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Deadly, little-known illness can strike without warning - but truckers can take steps to prevent it

By Mark H. Reddig
Associate Editor

Doug Finkbeiner was taking a rest at his favorite truck stop, the Iowa 80 in Walcott, IA, when the pain struck.

The pain, like a muscle cramp, was between his shoulder blades, so Finkbeiner ignored it. As an amputee – he lost his lower left leg many years ago – he often experienced such cramps as his body tried to adjust to the loss of the limb.

But the pain persisted. So much so that he began to think something else was wrong. And when that pain was followed by fever, chills and shakes, Finkbeiner said, “That’s when I knew, man, something wasn’t right.”

He hit the cell phone and dialed 9-1-1. The call saved his life. 

The former trucker from Saginaw, MI, was experiencing the early onset of what is called aortic dissection. In essence, the layers of his aorta – the massive blood vessel that carries blood from the heart to the rest of the body – were tearing apart from the inside. 

Aortic dissection is perhaps best known as what caused the death of actor John Ritter. However, it’s something that can hit anyone, but when you look at the risk groups, truckers are prime candidates.

It strikes anywhere, any time
Finkbeiner was a company driver for P.A.M. Transport, working a dedicated run from Pontiac, MI, to Williamsburg, IA, on Oct. 29, 2003, when he pulled into the Iowa 80 to rest. He spent every other night at the stop while working the run. 

And while he is modest about his physical condition, Finkbeiner did take steps to stay in shape – he tried to eat right, and he kept an exercise bike in the truck, which he used every other day, as well as doing other exercises. 

When he arrived at the Davenport hospital between 8 and 9 p.m. that day after calling 9-1-1, doctors were perplexed by Finkbeiner’s symptoms.

“They weren’t sure what was going on,” he said. “They ran a couple of different tests on me. The pain wasn’t going away or anything. They weren’t really sure what was going on until about 7 o’clock in the morning.”

That’s when the hospital’s cardiologist came in. After looking at the test results, he said Finkbeiner’s condition was beyond what the hospital could handle, and ordered the trucker airlifted to the University of Iowa in Iowa City, about an hour’s drive away.

“I thought they would just throw me in an ambulance and take me over there, but he said, ‘oh, no, you get the E-ticket ride, we’re putting you in a helicopter’ … because it was that serious,” Finkbeiner said. 

Once he arrived, doctors were standing by. Finkbeiner said they delayed other surgeries to fit him in. They quickly whisked him to the operating room, shaved his chest and prepared him for surgery. 

“The cardiologists were sitting there waiting for me,” he said. “They said ‘We gotta go. This is not pass go, collect $200, we gotta get you on the operating table now.’ ” 

Once he was on the operating table, his struggling aorta finally “blew wide open.”

The doctors repaired the massive artery, and also replaced a heart valve that was close to the damage. They then installed wires for a pacemaker, which was installed a week or so later.

Symptoms
What Finkbeiner experienced is fairly typical of what people with an aortic dissection feel. And those who have the condition are left with little doubt that something serious is wrong. 

“It’s not subtle,” Dr. William Cohn said.

Cohn, a heart surgeon and director of minimally invasive surgical technology at the Texas Heart Institute in Houston, said the sensation can hit a patient suddenly, and is frequently described as “the worst pain you’ve ever experienced in your life.”

Patients generally experience “chest or back pain, with a very stabbing, tearing quality,” he said. “Between the shoulder blades is a classic description.”

According to the Medline Plus Medical Encyclopedia, other symptoms can include:

  • Confusion, disorientation;
  • Pallor (extreme or unnatural paleness);
  • Rapid pulse;
  • Profuse sweating; 
  • Dry skin or mouth, thirst; 
  • Nausea and vomiting; 
  • Dizziness, fainting; and
  • Shortness of breath.

But there is another symptom that some people with aortic dissection show that is particularly interesting. 

“Not infrequently, for reasons that I don’t understand, patients have an appropriate feeling of dread, of impending doom,” Cohn said. “Some of them, aside from the incredible discomfort, know that something terribly wrong is going on and that their life is in peril. … There’s some sort of wiring there that we don’t understand; the patients understand that there is something very, very bad happening.”

However, the lack of that feeling doesn’t mean you shouldn’t seek medical help. Not that there’s ever been a problem with that, according to Cohn.

“I have never heard a patient say, ‘well, I experienced this horrible tearing pain between my shoulder blades, and I thought, well, I’ll have a beer, take an aspirin and see how it is in the morning,’ ” he said. 

In fact, Cohn said seeking medical help is a good idea for anyone who has severe chest pain of any kind.

Even when they do seek aide, some aortic dissection patients have showed up, had diagnostic tests done, but the dissection wasn’t found and they were sent home. Usually, a second or third trip and additional tests find the problem, and they are treated.

Causes
Cohn said that many different factors help determine who will and will not suffer an aortic dissection. There are certain coronary and other conditions that can contribute, or that can indicate you have a greater likelihood of having a dissection. 

Among those, as listed by Cohn, the American Heart Association, Medline and other sources:

  • Valve abnormalities;
  • Certain genetic markers;
  • Diseases such as Marfan’s Syndrome – an illness many think Abraham Lincoln had, marked by people who are tall, thin and have elongated fingers;
  • High blood pressure;
  • Atherosclerosis (hardening of the arteries); and
  • A traumatic injury, such as a blunt trauma to the chest.

Medline says that more men have aortic dissections than women.

But by and large, the most important thing to keep an eye on is family history, Cohn said. If someone in your family had an aortic dissection, your chances go up.

Finkbeiner said it wasn’t any one thing that caused him to suffer aortic dissection, but he said his doctors told him a big part was played by the Three S’s – smoking, stress and salt. On-the-job stress while behind the wheel of his rig was a big player, he thinks. 

And although he was fairly healthy, he also conceded that some of his other living habits likely played a role. 

“I smoked a pack a day; you know, when I started driving, I was living on Marlboros, Mountain Dew and McDonald’s. I wasn’t eating good, I was totally unhealthy,” Finkbeiner said, adding that he suspects some genetic predisposition, too.

Prevention and advice
There is one factor that you can control that affects whether you will have an aortic dissection, Cohn said. 

“The one thing that we do to reduce risk in anybody, given whatever their genetic makeup, is to control blood pressure,” he said. 

Finkbeiner made a number of changes in that department after he suffered a dissection. After the surgery, he’s stopped smoking, he eats healthier and he’s taken exercise to a new dimension – he’s currently in the middle of a 700-mile hike, from the central part of Michigan up across the Mackinaw Bridge and through the trails of the Upper Peninsula.

Cohn said you should also check whether you have any relatives who have experienced an aortic dissection. In fact, if you have any relative who died of a heart-related illness, but you don’t know what it is, find out. 

“If they did, they need to know that,” he said. 

Another important tip is if you think you are experiencing an aortic dissection, seek immediate medical help. 

Cohn said one mistake he’s seen made by people who think they’re experiencing an aortic dissection is trying to drive themselves to the hospital.

Cohn said the best advice is to pull off the road immediately. One of the possible symptoms of the illness is syncopy, meaning simply that a person experiencing it will frequently black out or faint – not a good scenario for a person behind the wheel of a semi. 

“Park your truck and call 9-1-1,” he said. “Most places in the civilized world, they can get help to you in very short order.”

Although his own illness ended his driving career, Finkbeiner hopes his experience can help other drivers who are still on the road. He urges truckers to “get away from salt, get away from the smoking, eat more fruits and vegetables, try to reduce the stress as much as you can.”

“Get out of the truck and go for a walk; do something,” he said. “It’s a good place to start.” 

“I can’t drive commercially anymore, but it doesn’t have to be the end of your life,” he said. “But you’ve got to catch it fast.”

mark_reddig@landlinemag.com

 

What is aortic dissection?

To see how serious aortic dissection can be, you only have to look at what the aorta is and what it does. Every organ and limb of the body – except the lungs – depends on blood pumped through the aorta. 

Dr. William Cohn is a heart surgeon and director of minimally invasive surgical technology at the Texas Heart Institute in Houston, which is rated as one of the top cardiac centers in the United States. He is one of the institute’s experts on aortic dissection. 

Cohn says the aorta is basically a hose made of tissue, about an inch in diameter, that comes out of the center of the heart, bends downward like a shepherd’s crook, and then runs down the spine and splits, with one branch going down to each leg. 

The walls of the artery are about as thick as a slice of American cheese, he said.

In every person, the aorta takes an incredible pounding. The heart beats 30 million to 40 million times a year, Cohn said, and each of those millions of times, the artery stretches and relaxes. Over time, the aorta wall loses some of its strength. 

Invariably, he said, if a person’s blood pressure is high, little tears can form in the aorta wall. In most people, platelets find the tears, cover them up and heal them. 

Cohn said that in patients who suffer aortic dissection, the material that makes up the aorta wall is structurally not very good, so that when those tears form, the wall suddenly starts to split apart. 

To imagine that splitting, Cohn said to think of the aorta wall as being made of layers – like a tube inside a tube inside a tube, all compressed together into a single wall. When the tear forms, blood gets between the layers of tube, and the pressure of the pumping blood suddenly pushes those layers apart. Now, you have one hose inside another, with blood running inside the inner hose, and between the layers of hose. And each hose wall is only half the thickness of the original. 

When the artery splits apart, “it kind of unzips like Velcro” – it can come apart quickly, traveling inches up and down the aorta, possibly within seconds. Depending on where it goes and how quickly, the dissection can rapidly turn into a deadly event.

If the dissection occurs near the point where the blood vessels that serve the brain branch off, the situation is dire, Cohn said. 

“That portion of the aorta is inside the heart sack,” he said. “The heart sack doesn’t have a lot of room.

“If this thing starts to expand, or starts to leak, or God forbid ruptures, there’s not enough space for the heart to beat in the heart sack … If that happens, you’re within minutes of the end of your life.”

A dissection can also damage the function of the aortic valve in the heart, impairing the function of the heart. It can compromise the coronary arteries that serve the heart or cut off the arteries to the brain, causing a stroke. 

The danger is very real, Cohn said. Even half of the people whose arteries rupture on the surgical table don’t survive … much less those who don’t make it there in time. 

“The key to having patients survive this is identifying them early and getting them to a place where they can be operated on,” he said. “Very bad things can happen if that doesn’t take place.”

July Digital Edition