The 'heart attack' case - total visits so far: 9
It was a busy day in the office. I am seeing patients. A man calls up and says that he has L sided chest pain, neck pain and jaw pain. He wants to see me. My receptionist is very nervous and I tell her to send him to the ER because it sounds like a heart attack. She comes back and says no he does not want to go to the ER, he insists on seeing me. I said, "Who is this guy? Does he know that I'm pediatrician? Send him away. I do not want to workup a heart attack in my office." She comes back again and says that he insists and will not take no for an answer. I'm thinking, " Does he know me? Who referred him? He is very persistent." We tried to deny him 3 times, and 3 times he insists. Finally, I allow my receptionist to book him in on my terms. If I had any suspicion of a heart attack, I will still insist he goes to the ER.
I sublease half of my space to 2 cardiologists and a man I don't know insists on seeing me for chest pains. Hmmm...curious...
It turns out that Gary has been having these symptoms for the last year and a half. When he first started he was so frightened he went to the ER. He subsequently was seen by the ER doctor, evaluated by a cardiologist, outpatient cardiac testing. Two other cardiologists signed off on him and told him he had the healthiest heart they had ever seen. He still had symptoms. All he was given an antihypertensive medication that was not helping. He was through with the million dollar workup (for which he paid a heavy deductible).
He says, "Just sitting here and talking to you doctor, I feel lightheaded. The tingling in my left chest is going up into my neck and jaw." I looked at his vitals: BP, pulse, respiratory rate were all normal. Thank goodness - he might pass out, but he was not going to die. I have time to figure things out.
I lay him down and I check his L chest. The individual muscle bundles were independently firing. The muscle fibers of the chest wall, shoulder, back, neck and jaw were all in spasm independently and erratically. I calmed all the spasms down, he sat up and breathed easier. He says that he feels better. I explained to him that his musculoskeletal system was disordered and disorganized. What happened? He did not know.
I recommended that he follow up for treatments so that we could resolve his symptoms.
On his 3rd visit, he asked me, "Dr. Hoang can you do this time what you did the very first time with my face? I found it very helpful and you didn't do it the second time and I did not think I did quite so well..."
I explained to him that we are trained not listen to patients as to what they think works best for them because their perception is usually disturbed and distorted. Gary has been mis-educated about his pains. The back segments which reflexively and indirectly supply the heart were tight and rotated. He stated that he used to go to a chiropractor who keep working and trying to crack that area to no avail. (I asked him, how does he know that all that cracking and forcing of the body was not detrimental to his health? He had no answer.)
Because he was paying cash, I obliged. But I warned him that repeating that work on his face (cookbook, following recipes) would not give him the desired effect; it would only waste my time. The following week, he affirmed what I told him. I hear this all the time.
The human body does not tolerate forceful external impressions of what it should be. Patients undergoing multiple different modalities like physical therapy, chiropractic, massage have been trained to believe that if a muscle is spasming, then it should be "worked out." Far from it.
I left that segment alone, found the primary strain treated it and symptoms resolved.
Total visits: 9 so far...