A Quick Listen

Jack Frommer has been my patient since last fall. He has high blood pressure and high cholesterol and he had a small heart attack six years ago.

Jack hates to take pills, and that was one of our topics when I first met him. He needed some changes in his regimen, based on his history, lab work and physical exam.

We had a lot of ground to cover in that first visit, but I don’t remember feeling particularly rushed. Other than his blood pressure, his cardiovascular exam was normal. I re-read my notes the other day. His heart sounded regular without murmurs, his neck veins weren’t engorged, his carotid arteries didn’t have bruits, and the pulses at his ankles were good and strong. I remember him pointing out as I listened to his neck that nobody had done that before.

His three-month follow-up was encouraging. His cholesterol had dropped below his target level with the new medication I had prescribed, and his blood pressure was almost normal. I spent some extra time on his smoking and the importance of taking aspirin.

I didn’t do much of an exam that day because it was a brief visit with a lot of numbers to talk about.

At his six-month follow-up all the numbers looked good. We talked about the 3-4 cigarettes he was still smoking. I listened to his lungs and repeated his cardiovascular exam.

Suddenly, there it was: A loud, harsh scraping bruit in the lower portion of his right carotid artery.

An ultrasound suggested a stenosis greater than 80% and an MRA clinched the deal. Within weeks, Jack had surgery to remove the buildup in his neck artery.

In follow-up he and his wife showered me with praise for saving him from a stroke by listening and noticing the abnormal sound in his carotid artery.

I felt humble. I had not heard it the first time I listened.

0 Responses to “A Quick Listen”

  1. Leave a Comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Bookmark and Share


contact @ acountrydoctorwrites.com

RSS A Country Doctor Reads:

  • Fish Oil May Have More Benefits for the Inuit than for Westerners
    I have heard many people advocate eating local foods, and avoiding things from far away. Human metabolism, some say, isn’t the same everywhere. Now there is new evidence that whale blubber may be better for the Inuit than for westerners. In the 1970s, Danish researchers studying Inuit metabolism proposed that omega-3 fatty acids found in […]
  • Value Based Care: Whose Values?
    The Journal of the American Medical Association is taking a stand for elderly and disabled patients in today’s online issue: “As Medicare moves to implement value-based payment initiatives tied only to current quality measures, the values of large populations of disabled and frail persons, whose care is the most costly and most concentrated in Medicare, […] […]
  • The Call Within the Call
    “We all go into professions for many reasons: money, status, security. But some people have experiences that turn a career into a calling. These experiences quiet the self. All that matters is living up to the standard of excellence inherent in their craft.” These words by The New York Times columnist David Brooks, in a […]
  • A Crazy Old-School Physician
    A post by Suneel Dhand on KevinMD asks the question who is crazy – the elderly physician who knows his patient’s history by heart, or today’s young doctors, who know the computer better than their patients: Then there’s the reality that his generation represents exactly what a personal physician should be. A solid physician with […]
© A Country Doctor Writes 2008-2015. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.