My Open Heart Surgery was almost three years ago, not four as I suggested earlier  – I came home on July Fourth – and I suppose it was a landmark chapter in my life. My broken heart has been doing  well, going strong. I shovel snow, mow lawns, move firewood. I have angina now, so walking up hills can be uncomfortable. But I bike for at least four hours a week without any trouble.

This afternoon is my annual (sometimes bi-annual) visit with the cardiologist. In some ways I look forward to knowing my broken heart is working well, but it is not something I really look forward to. My cardiologist is one of these very competent and professional men who live by scientific data, and will rarely venture beyond it.

If he sees me in the hallway, he looks the other way and pretends not to see me. He doesn’t like to chat. I trust him, but we will not be going to the movies together or having lunch.

These visits are fairly de-humanizing.  Lots of waiting, an EKG, 15 minutes with my doctor, it seems a short time for such  large subject, but that is the way of the world. I can’t afford the Concierge doctors you can call up on the phone and go see, that is for people with lots of money, for whom health care is very different in America.

I always feel a bit disconnected there, as if I am being treated well, but not in any way, known. Take your weight, blood pressure, take a seat, the doctor will be along shortly. Nobody knows my name.

Female nurses and doctors seem different to me, they wish to know me, at least a bit. But the cardiologist is important, I have done well in  my recovery, and he gets some credit for that.

Today,I will continue my efforts to assert more control over my medications and take responsibility for my heath.

I will seek to drop the beta-blocker, it is called metropolol and it is supposed to lower blood pressure and slow the heart. It also sometimes causes fatigue and drowsiness.

Last year, my doctor said he only had data for this medication for three years after surgery, and there was no data after that. If there is no data, then we don’t talk much about it, it’s up to me.

My doctor said he would consider letting me drop it after three years, so this is my chance. Earlier this year, I stopped taking statins, I was allergic to them and they cause severe joint and muscle pain. It took me several years of arguing to get off of that medication, which is a poison for me.

Like most patients, I am torn between listening to the doctor – he knows more than I do, and I know it  – and listening to myself: nobody knows more about me than I do.

I take several well-regarded and researched holistic medications for lowering cholesterol (two doctors I know recommended them to me, they are Red Yeast Rice and Cholestepure-Plus) and my cholesterol has always, in fact,  been low. I get blood work done every three months under the care of my (female) nurse practitioner and she says to follow my heart, as it were and get off the stains. She did.My cardiologist fought hard for me to stay on the statins the date is overwhelmingly good, especially for people like me.

We’ll keep testing to make sure everything is okay, and if it isn’t, we’ll make adjustments.

I appreciate her. As a diabetic and a heart patient, I am at risk for heart failure and strokes, but I also wish to live my life in a healthy and active way. It is not good for writers to get drowsy, even though it is short live and had not damaged my work.

The challenge for me is to make my own decisions and be the true primary care expert for me, within reason. I feel strong clear and active, and last night I biked for an hour and was not even mildly winded.  I’m going to tell my doctor what it is I wish to do. I don’t want to have a stroke or heart attack, but I don’t want to live forever either, and I want the time I have left to be meaningful and active.

So I know a lot more than I did four years ago, and it is in some measure now, up to me.

There are many more photos, books, blog posts, days with Maria and the dogs, new puppies and good works ahead of me. I plan to stay healthy for all of them.

I have a lot to do and I am eager to get to it. I hope my doctor can hear that, because I also know the final decisions and responsibility lies with me.