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September 22, 2005

Affairs of the Heart
Posted by Jim Macdonald at 11:59 AM * 73 comments

Last night I spent four hours up in Pittsburg, New Hampshire, helping teach CPR at a PAD (public access defibrillation) class. There’s a program nationwide for putting AEDs (Automatic External Defibrillators) into public places. These AEDs are being provided free, through the state, and up to ten people at each location are getting free CPR/AED training. We had folks from a truck stop, from the local Rite-Aid drugstore, from the Bridge Street Gym, and others present. The state has written legislation taking liability on itself for these AEDs, relieving businesses of the worry of getting themselves sued for any use of this equipment that they’ve got. There’s more legislation saying that anyone at all can use one.

The specific AED that we were handing out was a Zoll AED+Plus . These normally go for $1,500, but the state got ‘em as a group purchase for $750. The local ambulance squad put together little kits to put in the carrying case with each AED: One pair trauma shears, two pairs gloves (one pair nitrile, one pair vinyl), one CPR mask, one disposable razor, one washcloth, two alcohol wipes, all in a zip-lock Baggie.

(Formerly — way back in the 1970s — external defibrillation was done by physicians only. Then it became a paramedic-level intervention. Then it moved to specially-trained EMTs, the EMT-D. Then any EMT. Now any Joe or Jane on the street can do it. A big part of that is the advance in computer tech, so that the machine reads the heart rhythm rather than a skilled human operator.)

Around 250,000 people in the United States die of Sudden Cardiac Arrest (SCA) every year. That’s the guy walking down the street who just keels over. An AED right there on scene is a great thing, because at that moment you have 4-6 minutes to get that heart going again. CPR will extend that time, but it’s just putting the patient into a holding pattern. The electricity is what’s going to fix things.

But, SCA isn’t all, or even most, heart attacks.

Dearly beloved, let us pause to consider ataque del corazón.

To be exact, attacks of the heart that we middle-aged folks should beware of.

If you, or anyone around you, has any of the following signs and symptoms:

Chest pain
This can be anything from tightness, fullness, weight, or squeezing to Oh-Ghod-It-Hurts major pain. Often sub-sternal, but anywhere in the upper body counts. Especially if it radiates to an arm, to the jaw, or to the back.

Shortness of breath/difficulty breathing
Turning pale, blue, grey, or mottled counts.

Chest discomfort that starts with exercise and gets better with rest
Especially if the discomfort lasts longer than five minutes.

Cold Sweat
Big ol’ beads of moisture when it isn’t hot out.

Nausea, vomiting
When beer wasn’t even involved.

Lightheadedness
Dizziness. Like it says.

Feeling of Doom
You’ll know it when you have it.

Chest pain all by itself, or two or more of the others … dude, you could be having the Big One.

What to do
Sit down, chew four baby aspirin, and call 9-1-1. If it isn’t really a heart attack — the EMTs don’t mind false alarms. Really. (Concerning that aspirin: The only contraindication for aspirin is a documented allergy of the “I blow up like a balloon, turn blue, and die” variety. “Funny tummy” isn’t a good enough reason to avoid it. A diagnosed ulcer isn’t a good enough reason to avoid it. Just do it. And, for that matter, taking an 81 mg aspirin every day as a preventative measure isn’t a bad idea.)

Who’s at risk?
Middle-age or over males, females past menopause, and everyone else. Particularly folks who smoke, don’t get enough exercise, are overweight, or use cocaine.

Is learning CPR a good idea?
Yes. If nothing else it gives you something to do while you’re waiting for the ambulance. Actually, that’s unfair. I’ve seen CPR save lives. It isn’t 100%, but what in this world is? CPR buys you time. Time for an AED to get there. Time for people with really good drugs and specialized training to get there.

More info?
You got it.

A story.

Play a game.


Copyright © 2005 by James D. Macdonald

I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.

Creative Commons License
Affairs of the Heart by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.

(Attribution URL: http://nielsenhayden.com/makinglight/archives/006434.html)


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Comments on Affairs of the Heart:
#1 ::: Elaine ::: (view all by) ::: September 22, 2005, 12:26 PM:

Jim,

Since panic attacks involve the feeling of doom and shortened breathing, is there anyway to distinguish the symptoms from a heart attack?

#2 ::: Larry Brennan ::: (view all by) ::: September 22, 2005, 12:39 PM:

Thank you for this. One of my personal points of paranoia is that I'll be walking down the street one day and just keel over dead from a heart attack.

There's some history of heart problems in men on my mother's side of the family, but not usually appearing until their 70s or 80s. My mom had frequent CHF and died young (62) of a stroke, but she also had Type II diabetes which she neglected, led a very sedentary lifstyle and smoked heavily. The only thing she didn't do was drink. My father's side is a total blank.

When they put AEDs on airplanes, it really reduced my anxiety about flying. The mid-air heart attack used to be something I was really afraid of.

FWIW, I have no indicators of heart disease, but still, the presence of AEDs and people who can use them really does make me feel more secure.

#3 ::: Thomas Ware ::: (view all by) ::: September 22, 2005, 01:02 PM:

We've deployed four AEDs on campus this year - one to the security vehicle and the others in relatively centralized location across 50 sq/acres. We'll also deploy AEDs to each of our outlying centers, five across ten thousand sq/miles, and I am to begin carrying one in my service vehicle. None of it free.

Which begs the question: in our fifty-six year history we've never had a heart attack on campus. Why spend the money? Grant, 'tis better to err on the side of caution, I'd far rather take the five percent chance of it happening than follow NOLA's example of gambling on the five percent chance it wouldn't. But still...

Limited in location, limited in knowledgable users, both to training and location... I guess my concern is we'll have these resources on hand and Murphy's Law will weigh in and we'll experience a fatal simply due to the aforementioned limitations.

Oh well, great piece, and thanks for reminding us not so old farts it's time to start paying attention to our tickers.

Cocaine? What sensible person does cocaine (anymore)?

#4 ::: Vicki ::: (view all by) ::: September 22, 2005, 01:14 PM:

If I don't have baby aspirin, is there a reason not to swallow one regular adult aspirin?

#5 ::: Christopher B. Wright ::: (view all by) ::: September 22, 2005, 01:17 PM:

Elaine raises a good question. Just a few weeks ago I experienced Feeling of DOom and Shortness of Breath two days in a row. The first day I thought it was just on the job stress, the second day it scared me so much I went to the doctor. The doctor did a checkup that included an EKG and my heart seemed perfectly normal.

Which suggested it was stress after all. Which doesn't mean that won't develop into high blood pressure/heart problems some day if I don't find a way to calm the hell down, but thinking I was having a heart attack at the tender age of 34 didn't help matters in that regard, either. :)

#6 ::: Julia Jones ::: (view all by) ::: September 22, 2005, 01:24 PM:

Learning to do CPR is A Good Thing. I've never had to do it for real, but I know at least one person who has kept someone alive until the ambulance got there, and there have been two occasions when someone's gone down in front of me and I've been very glad to know as I went to help that I *could* help, that if necessary I could keep that person's breathing and circulation going long enough for an ambulance to get there.

I learned CPR in school. I didn't do it again until some fifteen years later, when I joined the First Aid Team at work. I got it right first time, so it *does* stick with you, even if ideally you should do a refresher every so often.

#7 ::: TexAnne ::: (view all by) ::: September 22, 2005, 01:25 PM:

I have the same question as Elaine, only in my case it's exercise-induced asthma.

#8 ::: Liz ::: (view all by) ::: September 22, 2005, 01:26 PM:

Good to hear that AED's are being deployed. I was an EMT in the early 1990's and had considerable experience using the "HeartStart" model. The new ones are even better. The only caveat I can think of is that people need to be cautioned not to use one on someone whose heart is actually beating! I suspect that if the new AED's read the heart rhythm, they won't shock a patient who doesn't need it.

#9 ::: Andrew Brown ::: (view all by) ::: September 22, 2005, 01:30 PM:

Yes. I mean, I have just yesterday got back from a stay in hospital where I was taken after reporting with sudden onset nausea, dizziness, faintness, feeling of impending doom ... and I mean bad nausea: throwing up; and bad dizziness: inability to stand up.

However, I had no pain, and when all the tests were done, I had had no heart attack. So these things are not, thank ghod, infallible. It could have been a panic attack on top of pre-existent labarynthitis, or it could have been a minor cardiac aarhythmia. But it's important to remeber that you may not, actually, be dying whatever the checklist says.

#10 ::: veejane ::: (view all by) ::: September 22, 2005, 01:46 PM:

My previous neighbor, known in the neighborhood as Creepy Basement Bob, was a man in his sixties, overweight, with rather the penchant for barbecue. I woke up one Saturday morning to the sound of EMTs loading him onto a stretcher in our back yard.

It turned out not to be a heart attack, or anything cardiac at all, but serious acid reflux, from barbecue. Still, the EMTs picked him up and took him off to the hospital, because you don't pooh-pooh chest pains.

You yell at Creepy Basement Bob for eating barbecue because he knows better, but you take his chest pains seriously every time.

#11 ::: Diana Rowland ::: (view all by) ::: September 22, 2005, 01:56 PM:

CPR works. Back when I was a road deputy I came across a traffic accident where it turned out that the driver had done a keel-over kinda thing. I performed CPR for almost 20 minutes on him, until the EMTs could get there and shock him back to life.

He was a smoker too. Yuck. And no, I didn't have a mask to use. Sometimes you just do what needs to be done.

#12 ::: James D. Macdonald ::: (view all by) ::: September 22, 2005, 02:03 PM:

Since panic attacks involve the feeling of doom and shortened breathing, is there anyway to distinguish the symptoms from a heart attack?

Yes. A 12-lead electrocardiogram or blood work will tell the difference. Both of those are ER procedures. If you have panic attacks, you might want to talk with a doctor about dealing with the underlying cause.

#13 ::: Adrian ::: (view all by) ::: September 22, 2005, 02:11 PM:

Elaine:
Electrocardiograms distinguish between panic attacks and heart attacks. Unfortunately, one symptom of a panic attack is thinking you're about to die. So you need to get to the ER. It's expensive, but said to be worth it anyhow.

Vicki:
Adult aspirin is better than nothing. But the chewed up aspirin gets into your bloodstream faster than a swallowed tablet with a coating that makes it dissolve a bit later in the digestive process. Minutes count for this.

#14 ::: James D. Macdonald ::: (view all by) ::: September 22, 2005, 02:12 PM:

Yeah, one adult aspirin is the same as four baby aspirin. The reason we say baby aspirin is they're flavored to be less yucky.

The reason you chew them rather than swallow is because the drug can enter your bloodstream directly through your gums and cheeks. If you swallow them -- one of the first things that happens when you go into shock is the digestive system slows way down. And if you vomit 'em back up they do even less good.

#15 ::: Tim Kyger ::: (view all by) ::: September 22, 2005, 02:14 PM:

Truly a great public service. Thank you for this.

I'm a month shy of turning 50, overweight by 50 pounds, and don't get any excercise. I have never smoked, so at least I don't have that particular risk factor. I have high blood pressure -- controlled by drugs -- and there is a history of high blood pressure in both parents. Oh, and mom died of an aortic dissection.

So...I know, I know...I really oughta do something...

#16 ::: janet ::: (view all by) ::: September 22, 2005, 03:17 PM:

The general recommendation about taking 81mg aspirin daily is that you should do it if you have one or more risk factors for cardiovascular disease (hypertension, diabetes, dyslipidemia, etc.; also age over ~50 for men or ~60 for women).

Also, keep in mind that more is not better. The protective effect of 325mg aspirin a day is the same as the protective effect of 81mg a day.

#17 ::: TH ::: (view all by) ::: September 22, 2005, 03:17 PM:

A few weeks back I spent an hour in the emergency room with a few of these symptoms. It was just a panic attack, but I was definitely encouraged to drop in any time I feel that way, and I'd recommend it to anyone. Even in countries where it's a matter of being able to afford it. lie, cheat and steal to pay for it, but go.

It's a very strange feeling when you hand over the car to someone else because it's better that *if* you keel over, at least it's only you, and not you, wife, child and friend.

#18 ::: janet ::: (view all by) ::: September 22, 2005, 03:23 PM:

Sorry, I think that was unclear; I didn't mean to say that you should take aspirin if you have a risk factor and are also over 50/60, but rather that age is a risk factor even if you don't have any other risk factors. One risk factor is enough.

So, to reiterate, if you have one or more CVD risk factors, no matter what they are, aspirin is recommended by all of the usual authorities. (But otherwise, don't take it. Aspirin is not 100% benign.)

#19 ::: Dave Bell ::: (view all by) ::: September 22, 2005, 03:25 PM:

When I broke my leg, a couple of years ago, I was put on aspirin for a couple of months. I have several of the liist of cardiovascular risk factors.

And then the doctor told me to stop taking aspirin.

So, while it's obviously useful in the short term, what are the risks of taking aspirin? What was scaring the doctors here?

#20 ::: janet ::: (view all by) ::: September 22, 2005, 03:33 PM:

Dave -- That's odd. The only major contraindication is if you're at high risk of hemorraghic stroke (i.e. one caused by a bleed in the brain) rather than an ischemic stroke (i.e. one cause by a blockage in a blood vessel in the brain). Ischemic strokes are far more common, and I can't remember what the risk factors for hemorraghic strokes are. Were you taking a lot of aspirin? Was it an orthopaedist who told you to stop taking it? If so, you might want to ask your general practitioner.

#21 ::: Christopher B. Wright ::: (view all by) ::: September 22, 2005, 03:57 PM:

Doesn't aspirin thin your blood? I thought that's why it was useful when you're having a heart attack. If that's right, I guess I could see why it would be a bad idea to take it regularly if you don't have to...

#22 ::: Lisa Hertel ::: (view all by) ::: September 22, 2005, 04:00 PM:

Jim, where can one get training on AEDs in Massachusetts? I know they're supposed to be self-explanatory, but you don't want to be reading directions during an emergency. I've been certified in CPR twice (including infant CPR once). And they basically told us to aim for breaking the sternum. As a health professional, I feel it's important to know this stuff, though I'd readily step aside for someone more qualified.

I personally think they should teach first aid basics in a required course in high school.

#23 ::: P J Evans ::: (view all by) ::: September 22, 2005, 04:02 PM:

The only sign of hemorrhagic stroke that I know of is severe headache. (The first time my father had one, they diagnosed it as TIA, with nothing turning up in the angiogram. The second time we knew what it was, and the MRI showed the damage left the first time. The third one killed him. All three were in the brainstem, which is non-treatable.)

#24 ::: James D. Macdonald ::: (view all by) ::: September 22, 2005, 04:05 PM:

Lisa, you can call your local AHA to find out where you can get training.

The newer AEDs have voice chips in them that talk you through the entire process. Still, it's a good idea if The Middle Of An Emergency isn't the first time you ever lay eyes on one.

#25 ::: Clifton Royston ::: (view all by) ::: September 22, 2005, 04:07 PM:

Dave:

Prolonged use of aspirin, OTC NSAIDs, and prescription NSAIDs together account for a fair number of deaths per year, many of them among arthritis patients who are on steady doses. One of the biggest risks of aspirin is peptic ulcers. Aspirin is one of the worst for the stomach lining, but the others are pretty bad and they can also affect the kidneys or liver.

Ulcers are no big deal, right? Well, 11 years ago just before Thanksgiving, I had a mild stomach-ache for a couple days due to the stress of starting up a new company. Thanksgiving morning I was taking a shower and started feeling so weak I could hardly stand up, together with a slightly stronger stomach-ache. It occurred to me that this might be an ulcer from the NSAIDs I was taking, so I went (with wife and daughter) to the GI dept at the local hospital, where I threw up congealed blood all over their floor and was so out of it I had to be tranquilized so they could get a scope down my stomach. The mild stomach-ache was a bleeding duodenal ulcer which is usually supposed to be excruciatingly painful; apparently I have a fairly high pain threshold. I had lost enough blood that I nearly needed a transfusion, and spent 4 days in the hospital under observation.

Other risks of prolonged aspirin use (below the overdose range) include triggering asthma, tinnitus, and stress on the kidneys. The effects of a slow overdose get very nasty.

However... the benefits of small doses can also be pretty substantial for some people. The point is it's not risk-free, taking it lowers overall risk for some people and raises it for others, and the right dose if any will be different for each person. It just can't be passed out to everyone like vitamin pills.

#26 ::: janet ::: (view all by) ::: September 22, 2005, 04:19 PM:

Aspirin is an antiplatelet medication -- it reduces the ability of the blood to clot. The rationale for taking it is to prevent blood clots from forming and blocking arteries. If you take aspirin daily and you get injured, your blood will still clot, it'll just take a bit longer. But, for example, people who are having surgery or major dental work are nearly always advised to stop taking aspirin and other antiplatelet meds for two weeks before surgery. One of the common side effects of daily aspirin is bruising more easily, and of course there are the GI effects. So like I said, not 100% benign, but for people with risk factors for CVD, probably a good trade-off.

I'm not a doctor, and I'm not prescribing anything -- just discussing the guidelines. Aspirin is over-the-counter medication, so you don't need to get your doctor's permission to take it, but it's always advisable to talk to your doc about whether taking aspirin is a good idea, especially if you're already on other regular meds.

#27 ::: janet ::: (view all by) ::: September 22, 2005, 04:31 PM:

Clifton -- I've had a couple of doctors tell me that if aspirin were a new drug, it could never get FDA approved for over-the-counter use.

#28 ::: jonquil ::: (view all by) ::: September 22, 2005, 04:33 PM:

"I personally think they should teach first aid basics in a required course in high school."

Back in 1977 in Indiana they did. You had to pass Health to graduate, and you became First Aid certified in Health class. Smart idea, but of course certifications do expire over time.

It turns out my employer has on-site CPR/First Aid classes; I'm pursuing them.

#29 ::: Daniel Martin ::: (view all by) ::: September 22, 2005, 04:58 PM:

Note that although you've referred to them as "baby aspirin", don't expect any aspirin product these days marketed to children, nor should you expect any friend or neighbor with a young child to have such a product in their home. In fact, parents of young children may very well not have aspirin of any kind at home, since the "do not give your child aspirin" message is repeated to parents from all corners.

That being said, there are still companies making chewable aspirin, but now they market it for heart attack prevention.

#30 ::: LeslieS ::: (view all by) ::: September 22, 2005, 05:01 PM:

And further, on the subject of NSAIDs, there are a few recent studies that show they inhibit bone growth after a bone injury. I found this out 6 weeks ago when I broke my ankle and the orthopod said vicodin or tylenol but no aspirin or ibuprofin for 6 weeks.

There have not been studies done to clearly document how long it's a problem - in mice it's the first two days but they heal broken bones in 2 weeks. In any case, NSAIDs are not entirely benign drugs and a significant number of people end up with adverse results from taking them for a prolonged period.

#31 ::: Adina ::: (view all by) ::: September 22, 2005, 05:21 PM:

I learned first aid basics in high school as part of my driver's ed course. It even came in handy once, as I was able to instruct my roommate in how to make a sling for me.

#32 ::: Jeremy Leader ::: (view all by) ::: September 22, 2005, 05:25 PM:

I'm an example of someone who shouldn't take aspirin (at least according to my doctor). I'm in my 40s, with high blood pressure controlled by medication, and I was taking the usual 81mg of aspirin per day, until I developed unexplained gastro-intestinal bleeding while on vacation. Like an idiot, I ignored my symptoms of black tarry bowel movements and severe anemia (feeling like I would imagine it would feel to climb Mt. Everest w/out oxygen) until I got back home. The next day, my doctor sent me to the hospital. At the hospital, I was eventually transfused with 3 units of whole blood, and given a series of increasingly invasive tests (cameras inserted from both ends, x-rays, radio-isotope tracers, eventually even swallowing a tiny video camera which reminded me of Fantastic Voyage) to try to find the source of the bleeding, to no avail. After, my doctor said I'd be wise to avoid aspirin. I'll have to ask him about the advisability of taking aspirin in the event of a suspected heart attack. I suspect it would be a good idea, given that we don't know for sure that aspirin caused my bleeding, but I don't know.

#33 ::: Allen Baum ::: (view all by) ::: September 22, 2005, 05:58 PM:

CPR is good. It won't restart a heart (are there exceptions?) but, as noted, its an excellent stopgap until the defibrillator arrives.
More defibrillators are therefore something I'd like to see.

My youngest brother is (literally) the poster child for the CPR certification course at Stanford Hospital.

He collapsed during his usual 15 mile weekend run in the hills above Stanford, after talking to his running partner about the shortness of breath that he'd been having lately during training.

He woke up after a month in a coma only because:
- said running partner was a doctor,
a. who knew the first thing to do is get help
b. was a runner who could run and get help
c. was a runner who could run back afterwards
d. was a doctor who knew CPR.
e. there was someone a the ranger station who could call paramedics (and show up with a breathing tube (whatever they're called) for aiding mouth-to-mouth resuscitation

It also helped that
- he was close enough to a field where a helicopter could land,
- it was just a 3 minute ride by helicopter to Stanford Hospital
- there was a free table in the catheter lab
- he was only 40 years old and in (otherwise) excellent health and shape.
- he often ran with Stanford nurses, some of whom worked in that lab (i.e. they took really good care of him...)

We don't know exactly how much time elapsed between heart stoppage and CPR, or even how long he was on CPR
( we think 20 - 40 minutes!) before the defibrillator managed to get a weak pulse (it took many tries)
- but there is no question that it kept him alive.

Having the cholestorol gene myself, I'm paying close attention to all this myself

#34 ::: Marilee ::: (view all by) ::: September 22, 2005, 07:59 PM:

Who needs prolonged exposure from NSAIDs to have bad things happen? I was taking it once a day about three days a week for a couple of weeks when it caused my kidneys to fail. I turned out to be sensitive to NSAIDs. My nephrologist says 2% of anybody who ever uses NSAIDs will have some level of kidney damage.

And then there's aspirin. During the first renal failure, my BP went up, the doctor ordered nifedipine sublingually which the nurse administrated and it dropped my BP so low that I didn't get oxygen to my brain for a while. I woke up from the coma 6 weeks later. So the neurologist wanted me to take low-dose aspirin daily. The nephrologist wanted me to not take it at all. The neurologist won.

#35 ::: Georgiana ::: (view all by) ::: September 22, 2005, 09:32 PM:

Great post with loads of useful information. I used to be a first responder in my county, now that I am too sick to be of much use my son Kit is the licensed responder in our family. My teacher was a battalion chief in the fire department and he said that our county was part of an experiment. The goal was to make one in every seven people trained in CPR.

I don't know what the results were but I do know that lots of people who deal with the public now have to be CPR certified and AEDs are much more prevalent. It was headline news when ambulances got to carry them several years ago and now they are installing them in restaurants and shops at the mall. I think it's wonderful.

If you're taking warfarin aka coumadin you don't want to take aspirin every day.

That's interesting about the bone growth inhibition. I have chronic blood clots and take extra calcium because I was told that "heparin sucks the calcium right out of your bones" - a charming image if I've ever heard one.

I've heard about some recent studies that show that vitamin K is pretty important for calcium retention and strong bones. Heparin and warfarin both work by interfering with the proper function of vitamin K on the blood so it seems to me that might help explain the bone loss.

Aspirin seems to work differently to thin the blood so what is the connection? If anyone knows more about this I am extremely interested.

#36 ::: Laurie Mann ::: (view all by) ::: September 22, 2005, 10:03 PM:

I've had two non-heart attacks - one time the chest pain turned out to be pleursy (a painful inflammation of the lung lining) and another time it turned out to be an oddly strained back muscle on the left side. While embarassing as all get out, it is useful to get these things checked out!

Unless you have some sort of major sensitivity, isn't taking some low-dose aspirin what you should always do "just in case" you're having a heart attack? I've been taking adult aspirin since I was 7 (I had chronic backaches and headaches as a child). The only time it bothered my stomach was when I was 22 and had a prolonged toothache. So far, I haven't had to take aspirin or Aleve for more than a few days at a time.

#37 ::: Mary Kay ::: (view all by) ::: September 22, 2005, 10:49 PM:

My possible heart attack, pain high in left chest radiating down left arm, turned out to be tendonitis in the shoulder. However I was in so much pain it never occured to me to be embarassed. The shot they eventually gave me sure was nice. I wish I had some of that stuff for when I go to the dentist.

I just had full blood fat panel done -- major heart, stroke, and high blood pressure in my family on both sides. Good triglycerides and HDL, LDL just a little elevated, and we're working on it. Nice to know there are those things available; I began noticing them in airports several years ago. Still if I have to go, I'd like to go like my mother's older sister. Got up one morning, walked into the bathroom to brush her teeth, massive heart attack, dead before she hit the floor. No warning or anything. The idea of watching death walk slowly towards me is horrifying.

MKK

#38 ::: Paula Helm Murray ::: (view all by) ::: September 22, 2005, 11:46 PM:

I'm with you, MKK... watching bone cancer take my dad after a prostate cancer recurrance was horrific--because he was as fit as a 70-year-old man can possibly be (worked on improving forest at his hobby farm, up to 8 hours a day of hard work, was P-Od that conservative suits had large waistlines, that sort of thing). So his body was durable enough to carry him on about six months longer than the docs gave us. The hospice nurses are blessed people!

That said, last November I was diagnosed with high blood pressure. The hospital did a full work up (went in to my internist with a really sore toe because of a blue ice attack, got sent to ER-family transport, not ambulance- because BP was waaaaaaaay too high). And I had a physical near my birthday, March 16. Have reasonable blood fat/sugar levels, it had apparently not been going on long enough to damage anything. And we got the meds right after only two tries (I have a friend who is still (6 mos or so) in hell because she's having blood pressure issues BUT also has issues with the various drugs they try to make it go down). When I was diagnosed, the doctor suggested taking one aspirin or ibuprofen a day. I told him I took ibupofen every day, usually about 400 mg a day and he said, 'never mind, that will do..."

I'm not sensitive to aspirin, it's just that the bit of joint arthritis i have is more receptive to iuprofen.

#39 ::: hrc ::: (view all by) ::: September 23, 2005, 01:09 AM:

what I thought was a heart attack 7 or 8 years ago turned out to be my first experience w/ gastrointestinal reflux (I think it's labelled GERD). It was rather embarassing once I found out what it was, but it has begun occurring on a regular basis and is quite painful when it does. Hamburgers w/ french fries seems to bring it on. Dang.

#40 ::: Bruce Arthurs ::: (view all by) ::: September 23, 2005, 03:06 AM:

Tim Kyger wrote:
"I'm a month shy of turning 50, overweight by 50 pounds, and don't get any excercise.

So...I know, I know...I really oughta do something..."


Start exercising.

I've been following Jorge Cruise' 8 Minutes In The Morning diet-&-exercise program since April. Lost 25 pounds, and dropped my cholesterol by 30 points, in three months, and have been at "ideal" weight since then (for the first time in 25 years). The exercise sessions, from getting out the mat and/or dumbbells to putting them away, only take about fifteen minutes each morning. Even I've managed to squeeze out that much time, usually.

Amazon has the book available here. Some of the reader reviews will give a better idea if it would be suitable for you.

#41 ::: amysue ::: (view all by) ::: September 23, 2005, 07:22 AM:

On the other hand...several years ago a friend left my home and unknown to me took a cab to the nearest hospital because of chest pain, arm numbness etc. He actually apologized to the person administering his eeg for "wasting her time" to which she replied while calling for some help "for what it's worth, your not wasting our time". He called me later to let me know he was being taken to the cath lab. He was only 35. Today (oh wait he just turned 50! - was it really that long ago?) he tells everyone it was because I had him move my damn couch for 2 hours from one spot to another.

" The nephrologist wanted me to not take it at all. The neurologist won." I am diabetic (insulin dependent) and also have several hundred hepatic tumors. It is amusing to watch the physicians duke it out over medication. I finally spoke with a doctor who pointed out that I should use a kind of triage mode of thought toward medication. In the case of insulin it's a no brainer, I will die without it. In the case of others it's a matter of will I be hurt in the short term severely enough to warrant a risk of possible long term damage. So, yes, the medicine to cure thrush has a high sugar content and wreaks havoc with my numbers but is only being taken for a week or two and thrush untreated is a bad thing and very annoying. However, the nsaids the doctor suggested for my lower back pain do not help any more than stretching and pt does and are really a bad idea for the limited capacity of my liver. And so on.

As for the AEDs...we have one at the temple (where I work) and my understanding is that it will detect a heart rythm and won't shock someone needlessly. The person who trained us stressed everything Jim has mentioned before: first get help, then open the case and do what the lovely voice tells you to. I hope we never have to use it. I'm glad we have it though.

#42 ::: Scott H ::: (view all by) ::: September 23, 2005, 11:35 AM:

Question for you medical types:

A couple of years ago a friend sent me an email about what to do if you think you're having a heart attack. In addition to all the measures previously discussed (get to a Dr., take aspirin,...) they suggested that it may help to put your head between your knees and cough as hard as you can.

IIRC, the theory was that coughing hyperoxygenates your blood and may also increase pressure in your heart enough to push through the blockage.

Anyone else ever heard of this? I guess it sort of sounds plausible, but that's the only time I ever heard of it.

Also, Tim K:

I'm 36 with a family history of heart disease and personal obesity. About a year ago I started an exercise program. The first couple of days were absolutely brutal, but it does get easier. Oct. 2 will be 1 year--I'm down about 20 pounds, the BP has backed out of the borderline-hypertensive, and I feel like I'm in high school again.

Push through the pain, dude. It's worth it.

#43 ::: James D. Macdonald ::: (view all by) ::: September 23, 2005, 11:52 AM:

A couple of years ago a friend sent me an email about what to do if you think you're having a heart attack. In addition to all the measures previously discussed (get to a Dr., take aspirin,...) they suggested that it may help to put your head between your knees and cough as hard as you can.

That's a technique for taking yourself out of superventricular tachycardia, which you can sometimes feel as "heart palpations." Regardless, you want to see a doctor, pronto.

It won't do a darned thing for you if your problem is an actual MI (myocardial infarction) -- a blood clot somewhere in one of the coronary arteries.

#44 ::: debcha ::: (view all by) ::: September 23, 2005, 12:02 PM:

[belated reply to Thomas]

FWIW, at the end of the first year of the small engineering college where I work (we're now three years old), we had a fatal heart attack (the father of a student at a school event). Partly as a result of that, every incoming student and most of the faculty and staff takes first aid, CPR and AED training. Between that sad event and the loads of equipment in labs that our students have open access to (many of them run off high voltage), you can believe that there is absolutely no question about the need for the training or for the AEDs scattered around campus.

#45 ::: mayakda ::: (view all by) ::: September 23, 2005, 02:23 PM:

I always like to pass this along: If you have high blood pressure or another risk factor, try to develop a taste for ginger*. If you google on ginger or "Zingiber Officinale" and anything like "platelet" , "cox-1", "heart disease", "cholesterol" etc., a bunch of studies in vitro and in mice show up which all look very promising.
If you're fairly healthy, and not scheduled for any surgery, try this little experiment. A week or a few days before you next give blood, add fresh ginger to your diet. Pop a few slices in soup that you're boiling, or boil some slices and add it to your tea, whatever. Also increase your fluid intake. When you give blood, chances are you'll be in and out in record time.
*Obviously, if your already on medication, discuss with your dr first.

#46 ::: nerdycellist ::: (view all by) ::: September 23, 2005, 03:03 PM:

Not to hijack the thread or anything, but I have a Red Cross related question:

The company I work for just hosted a Red Cross blood drive, and since that is the one resource I have plenty of, I happily donated. My friend who also works for the company wanted to give blood but is unable to as she spent a semester in London in '94 and RC rules specify you can't donate if you spent 3 months or more in the UK before 1996. I imagine this has to do with Cruetzfeld-Jakob disease, but it's frustrating to my friend since she'd gladly give if she could.

Is there any sort of test you can take to prove you don't have whatever crazy virus you might be at risk for, and so qualify to donate blood?

#47 ::: James D. Macdonald ::: (view all by) ::: September 23, 2005, 03:43 PM:

I know about the Red Cross thing. I, too, have a permanent deferment from giving blood through the Red Cross, due to the time I spent in Europe with the US Navy (and this after having given gallons over the years, since I was a teenager).

Well, nothing for it. Some other non-Red Cross programs exist that accept blood donations. Check 'em out. (I think, but I'm not sure, that Mass General is one of them.)

Meanwhile, there are other ways to help out.

#48 ::: LeslieS ::: (view all by) ::: September 23, 2005, 07:28 PM:

It's definitely the mad cow thing. The first time my husband tried to give blood after they changed the rules he exclaimed to me - "I can't give blood anymore" and every head in the room whipped around to stare at him! grad school at Cambridge made him too dangerous apparently. Since there are no tests for it and it is 100% fatal I can understand the red cross's conservativism on that issue but it is frustrating

#49 ::: Eric Sadoyama ::: (view all by) ::: September 23, 2005, 07:55 PM:

I tried giving blood once, and got rejected halfway through the procedure because I turned gray and started feeling dizzy. They told me that my blood was fine but I needed it more than they did, and sent me home.

#50 ::: Stefan Jones ::: (view all by) ::: September 23, 2005, 08:02 PM:

My dog made her second blood donation on Tuesday.

This is done by laying a beastie on its side and sticking a needle in the jugular. They had to jab Kira twice before getting a good flow. The assistant and I held her down while supplying cookies orally.

I made the mistake of looking at the collection bag this time. I know intellectually roughly how much 400 ml is, but seeing a great big ruddy sack of blood freshly squeezed from you pet . . . dang!

The dog didn't seem to mind at all.

#51 ::: Lila ::: (view all by) ::: September 23, 2005, 09:19 PM:

Stefan, thank you and tell Kira I said thanks and give her a cookie from me.

My beloved dachshund Phoebe died recently. We're still awaiting necropsy results, but the major symptom was severe hemolytic anemia. She had a transfusion, which in her case didn't help, but I am grateful it could be tried.

#52 ::: Larry Brennan ::: (view all by) ::: September 23, 2005, 09:26 PM:

Tim Kyger - I was probably about 40 pounds overweight (50 per the charts, which I think are too conservative) when I started a pretty serious diet and exercise program two months ago. I had been more or less sedentary for about five years. Oh, and I just turned 40. Funny how things like that can be a catalyst.

The first couple of weeks were pretty hard, more because of the high protein, low fat, low carb diet. The program adds back food groups looking for foods that stall weight loss or drive hunger or overeating. I've got everything except grain products back now.

The exercise wasn't so bad, and I hadn't really noticed a difference until today when I was in downtown Seattle and hiked up from First Ave to Fourth, which is pretty steep and a nice elevation gain, and I didn't break a sweat, even with a heavy backpack.

It can be done. I've lost about 25 pounds so far, but more importanly, I feel better. FWIW, the program I'm in has a one year loss retention rate of about 50%, which is way more than the industry average.

I don't think you necessarily need to do something so drastic as what I'm doing (it's like having a part-time job) but there are some things you can do.

First, try meal tracking. Write down everything you put in your mouth. Everything. And track the total calories and fat. Shoot for about 30% of calories from fat.

Second, don't starve yourself. Shoot for about 1600-1900 calories per day. Try restricting carbs, especially processed ones like white flour and white rice.

Third, make some time to exercise. You don't have to wear yourself out, but do get out. Join a gym and do cardio. Lift a little. Don't be self-conscious about it. Just go.

FYI, here's an article in the Seattle PI about the program my company sponsors. It's great, and I couldn't afford it if it wasn't sponsored. Still, this doesn't mean you can't do something like this on your own.

I'm hoping (and I'm pretty determined, too) that I will be on the winning side of the retention issue.

#53 ::: Larry Brennan ::: (view all by) ::: September 23, 2005, 09:33 PM:

Re: blood donation, I'm feeling slightly guilty that I can't give again until a year after I finish my current tattoo project. Everything's autoclaved, and the artist follows good sterility procedures, but the blood center doesn't know that so their precaution makes sense. When I'm eligible, I give at least three times a year, so it's a hard habit to break.

Stefan - the whole concept of doggie blood donors amazes me. I just never thought about it. Good on you, and on Kira too!

There must be kitty blood donors, too, but I have an even harder time imagining any cat I've ever owned sitting still for it.

#54 ::: Stefan Jones ::: (view all by) ::: September 23, 2005, 11:05 PM:

From what I understand, most canine blood donors live in "stables." It's their career, if you want to be cute about it. This lets the blood bank keep careful track of their health.

Portland's Dove Lewis Emergency Animal Hospital has a stable of feline donors -- rescued strays and shelter cats -- who live in the hospital and get tapped occasionally. When they age out they are put up for adoption.

They recruit canine donors from the community. The beasties must be big (50 lb. plus), healthy (no hepatitis; can't have gotten a transfusion themselves), and can never have been pregnant.

Kira (emulating donation pose) fit the bill and turned out to be one of the two universal donor types. I'll be bringing her in every two months (although, given how quickly she's been recovering I could probably do it every month); she gets handfulls of biscuits and a squeaky plush toy to eviscerate, and free blood if she ever needs it.

#55 ::: Jena Snyder ::: (view all by) ::: September 26, 2005, 11:41 AM:

>>Feeling of Doom
>>You’ll know it when you have it.

When I took a course on sudden death investigation, the M.E. said the reason so many heart attack victims are found in a washroom is because of that feeling of doom. He described it as "the feeling you're going to puke, crap, and faint -- all at once."

#56 ::: Lin Daniel ::: (view all by) ::: September 26, 2005, 01:07 PM:

I personally think they should teach first aid basics in a required course in high school.
It would be helpful to get a truly qualified person to do it. Our "health" instructor used to blush and mumble every time he came to something even remotely intimate.

experience w/ gastrointestinal reflux (I think it's labelled GERD). It was rather embarassing once I found out what it was, but it has begun occurring on a regular basis and is quite painful when it does.
I get severe hiccups occassionally - which causes acid reflux. I have had only one (so far) that was so severe I dropped to my knees from the pain. And yes, I've had it checked by a doctor, who was fascinated - he'd never encountered that pairing of conditions. My biggest fear is that someone will decide it's a heart attack and try to make me lie down. You can wire me to anything, you can poke me with any... almost anything, but dear ghods, don't make me lie down.

a gym and do cardio. Lift a little. Don't be self-conscious about it. Just go.
Getting a personal trainer has eliminated the fat-lady-in-the-gym embarrassment for me. And also guarantees I'm using the equipment correctly and getting the best benefit out of it I can.

#57 ::: flynngrrl ::: (view all by) ::: September 26, 2005, 02:35 PM:

They say that taking aspirin regularly can cause you to bruise easily, but it can also cause you to have bruises heal slowly. My grandfather recently fell because of a heart condition for which he was taking aspirin, but the bruise on his brain is taking much longer to heal than it would in a man who didn't take aspirin every day.

I don't know the statistics on heart failure related deaths versus brain injuries, but I do know that brain injuries are becoming more common as live-saving techniques get better.

#58 ::: Lenora Rose ::: (view all by) ::: September 26, 2005, 02:39 PM:

I'm still kind of peeved that I can't give blood, not because of anything I've done, but because of my fiance. I felt so much like saying, "Look, I've assessed the risk because it matters to me, too, and it's zero. ZERO." I'd give blood for a family member in a heartbeat (No pun intended) without the slightest fear. I, too, want some kind of formalized test where they can look at things and confirm you really are okay.

I used to have the problem of clotting too soon, though, because I used to be very bad about hydrating myself. Never occurred to me to try ginger, just to actually remember to drink (Doing so is much easier these days anyhow.)

To some degree I might already be doing the ginger thing, since I love ginger, and my fiance's allergy to it seems to have caused this to come to the fore -- I can't have even a little in any meal we make at home, so instead of a bit once in a while as a spice in a meal or cookies, I eat much more of it whenever we go out or I'm alone. It's backwards, but I know my intake went up.

#59 ::: mayakda ::: (view all by) ::: September 26, 2005, 02:56 PM:

He described it as "the feeling you're going to puke, crap, and faint -- all at once."

That's exactly how I felt when I woke up with hives all over a couple of weeks ago. Prednisone is my new friend.

It's backwards, but I know my intake went up.
Makes perfect sense to me. :)
How is your sweetie allergic to it (stomach upset, or hives, or what?). Just curious.

#60 ::: James D. Macdonald ::: (view all by) ::: March 06, 2006, 11:27 AM:

In the President's recent budget proposal we learned that the Rural and Community Access to Emergency Devices Program has been slated for elimination this year. Your help is needed right now to rescue this lifesaving program - take action today and ask your members of Congress to restore funding.

The Rural and Community AED Program provides states with grants to purchase automated external defibrillators, train lay rescuers and first responders to use AEDs and place them in public areas where cardiac arrests are likely to occur. The program provides rescuers with tools to help save lives.

Send a message to your legislators.

#61 ::: Heather ::: (view all by) ::: August 14, 2006, 10:02 PM:

Can anybody help? I am a new mother. My son is now 6 and 1/2 months old. Just before I got pregnant I weighed 250lbs, and had diabetes for 5 years w/out really worrying about it. I ate mcdonald's or some form of fast food for the 7-10 good years I was in college, and never associated diabetes w/ all the bad problems because my grandmother had it for a good 20-30 years (and didn't really watch her sugars) before she passed away from lung cancer (she never smoked).

Point is, I took very little good care of my body. But then my ob mentioned...oh...you're overweight and pregnant w/ diabetes...you could have a heart attack and kill both you and your baby both.

So, this is what I did. I got a nutritionist and started eating very healthily. And I couldn't stop having panic attacks, where my heart felt like it was racing right out of my chest. EMS would come, and it wasn't a heart attack...just very fast 120/minute lying down. I also started walking on a regular basis when my sugars were up.

Result: I didn't have to take insulin, and my sugars were very normal, AND I lost 50lbs...and after the baby was born I've lost another 30 or so, and now I weigh 164lbs.

After I had my baby I had to have my gallbladder removed due to horrible stomach aches. More panic attacks. I've felt so horrible..dizzyness, weakness for the past 6 months that I have layed around and done nothing...other than going to work, and basic household chores.

Off and on I've had weird stabby chest pains--they don't particularly come w/ excercise...they happen when at rest too..my doc thinks it's linked to gallbladder removal (though it's on left side of chest, and gallbladder is on right side of body). I've had ekg's and even 2 echo's which showed everything is okay (no stress echo yet).

Recently I started excercising again. To get both my nerves and body under better control, but this keeps happening to me and I'm scared...I'll excercise for a good 30 minutes-1hr. Whatever I can tolerate, but then I'll get this HORRIBLE stomache ache...like I want to throw up...sometimes I do throw up and it feels better.

I know that in diabetics and women especially, that stomach pain/ache and nausea can be a symptom of heart related issues.

My question is: Has any woman visiting this site...or anyone who knows...ever seen (professionally) or experienced this kind of heart problem? If so, what does the pain usually feel like? Are there any other symptoms if it is heart-related?

Is there any kind of test I can get done (the less invasive the better) to show how much damage I've done to my arteries so far, if any?

Is it possible to simply have a lot of blood diverted from my stomach while excercising, thereby causing this upset?

Please help me, I'm so scared. I do see my doc in a few days. Thanks!!!

#62 ::: James D. Macdonald ::: (view all by) ::: August 22, 2006, 11:30 AM:

Heather, I think you should print out your comment here and show it to your doctor when you go.

I'm not a doctor; I can neither diagnose nor prescribe. Even if I were, I wouldn't have an opinion about what's going on with you unless I were looking you in the eye at the time.

Stay safe, take care of yourself, and ask questions of your doctor until you get answers that you understand.

I have a post about diabetes here on Making Light. It's just an overview, but some folks think it's pretty clearly written.

#63 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 22, 2006, 11:40 AM:

What Jim said.

You're also allowed to go to another doctor and get a second opinion. People do it all the time.

#65 ::: D. Potter ::: (view all by) ::: July 19, 2011, 07:42 PM:

There's a poem coming on about hearts (there's that ghost again!), if I can ever get past the second line.

#66 ::: Jim Macdonald ::: (view all by) ::: July 28, 2013, 07:54 PM:

Public Access defibrillator works in the field (video).

Note patient clutching his left arm just before he goes down.

#67 ::: Tom Whitmore ::: (view all by) ::: July 28, 2013, 08:34 PM:

Wonderful this happened. My partner Karen would be happier if this were a Cardiac Science defibrillator, rather than a Medtronics one! She does web work for them....

#68 ::: Xopher Halftongue sees spam ::: (view all by) ::: January 23, 2014, 01:39 PM:

spam

#69 ::: Buddha Buck sees spam. ::: (view all by) ::: January 23, 2014, 01:43 PM:

I'm assuming it's in bad French.

#70 ::: Xopher Halftongue sees spam ::: (view all by) ::: February 10, 2014, 10:44 PM:

sapm

#71 ::: Cally Soukup sees SPAM ::: (view all by) ::: February 12, 2014, 05:31 PM:

More Vietnamese spam at 70.

#72 ::: Xopher Halftongue sees spam ::: (view all by) ::: April 13, 2014, 03:30 PM:

Not sure what language that's trying to be.

#73 ::: Claire sees yet more spam! ::: (view all by) ::: April 13, 2014, 03:31 PM:

In Vietnamese, again.

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