No run or exercise this morning. The back pain was minor and didn’t keep me from getting a lot of sleep. When I first got up it seemed entirely gone, but later there was a minor ache. I read internet articles about sudden back pain and about angina. This event, together with another sudden-onset pain across both shoulders a couple of weeks ago, could conceivably be angina.
So I got on My Health Online, the internet presence of Palo Alto Medical Foundation, and requested an appointment with my cardiologist. In the ridiculously small 55-character comment field, I wrote “2 events of sudden back/shoulder pain, might be angina”. 55 characters, but containing two words that I thought would catch somebody’s attention, “sudden” and “angina”.
Not so much. Very shortly came a response, quote,
Dear David E Cortesi,
My name is Fred Nelson, I am replying to your message about your appointment request in Encina Cardiology. I am going to help by scheduling your appointment for
Date: Wednesday, October 28, 2020
Time: 3:00 p.m.
With: Dr. Dibiase
…I hope that I have answered all of your questions. Please let me know if you have any additional questions. We appreciate you trusting Palo Alto Medical Foundation for your care.
Hmmm. I guess those words were not magic, for Fred.
There is a conflict here. The online appointment pages are full of red notices, “this is not for urgent problems; if you have blah blah, call 911 or go to an emergency room”. The conflict is, I do not know if this is an urgent problem. I would like my cardiologist’s opinion on whether or not it is urgent. Which apparently I will get a month from now.
I wonder what to do next. I guess I can try for a tele-appointment with either the cardio or my PCP. But what is the very first thing a doctor wants to do when presented with a symptom that might be cardiac-related? Put a stethoscope on it, duh! Which I don’t think their tele-appointment software is up to. Never mind, I went around the software again, requesting a video visit with the cardiologist, and the same 55-character comment. And got a 9/28 video appointment. So I canceled the 10/28 office visit.
Later I’m thinking, come on. Whatever happened yesterday was intense briefly, but then settled down to, and has remained, a low-level back-ache for 24+ hours. That isn’t angina by any description.
Also, it is not an issue with my artificial aortic valve. I’ve been well schooled in what to watch about that. If the valve starts to break down, the heart pumping action becomes inefficient, with a lot of blow-back on compression. So the BP drops, you feel tired and short of breath, maybe the rate goes up trying to compensate. That’s a 911 call immediately, no foolin’. Angina is a pain caused by the heart muscle not getting enough oxygen, usually from being clogged, sometimes by a “spasm”. Angina by itself is not reason for a 911 call, just a checkup, EKG, etc., to diagnose further.
Other than fussing over Doctor Google and making appointments, it was a very boring day. I started spraying color on pieces of the model. At 1:45 the housekeepers came to do my room, so I took the car out for a drive. But mostly I sogged around feeling… just a bit crappy.
It was hard to distinguish between boredom, combined with irritation at not being able to sit comfortably, versus actually feeling ill. Just before supper, I took my temperature: 99.1! Which is about 1.5F higher than my normal, as established by the spreadsheet where I’ve been recording temp, weight, and BP for months.
If it is still elevated in the morning, then shortly after I report my temp to the website where we do that each day, a nurse will arrive at my door in full PPE, take my vitals, give me a covid test, and tell me I am quarantined. So I have that to look forward to.