It’s a long way to Shanghai

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dr dave“And always remember to check the pulse of any Chinese patient, young David. The pulse is very important to that culture and so to gain their confidence you must check the pulse.”
–an astute old prof who has now gone the way of all astute old profs.

Normally I feel I have my finger on the pulse. I don’t always know what I am feeling but I feel it anyway. I suspect the patient thinks I am wisely diagnosing every woe that’s running amok in the chi when I close my eyes in a knowing and doctorly fashion, head bobbing ever so slightly as if following a pulse. In fact, I am usually catching a wee nap and listening to the iPod implanted in my frontal lobe. MD ... Master of Deception.

The quality of the pulse can, for the skilled Chinese practitioner, detect problems with the heart, stomach, lungs, intestines, spleen, gall bladder, kidney, liver, bladder and of course the good ol’ gate of vitality fire organ (don’t recall seeing a lot of those on the transplant list lately). Not being skilled nor terribly Chinese I cannot find these problems despite the length of time I grasp their pulse, often entering REM sleep and pitching forward onto their lap which is somewhat disconcerting to them, destroying any trust I might have gained as I extract my eyebrow from their zipper.

But one pulse rhythm I don’t nod off on is a pulse that is irregularly irregular. Sort of like being nicely nice or kumquatedly kumquat.

“Bloggins, you seem to be irregularly irregular.”

“Had chili last night doc and can’t predict ...”

“No your pulse is irregular, not the sort of lub dup lub dup we like but more of a lub duplub dupdupdididuplub. You have atrial fibrillation. You and 2.5 million other North Americans, most over age 65.”

Atrial fib can come from years of hypertension, heart valve problems, lung disease, a heart attack, heart failure, drinking lots of wobbly pops, sleep apnea and even an overactive thyroid. Some with an irregularly irregular pulse may have absolutely no symptoms at all but others may have shortness of breath, feel faint, have a sense of palpitations or even chest pain.

Atrial fib tends to make blood clots in unpleasant places like the atria of the heart or Cleveland. In atrial fib the atria gets happy feet, and starts dancing the macarena but not all of these exciting dance moves are passed on properly to the important part of the heart, the ventricle, the part responsible for the pulse. So the pulse becomes irregularly irregular. Makes you a fibber when your heart goes aflutter. When that happens some of the blood doesn’t clear out of the atrium and sort of sits there like the desperate dude at 3 a.m. at the bar. But blood hanging about and not moving is not a good thing because it tends to congeal like the hair gel of the aforementioned desperate dude and forms a clot. It is this clot that kills. When pieces of this clot break off … stroke, death or worse.

We must prevent that clot from forming. So hello rat poison. But of all the pain-in-the-keister-to-manage drugs we prescribe none comes close to Warfarin (aka Coumadin).

Warfarin is indeed war and it ain’t farin’ very well. Those who have to take Warfarin must have regular blood tests called an INR, often every week, to make sure that they aren’t about to hemorrhage (because the blood is too thin) or that they aren’t going to have a stroke (because it is too thick.). Warfarin is a twitchy poison and some of its effects can be altered by several foods, herbs, vitamins or apparently smiling the wrong way. But one of the most exciting medical blockbusters last year was the development of DTI’s, Direct Thrombin Inhibitors, a class of drug that does what Warfarin does (but even better) and has none of the problems! No need to watch your broccoli or get INR tests. Goodbye rat poison and lab techs. Hopefully available soon, keep your finger on the pulse, make sure yours is getting the best treatment. It’s a long way to Shanghai.

Like the column? You'll LOVE the book, The Doctor is In(sane) now available at Pages Bookstore, Cave Creek.
You can reach Dr. Dave at www.wisequacks.org.