Callin all Doc's, even PhD's

[Stormtruck2]

A very close friend of mine went to the ER last Tuesday night with what some thought was a heart attack.  At about 6 pm he was doing great.  Fueled his vehicle, and got back on the interstate. Suddenly started sweating profusely, chest pain, felt like a steel rod being driven into his chest through his shoulder blades. Blurred vision, shortness of breath, and pain in to the arms.  Symptoms lasted about 45 minutes. At hospital his BP was 102/60, HR 83, Troponin number was 2. Stress test Wednesday was reported as normal. Now some are telling him it could have been an anxiety attack.  He is not a man who believed in AA.  Said there was nothing of any import on his mind when the pain began.  What IS an anxiety attack??  Can AA hit out of the blue like that??  What triggers them?  Once you've had one will they become recurrent, and with steady frequency, or increasing frequency??  He knows nothing about them, neither do I.  What do the medical and psychological experts have to say about this?

[keithl]

Thinking that you may be having a heart attack can actually cause an anxiety/panic attack. I't could be something like that, he felt something: bad heart burn, indigestion, an allergy attack of some kind, and that triggered his anxiety attack.  Pain in the arms doesn't sound like it fits as a symptom, but fearing that something serious is wrong can trigger an anxiety/panic attack.

A very close friend of mine went to the ER last Tuesday night with what some thought was a heart attack.  At about 6 pm he was doing great.  Fueled his vehicle, and got back on the interstate. Suddenly started sweating profusely, chest pain, felt like a steel rod being driven into his chest through his shoulder blades. Blurred vision, shortness of breath, and pain in to the arms.  Symptoms lasted about 45 minutes. At hospital his BP was 102/60, HR 83. Stress test Wednesday was reported as normal. Now some are telling him it could have been an anxiety attack.  He is not a man who believed in AA.  Said there was nothing of any import on his mind when the pain began.  What IS an anxiety attack??  Can AA hit out of the blue like that??  What triggers them?  Once you've had one will they become recurrent, and with steady frequency, or increasing frequency??  He knows nothing about them, neither do I.  What do the medical and psychological experts have to say about this??

[Bill Havins]

Matt,

Only a fool would second-guess the health care people who initially evaluated your friend and later interpreted the stress test.  They had the cumulative diagnostic data.  All Wild Guzzi has is a ouija board, some red suspenders, some corn-cob pipes, and rubber chickens.

Anxiety attacks are funny things.  But I did not "read" anxiety attack in the symptoms as you wrote them.  I can explain, but, suffice it to say it would take too long.

I hope your friend is following up with a very competent cardiologist.  Over the years I had occasion to see a number of people who had had heart attacks after they had been to an ER with heart attack-like symptoms and sent home with a "don't know" diagnosis.

A heart attack is just like an occlusive stroke in the brain, only it happens in the heart.  Many strokes are preceded by episodes of transient ischemic attacks (TIAs).  The TIAs cause stroke-like symptoms that remit rather quickly.  Eventually, if untreated, a "full-blown" stroke can develop.

Now, take the TIA example, above, and think heart.  Get the picture?  Heart attack symptoms are nothing to screw around about, especially if the individual has predisposing factors (e.g., diabetes, smoker, age, personal/family history, high blood pressure, etc.).

And then there is acid reflux - that's a mind-blower when you see how that can screw with a person's head ("What do you mean it wasn't a heart attack?  What?  Just take Tums?  You're kidding!").

Good luck to your friend!

Bill

[stomatomoto]

Ohhhhhhh dude, I know of this far to well. I'm not a doctor, but I've endured this bullshit since 2009. They are the worst, especially when you get into panic attack country. I also am not a man who believed in stuff like anxiety or panic like that, and always thought I had a good handle on life and mental state. Does. Not. Matter.

There's two main sources for this kind of thing, physiological and psychological. I had the misfortune of discovering the physiological variety, which is what really messed with me because they came literally out of nowhere. Mind you when they started in 2009, I was a 25-year-old male ok-ish shape. I was in Brasil at the time and was using my inhaler more frequently than normal (asthmatic, air quality in Sao Paulo is atrocious), and I was under a lot of stress and abusing the hell out of caffeine (Brasilian coffee is like Italian coffee, potent and only to be had in small doses). Bam, adrenal fatigue, led to full-on panic attacks, was certain I was dying, nothing else like it in my life.

The psychological variety is more insidious, because a lot of people will have no idea that the things that are stressing them out are slowly causing these chemical buildups and changing your nervous system responses to things. Eventually it will also affect things like the adrenal glands.

Basically, the main thing you do to deal with them and basically prove that they are in fact panic attacks and not some other nefarious medical issue that is evanescent and difficult to diagnose is to get a prescription for something like lorazepam or alprazolam, which you only take when one is coming on. If the symptoms go away, basically that's the evidence you need that it's anxiety/panic attack. Then, it's learning to live with it/helping the body/mind recuperate.

[LowRyter]

maybe a virus?

The wife and I both got very sick this week.  Lasted about 6 hours and took two days to recover.  More than a stomach flu.  Got dizzy, and couldn't find the strength to move for three hours and sweated so badly my clothes were drenched the next day,  terrible dry heaves.  Came on extremely fast.  I thought I was going to die.  I am still sore from it.  She was got it a couple days before I did.  No idea where it came from.

[mrrick]

I'm not an expert, but I worked in the same office with a guy who had anxiety attacks.  He had only one of the symptoms you describe: shortness of breath.  He would hyper-ventilate in response until he keeled over.  And it was no mystery to him (or the rest of us) why he was having them; he was being placed under an enormously stressful load of responsibility which he could not control. 
Your friend's condition doesn't sound like AA to me at all. In fact, it sounds much more serious.  Years ago, I took myself to the hospital with a similar episode that never repeated, and during my visit, they told me that if I had had a heart attack, a simple blood test wd have confirmed it. 
I have learned only a paltry few things in this life, and one of them is that you must now be your own health advocate.  With very few exceptions, the days of being able to trust your PCP completely to act only in your interest are long gone.  Mis-diagnosis is common.

[oldbike54]

 It's all in his head Matt  Just kidding of course , tell him to keep a close I on things , and if he gets down to my part of the country , tell him to look me up .

  Dusty

[AJ Huff]

Had a similar experience once while out to dinner. My wife and her mega smart oncologist friend thought I was having a stroke. Tests all turned out fine. Around the same time I started experiencing migraines for the first time in my life. Horrible. Everything cleared in about six weeks. After MRIs, cat scans, stress tests, EKGs, the best they could come up with was a very slight indication of viral meningitis. <shrug>

-AJ

[Scud]

You got me with the subject line. Too funny.

I am not a medical doctor; my PhD is in Human and Organizational Systems, which includes a fair amount of psychology. I agree with other posts regarding the importance of listening to the medical professionals. I'll just add to the psychological view a bit.

A lot of people talk about the mind-body connection as though they are two separate things. However, they really are inextricably intertwined (for a lovely, short read, see "Descartes' Error" by Antonio Damasio). There is no psychology without biology. Sometimes people can suppress, or shield from awareness, the things they are worried about. Unconscious anxiety can manifest itself in physical symptoms. It might be worth talking with a professional therapist, just to explore whether this might be part of the story.

Now, we've all seen the one-liner:  "You never see a motorcycle outside a psychologist's office, unless it belongs to the psychologist." While motorcycling is undeniably therapeutic (and I keep trying to overdose), it really is no substitute for a relationship with a skilled counselor.

[will-t]

That sure sounds like a gallbladder to me, I went threw all the heart tests because of the pain ended up being the gallbladder .

[wrbix]

A diagnosis one would hate to miss with this symptom complex would be a thoracic aortic aneurysm dissection which can progress in fits and starts. Certainly more common in hypertensives but not unheard of as a genetic tendency. Cardiologist might suggest appropriate imaging procedure to rule this out.

[Rough Edge racing]

 I have anxiety attacks from time to time. The attacks appeared to be triggered by reading or hearing about  so and so got a terminal disease or died from it. The first one about 7 years ago after a guy I know was found to have a body full of cancer and died in five months...
  My symptoms are not readily apparent to others ...but my mind thinks crazy shit....I have Xanax but only take one as a last resort.
 Working on a bike or taking a ride always helps me....
 I am not religious in the conventional sense but always been spiritual....Thinki ng beyond my body can be calming...The end of the tunnel of life is getting closer and I prefer it to be lit rather than dark...

[JoeW]

I had an anxiety attack that sounds very similar to your friends, woke up for work, made it to the bathroom, I had pain in my left arm, cold sweat, so dizzy that I crawled back to bed. My wife took me to the ER all tests including an echo stress and wearing a heart monitor for 24 hours showed no evidence of a heart attack. My yearly physical with EKG shows all is still good. I know the source of my stress back then, and I've dealt with it. Your friend may need to do the same.

[father guzzi obrian]

If your friend has been fully checked out and anxiety is the issue, not something underlying, there are simple treatments for it.  As I hit 60 years old, I would occasionally get panic attacks, first time in my life, and I am certainly under less stress. Saw my GP, sent me to shrink, shrink said after interviewing me that I may have a family history of this as the years increase.  Gave me script for low dose Ativan, to take only when I have an attack which is rarely, did the deal.  I don't like taking pills, but I find just having them in my brief case stops most attacks anyway as I have a solution just a few minutes away
Best wishes to your friend and hope it is not something serious

[cruzziguzzi]

The very stealth nature of AAs is often further hidden and caused by unacknowledged stressors.

Paradoxically, not acknowledging stressors and their particular weight can increase the AA frequencies and intensities when added to "this can't be an A-A, must be a H-A!"

One thing my experience will note is that if the symptoms are AA related... the near-requisite follow up "Stress-Test" has often led to a self-fulfilling-prophecy manifested in heart related issues within 96 hours of being taken.

I loath the way the AMA wields the "stress test" revenue generator.

Todd.

[Rich A]

I was alone in the car this past Sunday when I felt some pain radiating out from above my heart. I thought it was an insect, scorpion, or spider bite, but it felt unusual, I didn't see anything, and I didn't remember being bitten. So, I'm driving along thinking, "Maybe this is the beginning of a heart attack."

Turns out it was a bite of some kind, but that certainly was unsettling.

Rich A

[Sasquatch Jim]

  Did anyone check to see if there really was a steel rod penetrating between his shoulder blades?

 Sometimes it's the simple stuff.

[wrbix]

I loath the way the AMA wields the "stress test" revenue generator.

Todd.

Ah jeez, not again - docs just out to generate revenue.
Any other conspiracy theories you want to trot out?

[Stormtruck2]

  Did anyone check to see if there really was a steel rod penetrating between his shoulder blades?

 Sometimes it's the simple stuff.

Yes that was checked.  All the steel, actually titanium rods in his body were in their proper positions, in his lower back. 

[cruzziguzzi]

Ah jeez, not again - docs just out to generate revenue.
Any other conspiracy theories you want to trot out?

Conspiracy theories? Not just yet.

Not a conspiracy - merely an over applied, industry wide practice endangering a great many people that I have known. And not the only one. But conspiracy theory? To quote: "Ah jeez, not again"? That's a wonderfully convenient argument to use not unlike "hater" or any given - ****ist. One is allowed to respond, ad hominem and supposedly take the "high ground" while in fact undermining one's self.


Todd.

[stomatomoto]

Conspiracy theories? Not just yet.

Not a conspiracy - merely an over applied, industry wide practice endangering a great many people that I have known. And not the only one. But conspiracy theory? To quote: "Ah jeez, not again"? That's a wonderfully convenient argument to use not unlike "hater" or any given - ****ist. One is allowed to respond, ad hominem and supposedly take the "high ground" while in fact undermining one's self.


Todd.

Upvote to Todd here, you'd have to be some other kind of naïve to think profit wasn't a motivator in the medical industry in the US. The flip side of that, though, is that we ended up with one of the most advanced medical industries in the world. This one of those "the evil of mankind but also look at all the good that's been done" situations.

[canuguzzi]

Twice bow I thought I was having a stroke, all tests showed zip. MRI, CT, blood, brain scans you name it. Went through a two day workup, Nada.

Doc asked me if I ever thought about dying, my reply "I ride a motorcycle", no kidding.

The big deal now is that having been told by no less than teams of experts that there was nothing to it, if something does happen, how do I know? My solution, going in anyway.

[jackson]

I am a big fan of doctors and the medical community.  Were it not for the learned, skilled people that have treated me since 2002 (first heart attack), I would have been dead a long time ago.  Three heart attacks, a quad by-pass, eight stents, several strokes and a pacemaker (and other stuff) would have put many a person in their grave a few years ago but doctors keep patching me up and I keep on ticking like the battery bunny in the commercials.  I do NOT begrudge one nickel that I've paid to the medical community.  These people go to school for years to learn their trade and then they continue to learn and stay on top of the latest techniques.  That takes a lot of dedication and too many people take them & their skills for granted.  Not me. I'd rather give my money to doctors and the medical community than squander it on politicians and religious organizations.  Just my two cents.

[Lannis]

I am a big fan of doctors and the medical community.  Were it not for the learned, skilled people that have treated me since 2002 (first heart attack), I would have been dead a long time ago.  Three heart attacks, a quad by-pass, eight stents, several strokes and a pacemaker (and other stuff) would have put many a person in their grave a few years ago but doctors keep patching me up and I keep on ticking like the battery bunny in the commercials.  I do NOT begrudge one nickel that I've paid to the medical community.  These people go to school for years to learn their trade and then they continue to learn and stay on top of the latest techniques.  That takes a lot of dedication and too many people take them & their skills for granted.  Not me. I'd rather give my money to doctors and the medical community than squander it on politicians and religious organizations.  Just my two cents.

Me too.

As I've mentioned before, I do NOT understand why anyone who is the normal age that you would be worrying about these things DOESN'T ALREADY HAVE A GOOD DOCTOR!    You know your Guzzi mechanic or parts supplier, you know the guy who fixes your Toyota .... WHY HAVEN'T YOU SOUGHT OUT A GOOD DOCTOR?

They're out there; there's lots of them.   WAY more good ones than bad ones.    Highly trained, motivated people who can get up to date on the state of your health and your blood chemistry, who know your habits, who know what you need, a guy (or gal) you can communicate with and who cares about your well-being.   People who can see you and test you every six months (me) or every year (most people) and do a gut check (sort of) and see if anything is going pear-shaped, including you.

But it seems like some sort of emergency Chinese fire drill anytime a 60-year-old man around here has something go wrong with him.   He's got NO doctor that knows anything about him, so he picks the first guy to get to the emergency room and then pisses and moans about him, and about how the guy just wants his money and doesn't know anything, and starts asking his buddies and surfing the Internet about what he should do to see if he needs a suprapubic cystotomy or something else he knows NOTHING about but is a matter of life and death.

I live in a rural area 20 miles from a hospital and I've got TWO good doctors, guys who know all about me and hardly even have to look at their notes to know whether my PSA or A1C or HDL or anything else is improving or getting worse, and can refer me to surgeons or podiatrists or other specialists who can fix something going wrong before it gets bad.  ANYBODY can do this if they're motivated - you'd think that possibly dying if you don't know someone who can fix you would be motivation enough, but apparently not ..... ?

Lannis

[Rich A]

I am a big fan of doctors and the medical community...That takes a lot of dedication and too many people take them & their skills for granted.  Not me. I'd rather give my money to doctors and the medical community than squander it on politicians and religious organizations.  Just my two cents.

When my father was in the hospital after a heart attack, I remember walking thru the parking lot and thinking, "Those doctors deserve to be driving BMWs and Mercedes, having time off for a few rounds of golf, etc." I couldn't handle the pressure and level of stress a surgeon lives with day in and day out.

Rich A

[Wayne Orwig]

I'm not a Doc, and I didn't even sleep in a Holiday Inn, or whatever that commercial says......

But I was just in the hospital to visit a long time friend. Over the past 10 years, he has had multiple stints inserted. This time, the stints are blocking the stints, so it is bypass time.
He said that over the years, ever time he has the chest pains, they put him through a stress test. It never ever has revealed anything. Ever. So each time, they have to follow with other tests to reveal the blockage. From his description, they run a catheter through him to see it.
For him, the stress test reveals nothing, but they always try it first. It does make a few Mercedes payments for the people doing the testing. 
 

[Wayne Orwig]

I live in a rural area 20 miles from a hospital and I've got TWO good doctors,

Luck you.
My wife and I have been looking for one that is good for a few decades. Our last mediocre personal care physician retired early, so we were on the move again. I think we found a good one this time, or at least we THINK we have. Time will tell, but at least this latest one talks to us.
In the mean time, I have an issue that is getting me moved from specialist to specialist. It is a slow and VERY expensive process. And there is little information to help me be informed about the quality of the next specialist. You take your chances, and it isn't cheap.
 

[stomatomoto]

Let's clear something up right now: I'm definitely pro-doctor as well, the MRI I got this morning should underscore that. But let's not fling around the red herring of this being about whether or not we're "pro doctors" or not; profit as a motivation in medical science and care has a clearly dubious record. This topic is waaaayyyy bigger than the context in this thread though; I just needed to grease that rusty joint before it locked up, lel.

[cruzziguzzi]

Let's clear something up right now: I'm definitely pro-doctor as well, the MRI I got this morning should underscore that. But let's not fling around the red herring of this being about whether or not we're "pro doctors" or not; profit as a motivation in medical science and care has a clearly dubious record. This topic is waaaayyyy bigger than the context in this thread though; I just needed to grease that rusty joint before it locked up, lel.

It's taken on a bit of a Kafkaesque/words in other's mouths tack.

I don't recall anyone saying anything to elicit this somewhat ad hominem "defense" of physicians.

Were the gushing testimonials tracked back to post number 14, I would note that no attack was made on physicians but rather the somewhat dangerous practice of willy-nilly assignment of stress tests to ultimately fragile individuals. Whether that is motivated by billing-drive is solely in the heart of the individual physicians as should be accountability.

Todd.

[r3bauer]

Hows your friend now?