Call meeting with specialists, family

Dear Dr. Gott: I am 70 with a long and complicated history of coronary artery disease, angioplasties and stents, and I take 10 different medicines a day. I am short of breath. My cardiologist says it’s from my lungs, my pulmonologist is convinced my heart is to blame

Also, I’ve read that low cholesterol is far more dangerous than high levels in causing stroke. Mine is 140. Comments?

Dear Reader: To say that your medical problems are challenging and complex is a gross understatement, and without more information than was contained in your short note, I cannot give you specific recommendations. Your heart history is distressing; I don’t know whether you have significant lung disease (from smoking?), but I suspect you do.

In my view, you need resolution of the heart/lung controversy. I believe that your shortness of breath is probably the consequence of coexisting cardiac and pulmonary disorders. Thus, I urge you to meet with your cardiologist and pulmonologist to resolve this issue. It’s not necessary to get the two busy specialists together in the same office; they could speak on the phone. Does each have enough information to address your problem? I hope so. If not, further testing — such as pulmonary function studies and a blood test of beta naturetic peptide — would be appropriate. Are they going to be unhappy with your insistence on a conference? In all likelihood, yes. But, sir, this is your life and you have a right to information about it. You also need a consensus.

Probably the easiest way to bring about this conference (which, incidentally, should also be attended by your wife, family members and anyone with power of attorney or health proxy) is to enlist the aid of your primary care physician. Unless I miss my guess, he is probably extremely interested in a resolution, because his advice and success depend on obtaining valid opinions from his consultants.

Before going any further, let me confirm that my solution is far from being customary. Yes, doctors have conferences with relatives and families of desperately ill hospital patients. But an office conference about an outpatient health problem would be unusual. But I believe that this approach is vital in your case.

Finally, in response to your comment about low cholesterol, the current recommendation by the authorities is that people with heart disease should have total cholesterol levels below 150, with LDL (the “bad cholesterol”) below 100. The dangers of low cholesterol have not been consistently documented, although such patients do appear to have a higher incidence of violent death, for no known reason. Perhaps this is a topic that should also be addressed by the doctors in your conference group.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.