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Mitral Valve Prolapse: Benign Syndrome?
By Sharon Anderson
OPEN ROAD INTEGRATED MEDIACopyright © 2001 Sharon Anderson
All rights reserved.
Citadel of the Gods
There is an intensive wave of enthusiasm throughout the country for athletics, both in the young and in the old. There is simultaneously a nation-wide interest in the great prevalence of cardiovascular disease. I have felt for a long time that the beneficial effects of athletics upon the circulation is very meagre ... Certain muscles in the body may be strengthened by exercise, but I find no proof that the strength or health of the circulation is similarly improved.
- Samuel A. Levine. "Some Unproved Impressions Concerning
The Subject of Heart Disease" (June 14, 1928) The New England
Journal of Medicine 198 (17): 885-887.
Exercise will not make you healthy. It will not make you live longer. Fitness and health are not the same thing ... Fitness refers to the body's capacity to do physical work and to engage in physical activity. Health refers to the presence or absence of disease.
- Dr. Henry A. Solomon, The Globe and Mail, Toronto, May 18, 1985.
Shortly after our marriage, like many young couples, my husband and I purchased an old house and sacrificed ourselves to its restoration. But this was an old, battered rooming house, and many months soon became years of grinding toil. While my husband went to work as a pharmacist, I scraped mummified layers of paper from the twelve foot walls. This meant standing on the top step of a ladder with a thirty pound steamer tray full of boiling water in one hand and a scraper in the other. On my husband's free evenings and weekends, we worked together, sanding floors clogged with years of dirt and motorcycle grease, scraping off paint and varnish, ripping up moldy, rubber tile, linoleum and rotting particle board with chisel and crowbar and demolishing or erecting walls. We were caught up in the craze of reviving the ghostly beauty of the old, the neglected or abused, restoring wood to its natural beauty and hanging jungles of green plants in big bay windows, tiny symbols of survival in an age bent on destruction of the natural environment or even the whole universe.
The reader may wonder what the restoration of an old house has To do with my story of Mitral Valve Prolapse and the medical profession. My aim is to stress the kind of work I was doing at the time my heart began to show the first signs of rebelling. In the beginning, we had no reason to believe that I would be unable, physically, to perform these Herculean tasks. Even after an eight or nine hour gruelling day, I was able to drum up the energy to cycle three miles, all uphill, back to the place we had rented until our new home was liveable.
One day when we had moved into our old house and I was heaving the steamer against the wall, I felt extraordinary fatigue even though it was only mid morning. My legs began to feel wobbly, and I found myself taking longer rests. Usually, when I was mechanically steaming and scraping, I was embellishing some scene or other in a novel I was working on, creating poetry, which I would rush to write down in the midst of my labours, or rehearsing some music I was practicing as part of my repertoire for my piano degree towards which I was working while I waited to find a teaching position in my new home town.
However, this particular day, my mind was too tired to compose, and the steamer tray leapt perversely from my exhausted grip and banged to the floor where it lay hissing at me. I had simply pushed myself beyond my limit. Though I took a longer rest than usual, I did not quit, and, in the evening, I staggered up to bed and flopped down fully clothed. I drifted off to sleep immediately but was awakened by a burst of sustained, rapid heart beat like rain drumming. As my consciousness dimmed, I called to my husband on the other side of the room. My voice seemed far away. My whole body felt numb, and there was a cold, prickly sensation in my hands and feet. My husband tried to take my pulse but it was so rapid that separate beats were indistinguishable. This episode lasted long enough for my husband to cross the room and attempt, several times, to record my pulse.
This was an entirely unexpected experience for me. All my husband and I could think of was heart attack, the doctor's buzz word, like "inferiority complex" of the shrink and "head space" of the druggie, to cover most heart problems and simple enough for the lay person to comprehend. On my father's side, there had been three victims of sudden cardiac deaths, a grandfather at 47, an aunt at 35 and an uncle at 26. When I questioned my mother about these deaths, she would say, "I don't know anything about them. The doctors said they died of heart attacks." When I pressed for more information, she added, "Well, your uncle was a blue baby. He had a hole in his heart and he had a heart attack."
This brief episode certainly did not send me scurrying to my doctor. Instead, I attributed this bizarre event to exhaustion and returned immediately to my strenuous labour. Occasionally, at night, a burst of rapid heart beat would wake me but it was so brief that I ignored it. It was only after a second episode, identical to the first, which occurred again just as I was falling asleep, that I even thought of consulting a doctor. But, still, I allowed several months to elapse before I made an appointment with my GP. Our desire to have a child was an important factor in our decision to seek a cardiac assessment. Since the rapid heart beat had taken place a long time ago, I felt silly about having a check-up. However, my GP said he heard a murmur and decided to send me to an internist who also heard the murmur but said he heard "something else" as well which he could not identify.
At first I was a little shocked to hear that I had a murmur since I had never paid any attention to my heart, and murmurs, in my mind, were synonymous with pale, sickly individuals with little stamina who were warned to avoid sports or heavy work, neither of which I had ever shunned. And I did not want to believe that the rapid heart beat or the murmur were, in any way, related to the hard work since I wanted to continue just as I was doing.
Although I told both my GP and the internist that I was unaware of a murmur, I recalled later that, a few years ago, when I was living in Toronto, my doctor had said that he had heard a murmur on one of my rare checkups about a year after my tonsils had been removed. He too had sent me on to a specialist who x-rayed my heart and reported that I had an enlarged aorta, the great vessel that transports the blood away from the heart to all parts of the body. In explaining the findings, this Toronto specialist had declared that the minor alteration in my aorta caused turbulence of the blood flow, but the sound was not really that of a murmur, and his advice to me was to ignore this new finding. This is, of course, exactly what I had done.
A second heart x-ray revealed no abnormality, not even the supposedly enlarged aorta. However, the internist referred me to a cardiologist, whom I will call Dr. G. N. Austin, who would be able to explain the "something else" heard in my heart. The internist considered him "one of the best cardiologists" in Toronto. In fact, this man was the Chief of the Department of Cardiology at a hospital which I will call The Toronto Medical Science Centre, TMSC.
Recently, I glanced at a little book for beginning readers in our school system. Pictures with appropriate words teach the young child whom to idolize, respect and trust: father, minister and doctor, the trinity of paternalism: God the Father, God the Son and God the Holy Spirit who literally breathes life into our ailing bodies. I, too, had been nourished on similar fairy tales and, as an adult, retained the child's trust, respect and awe for these worthies encountered in the first marvellous act of reading. I did not suspect that my relationship with this cardiologist would precipitate a disastrous chain of events, riddled with danger, medical incompetence, dishonesty and insensitivity and, although I would come out alive, my health would be as compromised as my blind, unquestioning faith in doctors.
My reluctance to consult a doctor can only be attributed to the subtle conditioning of poverty. When I was a child, there was no government supported medical insurance plan assuring universal access. Doctors were unaffordable luxuries for a father who was an unskilled labourer, often unemployed. From my earliest years into adulthood, I suffered two and three episodes of severe tonsillitis each year with fever and swollen lymph glands. On only one occasion, when I was particularly ill, did I see a doctor who gave me a shot of some drug or other in the buttocks.
Poverty and illness are inevitable though unwilling bedfellows. Medical care, beyond the wildest dreams of the poor, becomes magical care and the doctor a miracle worker. The child of poverty stricken parents learns to live with irremediable illness. Tonsillitis became a normal state of affairs, as dependable as summer and Christmas holidays. Needless to say, no friendly authority ever whispered in my ear that severe upper respiratory infections could damage my heart. All through high school and university, I didn't have a doctor and I avoided the infirmary at the university out of the persistent belief that any illness, if ignored, would go away. Only when I became a teacher and could pay the insurance premiums for medical care did I visit a doctor on an annual basis. But, by then, it was too late; I had already become one of poverty's victims.
Such educational and social conditioning made it difficult for me to shed my awe of the doctor who could dissolve pain, if only my parents had enough money to pay for his medical magic. And, when I finally saw Dr. Austin in the summer of 1976, I regarded him as one of those near divinities who could transplant human hearts in God-like defiance of death. The media constantly pumped out stories of mysterious, dazzling feats that only confirmed my childhood fantasies about these miracle workers. In comparison, a few flutters of the heart seemed as insignificant as a birthmark. It did not occur to me that the medical profession's obligation was to prevent me from becoming the victim of such acts of heroism.
At last, the day of my appointment arrived, and the cardiologist's secretary ushered me into the examining room. An uneasy glance at my husband and I was alone. This woman's impersonal efficiency and immensely dignified air advertised the importance of the personage who was about to probe the secrets of my fragile flesh. And the whispering, tip-toeing technician, who tried to silence the indecent clatter of a complicated looking machine she was wheeling into the room, only magnified the notion that I was soon to be thrust into the presence of a deity. The machine, of course, was an electrocardiograph. I had never seen one before. My knowledge of the doctor's tools extended to the stethoscope and the black bag, the symbols of the medicine man I had learned about as a child in the little readers like the one I just described. I had no idea what this queer machine did and little interest in its erratic scrawls on the graph paper. Besides, I couldn't imagine my heart being anything but normal.
As I lay on the examining table, waiting for Dr. Austin, I felt embarrassed for seeking attention for symptoms that had almost disappeared. Dr. Austin glided calmly into the room. He was an older man who exuded an aura of well-being and prosperity and, when he spoke in distant, imperious tones, it was to direct me through a series of postures: sit up, lie down, lie on my left side, squat, stand, lie down. Towards the end of his examination, a flock of his brothers materialized as if Dr. Austin were a genie who had rubbed a magic lamp. Having rarely used the health care system, I was completely unfamiliar with the procedure at a large, teaching hospital. I was surprised and apprehensive at the thought of more portentous souls examining my naked flesh, and doubt, the cardinal sin in the lay person, made me wonder if Dr. Austin was no more skillful in identifying the "noises" than the GP or even the internist. Or were the noises so unusual he wanted others to have a crack at hearing them? Naturally, it was lost on me that these other doctors represented the hierarchy of a teaching hospital, frequently the undergraduate working for the summer, the recent graduate doing his internship, the internist or resident in cardiology and usually another specialist, equal to the chief, to confirm his opinion.
Dr. Austin stepped back from the examining table and, with a puzzling look that had to me something of scorn in it, said, "Come and see what we've got here!" All the others crowded around the examining table as though I were a controversial insect that had defied identification by the entomologist and, when labelled at last, would be hugely disappointing. My composure disintegrated, and I responded in my most polished teacher voice, "I don't care to be a guinea pig." It was my only defense against an increasing feeling of dehumanization. "This is a teaching hospital. We all have to examine," Dr. Austin scolded. There was a certain self-righteousness in that remark which acted as a warning not to meddle in affairs that didn't concern me. "You can't expect these doctors to get any practice if you refuse them the opportunity."
What he said sounded reasonable, and, so, I swallowed my pride as the first of these doctors, the most experienced and obviously the equal of Dr. Austin, began examining me. My objection had not in the least disturbed his impregnable armour of professionalism. Like a drill sargeant, he fired out identical postural orders as he passed his stethoscope over different areas of my chest. When he was finished, he and Dr. Austin exchanged conspiratorial grins. "Mitral valve prolapse," Dr. Austin announced with established authority. "Yup," the other nodded in agreement.
I heard some bizarre Latin terms. Pectus excavatum. Hypomastia. Then the flurry of listeners, each putting me through the same routines. A kind of cockiness prevailed, a bit of private joking about this cryptic entity and an unmistakeable haste to get the business over with. As if to speed up the fumblings of the more lowly, perhaps the undergraduate or the intern, Dr. Austin offered crisp advice. "In these mitral valve prolapsers, the murmur is quite erratic, can even disappear altogether. It helps to have them squat or try the left lateral decubitus."
Though I had always loved Latin in school, it had by now completely deserted me, and, besides, I was no longer feeling like a human being but like an insect that had been identified. I was just a mitral valve prolapser. My passivity was consumate. I scrunched up in my shell like a wounded turtle escaping the vindictive jabs of cruel boys with sticks. The neck, hands, fingers, toes, legs were examined, and, then, the ten minute lesson on mitral valve prolapse was over. The doctors hurried out discussing the more glamorous heart attack, and the heroic by-pass. The silliness of MVP dissipated quickly and gratefully.
After dressing, I waited with my husband outside Dr. Austin's office, occasionally glancing expectantly at his door. "Well?" my husband asked. "Mitral valve prolapse," I whispered timidly, perplexed that, though a big long name seemed to mean nothing, I felt as if some unknown assailant had taken a swipe at me. When my husband asked what that was I could only reply that I hadn't the foggiest idea.
At last the door opened, and Dr. Austin crooked his finger to summon me. I meekly obeyed, and it occurred to me that he had not used this gesture with his colleagues to draw them around the examining table. There was in that crooking finger something of the outraged parent who silently orders a disobedient child to stop kicking the neighbour's garbage can and proceed to the place of punishment. It was a style seemingly cultivated for patients, evidently only female, for, later he would introduce himself to my husband, shaking hands and chatting politely.
"Sit down," he commanded icily. I took the chair opposite his huge, shiny desk that stretched intimidatingly between us. A multitude of questions tumbled in my mind, but his opening remark, designed to overshadow everything else he might say, silenced me. It was unforgettable. "Mitral valve prolapse is an entirely insignificant condition." He paused and looked directly at me as if waiting for that to sink in. "It is totally benign. It does not get worse."
"Was I born with it?" I asked timidly, unable to suppress my curiosity.
A smile hovered about his mouth. "Possibly." Head bowed, pen scratching, he asked, "Did you ever have swollen, inflamed joints?"
"Not that I recall, just a general achiness with the tonsillitis which I had two and three times a year until my tonsils were removed when I was ..."
"No inflamed joints. No rheumatic fever," his voice marched on. He was decidedly not interested in my tonsils. "Any heart problems in your family?"
I told him about my relatives, their stories seeming so dramatic as to barely relate to what I had. However, his interest perked up. "Well, you're not going to drop dead!" he uttered sternly. "People with mitral valve prolapse do not drop dead suddenly!" He seemed to grit his teeth, and what I earlier had thought was scorn became more obvious as if he were determined to squash a fear that he imagined might eat away at my reason.
Excerpted from Mitral Valve Prolapse: Benign Syndrome? by Sharon Anderson. Copyright © 2001 Sharon Anderson. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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