A MUST read: I dodged a bullet ...............(long)

anovaguyDecember 24, 2005

I am sharing this story in case it helps any of the readers of this forum, your families or friends.

About two months ago, I was experiencing this dull ache in my left arm. It was there most of the time and changing the position of the arm did not seem to alleviate it. After a month when it did not cease, I saw my internist. He did the usual EKG, etc and said that he thought it was a pinched nerve. However, he felt that out of an abundance of caution, I should see a cardiologist. I did this and the cardiologist also said that he was sure that it was nothing to do with my heart but suggested that we go ahead and do a thallium stress test. At the time I saw the cardiologist, the ache in my arm had still not ceased.

A week later, I did have the stress test - by which time the ache just disappeared as mysteriously as it started. The actual stress test went great but the results of the thallium study - which is where they inject a radio-active dye so that they can observe the circulation within the arteries would be available only in a couple of days.

The next thing I know is that I get a call from the cardiologist saying that there was "inconclusive" evidence that there might be a partial blockage in my right coronary artery (RCA). But he also said that he was convinced that it was more than likely a false reading but that the only way to know for sure is by having a cardiac catherization done. He did not see this as an urgent situation but something that we should do at some point. I asked if I should cut down on my exercise program and the cardiologist said that there was no need to do so.

At the urging of family and friends - several of whom are doctors - I went ahead and scheduled the test. NO ONE believed that there could be anything wrong. It was done just over a week ago.

Lo and behold, the test showed that my RCA was 90% blocked in two sections. Three stents were inserted to correct the situation. They also found that there is a 80% blockage in the left artery (LAD)! I have to go back early in the new year to have a stent put in there! The RCA had a clot already forming and I was told that it was a matter of time before I had a severe heart attack!

I basically dodged a bullet!

Why did everyone - health care professionals as well as lay-people - feel that it could not be my heart? First, there were absolutely NO SYMPTOMS other than the dull ache in my left arm. I run about 35-40 miles a week and despite the blockages there was no chest or other pain. I have no family history of coronary disease. I am very careful with my diet - I am substantially vegetarian though I do eat fish for protein. I hardly ever eat meat or chicken. I have blood pressure that is typically around 110/70. Blood-work has been fine for years - though I do take the lowest dosage of lipitor to keep my cholesterol low. I was just not the type of person one would consider at risk for heart disease. I used to be inactive, over-weight and careless about my diet in years gone by - so a lot of the damage was probably done during that period.

We read of runners who suddenly drop dead. I found out that the likely reason that I had no symptoms such as chest pain etc despite heavy exercising, is because the running caused collateral circulation to develop in my heart which camouflaged the impact of the blocked arteries. Someone who is less active would more than likely have had chest pain, etc with even minor exertion.

The purpose of this post, is to alert everyone that one should be very careful about even minor symptoms being indicative of a bigger problem. IT CAN SAVE YOUR LIFE. If I had not had this dull ache in my left arm - or if it had faded away in a few days - I'd never have had the tests done that resulted in the diagnosis of nearly blocked main arteries. Take care of your health - while you have it!

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WOW, anovaguy! Glad you're okay. You were very lucky!

Happy Holidays to you and your family!

    Bookmark   December 24, 2005 at 9:27AM
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Thanks goodness you are all right.

That ache in your arm is a classic symptom of heart disease/heart "attack" (myocardial infarction), other odd symptoms include an ache in your neck, jaw or shoulder on the left side, sometimes even a left side back ache. The usual sign is "crushing substernal chest pain", but it's not unusual to have an atypical presention like yours. The physicians did all recognize it, albeit they did seem to want to minimize it. I'm not sure why, unless they did not want to alarm you too much, but they sent you off for all the right tests. I'm glad you got them, and the outcome is good for you.

    Bookmark   December 24, 2005 at 9:33AM
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WOW. Thank you for sharing. I hope you're on the mend and have a healthy, prosperous, blessed new year.

    Bookmark   December 27, 2005 at 11:28PM
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Thanks to everyone for their good wishes.

I am on the mend; started working out slowly a couple of days ago but will not be able to get into the full swing of things until the blockage in my left artery is opened and stented - this is scheduled to take place on January 5.

momj47, you are right about an ache in the left arm being one of the warnings of something possibly being wrong with the heart. What confused matters in my case was that I was able to exercise vigorously despite the extent of the blockages without any shortness of breath or chest pain. I am told that it is because I probably had developed a lot of collateral circulation in my heart as a result of being active and exercising. Collateral circulation, as I understand it, are minor arteries that form providing additional blood to the heart. However if the major artery from which these collateral arteries branch gets blocked then the heart would still end up being starved off blood and a heart attack will occur.

I still cannot get over how close I came to something catastrophic happening. The one good thing is that several of my relatives and friends who are totally shocked by what happened to me have become a lot more alert to the need to go and get checked out and to generally take better care of themselves.

I hope that my story will motivate others on this forum to make sure that their friends and loved ones don't ignore warning signs.

A happy, healthful and prosperous new year to everyone.

    Bookmark   December 28, 2005 at 12:53PM
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anovaguy, congratulations on -- well, living to tell the story! I have a similar story but the disease would have been melanoma, the most aggressive form of skin cancer. Had I not taken my friend's pushy advice to go see a doctor for a physical after 3 years of not having gone (I wanted nothing to do with doctors after my baby's birth...long story) -- I went to a doctor she swore was intelligent and respectful. He turned out to be both of those; in addition, he found several suspicious moles, and two of them turned out to have been "early evolving melanoma", not merely dysplastic like the others, but already turning into melanoma which kills FAST. If I'd waited another year I could have not been there to wait the next year.

Now there are plenty of times when doctors miss things that prove to be catastrophic (including stories I heard later of doctors aggressively invalidating patients' concerns and *denying* referrals to have a mole checked out that later turned out to be cancer, including causing one person's father's death), but this was a time when one caught something.

So I would add to both our stories that although we got lucky, going and getting checked out isn't *necessarily* the be-all and end-all; sometimes it takes believing your own gut instincts and *pushing* for doctors to take you seriously when they would rather push you out the door.

    Bookmark   December 28, 2005 at 7:35PM
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flyleft, thanks for your comments. I did not have a chance to respond with so much going on.

You are so right about being proactive when it comes to medical issues and being willing and able to question and "push" medical professionals. We have to do this in our own best interest.

Three days ago, I went back to have an angioplasty perfomed in my left coronary artery (LAD) - the one that was 80% blocked - and a stent was placed in that artery as well. I had the procedure performed in a DC hospital that has one of the best heart programs. My wife - who happens to be a physician - found out that a new medication was being added to the ones that I was already taking after the first angioplasty. This one is a beta-blocker and so she asked the inteventional cardiologist who did the procedure why I needed this medication. He said that he did not prescribe it and perhaps the nurse practioner who had done my initial screening before the procedure had decided to prescribe it.

Now a beta-blocker can be a life-saver for many people but it also has side effects - like just about every medication does. Also, once one starts taking beta blockers, one frequently has to continue taking it just about forever. If one stops, one has to be weaned away from it - otherwise it can be dangerous and potentially fatal.

I declined the beta-blocker because my medical profile just does not require it. If my wife had not noticed it - and had the medical background to assess the need for it - I'd probably have ended up taking it just because a nurse practioner had made the medical judgement that I should be on it.

It is unfortunate but a sad reality that we cannot just accept medical judgements/evaluations at face value - although the natural inclination is to do so.

    Bookmark   January 9, 2006 at 10:31AM
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I'm glad you are okay, and that you heeded the advice of your friends and others. It's very sad the way some people are dismissed by these so-called 'professionals.' A family member passed away last year from a massive heart attack. He was being treated for GERD for a couple years. In April he almost passed out in church, then again he almost passed out at my home. I advised going to the ER but he called his doctor instead who in turn called in another prescription for stomach meds. In May the very same thing happened, until early June when he was vomitting, nauseated and very weak. He was dizzy and needed to rest quite a lot. Still the doctor didn't heed these signs and instead put him on anxiety medication thinking that perhaps he was anxious. At the urging of several family members, he went back to his doctor but again was dismissed and referred to a gastro specialist. Mind you, he had seen the specialist earlier in the year and nothing was wrong with his stomach or intestines. He saw the gastro specialist on the Friday before his death, and was told to take more stomach meds. This person had his heart attack on the Saturday after seeing these quacks! I have zero confidence in most doctor from my area, and my family is now in the process of a malpractice suit. This should NOT have happened!

Anyway, I will print your report and keep it safely. Heart disease apparently runs in my family because we have had three new 'young' people diagnosed with abnormalities which we would never have known had I not insisted on everyone being tested...

    Bookmark   January 9, 2006 at 1:23PM
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what's also sad is that many people just live w/ a dull ache in their arm, and end up dying of a heart attack.

I know I've been guilty of putting off medical attention, and of having that nearly be dangeorus at least once!

Pain is a warning sign--heed it. Fast.

    Bookmark   January 9, 2006 at 7:24PM
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mariposatraicionera, so sorry to hear about the tragic case of your relative. I can tell you from personal experience that finding responsive and expert medical assistance is not always easy even in the DC metro area. I am fortunate that since my wife is a physician who works at a major teaching hospital, she is able to utilize the resources of that center for consultations and/or treatment when it comes to family members. It was, in part, the insistence of physicians in the cardiology department at her medical center that provided the impetus to have a cardiac catherization done.

One other piece of information that may be of value to forum participants: for anyone who is ever faced with a situation requiring cardiac catherization - the two imperatives when it comes to such a procedure is that it is done by a cardiologist who does at least 75 of these procedures annually and it is done at a facility that has a by-pass program as well. The latter is important because there is an inherent risk that during angioplasty and stent placement, damage can be caused to an artery which would necessitate immediate by-pass surgery. If this should occur, time is of the essence and being at a facility that can perform by-pass surgery is a god-send.

Mine was done at a facility that does an average of 70 cardiac catherizations a day!! The interventional cardiologist who did mine does 6-8 daily! I now have to go to my regular cardiologist for follow-up visits since the interventional cardiologist does not do any "regular" cardiac care. It is amazing how specialized everything has become.

talley_sue_nyc, your comment that "many people just live w/ a dull ache in their arm, and end up dying of a heart attack" is probably true. In my case, the moment I told my wife about the ache she immediately scheduled an appointment with my internist for the very next day. I went and cancelled it telling her that she was over-reacting! So I know exactly what you mean.

    Bookmark   January 10, 2006 at 2:42PM
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mariposatraicionera, was your family member going to a gastro specialist for all of his symptoms? I say this gently, but really, after so many unsuccessful medications and advice, as well as misdiagnosing stomach problems, you would think that the patient would seek an evaluation from an internist, family practice doctor, or DO for a more rounded 'solution seeker' that would look at the bigger picture. Sometimes 'specialists' have a narrow scope. I've noticed it before dealing with health care providers.

    Bookmark   January 15, 2006 at 12:34AM
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