Tuesday, October 9, 2012

Case History : Young Man With An Attitude...

Ananda s/o Arumugam [ not his real name , of course ] was only 32 when he had his 'heart attack' some six years back. I could still remember the medical officer on duty at ER calling me at 3 AM  at home saying that he had a young Indian chap who was wokened up  an hour earlier with gripping  chest pain radiating to his jaw and back in between his shoulders associated with dripping cold sweat. 
I told the ER doctor to summon our emergency cath lab team for a 'primary infarct angioplasty and stenting' rightaway. Time is MUSCLE LOSS in this situation. 

 http://drnikisahak.blogspot.com/2012/05/procedures-in-medicine-coronary.html ,    
 http://www.youtube.com/watch?v=TS0Je1m9Q8A&feature=related
   
One hour later , with two, cobalt-chromium, drug eluting stents in his initially occluded Left Anterior Descending artery [ I always fondly called this, the' Federal Highway'] and  one long  38 mm stent in his Right Coronary artery, Ananda was breathing better in CCU. He had a full blown massive anterior infarct just one half hour in the making and TIME IS OF THE ESSENSE. His saving grace was that he arrived early, otherwise , there would have been more  'unsalvageable ' muscle loss leading to impaired LV function, weeks,months and years 'down the lane '. Discharged well on the 4th hospital day and given one full month MC since he needed a lot of rest for recuperation : he was a 'two-tonne'  small time lorry driver to a small ' Chinaman ' outfit. Despite this he had the right attitude. He took the right health insurance cover despite his meagre income.

On the first outpatient follow up Ananda dropped me a bombshell: Ah Kow, his boss, has asked him to stop work, on day one when he reported back for duty, since he thought Ananda would be a liability in the long run. With cash running low, three hungry young mouths and a wife to feed, and no decent job on sight in the near future Ananda requested me to refer him to Serdang Hospital for further outpatient follow up. I consented.

" Ananda, don't despair. Go back and do a lot of thinking . This is an opportunity for young man like you to 'fly'.... God is merciful and compassionate. He will look after people like you, insyaallah !....etc etc and etc "

Today, 6 years later, Ananda suddenly showed up at my busy outpatient clinic for a check up on a niggling 'chest pain '. I was happy to see him again, looking well and prosperous........
Stress test OK, Hbaic not bad meaning his diabetic control is almost optimal, Echo showed normal LV function.....Great news.
" Ananda, you are fine..your ECG does not not indicate any evidence of 'heart scarring'  at all and your echo showed excellent  heart muscle contraction. It is as if you never had that heart attack six years back. Disregard this pain, it is just muscular ", I retorted , reassuring him. " What have you been doing this six years since your dismissal?"

" Doc, I took your advise...now I have 20 people working for me collecting plastic and bottles..I have three lorries and I pay 30k a month to my people in salaries ".

It is 'basic' people like Ananda that keep me going and plodding on...he made my day today.

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