Articles for February 2014

Just Blame Me

Samuel A. Kojoglanian, MD, FACC, FSCAI

A 52 year old female visited me for shortness of breath. She had lost 60 pounds in the past 15 months, but regained 25 pounds within 2 months. “Yeah, it’s the doctor; what a jerk! I went back for a follow up and he didn’t adjust my lap band port right, and now I’m gaining weight.”

“What can we cut back in your diet?” I asked. “Honestly Doctor K, I don’t eat much.” I smiled and said, “Ok, what changed in the past 2 months?” “Well, I just don’t know,” she said.

Empty Syringes and Broken Hearts

Samuel A. Kojoglanian, MD, FACC, FSCAI

It was found on the counter. Consider it carefree or careless, arrogant or apathetic, a cry for help or a distain for life; whatever the intention, the syringe with blood stained needle was now empty.

Joe’s wife then called me with his recent blood pressures. They were in the neighborhood of 190/90’s, which is elevated and surprising. Over the years we’ve worked on stopping smoking and he’s given it up; we’ve pulled him out of the obesity puddle, and he’s down to norm; we’ve laughed about the doughnut chomping banquets and he’s snacking on vegetables instead.

Playing Life’s Song

Samuel A. Kojoglanian, MD, FACC, FSCAI

It was about 9:30PM on Tuesday. After seeing patients all day long, I finished giving a lecture and was heading home. My service called, and a flustered doctor told me about an 80 year old man with breathing difficulties.  He asked me to see the patient next morning and I proceeded to give a few orders.

After hanging up, a voice in my heart told me to bypass going home and head straight to the ER. When the automatic doors swung open, the primary doctor led me to the family. I greeted them and then saw our patient. One look. One glance. And I knew he was in trouble. I shook his hand, “Hi pal, how ya doing?” With labored breathing, he shook his head to let me know that he was fine, but he was being heroic.

Dr. Sam’s Three Step Health Plan

Ten years ago Carl underwent bypass surgery for coronary artery disease (CAD), and now, at the age of 59, presented with chest pains once again. He has CAD because he’s diabetic. He’s diabetic because he’s obese. When he first saw me 5 years ago, he didn’t care about his weight. After our recent angiogram, he was quite disappointed that 3 of his 5 bypass grafts were completely shut down,  but was pleased when I told him we opened up the fourth graft, 99% blocked, by deploying two stents.
Because of the reality of his situation and the fear of tomorrow, my patient asked, “Dr. Sam, can you help me get healthy?” “Absolutely pal, let’s roll!” I exclaimed.

Giving It Up

Samuel A. Kojoglanian, MD, FACC, FSCAI

“We had a ‘goodbye kidney’ party. I was Ok because I let go, gave it up, and smiled in my heart,” my 24 year old patient told me after I asked how she felt about her missing kidney. I usually don’t ask questions like that, but Mary had gentleness in her eyes that interested me.

Mary started flying back and forth from Los Angeles to Phoenix, AZ to care for her older sister, Martha. Diagnosed with kidney failure, Martha a mother of a 2 year-old son became short of breath. This led to heart failure and she became incapacitated and was subjected to hemodialysis. Wouldn’t you know that Mary was the perfect match!

Code Blue U.S.A., Code Blue U.S.A.

Samuel A. Kojoglanian, MD, FACC, FSCAI

Codes come in many colors, depending on which hospital you serve. One code is universal and ominous: Code Blue, as one’s skin turns grayish blue due to the lack of oxygen during a cardiac arrest.

I remember rushing to save my patient in a Code Blue. He was in his young 80’s, placed on a blood thinner to prevent clot formation after I opened his 100% blocked artery with a stent. Unbeknownst to me, a VA medical doctor later stopped this medication because he was “too old.” Shortly, a clot formed in the stent and my patient was dying. I reopened the artery emergently. His heart muscle was weakened and a man who played golf daily has become bed bound.

Headaches, Bleeds, and Heart Valves

Samuel A. Kojoglanian, MD, FACC, FSCAI

It was an innocent adjustment. The chiropractor took a hold of her neck and directed the muscles and bones in a way that was unfamiliar to her body. A loud crack was heard and there was silence by both parties. She said she felt better and he was pleased.

Mrs. T then contacted me regarding a severe headache after her adjustment. Because she was taking Coumadin, a notorious blood thinner, I was concerned. An MRI was done and bleeding was noted on both sides of the brain. The cause of her bleed could be assumed but not with certainty.

Life’s Mathematics

Samuel Kojoglanian, MD, FACC, FSCAI

Rushed to the ER, his heart was racing out of his chest.  He had an arrhythmia that could turn fatal. Medications were given with no resolution. I was called and we gave another medication that aborted the bad rhythm.

Our patient had been well, but days before, his son and the son’s girlfriend were getting drunk and doing drugs in Dad’s front yard. The girlfriend said something about the son’s previous wife, and laughter turned into violence. He kicked her until her jaw and nose broke. Dad tried to run after his son, but fear whispered its caution. Police were called and his son was incarcerated.

Slash, Strip and Toss

Samuel A. Kojoglanian, MD, FACC, FSCAI

The branches had mightily grown over the years, peering over the wall from my neighbor’s trees, and had encroached on the roof and gutters of my home. I asked my neighbor for permission to cut some of the branches and she consented.

With the help of my friend who stood fearlessly on his scaffold, the branches tumbled down and invaded the grass completely like a band of locusts that could cover up the skies.  In less than 10 minutes the chain saw cutting was complete, but the cleaning was to follow.

Lifetime

Samuel Kojoglanian, MD, FACC, FSCAI

A couple of months  ago when the winds ruled the land of Santa Clarita,  I found the backyard basketball goal, once firmly secured in concrete, face down on the ground. Rust had revealed its ugly face and undermined the integrity of the steel pole on which the manufacturers had proudly stamped “Lifetime.”

The water from the sprinkler system had gently jabbed at the pole over years, softening the steel, and allowing the winds to deal the last insult. The backboard that read “Shatter Proof” was in 100’s of pieces.