Medical detective: Anemia, Dr. Denton Cooley Busted! It’s real, just listen to the story:
Don is 85 year old man, who visited me for finding out the reason for Iron Deficiency Anemia. Anemia means low blood, Anemia is not one disease but many diseases. His specific type was Iron Deficiency Anemia, meaning that he is chronically losing iron from his blood. This means he had to have a mystery bleeding somewhere internally in his body, most common being in the GI or Gastrointestinal Tract. He had had this anemia for a good while and his primary care physicians had tried with iron as a band aid but he continued to be anemic and that is why he was sent to me so we could unmask his hidden bleeding. The cause could be hidden anywhere in this GI tract, from stomach to small intestine to colon and each of these being vast organs, the story could be complicated and challenging. It could be from Peptic ulcer in the stomach to small bleeding vessels deep in the crevices of small intestine which is a twenty two feet long organ to colon cancer
Don was born and brought up in Texas. Don had a serene look in his face, he is a man who is lean and thin still muscular even in this age, his dressing was clean cut, face was clean shaved and his gait had no hint of hesitancy totally unburdened by age.
Don grew up in a good loving family in the shadows of the great depression. When the strong wind that was blowing on the perched planes of the West and all the withered vegetation dried up like crispy potato chips and were finally uprooted to be tumbled down path of the strong wind, this gentleman in 1931 was born at the height of depression had no idea. His first memories were good family and the shortage of clothing but food was there although meager.
As a grown young man in the segregated USA, Don was enlisted in the army, a career that he liked and got out of the army when he was 23. That was 1954.
On his last physical exam in preparation from the discharge, the army doctors found that his blood pressure was high. They reconfirmed it several times and still the pressure was high. Being in the army, and with its macho outlook, they decided not to treat him and discharge him. The army doctor told him, “You’re probably little anxious, but you’ll be okay”.
Coming out of army, he found a job in the Oil Boom of Texas. He started as a machinist in a behemoth of a company that made the tools for oil drilling. Just when he was settling down in the civilian job with a good salary, he started having headaches. At first, few attacks. “I ignored it, being young and not paid much attention”, he attested. Then more frequent and more severe worth attention. He took Tylenol. By now he was already married and had their first child. These attacks were now stubborn, gnawing and at times made him dizzy. The situation continued no matter what he took and he had second child. But being a strong-headed Texan, he told him wife minimum if anything not to make her more burdened than she already was with two young kids.
The unrelenting headaches now graduated to its next degree: in work, from time to time he felt like someone was squeezing his head from all sides, like a vice had been put around his head and it put a strong squeeze. Then came the next step of disease: he started passing out while at work from time to time; fortunately, he would pass out and come right back up in few seconds like a missing heartbeat. Mind that he was a machinist! Did he tell any one? “No”, he said, “Cause I needed the job”! After dozens of times this had happened, he decided to check in with the doctors. Being in Houston, he was in luck. The world’s largest medical center, the Texas Medical Center was established in 1945, and now 11 years down the road, they were making major leaps in medial care breaking many new grounds, what could be described as second golden revolution in the cardiac care after the first one in the 1930s.
He first went to his general doctor, who found no reason for his high blood pressure, then he was sent to an internist, and then to a neurologist, who could not find any reason. Meanwhile he was getting frustrated and “tired and broke” of paying the doctor bills. Finally, he was sent to a Cardiologist. He told his wife, “This is it. If this guy cannot find a reason and treat me, I ain’t going to another doctor”!
After visiting with the cardiologist and he had a subsequent follow up. The cardiologist told him, “I think I found a reason for your high blood pressure, young man,” before he could absorb and express the surprise he felt at the heart, the doctor added, “it is Coarctation of Aorta!” To compensate for the bewildering situation Don finally said, “Well, good”! “Not good, young man!” retorted the cardiologist immediately that left Don paralyzed.
Aorta is the biggest of the arteries or blood distribution pipe in our body, it comes out of directly from heart, from the left ventricle. This chamber is the strongest and most muscular of all parts of heart, rightfully so because, this is the chamber that first accommodates all the freshly oxygen rich blood coming from our lungs and then with a great force it pumps out the blood through the aorta, so it could be distributed throughout the body. So, aorta, being nearest to the strong pump, has to be completely open for the flow and to withstand not only great pressure, but also great turbulence of the blood volume. When coarctation occurs, the aorta narrows down thus forming a barrier for the blood fluid to pass through this area and left untreated the pump can fail although it initially tries to compensate by getting even more muscular and thus generating more power. But after a while, even this is not enough, and the blood that circulates in our body is not enough to maintain the oxygen in vital organs like especially our brain which has a high demand for oxygen. When this happens, we lose consciousness; this is exactly what was happening to Don.
With such a burden of a diagnosis, his next stop was in the clinic of world famous cardiac surgeon Dr Denton Cooley, a legend in himself. Like Don, this brilliant second generation of life changing cardiac surgeon was also born and brought up in Houston, Texas. In this clinic he had tests done and Don states “They put me under a camera” meaning most likely he had undergone a Nuclear Medicine testing. Then he met Dr Cooley whom he describes as “A very plain and tall man with big hands but slender fingers”. He was very nice yet abrupt, “Yes you got Coarctation of Aorta”. To Don, he looked like “very much business, no aura of holiness exuding out of him, rather he looked like a big sloppy kid”. He was polite but “no BS”, states Don. Cooley clearly discussed the plan with him what the surgical plan was. Don, with the fear of going under knife then asked Dr. Cooley the same question anyone in his position would ask, “What are my options? What if I don’t do the surgery? ” Seeming unmoved to any extent, Dr Cooley replied, “Well, if you leave it where it is, you will be probably dead in 2 months! Your blood pressure is out of control”. Just staying at the point with laser-like focus Dr. Cooley added, “We can operate. You got a forty percent chance that you will come alive from the table, sixty percent chance that you’ll be down on the table”.
After absorbing the initial shock Don asked Dr. Cooley, “What would it cost?” thinking in his mind that he got married not too long ago and had two kids and a wife. Dr. Cooley said, “I do not charge you anything, Methodist Hospital charges you and whatever they charge”. Then he turned back, “You are a veteran Don, aren’t you? Why don’t you try VA (Veterans’ Hospital)?” The next morning Don went to Houston VA Hospital and waited for long many hours and finally got to speak with their cardiac surgeon. Again this surgeon was also very much to the point and said, “I will tell you Don, we have never done this surgery, but we’ll be glad to try on you!” Sitting in my office, Don added, “I will never forget this” and then broke out into a staccato laughter. “I think I’ll pass” said Don to this VA surgeon and he told this to Dr. Cooley. “I will set it up tomorrow” Dr. Cooley replied.
Three days after seeing the legendary surgeon, he was operated upon, Don felt like he was on a time travel machine. “Did you tell these things to your Wife?” I asked Don. “Not really” Don answered to me, I just mumbled through my mouth little bit of things, just enough to keep her quiet”. He did all of these consults and surgeries all by himself without involving his family. Ten days after surgery he was released from the hospital and in 6 weeks Don was back to work again as a machinist of Oil Exploration Tool company. Since that time he had never looked back. His only other surgery was a heart bypass surgery about a decade ago. Dr. Cooley was still active at this time, and he came by Don to say him hello after the bypass surgery and told Don, “Your aorta looked beautiful!”. “I think the good Lord is good to me, probably more than I deserve” explains Don to me. After 57 years of marriage his wife had passed away before him. Now he lives with a house full of grand kids from his own two children.
Don’s Magic Bullhorn Message:
Live right and listen to the Lord!
When Don came to me the fear was that he had a hidden cancer somewhere especially in his Gastrointestinal tract. His initial workup was normal. But this 60 year old story was my magic moment. It told me why he was anemic and specifically Iron Deficiency type. He is experiencing a slow breaking down of the red cells at the aortic area where he had surgery 60 years ago and it is just enough to make him anemic. This is why I say, story is the single best tool I have, for that any physician has for healing. So far no one was interested in his story. In our blessed country, we have so many labs and technologies, CT, MRI and what not. We run all of these not caring about the stories of humanity. Story is human. Let us not treat, but heal, and heal by stories.