SECOND STRING FULLBACK, FIRST
STRING CARDIOLOGIST
Henry Sadlo, MD
S
tarting in middle-age, some of my friends
have begun to worry out loud to me about
health issues, especially those who have relatives who have had heart attacks and open-heart
surgery
A good friend of mine, who played football at
St. Xavier with me, was asking me some questions
about his risks and the fact that his father had several heart attacks before age 60. He was soon approaching that age. I told him that to start,
he needed a primary care physician, and a lipid profile, and then we
would talk about various things such as risk stratification and possibly
a coronary calcium scan since he was a likely intermediate risk patient,
and coronary calcium scanning is now a level II recommendation for
intermediate risk patients.
Well, of course as many of us middle-aged people do, he put off
seeing the primary care doc, but did heed my advice to at least get the
coronary calcium scan. We were pleasantly shocked when he had a zero
score, but there were noted calcifications around the area of the aortic
valve. I once again recommended that he now even more needed to get
with his primary care physician and although he was asymptomatic, I
told him it would be a good idea to get an echocardiogram.
Once again, being asymptomatic he wasn’t all that rushed to follow
this advice. However one hot day while exercising in the back yard,
he fainted.
When he called me, I was in a restrictive period from my previous job,
where I was not allowed to work or have an office until the period was
over (somewhat of a creative paid sabbatical). (I told him that I could
not see him in an office but remembering in that he had calcifications
around his aortic valve, I told him that if he truly had aortic stenosis,
this syncope counted as medically urgent.)
He was seen in a local emergency room and released, and I’m not
sure they picked up on his calcium on his coronary calcium scan, but
in any regard he did obtain an appointment with a primary care doc,
but it was three weeks away. I was worried about my good friend,
former star fullback, and told him that I was meeting another good
friend the following day, Dr. Robert Lawrence, who was taking me
to Churchill Downs to see the early - morning workouts two weeks
before the Kentucky Derby - what an honor to be able to see the horses
without the large crowds! As a former chairman of the equine industry
program at the University of Louisville, Bob was highly knowledgeable
about the horse industry, and had access to going around the Downs
at restricted times such as this morning.
We were going to try to eat a heart healthy breakfast at Wagner’s
Pharmacy. Well, we had bacon, eggs and hash browns; a little treat
every now and then is appropriate even per Dr. Bryant Stamford, my
friend and respected medical writer for the Courier-Journal health
section, in keeping with his 80/ 20 rule. Wagner’s falls squarely into
the 20 percent of meals which we should avoid; it was a treat type of
breakfast, and what a great breakfast they serve. Derby On.
So Dr. Lawrence and I met over at the pharmacy and I told my
good football buddy, that if he would stop by Wagner’s on his way to
his work that day at 7 a.m., I would at least put my stethoscope to his
chest to see if I should judge his syncopal episode as serious, and see
if he truly had aortic stenosis.
We all pulled up in our cars bright and early, on a partially cloudy,
pretty April morning in Kentucky. I got my stethoscope out and told
him to sit in the front seat of my car. There I heard a loud harsh grade
3/6 crescendo decrescendo murmur, rather classic for significant aortic
stenosis. This was a murmur that Dr. Mary Barry would’ve called multiple medical students into the room to listen to. We of course didn’t
have that option in the parking lot of Wagner’s, but the importance
of that simple five second auscultati