Why follow up appointment?

[De__0__0]

  14 y.o. daughter has been seen by pediatric cardiologist since age 12 when an EKG was ordered as a precaution prior to prescribing Elavil for migraine prevention; was abnormal with enlarged right atrium and something wrong with one of the spikes being too large...however echo did not reveal anything wrong.  A few months later she had extensive testing due to episodes of mild chest pain (echo, exercise stress with PFT, and 30 day event monitor), all were described to me as normal, even though mild pain was reproduced during exercise test.  Cardiac pain was ruled out.  A few months later she began experiencing bouts of severe chest pain coupled with shortness of breath...ER treatment showed a normal EKG and normal chest x-ray, she was treated with oxygen and a sedative to reduce pain and sent home.  She was seen by gastroenterologist as pediatrician suspected reflux.  Gastroenterologist said not typical for reflux, but not impossible either.  He wanted her to go back to cardiologist as well, which we did.  She had normal exam in cardiologist office....EKG was shown to be within normal limits although there was some mention of an abnormal T-wave.  She was told to return to ER next episode of severe pain w/ shortness of breath for cardiac enzyme tests, then return to cardiologist in a month.  However she had also started Zantac.  During this whole month she had no episodes of severe pain, and only a couple episodes of mild chest pain, and no episodes of shortness of breath.  The mild pain, like the severe pain, is always triggered by strenuous exercise.  Being a competitive swimmer, she does strenuous exercise 4-6 days per week.  The mild pain tends to go away on its own with a short rest period.  The couple of times she has had severe pain, it starts suddenly with exercise, but is much more resistant to recovering with rest, it sometimes takes days for the pain to go away, although Naprosyn or 600mg of Ibuprofen does help.  Also, the shortness of breath comes only with the severe pain.  Since she has had no severe pain since the Zantac, she has not had the cardiac enzyme testing done.  I called the office and explained....their office is a long ways from here, she will have to miss school, I will have to miss work, and since she has had no new or repeated symptoms, and the test has not been done, I suggested delaying the followup appointment for a few weeks, or until pain recurred and we had the testing done.  Going for followup now, with no new information, and no symptoms, seems to me to be a waste of time and money.  But their office refused, and said it was important to keep her app't, especially since she seemed better with the Zantac.  With a slew of basically normal tests having been done within the last year, and with the Zantac seeming to prevent further episodes of severe pain, what could be the purpose of insisting we keep this appointment?  Are there other tests that should be done?  Also, assuming that it is the Zantac that is working, as opposed to coincidence since the pain is transient anyway, and assuming she has another basically normal EKG at this next appointment, and that no more episodes of severe chest pain and/or shortness of breath occur, what is a reasonable follow up/tests appointment schedule?  Previous history includes Graves Disease dxed at age 8 still treated with Tapizole, and positive antidsDNA, possibility exists of mild lupus or mild connective tissue disease, but not enough current symptoms to make a diagnosis, nor warrant any treatment, just observe.
---------------------------------------------------------------------------------------------------
Dear Dee
I agree with your doctors. You should keep the appointment, even if it is inconvenient. This is the only way that the doctors can really get a feel for her, her symptoms and what makes her feel better. Otherwise, the next time she has a severe pain episode, they will not have a handle on whether she really is better now, with the current treatment. Regarding further follow-up, you should follow whatever schedule your doctors recommend. Your daughter’s case is not typical, and it is especially important for her doctors to see her regularly. Regarding further tests, I cannot think of any.
I hope this has been useful. Feel free to write back with further questions. Good luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.