My list of questions for the Philippines Doctors

This is the email sent to the Mission president and his wife for them to ask the doctor when she returns on Friday for her doctor follow up.

Hi 

Since my husband and I can't be there this Friday (tomorrow) we have compiled a list of questions we have for the cardiologist.  I'm sorry, but since we aren't there it is quite long.

It sounds like we have quite a few issues going on with Jessica

1.  bradycardia

2.  low blood pressure

3.  arrhythmia (every 3-4 seconds)

4.  bacteria

5.  enlarged thyroid

6.  a few abnormal test results (neutrophils, lymphocytes and basophils)

So far we have determined that Jessica NEEDS to increase her water/fluid intake and take a multi-vitamin on a regular basis.  We also saw her sodium and potassium levels are normal (not what we were expecting).  Her younger sister had syncope so we are very familiar with it, however Marissa's heart doesn't have the abnormal beat like Jessica.

What is Jessica's current resting heart rate and blood pressure?  From what I can tell it was as low as 40 in the hospital with a blood pressure of 80/60 with the erratic spike every 3-4 seconds.  This combination is not good - leading to her symptoms dizziness, fainting, weakness, etc.  What can we do to increase her vitals to be more stable?

We also noticed in her Fecalysis analysis there is a "moderate" level of bacteria and that her white blood cell count is high - are you investigating if bacteria is effecting the heart tissue?  Should we be concerned about the high level of bacteria?  Is infection causing the bradycardia, low blood pressure and arrhythmia?

We noticed there were a few "out of normal range" results on some of her test ...

 - she was high on Neutrophils (85.1; normal 43-76) - white blood cell

 - she was low on Lymphocytes (8.6; normal 17-48)

 - she was low on Basophils (.2; normal 0-2)

- Was Jessica’s heart tested for level of oxygen rich pumped by the heart? If so was the level of oxygen in her blood normal or below normal?

- Jessica’s TSH level is at 1.26. Does she need some supplements to raise her TSH level which may give her more energy?

- What is causing her to have low level of lymphocytes?  What can she take to improve her lymphocytes?

- What do these mean?  Are they related?

- Another test mentioned "thyromegaly with diffuse parenchymal changes and few sub-centrimeter hypo echoic nodules". 

What does this mean with regards to Jessica and could this be causing her heart issue, or visa versa?  

- What would be the causing her thyroid to be enlarged?  How enlarged is her thyroid?  I read that an under active thyroid gland (hypothyroidism can cause bradycardia) - have we looked into this?

- Do we need other tests for her?

- Do you think she has sick sinus or blockage?

- So essentially - all those questions lead to - What is causing her slow heart rate, arrhythmia, and low blood pressure?

- Can this go away?  Can her heart return to normal? 

- Will any of this  cause permanent damage to her heart?

- At her age, what kind of risks does her heart condition create?

- Do we need to monitor her heart?

- How often will I need follow-up appointments?

- How is Jessica’s energy level currently? If she feels weak, is this due to her low heartbeat or is there a secondary cause?  

- Obviously right now she doesn't have the energy to be active, but will the permanently affect her activity level?    

- Is it safe for her to travel far distances - fly back to the USA when her mission is finished?

If I have overlooked anything please feel free to add or answer unasked questions.  This is all new territory  for us.

I wish we were there to ask our own questions.  I'm sorry to leave this in your hands.  We trust that you are taking care of our daughter the way you would take care of your own child.  Thank you.  We also trust that she is in the Lord's hands and he is dutifully watching over his precious daughter.  We look forward to hearing back from you with the answers.

Thank you again for all your time and attention to her.  It goes without saying that she means the world to us.  We have put her name on the temple prayer rolls, and have asked people from all around the world to pray for her health.  Thank you again for all that you are doing.

Sincerely and with much appreciation.

Mark and Betsy Lowe