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<p>It was the summer of 2009 and all seemed well in the universe. Tom Brady was returning to football after a season removed from injury, <em>The Office</em> was still on TV and Donald Trump could only be found on <em>The Apprentice</em>. <strong>Yet, my dad was living through a nightmare.</strong> </p>
<h1><strong>The Chief Complaint</strong> </h1>
<p>https://ehonami.blob.core.windows.net/media/2016/02/six-most-common-causes-of-chest-pain-800x600.jpg </p>
<p>He couldn’t walk more than a block before experiencing a sharp pain in his chest. He would constantly awake in the middle of the night gasping for air. And this was downright confusing to my dad because he always checked his blood pressure and took his cholesterol and blood pressure pills every day. For a man in his sixties, my dad was in impeccable condition thanks to a lifetime of maintaining a healthy diet while finding time to get some exercise on the weekends. However, my dad wasn’t a big fan of seeing the doctor (who is really?) and only visited the clinic once a year to get his blood work done. This was the most worried I had ever seen my father and I was even more surprised when he suggested himself that he needed a check-up; I agreed to accompany him. </p>
<h1><strong>Run like the wind!</strong> </h1>
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<p>When we arrived at the hospital, the nurse simply heard my father’s chief complaint of chest pain and peeked at his date of birth before sending us directly to the cardiologist. I doubt whether the cardiologist even checked his vital signs that day before ordering an ECG. As a technician clumsily attached the leads to a machine that was unfortunately not working (when does anything ever work in a hospital?), the cardiologist immediately launched into a speech describing the mechanisms behind chest pain or <em><strong>angina pectoris</strong></em> and without even waiting for the ECG result, ordered that my father remain at the hospital for an angioplasty that same day. There was no proof yet that this was a cardiac issue and yet the cardiologist wanted the surgeon involved right away! </p>
<p>Fortunately, we are able to spot the scam instantly and quickly bolted out of there, as the cardiologist screamed that we were leaving at our own risk. Since I still hadn't studied medicine, I couldn’t say with any certainty that my father was not having a cardiovascular issue; we decided to seek a second opinion. </p>
<h1><strong>Yet another crooked doctor</strong> </h1>
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<p>We went to another hospital in Washington D.C., not as good as the first but to a supposedly more experienced cardiologist. If I would have known earlier that this was the same guy that usually diagnosed EVERYONE with a cardiac arrhythmia upon inspection with his probably broken stethoscope (I learned about this much later when I rotated with him in medical school), I would never have agreed to this visit. </p>
<p>Indeed, this checkup proceeded to be <strong>EVEN WORSE</strong> than the previous fiasco of a checkup. This apparently famous cardiologist did his usual check with the stethoscope (“Systolic Ejection Murmur and S4 Hypertrophy of the Left Ventricle” he pronounced with little remorse) before stepping away to deliver his final diagnosis without any more tests. </p>
<p>“This looks very bad. I am sure that at least one coronary artery is already blocked. My estimation is that there are two arteries blocked so not only will we need to do an angioplasty, we will probably have to perform a bypass as well. I’ll be very surprised if you haven’t already had a heart attack or two. I would check that too but unfortunately, our ECG machine isn’t working today. Anyway, let me get you the number for our cardiac surgeon – he’s very good…” </p>
<p>If I hadn’t spotted my father’s somber expression, I would have probably laughed at the ridiculousness of the situation. Was this man seriously delivering a diagnosis without even listening to the entire history or performing a thorough physical exam? God knows what this quack would say if he pressed his stethoscope to his own damn chest…. </p>
<h1><strong>A Third Opinion and a Change in Strategy</strong> </h1>
<p>https://gastrosymptoms.files.wordpress.com/2015/08/bigstock-close-up-of-male-doctor-fillin-60543920.jpg </p>
<p>My father was very distraught that day when we returned home. After listening to opinions from two different cardiologists, my dad was ready to throw in the towel and let the cardiologists have their way with his heart. He had already begun his sentimental “If anything happens to me” speech, when I suddenly realized the big problem – <strong>we had only gone to cardiologists.</strong> Of course a cardiologist is going to automatically assume that any chest pain is cardiac in origin! </p>
<p>Wait, there is a possibility that chest pain isn’t related to the heart? Exactly my friend – you can get chest pain from a condition called <strong>costochondritis</strong>, which is an inflammation of the cartilage that connects the rib to the sternum, and also from something called <strong>Gastroesophageal Reflux Disease (GERD)</strong>, which is commonly known as heartburn.</p>
<p>Thanks to my persuasion, my father decided to visit his primary care physician (PCP) to seek his opinion on the issue. His PCP was very intrigued by my father’s condition and couldn’t readily disagree with two well-known cardiologists. Yet he decided to entertain our theory that the pain could also be due to reflux and immediately made a referral to a Gastroenterologist or a GI doctor. </p>
<h1><strong>Before we get to the GI checkup, what’s GERD?</strong> </h1>
<p>https://www.hillandponton.com/wp-content/uploads/2017/02/GERD.png </p>
<p>GERD denotes the <strong>regurgitation of gastric contents (most notably hydrochloric acid or HCl) from the stomach into the lower portion of the esophagus.</strong> This is usually lifestyle related – such as frequently eating spicy or hot foods and drinks (e.g. Indian food and hot tea) and not leaving enough time for digestion to complete before going to sleep at night (typically on a full stomach). It is a chronic condition that grows worse with time and is characterized by symptoms such as an <strong>acid-like taste in the mouth</strong>, <strong>cough</strong>, <strong>nighttime shortness of breath</strong> and a <strong>referred pain in the chest</strong>, which can either be on the left side or the right side of the chest. </p>
<p>Keeping that in mind, let’s continue with my dad’s checkup with the GI doctor. </p>
<h1><strong>The GI Solution</strong> </h1>
<p>http://southcityhospital.org/images/Barium_Swallow.jpg </p>
<p>We returned to the first hospital where we had escaped earlier and met this time with the Gastroenterologist. Perhaps due to the report of the cardiologist and to also rule out angina right from the outset, the GI physician first ordered an ECG, which fortunately revealed that there was no sign of cardiac damage or arrhythmias. Next, the GI doctor ordered a <strong>barium swallow test</strong> during the same visit – to determine once and for all if the chest pain was in fact due to heartburn. </p>
<p>So my father took a swig of a barium “milkshake” and the technician (who was incidentally the same one from the first visit) took a chest X-ray to see esophageal changes following ingestion of the barium solution. Almost instantly, a retrograde splash was observed in the lower portion of the esophagus, consistent with GERD. The Gastroenterologist simply nodded at the Barium X-ray, prescribed my father some <strong>pantoprazole</strong> (a proton pump inhibitor used to treat acid reflux) and said we were free to <em>walk</em> home this time. </p>
<p>It was only heartburn! My father was so relieved that he finally got a good night’s sleep after months of excessive worry. Yet from the very same day, he began to take a tablet a day to combat his chronic acid reflux in addition to eliminating all spicy food in the house and cutting down on his intake of tea. In less than a month, my father could walk without any discomfort and sleep like a baby every night. </p>
<p>It is important to mention that my father has continued to take acid reflux very seriously, since there are certain complications to always keep an eye on....</p>
<h1><strong>What are some complications of GERD if left untreated?</strong> </h1>
<p>https://i.ytimg.com/vi/_cEFHzMj3EY/maxresdefault.jpg </p>
<p>As you have just learned, GERD or acid reflux is treated with lifestyle changes (eliminating spicy and hot foods and drinks in addition to dining at least 3 hours before going to sleep every night) and in chronic cases addressed with proton pump inhibitor medications such as omeprazole, lansoprazole and pantoprazole. In very acute cases, as you may find yourself after finishing a particularly greasy pizza all by yourself (been there, done that!), you can neutralize the stomach acid and extinguish the heartburn instantly with an antacid pill (e.g. TUMS). </p>
<p>If you decide to ignore heartburn and continue your reckless lifestyle of eating spicy and very hot food well into the night, you could face some very serious complications which include the formation of a precancerous lesion in your esophagus known as <strong>Barrett’s Esophagus</strong>, in which the normal squamous epithelial cells of your distal esophagus transform into intestinal columnar epithelial cells. This is especially terrible because the often irreversible Barrett’s Esophagus can transform into <strong>Esophageal Cancer</strong>, which is currently untreatable. </p>
<p>Other lesser known complications of chronic untreated GERD include <strong>asthma and persistent cough</strong>, <strong>damage to tooth enamel</strong> and even <strong>esophageal ulceration with stricture formation</strong> (which occurs when ulceration heals with fibrosis and thus causes a narrowed esophageal lumen). </p>
<p>Have I scared you enough? Good! Always take acid reflux <strong>very seriously</strong> and start taking action by making the appropriate lifestyle modifications and dietary improvements today! </p>
<h1><strong>My final thoughts</strong> </h1>
<p>http://i.imgur.com/iUo0zOx.png </p>
<p>Since this incident, my father has become even more health-conscious by taking all of his medications every morning, incorporating even more vegetables and fish in his diet and exercising more during the week. Especially as he approaches his 70th birthday this August! This is moreover even more inspirational for a young pup like me to adopt good dietary habits from an early age, while remembering to exercise often and ensure that I breakfast like a king and dine like a pauper every night! </p>
<p>I hope you have learned a great deal about acid reflux today. I look forward to any questions you may have as well as your thoughts in the comments below. Always remember to make health your number #1 priority and let’s all stay healthy together, one day at a time. </p>
<p><strong>Reference:</strong> </p>
<p>Le, Tao, Vikas Bhushan, Jeffrey Hofmann. "First Aid for the USMLE Step 1 2012." McGraw Hill Medical, New York, 2012. pp. 350-352. </p>
<p><strong>Image Sources: </strong><a href="https://img.buzzfeed.com/buzzfeed-static/static/2014-10/21/15/enhanced/webdr04/anigif_enhanced-8014-1413920125-8.gif "><strong>1</strong></a><strong>, </strong><a href="https://ehonami.blob.core.windows.net/media/2016/02/six-most-common-causes-of-chest-pain-800x600.jpg"><strong>2</strong></a><strong>, </strong><a href="https://media.giphy.com/media/aX2P8kEFqt8u4/giphy.gif"><strong>3</strong></a><strong>, </strong><a href="http://2w6kxc22rrr9mabqt1mglgait6.wpengine.netdna-cdn.com/wp-content/uploads/2016/09/dr-nick-riviera.jpg"><strong>4</strong></a><strong>, </strong><a href="https://gastrosymptoms.files.wordpress.com/2015/08/bigstock-close-up-of-male-doctor-fillin-60543920.jpg"><strong>5</strong></a><strong>, </strong><a href="https://www.hillandponton.com/wp-content/uploads/2017/02/GERD.png"><strong>6</strong></a><strong>, </strong><a href="http://southcityhospital.org/images/Barium_Swallow.jpg "><strong>7</strong></a><strong>, </strong><a href="https://i.ytimg.com/vi/_cEFHzMj3EY/maxresdefault.jpg "><strong>8</strong></a><strong>, </strong><a href="http://i.imgur.com/iUo0zOx.png"><strong>9</strong></a><strong> </strong> </p>
<p><strong>Until next time, keep acing life!</strong> </p>
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