Sunday, February 10, 2013

Case History : Two Contrasting Cases...A Day in the Clinic

Yesterday I had two contrasting 'cases' in one morning at my outpatient clinic session.

Case 1 :

Young Malay man, hardly 30, accountant, just married with one child.
Had a major ' anterior myocardial infarct ' [ heart attack ] about a year ago and seen early in Kajang District Hospital. Duly given streptokinase [ agent that 'breaks blood clots', we call them 'thombolytics' ]by admitting physician. The right thing to do in a small hospital where primary infarct angioplasty needing a cardiac catheter lab with 24 hours cardiological specialist coverage is not available. Was referred to me three days later when an angiogram was done and balloon angioplasty and stenting to culprit artery instituted. A late damage limitation exercise I would say, as 'primary infarct angioplasty and stenting' at the earliest possible time is the gold standard therapy for the last 15 years now, without doubt. He has missed the boat, but better late than never. Left ventricular ejection fraction [ LVEF ] then was 40 %. Not great when you are just turning 30, normal being between 55 to 80 %. There was a lot of muscle loss at the point of the 'infarct'.

Yesterday was a disturbing finding. His follow up echo showed only LVEF was only 25 %.
?? Progression of disease despite his lipid and cholesterol already on the 'floor' and ideally very low.
?? Occluded stent, despite no chest pain and normal stress ECG.
Will bring him in and reangio  after these festive CNY season to reassess and get a new coronary road map...kiv stenting, I made a mental note.
Whatever the finding, the news is not great......
The chance this nice young man celebrating his 55th birthday, 'on statistical ' ground, is automatic thought.
Unless 'heart transplantation' become epidemic and organ donation acceptable then [ highly unlikely ],
Or 'Yamaha heart' or 'Suzuki heart' is easily accessible in 2030??..most unlikely.
Got to work on his 'soul'...he look like a good practising, committed Muslim  and can take the 'bad' news....have to be extremely careful here...not many people wants to know the score....just another mental note. [ kiv]

Case 2 :

Abdal Hakim Murab [ not his real name of course ], 65,a Norwegian sailor, a convert par excellence, domiciled in JB. I am seeing his wife regularly in outpatient for a ' moderately leaking mitral valve'.
Hakim had a full  annual employment medical check up in Sinapo and the Sinapo doctor wrote "adviced not to exert himself". This small advisory note in his report, according to Hakim, is going to affect his employability in Norway where he works as chief steward on a ' mining ocean going ship' off  the North Sea, a very well paid job with great vacation periods in between. He plans to work till 72.

I know Hakim very well. He does weight training in the gym four times a week, followed by cardio, the whole session lasting two solid hours. Three times a week he does 'interval training' on the beach or runs up a small hill at the back of his house in JB. OMG, this man embarassed me. I thought my one kilometer swim at lunch time , three time a week is already exemplary!

Hakim is 172cm tall and weighs 65 kg, ideal body weight. I have a simple formulla for calculating ideal body weight. Height in centimetres minus 100. That is your ideal body weight! Anything less is an added bonus.
He is almost all muscles.

I did a threadmill on him that day. He completed Bruce Protocol stage 5, at a workload of 15.5 MET!
A year earlier I did threadmill tests for all the Sime Darby footballers aged between 20 and 25 and none of them could complete stage 5.

" Hakim, I have bad news for your wife! You are a 64 year old man in a 16 year old body...."

Exercise , to me, is the perfect elixir of youth.

Previous articles of similar vein:

1. 'You Don't Have To Be A Marathoner'

2. 'Letter To Rifqi'

3. 'Mixing The Profane & The Sublime'

4. 'Some Random Thots On Death'

5. 'Unto HIM is the Journeying'

6. 'Longevity: A Muslim's Perspective'

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