Hello.

Hey, good evening.

Sorry to bother.

Um, are you Anal's dad?

Yes, yes, go ahead.

Yes.

Um,

My name is Luisa and I'm the doctor that is taking over from um, Dr.

Muhammad Abdullah Rahim for the follow up of our announce.

Oh, okay, very good.

Yes, hello.

Hi there.

Yeah, yeah.

Oh, it

Sounds like you were expecting, uh, to to hear from you.

Okay.

that's good.

I just wanted to tell you that the, the ECG, the 24 hour old ECG, we received the, the report and is normal.

Oh, good.

I don't know if you have received it already.

I don't think so.

Okay, that's okay, that's fine.

But it's all good.

And I was just wondering how she's doing.

It's the same really.

She occasionally does come.

complain of chest pain, but less so.

That's really good.

Yeah, it's a strange thing.

I'm sorry.

I'm at the hospital because my father had a heart attack.

And I've been thinking about chest pain in a different way.

But

It's a completely unrelated thing.

So she's she's complaining a bit less, but there's still a pattern with the eating that concerns us.

If you've seen the notes, there's something that that you've got a

Diagnosis of achalasia.

I have and there's some things that are alarmingly similar and we've really tried hard not to expose her to it, but she's still, um, still mention I feel like the food is stuck.

I've never said that in front of her and she comes out with it on her own, like she can't swallow it.

Occasionally.

So what is it that she cannot swallow?

Is it solid or

Anything, anything really.

It's after a meal, particularly if we're in a rush, which I know, I appreciate it can be normal up to a point, but she's like in the warm weather she was having, fruit every morning for breakfast and a couple of times she's been in a rush going to school and before getting to the school gate, it's coming back out now.

Anybody would say vomit but

It didn't look digested, which alarmed my wife because that's not something that happens to me.

It's perhaps not made it to the stomach.

I don't know.

I know she's very young as well.

We don't really want her to go through any invasive tests for that either with, you know, gastroscopy or anything like that.

But there is something when she eats, doesn't sit right.

Um, or she gets pain in the chest, something maybe like.

Could,

Could, could you describe these episodes that she gets?

Do they happen?

Like, are they in relation?

to meals?

I believe so.

And we we can't see a pattern with what she's eaten, what timing, no, we cannot.

You can.

We cannot.

It happens in a bedtime, she's ready for bed.

I say, I'm okay, but my chest is hurting a bit.

She might have used the phrase chest is hurting to describe a pressure or something else, but there's something

Bothering her, definitely.

Also, the last serious occasion was the school sports day.

She was running and very, very active and warm.

And she was she really she was holding her chest and saying my chest is hurting.

After running.

Yeah, after running.

Okay.

So it's a strange one for me.

Okay, so let's take a step backwards.

So, um, so first of all, so I understand that she had a scan over of her heart, is that right?

Yeah, and it was normal.

Yeah.

So, so from, so, the, the first thing I would think of after, after if, if the pain comes after, after running around, after a physical exertion, then the first thing to rule out is the heart.

So, she had all of the investigations from that point of view and everything I promise you is very, very reassuring, as I'm sure.

We're all happy with that, yeah.

Yeah.

Yeah.

So the other options are, of course, the

You having achalasia potentially does represent a little bit of a red flag.

However, and as I'm sure you know, it's a bit of a different thing.

So normally it's a difficulty with swallowing, liquids rather than solid?

I mean, I don't want to dispute it, but.

No, no, in children, I mean.

Okay, I see.

Yeah, yeah, yeah, sorry.

I'm guessing that your your diagnosis was later, right?

Yeah, I was in my 20s, yeah.

Yes, yes.

So in children, achalasia, that's normally how, so it can sometimes be part of syndromes, but I understand from reading the notes that Anna doesn't have any anything that would make us suspect that like her development is all good, is all normal.

And so outside of some syndrome, that's normally what we would expect is to have some.

difficulty swallowing liquids and having sometimes like drooling and coming out of the mouth and vomiting.

Yeah.

Um, the other thing in terms of esophagus, it could be

Um, like, uh, an esophagitis, but in that case what we normally have is a food infection.

So that means that we've got a difficulty swallowing solids with the food getting stuck in, in, in, getting stuck, not not farther up when she swallows like, so her, she wouldn't be pointing at her throat, but she would more frequently be pointing at her chest.

Yeah.

However, yeah, that would be also, like, she would also start drooling because there would be an inability due to the inflammation of the esophagus of the feeding tube to pass, to pass the, to pass the food down into the stomach.

Okay, understood.

Yeah.

So we don't think it doesn't point that way.

So I don't think these symptoms point in that direction.

However, having saved these things that the the far more common thing in children is to have musculoskeletal pain.

So what is very common with with growing is that, you know, the cartilage

That are, are in between the ribs.

They, they obviously they need to stretch, okay, with, with growth.

And that sometimes can cause a process that is similar to growth pain to the legs, you know, the pain that can.

In fact, yes, it coincides quite strongly with some growth pain she's had in the legs.

And she's even complained of the wrists and the elbows.

Is that normal to have growth pain in the wrist?

wrists and elbows?

Well, have you noticed any swelling or any redness or any.

Yeah, no, I mean, all of these can be growth pain.

And, um, I don't know if you you've noticed that has she grown a lot recently?

She's always crying, yes, yes, she has, yeah, she has spots and we can see she complains of pain in the legs at night.

Yeah, okay.

I was confident at the time that was, gross pain.

I can remember it myself as a child.

I don't remember having it anywhere else other than the legs, but fair enough, it makes sense, yeah.

It's a bit less

Common, it's a bit less common, and there is a degree

Also of the other thing that I should mention is that at around this age, children start becoming more aware of the more aware of their heart beating.

And it's very hard to describe it as the feeling that they start, but when their hearts start racing for any reason, then we start feeling it beating, and that is a new feeling for them.

because they're not used to it.

And when they become more aware of it, then the way they describe it sometimes is as pain, but it's some, but by most of the cases it's not really what we mean by pain.

if it

Makes sense.

I understand.

She, for for her age, she's remarkably eloquent.

Clever.

Very good, good, very clever and good vocabulary.

So she has it often said, I feel like my heart's beating.

too much.

There you go.

Which does fit that as well.

Yeah.

And this is in line with the with the alter ECG because sometimes she does have runs of the heart beating a bit faster, but they happen

When they happen when when she's awake, which is fine because that's, I mean, there is a variability in our heart rate that is absolutely normal.

If I'm speaking on the phone, my my heart rate is going to be, slightly faster than when I'm.

Of course. than when I'm silent.

And if I'm going up the stairs, my heart is, my heart rate is going to be, uh, higher.

Yeah.

So that's, that degree of variability, is normal, but at this age they start perceiving that variability and the way they describe it to to to anybody.

Yeah.

I am not a doctor, but sadly I've got fairly knowledge of the esophagus and this part of the anatomy.

Oh, bless.

No, but we learned quite a bit about the heart.

Also.

No, for a different reason.

Forgive me, but we, a couple of years ago, we had a steel bus.

Oh, I've read that, probably

Not, yeah.

Yes, it's something that really worried.

My wife is a little, if I'm honest, she's a bit paranoid and she's very worried about our daughter.

I even have been, I have been worried enough with seeing her in pain and from the chest and especially if there were any digestive symptoms or anything.

But our stillbirth was due to the root cause was SVT.

And.

Yeah, no, there isn't any SVT.

There's no sign whatsoever.

No, absolutely not.

No, I can read you the full report if you want.

So if you

Could email it from our wife's benefit to help her sleep, it would be fantastic.

You email the what do you mean?

Like the report if you could, because I know my wife will want to study it if it's possible.

So I don't know if it's possible, but I will ask my secretary to see what she what she can do because I don't think we can normally send out this report because we've only got one copy.

However, he is absolutely perfect in the, um, yeah, so I can, I can, the most important thing is only one line.

It says patient reported various symptoms of feeling sick,

Chest hurting and racing hard, which is exactly what you're telling me.

Correlating ECG at all these times show sinus rhythm with episodes of sinus tachycardia, which basically means the heart going a bit faster.

And that's not that's not compatible with SDT?

No, no, no, no, because because the ECG would would see the SVT 100%.

This is why we do it.

Fair enough.

So don't

Worry.

I remember from the foetus, I'm sorry to go over it.

I remember the foetus.

It's obviously more difficult to measure the foetus.

The sign was that it was racing in the foetus.

It was very, very fast.

period.

Yes.

And that was how they did Tuesday was the SVT in the first instance.

So so when you mentioned that, I just thought I have to clarify.

And are you expecting a follow up with my myself at some point.

I'm just checking because I'm not entirely sure of how everything is working.

I'm assuming this I had just assumed this was the follow up.

Yes, that was the way it was left, but

If you're confident from the description that we can rule out gastrointestinal problem or digestive, you know, swallowing problem and you're very happy with the heart and you can categorically rule out SVT, then I personally I

Can categorically rule it out, obviously.

I mean, I can rule it out on these 24 hours and it's very, but, but this, but she, the lucky thing is that she did have the episodes during the 24 hours.

So.

So that may explain her sensation that she's she's been complaining about.

Yeah.

And there's nothing to worry about with that.

It's a normal thing to happen.

Exactly.

Exactly.

It's a normal thing.

But what I can do, I can give you a patient initiative follow up if you want.

Yeah.

Because that would imply that it gives you more, um, out, autonomous.

We can self-refer back if we need, yes.

Exactly, precisely that.

But you're saying that the episodes are getting better R&D?

I think so, but between you and me, uh.

Mom is

Anxious.

Obama is very anxious and.

But which, I mean, obviously

Is absolutely fair with everything that has happened.

So, so, I, what, what I would say is that, I, she, I can give up a patient initiative, follow up for the next year even.

So if you have got any concerns?

Yeah.

Yeah, shall we do that?

Yes, please.

And one more time, for absolute clarity, so I can explain to her, to my wife, I'm sorry again.

The racing hard is a normal thing to happen, but we're filling a form, a log of activity during the 24 hour ECG.

So I presume that it correlates, it ties to together that she was playing or more active at the times when he was racing.

There's no reason it would race on its own for no apparent reason.

No, because, no, no, because look, the other thing I have not added is that um, so it, during the night, she didn't have any of these episodes.

Okay.

So when she

Stepped off the heart rate.

Yeah.

So it says 180 and

Diurnal episodes of sinus tachycardia, longest and fastest lasting 361 beats, okay?

At a peak rate of 181 beats per minute.

So that is more or less equivalent of a couple of minutes.

And she had these episodes a few times, but only during the day, which is a reassuring part.

She was probably.

And and and some of them correlated with their feeling, their heart racing.

Okay, okay.

So it's clearly what what she's feeling.

And yeah.

And she's really good at describing for a six year old, I would say.

But yeah, she's she's a girl and she's really clever.

So yeah.

She's very, very clever.

So I will leave it, I will leave it open then.

But but yes, yeah, so feel free to call and they'll book in and please reassure mom and, but yeah, tell her that she can still come whenever she she wants to, okay?

Thank you.

Yeah.

No problem.

We could have,

A copy of the report by email, I know it would be the best thing we could possibly have.

Absolutely.

I will ask, I will ask the secretary to try and complete it for you.

Okay.

Thank you.

Have a good evening.

Thanks for your call.

No problem.

Bye.