Nation of broken hearts

This article was first published on Subselfie.com

I’m back at the University of Santo Tomas, my Alma Mater — not at the plaza or my old building or even the walkways I spent endless hours in college just burning time, but at the hospital.

I’ve never been inside the UST Hospital before. I never needed anyway because my heart behaved well for four years. I never had to be wheeled to the emergency room, never had to gasp for breath crossing the bridge from the clinic ward to the laboratories.

But for a while now, I think I have a broken heart, literally.

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Tale as Old as Time

The storm is loud outside. It’s just 3pm but it looks like the sun had set for the day. There is a chatter of panic among everyone I pass by. España Boulevard had flooded again. But that wasn’t my worry for the moment. My main concern was the result of the heart test I just underwent the day before.

I was 10 when I first felt it. It starts with heavy beating; when I so much as pause for a second I can hear it. Gradually I will feel the pain, like there’s a weight on my chest not allowing my heart to do anything. Then I will find myself coming up for air every two minutes. The first diagnosis was Rheumatic Heart Fever or RHF.

RHF is a streptococcal (strep) infection. Its treatment requires years of regular intake of antibiotics. As I was told when I was 10, it isn’t life-threatening, just an inconvenience. I was told to take medicines to prevent it from developing into Rheumatic Heart Disease or RHD, where there is already valve damage.

I really thought I was going to die. I was a drama queen even when I was young, but I had seriously thought that was it. My cardiologist eventually ruled out RHF, but said I wasn’t allowed to undertake strenuous activities.

But I always had a high threshold for pain. They would always ask me: “how are you feeling?” And even though there is a tinge of pain inside my chest, I would always say “fine.” But there would be episodes like the one I had when I was 10 that would make me come out and say ‘I think I need to go to the Hospital.’

I was tested two more times after that. One during high school and another four years ago after I graduated. Same result: nothing more than just an irregular heartbeat.

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Borderline

Two months ago, I started to feel the pain again. At first I didn’t mind it because I feel it almost everyday. But it’s usually gone before I can complain. But that time, it was persistent. I would wake up in pain and sleep in pain. I would stop in the middle of conversations because my heart would suddenly sting.

The first test was the routinary electrocardiogram (ECG) test: negative.

I went back after a week for the 24-hour Holter Monitoring Test. It’s supposed to test the electrical system of the heart. Wires were strapped to my upper body and I had to go to work like that. I had a diary to log every change of activity and whenever I would feel something different. I logged almost every 30 minutes. If it wasn’t chest pain, it was difficulty of breathing.

It was a gloomy afternoon that August, but I was fine waiting for my test result. Not like when I was 10, my thoughts weren’t so grim. The attending physician hands me the paper with a smile on her face — negative.

But it didn’t feel right. I still felt pain. So I underwent a 2D Echo test to check whether there was any valve or muscle damage: negative.

By then my doctor had become frustrated:

Your heart is fine.

She continues the sentence upon listening to my heartbeat:

But I hear that — may kabog. Ang lakas.
( — there’s a murmur. It’s strong)

I look at her, puzzled. I tell her that it’s been my problem since I was 10.

Then she says something I’ve heard four times in the last 14 years:

Your heart is fine, but it’s just always borderline.

She went into a whole lecture of what food and drinks to avoid, a whole list of stressful activities I can’t do. But in that moment I just blurred out. If someone feels pain, the least that can make her feel better is to be told what’s wrong with her.

Not knowing — and always being borderline is just annoying.

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Filipinos and Broken Hearts

But I try to be thankful. First, for being fine. Second, for having the means to know that I am fine, in spite of being borderline. A lot of Filipinos do not have the luxury.

Five out of every ten casualties in the Philippines die because of cardiovascular diseases. It remains the leading cause of death in the country.

On the surface, this is understandable. Heart disease is a lifestyle disease. Filipinos still smoke, eat what we shouldn’t and exercise less than we should. Obesity, hypertension and diabetes are still prevalent.

But is it really what kills 50% of Filipinos? Dr. Ranulfo Javelosa, chief of Philippine Heart Center’s Preventive Cardiology Division, doesn’t think so:

Some ‘heart diseases’ could be due to other causes like infection, malignancy, metabolic disorders, electrolyte imbalance, kidney and lung diseases and some other unnamed or undetected conditions.

They are illnesses that are chalked up to a heart disease because it’s the heart that stops functioning last. But some of these cases may not be heart attacks at all. Instead, they may be other diseases, some, even treatable.

This may be a problem with the diagnostic equipment and ability of our doctors.

According to Dr. Javelosa, the problem is partly governance, political will and prioritizing health spending.

Some cases could have been recognized and treated early, some may have been prevented if information and public education were given priority.

The World Health Organization even posited in a paper that “less access to scanning facilities and laboratories in developing countries” lowers the validity of stroke diagnosis there.

The case is worse for poverty-stricken areas where technology is even less accessible and affordable.

So the next time you hear of someone who died of a heart attack, ask yourself: did she really die of a heart attack, or was it something else entirely that went undetected?

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Complicated Heart

And if it is indeed a heart disease, there is still difficulty in finding out which kind.

Some diseases may be quiet for many years and manifest later in life due to various stresses, other organ diseases or aggravated by changing lifestyle. Even some milder degrees heart attack may be “silent” or missed on routine examinations.

The heart is a complicated fellow, after all. According to Dr. Javelosa, a heart disease can be any of the following:

  • acute
  • sudden
  • slow
  • long­ standing
  • chronic
  • inborn
  • acquired

Last February, for a Valentine’s Day news feature, I produced a story on a condition called the “Broken Heart Syndrome,” with the scientific name: Stress Cardiomyopathy. It happens when stress hormones increase in levels and clog the veins in your heart. Over time, the veins are congested and the muscles weaken.

Even more alarmingly, people with no history of heart ailment or even risk factors, suddenly develop the condition because of severe stress.

The thing is, when it starts to manifest, it is not unique. It enlarges the heart just like many known heart diseases do. That is why it may also render some diagnosis inaccurate.

Broken Heart Syndrome was only discovered in 1990 in Japan. Cardiologists are still studying it. And in the Philippines, it is still not included in the list of diagnosis among specialists.

That’s why doctors have never heard of anybody who has Broken Heart Syndrome.

Maybe I could be the first, I thought to myself when I walked out of the hospital that day. It just makes sense. My doctors have always guessed my pain was just due to stress.

And the upside to having this condition: a literal broken heart heals. Treatment and medication can strengthen the muscle over time. But doctors here do not recognize this disease.

Undetected

Meanwhile, I get myself checked every now and then to make my family happy. But everytime I get a negative result, I just end up having more questions. And I become more paranoid.

Dr. Javelosa said it is possible for someone to have a heart disease yet go undiagnosed for years even with routine checkup.

The heart adopts or compensates to the slow changes and may not give warning signs like chest pain and other symptoms.

Common examples are rheumatic and congenital heart diseases, some heart rhythm abnormalities, cardiac muscle disease and silent myocardial ischemia or infarction.

RHF, the disease we first thought I have, is a burden in Asia. This, according to WHO. Over the years, experts believe the condition poses a specific threat to the Philippines.

The rise of RHF among young adults is linked to late diagnosis and inadequate treatment, according to Dr. Javelosa.

Moreover, RHF usually occurs among the poor, in congested schools and homes. So when a poor person develops RHF, it is even more difficult to get medical treatment or even a diagnosis.

But RHF is a preventable form of heart disease and Dr. Javelosa remains hopeful:

One need not go abroad to seek specialized care as was true 30 years ago.

Yet he admits we still face a tremendous challenge in making facilities and technology accessible to every Filipino, whether or not they are nursing a literal broken heart.

Maybe this explains why we are not a health conscious population. How could you be, when you can’t afford to? Data from the National Statistical Coordination Board indicate that we only spent P380 billion in 2013 on our health. That’s 13.2% of the total spending of the Philippines during that year.

A Heartbreaking Story

Months ago, I met 58-year-old Carol Gonzalez. She suffered from a mild heart attack two years ago but didn’t continue therapy and treatment. She cannot speak, or so much as lift her arms, and she has been stuck in her makeshift wheelchair ever since. Her younger brother cares for her during daytime, then waits tables at night.

The problem is obvious: they don’t have money to make her well. Unfortunately, such is the case for thousand others like Carol, whether they’re her age or mine.

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Until last year, Filipinos were still spending for their own health care with the government pitching in just a tiny bit. Private sources account for 63.1% of our total health expenditure, social insurance. Grants give 9.9%. Our government shares 27%.

I do not have medical insurance. My recent tests cost me up to almost P20,000. I have work to sustain me but how about Carol? How about the many others who carry a ticking time bomb in their chest?

Where and how do we take care of a nation of broken hearts? Hopefully we figure it out, before it’s too late.

As for me? I guess I would just have to live with the pain, and hope that one day I will be told my broken heart had healed, definitely this time.

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