COVID has rolled around again

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Tested myself this morning. Clare was unwell starting last Thursday, six days ago, and my own symptoms started on Sunday, three days ago.

Didn't quite feel like a cold - too much fatigue for both of us.

I'd almost forgotten about COVID (except for my vaccination against it coming up in a couple of weeks).

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Echocardiogram Results

 

I had my meeting with my GP yesterday afternoon, to discuss the report from my echocardiogram on February 25th 25. I scanned in the hard copy (little is electronically joined up in today's NHS) and asked ChatGPT to summarise the report and its implications.

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Summary of Echocardiogram Report (25 Feb 2025)     ---    [ChatGPT]

Key Findings

Heart Rhythm: Sinus rhythm, resting heart rate 58 bpm, with rare ventricular extrasystoles.

Left Ventricle: Normal size, normal systolic function (ejection fraction 57%), no regional wall motion abnormalities.

Right Ventricle: Normal size and function.

Mitral Valve: Thickened, fleshy leaflets with bi-leaflet bowing, opening well. Mild to moderate mitral regurgitation (MR) (vena contracta = 0.37 cm).

Aortic Valve: Normal trileaflet structure, thin and mobile leaflets, no significant stenosis or obstruction.

Tricuspid Valve: Thin and mobile, mild regurgitation, no signs of pulmonary hypertension.

Pulmonary Valve: Normal structure, trivial regurgitation.

Left Atrium: Normal size.

Inferior Vena Cava: Dilated but collapses less than 50% on sniffing (suggests mildly raised right atrial pressure).

No pericardial or pleural effusion.

Interpretation & Comments on Your Decision

1. Severity of Mitral Regurgitation

Your mitral regurgitation is mild to moderate, which is reassuring. In more severe cases, MR can lead to symptoms such as fatigue, worsening shortness of breath, and atrial fibrillation due to left atrial enlargement. However, your report suggests your heart function remains strong, and there’s no major impact on chamber size or overall circulation.

2. Implications of Mild to Moderate MR

Low immediate risk: Given your normal ejection fraction (57%) and the absence of significant left atrial enlargement or pulmonary hypertension, there’s no immediate concern.

Potential for progression: Mitral regurgitation can worsen over time, so monitoring symptoms is key. If breathlessness on exertion (SOBOE) worsens, a repeat echocardiogram in a year or two might be prudent.

Minimal impact on daily life: Your exercise tolerance may remain stable, though you should note any changes in fatigue, breathlessness, or irregular heartbeats.

3. Decision to Cancel the May Cardiologist Appointment

Your reasoning is understandable. The cardiologist would likely only suggest medications (e.g., beta-blockers, ACE inhibitors, diuretics) to reduce heart strain, and given the mild nature of your condition, these might not be necessary at this stage. You’re also right to consider quality of life—many cardiac medications come with side effects that may not be worth it for a condition that currently seems stable.

That said, if your symptoms progress (e.g., worsening breathlessness, palpitations, or fatigue), reconsidering follow-up in the future would be wise.

4. Recommendations Going Forward

Monitor symptoms: If you notice worsening exercise tolerance or arrhythmias, reassess.

Repeat echocardiogram: Consider one in 1–2 years to track any progression.

Lifestyle: Maintain heart-healthy habits (moderate exercise, balanced diet, hydration).

Blood pressure monitoring: Since low BP may play a role in your scotomas, keeping an eye on it is sensible.

Final Thoughts

Your echocardiogram is reassuring, showing only mild-moderate MR without major consequences. Your decision to avoid unnecessary medication is reasonable, provided you keep an eye on symptoms. If anything changes, a repeat scan in the future would be a logical step.

[I am booked in for a repeat echocardiogram in two years time.]

Visual field problem

 Dated: Sunday 26th January 2025

Yesterday evening I was watching TV in a low-lit room when suddenly the lower left half of my visual field vanished from my right eye. It had been replaced by what appeared to be a grey rectangle stretching from the lower left boundary of my visual field about two thirds of the way across.

There was a quite clear right-angled edge to the rectangle, just to the right of the lower-centre of my visual field. This sudden transition to partial visual occlusion was painless but I had a 'funny feeling' in my head as it happened.

After ten minutes or so the occluding rectangle vanished, although for a few subsequent minutes there was a flickering at the bottom-centre of my right visual field, as if I were seeing things there through rippling waves. But this too soon passed and my vision returned to normal. This is not the first time this has happened although episodes are spaced months apart (to-date).

I also quite often (weekly to monthly - for a number of years) have those jagged scintillating patterns which grow in size for maybe fifteen minutes before vanishing. Also accompanied by a 'funny feeling' in my head. I have put these down to a migraine aura - scotoma which I first started experiencing in 2016.

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ChatGPT is quite worried about all this ("What you’re describing strongly suggests a transient ischemic attack (TIA) involving the visual cortex or the blood supply to the retina of the right eye. TIAs are temporary episodes of reduced blood flow to a part of the brain or retina, often called “mini-strokes.”") but I'm inclined to add it to my list of concerns when I see the cardiologist in May 2025. But I will also take this note (not the ChatGPT part) around to the GP surgery tomorrow morning.

'Sugar Free Farm' - ITV

Clare and myself watched this last night (don't ask!):

"Forget The Jump. ITV's Sugar Free Farm might actually be the most horrendous reality show on television.

For over two weeks, seven celebrities will be completely ditching sugar from their diets.

That doesn’t just mean no chocolate, biscuits or cake – that’d be bad enough. But the rules also mean that natural sugar from fruit and syrups are also banned."

There were some real fatties on the sleb team, but the two worst offenders (from their pre-farm 'lifestyle questionnaires') were Joe Pasquale and Peter Davison (the fifth incarnation of the Doctor in Doctor Who and Tristan Farnon in All Creatures Great and Small) - we always call him 'the vet from space'.

Peter Davison

Davison presented as the complete sugar-addict, rarely passing a sweet shop without buying a large jar of fudge. In the event, he lasted less than twenty four hours before being carted off in an ambulance, anxious paramedics hovering over him.

They said that this showed how bad sugar was for you; I rather felt that it proved how bad lack of sugar was.

Your.MD - useless, boring and playing safe

"In an experimental trial, the National Health Service across parts of London is going to test an artificial intelligence app as a way for potential patients to find out how urgent their problems are.

More than 1.2 million people living in Camden, Islington, Enfield and Barnet will be able to use a chatbot created by Babylon as an alternative to the non-emergency 111 number."

This story was carried by many outlets, the quote above is from Wired.

I wondered why there wasn't already an 'app for that'. Reading The Economist Technology Quarterly this afternoon (on AI voice systems), I found that one does in fact exist: Your.MD.

I downloaded it at once onto my Nexus 6.

Turns out I have cause to use it. For a few days I've been a little under par: lacking energy, a bit of a runny nose, some 'room spinning around' when I turn over in bed and yesterday when doing the side plank (!).

A trivial Google search persuades me this is a side effect of the common cold virus. It's called labyrinthitis. It goes away after a while.

Your.MD took a lengthy history - chatty questions followed by answer options. After a while it knew my gender, age and symptoms as described above. It concluded I was suffering from either ME or Heat Stroke.

Useless.

As long as chatbots are simply doing verbose form-filling - a walk down a simple decision tree - they will be as much fun as calling the IVR system at a bank or the tax office. You want to scream, or hit something.

Of the many possible conditions consistent with my small number of vague symptoms, Your.MD chose the two worst possible outcomes.

I suppose this is fear of litigation, baked into the app.

A Doctor writes ...

From my GP today:

Dear Mr Seel

Thank you for your letter regarding your family history and suggestion for enhanced screening. I think this probably would be a sensible idea and I am sure the family history would fall within the referral guidelines for the enhanced screening. If you would like to go ahead with this please let me know and I can arrange the referral. The enhanced screening involves an endoscopy which is a fibre-optic camera which can look inside the bowel.

If you would like to discuss this in more detail before me making the referral please arrange to speak to me.

Here are some of the highlights from Wikipedia.

"The pain associated with the procedure is not caused by the insertion of the scope but rather by the inflation of the colon in order to do the inspection. The scope itself is essentially a long, flexible tube about a centimetre in diameter, i.e. as big around as the little finger, which is less than the diameter of an average stool.

"The colon is wrinkled and corrugated, somewhat like an accordion or a clothes-dryer exhaust tube, which gives it the large surface area needed for digestion. In order to inspect this surface thoroughly the physician blows it up like a balloon, using an air compressor, in order to get the creases out. The stomach, intestines and colon have a so-called "second brain" wrapped around them, which autonomously runs the chemical factory of digestion. It uses complex hormone signals and nerve signals to communicate with the brain and the rest of the body. Normally a colon's job is to digest food and regulate the intestinal flora. The harmful bacteria in rancid food, for example, creates gas. The colon has distension sensors that can tell when there is unexpected gas pushing the colon walls out—thus the "second brain" tells the person that he or she is having intestinal difficulties by way of the sensation of nausea. Doctors typically recommend either total anaesthesia or a partial twilight sedative to either preclude or to lessen the patient's awareness of pain or discomfort, or just the unusual sensations of the procedure. Once the colon has been inflated, the doctor inspects it with the scope as it is slowly pulled backwards. If any polyps are found they are then cut out for later biopsy.

"Some doctors prefer to work with totally anesthetized patients inasmuch as the lack of any perceived pain or discomfort allows for a leisurely examination. Twilight sedation is, however, inherently safer than general anesthesia; it also allows the patients to follow simple commands and even to watch the procedure on a closed-circuit monitor. For these reasons it is generally best to request twilight sedation and ask the doctor to take his or her time despite any discomfort which the procedure may entail. Tens of millions of adults annually need to have colonoscopies, and yet many don't because of concerns about the procedure.

"It is worth noting that in many hospitals (for instance St. Mark's Hospital, London, which specialises in intestinal and colorectal medicine) colonoscopies are carried out without any sedation. This allows the patient to shift his or her body position to help the doctor carry out the procedure and significantly reduces recovery time and side-effects. Although there is some discomfort when the colon is distended with air, this is not usually particularly painful and it passes relatively quickly. Patients can then be released from hospital on their own very swiftly without any feelings of nausea."

Something to look forward to before Christmas! Here is what my 23andMe health report has to say about my Colorectal Cancer risk.

Nigel Seel
4.2 out of 100 men of European ethnicity who share Nigel Seel's genotype will develop Colorectal Cancer between the ages of 15 and 79.

Average
5.6 out of 100 men of European ethnicity will develop Colorectal Cancer between the ages of 15 and 79.

And here's the caveat.

The 23andMe Odds Calculator only takes into account effects of markers with known associations that are also on our genotyping chip. Keep in mind that aside from genetics, environment and lifestyle may also contribute to one's risk for Colorectal Cancer.

Gym cuniculi

Yes, that's what the Romans called that vile species we know today as 'gym bunnies'. We popped round to our local sports centre this morning where I signed up to the induction course for Tuesday morning: you know, learning to use the walkers, rowers, static bikes, power-presses ...

I did not make a good impression there: I'm in recovery from the ghastly norovirus - my voice is squeaky, my hue wan. I fear the fit young lady at the service desk anticipated a combination of failure and/or death-in-action for Tuesday.

For a long time I used to run 3 miles or so three times a week. Eventually I could sustain an average 7-8 mph. And eventually I got knee and hip joint pains which never properly recovered so I had to stop, degrading into my current state of unfitness. With a two stone loss of weight I'm now in urgent need of muscle-toning - time to devolve fat, not muscle! Hence my entry into the Schwarzeneggerish world of the gym.

OK, I ask myself, I get all this body maintenance stuff  ... but run it past me again: what, exactly, in the end, is it all for?