Trying to get a tune up in San Francisco

We've been here only a month and the differences that this city provides have become more and more obvious. My latest experience involves health. People here are healthier than anywhere I have been, probably because the weather is so good that they can go out and run these hills. I used to be really proud of myself if I could make it to the top of the hills in our neighborhood. But almost never a day goes by when I don't see multiple people running these hills. But that's off of my current subject.

I never ran up hills- I would work up to a walk on Reilly Road- but had gotten real lazy the last couple of years and just walked the flat stuff- and then only 2 miles of flat stuff. LAZY! But here- I can't get to a single restaurant without a hill- and a walk- and I love to try new restaurants. Besides I promised Brandy I'd get into shape and it rather seems now or never- So I'm walking (crawling might be a better description of me on some of these hills) in San Francisco. We live at the very top- so even though I walk down (to eat, to shop, to go to church) there is always a walk back up in order to get home.


I have tried to walk these same hills and it's been tough. The first realization was when I was hiking with Matthew and Sharon in Muir Woods. Then Max and I were climbing some steep hills and I was really having trouble. I think my problem is that my pacemaker needs a little tuning up. Once I start working hard my heart speeds up like it is supposed to, but if it gets too high, the pacemaker drops the rate back down to my baseline of 65 and keeps it there until I relax. This same thing happened with my first pacemaker, so I know it can be fixed, but first I need to see a cardiologist.

I'm always really frightened when Don has problems with his HEART. Now when it is his back, or shoulder, or hip, or knee, or toe- I just tell him to suck it up and quit complaining (I try to say it in a nice sort of way) But not the HEART- then I am frightened. And I really don't like the pale, pasty, cool skin sort of response when we've been out walking/hiking. And we're getting those here. We've found other walks that aren't so steep- And we're trying to get in with a cardiologist- But for now I just have to live in that "always a little frightened stage". I think that Wednesday morning in November (it was the morning after- you know- the morning after Bush won and Kerry lost...) That was the worst morning of my life- And when anything is going on with Don's HEART I'm frightened all over again- even if he does try to reassure- And not look quite so pale (which is tough since Don looks pale even at his healthiest).

So I looked up a number of cardiologists that are part of my insurance. The first group said that they aren't taking any patients, so try someone else. The second group said that they would see me, but first I needed to have a local personal care physician. So next I started looking for a PCP and called several and finally found one that would see me in only about a week. Well, that appointment was last Friday, and it was another one of those San Francisco surprises.

I got there a little early to fill out the paperwork, paid my co-pay, and sat down to wait. I got into an exam room about 20 minutes after my appointment time (not too bad) and sat down to wait. Finally about 40 minutes later, Dr. William Nabor came in and apologized for being so late. It seems he was having a bad day too. But then he said: "It's good you are my last patient today so we can talk and get acquainted". It turns out Dr. Nabor was born in Jordan and went to medical school in Russia before coming to San Francisco. He is part of the UCSF medical staff and works in a small office not far from the medical school. He works in his practice by himself with a receptionist and no other help! There is no nurse! He took my blood pressure, listened to my heart etc. He took down my history, wrote down my current drugs and then filled out the insurance paperwork himself. I asked for a flu shot, so he went to the refrigerator to get the vaccine, got a syringe from the cabinet, filled it and gave me the injection. I spent over an hour with him talking. I told him about my heart attack and so he told me about his. He told me I was very lucky to have a nurse as a wife because she called 911 just like you should. He being a doctor thought he might be having a heart attack, but drove to his brother's house and then his brother drove him to the hospital. He almost died because he waited so long.

This guy was really fun to be with. I have a follow up appointment week after next and the wait is so long because I will be out of town, not because he wouldn't make time for me. He then wrote me a note of introduction to a UCSF cardiology group and is going to call them to ask them to get me in this week because I need to have my pacemaker checked.

San Francisco is full of surprises.

PS: Some doctors for my home health patients actually make house calls. And there is one group of doctors that don't have offices- they just go to the patients home. Go figure- Guess it's just life in the BIG CITY!

PSS I called the cardiology office this morning and to my surprise they asked me to come in today at 2:30! I met first with a Nurse Practioner who was extremely well trained in how to tune a pacemaker. This wasn't a Medtronics person, but a nurse that works in the practice. She told me they don't like to use Medtronics technicians because they often are technical experts, but don't really understand the medical issues. After doing a lot of testing on my pacemaker, she brought in the cardiologist who was also an expert on pacemakers. They discussed my situation, asked me lots of questions about my problem, jointly came up with a solution and then did the tune up. And it worked. As I walked home from the doctor's office (remember Max has our car) I looked at the hills in front of me and decided to test their work. It was wonderful. I was able to walk up the hills just like a real person in good health. I HAVE BEEN TUNED UP.