Heart Trouble -HCDT

        Chest pain.  Everyone, even a thick headed insurance company med cost manager, knows chest pain could be a heart attack.  So, I’m gonna start out by telling you about no chest pain first. The bug-a-boo of heart trouble is the subtlety of the clues.  If that wasn’t worrisome enough, at times there are no symptoms at all.  I went to a recent conference on the subject, and there were two big shot Tobacco Triangle U. cardiologists frettin’ over this issue as bad as a lowly country doc.

        One Sunday afternoon a few years back, I decided to go up the golf shop and see if anyone wanted to walk nine.  I ran into an old friend, Snookers.  I won’t tell him his full name for now.  For one, it would be a HIPAA violation, as his name is rather unique and would be identifying.  He gave me full permission to use it, but I have some other motivations to protect him for now.  You see, Snook was instrumental in unraveling a medical mystery a few years ago, and I promised I’d keep his role under wraps until the book comes out.  So for now, he has to go by Snook.

        Snook and I go back all the way to childhood.  In some ways, we had little in common.  My yearbook byline read like thousands of other well scrubbed southern kids.  Band 1,2,3,4.  Honor Society 1,2,3,4.  You know the routine.

        Snook didn’t even have his picture in the yearbook, ’cause he was out gambling on the golf course the day they took the photos.  If any of his accomplishments had been documented, I guess it would have simply stated, smoked cigarettes, gambled,  and of course, golf 1,2,3,4.     

        We played on the team together.  Snook was the star. I was the sixth man.  One time I shot 39 on the back nine for the team to hold onto the Conference title by a shot, but my most valuable contribution was to coach Snook to a C minus in History so he could keep his eligibility.  We won the State that year, though I only got in one match.  Snook shot 64 the last day.  No one came within a half dozen shots of him.

        So, fast forward some quarter century.  Me and Snook are still buddies.  When I walked into the golf shop, he was giving the pro some pointers on putting. 

        “Hey, Snook.  Wanna hoof nine?”

         “Sure Doc.”  Snook put out his cigarette, and retrieved his clubs.  “Play for a burger?”

        “No problem Snook.  Four a side?” 

        “Come on Doc, Three is all you get.  I’ve been watching your scores on the sheet.  You’re doing good here lately.  Four?  No way, partner.”

           “O.K. Snook. Three it is.”  I’d contributed many a cheeseburger to Snook’s monthly meal plan, and had no reason to suspect any different outcome today.  We set out with no anticipation of anything other than a walk in the park.

        It was one of those gorgeous spring days that leaves you hard pressed to believe God could frown on golf, at least if you didn’t use those blasted carts.  

        As usual, Snook jumped out to an early lead, but seemed a bit off his feed.  Still, I was closed out by number eight.  Eight is our number one handicap hole, and requires a solid drive of at least 240 yards to reach the top ot the hill, then a mid iron over water to a sloped green.  The hole is a tough one, and has shattered many a dream of a good front nine.  We both hit good drives that carried the hill. 

        When we crested the hill, I got my first clue something was wrong.  First of all, Snook only outdrove me twenty yards.  It was usually more like thirty.  More worrisome was the fact he stopped walking, and it wasn’t to light a cigarette, but to catch his breath.

        “You O.K. man?”

        “Yeah Doc.  I’m fine.” 

        He didn’t look fine.  “Honest to God, Snook, you’re gonna have to give up those cigarettes.”

        “I’ve cut way back, Doc.”  Right.  We’d been through this routine before.

        “When did you start having to stop on eight to catch your breath like that?”

        “Just in the last month.”  He paused to catch his breath.  “I’m just outta shape Bibey, that’s all.  I didn’t work out much this winter.”  

        “I dunno ’bout that Snook.”  I checked his pulse, and it was regular.  There were a few beads of sweat around his temples.  We waited a minute and they cleared up.  “Any chest pain, coughing up any blood?”  I went through all the standard questions.

        “Naw, Doc.  Hey, I’m fine.”  

        “Let me walk in and get you a cart.”

        “Hell no, Bibey.  I ain’t no invalid.”

         We played in, and Snook collected his cheeseburger.  I followed him out to the parking lot.  We sat on the tail gate of his truck and I watched him change his shoes.  He still seemed a little short of breath.  I thought through his family history.  His mom was elderly, but spry.  His Dad had run off when Snook was twelve.  I still remembered that trauma, and didn’t want to bring it up.  His sister was healthy.  He did not have any brothers.  “Anybody in your family with heart trouble Snook?”

        “Naw, Doc. Booze and womens our only problem.”  He seemed more like himself.

        “You getting short of breath every time you walk up number eight?”

        “Pretty much, yeah.”

         “Does it get better when you rest a spell?”

         “Sure.  Don’t it for you?”

          “Look, Snook.  I don’t want to alarm you, but this could be your heart, man.  You want to go over to the ER?”

        “HAIL no.”  As opposed to Snook, I am no gambler, and I did my best to convince him, but he was resolute.  No hospital today.

         “Well, at least let me line up some tests.”

        It took some powerful persuasion, but Snook did go for his treadmill.  As you might guess, he flunked it and wound up with bypass surgery. 

         The moral of the story.  First of all, “Doctor, know thy patient.”  I don’t think the finest cardiologist at Tobacco Triangle U.  coulda won Snook over unless he happened to be a scratch golfer, and there for the opportunity.

        Second, and for purposes of our more general discussion of how country doctors think, know the heart.  Once a patient had some odd symptoms in her chest, and kept telling me, “But it can’t be my heart.”

        I got frustrated and said, “Ma’am.  I don’t care if every time you sip cider through a straw your nose twitches and your left ear wiggles, it could be your heart.”  I regretted it as soon as I said it, ’cause no one wants a smart ^** for a doc.     

        I was exaggerating, but not by much.  Remember the Groopman hypothesis.  For acute illness, think of what might kill you first, and then work your way down the list.  If we are paranoid and turn out wrong, we can visit on the front porch of the nursing home someday and laugh at the war stories.

        Well, old long-winded Bibey has gone on too long again.  I’m gonna tell you more about heart in the next segment.  After that, we’ll talk some about how country doctors think about chronic illness over a few posts.  So far no one has gonged me back to bluegrass music, but we’ll get back to that in short order.

Dr. B          

Explore posts in the same categories: Advice- Five Cents, golf stories

12 Comments on “Heart Trouble -HCDT”

  1. mrschili Says:

    First of all, Doc, for all the griping you do about your insufficiency with the rules of English, you write a mean story. I want you to stop troubling yourself about how little you studied in school and just keep writing; your ease with language is telling in the lively and entertaining stories you relate.

    Second of all, I believe that God/Goddess/The Universe/The Higher Power, or whatever you want to name it, takes very good care of us, and that very little happens by accident. That you were looking for a golfing buddy that day and that Snook was there that day feels like a cosmic set-up to me, and I’m very glad that you were paying attention. The Universe might set up the conditions, but if we’re not looking around, we’ll miss the message.

    Last, about eleven or so years ago (I remember because I was mid-way through my first pregnancy), my beloved came home from work feeling rotten. He was worn out, pale and pasty, and jittery, all at the same time. I fussed over him (I tend to do that), but he insisted he was fine. We went to bed that night, where he proceeded to roll around and toss and turn and rub his left arm. I put my pregnant, hormonal foot down and took his ass to the ER, where they hooked him up to all manner of machines to make sure it wasn’t a heart attack. It wasn’t – they called it an “anxiety episode,” even though he said nothing happened to trigger it – and I’ve seen him experience a couple of similar, though not as severe, episodes since. I keep sending him to his yearly checkups and he’s in good shape – can you give me any hints for discerning between an anxiety attack and something potentially more serious? You know men, and mine’s no different – if it was an anxiety episode once, it’ll be an anxiety episode forever. I’m okay if it IS, but on the off chance that it ISN’T, I want to be paying attention if the Universe sets up the conditions, you know?

  2. drtombibey Says:

    mrschili,

    Thanks for your kind note. I tend towards being a worrier- especially in disciplines I have no formal training in. Of course, I’ve played the mandolin for years and can’t read a note of music. If I ever fully retire, I’m gonna take one of those music theory courses and figure out what the heck I’ve been doing all this time.

    Second, I agree with paragraph two 100%. Many times I’ve been lucky enough to be in the right place at the right time, and the Good Lord tugged on my heart strings to rethink my diagnosis. I was trained well, and I want to give each patient my best on every encounter, but to get through all these years with no major disaster is not from my own doing, but divine intervention.

    Regarding paragraph number three, here is my take on that. Just like I should not be too hard on myself for a relative lack of sophistication as to the road rules of English, you and your husband should not worry that the distinctions in this medical circumstance are difficult for you. Believe me, even seasoned pros worry over it and sometimes get burned. I’m gonna take a little time to compose my thoughts over the weekend and do a follow up post that addresses this question. In the meantime, if your gut says something is wrong, you have to listen to it. After all, very often that is exactly what ole Doc has done, and it has sustained me.

    Here is another secret to my survival in medicine. For a man, my intuition is reasonably good. It ain’t as good as women, though. I had a wonderful mom, and my fine wife about half raised me. I work with an office staff of twelve women. In particular, our lady Doc and the two R.N.s (they have worked with me a quarter century) were superb at combining medical education with intuition. This is not ingratiation, just simple fact. When their gut spoke to them on a subject, I never discounted it. It kept me out of trouble for years.

    Your question deserves a full response, so I’m gonna deviate from my planned writing schedule to do so on the next post. In the meantime, it’s supposed to snow today, so I’m gonna go rent some chick flicks for me and Ms. Marfar.

    Dr. B

  3. president of Neuse River fan club in Mississippi Says:

    Just want to say hello from the Mississippi based fan club. I detected a longing in the article for a little bluegrass gonging and thought this might get your G,D,A, and E strings satisfied.

    Enjoyed the story, it is so true about being able to have good ole’ common sense to take over when dealing with trying to find out what is wrong with someone. Boy, had Snook come a long way in his life. He seems like one of those self made men who never did much of nothing but always had all he needed. But this time he needed help. He did not cry out for it at first, say hole 8, but many a problems has been settled by sitting on the back of a tailgate( the secondary front porch in the south).

    We have just completed the semi-annual membership drive for adding members to the Neuse River fan club in Mississippi. I can report to you that we have increase our membership by 25 % with a recent addition. The convincing only took about 2 minutes to acquire a English school teacher named Mrs. Susan Lazy. She was floored to be accepted and she spoutted off some title she would like to have but I couldn’t understand her verbage. She is really an educated woman.

    Downloaded Neuse River music to my ipod the other day. I would like to think this is the only one downloaded west of the Tennesse River but I do not get to correspond with the other fan clubs much. Maybe we need to have a convention?

    Really big scare here last night, we almost had a real snow. Excitement was in the air. Kids down here do not get to see it much at all. My wife called the other day when a few flakes fell and said did you see it snowing. I replied that a single flake could not fall where I work and not be noticed.

    A little band news, we are practicing now in a beauty shop. I know bluegrass in a beauty shop. The sound is good and the bass player really enjoys it because we can adjust a chair where he can sit down and play. We are getting ready to play in February and we are working on a song that requires playing a pennywhistle.

    On a lesser note, just went over 100,000 miles on my 1989 truck. Why would I place this in my comments. I celebrated the achievement by stopping my truck when the odometer clicked and proceeded to add a “My Grass is Blue” sticker behind my driver side back glass. The truck had a little more get up and go for the rest of the day. The high lonsome sound has worked again to revive the things of the world. Take care and I will keep you posted on our members.

  4. drtombibey Says:

    For those of y’all who don’t know, Smitty, the President of the Neuse River fan club, Mississippi chapter, is a retired semi-pro baseball player, and now a school principal. (I seem to have a thing for educators.)

    He is a fine golfer, a mandolinist extraordinare, a connoisseur of peppered catfish cooked up in black skillets, a Faulkner and Jerry Clower fan, and an all around good guy who is dedicated to his chosen craft of educating high school students.

    Tell Ms. Lazy to live up to her name and not work so hard. She might enjoy mrschili’s blog, another English teacher trying to keep all her students in line. She is on my blogroll. Both of them are teachers with a commitment to excellence, and they might enjoy sharing strategies.

    Smitty recorded one of our N.C. gigs with one of those portable rigs like what Lomax used to get all those Smithsonian recordings off the ground. The thought of Neuse River on an IPOD is beyond a modern novelty. I wish I could tell you it was gonna be worth something someday!

    Keep the skillet good and greasy- will be down in the fall.

    Dr. B

  5. Ted Lehmann Says:

    Smitty (and doc B) – We crossed the Neuse Riiver on our way to the SUNNY South, but we haven’t found the sun yet. Would you be willing to accept an absentee membership for a Yankee member and his spouse. We’d pay our dues regular and not trash the meetings too bad. Maybe, one of these days, we can jam a bit. – Ted (and Irene)

  6. drtombibey Says:

    I’m glad to be able to introduce Smitty and the English Professor. From opposite ends of the Eastern Seaboard, but both very fine bluegrass gentlemen. What the h*** wuz it those ancestors fought about a hundred and half years ago anyway? If everybody had been playing bluegrass music the history books sure woulda been different.

    Dr. B

  7. bobleckridge Says:

    Great story Dr B. Yes you’re right the moral of the story is to know your patient. But there’s another moral too, and it’s coincidentally connected with my post yesterday about how human’s are wired to notice change. Because that’s what put you on the right track. You noticed changes. You noticed that he didn’t drive as far on that hole as usual, then you noticed he had to stop for breath. So, there are two elements here – knowing the patient, and noticing change.
    Of course, there’s a third element involved and that’s the way you interpreted the change and that’s what comes of your knowledge and experience.
    This is a great example of how doctors think! Thank you.
    Dr Bob

  8. pandemonic Says:

    Okay, this is very scary to me.

    My husband is a health nut. He works out an hour and a half a day, treadmill, weights, stationary bike. He’s 51 but trim, and except for the gray hair doesn’t look his age. Why, then can he not ascend a short flight of stairs without being winded? Why can’t he make a quick run to the car without the same happening?

    He’s a MAN, meaning he doesn’t believe in preventative medicine. He’ll just wait until it is unbearable. I finally made him go to the doctor, but his doctor said there was nothing wrong! (My husband lied to him about his mother having heart disease.) He did suggest a stress test. Now, if I can get him to go. I can’t!

    I think I will print this out and put it under his nose. Thank you for this post.

  9. drtombibey Says:

    Thanks Dr. Bob. Tis interesting- Dr. Bob is all the way over in Scotland. He is a scholar, and I am a country doc, yet his thought process is so dang similar to mine it is spooky. Y’all check out his blog. It is on my weblog with the byline “wisdom from across the pond.”

    Dr. B

  10. drtombibey Says:

    I hope he’ll let ‘em check it out Ms. Pandemonic. Odds are he is O.K., but the thing I have found over the years is I have to worry about ten patients to find the one I really need to be concerned about.

    Dr. B

  11. Itenueroort Says:

    drtombibey.wordpress.com – cool sitename man)))
    ————————
    sponsor: http://potet.ru/

  12. drtombibey Says:

    Itenueroot,

    Hey thanks for the visit. Hope you’ll come back.

    Dr. B


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