Monday, September 14, 2009

If it's not a heart attack, why does it hurt so much?

I had one of those experiences that really freaks you out: while walking with a group of birders, I started experiencing chest pain. It felt like there was a fist inside my chest, and it was squeezing my insides. My first thought wasn’t, “Oh my god I’m having a heart attack. I’m going to die.” It wasn’t, “I’m too young to die. I don’t want to die.” It was “I can’t die of a heart attack: I have two small children who I need to raise.”

I decided a while ago that no matter what, I need to live until my daughter—the youngest of the two—graduates from college, with a masters degree, or higher. That means that I need to live another 25 years. The federal government already decided that I’m going to live that long: they’re going to make 70 the retirement age for people of my generation. They’re guessing that as people live longer, there will be too many of us who refuse to die of old age & disease while collecting Social Security, so they need to make us work 5 years longer than the current generation of no-good, lazy Baby Boomers, to keep the government from going bankrupt.

Well, I’m glad the government thinks I’m gonna live a long time, because like Woody Allen, I’m a hypochondriac who is disappointed every time a doctor tells me, “All of your tests are normal.”

Back to my alleged heart attack. It happened again two days later, while I was working in my part-time, weekend job. Some idiot decided that the weekend crew were overdue for a fire drill. Can you believe that? It’s Sunday night, 10:00 p.m., and the fire alarms go off in the hospital. Strobe lights are flashing, all of the doors automatically close, and the hospital operator (a girl who is very cute, and far too in love with herself) announces a fire in a patient’s room literally at the far end of the hospital. Hey, it’s Sunday night. The last thing I expect is that this is a drill. Taking it seriously, I grab a fire extinguisher of the wall bracket, and run down the long, main hall to the other end of the building. Huffing and puffing, I find Olga, the Russian midget who owns the security guard contracting company (if the hospital ever gets attacked by a marauding mob of Chihuahuas, we’ll be safe), in street clothes, with a clipboard in her hands, and a stern look on her face.

I realize that:
1) There is no fire, and
2) I am having chest pain, again, and it’s worse than Friday morning.

With all of my years in emergency medicine, I find something suspicious in all of this:
1) I only get this chest pain when I eat, and then exert myself,
2) I think I only get the chest pain when carrying something heavy (tripods, spotting scopes, fire extinguishers), and
3) Other times when I exert myself, I don’t get the chest pain
4) I am still alive.

So Monday morning, I get off the train at Cal State LA, and run up the 4 flights of stairs to the street, wearing my backpack full of stuff (laptop, bird book, binoculars, thermos, lunch, two cell phones, etc). When I get to the bus stop, I am huffing and puffing, as usual, but there is no chest pain.
Well, I should still go to a doctor.
Monday night, the chest pain is so intense, that I’m thinking about calling 911, or going to the hospital (hey, if I’m having a heart attack, I don’t wanna play around with this). So I finally went to the local urgent care on Tuesday, where I met a nice young doctor who never made eye contact with me the whole time: they are so obsessed with electronic records keeping now, that while talking with me, he kept typing on his laptop that generated a report of my visit. It was like going to confessional, with the priest on the other side of the curtain.

So he says, “I don’t think it’s your heart.” I also had my doubts, too, but other than the EKG, he never ordered a blood draw for cardiac enzymes (if you have a heart attack, the dead heart muscle cells release enzymes into your bloodstream that are used as proof that you’ve recently had a heart attack). He also didn’t order a chest x-ray, which I thought was weird, because I was suspecting that maybe I’ve got a hiatal hernia (your stomach pokes up through the diaphragm, partially occupying your chest cavity, instead of staying in your abdomen, where it’s supposed to), and that usually shows up nicely on a chest x-ray.

So he tells me, “I can’t give you a referral to a cardiologist; your own doctor has to do that.” Great. (By the way, I already tried to see my doctor before going to urgent care, but she was out of town).

So now I went to my own doctor a few days later, and got a referral to a cardiologist. On the phone with the cardiologist’s office I am told that my first visit will be only a consult, and I will not be allowed to do a stress treadmill test. Great. How much time am I going to miss from work?

On the morning of the cardiology appointment, I notice on the referral that my doctor filled out, that she has written “cardiac enzymes normal” EXCUSE ME???? They never did a blood draw at the urgent care, so how could the test that I never (but should have!) had be normal? Unbelievable. You need to stay on top of your doctor, and what goes into your medical records.

So I get to the cardiologist’s office, where they do another resting EKG (I hate getting EKGs: I have a hairy chest, and it hurts like a mother-effer when they rip the tabs off my body). That’s normal, and he comes in, and asks me a bunch of questions, and pokes, prods, and listens all over. Then he says, “Would you like to just go ahead, and do the treadmill test, today?”
A man after my own heart (no pun intended—I think)

I kicked ass on the treadmill test. He was amazed that a fat guy like me went one minute past the maximum for my age, height, weight, etc.

By the way, my cholesterol is totally normal. Eat your heart out, Robb Myrtle.

So, whatever the hell is causing this chest pain (I had it again this past weekend, while in the forest, Sunday night, setting up our camp site, and it kept me awake, while Lisa and the kids snored next to me, inside the tent), it’s not my heart. Maybe it was that soup she cooked next to the campfire. Maybe it was the process of hauling all of our stuff out of the car, over to the tent.

Who knows.

I don’t appreciate this heart attack scare. Both of my parents are dead. I don’t even remember my father, since I was less than 2 years old when he died of a brain tumor. My mom had a massive stroke when she was 65, and spent the next 7 years slowly dying, in slow increments. Her brother has had several heart attacks (according to the cardiologist, the fact that he had them in his 70s, and not his 40s or 50s is a great sign). I’m really obsessed with living long enough to provide my two children with the opportunity to establish themselves in life, where they can buy their own houses, and not have to worry about money all the time, like we do.

I should have lunch with the guy who had a heart attack at USC last May. He had the good taste to drop unconscious in front of me—Mr Works in the E.R. and Has a CPR Card. Of all the people in USC that could have been near him when he had a heart attack, he chose me. Good man. Maybe he’ll slap some sense into me.


Jim said...

Have you investigated the possibility of GERD?

Thomas Geza Miko said...

Hi Jim,
My Dr prescribed Prilosec. BY the way, you were right: the urgent care doc should have ordered a chest x-ray, to look for aortic aneurysm.