With a variety of perspectives, I am grateful for the efforts to reduce the impact of cardiac disease in Manhattan. These range from working to reduce second-hand smoke, which contributes to acute and chronic coronary disease, to enhanced abilities to deal with acute heart attacks, which has saved lives and reduced the severity of outcomes of heart attacks.
Six years ago I was the beneficiary of local and regional efforts to deal with acute my own myocardial infarction. I recognized the possibility of a heart attack and sought care in the Mercy Regional Health Center emergency room within 30 minutes or so. I had to be shocked out of a lethal heart rhythm twice and then three more times before this issue was stabilized. Because I was so difficult to handle and so low on oxygen, I was intubated after sedation. And because of the com-plications of the cardiac arrest, it was not safe to give me powerful thrombotic medication that would dissolve the clot in the major coronary artery.
After four to five hours, including the air ambulance ride, the artery was opened up in Topeka by a skilled interven-tional cardiologist. My heart function was reduced to about 35 percent over the months. I received great cardiac rehabilitation training. I had two metal medicated stents placed in the strategic artery (called the widow artery) and did well for six years on Plavix. Plavix is a drug that makes the platelets less sticky (the opposite effect of second-hand smoke) and pre-vents the stent from closing prematurely.
About two months ago, my cardiologist and I decided that six years of the medication was sufficient and that the chance of something going awry was about one in 300. Twenty five days after stopping the Plavix, I had severe pain, and just as six years prior, I made it to to the hospital, this time in about 10 minutes. I was quickly diagnosed and one of our skilled local interventional cardiologists got the same artery open —all within 45 minutes of my arrival. With this fortunate outcome, my heart function remains in the 35 percent range, essentially unchanged. I am receiving an update in cardiac rehab and working back to a fitness level that I had before.
I am grateful to the hospital and physicians and technical staff for their commitment to have this interventional service available here. This saves time of effective treatment — at least two hours if I had been airlifted to another area. In my case, this meant the difference between having a debilitating reduction of heart function or death.
I have always been impressed with the general internal med-icine and family physicians and their attention to prevention and care of cardiac patients. Achiev-ing the option in the community for immediate interventional work has and will continue to be a real challenge because of the size of our community and the number of patients necessary to economically sup-port this sort of service.
An environment in which an interventional cardiolo-gist will make a competitive income, remain in the com-munity and enjoy their work is required. It is my hope that local physicians, the hospital, local cardiologists and general public will continue to support this important service for which I owe my life and current level of health and fitness.
Time is so much a factor with acute heart attacks, and current best practices can only be accomplished where a patient transfer is not required.
James D. Gardner, M.D., a general internal medicine phy-sician, was involved in efforts to eliminate second-hand smoke in Manhattan. He has practiced in Manhattan since 1977. He also has worked in the emergency rooms in Manhattan and Junction City, and dealt firsthand with other heart attack patients.