Appointment with my cardiologist

Friday morning I had an appointment with my cardiologist at the clinic here in Rincon de la Victoria.  My appointment was for 10:20, and I was on time.  After having retrieved my blood analysis report I went over it and and recorded the results in my notebook, where I previously had entered the previous two tests, so that it was easy to check the development.

The first I checked out was my LDL.  On December 12, 2003 the LDL was 2.39 g/l.  On May 26, 2005 it had dropped to 2.01 g/l, a drop of 15.9%, which is very good.  In fact, in the article Effective treatment of hypercholesterolemia - Tips from Other Journals, found at http://www.findarticles.com, the author, Richard Sadovsky, wrote on February 15, 1997, "Dietary management using an American Heart Association Step I diet or its equivalent reduces total cholesterol by an average of only 2 percent over time periods ranging from six months to six years. The Step II diet has been shown to reduce cholesterol up to 15 percent over two to five years. This drop has been demonstrated in persons with markedly elevated cholesterol levels who are highly motivated."  The last reading, taken on September 22, 2005 showed a further drop to 1.91 g/l, or a reduction of 20.08%, compared with the first reading, in approx.  one year and three months, without taking any medication for it.  This represents a remarkable reduction in such a short time, and beyond expection, even to me.  A LDL level up to 1.5 g/l is considered normal, so I am now only 0.41 g/l above that, or a further reduction of 21.47%.  Over time I might be able to bring it down to this level, if I tried, which would be quite interesting, and spectacular. It might even stir up some attention in medical circles, if the above article is a true indication, which it probably is, from what my cardiologist told me previously.  From my previous experience I know that I can bring my LDL level down to normal within 3 months by taking 10 mg of Lipitor, called Prevencor here in Spain, together with 3000 mg of Niacin (B3 vitamin) on a daily basis, with the former split in two, and the latter in three portions, with meals.  In Canada I used to take two Niacin tablets of 500 mg each, three times a day.  It is all in accordance with the instructions that Dr. Ruth McPherson, the manager of the lipid section at the Ottawa Heart Institute, gave me.  It works, and produces the desired results.  Sadovsky also mentions that "Niacin decreases the total cholesterol and LDL levels while increasing high-density lipoprotein (HDL) cholesterol. "  In fact, I told my cardiologist that McPherson was one of the leading experts in North America, and that she had said that Lipitor by itself is only about 40% effective, but this effectiveness is greatly enhanced through the combination with Niacin.

My cardiologist rushed to write a prescription that included 40 mg of Zorretor(?), which is the equivalent of Lipitor, even though I showed him I had  previously been taking 10 mg of Prevencor, which is identical to the Lipitor I took in Canada.  He was, however, clearly not ready to listen to anything I told him about this and the above.  

I told him at the outset I would speak English, as he told me he spoke and understood English the previous time I saw him.  Now, he suddenly said that he did not understand English that well.  However, when I switched over to Spanish his attitude did not change.  Instead he was hanging out his shingle, as I like to say, proclaiming he was cardiologist, and had given his opinion, in a way that he was expecting me to consider him a high priest, whose opinion was infallible.  I immediately told him there are many cardiologists, with differing views, and expertise.  I also told him he was very stubborn, and not willing to listen to his patient.  This was after having waited for more than an hour past my appointment time, but I did not bother to mention that.  I have never had much respect or faith in people who like to emphasize their professional title, etc., as I have generally found that their effectiveness has been  inverse to their emphasis and claims.

I had read to him from my notebook about the greater effectiveness of the combination therapy of using amlodipine, one of the calcium channel blocker class of drugs and the ACE inhibitor perindopril, that had been reported in HealthDrug News on September 4, 2005, by researchers, led by Björn Dahlof of Sahlgranska Hospital in Sweden, and republished by medicinenet.com. He quickly stated that he already knew all that.  That could be, but somehow I doubt it, not only because of its recency, but even more because of his actions.

After I had told him my medications were ineffective he quickly said that he had wanted to change my blood pressure medication, but that I had said at the previous consultation that I did not want to change it. I told him emphatically that was incorrect. All I had said was that I wanted to hold off with the cholesterol medication, but I had not said anything about the blood pressure medication.   After I told him  about having checked out  amlodipine and found it was the same as Norvasc, a bell went off in my head, as it was familiar.  I went to my cabinet, and immediately found a Norvasc canister, which confirmed I had been taking it when I arrived in Spain, and that had been very effective, after the head of the hypertension section at the Ottawa Heart Institute had changed over to it.  I even showed my cardiologist the canister, as I had brought it with me.  So the first thing he did was to write down Norvasc 5 mg, followed by Zorretor(?).  Why is it that doctors cannot write clearly, like other people?  I think it is also something they do to create an aura of mystique, etc., which is ridiculous, and could actually be dangerous.  At the bottom he added "the rest unchanged", which to me means that I were to go on with the other medications, that had proved ineffective, as I indicated.

He even had the nerve to tell me that I should discontinue my medical research, and instead concentrate on things like dance, art, music, etc.   I immediately told him, definitely not, as I had found it a tremendous help in my communication with my doctors in Canada.  I told him about having typed a 7-page write-up about my findings, and having left it with the receptionist the evening prior to my appointment with my doctor, Phillipowsky, and he immediately told me he had read it all, and was very impressed.  He told me it was the first time anybody had done that.  It led to him asking me if I would be interested in getting an appointment with Dr. McPherson.  Of course, I accepted, and I was greatly impressed with Dr. McPherson, and her method, which immediately produced the desired results within 3 months.

Now, how can you have any have any confidence in a doctor who is not only unwilling to listen to what his patient has to say, but who had also left out crucial elements from the blood analysis, such as sodium, potassium, and calcium, as I pointed out to him?  He should also have included other elements, such as magnesium.  His reaction is quite common among Spaniards, who cannot stand criticism, or to admit mistakes, etc., not that they are alone in such behaviour, but it is more pronounced here than in countries like England and Canada.  In fact, I informed him that it had been found that doctors were poor communicators in England, so a mandatory course in communication was introduced.  They need a similar course here in Spain. 

It is obvious that I cannot continue working with this cardiologist, but fortunately Nelly happened to speak to the director of the clinic and he recommended one in Malaga, so now it is just to set up an appointment with him.  Hopefully, he is one who listens, and is more professional.