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The Doctor As Patient
Further Observations
Brief Research News
Dear Friends,
I have often been in the position of discussing the needs
of the patient, and how sometimes doctors are unaware of the
fears, questions, and general uneasiness engendered by the
complex and intimidating nature of medical treatment. However,
no amount of reading, discussions with patients, dealing with
their psychology, or awareness of sensitivities can prepare
a doctor as much as actually being a patient. In fact, even
being a patient is not sufficient preparation for another
hospitalization.
I have had a defective aortic heart valve since I was a child,
and I have known for 40 years that someday I would have to
have it replaced. My parents were told by the surgeon when
I was 18 that he wanted to replace the valve then, otherwise,
he predicted, I would have symptoms of heart failure after
10 to 20 years. They also said that I should give up exercise.
I did not take their advice.
Years later, after I had run several marathons, I visited
George Sheehan, a cardiologist who had written books on running.
After lunch he listened to my heart. He told me that I did
have the leaky valve, but he said there was no science behind
the recommendation that I not exercise. (Of course, I always
had in the back of my mind that I might be taking a risk by
exercising.)
It has now been 40 years, rather than the predicted 20, and
I have done well, but because of the increasing strain on
the heart, on March 11th, I had valve replacement surgery
to protect my heart muscle from damage. I feel great, but
through all the weeks of anticipation I went through the entire
range of thoughts, feelings, and fears that any patients would
(am I going to wake up?; should I say goodbye before the operation?;
will I feel better?; will I be changed mentally?; how will
I tolerate the pain and discomfort?). The experience is what
all patients go through, and all doctors should try to understand,
although they can’t be in those shoes until they are.
However, I was also excited during those few preceding weeks
about being able to be physical again without limitation,
to run, swim, and bicycle with no fear of harming my heart
and no symptoms. I love physical activity, and soon I’ll
be able to go back to all of those activities. Right now I
am beginning my walking program, increasing every day, and
I can tell I have not been using those muscles–amazing
how quickly they lose tone and mass!
Naturally, I took all of the supplements for surgery that
I wrote about in my March newsletter to protect my heart and
brain during and after surgery, to promote the healing process,
and to maintain my immunity. In addition, I took liver support
(silymarin and calcium D-glucarate) to help detoxify the anesthetic.
I also did not eat hospital food, but had healthy whole foods
brought in for me, and I was fortunate enough to have the
nutritionists at the Brigham closely accommodating my own
dietary needs. (All hospital food should be so nutritious.)
I look forward to my full schedule of activities, aesthetic,
professional, and recreational, and I’ll have a new
understanding of patients.
I was in the hospital just over a week. The care in the cardiac
surgical ICU was superb. I had constant attention to my medical
and personal needs and my monitors, and careful adjustments
to medications by highly-skilled cardiac surgical nurses and
surgical fellows. I did have to leave that unit for two days
before discharge, and those days left something to be desired.
Hospital staff does not realize how difficult it is to sleep
(and how important it is to healing), and they pay little
attention to the noise level, night and day, at the nurses’
station. I finally asked them to shut the door to eliminate
the chatter, and that simple step made a dramatic difference
in my comfort levels. Hospitals would be well advised to provide
ear plugs and eye masks to enhance the possibility of getting
adequate rest. (If they are not provided, bring your own.)
***************
It is not easy to have an operation on the heart, even though
the technology is far superior to what it was 40 years ago
when they first wanted to do mine. In coming out of anesthesia,
they have to make sure your breathing is strong enough to
take out the breathing tube. By the time you are that awake,
you have recovered your gag reflex, and it is common to gag
on the tubes before they are removed (I did, several times).
This is quite painful on the evening of the operation, in
spite of ample medication.
After the tubes are removed, it is an incredible relief (for
the patient and for loved ones watching the process). At that
time, you realize how dry your mouth and mucous membranes
are, in spite of ample fluids being given intravenously. It
is a great relief to be allowed to suck on ice chips, enough
fluid to wet your mouth without being likely to choke. The
problem, however, is that ice chips are more likely than water
to provoke vomiting. Having survived the discomfort of the
gagging, I was unpleasantly surprised by the pain and wrenching
of two episodes of vomiting.
Because I recommend chelation therapy for arterial disease,
I have seen many patients who have had coronary artery bypass
grafts (CABG). A number of them have had it more than once,
which is now a much greater shock to me than it was before
I had my own open heart surgery. I am shocked because repeat
CABG is almost totally preventable through lifestyle change.
A patient in the next room to me had just had a bypass at
45 years old, and he was a smoker, with some emphysema. I
overheard the nurse giving him discharge instructions, including
information on a stop-smoking program. I would have thought
that the surgery itself would be all the “stop-smoking”
program he would need.
The same holds true for diet and exercise. It is quite clear
in the medical literature that whole, natural foods, rich
in vegetables, fruits, whole grains, beans, seeds, nuts, and
fish can prevent and reverse hardening of the arteries. (References
are in most of my previous newsletters.)
With even the possibility that you could avert the need for
another operation, why not give yourself the best shot at
a healthy future, free of surgery and other medical interventions.
My preliminary angiogram showed that my arteries were large
and free of plaque, surely related to my exercise, healthy
diet, and supplements.
I do have some research news for you. I have previously reported
on the value of curcumin as an antioxidant and anti-inflammatory.
BBC News now reports on a U.S. study of curcumin supplements
in animals to prevent radiation burns. When radiation treatment
for cancer is administered, it is common to see a side effect
of skin burning and blistering. In animals given curcumin,
from the curry ingredient, turmeric, the injury was much less
than in the controls. (BBC News, Health, October 8, 2002.)
***************
I have been looking at the schedule for an upcoming conference
on nutrition and cancer. One topic covered in great depth
is the value of folate in cancer protection. Folate is found
in green leafy vegetables (the name folate comes from “foliage”).
It has been known for a long time that folate is important
for cancer protection (lung, colon, breast, liver, and others),
and there are no risks from taking extra folate supplements.
***************
I look forward to bringing you a full newsletter once again
next month.
drjanson@drjanson.com
Year-round phone: 386-409-7747
180 Massachusetts Ave.,
Arlington, MA 02474
225 North Causeway, New Smyrna Beach, FL 32169
3 Overlook Dr., Suite 3, Amherst, NH 03131
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