Medical opinions desired; heart problems manifesting as gut issues

In My Humble Opinion
1

Right off the bat, let me say nobody’s opinions are gonna make the slightest bit of difference to the person who is actually ill. Nobody will be acting on anything. It is not me, it is my best friend, who is currently in one of the best hospitals in the country receiving some of the finest care available.

But because my friend is in the midst of getting that care I have been left panicking and high and dry waiting to hear more detail when she has the chance to share it. Making me crazy. I’m not blaming her. I’m just saying… my googling was giving me stuff that was a little too broad and not very reassuring.

Female, 67, naturally very thin, not fond of fat, not a drinker, regular exercise, lifelong smoker, but very, very light in recent years, 2 to 4 cigarettes per day. Lifelong pot smoker, but nothing in years.

Suffering from a bunch of weird maladies in recent years like Hashimoto’s, but no killer disease, generally healthy.

A few months ago she started having persistent gut issues, sort of all over the place. Pain on eating, nausea, diarrhea, bloating, constipation… You know the whole soup of things that can go wrong in that very complicated system.

Having good insurance, she has been getting the proverbial “battery” of tests. Plenty of blood work ups, colonoscopy, endoscopy, other oscopies, all her body fluids examined close range, really test after test after test. They did some heart testing a couple of weeks ago. I don’t know what kind, but a few days ago I think it was Thursday, they did a heart ultrasound. That evening she told me she figured it was OK because nobody said anything.

She was scheduled to have her gallbladder seriously gone over this coming week and we were sort of praying that that would turn out to be it, in spite of her not being a likely candidate, just because she’s running out of things to test and it’s such a simple fix: delete the offending organ.

Well, I hadn’t gotten any text back from her in a few days, pretty much since the day we spoke about her ultrasound. I hadn’t asked her anything, it just the sort of comments that she would react to and she hadn’t.

I have been pretty consistently asking her how she’s feeling almost every day for weeks and months now and she just is same/ or a little better/ or some medicine she took seem to work/ not work (it’s been maybe parasites, maybe bacteria, maybe viral. It’s been all over the map and nothing has cured it and no diagnosis has heretofore been offered in anything other than the most speculative way.

But today was very different. Our text conversation went like this:

ME: How ya doin’?

HER: At Cedars. It’s my heart.

ME: Woah…. what is it?

HER: Later

ME: I understand, but still, please as soon as you possibly can!

This is my best friend in the world. I love her so much and she’s so important to me. And I’m sitting here, not knowing if she went to the hospital today because she was feeling shitty (she’s done that a few times during this) or if after they looked at her ultrasound, they said, hustle your ass into the hospital!! I tend to think it was the latter because it’s Sunday and her other visits to the emergency room did not produce definitive answers worded as "it is X”.

So a-googling I went. I tried to narrow it to what heart ailments are most likely to manifest as ongoing gut issues of multiple types? And/or what heart ailments that can produce gut symptoms would be revealed on an ultrasound?

The answer seemed to be: everything that can go wrong with the heart, especially shit that can kill you.

Because she’s being treated and she’s getting what could very easily (according to my googling) be fucking terrifying information, I’m not gonna bug her and she knows I’m sitting here flipping out and I just have to wait to hear from her.

But while I wait… anyone (with either experience personally or professional education) wanna speculate? Reassure? Help me brace for the worst?

2

I’m not gonna lie, that sounds very scary.

But calm yourself, if as you say she’s at a good hospital and good doctors, your job is support only.

I’m sure her mind is reeling and processing. Give her time. If ya’ll are very good friends she’ll get around to telling you.

Or not. And do not fret if she doesn’t divulge all the details. It may be personal.

3

WAG here, but it’s possible her symptoms are from intestinal angina, due to severe atherosclerosis in the gut. Eating often triggers severe abdominal pain, vomiting, weight loss, diarrhea and nausea.

And it’s possible that discovering this, her docs also looked at her heart and found severe atherosclerosis there too. They would probably prioritize treating the coronary lesions first before considering surgical intervention on the gut vasculature.

Again, just a WAG and likely to be waaaay off base.

4

It’s a common scenario. Go into the clinic or hospital to get something diagnosed/taken care of, and in the process of working that up (whether or not they think it’s a significant problem), physicians find something else on bloodwork or scans they either prioritize or figure they’ll address while waiting to finalize a treatment plan for whatever signs/symptoms the patient initially came in for.

This kind of thing would tick me off, if for instance (hypothetical) I came into the hospital for a hernia repair, and a routine chest x-ray found an incidentaloma (i.e. a couple enlarged mediastinal lymph nodes that might reflect an old case of histoplasmosis, but maybe not). Nope, fix the hernia before you start thinking about doing a CT-guided biopsy of the lymph nodes.

5

I think this is the opposite. She has a serious problem that was undiagnosed, and went in for a treatment that maybe might possibly have helped, but was possibly just unneeded medical care. And in the prep, they seem to have diagnosed the actual problem she’s been struggling with.

6

FWIW ( just throwing this out here ) For 3 weeks or so I was dealing with sour stomach/acid reflux by plopping antacids and Malox, Pepto and the like. Always seemed to coincide with physical activity after eating, or eating certain foods. Turns out it was my LAD 98 percent blocked.

7

What is an LAD in this context?

8

Left anterior descending coronary artery, a frequent site for blockages.

9

This sounds like a critical medical emergency: what did you do?

10

I have an answer but not a lot of detail because of course I imagine she’s freaking out on her own. She sent me a text this morning after I ask that it’s not good. She has "abdominal aortic disease” and “shitty lungs” “more doctors more tests”

and I am flipping out because she’s my best friend in the world and I can’t handle it… I looked it up and it’s not good. I’m thinking it’s especially not good because she’s so fucking symptomatic that she’s gonna need some kind of real serious treatment-like surgery -I’m hoping that she gets it because if she has an aneurysm in her aorta, (which it seems pretty clear she probably does, what else could “abdominal aortic disease” thats been tearing up your gut for months possibly mean?) I want them to fucking get rid of it because that’s like having a goddamn bomb in your gut…

we’re boomers, we all started smoking when we were kids. And she’s been a lifelong pothead on top of that although not in recent years. I was such a fucking heavy smoker (turns out I have ADHD and I was self-medicating big time with 2+ packs a day, but I quit in 2000, which exposed my ADHD immediately since I haven’t read a novel since, but that’s a different story) but she never was. Heavier than she has been in recent years, but I don’t think at her worst she’d smoke a pack and usually less than that and like I said above in recent years, it’s just been a few cigarettes a day at most, and it just seems such a brutal kick in the head that she would end up with artery and lung disease!

It’s one of those super ironic situations because of course I have always been between overweight and obese, a dedicated meat and fat eater, and as I say, a heavy smoker. And I had an angiogram a couple of years ago and my arteries look power-washed.

Kind of goes to show you the limitation of lifestyle alone and how much genetics has to do with how our lifestyle affects us in the end. (Which my friend appreciates… We always laugh that she’s secretly a eugenicist.)

so… What do you got for me people? Now that we have a definitive answer… Anybody been through this know somebody who’s been through this? know what the possibilities are etc. I’ve been crying my eyes out because I love her more than anything and I can’t do life without her. Give me some positives.

11

I’m sorry that you are going through this pain. I’m going to think that we have the finest health care in the world, and that she is exactly where she belongs, and she’s going to get exactly the care she needs. I’m thinking she will get through this physically and you’re going to get through this emotionally, and I’m thinking that you will be together again laughing and enjoying each other! :heartbeat:

12

Thank you, Jasmine. I appreciate that. I truly do thank you and she is tough….

13

Well, you still lack a definitive answer as to what’s really going on as of yet. But many abdominal aortic aneurysms are managed medically and only have a recommendation for surgery if they reach a certain size or have other complicating factors. And if surgery is felt to be necessary, while it’s a big procedure that’s not without risks, elective repairs of it generally have excellent outcomes. The anesthesiologist will take into account the state of her ‘shitty’ lungs and adjust things to compensate as much as possible.

One thing I learned as a physician and a parent is to not grieve for losses that haven’t happened yet and may not ever occur. Be concerned and worried for her sake, but don’t catastrophize.

Of course that’s easy to say, harder to do.

14

After 3 weeks I got more and more suspicious that maybe it wasn’t gastro stuff so I went to my PCP who did an EKG test and said “Get to the ER right now…I’m calling ahead to the cardiologist”. Got there, was immediately triaged, they said some enzyme level was elevated ( one that indicated the heart was in stress ). Spent the night under observation and was sent to the catheter lab, where it was determined my LAD was 98 percent blocked…and right before a junction with other branches. Got a stent, been good for 3 years now, and have been exercising more, watching my diet, taking the meds they tell me to.. Lost 35 pounds. Funny thing was I was fairly diet conscious before…Mediterranean and all and always had quite good bloodwork labs on my annual physical exams. Perhaps not good enough.