may need to be airlifted out, also can find local healthcare professionals in other countries. So I called them up and asked for a local doctor who was bilingual and whose staff members were bilingual as well. And they delivered.

The new doctor's practice had a nice website that boasted of its "Integrated City Practice" approach, having a cardiologist on-site as well as internists and an accupuncturist, with other specialists within walking distance. The building is an old pre-war house (think brownstone) on Schweizer Straße about 100 meters from the river. You walk in through a big wooden door and follow some signs to the practice on the second floor.

Now, I thought perhaps there would be a sort of modern rehab inside the building, it being a medical practice and all. Not so much. The high ceilings with detailed wood crownwork are still visible with some fascinating lighting fixtures. The windows in the waiting room were tall French doors. Hardwood parquet floors throughout in beautiful patterns. I was taking all of this in, when I was called into the doctor's office. And I do mean the doctor's office. It was a big room with a large desk and two chairs in front of it, and a large couch/seating area in the other half. He invited me to take one of the seats in front of the desk, where I had a nice view of the courtyard out behind through the open windows sans window treatments. So with this in mind, you can imagine how I thought it a bit odd when he unceremoniously asked me to pull up my shirt. Uhhh.... But he was just going to listen to my lungs, my heart and then take my blood pressure. This was when I began to realize how prudish we may have become in the US.

His initial comments were that the heartrate/blood pressure readings I had brought with me were not particularly high, he thought it might make sense to do a few tests just to be sure. First step was to outfit me with a low-tech version of what the May doctor tried - 24-blood pressure monitoring. The lower tech version was a device the size of about two walkie talkies worn in a bag slung across me and with a rubber hose snaking down my sleeve to an arm cuff. Ever 20 minutes, the machine would power up and take my blood pressure. Including during sleep. Not so much fun. It was particularly awkward when I attended a dinner event and during the speech by a banker I started to "buzz" with the blood pressure taking event. Awkward.....

Step two was a full battery of tests, all performed at their office. The procedure rooms, if you will, are really just separate compartments created out of somewhat temporary partitions and some curtains. Not exactly noiseproof, but I guess if the doctor gives you the news that you are dying or have some awful disease while you are in his huge office, perhaps whatever goes on in the procedures room is not a big deal?

The tests were performed one at a time. You waited until you were called, went in for one of the tests, then were returned to the waiting room until your name was called again. The tests, though, were all performed by different people, so this perhaps made more sense. The tests included a breathing test, bloodwork, ultrasound of major organs and a separate ultrasound of the heart. All were directly connected to computers to capture and display the results. And what was perhaps most surprising is that the ultrasounds were performed by my primary care physician and the cardiologist themselves, whereas I would have expected some kind of technician to do those in the US. The prudish American in me was awakened many times, such as when, after he had performed the ultrasound of major organs, my doctor said I could get dressed. Apparently while he was still in the room. No big deal. But honestly, once I got used to it, it is so much smarter than dealing with the paper gowns that we have in the US that are more awkward than helpful most of the time.

The third step was a review of the results. Nutshell, I have a great heart that is responding well to stress. But the doctor's guidance was that I just needed to have less stress in my life and I should at a minimum take a three week vacation. At which point I literally laughed out loud. Which was followed by him making a remark about workaholic Americans.... He then noted that as someone trained in western medicine, he is trained to look for symptoms and causes, but not whole life health so he suggested I consider accupunture to reduce my stress levels and improve my overall health in a systemic manner. Uhh...? More reminders that I wasn't in the US anymore as you know that wouldn't be covered by most health insurance plans. All in all, though, a satisfactory experience. Anyone want to guess what all of these tests cost?